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Chest drain for pleural infection — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge and Acute Management DecisionsChest drain for pleural infectionSCE Acute Medicine

A 66-year-old man is assessed on the acute medical unit. He has pneumonia with pleural fluid pH 7.12, glucose 2.1 mmol/L and septations on ultrasound. He remains febrile despite antibiotics. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Insert a small-bore chest drain using ultrasound guidance

Insert a small-bore chest drain using ultrasound guidance is the best answer because low pleural pH in parapneumonic effusion indicates pleural infection needing drainage. Arrange same-day ambulatory follow-up 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: Ultrasound guidance reduces complications for pleural procedures.

Reference: BTS Pleural Disease Guideline