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Suspected pulmonary embolism — SCE Respiratory MCQ

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HardPulmonary vascular diseaseSuspected pulmonary embolismSCE Respiratory

A patient with pneumonia has a free-flowing pleural effusion. Aspiration yields non-purulent fluid with pH 7.18; ultrasound confirms enough accessible fluid for safe drainage. What is the next pleural intervention?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Insert a small-bore intercostal drain while continuing antibiotics

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

B is correct. BTS classifies pleural-fluid pH at or below 7.20 as high risk for complicated parapneumonic effusion or pleural infection and recommends intercostal drainage when ultrasound shows safely accessible fluid; initial drainage should use a small-bore tube. Frank pus is not required. Fibrinolytics are considered for residual collections after drainage, while delayed aspiration or immediate surgery bypasses first-line source control.

Reference: https://thorax.bmj.com/content/78/Suppl_3/s1