A 68-year-old man is hospitalized with pneumonia. - resi_hopeful

[ArchivalUser]

A 68-year-old man is hospitalized with pneumonia. He is being treated with oral antibiotics; however, on hospital day 4 he has a low-grade fever with a temperature of 38.2°C (100.8°F). He is tachypneic at 26/min, oxygen saturation is 87%-89%, pulse is 106/min, and blood pressure is 144/80 mm Hg. Examination demonstrates newly decreased breath sounds in the right posterior lung base with dullness to percussion. An x-ray of the chest demonstrates a new, large, right-sided pleural effusion; a thoracentesis is performed.
Which criterion would indicate the need for chest tube placement in this patient?

A.Cloudy-appearing fluid
B.Exudative effusion
C.Glucose level

[ArchivalUser]

D. transudative effusion
E. wbc

[ArchivalUser]

C. glucose

[ArchivalUser]

So C is the correct answer?

[ArchivalUser]

i was not able to write all the choices..

glucose

[ArchivalUser]

still am not able to write

i wanted to write

glucose less then 40.

[ArchivalUser]

The correct answer is C. 36% chose this.
A glucose level 100,000/mm³ or frank pus, a positive Gram stain with bacteria, and a lactate dehydrogenase (LDH) level >1000 IU/L. These features suggest empyema or a complicated parapneumonic effusion, which needs a chest tube for drainage and thus definitive therapy. If this type of infection is not drained, it behaves similarly to an abscess and is not well penetrated by antibiotics alone.
A is not correct. 20% chose this.
Although cloudy-appearing pleural fluid is likely indicative of an exudative process, this is not a strict criterion to place a chest tube. However, if the cytologic analysis yields a positive Gram stain, a chest tube should likely be placed.
B is not correct. 33% chose this.
Meeting Light's criteria for an exudative effusion alone does not confirm the need to drain the effusion for treatment. Exudates are characterized by a high fluiderum protein ratio >0.5, a fluiderum LDH ratio >0.6, or a pleural LDH level more than two thirds the serum LDH level. Examples of processes that can cause exudative effusions include malignancy, empyema, uncomplicated parapneumonic effusion, fungal infections, and chylothorax. Further analysis must be done on the fluid to determine the best course of therapy.
D is not correct. 9% chose this.
Transudative effusions occur because of imbalances in hydrostatic and oncotic pressures, as can be seen in congestive heart failure or hypoalbuminemia. These effusions do not typically need drainage for resolution, but rather treatment of the underlying state causing the shift in pressures.
E is not correct. 2% chose this.
A WBC count