Neurology: thrombolysis in ischaemic stroke: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: thrombolysis in ischaemic stroke

Sample item

A patient arrives 2 hours after onset of an ischaemic stroke. Which finding is a contraindication to intravenous alteplase?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Persistent blood pressure of 210/120 mmHg despite treatment

Blood pressure above 185/110 mmHg must be lowered before thrombolysis, and if it cannot be controlled, thrombolysis is contraindicated because of the risk of haemorrhage. Other contraindications include intracranial haemorrhage on CT, recent surgery, anticoagulation with raised INR and glucose below 50 mg/dL. Age alone and severity of deficit are not exclusions.

Option by option

  • A. Persistent blood pressure of 210/120 mmHg despite treatment (correct)

    Correct. Uncontrolled severe hypertension is a contraindication.

  • B. Age of 78 years

    Advanced age alone does not exclude thrombolysis.

  • C. Symptom onset 2 hours earlier

    Two hours falls within the 4.5 hour window.

  • D. NIHSS score of 12

    A moderate stroke severity is not a contraindication.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Persistent blood pressure of 210/120 mmHg despite treatment. Blood pressure above 185/110 mmHg must be lowered before thrombolysis, and if it cannot be controlled, thrombolysis is contraindicated because of the risk of haemorrhage.

Why is "Age of 78 years" not the answer?

Advanced age alone does not exclude thrombolysis.

Why is "Symptom onset 2 hours earlier" not the answer?

Two hours falls within the 4.5 hour window.

Why is "NIHSS score of 12" not the answer?

A moderate stroke severity is not a contraindication.

What concept does this question test?

It tests Neurology: thrombolysis in ischaemic stroke in General Medicine. Other contraindications include intracranial haemorrhage on CT, recent surgery, anticoagulation with raised INR and glucose below 50 mg/dL. Age alone and severity of deficit are not exclusions.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: thrombolysis in ischaemic stroke?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.