Evaluating Postoperative Shortness of Breath

In Episode 18 of Med School Question of the Week for USMLE, Alisa Khomutova, MedSchoolCoach expert tutor, answers this medical school question: One day after undergoing open ventral hernia repair, a 46-year-old male complains of shortness of breath. He has smoked one pack of cigarettes daily for 15 years. He does not drink alcohol. On physical exam, temperate is 100.3°F, pulse is 99/min, respirations are 21/min, and blood pressure is 126/72 mm Hg. He appears uncomfortable. Lung examination shows reduced breath sounds over the left lung base. Cardiac examination is benign. The surgical dressing over the lapaotomy site is c/d/i (clean dry intact). Bowel sounds are hypoactive. The calves appear symmetrical and homan sign is negative. His hemoglobin concentration is 12.1 g/gL, leukocyte count is 11,400/mm, and platelet count is 210,000/mm. An x-ray of the chest is supine position is shown. Labs are pending. Which of the following is the likely cause of this patient’s symptoms?

• Pneumonia
• Pleural Effusion
• Atelectasis
• Congestive Heart Failure
• Pulmonary Embolism
• COPD Exacerbation