SBA exam | 01

🔴Topic: Stroke Feel the MEDICINE | for final prof 📌 Question no-1 A 68-year-old man with hypertension and type 2 diabetes develops sudden weakness of the right arm and leg with difficulty speaking. His wife reports that he was last seen completely well 90 minutes ago. On examination, he has expressive dysphasia and right-sided hemiparesis. Blood pressure is 168/94 mmHg. Capillary glucose is 7.2 mmol/L. Non-contrast CT brain shows no intracranial haemorrhage or established large infarction. What is the single best next step in management? A. Start aspirin 300 mg orally and observe B. Give intravenous thrombolysis with alteplase C. Give intravenous heparin infusion D. Start dual antiplatelet therapy immediately E. Lower the blood pressure to below 140/90 mmHg before treatment 📌Question no-2 A 62-year-old man with long-standing hypertension suddenly develops weakness of the left face, arm and leg. He has no visual field defect, sensory loss, dysphasia, neglect or cerebellar signs. CT brain excludes haemorrhage. MRI later demonstrates a small infarct involving the right posterior limb of the internal capsule. Which of the following is the most likely mechanism underlying this stroke? A. Embolism from the left atrium due to atrial fibrillation B. Atherosclerotic plaque rupture in the internal carotid artery C. Lipohyalinosis of a penetrating small artery D. Thrombosis of the basilar artery E. Cerebral vasospasm following subarachnoid haemorrhage 📌 Question no - 3 A 59-year-old man with poorly controlled hypertension develops a sudden severe headache followed by vomiting and weakness of the left side. On examination, his blood pressure is 224/126 mmHg and GCS is 12/15. CT brain shows a right basal ganglia intracerebral haemorrhage with surrounding oedema but no significant intraventricular extension. What is the most appropriate initial management? A. Intravenous thrombolysis B. Immediate aspirin administration C. Rapid blood pressure reduction with intravenous antihypertensive therapy D. Therapeutic-dose low-molecular-weight heparin E. Oral antihypertensive therapy only 📌 Question no - 4 A 74-year-old woman is admitted with an acute ischaemic stroke. She has a history of hypertension and previous episodes of palpitations. ECG demonstrates atrial fibrillation. CT brain excludes haemorrhage. There is no evidence of carotid stenosis or another clear cause of the stroke. Which treatment is most appropriate for long-term secondary prevention once it is clinically safe to commence? A. Aspirin alone B. Clopidogrel alone C. Warfarin or a suitable direct oral anticoagulant D. Dual antiplatelet therapy indefinitely E. Intravenous unfractionated heparin indefinitely 📌 Question no - 5 A 55-year-old man develops a large right middle cerebral artery infarction. Over the next 36 hours, he becomes increasingly drowsy and develops worsening left-sided weakness. His pupils become unequal, and repeat CT brain demonstrates marked cerebral swelling with compression of the lateral ventricle and midline shift. Which is the most appropriate definitive treatment for this complication? A. Intravenous thrombolysis B. Aspirin 300 mg daily C. Immediate anticoagulation D. Decompressive hemicraniectomy E. Lumbar puncture 🎓 Answer 📌 Question no -1 Correct Answer: B. Give intravenous thrombolysis with alteplase 🔷 Explanation: This patient has an acute ischaemic stroke with a disabling neurological deficit and is presenting within the usual intravenous thrombolysis window. CT has excluded intracranial haemorrhage, and his blood pressure is already below the threshold that would normally prevent thrombolysis. Therefore, intravenous thrombolysis should be given promptly after assessment of contraindications. Aspirin is used when thrombolysis is not given or after the appropriate post-thrombolysis interval. Routine therapeutic heparin is not indicated in acute ischaemic stroke. 🔷 Note: In acute ischaemic stroke, time is brain. A patient with a disabling deficit presenting within the thrombolysis window should undergo urgent brain imaging to exclude haemorrhage and, if eligible, receive reperfusion therapy without unnecessary delay. 📌 Question no - 2 Correct Answer: C. Lipohyalinosis of a penetrating small artery 🔷 Explanation: The combination of pure motor hemiparesis without cortical signs is characteristic of a lacunar stroke. The posterior limb of the internal capsule is supplied by small penetrating arteries, which are particularly vulnerable to hypertensive small-vessel disease. Chronic hypertension causes arteriolar lipohyalinosis and may lead to occlusion of these penetrating vessels. Atrial fibrillation and carotid atherosclerosis more commonly produce cortical or embolic infarctions rather than a classic pure motor lacunar syndrome. 🔷 Note: Pure motor hemiparesis + no cortical signs + hypertension = think lacunar infarction, classically involving the internal capsule. 📌 Question no-3. Correct Answer: C. Rapid blood pressure reduction with intravenous antihypertensive therapy 🔷 Explanation: This patient has an acute intracerebral haemorrhage, most likely related to severe chronic hypertension. Markedly elevated blood pressure should be carefully and promptly lowered using an intravenous agent while maintaining adequate cerebral perfusion. Thrombolysis, aspirin and anticoagulation are contraindicated in the acute setting. Oral antihypertensive therapy alone is inappropriate because the patient requires controlled, titratable blood pressure reduction. 🔷 Note: In acute intracerebral haemorrhage, control of markedly elevated blood pressure is a key early management priority, alongside assessment of airway, neurological status and potential neurosurgical intervention. 📌 Question no - 4 Correct Answer: C. Warfarin or a suitable direct oral anticoagulant 🔷 Explanation: Atrial fibrillation is an important cause of cardioembolic ischaemic stroke. Long-term oral anticoagulation substantially reduces the risk of recurrent embolic stroke in patients with AF and appropriate stroke-risk factors. Aspirin or clopidogrel is not an adequate substitute for anticoagulation in this setting. The timing of anticoagulation after an acute stroke depends on infarct size, severity and the risk of haemorrhagic transformation. 🔷 Note: Ischaemic stroke + atrial fibrillation = think cardioembolism and anticoagulation for secondary prevention, but start anticoagulation at an appropriate time according to stroke severity and imaging. 📌 Question no - 5 Correct Answer: D. Decompressive hemicraniectomy 🔷 Explanation: This patient has a large malignant MCA infarction complicated by severe cerebral oedema and mass effect. Progressive neurological deterioration, cerebral swelling and midline shift indicate life-threatening intracranial hypertension. In appropriately selected patients, decompressive hemicraniectomy can reduce mortality and improve outcomes. Lumbar puncture is contraindicated because of the risk of precipitating herniation, while thrombolysis and anticoagulation do not treat established malignant cerebral oedema. 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