QuestionSBA
QuestionChoice
Osteomyelitis may present with severe systemic upset and it is possible the procedure introduced an infection, however, the absence of focal pain, fever, tachycardia and hypotension render septic shock secondary to osteomyelitis a less likely differential in this case.
10035896
e
Osteomyelitis
QuestionChoice
This is an excellent differential in this case with acute onset breathlessness following surgery but the acute onset confusion and rash render this less likely. Some massive pulmonary emboli are associated with consumptive coagulopathy presenting as disseminated intravascular coagulation which could present as a diffuse petechial rash. The absence of bleeding and chest pain makes this less likely.
10035893
b
Pulmonary embolism
QuestionChoice
This is unlikely in this young gentleman with the absence of any chest pain and would not commonly present with any of the symptoms described in the vignette.
10035895
d
ST Elevation Myocardial Infarction
QuestionChoice
This is correct. This is suggestive of a diagnosis of fat embolism which may occur following trauma to the long bones and presents with a triad of hypoxia, confusion and petechial rash. It is treated with urgent thrombectomy.
10035892
a
Fat embolism
QuestionChoice
This may well have occurred in the road traffic accident but should have been picked up in the primary survey and would not explain the confusion or rash.
10035894
c
Traumatic pneumothorax
Concept
Chapter
2693
6165
Fat embolism
Topic
145
Orthopaedics
19582
Fat embolism syndrome typically presents with hypoxia, confusion, and a petechial rash following long bone fractures.
A 23-year-old man is brought in by ambulance following a road traffic accident during which he fractured both femurs. He undergoes surgical fixation and is admitted to the orthopaedic ward where two days later he becomes suddenly dyspneoic and hypoxic, profoundly confused with a widespread petechial rash.

What is the most likely diagnosis?
a