COPD USMLE Step 1 Practice Question
A 25-year-old man with COPD on home BiPAP presents with acute onset dyspnea and hypotension (BP 88/52). Vital signs show HR 128/min, RR 28/min, SpO2 78% on supplemental oxygen, and temperature 37.2°C. Physical examination reveals absent breath sounds on the right, distended neck veins, and leftward tracheal deviation. Chest X-ray shows right-sided pneumothorax. He denies chest pain. Which of the following is the best next step in management?
Answer choices
- AImmediate needle decompressionCorrect answer
- BHigh resolution chest CT before intervention
- CUrgent bronchoscopy
- DThoracentesis for pleural fluid analysis
- EIntravenous loop diuretics
- FChest tube placement after confirmation with chest X-ray
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