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Malignant pleural effusion — MCCQE Part 1 MCQ

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HardPleural EffusionMalignant pleural effusionMCCQE Part 1

A 68-year-old former smoker presents with progressive dyspnea and weight loss. Chest x-ray shows a large unilateral right pleural effusion, and ultrasound confirms safe access. He has no fever and cardiac examination is normal. What is the most appropriate investigation?

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Correct answer: A — Diagnostic thoracentesis with pleural fluid analysis and cytology

A unilateral pleural effusion with weight loss and smoking history requires diagnostic thoracentesis, including cytology, to distinguish malignant, infectious and other exudative causes. Empiric diuretics are more appropriate for clear bilateral transudative heart failure. Sputum culture does not diagnose a pleural effusion.

Reference: Canadian Thoracic Society resources; MCC Objectives—Pleural Effusion