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Community-acquired pneumonia — MCCQE Part 1 MCQ

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ModerateDyspneaCommunity-acquired pneumoniaMCCQE Part 1

71-year-old woman in a long-term care home presents with fever, cough and dyspnoea. Temperature is 38.7°C, RR 28/min, oxygen saturation 89% and CXR shows right lower-lobe consolidation. Which of the following is the most appropriate next step?

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Correct answer: C — Admit, give oxygen and start empiric antibiotics guided by severity and local resistance

Admit, give oxygen and start empiric antibiotics guided by severity and local resistance is best because hypoxaemia, tachypnoea and radiographic consolidation indicate moderate-to-severe pneumonia. Prescribe an antibiotic without assessing severity or likely cause is suboptimal because antibiotics are not the default for all respiratory presentations; Discharge without oxygen assessment or safety-netting is suboptimal because oxygenation and work of breathing guide urgency; Request elective pulmonary function testing as the immediate step is suboptimal because spirometry is rarely the first step in an unstable acute presentation; Treat as anxiety without excluding cardiorespiratory disease is suboptimal because anxiety is a diagnosis of exclusion when objective respiratory features are present. Disposition is driven by severity, comorbidity, oxygenation and social support.

Reference: AMMI Canada CAP guidance