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Hypertensive encephalopathy — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsHypertensive encephalopathySCE Acute Medicine

A 51-year-old woman presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show severe BP elevation with confusion, papilloedema and AKI. 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: B — Start controlled intravenous blood pressure reduction in a monitored setting

The key discriminator is that severe BP elevation with confusion, papilloedema and AKI, which makes Start controlled intravenous blood pressure reduction in a monitored setting the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Give analgesia and antiemetic therapy would fit a different presentation or later stage of care. Arrange urgent CT imaging and Optimise chronic medication and discharge 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 hypertension guidance