04-25-2007, 10:01 AM
A 67-year-old man presents to the physician™s office with shortness of breath, pleuritic chest pain, mild coughing without sputum production, and exertional breathlessness. These symptoms have lasted for 12 days. The respiration rate is 24/min. The trachea is midline. There is dullness to percussion, decreased fremitus, and decreased breath sounds in the lower one third of the left side of the chest. Cardiac examination shows normal heart sounds, no murmur, and a three-component friction rub. There is no peripheral edema. The chest radiograph confirms the presence of a large, freely layering pleural effusion on the left, and no substantial parenchymal disease.
Thoracentesis yields 900 mL of blood-tinged fluid, and the findings are as follows:
Leukocyte count 1500/µL
Lymphocytes 87%
Polymorphonuclear leukocytes 10%
Eosinophils 2%
Mesothelial cells 1%
Pleural fluid protein 4.0 g/dL
Pleural fluid lactate dehydrogenase 985 U/L
Pleural fluid pH 7.41
Pleural fluid cholesterol 85 mg/dL
Pleural fluid glucose 95 mg/dL
Pleural fluid cytology Negative
Which additional component of the medical history explains the effusion?
(A) Recent bacterial pneumonia
(B) Congestive heart failure with recent decompensation
© Cirrhosis of the liver with recent dietary indiscretion
(D) Coronary artery bypass surgery 3 weeks earlier
(E) Seropositive rheumatoid arthritis
Thoracentesis yields 900 mL of blood-tinged fluid, and the findings are as follows:
Leukocyte count 1500/µL
Lymphocytes 87%
Polymorphonuclear leukocytes 10%
Eosinophils 2%
Mesothelial cells 1%
Pleural fluid protein 4.0 g/dL
Pleural fluid lactate dehydrogenase 985 U/L
Pleural fluid pH 7.41
Pleural fluid cholesterol 85 mg/dL
Pleural fluid glucose 95 mg/dL
Pleural fluid cytology Negative
Which additional component of the medical history explains the effusion?
(A) Recent bacterial pneumonia
(B) Congestive heart failure with recent decompensation
© Cirrhosis of the liver with recent dietary indiscretion
(D) Coronary artery bypass surgery 3 weeks earlier
(E) Seropositive rheumatoid arthritis