Typical exam stem
A patient has progressive dyspnoea, stony dull percussion and reduced breath sounds at the right base. How would you investigate the suspected pleural effusion?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What are common causes of transudative and exudative pleural effusions?
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Clinical recognition
- Reduced chest expansion on the affected side.
- Stony dull percussion note over fluid.
- Reduced or absent breath sounds and vocal resonance over a moderate or large effusion.
- Large effusions may cause mediastinal displacement; tension physiology is uncommon but important when severe respiratory compromise is present.
Think in causes before you tap
Common transudative causes include heart failure and other states that alter hydrostatic or oncotic pressure. Exudative causes include infection, malignancy, tuberculosis, pulmonary embolism and inflammatory disease. In Zambia and other high-TB-burden settings, tuberculosis should remain an important consideration when the clinical pattern fits.
Chest radiography confirms fluid and may show associated lung disease. Thoracic ultrasound is particularly useful because it confirms fluid, estimates volume, identifies septations and guides safer aspiration.
Pleural fluid analysis
- Send protein and LDH with paired serum values when classifying by Light criteria.
- Cell count and differential can support the differential diagnosis.
- pH and glucose are important when pleural infection is suspected.
- Gram stain and culture, cytology and targeted tuberculosis testing are selected according to clinical context.
- A frank empyema or complicated infected effusion generally requires drainage in addition to antimicrobial therapy.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.