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Retinal detachment — CCFP MCQ

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HardENT, OphthalmologyRetinal detachmentCCFP

A 46-year-old presents 10 hours after an abrupt maximal-at-onset headache with vomiting and neck stiffness. Neurologic examination and noncontrast head CT are normal. What is the most appropriate next diagnostic step?

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

Reveal the answer and explanation

Correct answer: D — Proceed to lumbar puncture or CT angiography for subarachnoid haemorrhage

Explanation lettering: D = shown as A · E = shown as B · A = shown as D · B = shown as E

A is correct. The very high sensitivity of modern CT applies principally within six hours under specified conditions; at 10 hours, persistent suspicion requires further investigation such as lumbar puncture or an accepted vascular-imaging pathway. B ignores time-dependent sensitivity. C dismisses red flags. D delays a lethal diagnosis. E investigates an unsupported alternative. The exact pathway should reflect local expertise and discussion of the benefits and limitations of lumbar puncture and CT angiography.

Reference: CMAJ: Subarachnoid haemorrhage assessment: https://www.cmaj.ca/content/189/43/E1343