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Pulmonary embolism — PARA MCQ

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HardGeneral Medicine - RespiratoryPulmonary embolismPARA

A patient admitted with an acute COPD exacerbation has received 1 hour of controlled oxygen, nebulised bronchodilators and systemic corticosteroid treatment. Repeat arterial blood gas shows pH 7.28 and PaCO₂ 8.2 kPa. The patient is conscious, can protect the airway and can clear secretions. Which ventilatory intervention is indicated?

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

Reveal the answer and explanation

Correct answer: C — Start non-invasive ventilation in a trained, dedicated setting

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

E is correct. Persistent hypercapnic ventilatory failure with acidosis after optimal initial treatment is the NICE indication for non-invasive ventilation. It should be delivered where trained staff can monitor response and where deterioration and ceilings of therapy have been planned. A and B do not correct ventilatory failure. C may become necessary if non-invasive ventilation is contraindicated or fails, but immediate intubation is not required by the information given. D prolongs clinically important acidosis without support.

Reference: NICE NG115: COPD diagnosis and management recommendations: https://www.nice.org.uk/guidance/ng115/chapter/Recommendations GMC: PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map