A 50-year-old man has 3-day history of shortness of breath, fever, productive cough, and left-sided pleuritic chest pain. On examination, Temp 39C, HR105/min, BP140/80mmHg, RR22/min, and oxygen saturation 94% on room air. Chest examination shows crackles on the left side. Chest x-ray shows left lower lobe consolidation and obliteration of the costophrenic angle. Left lateral decubitus film shows free flowing fluid that layers out to 7mm. Treatment with empirical antibiotics is initiated. Which of the following is the most appropriate next step and management of the pleural effusion?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. Observation
In pneumonia, a parapneumonic effusion is tapped only if it is significant (>1 cm on lateral decubitus film) or the patient fails to respond to antibiotics. Here it layers to only 7 mm and antibiotics were just started, so observe - fluid <1 cm is a contraindication to bedside thoracentesis. CT is not needed, and furosemide is for CHF effusions.
ليش كل خيار صح أو غلط
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A
ليش غلط
Chest CT is limited by radiation and contrast and is indicated where malignancy is suspected, which is not the case in this small parapneumonic effusion.
✓ Pleural effusion.pdf · p. 4 -
B
ليش غلط
Loop diuretics are used when the cause is acute congestive heart failure; this is a parapneumonic effusion.
✓ Pleural effusion.pdf · p. 5 -
C
ليش صح
Most parapneumonic effusions resolve with antibiotics, and a tap is only needed if the effusion is over 1 cm on lateral decubitus film or the patient fails to respond; this one layers to 7 mm.
✓ Step Up To Medicine 6th Edition 2024 (Pneumonia).pdf · p. 8 -
D
ليش غلط
Fluid less than 1 cm is the key contraindication to bedside thoracentesis, and this effusion layers out to only 7 mm.
✓ (Y4)-(M B) Pneumonia and pleural effusion - Resident.pdf · p. 21
- المصدر
- Step Up To Medicine 6th Edition 2024 (Pneumonia).pdf · p. 8
(Y4)-(M B) Pneumonia and pleural effusion - Resident.pdf · p. 21 - المحاضرة
- Pleural Effusion & Pneumothorax · Pulmonology · Module B
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