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Histories

Pulmonary Embolism History Station | MRCS Part B OSCE Revision

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Clinical Scenario

A 55-year-old woman, two weeks post-op following a hip replacement, presents with sudden-onset pleuritic chest pain, breathlessness. She called an ambulance this morning because of the breathlessness.

Take a focused history from this patient and answer the examiners questions.

Related Differentials · Same Topic
The examiner could set this station around a different diagnosis within the same presenting complaint. Know how each would change the history.
Differential What would point to it in the history Management in brief
Pulmonary embolism (this case)Sudden pleuritic pain, breathlessness and haemoptysis, tachycardia, recent surgery with immobility, unilateral calf swellingOxygen and analgesia, immediate treatment-dose LMWH or DOAC, CTPA → anticoagulate 3 months (longer if unprovoked); thrombolysis or embolectomy if massive
PneumoniaFever, productive cough, focal consolidation on CXRConservative: oxygen, fluids, antibiotics guided by CURB-65 and local policy, chest physiotherapy. Surgical: none, unless empyema → chest drain ± decortication
Myocardial infarctionCentral crushing pain, radiation to arm/jaw, ECG/troponin changesConservative: oxygen if hypoxic, aspirin and a second antiplatelet, anticoagulation, nitrate, analgesia, statin and beta-blocker. Surgical: primary PCI, or CABG for severe multivessel disease
Musculoskeletal chest painReproducible on palpation, worse with specific movementConservative only: reassurance, simple analgesia and NSAIDs, gentle mobilisation. No surgical role
PneumothoraxSudden pleuritic pain and breathlessness, reduced breath sounds, tall thin patient or traumaConservative: observe or aspirate a small primary pneumothorax. Surgical: chest drain; VATS pleurodesis or bullectomy for recurrence. Tension pneumothorax → immediate needle decompression

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