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Malignant pleural effusion — MCCQE Part 1 MCQ

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HardPleural EffusionMalignant pleural effusionMCCQE Part 1

A 68-year-old woman with weight loss and smoking history has progressive dyspnoea, a large unilateral pleural effusion and exudative fluid with atypical cells. Which of the following is the most appropriate next step?

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Correct answer: B — Refer urgently for malignancy work-up and symptom-directed pleural management

Refer urgently for malignancy work-up and symptom-directed pleural management is the single best answer because the age, timing, examination findings and investigations in the vignette fit Malignant pleural effusion better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Thoracic Society pleural disease guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian Thoracic Society pleural disease guidance