Paediatric emergencies: tension pneumothorax: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric emergencies: tension pneumothorax

Sample item

A 9-year-old after a road accident has severe respiratory distress, absent breath sounds on the right, hyperresonance, tracheal deviation to the left, distended neck veins and BP 70/40 mmHg. What should be done immediately?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Needle decompression of the right chest

Tension pneumothorax is a clinical diagnosis with obstructive shock, so decompression must not wait for imaging. Immediate needle decompression is followed by a chest drain. Positive pressure ventilation without decompression can worsen the tension.

Option by option

  • A. Rapid fluid bolus of 20 mL/kg

    A fluid bolus does not relieve the obstruction to venous return.

  • B. Needle decompression of the right chest (correct)

    Correct. Immediate needle decompression relieves the tension and restores venous return.

  • C. Chest radiograph before any intervention

    Waiting for a radiograph delays life-saving treatment in an unstable child.

  • D. Intubation with positive pressure ventilation

    Positive pressure ventilation before decompression increases intrathoracic pressure and can precipitate arrest.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is B, Needle decompression of the right chest. Tension pneumothorax is a clinical diagnosis with obstructive shock, so decompression must not wait for imaging.

Why is "Rapid fluid bolus of 20 mL/kg" not the answer?

A fluid bolus does not relieve the obstruction to venous return.

Why is "Chest radiograph before any intervention" not the answer?

Waiting for a radiograph delays life-saving treatment in an unstable child.

Why is "Intubation with positive pressure ventilation" not the answer?

Positive pressure ventilation before decompression increases intrathoracic pressure and can precipitate arrest.

What concept does this question test?

It tests Paediatric emergencies: tension pneumothorax in Pediatrics. Immediate needle decompression is followed by a chest drain. Positive pressure ventilation without decompression can worsen the tension.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric emergencies: tension pneumothorax?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.