American Board of Internal Medicine (ABIM) Certification Practice Exam

When managing a primary spontaneous pneumothorax greater than 2 cm, what is the initial recommended intervention?

1. Observation

2. Needle aspiration

3. Thoracostomy tube insertion

4. High-flow supplemental oxygen

The correct answer is: Needle aspiration

In the case of a primary spontaneous pneumothorax that is greater than 2 cm, the initial recommended intervention is needle aspiration. This approach is favored as it allows for immediate decompression of the pleural space, facilitating the re-expansion of the lung with minimal invasiveness. Needle aspiration can be performed quickly at the bedside and is effective in reducing the pneumothorax size. For patients with larger pneumothoraces, it provides symptomatic relief and may avoid more invasive procedures like chest tube placement if the lung re-expands properly after aspiration. This option is particularly beneficial in younger patients with early-stage pneumothorax, where intervention is critical to prevent complications. Observation could be appropriate for smaller pneumothoraxes (typically those less than 2 cm) without significant symptoms, as many may resolve spontaneously. High-flow supplemental oxygen can enhance the reabsorption of pneumothorax but is not a standalone intervention for larger pneumothoraces. Thoracostomy tube insertion is typically reserved for larger, symptomatic pneumothoraces or those that do not respond to needle aspiration. Therefore, needle aspiration serves as the effective first-line intervention for managing a primary spontaneous pneumothorax greater than 2 cm.