Internal Medicine Review Question of the DayABIM Exam Review Question of the Day, Courtesy of Med-Challenger
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A 40-year-old man is evaluated for a 4-week history of progressive shortness of breath, fatigue, decreased appetite, and a 5-pound weight loss.
He has a 20 pack-year smoking history, admits to active crack and heroin abuse, and drinks alcohol 2 to 3 times a week.
The patient's vital signs are: temperature 104 °F, heart rate 110 beats/minute, and blood pressure 110/60 mm Hg. He is generally unkempt with poor hygiene, and you are able to observe numerous track marks and healed scars on his skin.
He has decreased breath sounds and egophony on the right side. Findings on chest x-ray show a large, right-sided pleural effusion.
Pleural fluid analysis from thoracentesis shows:
White blood cell (WBC) count: 10,000/mm3
Total protein: 3.8 g/dL (pleural protein/serum protein = 0.6)
Lactate dehydrogenase (LDH): 210 U/L (pleural LDH/serum LDH: 0.72)
Glucose 45 mg/dL
Amylase 42 U/L
Which of the following is most likely?
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