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Hospital-acquired pneumonia — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsHospital-acquired pneumoniaSCE Acute Medicine

A 63-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 new consolidation and oxygen requirement occur five days into admission. What is the most appropriate next step in management?

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Correct answer: E — Start empirical hospital-acquired pneumonia antibiotics after cultures

The key discriminator is that new consolidation and oxygen requirement occur five days into admission, which makes Start empirical hospital-acquired pneumonia antibiotics after cultures 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; Start broad-spectrum intravenous antibiotics would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Provide supportive care and close monitoring 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: NICE NG139; NICE NG253