pleural effusion

Practice targeted AMC-style multiple-choice questions on pleural effusion.

A 40-year-old man presents with fever, pleuritic chest pain, and cough. A chest X-ray shows a pleural effusion. What is the next step in management?

A. Start steroids.

B. Perform a thoracentesis.

C. Start antibiotics.

D. Observe and repeat imaging in 2 weeks.

E. Order a CT scan.

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Giant hiatal hernia, CT image. 63 year old man.

Image by Jmarchn — CC BY 4.0 · Source

A 63-year-old man presents with increasing shortness of breath and epigastric discomfort, particularly after meals. He has a history of GERD. Physical examination reveals decreased breath sounds at the left lung base. An axial CT image is shown. Considering the clinical presentation and imaging findings, what is the MOST appropriate next step in management?

A. Arrange urgent upper gastrointestinal endoscopy

B. Request a barium swallow study

C. Referral for surgical repair

D. Discharge with advice on lifestyle modification and follow-up

E. Initiate high-dose proton pump inhibitor therapy

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CT scan showing hemothorax caused by warfarin use

Image by Cevik Y — CC BY 3.0 · Source

A 75-year-old male is brought to the emergency department by ambulance with sudden onset severe shortness of breath and left-sided pleuritic chest pain that began approximately 4 hours ago. He reports feeling lightheaded and generally unwell. His past medical history includes chronic atrial fibrillation, hypertension, and type 2 diabetes mellitus. He is currently prescribed warfarin 5mg daily, metoprolol 50mg twice daily, perindopril 4mg daily, and metformin 1000mg twice daily. He denies any recent falls, trauma, or invasive procedures. On examination, he is visibly distressed and tachypnoeic. His vital signs are: temperature 36.8°C, heart rate 125 bpm (irregularly irregular), blood pressure 88/55 mmHg, respiratory rate 32 breaths per minute, oxygen saturation 85% on room air. Jugular venous pressure is not elevated. Cardiac auscultation reveals a rapid, irregular rhythm with no murmurs. Pulmonary auscultation reveals significantly diminished breath sounds over the entire left hemithorax, with dullness to percussion. The right lung field is clear. Abdominal examination is unremarkable. Peripheral pulses are weak but present. His capillary refill time is prolonged at 4 seconds. Initial laboratory results show haemoglobin 135 g/L (baseline 140 g/L three months ago), white cell count 9.2 x 10^9/L, platelets 250 x 10^9/L, creatinine 110 µmol/L, electrolytes within normal limits. His INR is 7.8. An urgent CT scan of the chest is performed, and a representative axial image is shown. Based on the clinical presentation and the findings demonstrated in the image, what is the single MOST appropriate immediate management step?

A. Arrange for urgent echocardiography to assess for cardiac tamponade and pulmonary embolism.

B. Initiate high-flow oxygen via non-rebreather mask and administer intravenous furosemide.

C. Administer intravenous tranexamic acid and observe the patient closely in the intensive care unit.

D. Administer intravenous Prothrombinex-VF and insert a large-bore intercostal catheter into the left pleural space.

E. Administer intravenous Vitamin K and arrange for urgent surgical consultation for thoracotomy.

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pleural effusion

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