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Acute severe asthma — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsAcute severe asthmaSCE Acute Medicine

A 42-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 PEF is below 50 percent predicted with inability to complete sentences. What is the most appropriate next step in management?

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Correct answer: A — Give nebulised salbutamol, ipratropium, oxygen and systemic corticosteroid

The key discriminator is that PEF is below 50 percent predicted with inability to complete sentences, which makes Give nebulised salbutamol, ipratropium, oxygen and systemic corticosteroid the single best answer. Call critical care for escalation is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Arrange urgent specialist referral 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/SIGN Asthma Guideline; NICE asthma pathway