Typical exam stem
A 68-year-old smoker with COPD presents with worsening dyspnoea and purulent sputum. How would you assess and manage the patient?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What conditions commonly mimic COPD exacerbation?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Confirm the exacerbation and look for alternatives
An exacerbation is an acute worsening of respiratory symptoms beyond usual day-to-day variation. Examiners expect you to consider pneumonia, pulmonary embolism, pneumothorax, heart failure and arrhythmia because these can mimic or accompany COPD exacerbation.
- Assess work of breathing, mental state, oxygen saturation and haemodynamic stability.
- Chest radiograph helps identify pneumonia, pneumothorax or pulmonary oedema.
- ECG is useful when ischaemia or arrhythmia is possible.
- Obtain blood gas analysis when severe disease, drowsiness, significant hypoxaemia or hypercapnia is suspected.
Initial treatment
Use short-acting bronchodilators, systemic corticosteroid treatment and controlled oxygen when needed. In patients at risk of hypercapnic respiratory failure, oxygen should be titrated to an appropriate target rather than given indiscriminately at high concentration. Antibiotics are considered when bacterial infection is likely, guided by sputum purulence, severity and local antimicrobial policy.
Non-invasive ventilation is a key intervention when acute hypercapnic respiratory acidosis persists despite optimal initial medical therapy and there is no contraindication. Escalate early if NIV fails or the patient cannot protect the airway.
After stabilisation
- Review inhaled maintenance treatment and technique.
- Assess smoking status and provide cessation support.
- Consider pulmonary rehabilitation, vaccination and home oxygen assessment when indicated.
- Document whether the patient has recurrent exacerbations and address modifiable risks.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.