ACLS Acute Stroke Care 5

Question 1

A patient with acute ischemic stroke is on a direct oral anticoagulant (DOAC). When can IV tPA be safely administered?

Accepted Answer

Only if specific reversal agent was administered and coagulation assays are normal

Answer

IV tPA may be considered after DOAC reversal (e.g., idarucizumab for dabigatran) with confirmation that coagulation tests are normal.

Question 2

Which ECG finding is most commonly associated with acute ischemic stroke and requires cardiac monitoring?

Accepted Answer

Atrial fibrillation

Answer

Atrial fibrillation is the most clinically significant arrhythmia associated with cardioembolic stroke and requires continuous monitoring to detect paroxysmal episodes.

Question 3

A patient with acute stroke has blood glucose of 35 mg/dL. What is the appropriate management?

Accepted Answer

Treat hypoglycemia with IV dextrose; reassess neurological status after normalization

Answer

Hypoglycemia (glucose < 50–60 mg/dL) mimics stroke and must be corrected immediately before attributing symptoms to ischemic stroke.

Question 4

The concept of 'time is brain' refers to approximately how many neurons lost per minute in untreated ischemic stroke?

Accepted Answer

1.9 million neurons/minute

Answer

Approximately 1.9 million neurons are lost every minute during large vessel occlusion, underscoring the urgency of rapid reperfusion.

Question 5

Which of the following is a RELATIVE contraindication (not absolute) to IV tPA in acute ischemic stroke?

Accepted Answer

Rapidly improving or minor neurological deficits

Answer

Minor or rapidly improving symptoms are a relative contraindication; clinical judgment determines whether the deficit is disabling enough to justify tPA risk.

ACLS Practice Test

ACLS Practice Test

ACLS Acute Stroke Care 5