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A 34-Year-Old Man Comes to the Emergency Department Due to 3

question 119

Multiple Choice

A 34-year-old man comes to the emergency department due to 3 weeks of nonproductive cough, increasing shortness of breath, subjective fevers, night sweats, and intermittent right-sided, sharp chest pain. Two weeks ago, the patient was diagnosed with community-acquired pneumonia at an urgent care clinic and received a week of oral antibiotics without symptomatic improvement. He has no other medical problems and takes no medications. The patient has a history of injection drug use and was recently incarcerated. Temperature is 37.7 C (99.8 F) , blood pressure is 120/70 mm Hg, and pulse is 88/min. Chest examination reveals decreased breath sounds and dullness to percussion in the right lower chest. Heart sounds are normal and without murmurs. The abdomen is soft and non-tender with no hepatosplenomegaly. He has no skin rash or enlarged lymph nodes. Chest imaging reveals a right lower lobe pulmonary infiltrate and moderate-sized pleural effusion. A thoracentesis is performed; the pleural fluid is lymphocyte predominant and exudative with an elevated adenosine deaminase level. No organisms are seen on smear. Rapid HIV testing is positive. Which of the following is the best next step in management of this patient's pleural effusion?

Definitions:

Economic Support

Financial or material assistance provided to individuals, families, or communities to ensure their basic needs are met or to support economic development.

Middle Class

Describes a socio-economic group that falls between the working class and upper class, often characterized by moderate incomes, education levels, and occupations.

Upper Class

A social group at the top of a societal hierarchy which possesses more wealth, power, and prestige than other classes.

Working Class

A social group comprising individuals in manual-labor occupations or industrial work, often associated with lower socioeconomic status.