Pulmonology 1-A 60-year-old man presented with high-grade fever and left pleuritic chest pain. On examination, he has early clubbing and evidence of moderate pleural effusion in th... Pulmonology 1-A 60-year-old man presented with high-grade fever and left pleuritic chest pain. On examination, he has early clubbing and evidence of moderate pleural effusion in the left side of the chest. Pleural fluid analysis revealed pH of 7.0. Which of the following is the most likely diagnosis? A. Empyema B. Chylothorax C. Parapneumonic effusion D. Tuberculous pleural effusion (A) 2-A 38-year-old man presented to the Emergency Department with 5-day history of fever and a productive cough. Blood pressure 100/65 mHg, Temperature 39 deg * C, WBC 12 (4.5 - 10.5 * 109 / L), ESR 26 (2 - 10mm / h Male), Chest X-ray: Right middle lobe infiltrate. Sputum culture: Pending. Which of the following is the most appropriate immediate therapy? A. Moxifloxacin 400mg IV once daily B. Ceftazidime 1 gm IV every 8 hours C. Meropenem 1 gm IV every 8 hours D. Piperacillin/Tazobactam 4.5 gm every 6 hours. Read more

Understand the Problem

The question presents clinical scenarios related to pulmonology, specifically involving pleural effusion and pneumonia. It asks for the most likely diagnosis based on clinical symptoms, examination findings, and laboratory results for each case.

More Information

A low pleural fluid pH, usually less than 7.2, is consistent with empyema, which is an accumulation of pus in the pleural cavity as a result of infection.

Tips

A common mistake is not correlating the low pleural fluid pH with the diagnosis of empyema. Empyema typically presents with pleural fluid pH lower than 7.2, high fever, and pleuritic chest pain.

Sources

• Pleural effusion: diagnosis, treatment, and management - PMC - pmc.ncbi.nlm.nih.gov
• Pleural Effusion - Pulmonary Disorders - Merck Manuals - merckmanuals.com