skip to main content

COPD exacerbation without acidosis — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateAcute Respiratory PresentationsCOPD exacerbation without acidosisSCE Acute Medicine

A 69-year-old woman 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 ABG shows chronic hypercapnia but pH remains 7.38. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: C — Treat with controlled oxygen, bronchodilators, corticosteroid and antibiotics

The key discriminator is that ABG shows chronic hypercapnia but pH remains 7.38, which makes Treat with controlled oxygen, bronchodilators, corticosteroid and antibiotics the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Arrange urgent specialist referral 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 NG115; BTS Oxygen Guideline