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Community-acquired pneumonia with empyema — RCPSC EM MCQ

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HardRespiratory emergenciesCommunity-acquired pneumonia with empyemaRCPSC EM

CTAS 2: A 61-year-old has fever, pleuritic pain and dyspnoea after a week of pneumonia treatment. Vitals are T 38.9°C, HR 118, RR 28, SpO2 91%. CXR shows a large left pleural effusion; ultrasound shows septations and loculations. WBC is 22. What is the most appropriate investigation?

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Correct answer: A — Diagnostic thoracentesis with pleural fluid pH, Gram stain and culture

A complicated parapneumonic effusion or empyema needs pleural fluid analysis and drainage planning. Ultrasound loculations and sepsis raise urgency.

Reference: Canadian respiratory infection practice; pleural infection guidance