Your patient with community-acquired pneumonia shows a pleural effusion on chest x-ray, indicating the need for:
A. Immediate endotracheal intubation
B. Broad spectrum intravenous antibiotics
C. Thoracentesis to rule out empyema
D. Gram stain and culture of sputum
ANS: C
In pneumonia, chest film typically reveals an area of infiltrate. It is a red flag if a pleural effusion is also visualized, in which case adequate follow-up to exclude development of an empyema is mandatory. This often involves prompt referral to a pulmonologist for possible thoracentesis. Cultures and Gram stains of sputum are usually not ordered for outpatients.
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