Practice Test Geeks(ASC) Advanced Stroke Coordinator Certification Practice Test
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Evidence-Based Stroke Protocols Flashcards

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  1. Per evidence-based stroke protocols, what is the recommended target time from stroke symptom onset to groin puncture for mechanical thrombectomy?

    Answer: ≤90 minutes

    AHA/ASA guidelines recommend a target onset-to-puncture time of ≤90 minutes when the patient arrives directly to a thrombectomy-capable center.

  2. A patient with known non-valvular atrial fibrillation suffers an acute ischemic stroke. According to AHA/ASA guidelines, when should anticoagulation for secondary prevention be initiated?

    Answer: After 2–14 days based on stroke severity and infarct size ('1-3-6-12 rule')

    The '1-3-6-12 day rule' guides anticoagulation timing: TIA after 1 day, small non-disabling stroke after 3 days, moderate stroke after 6 days, and large/disabling stroke after 12 days.

  3. In the management of cerebral venous sinus thrombosis (CVST), which treatment is recommended even in the presence of hemorrhagic infarction?

    Answer: Anticoagulation with heparin

    Anticoagulation with heparin is recommended for CVST even with hemorrhagic infarction, as it treats the underlying venous thrombosis and does not worsen outcomes.

  4. Which evidence-based protocol component is most associated with reducing door-to-needle time for IV tPA administration?

    Answer: Pre-notification from EMS with prehospital stroke screen

    EMS pre-notification with a validated prehospital stroke screen (e.g., CPSS, FAST) allows the stroke team to mobilize before patient arrival, consistently reducing door-to-needle time.

  5. According to the CLOSE trial, which combination is recommended for PFO closure candidate selection after cryptogenic stroke?

    Answer: Age <60, PFO with high-risk features (large shunt or atrial septal aneurysm), and exhaustive negative workup

    Based on CLOSE, RESPECT, and REDUCE trials, PFO closure is recommended for patients <60 years old with high-risk PFO features (large shunt or atrial septal aneurysm) after thorough negative stroke workup.

  6. For acute ischemic stroke patients receiving IV tPA who also have a large vessel occlusion (LVO), what is the evidence-based approach?

    Answer: Administer IV tPA and proceed immediately to thrombectomy ('drip-and-ship' or 'mothership')

    Current evidence supports administering IV tPA followed by immediate mechanical thrombectomy for eligible LVO patients, as IV tPA may partially recanalize clot and improve collaterals.

  7. The INTERACT2 trial's finding that early intensive blood pressure lowering in ICH was associated with better functional outcomes was primarily measured by:

    Answer: Modified Rankin Scale score at 90 days

    INTERACT2 showed that early intensive BP lowering (target SBP <140 mmHg) was associated with improved modified Rankin Scale scores at 90 days compared to guideline-recommended treatment.