Stroke Flashcard 5
Rationale
C. Rationale: The inclusion criterion is that the onset of symptoms must have been < 12 hours before beginning treatment. (ACLS Case: Acute Stroke: Inclusion and Exclusion Criteria)
Question
The harmful effects of fibrinolytic therapy can be avoided by following specific guidelines. One of the contraindications to fibrinolytic therapy is:
a. The CT scan does not show the presence of intracerebral hemorrhage.
b. The patient has a measurable neurologic deficit.
c. The onset of symptoms was < 12 hours before beginning treatment.
d. The patient is at least 18 years old.
Answer
c. The onset of symptoms was < 12 hours before beginning treatment.
Rationale
B. Rationale: The major complication of rtPA is intracranial hemorrhage.
Question
The major complication of rtPA is transient hypotension.
a. True
b. False
Answer
b. False
Rationale
D. Rationale: Endovascular therapy is recommended to be given within 6 hours of the onset of symptoms. (ACLS Case: Acute Stroke: Approach to Stroke Care)
Question
The neurovascular surgeon is planning to utilize endovascular therapy to treat a patient with thromboembolic stroke. When is the optimal window of time to provide endovascular therapy to this patient?
a. Within 24 hours of the onset of symptoms
b. Within 12 hours of the onset of symptoms
c. Within 8 hours of the onset of symptoms
d. Within 6 hours of the onset of symptoms
Answer
d. Within 6 hours of the onset of symptoms
Rationale
D. Rationale: Alteplase is the fibrinolytic of choice for acute ischemic stroke patients. It is administered only by an experienced physician and given within 3 hours or 4.5 hours in selected patients. Early treatment yields better recovery outcomes. (Case: Suspected Stroke)
Question
The recommended pharmacologic treatment for acute ischemic stroke is:
a. Coumadin
b. Aspirin
c. Enalaprilat
d. alteplase
Answer
d. alteplase
Rationale
C. Rationale: The National Institute of Neurological Disorders and Stroke (NINDS) has set critical time goals to assess and manage acute stroke. This is based on large studies done on stroke patients.
Question
What is the critical time period for immediate neurologic assessment once a patient with suspected acute stroke arrives in the emergency department?
a. 10 minutes
b. 15 minutes
c. 20 minutes
d. 25 minutes
Answer
c. 20 minutes
Rationale
A. Rationale: The stroke chain of survival provides healthcare providers a framework on which training must be focused to increase the chance of successful treatment. Early recognition of stroke signs and calling EMS is the first link in the stroke chain of survival. Timely EMS response is the second link. Notification and transport to a stroke unit is the third link. And the fourth link is the diagnosis and treatment of the patient in the hospital, preferably at an institution with a specialized stroke unit. (ACLS Case: Stroke)
Question
What is the first link in the stroke chain of survival?
a. Recognition of stroke signs by the patient or relatives
b. Diagnosis of stroke and treatment in the hospital
c. Training of EMS in stroke care
d. EMS transport to the hospital
Answer
a. Recognition of stroke signs by the patient or relatives
Rationale
C. Rationale: All drugs have potential side effects, and the major adverse effect of recombinant tissue plasminogen activator is intracranial hemorrhage.
Question
What is the major complication of IV recombinant tissue plasminogen activator therapy in a patient with stroke?
a. Allergic reaction or anaphylaxis
b. Tinnitus and hearing loss
c. Intracranial hemorrhage
d. Sudden cardiac arrest
Answer
c. Intracranial hemorrhage
Rationale
C. Rationale: A thrombus (blood clot) is the most common cause of stroke. Up to 80% of strokes are ischemic in nature, meaning that a blood clot blocks blood flow to a portion of the brain.
Question
What is the most common cause of stroke?
A. Hemorrhage
B. Tumor
C. Thrombus
D. Vasospasm
Answer
C. Thrombus
Rationale
D. Rationale: Ischemic stroke makes up 87% of the ischemic type of stroke, which can be treated with fibrinolytic therapy in qualified patients.
Question
What is the most common type of acute stroke?
a. Ruptured berry aneurysms
b. Subarachnoid hemorrhage
c. Intracerebral hemorrhagic stroke
d. Ischemic stroke
Answer
d. Ischemic stroke
Rationale
A. Rationale: A decision point in the management of acute stroke patients depends on the result of the non contrast CT scan of the head. This imaging study can determine if the stroke is an ischemic or hemorrhagic type, leading healthcare providers to the appropriate treatment.
Question
What is the most important test that should be requested for all patients with suspected acute stroke?
a. MRI of the brain with contrast
b. 12-lead ECG
c. Prothrombin time, platelet count, and activated partial thromboplastin time
d. Non contrast CT scan of the head
Answer
a. MRI of the brain with contrast