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Community Acquired Pneumonia — UKMLA MCQ

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HardInfectious DiseasesCommunity Acquired PneumoniaUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A 65-year-old with community-acquired pneumonia has CRB65 score 2, new functional decline and limited support at home. He is haemodynamically stable. What is the most appropriate next action under current NICE guidance?

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Correct answer: B — Arrange hospital assessment because intermediate mortality risk and social factors favour referral

B is correct. CRB65 scores of 1 or 2 indicate intermediate mortality risk. NICE requires clinical judgement alongside the score when deciding place of care, including comorbidity, functional status, support and the safety of home management. A score of 2 with new decline and limited support therefore favours hospital assessment even without shock. Primary care does not need urea to calculate CURB65 before acting. Antibiotic choice cannot make an unsafe home plan appropriate, and pneumonia should receive prompt antibiotics while referral and local pathways are followed.

Reference: NICE NG250, recommendations 1.2.1 to 1.2.4 and 1.6.1: https://www.nice.org.uk/guidance/ng250/chapter/recommendations