Stroke Practice Questions

13. Which of the following is an appropriate monitoring parameter for a patient given alteplase? A. Bleeding B. Blue discoloration of the skin C. Headache D. Tongue swelling

A. It is appropriate to monitor bleeding in a patient given alteplase.

11. What is the HAS-BLED score for JC from question 10? A. 1 B. 2 C. 3 D. 4

B. This patient would receive points for a history of stroke and his age (>65 years).

15. MP is a 66-year-old woman who sustained an ischemic stroke. She is discharged on clopidogrel 75 mg daily plus aspirin 81 mg daily for 21 days. Which of the following will help decrease her chance of recurrent stroke? A. Follow-up regarding adherence B. Frequently monitoring her blood pressure C. Frequently monitoring her weight D. Screening for depression

A. Some of the most important causes of breakthrough strokes are nonadherence, inappropriate dosing, reduced absorption, increased metabolism, drug-drug interactions, and genetic polymorphisms. Monitoring blood pressure, weight, or mood are unlikely to decrease future strokes.

6. BN is an 84-year-old male who presents to the emergency department with acute ischemic stroke symptoms. His symptoms began 2 hours ago. His current blood pressure is 176/98 mm Hg and his glucose is 110 mg/dL (6.1 mmol/L). He has had a computed tomography (CT) scan of the head that shows no bleeding. He is currently taking aspirin 81 mg daily and lisinopril 10 mg daily. He has no medication allergies. Is BN a candidate for alteplase? A. Yes B. No, his symptoms began too long ago C. No, he is too old D. No, he is taking aspirin

A. This patient is within the 4.5-hour window for alteplase administration, his blood pressure is <180/110 mm Hg, and he has no intracranial bleeding. Patients can be maintained on aspirin and receive alteplase.

5. Who is the best candidate for carotid stenting to reduce recurrent stroke? A. A 65-year-old female with 50% stenosis of the ipsilateral internal carotid artery B. A 65-year-old male with 75% stenosis of the ipsilateral internal carotid artery C. A 75-year-old male with 50% stenosis of the ipsilateral internal carotid artery D. A 75-year-old female with 75% stenosis of the ipsilateral internal carotid artery

B. In patients younger than 70 years with 70% to 99% stenosis of an ipsilateral internal carotid artery, carotid stenting can be performed. See "Nonpharmacologic Therapy" section for more details.

1. A cardioembolic stroke is a type of ______________ stroke. A. Hemorrhagic B. Ischemic C. Lacunar D. Intracerebral hemorrhage

B. The two major types of stroke are ischemic and hemorrhagic. Ischemic strokes are often the result of large artery atherosclerosis, small artery disease, or cardioembolism. These three subtypes are the most common etiologies of ischemic strokes.

8. ST is a 68-year-old woman who presented with an ischemic stroke 2 days ago. She received alteplase and her deficits improved. Prior to the stroke, she was taking no medications. She is allergic to aspirin (hives and shortness of breath). Which of the following agents should ST receive to prevent recurrent strokes? A. Aspirin B. Clopidogrel C. Clopidogrel plus aspirin D. Extended-release dipyridamole plus aspirin

B. This patient is allergic to aspirin; thus, it should not be a component of her therapy.

7. KC is a 65-year-old woman who presents to the emergency department with acute ischemic stroke symptoms. Her symptoms began 6 hours ago. Her current blood pressure is 170/96 mm HG and her glucose is 104 mg/dL (5.8 mmol/L). She has had a computed tomography (CT) scan of the head that shows no bleeding. She is currently taking hydrochlorothiazide 25 mg daily. She is allergic to aspirin (oral facial edema). Is KC a candidate for alteplase? A. Yes B. No, her symptoms began too long ago C. No, she is too old D. No, she is taking hydrochlorothiazide

B. This patient is not within the 4.5-hour window for alteplase administration.

12. RG is a 74-year-old man who is being discharged from the hospital after a mild stroke. His blood pressure has stabilized at 156/98 mm Hg and is low-density lipoprotein cholesterol is 110 mg/dL (2.84 mmol/L). On which of the following regimens should RG be placed? A. Atorvastatin 40 mg daily B. Hydrochlorothiazide 25 mg daily plus rosuvastatin 20 mg daily C. Lisinopril 5 mg daily D. Lovastatin 40 mg daily plus losartan 50 mg daily

B. This patient will require blood pressure lowering because his blood pressure is >140/90 mm Hg. He will also require high-intensity statin therapy because he is less than 75 years old.

2. Match the type of hemorrhagic stroke to its cause. A. Intracerebral hemorrhage: the rupture of an intracerebral aneurysm B. Intracerebral hemorrhage: trauma C. Subarachnoid hemorrhage: the rupture of an arteriovenous malformation D. Subarachnoid hemorrhage: uncontrolled hypertension

C. Subarachnoid hemorrhage occurs when blood enters the subarachnoid space, which can occur due to trauma, rupture of an intracerebral aneurysm, or rupture of an arteriovenous malformation. Intracerebral hemorrhage, however, occurs when bleeding occurs in the brain parenchyma itself, with the formation of a hematoma within the brain. Uncontrolled hypertension is the most common causative factor for intracerebral hemorrhage, but antithrombotic therapy, cerebral amyloid angiopathy, and some drugs of abuse are also associated with intracerebral hemorrhage.

14. BC is a 58-year-old man with atrial fibrillation who sustained an ischemic stroke. He was placed on warfarin. Which of the following is an appropriate monitoring plan for BC? A. Check blood glucose daily B. Check blood pressure three times daily C. Monitor INR for a target of 2.5 D. Monitor tyramine-containing food consumption

C. Target INR for patients with atrial fibrillation who are given warfarin is 2.5.

3. RT is a 77-year-old man who presents to the emergency department with symptoms of an ischemic stroke. His past medical history includes hypertension, hypothyroidism, benign prostatic hypertrophy, and hypercholesterolemia. What are RT's stroke risk factors? A. Age, hypertension, and hypercholesterolemia B. Age, sex, hypertension, hypothyroidism, and hypercholesterolemia C. Age, sex, hypertension, hypercholesterolemia D. Sex, hypothyroidism, benign prostatic hypertrophy, and hypercholesterolemia E. Sex, hypertension, hypercholesterolemia

C. The nonmodifiable stroke risk factors are age, race, sex, low birth weight, and genetic factors. The most common modifiable, well-documented risk factors for ischemic stroke include hypertension, cigarette smoking, diabetes, atrial fibrillation, and dyslipidemia.

9. FR is a 58-year-old man who has had atrial fibrillation for 5 years. He was maintained on aspirin 325 mg daily. Four days ago, he sustained an ischemic stroke. What is the best choice of therapy for FR to prevent recurrent stroke? A. Aspirin B. Clopidogrel C. Extended-release dipyridamole plus aspirin D. Rivaroxaban

D. Oral anticoagulation is the treatment of choice for the prevention of stroke in patients with atrial fibrillation. Choice of agent may include warfarin, dabigatran, rivaroxaban, edoxaban, and apixaban.

4. Which of the following is not a symptom of an acute stroke? A. Inability to speak B. Loss of vision C. Weakness on one side of the body D. Whole body numbness

D. Symptoms of acute stroke include weakness on one side of the body, inability to speak, loss of vision, vertigo and/or falling and occasionally headache. Stroke symptoms tend to involve only one side of the body. See the Clinical Presentation box for a review of stroke presentation.

10. JC is a 79-year-old 150 kg man who recently sustained an ischemic stroke. During the workup, he was found to have atrial fibrillation. His blood pressure is 145/90 mm Hg. His serum creatinine is 4.5 mg/dL (398 µmol/L)(creatinine clearance 28 mL/min [0.47 mL/s]) and his BMI is 50 kg/m2. Which of the following oral anticoagulants is most appropriate for JC? A. Apixaban 5 mg daily B. Edoxaban 30 mg daily C. Dabigatran 150 mg twice daily D. Warfarin adjusted to a target INR of 2.5

D. The direct-acting oral anticoagulant doses need to be adjusted for patients with renal dysfunction. There is limited information on the use of these agents in patients with a body mass index over 40 kg/m2. Therefore, warfarin would be the better choice for this patient.