American Board of Internal Medicine (ABIM) Certification Practice Exam

How do patients with malignant pleural mesothelioma most commonly present?

1. Shortness of breath

2. Acute respiratory distress

3. Slowly enlarging pleural effusion

4. Chest pain

The correct answer is: Slowly enlarging pleural effusion

Patients with malignant pleural mesothelioma most commonly present with a slowly enlarging pleural effusion. This type of cancer, which is primarily linked to asbestos exposure, often leads to the accumulation of fluid in the pleural space as a result of tumor growth. The effusion can develop gradually, making its detection subtle in the early stages. As the cancer progresses, patients may begin to notice symptoms related to the pleural effusion, such as progressive shortness of breath, which can occur as the fluid volume increases and compresses the lung. However, the key feature in this presentation is indeed the slow accumulation of pleural effusion rather than acute phenomena like sudden respiratory distress or spontaneous chest pain, which might be more indicative of other acute conditions or complications. Understanding this gradual presentation is essential for early diagnosis; identifying and analyzing pleural effusions in high-risk populations can lead to timely interventions and improve patient outcomes.