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Epilepsy and Pregnancy Planning — UKMLA MCQ

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MediumNeurologyEpilepsy and Pregnancy PlanningUKMLAMRCP Part 1MRCGP AKTPARAPSA

A man with atrial fibrillation has a CHA2DS2-VASc score of exactly 2 and recurrent mechanical falls. Anticoagulation is otherwise suitable, but his bleeding risk has not yet been assessed. A falls-prevention programme will take several weeks to complete. Which sequence most precisely follows NICE guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Assess bleeding risk, then offer a direct-acting oral anticoagulant without waiting for completion of the falls-prevention programme

Explanation lettering: E = shown as A · D = shown as B · A = shown as D · B = shown as E

A is correct. NICE requires bleeding risk to be taken into account and says to offer a direct-acting oral anticoagulant when the CHA2DS2-VASc score is 2 or above. Equality at 2 therefore meets the offer threshold, and falls risk alone must not delay or prevent treatment. B puts anticoagulation before the required bleeding-risk assessment. C incorrectly changes the inclusive threshold to above 2 and substitutes “consider” for “offer.” D makes completion of falls management a prerequisite despite falls being the sole stated reason for delay. E likewise lets falls risk postpone both bleeding-risk assessment and the anticoagulation decision, and it weakens the recommendation from offering to considering treatment.

Reference: NICE NG196 recommendations 1.6.3 and 1.6.8: https://www.nice.org.uk/guidance/NG196/chapter/recommendations