Intensive Care Medicine (ICM) Practice Exam

What is the least likely true statement about a patient with aspiration pneumonia following heavy drinking?

1. His lungs contain anaerobic bacteria

2. He is suffering from chemical pneumonitis

3. The best treatment is thoracentesis

4. He is at risk of developing empyema

The correct answer is: The best treatment is thoracentesis

In patients with aspiration pneumonia, particularly following heavy drinking, the presence of anaerobic bacteria in the lungs is common. This is because aspiration typically involves the inhalation of oropharyngeal contents, which can be rich in these types of bacteria, especially in individuals who abuse alcohol since they may have poor oral hygiene and altered consciousness. Chemical pneumonitis can occur due to the inhalation of caustic substances, such as gastric contents. In the case of someone who has aspirated after heavy drinking, there is a likelihood of experiencing this condition due to the acidic nature of gastric secretions, which can cause lung inflammation even before any bacterial infection sets in. Empyema is a potential complication of pneumonia, including aspiration pneumonia, where infected fluid accumulates in the pleural space. If the infection progresses, it can lead to the development of pus in the pleural cavity, which represents a significant risk for these patients, especially in the setting of aspiration. In contrast, thoracentesis is not the best treatment for aspiration pneumonia. While this procedure is indicated for pleural effusions to relieve distress or for diagnostic purposes, it does not address the underlying infection caused by aspiration. Instead, aspiration pneumonia is typically treated with antibiotics targeting the specific