Subarachnoid Haemorrhage AND Intracranial Haemorrhage — Written Clinical Reasoning · Phys Written Answers

Prompt

DCE-style written reasoning for Subarachnoid Haemorrhage AND Intracranial Haemorrhage.

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in Subarachnoid Haemorrhage AND Intracranial Haemorrhage and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Tariq Z, Shahzad F, Jannat NE, Hashmi TM, et al. Radially adjustable Tigertriever demonstrates higher reperfusion compared to self-expanding stent-retrievers during mechanical thrombectomy of large vessel occlusions: a systematic review and meta-analysis Front Neurol, 2026.PMID 42459847
[2]Tamer C, Ltaif DA, Ghalayini T, El Sardouk O, et al. A novel face-level blast mechanism: CT findings of neuro-ocular injury from a mass-casualty event BMC Med Imaging, 2026.PMID 42443800
[3]Mistretta F, Russo R, Molinaro S, Gava UA, et al. Management of hemorrhagic isolated pure lenticulostriate artery aneurysms: a systematic review and three illustrative cases Neurosurg Rev, 2026.PMID 42435087
[4]Vergouwen MDI, Ramos-Pachon A, Terecoasa EO, Willett N, et al. European Stroke Organisation (ESO), European Association of Neurosurgical Societies (EANS) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on aneurysmal subarachnoid haemorrhage Eur Stroke J, 2026.PMID 42095754
[5]Chan MMY, Nijenhuis T, Galletti F, Figueres L, et al. KDIGO 2025 Clinical Practice Guideline for ADPKD: a commentary on intracranial aneurysms and other vascular manifestations from the ERA Working Group Genes & Kidney Nephrol Dial Transplant, 2026.PMID 42065712
[6]Nene RV, Simon N, Smith AM, Costantini TW, et al. Impact of aspirin use on the modified brain injury guidelines for the management of mild traumatic intracranial hemorrhage Am J Emerg Med, 2026.PMID 42061202
[7]Doan HN, Chang MC Comparative Effectiveness of Unstable Versus Stable Resistance Training on Lower Limb Strength, Mobility, and Fear of Falling in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials Am J Phys Med Rehabil, 2026.PMID 42468010
[8]Liu HW, Tsai TL Virtual Reality-assisted Physiotherapeutic Training for Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis Am J Phys Med Rehabil, 2026.PMID 42468005

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in Subarachnoid Haemorrhage AND Intracranial Haemorrhage and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Tariq Z, Shahzad F, Jannat NE, Hashmi TM, et al. Radially adjustable Tigertriever demonstrates higher reperfusion compared to self-expanding stent-retrievers during mechanical thrombectomy of large vessel occlusions: a systematic review and meta-analysis Front Neurol, 2026.PMID 42459847
[2]Tamer C, Ltaif DA, Ghalayini T, El Sardouk O, et al. A novel face-level blast mechanism: CT findings of neuro-ocular injury from a mass-casualty event BMC Med Imaging, 2026.PMID 42443800
[3]Mistretta F, Russo R, Molinaro S, Gava UA, et al. Management of hemorrhagic isolated pure lenticulostriate artery aneurysms: a systematic review and three illustrative cases Neurosurg Rev, 2026.PMID 42435087
[4]Vergouwen MDI, Ramos-Pachon A, Terecoasa EO, Willett N, et al. European Stroke Organisation (ESO), European Association of Neurosurgical Societies (EANS) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on aneurysmal subarachnoid haemorrhage Eur Stroke J, 2026.PMID 42095754
[5]Chan MMY, Nijenhuis T, Galletti F, Figueres L, et al. KDIGO 2025 Clinical Practice Guideline for ADPKD: a commentary on intracranial aneurysms and other vascular manifestations from the ERA Working Group Genes & Kidney Nephrol Dial Transplant, 2026.PMID 42065712
[6]Nene RV, Simon N, Smith AM, Costantini TW, et al. Impact of aspirin use on the modified brain injury guidelines for the management of mild traumatic intracranial hemorrhage Am J Emerg Med, 2026.PMID 42061202
[7]Doan HN, Chang MC Comparative Effectiveness of Unstable Versus Stable Resistance Training on Lower Limb Strength, Mobility, and Fear of Falling in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials Am J Phys Med Rehabil, 2026.PMID 42468010
[8]Liu HW, Tsai TL Virtual Reality-assisted Physiotherapeutic Training for Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis Am J Phys Med Rehabil, 2026.PMID 42468005