This question has a 45% incorrect rate, and that generally indicates a rewrite is needed.
In the actual exams across most specialties, that’s how they handle extremely high miss rates. But we’ll go through the question as-is, because this type of unclear learning objective does occur even on live exam questions.
Your exam trick here is to cue in on even slight mentions of prior history. Ninety percent of the time they are there to refine the testing objective. Ten percent of the time they are there to mislead you.
PEM is already one of the hardest exams out there.
The key to the question here is in the first paragraph. “…this feels similar to the last time he had a collapsed lung”. His height and weight are not given. Spontaneous primary pneumothorax occurs most frequently in tall, thin young males, and can recur in some patients.
The most common incorrect answer however is #2, meaning the test-takers got the recurrent spontaneous pneumothorax correct, but put in a larger chest tube that would normally be reserved for larger or tension pneumothoraces - unnecessarily aggressive in this setting.
The correct answer is #1, 14 Fr Chest catheter placement. A small-bore chest catheter is preferred for managing a small recurrent spontaneous pneumothorax.
And for those test-takers that answered observation and discharge (which were several), it’s probably an indication that they missed the little bit in the first paragraph about the “last time”.
Perhaps a clearer example might be:
That hits the recurrence twice in the question, and leaves the knowledge test here as the catheter size to use for treatment, with the distractor answers being obviously incorrect.
This question appears in Med-Challenger Pediatric Emergency Medicine 3rd Edition Exam Review with CME
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