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Foreign body aspiration in older adult — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsForeign body aspiration in older adultSCE Acute Medicine

A 81-year-old woman is assessed on the acute medical unit. She develops sudden cough and unilateral wheeze while eating. Chest radiograph is equivocal but oxygen requirement and focal signs persist. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: E — Bronchoscopy arranged urgently with respiratory support

Bronchoscopy arranged urgently with respiratory support is the best answer because persistent focal wheeze and hypoxia after choking require bronchoscopy even if the chest radiograph is non-diagnostic. Serum osmolality with urine osmolality and sodium 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: A normal radiograph does not exclude an airway foreign body.

Reference: BTS bronchoscopy guidance