American Board of Internal Medicine (ABIM) Certification Practice Exam

In uncomplicated pleural effusion, what is typically the treatment approach?

1. Immediate surgical intervention

2. Antibiotics and serial follow-up

3. Thoracentesis only

4. Intravenous diuretics

The correct answer is: Antibiotics and serial follow-up

In uncomplicated pleural effusion, the treatment approach often involves the use of antibiotics in conjunction with serial follow-up. This approach is based on the understanding that uncomplicated pleural effusions, particularly those that are transudative (such as in cases of congestive heart failure or cirrhosis), may resolve on their own with appropriate management of the underlying condition, and there is often no need for invasive interventions initially. Antibiotics may be indicated if there is a concern for infection, particularly if the patient exhibits signs and symptoms suggestive of an infection, or if the effusion is suspected to be complicated. Serial follow-up includes monitoring the effusion through clinical assessment and imaging studies to ensure it does not progress or become complicated. While thoracentesis can provide rapid relief from symptoms and allow for diagnostic analysis of the pleural fluid, in uncomplicated cases, it is not typically the first-line treatment unless there is significant respiratory distress or if diagnostic information is necessary. Invasive procedures are generally reserved for complicated effusions or where the diagnosis is uncertain. The use of intravenous diuretics may help in some cases of congestive heart failure-related effusions but is not a standard treatment for uncomplicated pleural effusion on its own. Immediate surgical interventions