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COPD exacerbation — MCCQE Part 1 MCQ

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ModerateDyspneaCOPD exacerbationMCCQE Part 1

69-year-old former smoker with copd presents with increased dyspnoea and purulent sputum. He is using accessory muscles; saturation is 86% on room air and venous CO2 is elevated. Which of the following is the most appropriate next step?

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Correct answer: A — Give controlled oxygen targeting 88-92%, bronchodilators and systemic corticosteroids

Give controlled oxygen targeting 88-92%, bronchodilators and systemic corticosteroids is best because COPD exacerbation with risk of hypercapnia requires controlled oxygen and bronchodilator-based treatment. Prescribe an antibiotic without assessing severity or likely cause is suboptimal because antibiotics are not the default for all respiratory presentations; Discharge without oxygen assessment or safety-netting is suboptimal because oxygenation and work of breathing guide urgency; Request elective pulmonary function testing as the immediate step is suboptimal because spirometry is rarely the first step in an unstable acute presentation; Treat as anxiety without excluding cardiorespiratory disease is suboptimal because anxiety is a diagnosis of exclusion when objective respiratory features are present. Over-oxygenation can worsen hypercapnia in susceptible COPD patients.

Reference: CTS COPD guidance