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Complicated parapneumonic effusion — RCPSC EM MCQ

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HardRespiratory emergenciesComplicated parapneumonic effusionRCPSC EM

A 58-year-old woman on chemotherapy presents CTAS 2 with fever, pleuritic pain and dyspnoea. RR is 30, SpO2 90% on room air, BP is 104/66, and chest X-ray shows a moderate loculated pleural effusion with adjacent consolidation. WBC is 22 and lactate is 2.7. What is the most appropriate next step?

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Correct answer: A — Start antibiotics and arrange diagnostic pleural drainage with admission

Parapneumonic effusion with sepsis features and loculation suggests complicated effusion or empyema. Antibiotics, pleural sampling/drainage and admission are required.

Reference: CAEP Clinical Practice Guidelines