Stroke (Megacode Simulations)

Stroke is a critical and time-sensitive condition marked by sudden interruptions in blood flow to the brain. This leads to potential neurological damage and rapid decline in function. This practice paper is dedicated to ACLS megacode simulation exercises designed to refine your skills in recognizing and managing stroke effectively. By solving these questions, you will enhance your preparedness for real-world emergencies.

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1

What is the most appropriate initial step in managing this patient?

 A 65-year-old male is brought to the emergency department with sudden weakness on one side of his body, slurred speech, and a severe headache. His wife reports that these symptoms started 2 hours ago.

Hint: Rapid assessment is crucial to determine the type of stroke and eligibility for thrombolysis.
2

What should be the next step in the management of this patient?

A 70-year-old woman is found in her home with signs of a stroke, but no one knows when the symptoms began.

Hint: Imaging helps determine if the stroke is hemorrhagic or ischemic, guiding further treatment.
3

Given his medical history, which treatment should be avoided?

A 55-year-old male with a history of hypertension and recent gastrointestinal bleeding presents with stroke symptoms.

Hint: Recent bleeding and hypertension are contraindications for thrombolytic therapy.
4

What complication should you most closely monitor for?

A 60-year-old female who received thrombolytics for an ischemic stroke is being monitored in the ICU.

Hint: Thrombolytics can increase the risk of bleeding in the brain.
5

Which of the following should be a part of the secondary prevention plan?

 A 75-year-old patient with a recent ischemic stroke is being discharged from the hospital.

Hint: Lifestyle modifications like smoking cessation are critical in preventing future strokes.
6

What is the most appropriate immediate action?

A 68-year-old male with suspected stroke is unresponsive and has a Glasgow Coma Scale (GCS) score of 8.

Hint: Ensuring airway protection is critical in patients with low GCS scores to prevent respiratory complications.
7

What should be the priority in her care?

A 62-year-old woman who has just had a stroke is experiencing difficulty swallowing and shows signs of aspiration.

Hint: Swallowing difficulties increase the risk of aspiration and need to be addressed promptly.
8

What is the recommended approach for managing his blood pressure?

A 58-year-old male with a recent ischemic stroke is noted to have elevated blood pressure.

Hint: Blood pressure management should be careful and controlled, especially in the acute phase of stroke.
9

What is a key criterion for this procedure?

A 72-year-old patient with a large vessel occlusion is being considered for endovascular thrombectomy.

Hint: Endovascular thrombectomy requires imaging to confirm an absence of hemorrhage and ensure suitability.
10

What is the most important factor in determining his risk for recurrent stroke?

 A 66-year-old male with a history of transient ischemic attack (TIA) presents with symptoms consistent with a stroke.

Hint: Chronic conditions like diabetes and hypertension significantly increase the risk of stroke recurrence.

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