A 45 year old male, who was operated for fracture of the femur neck, developed severe chest pain, dyspnea, and streaky hemoptysis, followed by hypotension on the 4th postoperative day. The likely etiology is
**Core Concept**
Pulmonary embolism (PE) is a life-threatening condition caused by the obstruction of a pulmonary artery by a blood clot, often originating from a deep vein thrombosis (DVT) in the legs. In the postoperative period, patients are at increased risk of developing PE due to factors like immobility, surgical trauma, and hypercoagulability.
**Why the Correct Answer is Right**
The patient's symptoms of severe chest pain, dyspnea, and streaky hemoptysis, followed by hypotension, are classic signs of a pulmonary embolism. The recent surgery for a femur neck fracture has put the patient at high risk for DVT, which can then break loose and travel to the lungs, causing a PE. The presence of streaky hemoptysis suggests that the clot has caused damage to the pulmonary capillaries, leading to bleeding.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not provided.
**Option B:** While acute respiratory distress syndrome (ARDS) can cause hypoxia and respiratory failure, it is not typically associated with streaky hemoptysis or a sudden onset of severe chest pain.
**Option C:** Cardiac tamponade can cause hypotension and dyspnea, but it is not typically associated with streaky hemoptysis or a sudden onset of severe chest pain.
**Clinical Pearl / High-Yield Fact**
In postoperative patients, a high index of suspicion is essential for diagnosing pulmonary embolism, as the symptoms can be non-specific and easily mistaken for other conditions. A D-dimer test can be used as a screening tool, but a negative result does not rule out PE in high-risk patients.
**Correct Answer: D. Pulmonary Embolism**