A 22-year-old man presents with fever, right-sided pleuritic chest pain, and dyspnea for 5 days. Chest X-ray shows a moderate right pleural effusion. Thoracentesis yields cloudy fluid: pH 7.10, glucose 35 mg/dL, LDH 1800 IU/L, Gram stain shows gram-positive cocci in clusters. What is the most appropriate next step?

• A Intrapleural streptokinase
• B Diuretic therapy
• C Pleural biopsy for TB
• D Intercostal tube drainage ✓

Explanation

The pleural fluid features (pH <7.20, glucose <40 mg/dL, LDH >1000 IU/L, cloudy appearance, organisms on Gram stain) indicate a complicated parapneumonic effusion/empyema requiring urgent chest tube drainage. Intrapleural fibrinolytics may be used for loculated effusions but drainage is primary. Diuretics and TB biopsy are inappropriate here.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.