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Self-Assessment Questions

Pulmonary Disease

Diagnosis of Pleural Effusions: Review Questions

Rebecca L. Shriver, MD, FCCP

Dr. Shriver is an assistant professor of medicine, Division of Pulmonary and Critical Care Medicine, University of Missouri-Kansas City, Kansas City, MO.

Choose the single best answer for each question.

All questions refer to the following case. A 67-year-old man presents to the emergency department with a 5-day history of fever and cough that produces green sputum. He has a history of tobacco use and ischemic cardiomyopathy with a left ventricular ejection fraction of 25%. He is admitted with a presumptive diagnosis of pneumonia and is started on antibiotics. A chest radiograph is obtained and shows a left-sided infiltrate and moderate-size effusion.

1. Why should a diagnostic thoracentesis be performed on this patient?
  1. This patient’s effusion is likely related to his congestive heart failure (CHF)
  2. The effusion is a new finding and its etiology is unknown
  3. Thoracentesis should be performed on all pleural effusions
  4. This patient’s effusion is malignant given his smoking history
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2. Which of the following studies can be used to determine if the patient’s effusion is due to his CHF (a transudate) or is a parapneumonic effusion (an exudate)?

  1. Pleural fluid pH
  2. Pleural fluid glucose
  3. Pleural fluid cell count
  4. Lactate dehydrogenase (LDH)
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3. The fluid from thoracentesis has a pH of 7.3, which can be consistent with either CHF or a parapneumonic effusion. Which of the following types of pleural effusions have a pleural fluid pH greater than 7.2?
  1. Empyema
  2. Rheumatoid pleuritis
  3. Hepatic hydrothorax
  4. Urinothorax
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4. Results of the patient’s pleural fluid and serum glucose measurements are 56 mg/dL and 90 mg/dL, respectively. Which of the following types of effusions typically have a pleural fluid glucose concentration similar to that of blood glucose?

  1. Malignant effusion
  2. Lupus pleuritis
  3. Esophageal rupture
  4. Effusion due to CHF
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5. Results of additional pleural fluid studies reveal an LDH of 670 U/L and a protein level of 3.4 g/dL. Gram stain and culture are negative. Based on these data, what is the most likely cause of this patient’s pleural effusion?

  1. Typical parapneumonic effusion
  2. Complicated parapneumonic effusion
  3. Empyema
  4. CHF
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