Pleural Effusion: ABFM practice questions

4 board-style questions on pleural effusion in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 68-year-old man with heart failure presents with progressive dyspnea. Chest X-ray shows a large left-sided pleural effusion. Thoracentesis is performed, yielding straw-colored fluid. Pleural fluid analysis shows: protein 2.1 g/dL (serum protein 6.8 g/dL), LDH 95 IU/L (serum LDH 220 IU/L), and pleural fluid to serum LDH ratio 0.43. Using Light's criteria, how is this effusion classified?

  1. Empyema
  2. Transudative effusion
  3. Complicated parapneumonic effusion
  4. Exudative effusion

Sample question 2

A 55-year-old woman with a history of breast cancer treated 3 years ago presents with progressive dyspnea over 4 weeks. Chest X-ray reveals a large right-sided pleural effusion. Thoracentesis yields 1,200 mL of bloody fluid. Pleural fluid analysis shows: protein 4.8 g/dL (serum protein 6.5 g/dL), LDH 320 IU/L (serum LDH 190 IU/L), glucose 42 mg/dL, and pH 7.18. Cytology is pending. What is the most likely cause of this effusion?

  1. Congestive heart failure
  2. Pulmonary embolism with infarction
  3. Tuberculous pleuritis
  4. Malignant pleural effusion

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