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Acute post-stroke dysphagia — SCE Geriatric Medicine MCQ

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HardStroke careAcute post-stroke dysphagiaSCE Geriatric Medicine

An 83-year-old man with previous stroke develops new dysphagia and cough after a further left hemispheric infarct. He is alert but coughs on water swallow screen; oxygen saturation is 94% and chest is clear. His medications include clopidogrel, atorvastatin and ramipril. What is the most important next step?

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

A failed swallow screen after acute stroke requires nil by mouth status, urgent specialist assessment and safe routes for hydration, nutrition and medicines. A clear chest does not exclude aspiration risk. PEG is not the immediate first-line response in the acute phase; decisions depend on prognosis and recovery trajectory. The pearl is that stroke-associated pneumonia prevention starts with early dysphagia screening.

Reference: National Clinical Guideline for Stroke 2023; NICE NG236