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Refractory breathlessness in end-stage COPD — SCE Acute Medicine MCQ

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ModeratePerioperative, Safety and End-of-Life CareRefractory breathlessness in end-stage COPDSCE Acute Medicine

A 45-year-old man presents with postoperative deterioration, treatment refusal or advanced illness. Relevant history includes recent surgery, frailty or a governance issue. On assessment, physiology and communication context require senior decision-making. Investigations show distressing breathlessness despite appropriate oxygen and no reversible trigger. What would you advise this patient?

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

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Correct answer: E — Give low-dose opioid for refractory breathlessness with careful titration

The key discriminator is that distressing breathlessness despite appropriate oxygen and no reversible trigger, which makes Give low-dose opioid for refractory breathlessness with careful titration the single best answer. Offer safety-netted admission with shared decision-making is less appropriate because it does not address the dominant acute risk in the vignette; Explain the need for urgent treatment despite uncertainty would fit a different presentation or later stage of care. Explain that active treatment and palliative care can run together and Discuss risks and benefits of imaging in pregnancy 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 NG31; BNF palliative care