archer q3 - sadhan

[ArchivalUser]

i will go for b, based on premier review but pt bnp is very high with ijection fraction only 30 that mean sever chf which leads me to pick e. very confusing ------------any body help

[ArchivalUser]

Very good Q answer is D
Cardiomyopathy can cause elevated BNP. The specificity of BNP for CHF is high only when > 500 pg. He does have history of CHF , but current effusion is not typical of CHF. this effusion is unilateral, left sided, there is no s3 gallop, no JVD, no bilateral crepitations . So confusion with CHF should be avoided. I think that's the point of this question


Indications for thoracentesis are clear ;

Indications
• Diagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection

• Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis


This patient ahs cardiomypoathy but no CHF exacerbation to explain new effusion. Right lung is clear. CHF would cause bilateral effusions.

If CHF and effusions ( bilateral or right sided) and has clear diagnosis ( Presence of S3 gallop, JVD, BNP > 500 ) - no need to do thoracentesis. We should do furosemide and see if effusions go away. If they persist even after diuretics, thoracentesis

Unilateral effusion, particularly left sided in absence of strong evidence of CHF exacerbation - next step diagnostic thoracentesis. Chest tube indicated only if diagnostic needle procedure showed hemothorax or empyema or chyle.

[ArchivalUser]

Right, I eventually went over pulmonary today coz of this q,lol..
The thoracentesis is diagnostic and therapeutic in this case and the q is a picture of pleural effusion..nice question and discussion.. thanks guys

[ArchivalUser]

ddd