American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition often requires thoracentesis when there is ongoing sepsis with an uncomplicated pleural effusion?

1. Stable persistent effusion

2. Pneumothorax

3. Acute respiratory distress syndrome

4. Failure of antibiotics to resolve effusion

The correct answer is: Failure of antibiotics to resolve effusion

When there is ongoing sepsis in the presence of an uncomplicated pleural effusion, it is crucial to consider the potential need for thoracentesis, especially if there is a failure of antibiotic therapy to resolve the effusion. In this scenario, the presence of sepsis suggests that the effusion may be infected or contributing to the patient's clinical deterioration. Thoracentesis serves two significant purposes: it can relieve symptoms by removing excess fluid from the pleural space and allows for analysis of the fluid to determine the underlying cause. If the antibiotics are not adequately controlling the patient's infection, obtaining pleural fluid can help identify any possible exudative processes or empyema that might require further intervention, such as drainage or additional targeted antibiotic therapy. In contrast, a stable persistent effusion typically does not require immediate intervention as long as the patient is stable and the fluid does not show signs of infection. Pneumothorax is unrelated to pleural effusions, as it involves air in the pleural space rather than fluid. Acute respiratory distress syndrome (ARDS) can occur due to numerous causes but is not directly indicated for thoracentesis unless there is a notable pleural effusion that needs evaluating.