Cerebrovascular Disease USMLE Step 1 Practice Question
A 55-year-old man with hypertension and a 30 pack-year smoking history presents to the emergency department with acute-onset right hemiparesis and expressive aphasia. His wife reports symptom onset 4 hours prior to arrival. Vital signs: BP 158/92 mmHg, HR 98 bpm, RR 18, Temperature 37.2°C, SpO2 98% on room air. Physical examination confirms right-sided weakness (3/5) with non-fluent speech output. CT head is unremarkable for hemorrhage. CT angiography demonstrates occlusion of the left middle cerebral artery M1 segment. Laboratory studies show INR 1.0, glucose 128 mg/dL, and platelet count 245,000/μL. The patient has no history of anticoagulation use and no contraindications to intervention. Which of the following is the most appropriate next step in management?
Answer choices
- AInitiate intravenous heparin and serial neurological assessments
- BAdminister intravenous alteplase followed by observation
- CPerform mechanical thrombectomyCorrect answer
- DAdminister aspirin 325 mg orally and discharge with outpatient neurology follow-up
- EAdminister intravenous nitroglycerin to reduce blood pressure to <140/90 mmHg
- FInitiate subcutaneous enoxaparin and plan for imaging in 24 hours
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