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Hospital-acquired pneumonia — SCE Respiratory MCQ

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HardRespiratory InfectionsHospital-acquired pneumoniaSCE Respiratory

After pulmonary rehabilitation, a non-smoker with CT-confirmed emphysema remains MRC grade 4 despite optimal inhaled treatment. FEV1 is 46% predicted and six-minute walk distance is 168 m. Which next step follows the NICE lung-volume-reduction pathway?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Refer for specialist lung-volume-reduction review with gas transfer and hyperinflation assessment

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

B is correct. NICE prompts specialist lung-volume-reduction review after rehabilitation when emphysema is confirmed, FEV1 is below 50%, the patient does not smoke, breathlessness remains quality-of-life limiting and six-minute walk distance is at least 140 m. The review then considers hyperinflation, TLCO, emphysema distribution, fissure completeness, collateral ventilation and procedural risk. An FEV1 below 30% is not the referral threshold, walking at least 140 m supports rather than excludes consideration, and valves should not be offered before anatomical and physiological MDT selection.

Reference: https://www.nice.org.uk/guidance/ng115/chapter/Recommendations