skip to main content

Subarachnoid Haemorrhage — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyNeurologySubarachnoid HaemorrhageRACP Adult Medicine

A 55-year-old woman presents with a thunderclap headache reaching maximum intensity in 1 minute. CT brain performed within 6 hours is normal. What is the most appropriate next investigation?

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

Reveal the answer and explanation

Correct answer: C — Lumbar puncture

A thunderclap headache mandates exclusion of subarachnoid haemorrhage (SAH). If CT brain is performed within 6 hours and is normal, sensitivity is ~99% but not 100%. Lumbar puncture should be performed (ideally ≥12 hours after onset) to look for xanthochromia and red blood cells. CT angiography may be performed concurrently to assess for aneurysm but does not replace LP for ruling out SAH.

Reference: Stroke Foundation – 2024 – Clinical Guidelines for Stroke Management; eTG – 2025 – Neurology