A 40-year-old man is admitted to the hospital with a diagnosis of left sided community acquired pneumonia. Three days later, he is still febrile and requiring oxygen. His follow up physical exam shows central trachea, a decreased chest expansion and decreased tactile vocal fremitus on the left lower zone in addition to a stony dull percussion note and absent breath sounds Which of the following is the most appropriate action?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Perform CXR and then aspirate pleural fluid
Stony dullness, reduced fremitus and absent breath sounds = pleural effusion (pneumothorax is hyper-resonant, so B is wrong). A CAP patient who is not responding by day 3 may have a parapneumonic effusion/empyema, so confirm with CXR and then tap the fluid (pH, glucose, Gram stain/culture). Changing antibiotics or only taking blood cultures misses the effusion.
ليش كل خيار صح أو غلط
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A
ليش غلط
Blood cultures are part of the work-up of severe CAP, but the findings here (stony dullness, absent breath sounds, not improving) point to an effusion that needs sampling.
✓ Pneumonia (1).pdf · p. 4 -
B
ليش غلط
Pneumothorax gives hyper-resonance to percussion; this patient has a stony dull note and absent breath sounds, i.e. an effusion.
✓ 7• Pleural Diseases [Notes].pdf · p. 4 -
C
ليش غلط
Failure to respond to antibiotics together with an effusion calls for thoracentesis, not simply a change of antibiotic.
✓ Step Up To Medicine 6th Edition 2024 (Pneumonia).pdf · p. 8 -
D
ليش صح
Stony dullness with absent breath sounds in a CAP patient not responding to antibiotics suggests a parapneumonic effusion, and thoracentesis (fluid for Gram stain, culture, pH, glucose, LDH) is performed in that situation.
✓ Step Up To Medicine 6th Edition 2024 (Pneumonia).pdf · p. 8
- المصدر
- Step Up To Medicine 6th Edition 2024 (Pneumonia).pdf · p. 8
Pleural effusion.pdf · p. 3 - المحاضرة
- Pleural Effusion & Pneumothorax · Pulmonology · Module B
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- Respi bank