skip to main content

Herpes simplex encephalitis — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardSepsis and Infectious EmergenciesHerpes simplex encephalitisSCE Acute Medicine

A 47-year-old man is assessed on the acute medical unit. He has fever, confusion, focal seizures and expressive dysphasia. CT head is normal and CSF is pending. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Start intravenous aciclovir urgently

Start intravenous aciclovir urgently is the best answer because temporal-lobe features with fever and seizures should trigger urgent aciclovir because delay worsens outcomes. Start intravenous N-acetylcysteine promptly 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: HSV encephalitis can have a normal early CT.

Reference: NICE encephalitis guidance; ABN/BIA guideline