Cerebrovascular Disease USMLE Step 1 Practice Question
A 67-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with acute onset of left-sided weakness and dysarthria. His wife reports symptom onset was approximately 2 hours ago while he was watching television. Vital signs are: BP 168/94 mmHg, HR 92/min regular, RR 18/min, temperature 37.2°C, SpO2 98% on room air. Physical examination reveals left arm and leg weakness (3/5), dysarthria, and no facial droop. Non-contrast CT of the head shows no acute hemorrhage. MRI brain with diffusion-weighted imaging demonstrates acute ischemic changes in the right middle cerebral artery territory. Cardiac examination reveals regular rate and rhythm with no murmurs; ECG shows normal sinus rhythm. Which of the following is the most appropriate next step in management?
Answer choices
- AInitiate aspirin 325 mg orally and schedule carotid ultrasound for the following day
- BAdminister intravenous alteplase immediately and initiate aspirin after 24 hoursCorrect answer
- CBegin intravenous heparin for anticoagulation pending identification of embolic source
- DAdminister intravenous labetalol to achieve systolic BP <140 mmHg before thrombolysis
- EPerform emergent transthoracic echocardiography and defer thrombolysis pending results
- FStart dual antiplatelet therapy with aspirin and clopidogrel and monitor neurological status
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