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Anticoagulation and Dental Procedures — UKMLA MCQ

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MediumAnticoagulationAnticoagulation and Dental ProceduresUKMLAMRCGP AKTPARAPSA

Two adults with suspected community-acquired pneumonia each have a CRB65 score of 0 and a room-air oxygen saturation of 92%. Patient 1 has stable COPD, a documented usual saturation of 92% and no other feature suggesting illness more severe than the score indicates. Patient 2 usually has a saturation of 98%; the new value of 92% is reproducible, and clinical assessment indicates greater severity than the score suggests. Assume no other place-of-care factors. Which paired interpretation follows NICE guidance?

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

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Correct answer: C — Patient 1: community management remains supported; patient 2: consider hospital referral

C is correct. CRB65 supports rather than determines place of care. Patient 1's saturation equals the documented stable baseline and no separate severity override is present, so the supplied facts do not displace the low-score assessment. Patient 2 has new hypoxaemia and has been clinically judged more severely ill than CRB65 suggests, so hospital referral should be considered. A wrongly treats CRB65 as excluding the clinical-judgement override. B applies the override to the patient without evidence of increased severity and withholds it from the patient who has it. D treats 92% as a context-free automatic threshold, which the supplied evidence does not establish. E changes a recommendation to consider referral into mandatory admission for both patients.

Reference: NICE NG250, pneumonia: diagnosis and management, assessment in primary care and referral recommendations. Source: https://www.nice.org.uk/guidance/ng250/chapter/Recommendations