American Board of Internal Medicine (ABIM) Certification Practice Exam

How should a patient with a pneumothorax smaller than 2 cm on a chest radiograph and minimal symptoms be treated?

1. Observation alone

2. Immediate thoracostomy tube insertion

3. Needle aspiration

4. High-flow oxygen therapy

The correct answer is: Observation alone

The appropriate management for a patient with a pneumothorax smaller than 2 cm on a chest radiograph and minimal symptoms is observation alone. In cases like this, where the pneumothorax is small and the patient is stable without significant symptoms, active interventions are generally not required. Observation allows for monitoring of the pneumothorax, as many such cases will resolve spontaneously without intervention. This approach minimizes unnecessary procedures and associated risks while ensuring that the patient is observed for any changes in their condition or the size of the pneumothorax. In contrast, immediate thoracostomy tube insertion would be indicated in larger pneumothoraces or cases where the patient is symptomatic, particularly if there are signs of respiratory distress. Needle aspiration is often reserved for larger pneumothoraces or symptomatic patients needing rapid decompression. Similarly, high-flow oxygen therapy is not a first-line treatment for small asymptomatic pneumothoraces, though it can enhance reabsorption of the pneumothorax in some cases, it is not necessary or standard for routine management in this scenario. In summary, the best course of action for a small, asymptomatic pneumothorax is to observe the patient, ensuring a safe and effective management strategy.