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Severe community-acquired sepsis unclear source — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesSevere community-acquired sepsis unclear sourceSCE Acute Medicine

A 66-year-old woman is assessed on the acute medical unit. She has fever, rigors, hypotension and no clear source on examination. Lactate is 3.4 mmol/L and NEWS2 is high. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: A — Blood cultures before antibiotics

Blood cultures before antibiotics is the best answer because blood cultures should be obtained promptly before antibiotics if this does not delay treatment. Urgent transthoracic echocardiography 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: Cultures support later narrowing of therapy and antimicrobial stewardship.

Reference: NICE NG253