American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first step in treating a pneumothorax larger than 2 cm with associated symptoms like breathlessness and chest pain?

1. Surgical intervention

2. Needle aspiration

3. Observation

4. High-flow oxygen therapy

The correct answer is: Needle aspiration

In the scenario of a pneumothorax larger than 2 cm accompanied by symptoms such as breathlessness and chest pain, the first step in treatment is needle aspiration. This procedure is recommended because it addresses the acute symptoms of a significant pneumothorax by quickly decompressing the pleural space, thereby relieving pressure on the lung and improving respiratory function. Needle aspiration effectively allows air to be removed from the pleural cavity, which helps reinflate the collapsed lung. It is generally performed in a controlled setting and is suitable for patients who exhibit significant clinical symptoms, as in this case. It serves as a minimally invasive approach that can provide immediate relief. While surgical intervention could ultimately be necessary for persistent or recurrent cases, it is more invasive and typically reserved for instances where needle aspiration is ineffective or in cases of tension pneumothorax. Observation and high-flow oxygen therapy may be appropriate for smaller or asymptomatic pneumothoraces, but they are not suitable initial interventions for larger, symptomatic cases. Therefore, needle aspiration is the most appropriate first step in the treatment pathway for this condition.