Physician Assistant Physician Assistant Neurological System Disorders 1 — Questions and Answers
Question 1: A 65-year-old male presents with sudden onset right-sided facial droop, arm weakness, and aphasia that resolved completely within 45 minutes. What is the most likely diagnosis?
- Ischemic stroke
- Transient ischemic attack (TIA) (Correct answer)
- Complex migraine
- Todd's paralysis
Correct answer: Transient ischemic attack (TIA)
A transient ischemic attack (TIA) presents with stroke-like symptoms that resolve completely within 24 hours (typically minutes), with no infarction on imaging.
Question 2: Which of the following is the most common type of stroke?
- Hemorrhagic stroke
- Ischemic stroke (Correct answer)
- Subarachnoid hemorrhage
- Subdural hematoma
Correct answer: Ischemic stroke
Ischemic stroke accounts for approximately 87% of all strokes, caused by thrombotic or embolic occlusion of cerebral vessels.
Question 3: A patient presents with thunderclap headache described as 'the worst headache of my life.' CT head is negative. What is the next most appropriate step?
- Discharge with analgesics
- MRI brain without contrast
- Lumbar puncture to check for xanthochromia (Correct answer)
- EEG
Correct answer: Lumbar puncture to check for xanthochromia
When CT is negative in a patient with thunderclap headache, lumbar puncture to detect xanthochromia is essential to rule out subarachnoid hemorrhage, which may not appear on CT after several hours.
Question 4: What is the time window for administration of IV alteplase (tPA) in acute ischemic stroke?
- Within 1 hour of symptom onset
- Within 3–4.5 hours of symptom onset (Correct answer)
- Within 6 hours of symptom onset
- Within 12 hours of symptom onset
Correct answer: Within 3–4.5 hours of symptom onset
IV alteplase is approved for administration within 3 hours of symptom onset, with select patients eligible up to 4.5 hours based on AHA/ASA guidelines.
Question 5: Which of the following is a contraindication to IV tPA in acute ischemic stroke?
- Age over 65
- Blood pressure of 150/90 mmHg
- Ischemic stroke or head trauma within the past 3 months (Correct answer)
- Atrial fibrillation
Correct answer: Ischemic stroke or head trauma within the past 3 months
Recent ischemic stroke or serious head trauma within the prior 3 months is an absolute contraindication to IV tPA due to the risk of hemorrhagic transformation.
Question 6: A 25-year-old woman presents with optic neuritis and new-onset sensory disturbances in her extremities. MRI shows periventricular white matter lesions. What is the most likely diagnosis?
- Neuromyelitis optica
- Multiple sclerosis (Correct answer)
- CNS vasculitis
- Vitamin B12 deficiency
Correct answer: Multiple sclerosis
Multiple sclerosis classically presents in young women with relapsing-remitting neurological symptoms, optic neuritis, and periventricular demyelinating lesions on MRI.
Physician Assistant Physician Assistant Neurological System Disorders 1
A 65-year-old male presents with sudden onset right-sided facial droop, arm weakness, and aphasia that resolved completely within 45 minutes.
What is the most likely diagnosis?