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Bronchiectasis exacerbation with sepsis — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsBronchiectasis exacerbation with sepsisSCE Acute Medicine

A 70-year-old woman is assessed on the acute medical unit. She has known bronchiectasis, purulent sputum and rigors. Blood pressure is 86/50 mmHg, respiratory rate 30/min and lactate is 3.8 mmol/L. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: B — Give broad-spectrum intravenous antibiotics within one hour

Give broad-spectrum intravenous antibiotics within one hour is the best answer because bronchiectasis exacerbation with shock physiology should be managed as sepsis with prompt intravenous antibiotics and cultures. Start intravenous hydrocortisone after blood cultures is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Previous sputum microbiology should guide antimicrobial selection where available.

Reference: BTS bronchiectasis guideline; NICE NG253