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A 40 yr old female undergoes cholecystectomy and she develops dyspnoea within 24 hr.
O/E: RR-22/min
Pulse: 122/min
temp.: 99F
DEcreased breath sounds are noted in the left lower lobe.
the complete blood count shows leucocytosis if 30,000
1. next step in managment
2. first step in treatment
3. definative diagnostic test?


This is Atelectasis, which is common post-op.

1st step, do incentive spirometry, postural drainage, deep breathing and coughing.

diagnostic : CXR, best test: Bronchoscopy.


I am not under the impression that atelectasis really causes dyspnea or tachycardia normally. The left lower lobe may be atelectic but after a cholecystectomy you would expect greater atelectasis on the right (nearer the operative site).
PE's are common postoperative problem and when called at three in the morning by the nurse I am thinking I am getting an ABG, CXR & EKG...anti-coagulate w/ heparin if not contraindicated and get a spiral CT of the Chest to eval for PE


Well with a finding on the chest in a patient in this scenario with no other information given to you....suspecting PE is too radical.....

Atelactasis is the better choice and with any localized finding on the chest nothing wld beat CXR as the most important investigation...
ABG shld also be taken in such a patient(dyspnea)


Same old thing..
What the question asks...the answer lies within.
So, it does not matter what happens in real life,

PE should not cause any decrease in breath sound in the lower lobe. Obviously, it directs to atelectesis, (does not matter if its left or right, for the sake of the exam).

Its not what the examiner thought of, its what actually was asked in the question.

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