# PLAB 1 Pneumonia Questions: 10 Free Practice MCQs

> 10 free PLAB 1 pneumonia questions with answers and explanations, from a bank of 31 pneumonia questions. Try them now, no sign up.

Canonical: https://medhub.one/practice/plab-1/pneumonia
Last updated: 2026-10-29

Ten PLAB 1-style pneumonia questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 31 pneumonia questions and many more across every topic.

1. 1 / 10  
A 76-year-old presents to hospital with suspected community-acquired pneumonia. The patient is stable enough for diagnostic assessment, and the clinical team is arranging the initial investigations. They report cough, fever and breathlessness.  
What should the hospital have processes in place to achieve?  
Show answer

**Answer: A.** Diagnosis, including chest X-ray, within 4 hours of hospital presentation

**Why:** NICE NG250 recommendation 1.4.1 says to put processes in place to allow diagnosis, including chest X-ray, of community-acquired pneumonia in adults within 4 hours of hospital presentation. Recommendation 1.4.2 recognises lung ultrasound for selected situations, such as a sick or deteriorating person, a possible alternative diagnosis, or suspected pleural complications.

  * **B.** NICE specifies timely diagnostic processes including chest X-ray; it does not recommend routine CT for every adult with suspected pneumonia.
  * **C.** The recommendation is to enable diagnosis, including chest X-ray, within 4 hours of hospital presentation.
  * **D.** NICE includes chest X-ray in its recommendation for hospital diagnosis. Lung ultrasound may also be used in specified situations.  
Sources: NICE NG250 recommendations 1.4.1 and 1.4.2
2. 2 / 10  
A 63-year-old is being treated for community-acquired pneumonia in the community. After starting antibiotics, their symptoms have not improved as expected. Their cough, fever and breathlessness have not improved as expected.  
What is the recommended next step?  
Show answer

**Answer: D.** Refer the person to hospital

**Why:** NICE NG250 recommendation 1.11.1 says to reassess people with pneumonia if symptoms or signs do not improve as expected or worsen rapidly or significantly. Recommendation 1.11.3 recommends hospital referral for people with community-acquired pneumonia whose symptoms are not improving as expected with antibiotics.

  * **A.** NICE recommends reassessment when symptoms do not improve as expected and hospital referral when symptoms are not improving as expected with antibiotics.
  * **B.** A longer course should not be prescribed automatically; the person needs reassessment and the guideline recommends referral when symptoms are not improving as expected.
  * **C.** Microbiological testing can be considered in selected circumstances, but it should not delay reassessment and referral when symptoms are not improving as expected.  
Sources: NICE NG250 recommendations 1.11.1 and 1.11.3
3. 3 / 10  
A 58-year-old adult with a clinical diagnosis of community-acquired pneumonia is admitted to hospital. The team is assessing mortality risk to support severity stratification and decisions about care. They have had a cough and breathlessness during this illness.  
Which mortality risk score does NICE recommend using for adults with community-acquired pneumonia diagnosed in hospital?  
Show answer

**Answer: D.** CURB65, interpreted together with clinical judgement

**Why:** NICE NG250 recommendation 1.2.7 recommends CURB65 to determine mortality risk for adults with community-acquired pneumonia diagnosed in hospital. Recommendation 1.2.8 says to use the score with clinical judgement to stratify disease severity. The community primary care recommendation uses CRB65 instead.

  * **A.** The score informs risk assessment, but NICE explicitly recommends combining CURB65 with clinical judgement.
  * **B.** This is an adult inpatient with community-acquired pneumonia; NICE recommends CURB65 in this setting.
  * **C.** NICE specifies CURB65 for adults with community-acquired pneumonia diagnosed in hospital; CRB65 is the primary care score.  
Sources: NICE NG250 recommendations 1.2.7 and 1.2.8
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5. 4 / 10  
A 77-year-old has been treated in hospital for community-acquired pneumonia. During the past 24 hours their temperature reached 38.0°C and staff documented abnormal mental status. Other observations are stable. The abnormal mental status is new for this patient.  
What does NICE advise about routine discharge today?  
Show answer

**Answer: C.** Do not routinely discharge, because two listed findings occurred in the past 24 hours

**Why:** NICE NG250 recommendation 1.6.7 says not to routinely discharge adults with community-acquired pneumonia if, in the past 24 hours, they have had 2 or more listed findings. These include temperature above 37.5°C and abnormal mental status. This patient meets two criteria, so routine discharge is not recommended; clinical judgement and the broader situation still matter.

  * **A.** Temperature above 37.5°C is one of the listed findings in the NICE safe-discharge recommendation.
  * **B.** NICE gives specific clinical criteria for not routinely discharging; it does not require a fixed 14-day admission for every adult.
  * **D.** The recommendation considers findings during the past 24 hours, not just the latest observations.  
Sources: NICE NG250 recommendation 1.6.7
6. 5 / 10  
A 68-year-old with a new clinical diagnosis of community-acquired pneumonia is assessed in primary care. They have no confusion, tachypnoea or hypotension.  
Which score should be used to assess mortality risk?  
Show answer

**Answer: A.** CRB65

**Why:** NICE NG250 recommends CRB65 to assess 30-day mortality risk for adults with community-acquired pneumonia in primary care. Use clinical judgement with the score to assess severity and inform shared decisions about place of care.

  * **B.** CURB65 does not follow this pathway. Use CRB65 to assess mortality risk in adults with CAP in primary care.
  * **C.** Wells score does not follow this pathway. Use CRB65 to assess mortality risk in adults with CAP in primary care.
  * **D.** HAS-BLED does not follow this pathway. Use CRB65 to assess mortality risk in adults with CAP in primary care.  
Sources: NICE NG250 recommendations 1.2.1 to 1.2.3
7. 6 / 10  
A 72-year-old in primary care has a clinical diagnosis of community-acquired pneumonia. They are alert, have a respiratory rate of 31 breaths per minute, blood pressure of 118/72 mmHg, and no other prognostic features. They report 3 days of cough, fever and breathlessness.  
What is the CRB65 score, and what should be considered?  
Show answer

**Answer: C.** Score 2; consider referral to hospital, using clinical judgement to decide place of care

**Why:** NICE NG250 recommends CRB65 risk assessment for adults with community-acquired pneumonia in primary care. The score assigns one point each for confusion, respiratory rate 30 or more, low blood pressure, and age 65 or over. A score of 2 or more prompts consideration of hospital referral with clinical judgement.

  * **A.** The patient is alert and the blood pressure is not low by CRB65 criteria. Those features do not contribute points in this vignette.
  * **B.** A respiratory rate of 30 or more gives 1 point, but age 72 also gives 1 point, so the score is 2 rather than 1.
  * **D.** NICE recommends considering referral for a score of 2 or more and explicitly pairs the score with clinical judgement; it does not make admission automatic.  
Sources: NICE NG250 recommendations 1.2.1 to 1.2.3
8. 7 / 10  
A 70-year-old with community-acquired pneumonia has completed 5 days of antibiotic treatment. They have been afebrile for 72 hours, have a respiratory rate of 18, a pulse of 82, systolic blood pressure of 112 mmHg and oxygen saturation of 96% on room air, and microbiology has not identified a reason for a longer course. Their initial symptoms included cough, fever and breathlessness.  
What does NICE recommend about antibiotic duration?  
Show answer

**Answer: D.** Stop after 5 days unless microbiology or ongoing clinical instability supports continuing

**Why:** NICE NG250 recommendation 1.6.3 says to stop antibiotics after 5 days for adults with community-acquired pneumonia unless microbiological results suggest a longer course or the person is not clinically stable. The guideline gives recent fever and specified instability findings as examples. Persistent cough alone is not listed as a reason to continue antibiotics.

  * **A.** NICE does not require radiographic resolution before stopping antibiotics; it recommends 5 days unless specific clinical or microbiological exceptions apply.
  * **B.** Cough can persist after pneumonia treatment; symptom resolution is not the stated criterion for extending antibiotics beyond 5 days.
  * **C.** NICE recommends stopping after 5 days for adults unless microbiology indicates a longer course or the person is not clinically stable.  
Sources: NICE NG250 recommendation 1.6.3
9. 8 / 10  
A 52-year-old is recovering at home after community-acquired pneumonia. At 2 weeks, their fever has resolved and they ask when cough and breathlessness should be substantially better. Their cough and breathlessness are gradually improving.  
What recovery timeframe should be discussed for most adults?  
Show answer

**Answer: A.** By 6 weeks, cough and breathlessness should have substantially reduced

**Why:** NICE NG250 recommendation 1.10.1 says symptoms should steadily improve after starting treatment, with the rate depending on severity. For most adults, fever should have resolved by 1 week, chest pain and sputum production should be substantially reduced by 4 weeks, and cough and breathlessness should be substantially reduced by 6 weeks.

  * **B.** NICE expects cough and breathlessness to have substantially reduced by 6 weeks for most adults, although recovery varies with severity.
  * **C.** NICE says fever should have resolved by 1 week; cough and breathlessness are expected to be substantially reduced by 6 weeks.
  * **D.** NICE gives 4 weeks for chest pain and sputum production to have substantially reduced, and 6 weeks for cough and breathlessness.  
Sources: NICE NG250 recommendation 1.10.1
10. 9 / 10  
A 43-year-old with community-acquired pneumonia has no haemodynamic instability or other feature requiring intravenous treatment. They are alert, can swallow, and are absorbing oral medicines. They have had fever and cough during this illness.  
Which route should generally be used first?  
Show answer

**Answer: C.** Oral antibiotics, because the patient can take them and severity does not require intravenous treatment

**Why:** NICE NG250 recommendation 1.5.4 says to give oral antibiotics first line if the person can take oral medicines and the severity of their condition does not require intravenous antibiotics. This is an individualised route decision; clinical severity or inability to take oral medicine can change the plan.

  * **A.** Nebulised antibiotics are not the first-line route recommended by NG250 for this uncomplicated adult community-acquired pneumonia scenario.
  * **B.** NICE recommends oral antibiotics first line when the person can take oral medicines and disease severity does not require intravenous therapy.
  * **D.** NICE recommends offering antibiotics for people with community-acquired pneumonia; microbiology testing is not a prerequisite in this scenario.  
Sources: NICE NG250 recommendation 1.5.4
11. 10 / 10  
A 46-year-old adult has low-severity community-acquired pneumonia. They are clinically stable, have no suspected sepsis or other microbiological indication, and can be managed in the community. They have had a cough and fever for 2 days.  
What does NICE recommend about routine microbiological testing in this case?  
Show answer

**Answer: B.** Do not routinely offer microbiological tests

**Why:** NICE NG250 recommendation 1.4.5 says not to routinely offer microbiological tests to adults with low-severity community-acquired pneumonia. For moderate or high-severity illness, recommendation 1.4.6 says to consider selected tests based on additional clinical indications, history, trajectory and other factors.

  * **A.** NICE recommends offering antibiotics for community-acquired pneumonia and does not require routine tests to identify a pathogen in low-severity cases.
  * **C.** NICE does not recommend routine microbiological testing for adults with low-severity community-acquired pneumonia.
  * **D.** A urinary antigen test is not routinely required for adults with low-severity community-acquired pneumonia.  
Sources: NICE NG250 recommendations 1.4.5 and 1.4.6

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