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Palliative management of refractory breathlessness — SCE Acute Medicine MCQ

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ModeratePerioperative Medicine, End-of-Life Care and Patient SafetyPalliative management of refractory breathlessnessSCE Acute Medicine

A 76-year-old woman is assessed on the acute medical unit. She has end-stage COPD, distressing breathlessness despite optimal inhaled therapy and no reversible acute cause. She wants comfort-focused treatment. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Use low-dose opioid with non-pharmacological measures

Use low-dose opioid with non-pharmacological measures is the best answer because low-dose opioid can reduce refractory breathlessness when reversible causes and goals of care are addressed. Commence fixed-rate intravenous insulin infusion is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Palliative treatment can sit alongside active management when aligned with goals.

Reference: NICE palliative care guidance