skip to main content

Pleural empyema — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute Respiratory PresentationsPleural empyemaSCE Acute Medicine

A 29-year-old man presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show complex effusion with pleural pH 7.12 and persistent sepsis. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Insert an image-guided chest drain and continue antibiotics

The key discriminator is that complex effusion with pleural pH 7.12 and persistent sepsis, which makes Insert an image-guided chest drain and continue antibiotics the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Optimise chronic medication and discharge and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BTS Pleural Disease Guideline