A 60-year-old female with a smoking history presents with shortness of breath and a new pleural effusion. What is the next management step?

The next management step in this scenario involves performing a diagnostic thoracentesis. This procedure is the most appropriate step because the patient has a new pleural effusion, and it is essential to determine the nature of the effusion, especially given her smoking history and presenting symptoms of shortness of breath.

Diagnostic thoracentesis allows for the analysis of the pleural fluid, which can provide critical information about the cause of the effusion—whether it is transudative or exudative. This distinction can help diagnose potential underlying conditions such as infections, malignancies, or heart failure. Given the patient's history and presentation, assessing the fluid can guide further management effectively.

Other options are less appropriate in this situation. Simply repeating a chest x-ray in two months would not provide immediate information on the cause of the pleural effusion or the patient's current clinical condition. Ordering an MRI of the chest is typically reserved for situations requiring more detailed imaging, such as further investigating a suspected malignancy or other pathologies, rather than for an immediate evaluation of pleural effusion. Treating with antibiotics would be indicated only if there were signs of infection, but without further evaluation of the pleural fluid, this approach may be premature and could delay addressing the