71.A 62-year-old man presents to the ED with gradual dyspnea over the
last few weeks. He reports that he is a daily smoker and has not seen a
physician in years. Upon physical examination, there are decreased breath
sounds on the right as compared to the left. A chest radiograph indicates
blunting of the right costophrenic angle with a fluid line. A thoracentesis is
performed. Given this patient’s history, which of the following most likely
describes his effusion?
a. Transudative effusion
b. Exudative effusion
c. Transudative and exudative effusion
d. Lactate dehydrogenase < 200 U
e. Fluid-to-blood protein ratio < 0.5
72.A 40-year-old man with a history of untreated HIV for 8 years comes
into the ED complaining of cough, fever, and malaise for 3 days. He is
tachypneic and diaphoretic. Chest radiograph reveals bilateral infiltrates.
Arterial blood gas (ABG) analysis is significant for a PaO 2 of 62 on room air.
His chest radiograph is seen below. Which of the following is the most
appropriate initial management?
Shortness of Breath 61a. Corticosteroid treatment prior to antibiotic therapy
b. Immediate treatment with IV trimethoprim/sulfamethoxazole (TMP/SMX)
c. Administer antibiotics after a rapid sputum Gram stain is obtained
d. Nebulizer treatment
e. Racemic epinephrine
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB.Atlas of Emergency
Medicine. New York, NY: McGraw-Hill, 2002: 666.)