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Chest drain for pleural infection — SCE Acute Medicine MCQ

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HardProcedural Knowledge in Acute MedicineChest drain for pleural infectionSCE Acute Medicine

A 45-year-old woman presents with a procedure-related acute decision. Relevant history includes coagulation, imaging, respiratory physiology or procedural risk. On assessment, bedside findings determine whether the procedure is safe and urgent. Investigations show loculated effusion with pleural pH 7.05 and ongoing sepsis. What is the most appropriate next step in management?

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

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Correct answer: E — Insert an ultrasound-guided small-bore chest drain

The key discriminator is that loculated effusion with pleural pH 7.05 and ongoing sepsis, which makes Insert an ultrasound-guided small-bore chest drain 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; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Start anticoagulation after assessing bleeding risk 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: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-27-1