A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 52-year-old man with a history of alcohol use disorder presents with fever, productive cough, and pleuritic chest pain. His temperature is 38.5°C (101.3°F), pulse is 98/min, respirations are 22/min, and blood pressure is 120/78 mmHg. Physical examination reveals dullness to percussion and decreased breath sounds at the right lung base. A chest X-ray shows a right lower lobe consolidation. Which of the following is the most likely finding on pleural fluid analysis if a thoracentesis is performed?
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A
Low glucose levelsIncorrect. Low glucose typifies empyema or rheumatoid effusion; uncomplicated parapneumonic effusions retain higher glucose initially.
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B
Predominance of neutrophilsCorrect. Parapneumonic effusions show neutrophil-predominant exudates due to acute bacterial inflammation.
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C
Elevated hemoglobin levelsIncorrect. Elevated hemoglobin (hemothorax) requires trauma or vascular bleed, not pneumonia.
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D
High amylase levelsIncorrect. High amylase indicates esophageal rupture or pancreatic effusion, not parapneumonic process.
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E
Presence of chylomicronsIncorrect. Chylomicrons indicate chylothorax from lymphatic disruption, not bacterial pneumonia.
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Answer: B. The clinical picture suggests a parapneumonic effusion secondary to pneumonia, given the pleuritic chest pain and consolidation on X-ray. A pleural fluid analysis in this context would typically show a predominance of neutrophils due to the inflammatory response. Low glucose levels would suggest an empyema, and high amylase levels would be indicative of pancreatitis-related effusion.