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Pulmonary oedema from acute heart failure — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsPulmonary oedema from acute heart failureSCE Acute Medicine

A 76-year-old woman is assessed on the acute medical unit. She has severe breathlessness, bibasal crackles, elevated JVP and hypertension. Chest radiograph shows interstitial oedema and NT-proBNP is markedly raised. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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

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Correct answer: B — Give intravenous furosemide and sit the patient upright

Give intravenous furosemide and sit the patient upright is the best answer because the clinical and radiographic findings indicate acute cardiogenic pulmonary oedema requiring diuresis and supportive oxygen therapy. Perform synchronised direct-current cardioversion 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: NIV is reserved for severe dyspnoea with acidaemia or poor response to initial therapy.

Reference: NICE CG187