ACLS Acute Stroke Care 4

Question 1

A patient with acute stroke is found to have a platelet count of 85,000/μL. IV tPA is being considered. What is the correct action?

Accepted Answer

Withhold tPA; platelet count < 100,000/μL is a contraindication

Answer

Platelet count < 100,000/μL is a contraindication to IV tPA in acute ischemic stroke due to increased hemorrhage risk.

Question 2

Which type of stroke most commonly results from cardioembolic sources such as atrial fibrillation?

Accepted Answer

Cardioembolic stroke

Answer

Atrial fibrillation causes cardioembolism, typically producing large cortical infarcts often involving multiple vascular territories.

Question 3

After IV tPA, when should antiplatelet therapy (aspirin) be initiated in acute ischemic stroke?

Accepted Answer

24 hours after tPA, once imaging excludes hemorrhage

Answer

Antiplatelet agents should be withheld for 24 hours after tPA administration; a repeat CT should confirm no hemorrhage before starting.

Question 4

A 55-year-old patient presents with sudden onset of the 'worst headache of my life.' CT head is normal. What is the next diagnostic step?

Accepted Answer

Lumbar puncture to detect xanthochromia

Answer

A normal CT does not exclude subarachnoid hemorrhage; lumbar puncture should be performed to detect xanthochromia when SAH is suspected.

Question 5

In a patient with hemorrhagic stroke due to warfarin, which reversal agent is preferred for rapid INR correction?

Accepted Answer

4-factor prothrombin complex concentrate (4F-PCC)

Answer

4F-PCC rapidly reverses warfarin anticoagulation with smaller volume than FFP and faster INR correction, making it preferred in hemorrhagic stroke.

ACLS Practice Test