Neurology: subarachnoid haemorrhage: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: subarachnoid haemorrhage

Sample item

A 40-year-old woman has a sudden severe headache, 'the worst of her life', with neck stiffness. A non-contrast CT head done 18 hours after onset is normal. What is the next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Lumbar puncture, looking for xanthochromia

CT within 6 hours of onset is highly sensitive for subarachnoid haemorrhage but loses sensitivity with time. If suspicion remains and CT is negative or delayed, lumbar puncture performed at least 12 hours after onset can show xanthochromia from bilirubin. A confirmed bleed is followed by CT or catheter angiography, nimodipine and aneurysm securing.

Option by option

  • A. Lumbar puncture, looking for xanthochromia (correct)

    Correct. Xanthochromia in CSF can detect blood missed by a late CT.

  • B. Start intravenous heparin

    Heparin could worsen bleeding.

  • C. Repeat the CT after one week

    A week's delay risks fatal rebleeding.

  • D. Discharge with analgesics because CT is normal

    A normal CT beyond 6 hours does not exclude haemorrhage in this setting.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Lumbar puncture, looking for xanthochromia. CT within 6 hours of onset is highly sensitive for subarachnoid haemorrhage but loses sensitivity with time.

Why is "Start intravenous heparin" not the answer?

Heparin could worsen bleeding.

Why is "Repeat the CT after one week" not the answer?

A week's delay risks fatal rebleeding.

Why is "Discharge with analgesics because CT is normal" not the answer?

A normal CT beyond 6 hours does not exclude haemorrhage in this setting.

What concept does this question test?

It tests Neurology: subarachnoid haemorrhage in General Medicine. If suspicion remains and CT is negative or delayed, lumbar puncture performed at least 12 hours after onset can show xanthochromia from bilirubin. A confirmed bleed is followed by CT or catheter angiography, nimodipine and aneurysm securing.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: subarachnoid haemorrhage?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.