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Acute exacerbation of COPD — MCCQE Part 1 MCQ

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HardShortness of BreathAcute exacerbation of COPDMCCQE Part 1

A 70-year-old man with COPD presents with worsening dyspnea and purulent sputum. Oxygen saturation is 82% on room air, respiratory rate 30/min, and ABG on 2 L/min oxygen shows pH 7.29, PaCO2 62 mmHg, PaO2 58 mmHg. Chest x-ray shows hyperinflation without consolidation. What is the most appropriate next step in management?

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Correct answer: B — Controlled oxygen, bronchodilators, steroids, antibiotics, and non-invasive ventilation

Acute COPD exacerbation with hypercapnic acidosis warrants controlled oxygen, bronchodilators, systemic steroids, antibiotics when sputum is purulent, and non-invasive ventilation if no contraindication. High-flow oxygen can worsen hypercapnia. Immediate intubation may be needed if NIV fails, but NIV is the next step in a cooperative patient.

Reference: Canadian Thoracic Society COPD guidance; MCC Objectives—Dyspnea