Megacode 2

1 You are called to a patient's hospital room by family members. According to the family, the 63-year-old patient was awaiting discharge for a diabetes mellitus-related complication when she suddenly started to slur her speech. This started about 10 minutes ago. You examine the woman and ask her to smile. One side of her face does not lift symmetrically with the other. You then ask her to close her eyes and hold both arms in front of her, palms up. She cannot lift one arm. She is in no acute pain. What is most likely occurring in this patient?

1 You are called to a patient's hospital room by family members. According to the family, the 63-year-old patient was awaiting discharge for a diabetes mellitus-related complication when she suddenly started to slur her speech. This started about 10 minutes ago. You examine the woman and ask her to smile. One side of her face does not lift symmetrically with the other. You then ask her to close her eyes and hold both arms in front of her, palms up. She cannot lift one arm. She is in no acute pain. What is most likely occurring in this patient?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

2 You believe the woman is having an acute stroke and it is likely ischemic. You assess airway, breathing, and circulation. She is breathing normally with mild tachycardia (105 bpm) and good oxygen saturation (96% on room air). What diagnostic test should be done that can be performed at the bedside?

2 You believe the woman is having an acute stroke and it is likely ischemic. You assess airway, breathing, and circulation. She is breathing normally with mild tachycardia (105 bpm) and good oxygen saturation (96% on room air). What diagnostic test should be done that can be performed at the bedside?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

3 Which of the following diagnostic test/study should be ordered emergently for this patient and is the most important for determining further treatment?

3 Which of the following diagnostic test/study should be ordered emergently for this patient and is the most important for determining further treatment?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

4 The patient is immediately moved to radiology for a CT scan. A qualified physician states that the head CT shows no sign of bleeding (hemorrhage). There is radiological evidence to suggest early ischemic stroke. The patient’s symptoms have not resolved. True or false: the patient should be evaluated for fibrinolytic therapy? 

4 The patient is immediately moved to radiology for a CT scan. A qualified physician states that the head CT shows no sign of bleeding (hemorrhage). There is radiological evidence to suggest early ischemic stroke. The patient’s symptoms have not resolved. True or false: the patient should be evaluated for fibrinolytic therapy? 

  • Key A
    A
  • Key B
    B

5 The hospital's stroke team has been called to radiology and the patient is being assessed for fibrinolytic therapy. Which of the following would NOT disqualify the patient from receiving this treatment?

5 The hospital's stroke team has been called to radiology and the patient is being assessed for fibrinolytic therapy. Which of the following would NOT disqualify the patient from receiving this treatment?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

6 The patient is diagnosed with an ischemic stroke by the stroke team. She meets all inclusion criteria and has no exclusion criteria. She is given fibrinolytic therapy (tPA) intravenously. Assuming proper protocol was followed, we know that this drug was given within what time of symptom onset?

6 The patient is diagnosed with an ischemic stroke by the stroke team. She meets all inclusion criteria and has no exclusion criteria. She is given fibrinolytic therapy (tPA) intravenously. Assuming proper protocol was followed, we know that this drug was given within what time of symptom onset?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

7 You are in the room with her two hours after tPA treatment. She complains of a terrible headache and then becomes unresponsive. The patient has no history of epilepsy, but begins to convulse. Her eyes are pointed toward the left side of her face. You suspect which of the following?

7 You are in the room with her two hours after tPA treatment. She complains of a terrible headache and then becomes unresponsive. The patient has no history of epilepsy, but begins to convulse. Her eyes are pointed toward the left side of her face. You suspect which of the following?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

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