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Spinal epidural abscess — SCE Acute Medicine MCQ

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EasyAcute Neurological PresentationsSpinal epidural abscessSCE Acute Medicine

A 42-year-old man presents with acute neurological symptoms. Relevant history includes vascular, infectious or neuromuscular risk factors. On assessment, neurological examination shows focal or global dysfunction. Investigations show back pain, fever, cord signs and epidural collection on MRI. What is the most appropriate next step in management?

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Correct answer: CArrange urgent neurosurgical referral with intravenous antibiotics

The key discriminator is that back pain, fever, cord signs and epidural collection on MRI, which makes Arrange urgent neurosurgical referral with intravenous antibiotics the single best answer. Call critical care for escalation is less appropriate because it does not address the dominant acute risk in the vignette; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy and Give targeted antidote or reversal therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: IDSA spinal infection guidance