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Secondary spontaneous pneumothorax — SCE Respiratory MCQ

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HardPleural diseaseSecondary spontaneous pneumothoraxSCE Respiratory

A 69-year-old man with severe COPD develops acute pleuritic pain and breathlessness. Chest radiograph shows a 3 cm left pneumothorax; SpO2 is 89% on controlled oxygen and respiratory rate is 30/min. He is haemodynamically stable but cannot walk to the toilet because of dyspnoea. There is no evidence of tension physiology. What is the most appropriate management?

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Correct answer: A — Small-bore chest drain insertion with admission

The best answer is “Small-bore chest drain insertion with admission”. Small-bore chest drain insertion with admission is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Discharge with outpatient radiograph in one week”, “Simple reassurance because it is primary pneumothorax”, “Immediate talc pleurodesis in the absence of drainage”, “High-flow oxygen targeting 100% saturation”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1