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Wernicke encephalopathy — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsWernicke encephalopathySCE Acute Medicine

A 51-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 confusion, ataxia, nystagmus and malnutrition. What is the most appropriate next step in management?

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Correct answer: B — Give high-dose parenteral thiamine before carbohydrate

The key discriminator is that confusion, ataxia, nystagmus and malnutrition, which makes Give high-dose parenteral thiamine before carbohydrate the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Provide supportive care and close monitoring would fit a different presentation or later stage of care. Optimise chronic medication and discharge and Give controlled oxygen and senior review 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 alcohol-use disorders guideline; BNF