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Chapter 11. Stroke

Student Questions

Which one of the following is the most important diagnostic test for ischemic and hemorrhagic stroke?

A. Carotid Doppler studies

B. Transcranial Doppler

C. CT scan of the head

D. MRI of the neck

Answer: C

Option A: Incorrect. Carotid Doppler studies may be indicated; however, a CT scan or MRI of the head must be completed to rule out a hemorrhagic stroke before treatment can be initiated.

Option B: Incorrect. A transcranial Doppler may be indicated; however, a CT scan or MRI of the head must be completed to rule out a hemorrhagic stroke before treatment can be initiated.

Option C: Correct. CT scan of the head is the most important diagnostic test for ischemic and hemorrhagic stroke.

Option D: Incorrect. An MRI of the neck is typically not indicated in the diagnosis of stroke.

A 68-year-old male patient is admitted to the acute stroke unit for IV alteplase approximately 2.5 hours after his symptoms began. His blood pressure is 198/115 mm Hg on admission to the acute stroke unit. Which one of the following is the appropriate treatment at this time?

A. Administer IV alteplase immediately using recommended dosing

B. Administer labetalol 10 mg IV and recheck BP in 10 minutes

C. Hold IV alteplase and recheck BP in 30 minutes

D. IV alteplase contraindicated due to patient's BP

Answer: B

Option A: Incorrect. Immediate administration of alteplase in not indicated as this patient does not meet the criteria for administration due to his elevated BP.

Option B: Correct. Cautious lowering of his BP to meet the goal for alteplase administration is indicated in this patient.

Option C: Incorrect. Blood pressure should be monitored frequently in patients presenting with stroke who are being considered for treatment with alteplase.

Option D: Incorrect. If the BP can be lowered, this patient is a candidate for treatment with alteplase, so efforts to lower his BP should be attempted.

A 54-year-old white woman has diabetes, hypertension and dyslipidemia. She gets little activity during her working hours as an administrative assistant and eats a normal diet. Which one of the following represents her combination of risk factors for stroke?

A. Inactivity, age, race, poor diet

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