sandra
Forum Guru
Topics: 180
Posts: 433
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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
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| dr.wad
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D
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| guangyu
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yes, D
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| simi
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d
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| mildus
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| WaqasQureshi
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the lab values fulfill the crieteria for exudative effusion with LDH >200, LDH pleural fluid/serum >0.6 and Protein pleural fluid/serum >0.5.
there is a history of 2 months of progressive shortness of breath. I dont think that infarction related embolism can present with progressive shortness of breath. The chronic PE can cause corpulmonale but there is no infarction in it.
Finally if asked for odds
most common exudative effusion is pneumonia then comes cancer then pulmonary embolism then some bacterial infection then TB then connective tissue disease
there is a positive history of 30 years. so I would say its a CANCER!!! 
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| Ivonne
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D
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