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Pleural effusion from malignancy — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsPleural effusion from malignancySCE Acute Medicine

A 64-year-old woman is assessed on the acute medical unit. She has progressive dyspnoea and a unilateral stony dull effusion. Chest radiograph shows a large right pleural effusion with mediastinal shift away. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: B — Bedside ultrasound for pleural fluid

Bedside ultrasound for pleural fluid is the best answer because ultrasound confirms fluid and guides safe aspiration for diagnostic cytology and symptom relief. Non-contrast CT head is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Do not perform blind pleural procedures when ultrasound is available.

Reference: BTS Pleural Disease Guideline