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Raised intracranial pressure from mass — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsRaised intracranial pressure from massSCE Acute Medicine

A 64-year-old woman is assessed on the acute medical unit. She has progressive headache, vomiting and papilloedema. CT shows a frontal mass with vasogenic oedema and midline shift. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Give dexamethasone and seek urgent neurosurgical advice

Give dexamethasone and seek urgent neurosurgical advice is the best answer because symptomatic cerebral oedema from a mass lesion requires steroid therapy and urgent specialist input. Arrange same-day ambulatory follow-up 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: Steroids are useful for vasogenic oedema around tumours, not routine stroke.

Reference: NICE brain tumours guidance