skip to main content

Pleural infection/empyema — SCE Acute Medicine MCQ

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

ModerateRespiratory medicinePleural infection/empyemaSCE Acute Medicine

A 69-year-old man has progressive breathlessness, pleuritic pain and fever two weeks after pneumonia. Chest radiograph shows a large left pleural effusion. Ultrasound-guided aspiration yields frank pus with pH 6.9 and glucose 1.0 mmol/L. 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: C — Insert an image-guided chest drain and give appropriate antibiotics

Frank pus and very low pleural pH confirm pleural infection requiring drainage plus antibiotics. BTS guidance supports image-guided drain insertion rather than repeated diagnostic aspiration alone. Talc pleurodesis is a treatment for recurrent malignant effusion, not acute empyema.

Reference: BTS Pleural Disease Guideline 2023