Question 1

What is the CURB-65 score and how does it guide pneumonia management in primary care?

Accepted Answer

CURB-65 assesses severity of community-acquired pneumonia (CAP). Score 1 point for each: Confusion (new onset); Urea >7 mmol/L; Respiratory Rate ≥30/min; Blood Pressure (systolic <90 or diastolic ≤60 mmHg); Age ≥65. Interpretation: 0–1 = low severity — outpatient with Amoxicillin 500 mg TDS × 5 days (add Clarithromycin 500 mg BD if atypical organism suspected); 2 = intermediate — consider hospital admission, dual antibiotic cover; ≥3 = severe — hospital admission required; 4–5 = consider ICU. Always combine with clinical judgement — a patient scoring 0–1 who looks unwell should still be admitted.

Question 2

What is the Sepsis Six and when should it be initiated in primary care?

Accepted Answer

The Sepsis Six bundle should be completed within 1 hour of suspected sepsis recognition: (1) High-flow oxygen (target SpO2 ≥94%); (2) Blood cultures before antibiotics (do not delay antibiotics >1 hour for cultures); (3) IV broad-spectrum antibiotics — Ceftriaxone 2g IV (adult); (4) IV fluid resuscitation — 500 mL crystalloid bolus if hypotension or lactate >2 mmol/L; (5) Serum lactate measurement (if >4 mmol/L = septic shock); (6) Urine output monitoring (catheterise if required). In primary care, activate 999 for transfer immediately for any patient meeting SIRS/sepsis criteria. Do not delay transfer to complete all six steps — start the bundle while awaiting ambulance.

Question 3

What malaria prophylaxis is recommended for travel to sub-Saharan Africa?

Accepted Answer

For travel to high-risk sub-Saharan Africa (chloroquine-resistant P. falciparum areas): Recommended prophylaxis options — Atovaquone/Proguanil (Malarone): 1 tablet daily starting 1–2 days before travel, during, and 7 days after; excellent tolerability, no photosensitivity, suitable for short trips; Doxycycline: 100 mg daily starting 1–2 days before travel, during, and 28 days after; cheap, also provides ABRS/rickettsial cover, avoid in pregnancy and children <8 years; Mefloquine (Lariam): weekly, start 2–3 weeks before — not first choice due to neuropsychiatric side effects; screen carefully. All travellers should also use DEET-based repellent, insecticide-treated bed nets, long-sleeved clothing, and seek immediate medical attention if febrile within 1 year of return from malaria-endemic area.

Infectious Diseases

Pneumonia

Emergency — Call 999 / Immediate Transfer

CURB-65 Severity Score

Diagnosis — Clinical Criteria

CAP Antibiotic Treatment

Follow-Up & Safety-Netting