<prompt> Which of the following will not present in pleural effusion-Stony dullnessHyper resonance in affected sideAbsent breath soundDiminished vocal fremitus  <response>: B Hyperresonance in affected side 643, 659 Davidson 21st 2178-80- H 18thPLEURAL EFFUSIONINSPECTIONPERCUSSION Bulging of the intercostal space Stony dullness with increased resistance and no shifting dullness below the level of fluid Diminished mobility of the chest wall on the affected side Skodiac resonance boxy note just above the effusion Shift of the mediastinum to the opposite side i.e. Trailes sign Obliteration ofTroubes space if left sided effusion Tachypnoea Groccos triangle: Triangular area of dullness against the vertebral column at the base of the opposite lung due to collapse of the lung.Ausculation: Absent breath sound or diminished, below the level of effusion. Bronchial breathing at the level of pleural effusion due to relaxed lung. Vocal resonance at the base Crackles above effusion Aegophony at the level of the pleural effusion Diminished or absent vocal fremitus below the level of the fluid. Around 200ml of fluid is required to be detectable on a PA chest X-ray. Ultrasound is more accurate than plain chest X-ray Pleural effusion is an exudates if one or more of the following criteria are met.1. Pleural fluid protein serum protein ratio 0.052. Pleural fluid LDH serum LDH ratio 0.63. Pleural fluid LDH two third of the upper limit or normal serum LDHCauses of Transudative Pleural Effusions1. Congestive heart failure2. Cirrhosis3. Pulmonary embolization4. Nephrotic syndrome Peritoneal dialysis SVC obstruction Myxedema UrinothoraxAMYLASE ELEVATEDGLUCOSE 60mgdl Causes: Esophageal rupture Pancreatic pleural effusion Malignancy Malignancy Bacterial infection Rheumatoid pleuritisCholesterol effusions: Tuberculosis Carcinoma Nephrotic syndrome Myxedema Post myocardial infection 