Which one is the commonest cause of pleural effusion in young patients?

UPPSC 2022

Medical Surgical Nursing

Easy

Appeared in: UPPSC 2022

Explanation

Tuberculosis is the most frequent cause of exudative pleural effusion in young individuals (under 40), especially in parts of the world where TB is prevalent.
The effusion is caused by a hypersensitivity reaction to tuberculous proteins in the pleural space, leading to an exudate rich in lymphocytes.
Clinically, patients often present with fever, weight loss, and pleuritic chest pain.

Option A: Lung cancer is a leading cause of malignant pleural effusion, but it is primarily a disease of older adults, typically those with a history of smoking.
Option B: While S.L.E. can cause pleural effusions and often affects young women, its overall incidence is much lower than that of tuberculosis, making it a less common cause in the general young population.
Option D: Pleural effusion in rheumatoid arthritis is a relatively rare complication, typically seen in older males with long-standing, severe, and nodular disease.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Pleural Effusion in Young Adults as background academic context rather than a clinical decision trigger.
A nurse assessing a young patient with signs of pleural effusion (dyspnea, chest pain) must maintain a high index of suspicion for Tuberculosis, especially in endemic areas.
Nursing care involves implementing airborne precautions promptly if TB is suspected, collecting detailed patient history (including exposure and travel), and preparing the patient for diagnostic procedures like thoracentesis.
What if? - If the patient was an immunocompromised individual (e.g., with HIV), the differential diagnosis for pleural effusion would broaden significantly to include opportunistic infections and malignancies like Kaposi's sarcoma, although TB would still remain a primary consideration.

How to Approach the Question

First, identify the core components of the question: the condition ('pleural effusion') and the specific patient population ('young patients').
The keyword 'commonest' directs you to consider the epidemiology and prevalence of the potential causes.
Evaluate each option based on its typical demographic profile.
Eliminate 'Lung cancer' and 'Rheumatoid arthritis' as they are primarily diseases affecting older populations.
Compare the remaining options, 'S.L.E.' and 'Tuberculosis'. While S.L.E. does affect young people, Tuberculosis is a far more prevalent infectious disease globally and a very common cause of pleural effusion in the young.
Conclude that Tuberculosis is the most statistically likely cause in this demographic.

Concept Tested & Keywords

Concept Tested: Etiology of Pleural Effusion in Young Adults
Stem keywords: pleural effusion, young patients, commonest cause
Lead-in keywords: Which one
Clinical cues: Patient demographic: 'young patients' is the key to differentiating the causes.

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E6 Medicine Harrison 22e Part 2 p. 174-176

E6 Medicine Davidson Principles Practice 24e p. 631-633