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Post-stroke dysphagia with aspiration pneumonia — SCE Acute Medicine MCQ

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ModerateMedicine in the ElderlyPost-stroke dysphagia with aspiration pneumoniaSCE Acute Medicine

An 80-year-old man with previous stroke is admitted with recurrent coughing during meals and aspiration pneumonia. He is alert but has wet voice after sips of water. Chest radiograph shows right lower-zone consolidation. What is the most appropriate immediate management?

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Correct answer: C — Keep nil by mouth pending urgent swallow assessment and provide alternative hydration

Coughing with wet voice after swallowing suggests unsafe swallow, so oral intake should pause pending urgent speech and language assessment while hydration and medicines are managed safely. Thin fluids may worsen aspiration. Long-term PEG decisions are not immediate and require broader assessment of prognosis and goals. The key ward intervention is preventing further aspiration while the acute pneumonia is treated.

Reference: NICE stroke rehabilitation guidance, RCP stroke guideline