Complicated Parapneumonic Effusion — RACP Adult Medicine MCQ

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ModerateRespiratoryComplicated Parapneumonic EffusionRACP Adult Medicine

A 55-year-old man with complicated parapneumonic effusion (pH 7.15, glucose 1.5 mmol/L, LDH 2500, Gram + cocci). What definitive management?

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Correct answer: C — Intercostal catheter drainage plus antibiotics

Complicated parapneumonic/empyema (pH <7.2, low glucose, high LDH, positive Gram stain): ICD drainage + IV antibiotics. Add fibrinolytics if loculated (MIST2 protocol).

Reference: eTG – 2025 – Respiratory; BTS – 2023; MIST2