Typical exam stem
A 70-year-old patient presents with fever, productive cough, pleuritic pain and confusion. How would you assess severity and manage the patient?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What are the components of CURB65?
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Clinical diagnosis and severity
Community-acquired pneumonia is suggested by an acute lower respiratory illness with compatible focal or systemic features and is usually confirmed radiologically in hospital. The exam answer should combine clinical judgement with a validated severity tool rather than quoting a score without context.
In adults, CRB65 can support community assessment and CURB65 is commonly used in hospital. Severe physiological disturbance, sepsis, hypoxaemia or important comorbidity can justify higher-level care even when a numerical score appears modest.
Investigations
- Chest radiograph in hospital to confirm infiltrate and look for complications or alternatives.
- Oxygen saturation and blood gas analysis when severe hypoxaemia or ventilatory failure is suspected.
- Full blood count, renal function, electrolytes and inflammatory markers as clinically useful.
- Microbiological testing is targeted to disease severity, epidemiological clues, recent antibiotics and risk of resistant organisms rather than ordered indiscriminately.
Management and complications
Provide oxygen when indicated, fluids according to haemodynamic state and prompt antibiotics selected according to severity, allergy history, local resistance patterns and antimicrobial policy. If sepsis is suspected, manage it as a time-critical syndrome.
Reassess for pleural effusion or empyema, respiratory failure, abscess, sepsis and decompensation of comorbid disease when recovery is slower than expected.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.