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Bronchiectasis exacerbation — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsBronchiectasis exacerbationSCE Acute Medicine

A 76-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 increased sputum volume with previous Pseudomonas colonisation. What is the most appropriate next step in management?

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Correct answer: B — Treat using previous sputum microbiology and send a new sputum culture

The key discriminator is that increased sputum volume with previous Pseudomonas colonisation, which makes Treat using previous sputum microbiology and send a new sputum culture the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Start anticoagulation after assessing bleeding risk 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: BTS Bronchiectasis Guideline