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Malignant pleural effusion — SCE Respiratory MCQ

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HardPleural DiseaseMalignant pleural effusionSCE Respiratory

A 74-year-old woman with metastatic breast cancer has a symptomatic recurrent pleural effusion. The lung fully re-expands after therapeutic aspiration and she wishes to minimise future admissions. Estimated prognosis is 8 months. What is the most appropriate management?

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Correct answer: B — Offer indwelling pleural catheter or talc pleurodesis after shared decision-making

The best answer is “Offer indwelling pleural catheter or talc pleurodesis after shared decision-making”. Offer indwelling pleural catheter or talc pleurodesis after shared decision-making is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Repeated emergency aspiration as the planned strategy, within a respiratory pathway”, “Long-term oral furosemide for malignant exudate, after safety review”, “Immediate extrapleural pneumonectomy, after specialist assessment, after specialist assessment”, “Observation in the absence of symptom-directed intervention, with clinical reassessment”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1