MLA Domain 5 · Presentation

Neck pain/ stiffness

13 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 6

Bacterial meningitis

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures → do not delay antibiotics; signs of raised ICP

Carotid & cervical artery dissection

Stroke/TIA from dissection → urgent stroke pathway; thrombolysis decisions need imaging confirmation

Cervical spondylotic myelopathy

Rapid deterioration, bladder/bowel involvement, or significant cord signal change → urgent neurosurgical/spinal referral

Febrile convulsions

Meningitis/encephalitis features, focal/prolonged seizure, age <6 months or >6 years, not returning to normal

Meningitis

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures, raised-ICP signs → do not delay antibiotics

Subarachnoid haemorrhage

Reduced GCS, focal deficit, rebleeding (highest risk first 12h), hydrocephalus, vasospasm (delayed ischaemia)

recognised feature · 1

Gram-negative & anaerobic organisms

Gram-negative sepsis → LPS-driven shock; Sepsis Six + broad-spectrum cover, source control

differential of the above · 6

Cluster headache

First presentation needs imaging to exclude a secondary cause; very high pain/suicidality risk in clusters

Encephalitis

Reduced GCS, status epilepticus, raised ICP; delay in aciclovir worsens outcome

Epilepsy

Status epilepticus (≥5 min); first seizure needs assessment; pregnancy/teratogenicity; SUDEP risk

Migraine

Aura + COCP (stroke risk → COCP is UKMEC 4); thunderclap or new focal/systemic features → exclude secondary causes (see

Motor neurone disease

Respiratory compromise (FVC), bulbar dysfunction with aspiration; weight loss

Multiple sclerosis

Acute relapse with disabling features; progressive course; tumefactive/atypical presentations