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Large vessel occlusion stroke — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsLarge vessel occlusion strokeSCE Acute Medicine

A 71-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 NIHSS 21 with CT angiography showing M1 occlusion. What is the most appropriate next step in management?

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Correct answer: B — Refer urgently for mechanical thrombectomy while considering thrombolysis eligibility

The key discriminator is that NIHSS 21 with CT angiography showing M1 occlusion, which makes Refer urgently for mechanical thrombectomy while considering thrombolysis eligibility the single best answer. Provide supportive care and close monitoring is less appropriate because it does not address the dominant acute risk in the vignette; Start anticoagulation after assessing bleeding risk would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Arrange routine outpatient follow-up 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 NG128