ASC Post-Stroke Complications Management 3 — Questions and Answers
Question 1: Post-stroke depression occurs in approximately what percentage of stroke survivors within the first year?
- 30–40% (Correct answer)
- 5–10%
- 60–70%
- 15–20%
Correct answer: 30–40%
Post-stroke depression affects roughly one-third of survivors and is independently associated with increased mortality and worse functional outcomes.
Question 2: A stroke patient develops urinary incontinence. Which initial management strategy is MOST appropriate?
- Timed voiding schedule and bladder training (Correct answer)
- Immediate insertion of an indwelling urinary catheter
- Oxybutynin prescription on day 1
- Cystoscopy to rule out structural causes
Correct answer: Timed voiding schedule and bladder training
Behavioral interventions (timed voiding, prompted voiding) are the first-line approach and minimize catheter-associated infection risk.
Question 3: Which finding on post-stroke EEG is MOST indicative of non-convulsive status epilepticus (NCSE)?
- Continuous rhythmic epileptiform discharges without clinical convulsions (Correct answer)
- Generalized slowing with delta waves
- Burst-suppression pattern
- Alpha coma pattern
Correct answer: Continuous rhythmic epileptiform discharges without clinical convulsions
NCSE in stroke patients presents as continuous or near-continuous rhythmic epileptiform discharges on EEG with altered consciousness but no overt motor activity.
Question 4: Shoulder subluxation after stroke is BEST prevented by which intervention?
- Proper arm positioning and use of arm slings during transfers (Correct answer)
- Early aggressive passive range-of-motion exercises
- Application of a heat pack to the affected shoulder
- Botulinum toxin injection within 48 hours
Correct answer: Proper arm positioning and use of arm slings during transfers
Subluxation results from flaccid paralysis and gravity; supported positioning and slings during mobilization prevent inferior displacement of the humeral head.
Question 5: A post-stroke patient has a serum sodium of 126 mEq/L on day 5 with euvolemia. What is the MOST likely diagnosis?
- Syndrome of inappropriate antidiuretic hormone (SIADH) (Correct answer)
- Cerebral salt wasting
- Diabetes insipidus
- Adrenal insufficiency
Correct answer: Syndrome of inappropriate antidiuretic hormone (SIADH)
SIADH is the most common cause of hyponatremia after stroke, characterized by low serum osmolality, concentrated urine, and euvolemia.
Question 6: Which antidepressant class is PREFERRED for post-stroke depression due to its favorable safety profile and evidence base?
- Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Correct answer: Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are first-line for post-stroke depression due to their tolerability, low anticholinergic burden, and evidence from multiple randomized controlled trials.
Question 7: Post-stroke fatigue differs from pre-stroke fatigue in that it is CHARACTERISTICALLY:
- Disproportionate to activity level and not relieved by rest (Correct answer)
- Directly correlated with depression severity
- Relieved by a single night of sleep
- Caused exclusively by sleep apnea
Correct answer: Disproportionate to activity level and not relieved by rest
Post-stroke fatigue is a distinct neurological symptom that occurs out of proportion to exertion and persists despite adequate rest, differentiating it from simple tiredness.
ASC Post-Stroke Complications Management 3
Post-stroke depression occurs in approximately what percentage of stroke survivors within the first year?