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Subarachnoid haemorrhage — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsSubarachnoid haemorrhageSCE Acute Medicine

A 51-year-old man is assessed on the acute medical unit. He has sudden thunderclap headache during exercise with vomiting and neck stiffness. CT head within 4 hours shows blood in the basal cisterns. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: B — Subarachnoid haemorrhage

Subarachnoid haemorrhage is the best answer because thunderclap headache with meningeal features and CT blood is diagnostic of SAH. Pulmonary embolism 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: A normal neurological examination does not exclude SAH.

Reference: https://www.nice.org.uk/guidance/ng228#acute-medicine-order-64-1