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Pneumocystis jirovecii pneumonia — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsPneumocystis jirovecii pneumoniaSCE Acute Medicine

A 71-year-old woman presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show untreated HIV, exertional desaturation and bilateral ground-glass change. What is the most appropriate next step in management?

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

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Correct answer: B — Start high-dose co-trimoxazole with adjunctive corticosteroid if hypoxaemic

The key discriminator is that untreated HIV, exertional desaturation and bilateral ground-glass change, which makes Start high-dose co-trimoxazole with adjunctive corticosteroid if hypoxaemic the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Give targeted antidote or reversal therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BHIVA opportunistic infection guidance; BNF