skip to main content

Acute hypercapnic respiratory failure — SCE Acute Medicine MCQ

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

ModerateAcute Respiratory PresentationsAcute hypercapnic respiratory failureSCE Acute Medicine

A 34-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 ABG shows pH 7.25 with PaCO2 9.1 kPa after initial COPD treatment. 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: D — Start controlled oxygen and bilevel non-invasive ventilation

The key discriminator is that ABG shows pH 7.25 with PaCO2 9.1 kPa after initial COPD treatment, which makes Start controlled oxygen and bilevel non-invasive ventilation the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent CT imaging would fit a different presentation or later stage of care. Give targeted antidote or reversal therapy and Start broad-spectrum intravenous antibiotics 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: BTS/ICS NIV Guideline; NICE NG115