Cerebrovascular Disease USMLE Step 1 Practice Question
A 67-year-old man with a history of hypertension and atrial fibrillation presents to the emergency department with acute onset left-sided weakness and left facial drooping that began 2 hours ago. He denies headache, vision changes, or recent trauma. His wife states he was at baseline cognitively just before symptom onset. Vital signs: BP 158/92 mmHg, HR 88 (irregularly irregular), RR 16, Temperature 37.2°C, SpO2 98% on room air. On examination, he has left upper and lower extremity weakness (4/5), left facial droop, and intact speech. Point-of-care glucose is 118 mg/dL. Non-contrast CT head shows no acute intracranial hemorrhage, mass, or edema. Which of the following is the most appropriate next step in management?
Answer choices
- AAdminister intravenous alteplase (recombinant tissue plasminogen activator)Correct answer
- BInitiate unfractionated heparin infusion and arrange urgent carotid imaging
- CObtain diffusion-weighted imaging MRI to confirm acute ischemia before thrombolysis
- DAdminister aspirin 325 mg orally and perform serial neurologic examinations
- EPerform emergent mechanical thrombectomy without further imaging
- FAdmit for monitoring and initiate warfarin for atrial fibrillation-related stroke prevention
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