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Subarachnoid haemorrhage — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsSubarachnoid haemorrhageSCE Acute Medicine

A 73-year-old woman 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 thunderclap headache with basal cistern subarachnoid blood on CT. What is the most appropriate next step in management?

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Correct answer: E — Arrange urgent neurosurgical referral and CT angiography

The key discriminator is that thunderclap headache with basal cistern subarachnoid blood on CT, which makes Arrange urgent neurosurgical referral and CT angiography the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Give intravenous fluids with reassessment 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: NICE NG228