NMS Q&A Family Medicine

56 NMS Q&A Family Medicine6 For the person rendered hemiparetic by a stroke, secondaryprevention is a critical aspect of his overallmanagement. Which of the following risk factors, ifpresent and corrected by the specific treatment planslisted, would be the most potent in secondary preventionof stroke?(A) Antihypertensive drug therapy for hypertension(B) Statin therapy for TC(C) Smoking cessation in a one pack per day smoker(D) Daily dosage of aspirin(E) Warfarin (Coumadin) anticoagulation therapy7 Risk of stroke with untreated nonrheumatic (nonvalvular)atrial fibrillation varies greatly according toage, presence of risk factors, and history of priorstroke. With all categories thrown together, what isthe average annual risk of stroke in the presence ofnonvalvular atrial fibrillation?(A) 1%(B) 2.5%(C) 5%(D) 10%(E) 17%8 In an emergency department, each of the followingmay be included in the differential diagnosis of acuteonset monoplegia, in addition to stroke, if consideredwithin the first few minutes of neurologic symptomsexcept for which one?(A) Migraine syndrome(B) Hypoglycemia(C) Metastatic cancer(D) Seizure(E) Amyotrophic lateral sclerosis (ALS)9 Knowing that control of hypertension is the mostproductive of therapeutic measures available for secondaryprevention of stroke, within 48 hours after apatient has an acute cerebrovascular event, you wouldbe least aggressive in control of elevated BP in whichof the following clinical situations?(A) BP of 200/ 120 mm Hg(B) Concurrent acute myocardial infarction withleft ventricular failure(C) Concurrent renal failure(D) Acute hemiplegia with a BP of 180/95(E) Hypertensive encephalopathy10 A 65-year-old white woman has seen you for heryearly gynecologic examination. You have seized theopportunity to pursue other preventive healthmeasures and draw lipids. On the return visit, younote her lipids are at reasonably good levels. Earliershe smoked, but you talked her into successfulcessation 5 years ago. Her past medical history is significantfor stenosis of her left femoral artery secondaryto atherosclerosis. She has no history ofhypertension or diabetes mellitus. On cardiac auscultation,you detect sinus arrhythmia but no murmurs.You do not appreciate any carotid bruit. An electrocardiogramreveals sinus arrhythmia with a rate ofabout 74 and a left anterior hemiblock. Which of thefollowing features from her history or examination isa risk factor for stroke?(A) Caucasian race(B) Femoral artery stenosis secondary toatherosclerosis(C) Sinus arrhythmia(D) Female sex(E) Left anterior hemiblock11 With regard to stroke prevention, which of the followingis the most accurate statement about ticlopidine?(A) Ticlopidine is the best drug available forinhibition of platelet aggregation.(B) Ticlopidine functions through a thrombolyticmechanism.(C) The best application of ticlopidine is for plateletdeaggregation in patients who are allergic toaspirin or in whom aspirin is contraindicated.(D) Ticlopidine therapy must be monitored throughserial prothrombin time.(E) Ticlopidine therapy must be monitored throughserial partial thromboplastin time.12 Which of the following patients listed would mostwarrant an evaluation for vasculitis and the antiphospholipidantibody syndrome as cause(s) of stroke asopposed to the more common atherosclerotic orembolic cause?(A) A 40-year-old woman with an ischemic stroke(B) A 54-year-old man with known atherosclerosisof his iliac arteries and who has had twomyocardial infarctions(C) A 20-year-old patient who has had anintracerebral hemorrhage secondary to therupture of an arteriovenous malformation(D) A 60-year-old diabetic patient withhypertension(E) A 70-year-old patient with chronic atrialfibrillation13 A 65-year-old white man complains of the worstheadache he has ever experienced. The headache hadits onset at 3:15 pm today, and his wife has broughthim to you. The patient can speak and walk and isstable as to cardiorespiratory status. Which of thefollowing tests would you order first?