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Severe community-acquired pneumonia — SCE Acute Medicine MCQ

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HardRespiratory medicineSevere community-acquired pneumoniaSCE Acute Medicine

A 62-year-old man with community-acquired pneumonia has confusion, urea 12.4 mmol/L, respiratory rate 34/min and BP 84/50 mmHg. Lactate is 4.6 mmol/L despite an initial cautious crystalloid bolus. Chest radiograph shows multilobar consolidation. What is the most appropriate disposition and initial treatment strategy?

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Correct answer: A — Obtain critical-care input for antibiotics and organ support

The CURB65 score is 4 and the patient has shock physiology with multilobar disease. He needs prompt source-appropriate intravenous antibiotics, controlled oxygen, cautious haemodynamic resuscitation and immediate critical-care assessment for vasopressors or ventilatory support. A severity score supports but does not replace assessment of organ failure; ambulatory or routine ward pathways are unsafe.

Reference: https://www.nice.org.uk/guidance/ng250/resources/visual-summary-community-acquired-pneumonia-adults-presenting-to-hospital-pdf-15434376301