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Aphasia – Intensive SLT — SCE Neurology MCQ

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HardNeurorehabilitationAphasia – Intensive SLTSCE Neurology

A patient with limb-onset MND reports morning headache and orthopnoea. Room-air arterial blood gas shows PaCO2 6.3 kPa. FVC is 78% predicted. What is the required respiratory referral urgency?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Urgent referral to a respiratory ventilation service, to be seen within 1 week

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

C is correct. NICE uses PaCO2 above 6 kPa as an independent trigger for urgent respiratory-ventilation referral within one week. The FVC does not neutralise hypercapnia, and at 78% plus orthopnoea it is itself abnormal within the NICE symptom-linked threshold. A and E delay assessment. B skips patient-centred non-invasive ventilation evaluation. D is the pathway when PaCO2 is at most 6 kPa but symptoms still warrant nocturnal testing and referral.

Reference: NICE NG42 — motor neurone disease recommendations: https://www.nice.org.uk/guidance/ng42/chapter/Recommendations