Progressive Shortness Of Breath in Medicine / Internal Medicine — 69yo Man | Respiratory / Pulmonology | SMLE Q#18269
SMLE Question #18269
Medicine / Internal Medicine
Respiratory / Pulmonology
Objective: OBJ-RESP-PLEFF-001
Last updated: February 2026
A 69-year-old man presents to a pulmonary clinic with progressive shortness of breath and unintentional weight loss for 6 months. He has a 40-pack-year smoking history and no known tuberculosis or HIV risk factors. Chest X-ray shows a large left-sided pleural effusion. Diagnostic thoracentesis removes 1,500 mL of grossly bloody pleural fluid that meets Light’s criteria for an exudate. Pleural fluid Gram stain is negative. What is the most appropriate next step in management?
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