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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is fat embolism. While this may seem a odd practice, it is useful to see multiple examples of how fat embolism will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for fat embolism.
Chief Complaints:
- Dyspnea/shortness of breath
- Confusion/agitation can occur as well.
Patient History:
- Recent long bone fracture: often times the femur.
Clinical Workup:
- Respiratory distress seen on vitals: increased respiration rate, low oxygen saturation.
- Petechiae can be noted on they physical exam.
QUESTION EXAMPLES
Question # 1
One day after being hospitalized for a femoral fracture, a 78 year old woman begins to develop dyspnea and becomes confused. Her pulse is 115/min, respirations are 25/min, blood pressure is 145/75 mm Hg and oxygen saturation on room air is 83%. The patient is not oriented to place or time. A physical exam reveals the presence of petechiae over the face, neck, and abdomen. Auscultation of the lung fields reveals scattered rhonchi but no crackers or wheezes are heard. The patient’s platelet count is 320,000. What is the likely diagnosis in this patient?
Explanation #1
Recent long bone fracture + dyspnea + increased respirations/low oxygen saturation + petechiae = fat embolism
Question #2
Thirteen hours after a rod stabilization of a femoral shaft fracture, a 30 year old homeless man quickly develops a combative nature and is disoriented. His pulse is 115/min, respirations are 26/min, and his blood pressure is 145/80 mm Hg. A physical exam is remarkable for petechiae over the axilla, and the rest of the exam is non-contributory. What diagnosis is likely in this patient?
Explanation #2
Recent long bone fracture + confusion + increased respirations + petechiae = fat embolism
Question #3
A 23 year old male is evaluated in the post-operative recovery unit when he experiences a worsening shortness of breath. The patient was brought to the hospital initially because an ATV rolled on top of him. He has no remarkable past medical history, and does not take any medications. The patient explains that he drinks often, and was drinking before the incident occurred. He was found to a have a right femoral fracture, as well as right foot metatarsal fractures. These fractures were resolved this morning with an orthopedic operation . He also received 98.6°F, blood pressure is 130/75 mm Hg, pulse is 115/min, and respirations are 25/min. A pulse oximetry shows 83% on room air. The patient appears to be agitated and restless in bed. He has scattered petechiae on the trunk but no chest-wall bruising. His breath sounds are normal and present on both lung fields. His left lower extremity shows expected postoperative changes. An urgent chest X-ray is unremarkable. What is the likely cause of this patient’s symptoms.
Explanation #3
Recent long bone fracture + dyspnea + increased respirations/low oxygen saturation + petechiae = fat embolism
Question #4
A 35 year old male is hospitalized aver being involved in a motor vehicle collision. The patient sustains a right femur fracture as well as a pelvic fracture. He has not sustained any injury to his thorax. 2 days after he initially presents, he complains of shortness of breath. His temperature is 98.9°F, heart rate is 115/min, respirations are 22/min, and oxygen saturation is 82% on room air. He currently is confused and agitated, and a physical exam reveals the presence of petechiae on the upper arms. An ECG is unremarkable other then for sinus tachycardia. What is the likely diagnosis in this patient?
Explanation #4
Recent long bone fracture + dyspnea + increased respirations/low oxygen saturation + petechiae = fat embolism
Question #5
A 26 year old male develops shortness of breath about 24 hours after internal fixation of a left femur mid-shaft fracture. The patient’s pulse is 95/min, respirations are 26/min, and blood pressure is 135/70 mm Hg. A physical exam is notable for petechiae across the chest. What is a possible diagnosis in this patient?
Explanation #5
Shortness of breath + recent long bone fracture + increased respirations + petechiae = fat embolism
Question #6
A 21 year old male becomes acutely confused about two days after being admitted to the hospital for treatment of injuries sustained when his bicycle was hit by a bus. He underwent internal fixation of his fractured right femur soon after being hospitalized. He currently is not oriented to his name, the date, or location. His temperature is 102.1°F, pulse is 114/min, and respirations are 25/min, and blood pressure s 110/60 mm Hg. The patient’s oxygen saturation is 83% on room air. A physical exam reveals petechiae over the upper arms and the chest. The cardiac and lung components of the physical exam are unremarkable. What is the likely diagnosis in this patient?
Explanation #6
Acute confusion + recent long bone fracture + increased respirations/decreased oxygen saturation + petechiae = fat embolism
TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clincial implications that are commonly asked. Some of these are listed below:
Page Updated: 12.23.2016