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Primary spontaneous pneumothorax — SCE Acute Medicine MCQ

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HardRespiratory medicinePrimary spontaneous pneumothoraxSCE Acute Medicine

A 28-year-old man with Marfan syndrome presents with sudden dyspnoea and right-sided pleuritic pain. He is tall and thin, RR 24/min, SpO2 95% on air and BP 126/78 mmHg. Chest radiograph shows a moderate right primary spontaneous pneumothorax without mediastinal shift. He has mild breathlessness but is comfortable speaking. What is the most appropriate next step in management?

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Correct answer: C — Discuss ambulatory or conservative management with respiratory follow-up if clinically stable

The 2023 BTS approach supports symptom-based management rather than size alone in stable primary spontaneous pneumothorax. Conservative or ambulatory management can be appropriate in minimally symptomatic patients with reliable follow-up. Immediate large-bore chest drain is reserved for physiological compromise, tension pneumothorax or selected secondary pneumothoraces.

Reference: BTS Pleural Disease Guideline 2023