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Secondary spontaneous pneumothorax — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsSecondary spontaneous pneumothoraxSCE Acute Medicine

A 67-year-old man presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show pneumothorax occurs in severe emphysema with significant hypoxaemia. 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: B — Insert a small-bore chest drain

The key discriminator is that pneumothorax occurs in severe emphysema with significant hypoxaemia, which makes Insert a small-bore chest drain the single best answer. Call critical care for escalation 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. Give targeted antidote or reversal therapy and Arrange urgent CT imaging 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