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Clinical Review Quiz

Management of Ischemic Stroke

Gary L. Bernardini, MD, PhD, and Dileep R. Yavagal, MD

Dr. Bernardini is an associate professor, Departments of Neurology and Neurosurgery, and director, Stroke and Neurocritical Care. Dr. Yavagal is an assistant professor, Departments of Neurology and Neurosurgery, and co-director of neuroendovascular surgery; both are at Albany Medical Center, Albany, NY.

The questions below are based on the article
“Management of Ischemic Stroke”.

Choose the single best answer for each question.

1. All of the following are nonmodifiable risk factors for stroke EXCEPT:
  1. Age
  2. Hypertension
  3. Race
  4. Gender
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2. The hypoperfused area of brain around the core of infarction that is salvageable if cerebral blood flow is rapidly restored is called

  1. Collateral flow
  2. Cytotoxic edema
  3. The ischemic penumbra
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3. Which of the following stroke risk factors is best treated with anticoagulation?

  1. Aortic arch plaque
  2. Atrial fibrillation
  3. Carotid disease
  4. Patent foramen ovale (PFO)
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4. The percentage of ischemic stroke patients in the United States who receive intravenous recombinant tissue-plasminogen activator (rt-PA) therapy ranges from

  1. 2%-5%
  2. 5%-10%
  3. 15%-20%
  4. 25%-30%
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5. According to the National Institute of Neurological Disorders and Stroke (NINDS) trial, what is the therapeutic time window for intravenous rt-PA and the duration of time over which significant neurologic improvement is expected with rt-PA?
  1. 3-6 hours, 1 day
  2. ≤ 3 hours, 1 day
  3. ≤ 90 minutes, 90 days
  4. ≤ 3 hours, 90 days
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6. A stroke in which area of the brain would cause aphasia?

  1. Left hemisphere
  2. Right hemisphere
  3. Pons
  4. Cerebellum
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7. Which of the following results was seen in the Prolyse in Acute Cerebral Thromboembolism (PROACT) II trial, which evaluated intra-arterial treatment of acute stroke with pro-urokinase?

  1. Nonsignificant benefit in 90-day outcomes in the treatment arm
  2. Worse outcome in 90-day outcomes in treatment arm
  3. Better outcome in 90-day outcomes in placebo arm
  4. Significant benefit in 90-day outcomes in treatment arm
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8. In the prospective multicenter, nonrandomized Mechanical Embolus Removal in Cerebral Ischemia (MERCI II) trial, the rate of recanalization with mechanical embolus removal was

  1. 18%
  2. 30%
  3. 46%
  4. 66%
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