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Posterior circulation stroke — MCCQE Part 1 MCQ

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ModerateDizziness/VertigoPosterior circulation strokeMCCQE Part 1

A 69-year-old man with hypertension has continuous vertigo, vomiting, new ataxia and direction-changing nystagmus that is not brief or positional. Which of the following is the most appropriate next step?

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Correct answer: CActivate stroke assessment with urgent neuroimaging and specialist input

Activate stroke assessment with urgent neuroimaging and specialist input is the single best answer because the age, timing, examination findings and investigations in the vignette fit Posterior circulation stroke 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: Canadian Stroke Best Practices