INSTRUCTIONS The golden hour Performing an acute ischemic stroke workup
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The golden hour Performing an acute ischemic stroke workup
General Purpose: To provide a summary of recent updates on the rapid evaluation and workup for patient selection and treatment with I.V. fibrinolysis. Learning Objectives: After reading the preceding article and taking this test, you should be able to: 1. Assess patients with symptoms of acute ischemic stroke (AIS) and determine eligibility for the use of I.V. rt-PA. 2. Identify the treatment recommendations for the use of I.V. rt-PA in patients with AIS.
1. Ischemic stroke accounts for what percentage of all strokes?
2. Cardinal symptoms predictive of stroke include the sudden onset of any of the following except
a. facial droop.
b. visuospatial neglect.
c. slurred speech.
3. A hallmark symptom that may result from thrombosis of the basilar artery is the acute onset of
a. gait disturbances.
b. isolated leg weakness.
c. receptive aphasia.
4. The time of symptom onset is defined as
a. when the patient was last seen normal.
b. time of arrival in the ED.
c. when the patient was first observed to be symptomatic.
d. when the symptoms became severe enough to require an ED visit.
5. According to the U.FDA, treatment of AIS with I.rt-PA must begin within (at most) how many hours after symptom onset?
6. The NINDS door-to-treatment goal for treating AIS with I.rt-PA is
a. ≤30 minutes.
b. ≤60 minutes.
c. ≤90 minutes.
d. ≤120 minutes.
7. The NINDS time target for interpretation of the CT scan for patients with suspected AIS is
a. ≤15 minutes.
b. ≤25 minutes.
c. ≤45 minutes.
d. ≤60 minutes.
8. Which is a contraindication for the treatment of AIS with I.rt-PA within 3 to 4.5 hours?
a. age > 80
b. gastrointestinal surgery 4 weeks ago
c. platelet count 200,000/mm3
d. NIHSS score of 20
9. Which is not recognized as a condition that mimics stroke?
c. systemic infection
10. One “essential, immediate” diagnostic test needed before treatment with I.rt-PA is
a. an ECG.
b. a complete blood cell count.
c. cardiac enzymes.
d. an oxygen saturation.
11. For a patient who is not on anticoagulants and has no known bleeding diatheses, the only lab test that must be obtained before I.rt-PA administration is
a. blood glucose.
12. Which statement about use of I.rt-PA for patients on the newer anticoagulants such as dabigatran is true?
a. The risk of using I.rt-PA for the treatment of AIS in any patient on dabigatran outweighs the potential benefits.
b. An INR will accurately reflect of the degree of anticoagulation.
c. I.rt-PA is contraindicated in any patient on anticoagulants.
d. I.rt-PA may be used in eligible patients who have not received the medication for at least 2 days.
13. Which test is used routinely for emergent brain imaging in AIS?
a. contrast CT
b. noncontrast CT
d. magnetic resonance angiography
14. Treatment with I.rt-PA should be avoided if the imaging study results reveal frank hypodensity involving > 1/3 of the
a. basilar artery territory.
b. posterior cerebral artery territory.
c. MCA territory.
d. anterior inferior cerebellar artery territory.
15. During the golden hour, patients eligible for rt-PA must have their BP lowered when systolic and diastolic pressures rise above
a. 155 mm Hg or 80 mm Hg, respectively.
b. 165 mm Hg or 90 mm Hg, respectively.
c. 175 mm Hg or 100 mm Hg, respectively.
d. 185 mm Hg or 110 mm Hg, respectively.
16. Which statement is true about managing BP in patients eligible for rt-PA treatment?
a. It is reasonable to abstain from I.rt-PA therapy when the BP is resistant to treatment.
b. The BP should be maintained ≤160/90 mm Hg for at least 12 hours post rt-PA treatment.
c. Metoprolol is recommended for lowering BP during the hyperacute period of AIS.
d. Rapidly lowering the systemic BP can have a dramatic, beneficial effect on cerebral ischemia.
17. The dose for I.rt-PA in the treatment of AIS is
a. 0.6 mg/kg.
b. 0.9 mg/kg.
c. 1.2 mg/kg.
d. 1.5 mg/kg.
18. The maximum dose of rt-PA for patients with AIS is
a. 50 mg.
b. 65 mg.
c. 90 mg.
d. 100 mg.