Quiz แนวทางการวินิจฉัยน้ำในเยื่อหุ้มปอด (diagnostic approach to pleural effusion)
1. A previously healthy 4-year-old boy presents with cough and chest tightness for 3 days. PE: BT 38.5 C, RR 40/min, PR 145/min, BP 90/60 mmHg, lung: subcostal retraction, dullness on percussion, decrease breath sounds and vocal resonance on right hemithorax. A lateral decubitus film shows free-flowing fluid in right pleural space. Which of the following is the most likely etiology of pleural effusion?
B. Pulmonary embolism
C. Parapneumonic effusion
D. Congestive heart failure
E. Malignant pleural effusion
2. Which of the following cell in pleural fluid indicated subacute inflammation in pleural space?
3. A 12-year-old girl presents with edema and progressive dyspnea for 2 weeks. PE: pale facial swelling, BT 37.5 C, RR 25/min, PR 135/min, BP 100/70 mmHg, SpO2 98% on room air. lung: mild subcostal retraction, decrease breath sound and chest wall expansion on left lung, hepatomegaly. CXR shows homogenous opacity of left hemithorax with mediastinum shift rightward. Which of the following is the most likely mechanism of pleural effusion?
B. Pulmonary infection
C. Tuberculous pleuritis
D. Lymphatic obstruction
E. Superior vena cava obstruction
4. According to Quiz 2, Which of the following is the most appropriate initial investigation?
B. Pleural biopsy
C. Tuberculin skin test
D. Lateral decubitus film
E. Ultrasonography of chest
5. A 1-year-old boy underwent cardiac surgery 4 days ago. He had no postoperative complication except persistent draining of left intercostal drainage, approximately 100 mL/day. Pleural analysis: cloudy yellowish fluid, pH 7.3, protein 3.0 g/dL(serum protein 3.5 g/dL, LDH 200 U/L (serum LDH 350 U/L), cell: WBC 1,500 cell/mm3, PMN 2%, mono 98%.Which of the following is the most likely presumptive diagnosis?
C. Empyema thoracis
D. Parapneumonic effusion
E. Congestive heart failure
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