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

CT angiography should be obtained to assess for large vessel occlusion (LVO), which determines eligibility for mechanical thrombectomy in addition to IV tPA.

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

BP must be < 185/110 mmHg before alteplase administration and maintained < 180/105 mmHg for at least 24 hours afterward.

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

IV tPA can be given if INR is ≤ 1.7; an INR > 1.7 in a patient on warfarin is a contraindication.

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

Trials (DAWN, DEFUSE 3) support mechanical thrombectomy up to 24 hours from last known well in selected patients with target mismatch on imaging.

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

A positive LAPSS (all criteria met) indicates high likelihood of stroke, prompting immediate stroke team activation and transport to a stroke center.

ACLS Practice Test

ACLS Practice Test

ACLS Acute Stroke Care 2