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Intracerebral haemorrhage on anticoagulation — SCE Acute Medicine MCQ

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EasyAcute Neurological PresentationsIntracerebral haemorrhage on anticoagulationSCE Acute Medicine

A 29-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 CT shows basal ganglia haemorrhage in a patient taking apixaban. What is the most appropriate next step in management?

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Correct answer: C — Reverse anticoagulation where appropriate and control blood pressure urgently

The key discriminator is that CT shows basal ganglia haemorrhage in a patient taking apixaban, which makes Reverse anticoagulation where appropriate and control blood pressure urgently the single best answer. Arrange urgent specialist referral 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. Call critical care for escalation 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 NG128; BNF