Respiratory Medicine — SCE Respiratory MCQ
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Hard"First‑line includes positive airway pressure (NIV/CPAP as indicated) and weight reduction. Oxygen alone may worsen hypercapnia; intubation/tracheostomy are not initial steps; acetazolamide is not definitive."Respiratory MedicineSCE Respiratory
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Correct answer: D — Trial of noninvasive ventilation and weight loss strategies
The best answer is “Trial of noninvasive ventilation and weight loss strategies”. Trial of noninvasive ventilation and weight loss strategies is supported by the decisive clinical findings and the cited specialist guidance. The alternatives remain plausible in related respiratory presentations but do not fit the stated threshold, sequence or physiology. The remaining choices—“PaCO₂ 60 mm Hg, after specialist assessment”, “HCO₃⁻ 31. Initial management includes:, with clinical reassessment”, “Immediate intubation, within a respiratory pathway, within a respiratory pathway”, “Acetazolamide principally, after specialist assessment, after safety review”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.
Reference: NICE NG202 obstructive sleep apnoea and obesity hypoventilation syndrome: https://www.nice.org.uk/guidance/ng202/chapter/Recommendations