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Primary spontaneous pneumothorax — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsPrimary spontaneous pneumothoraxSCE Acute Medicine

A 58-year-old woman 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 stable symptomatic patient with a 3 cm primary pneumothorax. 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 — Perform needle aspiration with follow-up imaging

The key discriminator is that stable symptomatic patient with a 3 cm primary pneumothorax, which makes Perform needle aspiration with follow-up imaging the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Call critical care for escalation would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy 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