ASC Evidence-Based Stroke Protocols 3

Question 1

According to evidence-based stroke protocols, which antiplatelet regimen is recommended for secondary prevention after a minor ischemic stroke or high-risk TIA (ABCD2 ≥4)?

Accepted Answer

Dual antiplatelet therapy with aspirin and clopidogrel for 21 days

Answer

Based on the POINT and CHANCE trials, dual antiplatelet therapy (aspirin + clopidogrel) for 21 days significantly reduces early recurrent stroke after minor stroke or high-risk TIA.

Question 2

In hemorrhagic stroke management, which evidence-based target systolic BP is recommended for patients with ICH and initial SBP between 150–220 mmHg?

Accepted Answer

SBP < 140 mmHg

Answer

AHA/ASA guidelines support rapid lowering of SBP to <140 mmHg for ICH patients with initial SBP 150–220 mmHg, as supported by the ATACH-2 and INTERACT2 trials.

Question 3

Which finding on CT angiography most strongly predicts hematoma expansion in intracerebral hemorrhage?

Accepted Answer

Spot sign (contrast extravasation within hematoma)

Answer

The CT angiography 'spot sign' — active contrast extravasation within the hematoma — is a strong independent predictor of hematoma expansion and poor outcome.

Question 4

Per AHA/ASA guidelines, which patient with cryptogenic stroke has the strongest indication for prolonged cardiac monitoring (≥30 days)?

Accepted Answer

55-year-old with embolic stroke of undetermined source (ESUS) after negative standard workup

Answer

Prolonged cardiac monitoring is most strongly indicated in ESUS patients without a detected source after standard workup, to detect paroxysmal atrial fibrillation.

Question 5

The CHANCE-2 trial demonstrated that ticagrelor-aspirin was superior to clopidogrel-aspirin for minor stroke/TIA prevention specifically in patients with:

Accepted Answer

CYP2C19 loss-of-function variants

Answer

CHANCE-2 showed ticagrelor-aspirin was superior to clopidogrel-aspirin in minor stroke/TIA patients carrying CYP2C19 loss-of-function alleles who have reduced clopidogrel metabolism.

(ASC) Advanced Stroke Coordinator Certification Practice Test

(ASC) Advanced Stroke Coordinator Certification Practice Test

ASC Evidence-Based Stroke Protocols 3