MND Anticipatory Secretion Management Planning — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareMND Anticipatory Secretion Management PlanningSCE Palliative Medicine

A 55‑year‑old woman with advanced motor neurone disease and progressive respiratory failure discusses her end‑of‑life wishes. She expresses the fear that she does not want to “drown in her own secretions.” What anticipatory planning specifically addresses this fear?

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Correct answer: B — Prescribe anticipatory antimuscarinic medication (e.g. glycopyrronium or hyoscine) for secretion management, explain how secretions will be managed at the end of life, and document her wish for proactive secretion control in her advance care plan

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

Option E is correct. NICE guideline NG42 (Motor neurone disease: assessment and management) recommends anticipatory antimuscarinic medicines for problematic saliva and respiratory secretions at the end of life, specifically naming glycopyrronium bromide as first‑line in sialorrhoea ([nice.org.uk](https://www.nice.org.uk/guidance/NG42/chapter/Recommendations?utm_source=openai)). NICE NG31 (Care of dying adults in the last days of life) also recommends considering glycopyrronium or hyoscine for noisy respiratory secretions in dying patients, alongside individualized anticipatory prescribing within a care plan ([nice.org.uk](https://www.nice.org.uk/guidance/ng31/evidence/full-guideline-2240610301?utm_source=openai)). This approach directly addresses the patient's fear by planning proactive pharmacological and supportive measures. Distractors A and B are incorrect because secretion management is explicitly part of end‑of‑life planning. Option C is incomplete—suction alone is not recommended over antimuscarinics. Option D is dismissive and provides no clinical or emotional plan.

Reference: NICE NG42 (Motor neurone disease: assessment and management, recommendations 1.7.7 and 1.8.12–1.8.13, 2016, updated 2019) and NICE NG31 (Care of dying adults in the last days of life, recommendations 1.5.31–1.5.32, 2015), https://www.nice.org.uk/guidance/ng42/chapter/Recommendations