USMLE Next step in a pleural effusion? OME vs UWorld

[Lifeman]

So in Online MedEd, it says if you see a pleural effusion on CXR, next step is to get further imaging to determine if it's loculated or not and THEN do a thoracentesis. The imaging can be U/S, dependent CXR, or CT.

And then in Uworld, I got a question where the patient has a pleural effusion from CXR, and I said the next best step was U/S which was wrong and the right answer was diagnostic thoracentesis to determine if it's exudative or transudative.

So what do I pick on the real exam?

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[chromuffin]

So in Online MedEd, it says if you see a pleural effusion on CXR, next step is to get further imaging to determine if it's loculated or not and THEN do a thoracentesis. The imaging can be U/S, dependent CXR, or CT.

And then in Uworld, I got a question where the patient has a pleural effusion from CXR, and I said the next best step was U/S which was wrong and the right answer was diagnostic thoracentesis to determine if it's exudative or transudative.

So what do I pick on the real exam?

Correct me if I’m wrong, but I would do a thoracentesis if the patient is symptomatic simply for therapy. Now I know the question doesn’t state therapeutic..

The reason UWord says that ultrasound is wrong is because it provides no new information. The CXR diagnoses pleural effusion. The next step would be to find out what is causing the pleural effusion, so you want to analyze the fluid (I.e. Light’s Criteria).

For OME, I’m not sure. I personally would go the UWorld route. Why use a second imaging study to diagnose something that will ultimately need a procedure. I think a lot of what comes into play is the patient’s clinical picture.

Hope that helps.

 

[Shams al Deen]

If OME ever contradicts UWorld, forget about what is said on OME. UWorld is king. You ever notice the "date last modified" on almost every UWorld question is like in the last few months. The explanations are constantly getting updated and improved. UWorld is the best resource for the USMLE. OME is great, but it's one guy teaching--he's bound to mess up here and there (or for things in medicine to change, and he hasn't had a chance to update).