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Bacterial meningitis — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsBacterial meningitisSCE Acute Medicine

A 82-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 fever, photophobia, neck stiffness and high inflammatory markers. What is the most appropriate next step in management?

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Correct answer: C — Take blood cultures and give intravenous ceftriaxone immediately

The key discriminator is that fever, photophobia, neck stiffness and high inflammatory markers, which makes Take blood cultures and give intravenous ceftriaxone immediately the single best answer. Arrange urgent CT imaging is less appropriate because it does not address the dominant acute risk in the vignette; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Give targeted antidote or reversal therapy 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 NG240