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Lumbar puncture contraindication — SCE Acute Medicine MCQ

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HardProcedural Knowledge in Acute MedicineLumbar puncture contraindicationSCE Acute Medicine

A 34-year-old woman presents with a procedure-related acute decision. Relevant history includes coagulation, imaging, respiratory physiology or procedural risk. On assessment, bedside findings determine whether the procedure is safe and urgent. Investigations show suspected meningitis with seizure, papilloedema and reduced consciousness. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give antibiotics immediately and perform CT before considering lumbar puncture

The key discriminator is that suspected meningitis with seizure, papilloedema and reduced consciousness, which makes Give antibiotics immediately and perform CT before considering lumbar puncture the single best answer. Start broad-spectrum intravenous antibiotics 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. Arrange urgent specialist referral and Arrange urgent CT imaging 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