• Middle-aged woman who had a right subclavian catheter placed (which is common NBME risk factor for pneumothorax) and then developed right-sided chest pain and dyspnea with normal O2 saturation and a small (10%) apical pneumothorax who should be managed with observation
• Key idea: If patient had a tension pneumothorax (medical emergency requiring immediate needle decompression or chest tube placement), they would have hemodynamic instability and tracheal deviation away from the affected side
• Key idea: Patients with a small, largely asymptomatic pneumothorax can be conservatively managed with observation and repeat chest x-ray hours later
• https://www.mrinz.ac.nz/2020/01/30/psp-nejm/

https://step-prep.org/tutoring/

Initial management for a small (< 2 cm), spontaneous pneumothorax: observation and supplemental O2

Initial management for a large pneumothorax in a hemodynamically stable patient: Needle decompression

The PTX is sufficiently small to be managed with observation. The criteria vary. FA says ≤ 2 cm, which doesn't help for this question.

The following article has advice regarding an asymptomatic apical PTX but the advice don't apply to this patient who is symptomatic.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203987/