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Pneumothorax — MCCQE Part 1 MCQ

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ModerateDyspneaPneumothoraxMCCQE Part 1

24-year-old tall thin man presents with sudden pleuritic chest pain and shortness of breath. Chest examination shows reduced breath sounds on the right and trachea is central. Which of the following is the most appropriate next step?

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Correct answer: A — Obtain chest imaging and manage according to size and symptoms, escalating urgently if tension develops

Obtain chest imaging and manage according to size and symptoms, escalating urgently if tension develops is best because primary spontaneous pneumothorax is likely and management depends on clinical stability and size. Prescribe an antibiotic without assessing severity or likely cause is suboptimal because antibiotics are not the default for all respiratory presentations; Discharge without oxygen assessment or safety-netting is suboptimal because oxygenation and work of breathing guide urgency; Request elective pulmonary function testing as the immediate step is suboptimal because spirometry is rarely the first step in an unstable acute presentation; Treat as anxiety without excluding cardiorespiratory disease is suboptimal because anxiety is a diagnosis of exclusion when objective respiratory features are present. Tension physiology is clinical and should not wait for imaging.

Reference: Canadian Thoracic Society pleural disease guidance