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Central venous catheter pneumothorax — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge in Acute MedicineCentral venous catheter pneumothoraxSCE Acute Medicine

A 58-year-old man presents with a procedure-related acute decision. Relevant history includes coagulation, imaging, respiratory physiology or procedural risk. On assessment, bedside findings determine whether the procedure is safe and urgent. Investigations show dyspnoea and right pneumothorax after subclavian central line. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Assess size and symptoms and insert chest drain if clinically significant

The key discriminator is that dyspnoea and right pneumothorax after subclavian central line, which makes Assess size and symptoms and insert chest drain if clinically significant the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Give intravenous fluids with reassessment are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BTS Pleural Disease Guideline