Systemic paediatrics: complicated parapneumonic effusion: practice question

A Pediatrics 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.

Try it

Pediatrics · Systemic paediatrics: complicated parapneumonic effusion

Sample item

A 4-year-old with pneumonia remains febrile after 72 hours of intravenous antibiotics. The radiograph shows a large right pleural effusion. Aspirated fluid is turbid with pH 7.0, glucose 30 mg/dL and LDH above 1000 U/L. What is the next step?

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

The answer and the reasoning

A. Intercostal tube drainage with continued antibiotics

A pleural fluid pH below 7.2, low glucose and high LDH indicate a complicated effusion or empyema, which needs drainage. Intercostal tube drainage is the standard, with fibrinolytics or VATS if loculated, and antibiotics are continued.

Option by option

  • A. Intercostal tube drainage with continued antibiotics (correct)

    Correct. Infected, acidic, low-glucose fluid needs drainage along with antibiotics.

  • B. Repeat diagnostic aspiration after another 72 hours

    Repeating aspiration after a delay lets the effusion organise and does not drain it adequately.

  • C. Add systemic corticosteroids and observe

    Corticosteroids do not clear infected pleural fluid and may impair defence.

  • D. Switch to oral antibiotics with chest physiotherapy

    Oral antibiotics and physiotherapy do not drain an empyema, and the child is still febrile.

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.

More Pediatrics questions

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Intercostal tube drainage with continued antibiotics. A pleural fluid pH below 7.

Why is "Repeat diagnostic aspiration after another 72 hours" not the answer?

Repeating aspiration after a delay lets the effusion organise and does not drain it adequately.

Why is "Add systemic corticosteroids and observe" not the answer?

Corticosteroids do not clear infected pleural fluid and may impair defence.

Why is "Switch to oral antibiotics with chest physiotherapy" not the answer?

Oral antibiotics and physiotherapy do not drain an empyema, and the child is still febrile.

What concept does this question test?

It tests Systemic paediatrics: complicated parapneumonic effusion in Pediatrics. 2, low glucose and high LDH indicate a complicated effusion or empyema, which needs drainage. Intercostal tube drainage is the standard, with fibrinolytics or VATS if loculated, and antibiotics are continued.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Systemic paediatrics: complicated parapneumonic effusion?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.