determine
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A 55-year-old asthmatic woman, on systemic steroids for 1 year, has developed a recent right pleural effusion. She feels unwell and tires easily. Aspiration revealed a turbid fluid with numerous lymphocytes and a high lactate dehydrogenase (LDH) and low glucose level. Fluid pH is 7.4. The most likely diagnosis is
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1) a pulmonary embolism.
2) an empyema.
3) tuberculosis.
4) a subphrenic abscess.
5) pancreatitis
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| p53
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3) tuberculosis ?
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| usmle_2
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3) tuberculosis
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| yasmeen
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 T.B
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| achilles
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TB ?
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| determine
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yes TB
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| msyamp
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hmm tb
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| srf
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PULMONARY EMBOLISM.
as far as I know TB effusion is clear, straw coloured[yellow] usaually does not have low glocose but may have low pH.
determine can say the answer.
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| srf
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it might be pancreatitis becuase numerous lymphocytes.
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| determine
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Answer is tb. In tb there are num. lymphocytes.
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| PKG
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patient is immunocompromised cos she is on steroids. so more prone for tb. besides the pleural fluid findings are suggestive. tb give exudative effusion
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| ruhighazi
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Effusions with low glucose: Parapneumonic effusions, Empyema, RA, Esophageal rupture, Malignant effusions & TB
Effusions with Mononuclear(lymph) predominance: Malignant effusions & TB
So the DDx is between TB & malignant effusion but in TB effusions the pH is generally < 7.2 . In addition the effusion of TB is serous to serosanguineous but in malignancy it's turbid or bloody & occasionally serous. In pulmonary embolism the effusion glucose levels are equal to serum levels so its very unlikely to be the etiology.So I think the answer is malignant effusion!!!
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| srf
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Has any body seen turbid effusion in T. B.?
I have done & seen pleural effusion tapping.
It is always clear yellow colour fliud, never turbid.
THis is not T. B.
What is answer I do not know.
I will be very happy if someone confirm that yes I have seen turbid T.B. effusion
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| msyamp
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I hae seen turbid effusion in TB in my TB hospital posting from the IC tube. I saw bloody effusion too
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| srf
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msyamp,
thanks for answering.
As you have worked in T.B. hospital, you can give further opinon on this issue.
what do you expect if you tap T.B. effusion? clear fliud or turbid?
turbid fluid or bloody tap can occur but it is a complication and not a usual or normal happenning.
what is your opinion?
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| AAAAA
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TB
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| msyamp
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actually in our tb hosp where ever patients have plce IC tubes they have the bag filled with either bloody or purulent tap. purulent is because of lymphocytes or sec infections. bloody is not so uncommon in those
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| Rasul
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bloody or purulent-I don't think it has that much importance.Do technical mistake during punction-there goes Your blood. Lymphocytes= TB,pretty much, especially considering the hx of steroid use.
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| msyamp
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no boss not necessarily a technical problem . even in a good technique can give bloody tap. malignancy and TB are two things that can give bloody tap. leave it. that would not be so important in the exam.
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| Rasul
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Of course, msyamp, bloody tap is not exclusively a result of technical problem. What I meant is, I don't think discussion about if the tap is bloody, or purulent, or serous will decide the outcome in this case. But lymphocytes are important.
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| AAAAA
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All pleural effusion must tap before sunset (means it must be tap when the patient arrives on the floor)
If they ask you in exam what do you do with pleural effusion---->tap the patient
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