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Clinical MCQ - Acute Ischemic Stroke

The document presents multiple-choice questions (MCQs) related to the management of acute ischemic stroke, detailing patient scenarios and appropriate interventions. Key treatments include IV alteplase for eligible patients within 4.5 hours, mechanical thrombectomy for large vessel occlusions within 6-24 hours, and oral anticoagulation for patients with atrial fibrillation. The document also emphasizes the importance of blood pressure management before thrombolysis and the initiation of aspirin therapy post-treatment.

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Matthew Zane Broderick
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13 views3 pages

Clinical MCQ - Acute Ischemic Stroke

The document presents multiple-choice questions (MCQs) related to the management of acute ischemic stroke, detailing patient scenarios and appropriate interventions. Key treatments include IV alteplase for eligible patients within 4.5 hours, mechanical thrombectomy for large vessel occlusions within 6-24 hours, and oral anticoagulation for patients with atrial fibrillation. The document also emphasizes the importance of blood pressure management before thrombolysis and the initiation of aspirin therapy post-treatment.

Uploaded by

Matthew Zane Broderick
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Clinical MCQ’s - Acute Ischemic Stroke

1) A 66-year-old man with a history of hypertension and atrial fibrillation presents with sudden
right-sided weakness and slurred speech that started 90 minutes ago. CT brain shows no
hemorrhage. His NIHSS score is 8. What is the next best step in management?

A. Administer aspirin 300 mg


B. Start warfarin immediately
C. Administer IV alteplase
D. Order MRI brain before treatment

__________________Answer: C. Administer IV alteplase

Explanation:
For eligible patients presenting within 4.5 hours of symptom onset and with no contraindications,
IV alteplase is the standard treatment for acute ischemic stroke. Aspirin and anticoagulation are
delayed in this context.
References:

• Powers WJ et al. 2023 AHA/ASA Guidelines for the Early Management of Patients with
Acute Ischemic Stroke.
• Saver JL. Time is brain—quantified. Stroke. 2006.

_____________________________________________________________________

2) A 74-year-old woman with diabetes presents 6 hours after sudden onset of left-sided
hemiparesis. CT angiography reveals a right MCA occlusion. Which intervention offers the
greatest potential benefit?

A. IV alteplase
B. Aspirin therapy
C. Mechanical thrombectomy
D. Mannitol administration

__________________Answer: C. Mechanical thrombectomy

Explanation:
Patients with large vessel occlusion presenting within 6–24 hours may benefit from mechanical
thrombectomy, particularly if there’s salvageable brain tissue. Alteplase is only approved up to
4.5 hours.
References:

• Nogueira RG et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between


Deficit and Infarct. NEJM 2018.
• Powers WJ et al. 2023 AHA/ASA Guidelines.

_____________________________________________________________________

3) A 58-year-old man is brought in with sudden onset aphasia and right hemiplegia. BP is
210/110 mmHg. CT brain shows no hemorrhage. He is eligible for thrombolysis. What is the
appropriate BP target before administering alteplase?

A. <220/120 mmHg
B. <200/110 mmHg
C. <180/105 mmHg
D. <160/100 mmHg

__________________Answer: C. <180/105 mmHg

Explanation:
Before administering IV alteplase, BP should be lowered to <180/105 mmHg to reduce the risk
of hemorrhagic transformation.

References:

• Powers WJ et al. 2023 AHA/ASA Guidelines.


• Jauch EC et al. Guidelines for the Early Management of Patients with Acute Ischemic
Stroke. Stroke 2013.

_____________________________________________________________________

4) A 65-year-old woman is diagnosed with an acute ischemic stroke. She received IV alteplase 2
hours after onset. 24 hours later, she is stable and CT shows no hemorrhage. What is the next
best step?

A. Start dual antiplatelet therapy


B. Begin aspirin 300 mg
C. Start therapeutic anticoagulation
D. Repeat alteplase dose

__________________Answer: B. Begin aspirin 300 mg


Explanation:
Aspirin (usually 160–325 mg) is initiated 24 hours after thrombolysis if there is no hemorrhage
on repeat imaging. Antiplatelets are withheld during the first 24 hours post-alteplase.

References:

• Powers WJ et al. 2023 AHA/ASA Guidelines.


• Sandercock P et al. Antithrombotic therapy in acute ischemic stroke. Lancet 2014.

_____________________________________________________________________

5) A 72-year-old man presents with sudden visual loss and left-sided weakness. MRI shows
acute infarct in the PCA and MCA territories. ECG shows new-onset atrial fibrillation. What is
the best long-term secondary prevention?

A. Clopidogrel alone
B. Dual antiplatelet therapy
C. Oral anticoagulation
D. High-dose statin only

__________________Answer: C. Oral anticoagulation

Explanation:
In patients with cardioembolic stroke due to atrial fibrillation, oral anticoagulation (e.g., DOAC
or warfarin) is the most effective long-term prevention strategy to reduce recurrence risk.
References:

• Hart RG et al. Antithrombotic therapy for stroke prevention in atrial fibrillation. Chest
2012.
• Diener HC et al. Oral anticoagulants in stroke prevention. Stroke 2019.

_____________________________________________________________________

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