A 55-year-old man has a pleural effusion after a 2-week history of fever, productive cough, dyspnea, chills, and pleuritic chest pain. A thoracentesis is performed, and 1.2 L of fluid is removed. Analysis of the pleural fluid reveals a leukocytic count 3000/L with 82% neutrophils, glucose 25 mg/dl, Lactate dehydrogenase 2500 u/l and pH 6.95. Gram stain and culture are pending. Blood cultures are obtained. Empiric broad-spectrum antibiotics are begun. Which of the following is the most appropriate next step in the management of this patient?
سؤال مجاني 7 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Chest tube insertion
pH 6.95, glucose 25 mg/dL and LDH 2500 meet the criteria of a complicated parapneumonic effusion/empyema (pH <7.2, glucose <60, LDH >1000). This needs chest tube drainage plus antibiotics - antibiotics alone (E) are not enough. VATS is reserved for failure of tube drainage; pleurodesis is for recurrent malignant effusions.
ليش كل خيار صح أو غلط
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A
ليش صح
pH 6.95, glucose 25 and LDH 2500 meet the criteria for a complicated parapneumonic effusion, which requires tube drainage plus antibiotics.
✓ Pleural effusion.pdf · p. 6 -
B
ليش غلط
The treatment listed for a complicated parapneumonic effusion or empyema is tube drainage with antibiotics, not repeated therapeutic thoracentesis.
✓ Pleural effusion.pdf · p. 6 -
C
ليش غلط
Pleurodesis is indicated for recurrent malignant effusions and effusions that do not respond to drugs, not for a first presentation of infected fluid.
✓ Pleural effusion.pdf · p. 5 -
D
ليش غلط
VATS debridement is a second step when chest tube drainage (first-line) is ineffective.
✓ Pleural effusion.pdf · p. 6 -
E
ليش غلط
Antibiotics alone resolve only uncomplicated effusions; this one is complicated (pH below 7.2, glucose below 60, LDH above 1000) and needs drainage as well.
✓ Pleural effusion.pdf · p. 6
- المصدر
- Pleural effusion.pdf · p. 6
Step Up To Medicine 6th Edition 2024 (Pleural disease).pdf · p. 5 - المحاضرة
- Pleural Effusion & Pneumothorax · Pulmonology · Module B
- ظهر في
- Respi bank