#august2020mccqe1
A 40-year-old man is evaluated for shortness of breath and left-sided chest discomfort without cough, fever, or hemoptysis. The patient has a history of lymphoma that is now in remission.
Examination of the chest shows dullness to percussion and decreased breath sounds on the left side. Chest radiograph shows a moderate-sized, left-sided pleural effusion without a pneumothorax. Serum protein is 5.8 g/dL (58 g/L), cholesterol is 200 mg/dL (5.2 mmol/L), and triglycerides are 100 mg/dL (1.1 mmol/L). Thoracentesis yields 500 mL of milky-appearing pleural fluid, and analysis shows the following:
Cell count : Erythrocytes 300/μL (300 × 106/L); leukocytes 890/μL (890 × 109/L) with 65% lymphocytes, 22% neutrophils, 8% mesothelial cells, and 4% eosinophils
Total protein : 3.5 g/dL (35 g/L)
Lactate dehydrogenase : 250 U/L
pH : 7.50
Amylase : 25 U/L
Triglycerides : 145 mg/dL (1.6 mmol/L)
Cholesterol : 38 mg/dL (1.0 mmol/L)
Cytology, Gram stain, acid-fast bacilli stain, and bacterial culture are negative.
Which of the following is the most likely diagnosis?
(A) Chylothorax
(B) Heart failure
(C) Parapneumonic effusion
(D) Tuberculous pleural effusion
A 40-year-old man is evaluated for shortness of breath and left-sided chest discomfort without cough, fever, or hemoptysis. The patient has a history of lymphoma that is now in remission.
Examination of the chest shows dullness to percussion and decreased breath sounds on the left side. Chest radiograph shows a moderate-sized, left-sided pleural effusion without a pneumothorax. Serum protein is 5.8 g/dL (58 g/L), cholesterol is 200 mg/dL (5.2 mmol/L), and triglycerides are 100 mg/dL (1.1 mmol/L). Thoracentesis yields 500 mL of milky-appearing pleural fluid, and analysis shows the following:
Cell count : Erythrocytes 300/μL (300 × 106/L); leukocytes 890/μL (890 × 109/L) with 65% lymphocytes, 22% neutrophils, 8% mesothelial cells, and 4% eosinophils
Total protein : 3.5 g/dL (35 g/L)
Lactate dehydrogenase : 250 U/L
pH : 7.50
Amylase : 25 U/L
Triglycerides : 145 mg/dL (1.6 mmol/L)
Cholesterol : 38 mg/dL (1.0 mmol/L)
Cytology, Gram stain, acid-fast bacilli stain, and bacterial culture are negative.
Which of the following is the most likely diagnosis?
(A) Chylothorax
(B) Heart failure
(C) Parapneumonic effusion
(D) Tuberculous pleural effusion
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