NMS Q&A Family Medicine

chap ter 8Cerebrovascular DiseaseExamination questions : Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 65-year-old man with a history of poorly controlledhypertension and a 45 pack-year smoking history fallsdown returning to the bedroom from the bathroom.His wife finds him to be unable to move his right arm,and his face is drooping on the right. His speech isgarbled. She calls 911, and the man is taken to anemergency department where he arrives 45 minutesafter the onset of his symptoms. A decision was madeto consider thrombolysis. Which of the following isnot a satisfied criterion for going forward with theprocess of thrombolysis to interrupt a thromboticstroke?(A) Treatment with thrombolysis within 3 hours(B) Computed tomography (CT) scan of the headnegative for signs of hemorrhage(C) Neurologic defect neither too small nor toolarge(D) Blood pressure (BP) of 185/105(E) Patient underwent herniorraphy 10 days ago2 A 67-year-old female reports a bout of apparentparalysis of the right upper extremity, a feeling of“totally dead” right arm, unable to be moved, thatlasted for about 2 minutes. Which of the following istrue regarding this attack?(A) The majority of people who suffer such anattack will manifest infarction on MRI.(B) If such an attack resolves within 1 hour, the riskof stroke is minimal in the foreseeable future.(C) Anticoagulation therapy should beginforthwith.(D) The involvement of the upper extremityindicates anterior cerebral artery pathology.(E) A carotid duplex scan is indicated.3 Regarding hypercoagulable states in cerebrovasculardisease, which of the following is true?(A) Testing for protein C should be carried out assoon as possible.(B) Testing for protein S should be accomplishedbut not until 2 months after the stroke onset.(C) Testing for antithrombin III is not relevant inthe clinical setting of acute stroke.(D) Warfarin therapy should always beginimmediately after hemorrhage has beenruled out.(E) Prothrombin gene mutation is an indication forimmediate anticoagulation therapy, oncehemorrhage has been ruled out.4 A 65-year-old man successfully underwent carotidendarterectomy after discovery of a carotid bruit anda duplex ultrasound. His family physician decides toprescribe clopidogrel (Plavix). Which of the followingdrugs would decrease the platelet deaggravationeffectiveness of clopidogrel?(A) Motrin (Ibuprofen)(B) Protonix (pantoprozole)(C) Naprosyn (naproxen)(D) Prilosic (omeprozole)(E) Coumadin (warfarin)5 A 45-year-old white man comes to you for the firsttime for a “complete physical.” He is concerned thatboth his father and paternal grandfather died in theirfifties of stroke; further, a paternal uncle recently hada stroke leaving him left hemiparetic but functional.After a complete review of systems and examinationof all sectors, he returns to review the results, includingthose of comprehensive laboratory testing. Youhave found that he has a BP of 155/98 averaged overthree determinations. His total cholesterol (TC) is240 mg/dL, his high-density lipoprotein cholesterol(HDL-C) is 35 mg/dL, and his low-density lipoproteincholesterol (LDL-C) is 140 mg/dL. He has smokeda pack of cigarettes per day for the past 25 years. He isemployed in a high-tension occupation, that of stocktrader, in which his income depends on his successon behalf of his clients. Which of the following riskfactors are most prevalent in cerebrovascular (stroke)disease?(A) Elevated LDL-C(B) Reduced HDL-C(C) Elevated TC(D) Cigarette smoking(E) Hypertension55