doyoudig
Forum Guru
Topics: 144
Posts: 613
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A 67-year-old man comes to the physician because of a
2-month history
of progressive shortness of breath. He has had a
4.5-kg (10-lb) weight
loss over the past 4 months. He has not had chest
pain. He has
congestive heart failure treated with furosemide,
digoxin, and enalapril. He
has smoked two packs of cigarettes daily for 30 years.
He appears
alert and is in no acute distress. His temperature is
37.2 C (99 F), blood
pressure is 140/85 mm Hg, pulse is 84/min, and
respirations are 18/min.
Examination shows no jugular venous distention. There
is dullness to
percussion, and breath sounds are decreased at the
left base. Cardiac
examination shows a laterally displaced point of
maximal impulse, normal
S1 and S2, and an S3 at the apex. There is 1+ edema
over the
extremities. An x-ray film of the chest shows an
enlarged cardiac silhouette,
left hilar fullness, and a moderate-sized left pleural
effusion.
Thoracentesis yields straw-colored fluid. Laboratory
studies show:
Serum
Glucose 90 mg/dL
Protein 7 g/dL
Lactate dehydrogenase 300 U/L
Pleural fluid
pH 7.25
Glucose 75 mg/dL
Protein 4.5 g/dL
Lactate dehydrogenase 280 U/L
Leukocyte count 2000/mm3
Segmented neutrophils 15%
Lymphocytes 85%
A Gram's stain and acid-fast stains are negative for
any organisms.
Which of the following is the most likely cause of
this patient's pleural
effusion?
A
) Bacterial pneumonia
B
) Collagen vascular disease
C
) Congestive heart failure
D
) Malignancy
E
) Pulmonary embolus with infarction
F
) Viral pleuritis
I am btw Viral Pleuritis and Maligancy but pls tell me on what info in
the case can we rule out malignancy or viral cause. I can seem to find that one piece of info to base it on either viral or cancer???
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,907
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For viral pleuritis there is no history...
But hilar mass is suggestive of SCLC which frequently causes metastatic pleuritis... I go with D) Malignancy
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| Drtweetie
Forum Elite
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Posts: 301
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history of smoking + wt loss + hilar mass +straw-colored exudative pleural effusion=> malignancy!
agree w/ Justice
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| cirus
Forum Guru
Topics: 108
Posts: 740
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, The high protein level & LDH Level stand on that side too ( add to the hist) then its Malignancy
As for Viral infection, the WBCs count is not suggestive of an infec from the start (2000)
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
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D
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