A fictional 71-year-old presents with fever, headache, neck stiffness and confusion. They are haemodynamically stable but increasingly drowsy.
Listen for the assumption.
I requested CT before lumbar puncture and planned to wait for both before giving antibiotics.
Which part of that sequence risks avoidable harm?
Investigations should be obtained promptly when safe, but they must not cause a clinically significant delay to antibiotics.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Blood cultures have been obtained
- Drowsiness progresses and immediate imaging criteria require reassessment
- The patient has a risk factor for Listeria infection
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
I will state whether LP is safe now, what makes imaging immediate and exactly when antibiotics were given.
Good. Involve infection and critical-care specialists early, and explain to the family what is suspected, what remains uncertain and why timing matters.
I will keep diagnosis, treatment timing and investigation sequence separate and explicit in the handover.
What must remain explicit.
- Follow NICE NG240 and the current local antimicrobial pathway.
- Do not allow CT or lumbar puncture to create a clinically significant antibiotic delay.
- Escalate reduced consciousness, seizures, shock or respiratory compromise immediately.
Where reasoning fails.
- Treating the complete red-flag combination as mandatory
- Waiting for CT and LP before antibiotics
- Missing Listeria risk factors
Suspected bacterial meningitis with symptoms [summary], consciousness [trend], blood tests/cultures [status], LP/imaging safety decision [details], antibiotics and adjuncts [times] and specialist escalation [status].
How would you explain to a family why treatment may begin before diagnostic certainty?