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Primary spontaneous pneumothorax — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsPrimary spontaneous pneumothoraxSCE Acute Medicine

A 25-year-old man is assessed on the acute medical unit. He presents with pleuritic pain and breathlessness. Chest radiograph shows a large right pneumothorax and he remains breathless after aspiration. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Insert a large-bore chest drain using image guidance

Insert a large-bore chest drain using image guidance is the best answer because persistent symptoms after aspiration with a large pneumothorax require intercostal drainage. Give intramuscular adrenaline 500 micrograms is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Aspiration is often first-line in stable primary pneumothorax, but failure changes management.

Reference: BTS Pleural Disease Guideline