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Recurrent primary spontaneous pneumothorax — SCE Respiratory MCQ

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HardPleural diseaseRecurrent primary spontaneous pneumothoraxSCE Respiratory

A 38-year-old woman has her third right-sided primary spontaneous pneumothorax. She previously required aspiration once and chest drain drainage once; CT shows apical blebs and no diffuse cystic lung disease. She is now stable after small-bore drain insertion, with full lung re-expansion. She asks how to reduce recurrence risk. What is the most appropriate management?

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Correct answer: A — Referral for surgical bullectomy and pleurodesis discussion

The best answer is “Referral for surgical bullectomy and pleurodesis discussion”. Referral for surgical bullectomy and pleurodesis discussion 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 in the absence of recurrence-prevention advice”, “Long-term inhaled corticosteroid therapy”, “Home oxygen for six months”, “Repeated needle aspiration as definitive prevention”—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