Online OSCEs - Station SIX - Pleural Fluid Analysis

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A 62 year-old man is admitted short of breath. The admitting A&E doctor informs you he has a right pleural effusion.

Pleural fluid is aspirated and sent for analysis:

Total Protein: 38 g/l

LDH: 243 IU/l

pH: 7.38

Microbiology: Gram +ive cocci

Question 1: Summarise what would be found on clinical examination (3 marks)

Question 2: Would a large pleural effusion pull the trachea to the abnormal side, or push it away? (1 mark)

Question 3: How are pleural effusions classified? (2 marks)

Question 4: What type of pleural effusion does this patient have? (1 mark)

Question 5: Give 3 other causes of a pleural effusion (3 marks)

Answer 1:	Summarise what would be found on clinical examination. Reduced chest expansion on side of effusion (1 mark) Stony dull to percussion (1 mark) Absent or reduced breath sounds (1 mark)
Answer 2:	Would a large pleural effusion pull the trachea to the abnormal side, or push it away? The trachea will be pushed away from the affected side with a large pleural effusion (1 mark)
Answer 3:	How are pleural effusions classified? Pleural effusions are classified by the total content of protein within the aspirated fluid. under 30 g/l of protein = transudate over 30 g/l of protein = exudate (2 marks)
Answer 4:	What type of pleural effusion does this patient have? An exudate pleural effusion. More specifically a parapneumonic pleural effusion (1 mark)
Answer 5:	Give 3 other causes of a pleural effusion. Bronchial carcinoma Pulmonary infarction Malignant mesothelioma Rheumatoid arthritis Acute pancreatitis (*One mark for any of the above to a maximum of three.)