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Tuberculous meningitis — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesTuberculous meningitisSCE Acute Medicine

A 39-year-old woman is assessed on the acute medical unit. She has 3 weeks of headache, low-grade fever and weight loss, now with sixth nerve palsy. CSF shows lymphocytes, high protein and low glucose. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: A — Tuberculous meningitis

Tuberculous meningitis is the best answer because subacute meningitis with cranial neuropathy and lymphocytic low-glucose CSF suggests TB meningitis. Severe community-acquired sepsis unclear source is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Treatment should not wait for culture when suspicion is high.

Reference: https://www.nice.org.uk/guidance/ng33#acute-medicine-order-37-1