ISCHEMIC CVD/TIA Flashcards
What is the maximum time window for administering IV rtPA after symptom onset?
A) 3 hours
B) 4.5 hours
C) 6 hours
D) 12 hours
Answer: B) 4.5 hours
Rationale: The table states that IV rtPA should be administered within 4.5 hours of symptom onset, though some countries may have additional restrictions.
Which of the following is NOT an indication for IV rtPA?
A) Age ≥18 years
B) CT scan showing no hemorrhage
C) Symptom onset within 6 hours
D) Clinical diagnosis of stroke
Answer: C) Symptom onset within 6 hours
Rationale: IV rtPA is only approved for administration within 4.5 hours of symptom onset. Beyond this window, the risk of hemorrhage outweighs the benefits
Which of the following is an absolute contraindication for rtPA administration?
A) Age > 18 years
B) History of gastrointestinal bleeding within the last 21 days
C) Blood pressure of 140/90 mmHg
D) Minor stroke symptoms
Answer: B) History of gastrointestinal bleeding within the last 21 days
Rationale: The table lists gastrointestinal bleeding in the preceding 21 days as a contraindication, as it increases the risk of hemorrhage after rtPA administration.
What is a necessary step before administering rtPA?
A) Administering heparin
B) Placing two peripheral IV lines
C) Conducting a lumbar puncture
D) Giving aspirin before rtPA infusion
Answer: B) Placing two peripheral IV lines
Rationale: The table indicates that two peripheral IV lines should be placed before rtPA administration to avoid arterial or central line complications.
How long should alternative anticoagulant treatments be avoided after administering rtPA?
A) 6 hours
B) 12 hours
C) 24 hours
D) 48 hours
Answer: C) 24 hours
Rationale: The table states no other antithrombotic treatment for 24 hours to minimize the risk of bleeding.
Which of the following conditions is NOT a contraindication for rtPA?
A) Major surgery in the past 14 days
B) Blood pressure of 185/110 mmHg despite treatment
C) Mild ischemic stroke symptoms
D) Recent myocardial infarction
Answer: C) Mild ischemic stroke symptoms
Rationale: Mild stroke symptoms are not explicitly listed as a contraindication, but cautious evaluation is needed. However, the other options are listed as contraindications in the table.
f a patient develops uncontrolled blood pressure after receiving rtPA, what should be done?
A) Continue the infusion as planned
B) Administer aspirin immediately
C) Stop infusion and manage blood pressure
D) Give an additional rtPA bolus
Answer: C) Stop infusion and manage blood pressure
Rationale: The table advises stopping infusion and managing BP if there is a decline in neurological status or uncontrolled hypertension, as high BP increases hemorrhagic risk.
What is the standard definition of the duration of a transient ischemic attack (TIA)?
A) <1 hour
B) <12 hours
C) <24 hours
D) <48 hours
Answer: C) <24 hours
Rationale: The passage states that the standard definition for TIA duration is less than 24 hours, though most TIAs last less than 1 hour.
What does a normal brain imaging study indicate following a TIA?
A) The patient did not have a TIA
B) The TIA diagnosis is ruled out
C) Clinical evaluation remains the diagnostic standard
D) The patient is at low risk for stroke
Answer: C) Clinical evaluation remains the diagnostic standard
Rationale: The passage states that a normal brain imaging study does not rule out TIA, and that clinical syndrome remains diagnostic.
Which scoring system is used to estimate the risk of stroke following a TIA?
A) CHADS2 score
B) ABCD2 score
C) NIH Stroke Scale
D) HAS-BLED score
Answer: B) ABCD2 score
Rationale: The passage explicitly mentions that the ABCD2 score is a well-validated tool used to estimate stroke risk following a TIA.
Which combination of medications was found to be more effective than aspirin alone in preventing stroke after TIA?
A) Aspirin + Warfarin
B) Aspirin + Ticagrelor
C) Aspirin + Clopidogrel
D) Aspirin + Heparin
Answer: C) Aspirin + Clopidogrel
Rationale: The passage describes that a large Chinese randomized trial and the NIH-sponsored POINT study showed that aspirin combined with clopidogrel was more effective than aspirin alone in preventing stroke after TIA.
Why might some patients not respond well to clopidogrel for stroke prevention?
A) They have an unknown drug allergy
B) They develop tolerance over time
C) They carry a CYP2C19 polymorphism
D) Clopidogrel is ineffective for ischemic stroke
Answer: C) They carry a CYP2C19 polymorphism
Rationale: The passage states that poor metabolism of clopidogrel is linked to a CYP2C19 polymorphism, which is particularly common in Asians.
Which of the following clinical factors in the ABCD² score is assigned the highest individual point value?
A) Age ≥60 years
B) Speech disturbance without weakness
C) Duration >60 minutes
D) Diabetes
Answer: C) Duration >60 minutes
Rationale: According to the table, a TIA lasting more than 60 minutes is assigned 2 points, which is the highest individual score along with unilateral weakness.
A patient with a history of diabetes who experiences a TIA lasting 45 minutes, has a blood pressure of 150/95 mmHg, and is 65 years old would have what total ABCD² score?
A) 3
B) 4
C) 5
D) 6
Answer: B) 4
Rationale:
Age ≥60 years: 1 point
Blood pressure >140/90 mmHg: 1 point
Duration (10–59 minutes): 1 point
Diabetes: 1 point
Which of the following statements about the ABCD² score is TRUE?
A) A score of 0 means the patient has no risk of stroke.
B) Diabetes contributes the highest individual score.
C) Unilateral weakness is weighted more than speech disturbance.
D) The ABCD² score does not include blood pressure as a factor.
Answer: C) Unilateral weakness is weighted more than speech disturbance.
Rationale: The table assigns 2 points for unilateral weakness but only 1 point for speech disturbance without weakness.
What is a major limitation of neuroprotective drugs in the treatment of ischemic stroke?
A. They have only been tested in animals
B. They significantly increase the risk of stroke recurrence
C. They have not yet been proven beneficial in human trials
D. They cause severe side effects that outweigh any benefits
Answer: C
Rationale: Although neuroprotective drugs have shown promise in animal models by blocking excitatory amino acid pathways, clinical trials in humans have not demonstrated clear benefits, limiting their use in stroke treatment.
Which of the following is the most common risk factor for small-vessel stroke?
A. Smoking
B. Diabetes
C. Hypertension
D. Hyperlipidemia
Answer: C
Rationale: Hypertension is the principal risk factor for small-vessel strokes, as it contributes to the development of lipohyalinotic thickening and atherothrombotic disease in small arteries.
Which of the following clinical syndromes is NOT typically associated with small-vessel stroke?
A. Pure motor hemiparesis
B. Pure sensory stroke
C. Ataxic hemiparesis
D. Hemianopia
Answer: D
Rationale: Hemianopia (loss of vision in half the visual field) is typically associated with larger-vessel strokes affecting the occipital lobe. Small-vessel strokes more commonly cause syndromes such as pure motor hemiparesis, pure sensory stroke, and ataxic hemiparesis.
Which artery branches are commonly involved in small-vessel stroke?
A. Middle cerebral artery (MCA) stem and the circle of Willis branches
B. Superficial cortical arteries
C. Posterior cerebral artery (PCA) main trunk
D. External carotid artery branches
Answer: A
Rationale: Small-vessel strokes occur due to occlusion of small penetrating arteries that originate from the MCA stem, the arteries of the circle of Willis, and the basilar and vertebral arteries. These branches supply deep gray and white matter structures.
Which of the following small-vessel stroke syndromes results from an infarct in the ventral thalamus?
A. Pure motor hemiparesis
B. Pure sensory stroke
C. Dysarthria-clumsy hand syndrome
D. Ataxic hemiparesis
Answer: B
Rationale: Pure sensory stroke is caused by an infarct in the ventral thalamus, leading to sensory deficits without motor involvement.
What is the key strategy for secondary prevention of small-vessel strokes?
A. Long-term anticoagulation therapy
B. Surgical removal of the occluded artery
C. Blood pressure reduction
D. Routine thrombolytic therapy
Answer: C
Rationale: Reducing blood pressure is the most effective strategy for preventing recurrent small-vessel strokes, as hypertension is a primary risk factor for their development.
What was the primary outcome of combining aspirin with clopidogrel or ticagrelor following minor stroke or TIA?
A. Increased risk of hemorrhagic stroke
B. Higher mortality rates
C. Prevention of a second stroke
D. No measurable benefit
Answer: C
Rationale: The combination of aspirin with clopidogrel or ticagrelor has been shown to be effective in preventing second strokes after minor stroke or TIA, making dual antiplatelet therapy a recommended strategy in certain cases.
What is a major limitation of neuroprotective drugs in the treatment of ischemic stroke?
A. They have only been tested in animals
B. They significantly increase the risk of stroke recurrence
C. They have not yet been proven beneficial in human trials
D. They cause severe side effects that outweigh any benefits
Answer: C
Rationale: Although neuroprotective drugs have shown promise in animal models by blocking excitatory amino acid pathways, clinical trials in humans have not demonstrated clear benefits, limiting their use in stroke treatment.
