Step 2

Pulmonary 11

A 22-year-old man presents to the emergency department with sudden-onset, left-sided chest pain and shortness of breath that began one hour ago. He denies fever, recent illness, palpitations, or abdominal pain. He was diagnosed with Kawasaki disease at the age of 5 and was treated appropriately and did not have any complications. Follow-up with transthoracic echocardiogram was unremarkable. He does nt take any medications. Family history is significant for hypertension in his father years and diabetes in his mother. He does not smoke cigarettes, drink alcohol, or use any illicit drugs. Vital signs are blood pressure of 129/85 mmHg, pulse 89 beats/min, respirations 18/min, and temperature of 37.5° C (99.5° F). Pulse oximetry shows 92% on room air. On physical examination, he is noted to be a tall, thin male. Auscultation of the chest reveals decreased breath sounds in the left upper lung field as well as hyperresonance. A chest x-ray is performed and demonstrates a 2 cm pneumothorax at the level of the apex.

Which of the following is the most appropriate next step in management of this patient?

  • A) Antibiotics
  • B) Aspiration
  • C) Close observation with 100% oxygen
  • D) Intubation and mechanical ventilation
  • E) Tube thoracostomy


Min Gyu Kim


Dr. Ted O'Connell

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