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Subarachnoid haemorrhage — MCCQE Part 1 MCQ

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HardHeadacheSubarachnoid haemorrhageMCCQE Part 1

45-year-old woman presents with sudden thunderclap headache during exercise. She vomited and has neck stiffness; CT is pending. Which of the following is the most appropriate next step?

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

Obtain urgent non-contrast CT head and further testing if CT is negative but suspicion remains is best because thunderclap headache with meningism is subarachnoid haemorrhage until proven otherwise. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. A normal examination does not exclude SAH.

Reference: Canadian Stroke Best Practices