#may2020mccqe1
A 55-year-old man is found to have a pleural effusion after a 2-week history of cough, sputum production, dyspnea, chills, and pleuritic chest pain. Upright and lateral decubitus chest x-rays confirm that the effusion is free flowing (without evidence of loculation). He has otherwise been in good health and takes no medications. A thoracentesis is performed and 1.2 L of fluid is removed. Analysis of the pleural fluid is performed.
Leukocytes 3000/μL (3 × 109/L) with 82% neutrophils
Glucose 25 mg/dL (1.4 mmol/L)
Lactate dehydrogenase 2500 U/L
pH 6.95
Gram stain and culture are pending. Blood cultures are obtained. Empiric broad-spectrum antibiotics are begun. Which of the following is the most appropriate next step in the management of this patient?
(A) Chest CT
(B) Chest tube drainage of the effusion
(C) Video-assisted thorascopic surgery (VATS)
(D) No additional treatment
A 55-year-old man is found to have a pleural effusion after a 2-week history of cough, sputum production, dyspnea, chills, and pleuritic chest pain. Upright and lateral decubitus chest x-rays confirm that the effusion is free flowing (without evidence of loculation). He has otherwise been in good health and takes no medications. A thoracentesis is performed and 1.2 L of fluid is removed. Analysis of the pleural fluid is performed.
Leukocytes 3000/μL (3 × 109/L) with 82% neutrophils
Glucose 25 mg/dL (1.4 mmol/L)
Lactate dehydrogenase 2500 U/L
pH 6.95
Gram stain and culture are pending. Blood cultures are obtained. Empiric broad-spectrum antibiotics are begun. Which of the following is the most appropriate next step in the management of this patient?
(A) Chest CT
(B) Chest tube drainage of the effusion
(C) Video-assisted thorascopic surgery (VATS)
(D) No additional treatment
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