A 55-year-old woman presents with worsening dyspnea and pleuritic chest pain. She was discharged from the hospital two weeks ago after a total hip replacement. What is the most likely diagnosis and the next steps?
The patient's recent hospitalization and major surgery, along with her symptoms of dyspnea and pleuritic chest pain, make pulmonary embolism a strong consideration. Major surgery, especially orthopedic surgery, is a known risk factor for PE. The next steps should include stabilizing the patient, starting empiric anticoagulation if there are no contraindications, and performing diagnostic testing with D-dimer and imaging, typically with a CT pulmonary angiography if renal function is adequate.