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Heart failure pleural effusions — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsHeart failure pleural effusionsSCE Acute Medicine

A 73-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 bilateral effusions, raised JVP and markedly raised NT-proBNP. What is the most appropriate next step in management?

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Correct answer: A — Treat decompensated heart failure and reserve aspiration for atypical features

The key discriminator is that bilateral effusions, raised JVP and markedly raised NT-proBNP, which makes Treat decompensated heart failure and reserve aspiration for atypical features 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 routine outpatient follow-up would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Optimise chronic medication and discharge 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 Pleural Disease Guideline