arlete
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An 82 year-old lady comes to the Emergency room after 14 days treating "pneumonia" with an antibiotic that she forgot to bring with her. She states she had a little improvement during the first five days, but now she has high fever, chils and cough with purulent sputum. On PE, she has dullness at percussion on right lung base, no breath sounds on this region, and fine crepitation in the area right above it. An X-ray is ordered and shows blunting of the right costophrenic angle. What findings on analysis of pleural effusion are consistent with empyema?
pleural/serum protein pleural/serum LDH pH glucose
(A) 0.4 0.5 7.1 60
(B) 0.4 0.5 7.3 40
(C) 0.6 0.7 7.1 30
(D) 0.6 0.7 7.3 60
(E) 0.6 0.5 7.2 40
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| drpepper7
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d ?
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| Lim
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c
glucose should be low cause of infection.
and PH must be acidic.
pleural/serum protein > 0.5
isn't it c?
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| Justice
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(C)
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| dr in trouble
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not sure between cand d
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| jodin99
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C
Pleural/serum protein is more than 0.5 ( same mechanism as exudate in bvs)
LDH is inresed ofcourse
this is a bacterial infection ( most probably) so the pH will be acidic.
Bacteria takes glucse(which is low) and forms acid ( which is high)
This makes C an appropriate answer
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| virgola82
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I'd say C for the same reasons explained by jodin99
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| sprint123
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 In empyema-->pH is < 7.2 Answer is C
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| arlete
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Yeap, C.
You nailed, guys!
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| elitoki
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Answer is C and the reasons are: Light's criteria for exudate to dx empyema:
1. The ratio of pleural fluid protein to serum protein is greater than 0.5
2. The ratio of pleural fluid LDH and serum LDH is greater than 0.6
3. Pleural fluid LDH is more than two-thirds normal upper limit for serum
remember glucose is decrease and pH must be less than 7.2
Edited by elitoki on 06/26/07 - 02:02 PM
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| doyoudig
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CCC
Exudate Effusion + Ph < 7.2, Glucose < 60, PMN/+G Stain...
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| cirus
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has to be C
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| sailing boat
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yes c
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| arlete
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Clap clap clap clap
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