Stroke quiz with complete solutions
A+ graded
59-year-old man with a history of hypertension presents to the emergency department (ED)
with right-sided paralysis and aphasia. The patient's wife states he was in his normal state of
health until 1 hour ago, when she heard a thud in the bathroom and walked in to find him
collapsed on the floor. She immediately called emergency medical services, which transported
the patient to your ED. En route, his fingerstick blood sugar was 108 mg/dL. On arrival in the ED,
the patient is placed on monitors and an IV is established. His temperature is 36.8°C (98.2°F),
blood pressure is 169/93 mm Hg, heart rate is 86 beats per minute, and respiratory rate is 20
breaths per minute. The patient has a noticeable left-gaze preference and is verbally
unresponsive, although he will follow simple commands such as raising his left thumb. He has a
normal neurologic examination on the left, but on the right he has a facial droop, no motor a -
correct answer ✔✔ Summary: This is a 59-year-old man with acute onset of aphasia and right-
sided paralysis 60 minutes prior to arrival in the ED.
Most likely diagnosis: Stroke.
Most appropriate next step: CT scan of the head.
Best therapy: Thrombolytics.
Considerations
This 59-year-old man presents with an acute onset of focal neurologic deficits, which are typical
for a cerebrovascular accident (CVA). Management priorities include: ABCs (airway, breathing,
and circulation), stabilization of vitals, and a careful history and physical to distinguish CVA from
other etiologies which may present similarly, such as hypoglycemia. Non-contrast CT is used to
quickly determine whether the CVA is ischemic or hemorrhagic. If the event is ischemic, the
patient may be a candidate for thrombolytic administration. The goal is to complete an
, evaluation and, if the patient is eligible, initiate treatment within 60 minutes of the patient's
arrival to the ED. We must be cognizant that "Time is Brain Tissue."
A 58-year-old man experienced a neurologic deficit and is diagnosed as having a stroke. Which
of the following is the most likely etiology?
A
Ischemic
B
Hemorrhagic
C
Drug-induced
D
Trauma-induced
E
Metabolic-related - correct answer ✔✔ The correct answer is A.
Explanation:
A. Ischemia is the most common etiology of stroke (due to thrombosis, embolism, or
hypoperfusion) and is responsible for up to 80% of strokes.
An 80-year-old man is being evaluated for possible thrombolytic therapy after presenting with 2
hours of right arm weakness and aphasia. Which of the following is a contraindication for
thrombolytic therapy?
A+ graded
59-year-old man with a history of hypertension presents to the emergency department (ED)
with right-sided paralysis and aphasia. The patient's wife states he was in his normal state of
health until 1 hour ago, when she heard a thud in the bathroom and walked in to find him
collapsed on the floor. She immediately called emergency medical services, which transported
the patient to your ED. En route, his fingerstick blood sugar was 108 mg/dL. On arrival in the ED,
the patient is placed on monitors and an IV is established. His temperature is 36.8°C (98.2°F),
blood pressure is 169/93 mm Hg, heart rate is 86 beats per minute, and respiratory rate is 20
breaths per minute. The patient has a noticeable left-gaze preference and is verbally
unresponsive, although he will follow simple commands such as raising his left thumb. He has a
normal neurologic examination on the left, but on the right he has a facial droop, no motor a -
correct answer ✔✔ Summary: This is a 59-year-old man with acute onset of aphasia and right-
sided paralysis 60 minutes prior to arrival in the ED.
Most likely diagnosis: Stroke.
Most appropriate next step: CT scan of the head.
Best therapy: Thrombolytics.
Considerations
This 59-year-old man presents with an acute onset of focal neurologic deficits, which are typical
for a cerebrovascular accident (CVA). Management priorities include: ABCs (airway, breathing,
and circulation), stabilization of vitals, and a careful history and physical to distinguish CVA from
other etiologies which may present similarly, such as hypoglycemia. Non-contrast CT is used to
quickly determine whether the CVA is ischemic or hemorrhagic. If the event is ischemic, the
patient may be a candidate for thrombolytic administration. The goal is to complete an
, evaluation and, if the patient is eligible, initiate treatment within 60 minutes of the patient's
arrival to the ED. We must be cognizant that "Time is Brain Tissue."
A 58-year-old man experienced a neurologic deficit and is diagnosed as having a stroke. Which
of the following is the most likely etiology?
A
Ischemic
B
Hemorrhagic
C
Drug-induced
D
Trauma-induced
E
Metabolic-related - correct answer ✔✔ The correct answer is A.
Explanation:
A. Ischemia is the most common etiology of stroke (due to thrombosis, embolism, or
hypoperfusion) and is responsible for up to 80% of strokes.
An 80-year-old man is being evaluated for possible thrombolytic therapy after presenting with 2
hours of right arm weakness and aphasia. Which of the following is a contraindication for
thrombolytic therapy?
