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Complicated parapneumonic effusion — SCE Respiratory MCQ

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HardPleural DiseaseComplicated parapneumonic effusionSCE Respiratory

A 49-year-old man with community-acquired pneumonia has a moderate pleural effusion. He is febrile and breathless despite 48 hours of antibiotics. Pleural fluid is turbid with pH 7.16 and LDH 1,600 IU/L; Gram stain is negative. What is the most appropriate management?

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Correct answer: A — Chest tube drainage and continue antibiotics

Pleural fluid pH below 7.2 in a parapneumonic effusion indicates a complicated effusion requiring drainage even if Gram stain is negative. Antibiotics alone risk persistent sepsis and pleural organisation. Talc pleurodesis is inappropriate in active infection.

Reference: BTS Pleural Disease Guideline 2023