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Lumbar puncture safety — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge and Acute Management DecisionsLumbar puncture safetySCE Acute Medicine

A 41-year-old man is assessed on the acute medical unit. He needs lumbar puncture for suspected meningitis but has new focal neurological signs and papilloedema. Antibiotics have been started. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: D — Non-contrast CT head

Non-contrast CT head is the best answer because cranial imaging is required before LP when there are signs of raised intracranial pressure or focal deficit. Plasma glucose and beta-hydroxybutyrate 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: Antibiotics should not be delayed while awaiting imaging.

Reference: NICE NG240