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Community-acquired pneumonia — MCCQE Part 1 MCQ

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ModerateCoughCommunity-acquired pneumoniaMCCQE Part 1

A 45-year-old man presents with fever, cough, and right-sided pleuritic pain. His BP is 118/74 mmHg, pulse 106/min, respiratory rate 24/min, oxygen saturation 94%, and temperature 38.8°C. Chest radiograph shows right lower-lobe consolidation; he is alert and able to drink. What is the most appropriate next step in management?

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Correct answer: A — Treat as outpatient with oral antibiotics and safety-netting

He has community-acquired pneumonia without shock, confusion, severe hypoxaemia, or inability to manage orally, so outpatient oral antibiotics with follow-up is reasonable. Waiting for cultures before antibiotics is unsafe when bacterial pneumonia is clinically likely. Bronchoscopy is not needed for uncomplicated lobar pneumonia. Empiric TB therapy is inappropriate without a compatible subacute syndrome or epidemiologic evidence.

Reference: Canadian Thoracic Society community-acquired pneumonia guidance