A 64-year-old man with type 2 diabetes and COPD has fever, pleuritic chest pain and productive cough for 4 days. He was admitted 3 weeks ago for a foot ulcer. CXR shows left lower lobe consolidation with a pleural effusion. Thoracentesis: turbid fluid, pH 7.12, LDH 1100, WBC 18,000 (neutrophils). Gram stain pending. What is the next step?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Switch to piperacillin-tazobactam and vancomycin, and insert a chest tube
Turbid fluid with pH < 7.2 and LDH > 1000 = complicated parapneumonic effusion/empyema, which must be drained with a chest tube plus antibiotics – antibiotics alone (B) or waiting/repeat tapping (A, C) is not enough. Because he was hospitalised 3 weeks ago (risk of resistant organisms), empiric cover should include vancomycin (MRSA) plus piperacillin-tazobactam/cefepime (Pseudomonas).
ليش كل خيار صح أو غلط
-
A
ليش غلط
His fluid (pH 7.12, LDH 1100) meets the complicated criteria (pH <7.2, LDH >1000). A complicated effusion needs tube drainage plus antibiotics, not just a repeat tap.
✓ Pleural effusion.pdf · p. 6 -
B
ليش غلط
Antibiotics alone are enough only for an uncomplicated effusion. A complicated one (pH <7.2, LDH >1000) also needs tube drainage.
✓ Pleural effusion.pdf · p. 6 -
C
ليش غلط
Turbid, low-pH fluid is an empyema/complicated effusion, which must always be drained; waiting and re-tapping only if it grows is not enough.
✓ Pleural effusion.pdf · p. 6 -
D
ليش صح
Empyema needs a chest tube to remove infected material, plus empiric vancomycin (MRSA) and piperacillin-tazobactam or cefepime (pseudomonas).
✓ 7• Pleural Diseases [Notes].pdf · p. 12
- المصدر
- Pleural effusion.pdf · p. 6
7• Pleural Diseases [Notes].pdf · p. 12 - المحاضرة
- Pleural Effusion & Pneumothorax · Pulmonology · Module B
- ظهر في
- MED42 Compre B