Management of Acute Stroke? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-14-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Neuro Management of Acute Stroke?

A 66-year-old man with hypertension and diabetes presents to the emergency department two hours after developing acute weakness of the left side of his body. He fell from a chair at home while watching TV. He lost consciousness and was noted by his wife to have left arm and leg twitching, which resolved spontaneously at home. His current medications are aspirin, metoprolol, and metformin, with which he is compliant. On examination, he is alert and awake with a blood pressure of 190/100 mm Hg. He has dysarthric speech and left-sided face, arm, and leg weakness. There is no evidence of seizure activity in the emergency department. A head CT scan is done in the emergency department (about 2.5 hours after the onset of symptoms) that showed bilateral cortical atrophy and a lacunar infarction of the left putamen. There is no hemorrhage.

What is the most appropriate therapeutic option at this stage?

(A) Control blood pressure, then give tPA
(B) Control blood pressure and add clopidogrel
(C) Start intravenous heparin
(D) Load with phenytoin and add clopidogrel
(E) Give tPA immediately
Reply With Quote Quick reply to this message



  #2  
Old 06-14-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 458 Times in 289 Posts
Reputation: 468
Default

B............???/
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #3  
Old 06-14-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

(A) Control blood pressure, then give tPA

clopidogrel is NEVER ADDED to aspirin for stroke.
the option is add plavix/dipyradamole or SWITCH to clopidogrel hence 2 options are already wrong.

giving tPA immediately risks bleed due to high BP hence NO


tPA has to be given within 3 hours if given systemically or 6 hours if given locally.

so control BP and give tPA
Reply With Quote Quick reply to this message
 
  #4  
Old 06-15-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by mbbs2010 View Post
(A) Control blood pressure, then give tPA
arent tpa contraindicated in patient with seizures ?
Reply With Quote Quick reply to this message
  #5  
Old 06-15-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

Quote:
Originally Posted by tyagee View Post
arent tpa contraindicated in patient with seizures ?
Iv read that too.. But am unsure about specifics.

However all other answers in this case are wrong.

So I'd stick to the answer.
Reply With Quote Quick reply to this message
  #6  
Old 06-15-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

this is from harrisons again... (and frankly i consider this to be the bible for IM.. )
these are the only contra-indications to tPA that they list.

(excuse the poor quality)
Attached Thumbnails
Management of Acute Stroke?-img_0344.jpg  
Reply With Quote Quick reply to this message



Reply

Tags
Internal-Medicine-, Neurology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Acute alkali ingestion management Ace3 USMLE Step 2 CK Forum 8 12-19-2014 10:32 AM
Acute and chronic pancreatitis management Ace3 USMLE Step 2 CK Forum 2 05-05-2012 01:42 AM
Management of Ischemic Stroke! ag2011n USMLE Step 2 CK Forum 4 09-09-2011 03:08 AM
Acute cholecystitis management Q. drarnab USMLE Step 2 CK Forum 13 05-27-2011 10:42 AM
Management of Acute Calcular Cholecystitis mosallam USMLE Step 2 CK Forum 4 03-19-2010 09:43 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)