skip to main content

Tension pneumothorax — USMLE Step 2 CK MCQ

Instant feedback + full explanation. One question, done properly.

EasyEmergency MedicineTension pneumothoraxUSMLE Step 2 CK

A 60-year-old Hispanic woman comes to the urgent care clinic because of progressive symptoms. History and focused examination are notable for hypotension, unilateral absent breath sounds, tracheal deviation, and distended neck veins. Temperature is 101.5°F (38.6°C), blood pressure is 82/48 mmHg, pulse is 132/min, respirations are 28/min, and oxygen saturation is 90% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Needle decompression followed by chest tube placement

The vignette describes Tension pneumothorax, supported by hypotension, unilateral absent breath sounds, tracheal deviation, and distended neck veins. Needle decompression followed by chest tube placement is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: ATLS 10th Edition Trauma Guidance