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ABFM CVA – Questions With Complete Solutions
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ABFM CVA – Questions With Complete Solutions
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ABFM CVA – Questions WithComplete Solutions
True statements regarding the long-term prognosis for death and disability in
a patient who has had a stroke include which of the following? (Mark all that
are true.)
Early recovery of neurologic function is a sign of a good prognosis
The severity of the stroke as measured by the National Institutes of Health
Stroke Scale can be used to predict long-term prognosis
In general, lacunar strokes cause more severe disability than ischemic
strokes of the major cerebral arteries
The risk of recurrence of stroke is higher in the second year after a stroke
than in the first year
Patients who have two strokes in the same arterial territory will typically
recover more quickly the second time
Patients with poor function prior to the stroke are less likely to make a
complete recovery to their pre-stroke state - -A, B, F
The National Institutes of Health Stroke Scale (NIHSS) score predicts the
long-term outcome for patients with stroke. The NIHSS score at 6 days is a
more accurate predictor than the score in the first 24 hours (SOR B).
Consistent markers of better long-term recovery include younger age, less
severe initial symptoms, early recovery from symptoms, and good social
support (SOR B). Lacunar infarcts are more likely to be followed by either
complete recovery or minimal disability (SOR B).The risk of recurrence is
highest immediately after a stroke and falls throughout the first year,
reaching a plateau thereafter that is still higher than that of the general
population (SOR B). Multiple strokes in the same area tend to create more
severe disability than the first stroke (SOR B). Poor functional ability prior to
the stroke is a poor prognostic factor for recovery (SOR B).
-A 74-year-old male has an acute ischemic stroke. He has a history of
hypertension adequately controlled with medication. CT does not indicate
any hemorrhagic component.Which one of the following is true about early
anticoagulation with heparin or low molecular weight heparin in this
situation?
Urgent anticoagulation is recommended to prevent recurrent stroke
Urgent anticoagulation is recommended to prevent neurologic worsening
Urgent anticoagulation is recommended to improve neurologic outcomes
Urgent anticoagulation should be avoided in stroke
Initiation of anticoagulant therapy within 24 hours of treatment with
intravenously administered rtPA is recommended - -D
,Research has not shown a benefit from urgent anticoagulation in preventing
recurrent stroke or neurologic deterioration (SOR A), or for improving
outcomes after acute ischemic strokes. Initiation of anticoagulation within 24
hours of treatment with intravenous rtPA is associated with increased risks of
bleeding complications (SOR B). Urgent anticoagulation is not indicated in
moderate to severe strokes, due to an increased risk of serious intracranial
hemorrhagic complications (SOR A).
-A 67-year-old male suffers a stroke. Which of the following factors would be
likely to compromise his nutrition and hydration status following the stroke?
(Mark all that are true.)
Depression
Sensory or perceptual deficits
Swallowing difficulties
Unilateral lower extremity weakness
Altered consciousness - -ALL OF THE ABOVE
Nutrition and hydration can be affected by a number of factors following a
stroke. Physical problems that can affect the patient's ability to eat and drink
include altered consciousness, dysphagia, sensory deficits, and reduced
mobility. Depression can reduce the patient's interest in food. Patients
should be evaluated for nutrition and hydration status as soon as possible
after admisssion, and intake and body weight should be monitored regularly
(SOR C). A variety of methods should be used as necessary to maintain
adequate intake of food and fluids.
-Well documented measures to prevent an initial stroke include modification
of which of the following, by either treating or eliminating the condition?
(Mark all that are true.)
Cigarette smoking
Obesity
Migraine headaches
Atrial fibrillation
Hypertension - -A, B, D, E
Risk factors for a first stroke include both modifiable and nonmodifiable risk
factors. Well documented nonmodifiable risk factors include age, gender, low
birth weight, and genetic factors. Modifiable risk factors that have been well
documented include cigarette smoking, poor diet, physical inactivity,
postmenopausal hormone therapy, obesity, and body fat distribution (SOR
A). Other well-documented modifiable risk factors include medical conditions
such as hypertension, atrial fibrillation, other cardiac conditions,
dyslipidemia, carotid artery stenosis, and sickle cell disease (SOR A).Some
modifiable risk factors have been linked to an increased risk for stroke, but
the link is not well established. Medical conditions in this category include
,sleep apnea, metabolic syndrome, migraine, hyperhomocysteinemia,
hypercoagulability, inflammation, and infection (SOR B).
-True statements regarding the epidemiology of stroke and TIA in the United
States include which of the following? (Mark all that are true.)
Cerebrovascular disease ranks among the top five causes of death
Each year more men than women have a stroke
More than 10 million people in the United States have had a silent stroke
Approximately 15% of all strokes are heralded by a TIA
Approximately half of all patients who experience a TIA fail to report it to
their health care providers - -A, C, D, E
In the United States, someone suffers a stroke approximately every 40
seconds and someone dies from a stroke every 3-4 minutes. Given the
tremendous morbidity and mortality of stroke, the American Heart
Association and American Stroke Association publish yearly stroke statistics
to educate health care providers and the general public about key
epidemiologic factors. Cerebrovascular diseases rank fourth among all
causes of death, behind heart disease, cancer, and lung disease (SOR A).
Every year approximately 55,000 more women than men have a stroke (SOR
A). An estimated 13 million people in the United States have had a silent
stroke (SOR A). Approximately 15% of all strokes are heralded by a TIA (SOR
A). Approximately half of all patients who experience a TIA fail to report it to
their health care providers (SOR A).
-A 67-year-old female had a cerebrovascular accident 1 week ago, and now
has spasticity in her right upper extremity. True statements regarding
treatment of her spasticity and prevention of contractures include which of
the following? (Mark all that are true.)
Tizanidine (Zanaflex) can be used to treat painful spasticity
Benzodiazepine therapy is recommended for the treatment of spasticity and
prevention of contractures
Constraint-induced therapy for 90% of waking hours can improve functional
use of the affected arm and reduce disability
Positioning, passive stretching, and range-of-motion exercises should be
performed several times daily
Splinting, serial casting, and surgical correction can be considered for
contractures interfering with function - -A, C, D, E
Patients with muscle spasticity are at high risk of developing contractures
following stroke. Contractures in turn increase the risk of poor hygiene, skin
breakdown, pain, and loss of function. Early intervention is of the utmost
importance and should be performed in a stepwise fashion beginning with
positioning and passive range-of-motion exercises and proceeding to
constraint-induced therapy. Pharmacotherapy may be required and the
, judicious use of agents such as tizanidine, dantrolene, and baclofen is
important to avoid excessive sedation, which may interfere with the
rehabilitation process. More severe, painful, or debilitating spasticity and
contractures may require more invasive treatment such as botulinum toxin
administration, intrathecal baclofen, orphenol/alcohol neurolysis.
Neurosurgical procedures such as selective dorsal rhizotomy may be
required in selected cases. Tizanidine has been used specifically for chronic
stroke patients with painful spasticity (SOR B). Benzodiazepine therapy may
have a deleterious effect on post-stroke recovery. The effectiveness of
constraint-induced therapy and the use of a restraining mitt has been
demonstrated in a randomized, controlled trial (SOR A). Positioning, passive
stretching, and range-of-motion exercises have also been shown to provide
relief in randomized, controlled trials (SOR A). There is some evidence from
clinical trials that splinting, serial casting, and surgical correction may be
helpful (SOR C).
-True statements regarding the use of warfarin (Coumadin) for primary
prevention of ischemic stroke in patients with sinus rhythm include which of
the following? (Mark all that are true.)
Warfarin should be considered for stroke prevention in patients with elevated
high-sensitivity C-reactive protein levels, particularly if they have three or
more cardiovascular risk factors
Warfarin may be considered in patients with severe left ventricular
dysfunction with or without heart failure
Warfarin should be used for stroke prevention in essentially all patients in
the first 3 weeks after a myocardial infarction
It is reasonable to prescribe warfarin for patients with left ventricular
dysfunction and extensive regional wall-motion abnormalities following an
ST-segment-elevation myocardial infarction - -B, D
No evidence supports the use of C-reactive protein (CRP) screening as a
marker of vascular risk, much less the use of warfarin in patients with
elevated CRP (SOR B). Warfarin may be considered in patients with severe
left ventricular dysfunction, with or without heart failure (SOR C). There is no
convincing evidence to support the use of warfarin for stroke prevention in
all patients following a myocardial infarction (SOR C). Warfarin can be
prescribed to patients with left ventricular dysfunction and extensive
regional wall-motion abnormalities or a left ventricle thrombus on an imaging
study following an ST-segment-elevation myocardial infarction (SOR A).
-An 81-year-old male is brought to the emergency department by his wife 1
hour after the onset of right-sided weakness. She also reports that 2 months
ago the patient suffered a severe concussion from a bicycling accident and
was hospitalized overnight. The patient has known coronary artery disease
and takes aspirin, 81 mg daily. He had a total right knee replacement 1
month ago, using spinal anesthesia. CT of the head shows no hemorrhage.
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