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Acute pulmonary oedema — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsAcute pulmonary oedemaSCE Acute Medicine

A 29-year-old man presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show severe hypertension, raised JVP and bilateral alveolar oedema. What is the most appropriate next step in management?

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Correct answer: E — Give oxygen, nitrates and intravenous loop diuretic therapy

The key discriminator is that severe hypertension, raised JVP and bilateral alveolar oedema, which makes Give oxygen, nitrates and intravenous loop diuretic therapy the single best answer. Start anticoagulation after assessing bleeding risk is less appropriate because it does not address the dominant acute risk in the vignette; Call critical care for escalation would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE acute heart failure guidance; BNF