OSCE — Community-Acquired Pneumonia · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Community-Acquired Pneumonia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside hospital (or within the first 48 hours of admission). The commonest pathogen is Streptococcus pneumoniae; atypicals (Mycoplasma pneumoniae, Chlamydophila pneumoniae/psittaci, Legionella pneumophila), respiratory viruses (influenza, SARS-CoV-2, RSV), Haemophilus influenzae, Moraxella catarrhalis, and in selected hosts Staphylococcus aureus, Klebsiella pneumoniae and anaerobes. Typical CAP presents abruptly with fever, productive or rust-coloured sputum, dyspnoea, pleuritic chest pain and signs of consolidation; atypical CAP is insidious with a dry cough and prominent systemic features. Diagnosis is clinical plus a chest X-ray showing new shadowing not explained by oedema or infarction. Grade severity with CURB-65 (Confusion, Urea over 7 mmol/L, respiratory rate 30 or more, systolic BP under 90 or diastolic 60 or less, age 65 or more). NICE: consider home care at 0–1, hospital at 2 or more, intensive-care assessment at 3 or more; diagnosis and treatment within 4 hours of presentation.

Candidate tasks

Clarify onset, severity, associated features, and red-flag symptoms.
State focused examination priorities.
List first-line investigations and any named score/criteria.
Give immediate resuscitation steps.
Outline definitive management with doses/routes where standard.
Name complications and disposition (ward / HDU / theatre / discharge safety-net).
Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Domain	Pass behaviours
Definition	Correct working diagnosis language
Assessment	Focused, prioritised, red flags sought
Investigations	Appropriate first-line + interpretation
Emergency care	ABC / time-critical actions first
Definitive care	Specific drugs/procedures, not generic phrases
Safety	New consolidation: start treatment; do not delay the first antibiotic for tests
Safety	CURB-65 2 or more: consider hospital; 3 or more: consider intensive-care assessment
Safety	Hypotension or septic shock: effective antimicrobials within 1 hour of hypotension
Communication	Clear plan and safety-netting

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.