Emergency medicine: acute pulmonary oedema: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Emergency medicine: acute pulmonary oedema

Sample item

A 70-year-old man with acute pulmonary oedema has a blood pressure of 150/90 mmHg, bilateral crackles and an oxygen saturation of 85 percent. Which initial combination is appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Sitting up, oxygen or non-invasive ventilation, intravenous furosemide and a nitrate

Cardiogenic pulmonary oedema is treated by sitting upright, oxygen or CPAP, intravenous loop diuretic and vasodilators such as nitroglycerine when blood pressure allows. Venodilation reduces preload and CPAP improves oxygenation and reduces work of breathing. The cause, such as ischaemia or arrhythmia, is then treated.

Option by option

  • A. Lying flat with a rapid fluid bolus

    A fluid bolus would worsen pulmonary congestion.

  • B. Sitting up, oxygen or non-invasive ventilation, intravenous furosemide and a nitrate (correct)

    Correct. Oxygen or NIV with diuretic and nitrate relieves congestion rapidly.

  • C. Oral digoxin alone

    Oral digoxin is too slow.

  • D. Intravenous beta-blocker bolus

    Beta-blockers can precipitate shock in acute decompensation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Sitting up, oxygen or non-invasive ventilation, intravenous furosemide and a nitrate. Cardiogenic pulmonary oedema is treated by sitting upright, oxygen or CPAP, intravenous loop diuretic and vasodilators such as nitroglycerine when blood pressure allows.

Why is "Lying flat with a rapid fluid bolus" not the answer?

A fluid bolus would worsen pulmonary congestion.

Why is "Oral digoxin alone" not the answer?

Oral digoxin is too slow.

Why is "Intravenous beta-blocker bolus" not the answer?

Beta-blockers can precipitate shock in acute decompensation.

What concept does this question test?

It tests Emergency medicine: acute pulmonary oedema in General Medicine. Venodilation reduces preload and CPAP improves oxygenation and reduces work of breathing. The cause, such as ischaemia or arrhythmia, is then treated.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Emergency medicine: acute pulmonary oedema?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.