Respiratory medicine: parapneumonic effusion and empyema: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: parapneumonic effusion and empyema

Sample item

A 40-year-old man treated for right lower lobe pneumonia a week ago still has fever and pleuritic pain. Chest radiograph shows a moderate right effusion. Pleural aspirate is turbid, with pH 6.9, glucose 20 mg/dL, raised LDH and Gram-positive cocci on stain. What is the next best step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Intercostal tube drainage along with antibiotics

A parapneumonic effusion with pH below 7.2, glucose below 40 mg/dL, frank pus or organisms on Gram stain is a complicated effusion or empyema and will not resolve with antibiotics alone. It needs prompt drainage, usually by an intercostal tube, with intrapleural fibrinolytics or surgical decortication if it loculates.

Option by option

  • A. Continue antibiotics alone and repeat the tap after one week

    Waiting a week risks loculation and a trapped lung because the fluid is already infected.

  • B. Intravenous diuretics for a presumed transudate

    Heart failure produces a transudate with normal pH and glucose, which does not fit this picture.

  • C. Therapeutic aspiration of 2 litres and discharge

    A single large aspiration does not clear viscous pus and removing over 1.5 litres at once risks re-expansion oedema.

  • D. Intercostal tube drainage along with antibiotics (correct)

    Correct. Infected pleural fluid with these features must be drained to prevent a fibrous peel and sepsis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Intercostal tube drainage along with antibiotics. A parapneumonic effusion with pH below 7.

Why is "Continue antibiotics alone and repeat the tap after one week" not the answer?

Waiting a week risks loculation and a trapped lung because the fluid is already infected.

Why is "Intravenous diuretics for a presumed transudate" not the answer?

Heart failure produces a transudate with normal pH and glucose, which does not fit this picture.

Why is "Therapeutic aspiration of 2 litres and discharge" not the answer?

A single large aspiration does not clear viscous pus and removing over 1.5 litres at once risks re-expansion oedema.

What concept does this question test?

It tests Respiratory medicine: parapneumonic effusion and empyema in General Medicine. 2, glucose below 40 mg/dL, frank pus or organisms on Gram stain is a complicated effusion or empyema and will not resolve with antibiotics alone. It needs prompt drainage, usually by an intercostal tube, with intrapleural fibrinolytics or surgical decortication if it loculates.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: parapneumonic effusion and empyema?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.