MLA Domain 5 · Presentation

Pleural effusion

7 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 4

Boerhaave syndrome

Sepsis/mediastinitis → emergency resuscitation + surgery (high mortality, time-critical)

Empyema & lung abscess

Empyema (pleural fluid pH <7.2 / pus / low glucose / organisms) → CHEST DRAIN — antibiotics alone won't clear it

Occupational & environmental lung disease

Mesothelioma (asbestos exposure + pleural effusion/chest pain/pleural thickening) → urgent investigation; it is compensa

Pleural effusion

Empyema (purulent fluid, pH <7.2, low glucose) → chest drain (see empyema/abscess)

recognised feature · 1

Heart failure

Acute pulmonary oedema (severe dyspnoea, pink frothy sputum, hypoxia) → sit up, oxygen, IV loop diuretic ± nitrates → cr

differential of the above · 2

Mallory-Weiss tear

Significant/ongoing bleeding → endoscopic therapy

Sarcoidosis

Cardiac sarcoid (arrhythmia/heart block), neurosarcoidosis, or sight-threatening uveitis → urgent specialist treatment