ACLS Acute Stroke Care 2

Question 1

A patient presents with sudden onset aphasia and right-sided weakness. CT head shows no hemorrhage. Last known well was 90 minutes ago. What is the next priority intervention?

Accepted Answer

Perform CT angiography to evaluate large vessel occlusion

Answer

Administer IV tPA immediately

Answer

Obtain MRI brain before treatment

Answer

Start aspirin 325 mg

Question 2

Which blood pressure threshold must be achieved and maintained BEFORE administering IV alteplase for acute ischemic stroke?

Accepted Answer

< 185/110 mmHg

Answer

< 220/120 mmHg

Answer

< 160/90 mmHg

Answer

< 140/80 mmHg

Question 3

A 78-year-old patient with known atrial fibrillation on warfarin presents with acute ischemic stroke. INR is 1.7. Is IV tPA indicated?

Accepted Answer

Yes, INR < 2.0 permits tPA administration

Answer

No, any anticoagulant use is an absolute contraindication

Answer

Yes, if onset was less than 3 hours ago

Answer

No, INR > 1.7 is a contraindication to tPA

Question 4

What is the maximum time window for mechanical thrombectomy in selected patients with large vessel occlusion and favorable imaging?

Accepted Answer

24 hours from onset

Answer

4.5 hours from onset

Answer

6 hours from onset

Answer

16 hours from onset

Question 5

During stroke assessment, a patient scores 4 points on the Los Angeles Prehospital Stroke Screen (LAPSS). What does this indicate?

Accepted Answer

Stroke is likely; activate the stroke team immediately

Answer

Stroke is unlikely; reassess for other diagnoses

Answer

Hemorrhagic stroke is confirmed

Answer

The patient requires only aspirin therapy

Question 6

Which finding on non-contrast CT head is an absolute contraindication to IV tPA in acute ischemic stroke?

Accepted Answer

Hemorrhagic transformation

Answer

Hyperdense MCA sign

Answer

Early ischemic changes in less than 1/3 of MCA territory

Answer

Loss of gray-white differentiation in basal ganglia

Question 7

A stroke patient receiving IV alteplase develops sudden severe headache, hypertension, and neurological deterioration 45 minutes into the infusion. What is the immediate action?

Accepted Answer

Stop the infusion and obtain emergent CT head

Answer

Increase the infusion rate to complete the dose faster

Answer

Administer labetalol and continue infusion

Answer

Give cryoprecipitate and continue monitoring