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Tuberculous meningitis — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesTuberculous meningitisSCE Acute Medicine

A 76-year-old man presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show subacute meningitis, cranial nerve palsy and low-glucose lymphocytic CSF. What is the most appropriate next step in management?

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Correct answer: C — Start antituberculous therapy with adjunctive corticosteroid after specialist discussion

The key discriminator is that subacute meningitis, cranial nerve palsy and low-glucose lymphocytic CSF, which makes Start antituberculous therapy with adjunctive corticosteroid after specialist discussion the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Start broad-spectrum intravenous antibiotics would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Arrange urgent specialist referral 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 NG33; BTS TB guidance