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Wernicke encephalopathy — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsWernicke encephalopathySCE Acute Medicine

A 60-year-old man is assessed on the acute medical unit. He is malnourished and confused with nystagmus and broad-based gait. He has been vomiting after alcohol cessation. 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: D — Give parenteral thiamine immediately

Give parenteral thiamine immediately is the best answer because confusion, ophthalmoplegia and ataxia in a malnourished patient require immediate parenteral thiamine. Give vitamin K and prothrombin complex concentrate 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 is clinical; do not wait for thiamine levels.

Reference: NICE CG100; BNF