Neurologists Exam Cerebrovascular Disease & Stroke 3

Question 1

Which of the following is an absolute contraindication to IV alteplase in acute ischemic stroke?

Accepted Answer

Intracranial surgery, serious head trauma, or prior stroke within 3 months

Answer

Intracranial surgery, serious head trauma, or prior ischemic stroke within the preceding 3 months are absolute contraindications to IV tPA due to markedly increased hemorrhage risk.

Question 2

First-line antiplatelet therapy for secondary prevention of non-cardioembolic ischemic stroke or TIA includes:

Accepted Answer

Aspirin alone or clopidogrel alone

Answer

Aspirin and clopidogrel are both first-line options for secondary prevention of non-cardioembolic stroke; dual antiplatelet therapy (DAPT) with both agents is used short-term for minor stroke/high-risk TIA.

Question 3

For secondary stroke prevention in a patient with ischemic stroke caused by non-valvular atrial fibrillation, the preferred long-term treatment is:

Accepted Answer

Oral anticoagulation with a DOAC or warfarin

Answer

Oral anticoagulation (DOACs preferred over warfarin where applicable) is the standard of care for secondary prevention in AF-related cardioembolic stroke, reducing recurrence risk by ~60–70%.

Question 4

In patients with acute ischemic stroke NOT receiving IV thrombolysis, current guidelines recommend which blood pressure management approach?

Accepted Answer

Permissive hypertension — allow BP up to 220/120 mmHg unless end-organ damage is present

Answer

Permissive hypertension (allowing BP up to 220/120 mmHg) is recommended in the first 24–48 hours for non-thrombolysis stroke patients to maintain cerebral perfusion in the ischemic penumbra.

Question 5

The most feared and clinically significant complication of IV alteplase therapy in acute ischemic stroke is:

Accepted Answer

Symptomatic intracranial hemorrhage (sICH)

Answer

Symptomatic intracranial hemorrhage (sICH) occurs in approximately 6% of tPA-treated patients and is associated with high mortality and disability, making it the most feared complication.

Neurologists Exam Practice Test

Neurologists Exam Practice Test

Neurologists Exam Cerebrovascular Disease & Stroke 3