skip to main content

Severe hyperkalaemia — PARA MCQ

Instant feedback + full explanation. One question, done properly.

HardEmergency presentations - ElectrolytesSevere hyperkalaemiaPARA

An adult with sickle cell disease presents to hospital with a typical severe vaso-occlusive pain episode. Oxygen saturation is 96% on air, observations are otherwise stable and no acute-chest feature is present. Their individual care plan confirms previous benefit from morphine. What should happen first?

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

Reveal the answer and explanation

Correct answer: D — Give a strong opioid within 30 minutes and monitor adverse effects

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

B is correct. NICE requires analgesia within 30 minutes for every acute painful sickle episode. Severe pain warrants a strong opioid by a route appropriate to severity and the individual care plan, with sedation and adverse-effect monitoring. A creates a harmful delay in a typical episode. C is wrong because oxygen is offered when saturation is 95% or below, not routinely at 96%. D is specifically not recommended for an uncomplicated painful episode. E undertreats severe pain and delays reassessment. New chest symptoms, fever or falling saturation would require urgent evaluation for acute chest syndrome.

Reference: NICE CG143: sickle cell acute painful episode recommendations: https://www.nice.org.uk/guidance/cg143/chapter/recommendations GMC: physician associate registration assessment content map: https://www.gmc-uk.org/cdn/documents/guide---assess-dev---para-content-map--pa----dc21953_pdf-104351674.pdf