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Post-stroke aspiration — DGM MCQ

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ModerateStroke and rehabilitationPost-stroke aspirationDGM

An 88-year-old man develops fever and cough after a stroke. He coughs during meals and has a wet voice. Chest examination reveals right basal crackles. Current medicines include clopidogrel and atorvastatin. What is the most likely diagnosis?

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Correct answer: A — Aspiration pneumonia

Fever, cough, basal crackles and swallowing difficulty after stroke suggest aspiration pneumonia. Pulmonary embolism may cause breathlessness but does not explain meal-related coughing, heart failure lacks fever, lung cancer is more chronic, and coryza is upper respiratory. Dysphagia management is central to preventing recurrent aspiration.

Reference: NICE NG236; NICE pneumonia guidance