CNS Treatment Protocols & Therapeutic Interventions 2

Question 1

Before IV alteplase is given for acute ischemic stroke, blood pressure must be lowered to below what level?

Accepted Answer

185/110 mmHg

Answer

AHA/ASA guidelines require BP below 185/110 mmHg before thrombolysis and below 180/105 mmHg for 24 hours afterward.

Question 2

What is the standard IV alteplase dose for acute ischemic stroke?

Accepted Answer

0.9 mg/kg, max 90 mg, with 10% as a bolus

Answer

Alteplase is dosed at 0.9 mg/kg (max 90 mg): 10% as a 1-minute bolus and the rest infused over 60 minutes.

Question 3

A patient in status epilepticus is still seizing after two doses of IV lorazepam. What is the most appropriate next step?

Accepted Answer

Give an IV second-line drug such as fosphenytoin, valproate, or levetiracetam

Answer

Benzodiazepine-refractory status epilepticus calls for an IV second-line antiseizure drug; the ESETT trial found fosphenytoin, valproate, and levetiracetam about equally effective.

Question 4

Which intervention is first-line for an acute multiple sclerosis relapse that impairs function?

Accepted Answer

High-dose IV methylprednisolone for 3–5 days

Answer

High-dose corticosteroids (usually methylprednisolone 1 g daily for 3–5 days) speed recovery from MS relapses.

Question 5

For steroid-refractory severe MS relapses, which therapy is the usual rescue option?

Accepted Answer

Plasma exchange

Answer

Plasma exchange is recommended for severe demyelinating attacks that do not respond to high-dose corticosteroids.

CNS - Certified Neuro Specialist Practice Test

CNS - Certified Neuro Specialist Practice Test

CNS Treatment Protocols & Therapeutic Interventions 2