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Subarachnoid haemorrhage — MCCQE Part 1 MCQ

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ModerateHeadacheSubarachnoid haemorrhageMCCQE Part 1

A 43-year-old woman develops sudden thunderclap headache during exertion with vomiting and neck stiffness; neurologic examination is normal. Which of the following is the most appropriate next step?

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

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Correct answer: A — Arrange urgent non-contrast CT head and further testing if CT is negative but suspicion remains

Arrange urgent non-contrast CT head and further testing if CT is negative but suspicion remains is the single best answer because the age, timing, examination findings and investigations in the vignette fit Subarachnoid haemorrhage better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Stroke Best Practices, with attention to acuity, safety-netting and local provincial pathways.

Reference: https://mcc.ca/objectives/medical-experts/