Stroke

Stroke US Medical PG Question 1: A 78-year-old woman is accompanied by her family for a routine visit to her primary care provider. The family states that 5 months prior, the patient had a stroke and is currently undergoing physical therapy. Today, her temperature is 98.2°F (36.8°C), blood pressure is 112/72 mmHg, pulse is 64/min, and respirations are 12/min. On exam, she is alert and oriented with no deficits in speech. Additionally, her strength and sensation are symmetric and preserved bilaterally. However, on further neurologic testing, she appears to have some difficulty with balance and a propensity to fall to her right side. Which of the following deficits does the patient also likely have?

• A. Hemiballismus
• B. Hemispatial neglect
• C. Intention tremor
• D. Contralateral eye deviation
• E. Truncal ataxia (Correct Answer)

Stroke Explanation: ***Truncal ataxia*** - This patient's symptoms of **difficulty with balance** and a **propensity to fall to her right side** are highly suggestive of truncal ataxia. - While she had a stroke, her preserved speech, symmetric strength and sensation, and alertness rule out typical hemiparesis or aphasia, pointing towards a **cerebellar lesion** affecting balance and coordination. *Hemiballismus* - This condition involves **flailing, high-amplitude, involuntary movements** typically affecting one side of the body. - The patient's description of balance issues and falling, without mention of such specific movements, makes hemiballismus less likely. *Hemispatial neglect* - Characterized by the **inability to attend to one side of the environment**, usually the left side following a right parietal stroke. - The patient's presentation does not describe an indifference to one side of her visual or personal space. *Intention tremor* - An **intention tremor** is a tremor that worsens during purposeful movement towards a target. - While it can be associated with cerebellar dysfunction, the primary deficit described is imbalance and falling to one side, not specifically a tremor. *Contralateral eye deviation* - This typically occurs in acute stroke scenarios as part of a **gaze preference**, where the eyes deviate towards the side of the lesion (or away from the hemiparesis). - The patient is 5 months post-stroke and is alert with no acute focal deficits, making acute eye deviation unlikely as a chronic presenting symptom here.

Stroke US Medical PG Question 2: A 67-year-old man with a past medical history of poorly-controlled type 2 diabetes mellitus (T2DM) is brought to the emergency department for acute onset nausea and vomiting. According to the patient, he suddenly experienced vertigo and began vomiting 3 hours ago while watching TV. He reports hiking in New Hampshire with his wife 2 days ago. Past medical history is significant for a myocardial infarction (MI) that was treated with cardiac stenting, T2DM, and hypertension. Medications include lisinopril, aspirin, atorvastatin, warfarin, and insulin. Physical examination demonstrates left-sided facial droop and decreased pinprick sensation at the right arm and leg. What is the most likely etiology of this patient’s symptoms?

• A. Hypoperfusion of the anterior spinal artery (ASA)
• B. Labyrinthitis
• C. Early disseminated Lyme disease
• D. Thrombotic stroke at the anterior inferior cerebellar artery (AICA)
• E. Embolic stroke at the posterior inferior cerebellar artery (PICA) (Correct Answer)

Stroke Explanation: ***Embolic stroke at the posterior inferior cerebellar artery (PICA)*** - The constellation of left-sided **facial droop** (cranial nerve impairment) and **contralateral decreased pinprick sensation** (spinothalamic tract deficit) in the context of acute vertigo, nausea, and vomiting is classic for a **lateral medullary syndrome (Wallenberg syndrome)**. - Wallenberg syndrome is most commonly caused by an **ischemic stroke in the PICA territory**, often embolic, especially in patients with risk factors like **atrial fibrillation** (implied by warfarin use) or a history of MI. *Hypoperfusion of the anterior spinal artery (ASA)* - **ASA syndrome** typically presents with sudden onset **flaccid paraplegia, loss of pain and temperature sensation below the level of the lesion**, and preservation of proprioception and vibration sense. - It does not typically cause **facial droop** or **vertigo**, as these are signs of brainstem involvement. *Labyrinthitis* - **Labyrinthitis** is an inflammation of the inner ear, causing acute onset **vertigo, nausea, vomiting**, and sometimes hearing loss or tinnitus. - It would **not cause neurological deficits** like facial droop or contralateral sensory loss in the extremities, which are indicative of a central neurological event. *Early disseminated Lyme disease* - **Early disseminated Lyme disease** can cause neurological symptoms, including **facial nerve palsy** (often bilateral), but it typically presents with other symptoms like **meningitis, radiculopathy, or carditis**. - The **hyperacute onset (3 hours)** strongly favors an acute vascular event over Lyme disease, which takes **days to weeks** to develop neurological manifestations after tick exposure. *Thrombotic stroke at the anterior inferior cerebellar artery (AICA)* - An **AICA stroke** typically presents with **ipsilateral facial paralysis, ipsilateral hearing loss**, vertigo, nystagmus, and sometimes contralateral loss of pain and temperature sensation. - While it can cause vertigo and facial weakness, the specific pattern of **contralateral body sensory loss** combined with facial droop strongly points to a PICA distribution affecting the lateral medulla, not AICA.

Stroke US Medical PG Question 3: A 62-year-old man is brought to the emergency department by his wife because she thinks he has had a stroke. He has hypertension and type 2 diabetes mellitus. Current medications include enalapril and metformin. He has smoked 1 pack of cigarettes per day for the past 35 years. His blood pressure is 162/95 mm Hg. A CT scan of the brain shows a lacunar stroke involving the left subthalamic nucleus. The patient most likely presented with which of the following findings on physical examination?

• A. Cogwheel rigidity
• B. Dystonia
• C. Hemispatial agnosia
• D. Vertical gaze palsy
• E. Hemiballismus (Correct Answer)

Stroke Explanation: ***Hemiballismus*** - A lacunar stroke in the **subthalamic nucleus (STN)** typically causes **hemiballismus**, which is characterized by wild, involuntary, large-amplitude flinging movements on one side of the body. - The STN is part of the **basal ganglia circuit** and its damage leads to disinhibition of the thalamus, resulting in hyperkinetic movements. *Cogwheel rigidity* - This is a feature of **Parkinson's disease**, resulting from damage to the **substantia nigra** affecting dopamine production, not typically a direct result of a lacunar stroke in the subthalamic nucleus. - It is characterized by a jerky resistance to passive movement in a limb. *Dystonia* - Characterized by sustained or repetitive muscle contractions resulting in **twisting and repetitive movements** or abnormal fixed postures. - While basal ganglia dysfunction can cause dystonia, it's a broader term, and **hemiballismus** is a more specific and classic presentation of STN lesions. *Hemispatial agnosia* - Refers to a deficit in attention to one side of space, most commonly associated with lesions in the **non-dominant (right) parietal lobe**. - This is distinct from the motor symptoms expected from a subthalamic nucleus lesion. *Vertical gaze palsy* - Commonly associated with lesions in the **midbrain**, particularly the **dorsal midbrain syndrome (Parinaud syndrome)**. - This is not a typical presentation of a lacunar stroke specifically involving the subthalamic nucleus.

Stroke US Medical PG Question 4: A 5-year-old boy is brought to the emergency department by his mother because of a 2-hour history of word-finding difficulty, speech slurring, and weakness and sensory loss of his right arm and leg. He has not had fever, nausea, headache, or diarrhea. His mother reports an episode of severe pain and soft tissue swelling of the dorsum of his hands and feet when he was 12 months old, which self-resolved after 2 weeks. His temperature is 37.7°C (99.8°F), pulse is 90/min, and blood pressure is 110/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 91%. He follows commands but has nonfluent aphasia. Examination shows marked weakness and decreased sensation of the right upper and lower extremities. Deep tendon reflexes are 2+ bilaterally. Babinski sign is present on the right. An MRI scan of the brain shows signs of an evolving cerebral infarction on the patient's left side. Which of the following is the most appropriate initial step in management?

• A. Hydroxyurea therapy
• B. Exchange transfusion therapy (Correct Answer)
• C. Heparin therapy
• D. Intravenous tissue plasminogen activator therapy
• E. Aspirin therapy

Stroke Explanation: ***Exchange transfusion therapy*** - The patient's presentation with **acute neurological deficits** (word-finding difficulty, speech slurring, right-sided weakness/sensory loss) and imaging showing an **evolving cerebral infarction** in a 5-year-old child with a history concerning for **sickle cell disease** (dactylitis at 12 months) indicates an acute ischemic stroke. - **Exchange transfusion therapy** is the **most appropriate initial management** for an acute ischemic stroke in a patient with sickle cell disease as it rapidly reduces the percentage of sickled cells and increases oxygen-carrying capacity, improving cerebral perfusion and preventing further infarction. *Hydroxyurea therapy* - **Hydroxyurea** is a long-term preventative therapy for sickle cell disease, increasing fetal hemoglobin (HbF) and reducing the frequency of vaso-occlusive crises and acute chest syndrome. - It is **not an acute treatment** for an evolving stroke, which requires immediate intervention to reduce sickled cells and improve blood flow. *Heparin therapy* - **Heparin therapy** (anticoagulation) is typically used for specific types of stroke (e.g., cardioembolic stroke, cerebral venous sinus thrombosis) but is generally **not indicated for acute ischemic stroke** in sickle cell disease. - The primary pathophysiology of stroke in sickle cell disease involves sickled cells causing vaso-occlusion, rather than a thrombotic event usually responsive to heparin. *Intravenous tissue plasminogen activator therapy* - **Intravenous tissue plasminogen activator (tPA)** is a fibrinolytic agent used to break down clots in acute ischemic stroke, but its use is **contraindicated in pediatric patients** and in patients with known sickle cell disease due to an increased risk of hemorrhage and lack of demonstrated benefit. - The underlying mechanism of stroke in sickle cell disease (vaso-occlusion by sickled cells) is not directly addressed by tPA. *Aspirin therapy* - **Aspirin therapy** (antiplatelet agent) is used for secondary stroke prevention in some cases of ischemic stroke but is **not the primary acute treatment** for an evolving stroke in sickle cell disease. - It does not rapidly reduce the burden of sickled cells or improve oxygen delivery, which are critical for acute management in this patient population.

Stroke US Medical PG Question 5: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Stroke Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Stroke US Medical PG Question 6: A 75-year-old woman presents with sudden loss of vision. She says that she was reading when suddenly she was not able to see the print on half of the page. Her symptoms started 4 hours ago and are accompanied by a severe posterior headache. Vital signs reveal the following: blood pressure 119/76 mm Hg, pulse 89/min, SpO2 98% on room air. The patient was unable to recognize her niece when she arrived to see her. A noncontrast CT of the head shows no evidence of hemorrhagic stroke. What is the most likely diagnosis in this patient?

• A. Lacunar stroke
• B. Middle cerebral artery stroke
• C. Vertebrobasilar stroke
• D. Subarachnoid hemorrhage
• E. Posterior cerebral artery stroke (Correct Answer)

Stroke Explanation: ***Posterior cerebral artery stroke*** - The sudden severe posterior headache along with **unilateral vision loss** and **prosopagnosia** (inability to recognize familiar faces) are characteristic signs of a **posterior cerebral artery (PCA) stroke**. - PCA occlusion often affects the **occipital lobe** (vision) and can extend to the **temporal lobe** (facial recognition). *Lacunar stroke* - This type of stroke results from the occlusion of small penetrating arteries and typically causes **pure motor** or **pure sensory deficits**, not complex visual or recognition problems. - While headache can occur, the specific combination of symptoms points away from a lacunar infarct. *Middle cerebral artery stroke* - MCA stroke commonly presents with **contralateral hemiparesis**, **aphasia** (if dominant hemisphere), and **hemianopia** but usually not isolated unilateral vision loss or severe posterior headache with prosopagnosia. - The symptoms are more consistent with involvement of the posterior circulation. *Vertebrobasilar stroke* - A vertebrobasilar stroke can cause **visual disturbances**, but it is typically associated with other **brainstem symptoms** like vertigo, ataxia, or cranial nerve deficits, which are not described here. - The specific presentation of unilateral vision loss and prosopagnosia is less typical for a vertebrobasilar stroke affecting widespread brainstem structures. *Subarachnoid hemorrhage* - While a **sudden severe headache (thunderclap headache)** is a hallmark of SAH, it usually presents with meningeal irritation symptoms like **neck stiffness** and often altered mental status, and the visual deficits are usually different (e.g., oculomotor nerve palsy). - The patient's focal neurological deficits, specifically prosopagnosia and unilateral visual field loss, are more indicative of an ischemic event in a specific vascular territory.

Stroke US Medical PG Question 7: A 48-year-old woman presents with acute stroke symptoms 18 hours ago. MRI shows a right MCA M1 occlusion with large penumbra on perfusion imaging (mismatch ratio >1.8) and small infarct core (25 mL). Her NIHSS is 16. She has no significant comorbidities. Her family is concerned about disability but wants to pursue treatment if reasonable chance of benefit exists. Synthesize the evidence and evaluate the treatment approach.

• A. Intravenous alteplase as salvageable tissue is present
• B. Intra-arterial thrombolysis combined with mechanical device
• C. No intervention as she is outside the standard treatment window
• D. Mechanical thrombectomy based on perfusion imaging criteria (Correct Answer)
• E. Medical management with antiplatelet and early rehabilitation

Stroke Explanation: ***Mechanical thrombectomy based on perfusion imaging criteria*** - For patients with large vessel occlusion (LVO) in the extended 6–24 hour window, **DAWN** and **DEFUSE-3** trials demonstrated significant functional benefit when clinical-core mismatch is present. - This patient satisfies criteria with an **M1 occlusion**, a **small infarct core (<70 mL)**, and a **large mismatch ratio (>1.8)**, indicating substantial salvageable penumbra. *Intravenous alteplase as salvageable tissue is present* - The therapeutic window for **IV alteplase** is strictly limited to within **4.5 hours** of symptom onset; it is not recommended at 18 hours due to high hemorrhage risk. - While salvageable tissue exists, chemical thrombolysis is less effective than mechanical intervention for **proximal M1 occlusions** and is unsafe in this late window. *Intra-arterial thrombolysis combined with mechanical device* - **Intra-arterial thrombolysis** is generally superseded by modern **stent retrievers** and aspiration catheters which provide faster and more complete recanalization. - Current guidelines prioritize standalone **mechanical thrombectomy** in the late window to minimize procedural risks and intracranial hemorrhage. *No intervention as she is outside the standard treatment window* - The "Time is Brain" concept has evolved into "Tissue is Brain," where **perfusion imaging** identifies candidates who benefit regardless of the traditional 6-hour clock. - Denying treatment based solely on the 18-hour timeframe ignores high-level evidence from the **DAWN** trial showing benefit up to 24 hours. *Medical management with antiplatelet and early rehabilitation* - Standard **medical management** (aspirin/heparin) for an M1 occlusion with a high **NIHSS score (16)** usually results in poor functional outcomes and severe disability. - While rehabilitation is essential, it does not address the underlying **large vessel occlusion** which can be reversed with mechanical intervention to prevent infarct expansion.

Stroke US Medical PG Question 8: A 55-year-old man undergoes successful thrombectomy for left MCA occlusion. Post-procedure, he develops progressive lethargy and his blood pressure increases to 180/100 mmHg. CT shows hyperdensity in the treated territory without hemorrhage, and his symptoms worsen over 4 hours despite blood pressure control. Evaluate the most likely diagnosis and management priority.

• A. Hemorrhagic transformation; reverse anticoagulation immediately
• B. Cerebral edema from large infarction; emergent decompressive hemicraniectomy
• C. Reperfusion injury; start high-dose corticosteroids and osmotic therapy
• D. Contrast extravasation from blood-brain barrier disruption; supportive care and avoid aggressive BP lowering (Correct Answer)
• E. Recurrent arterial occlusion; emergent repeat angiography and thrombectomy

Stroke Explanation: ***Contrast extravasation from blood-brain barrier disruption; supportive care and avoid aggressive BP lowering*** - Post-thrombectomy **hyperdensity** on CT often represents contrast that leaked through an ischemic **blood-brain barrier**, which can mimic hemorrhage but lacks significant **mass effect**. - Management is **supportive care** because the contrast is typically reabsorbed within 24–48 hours; avoiding aggressive **blood pressure lowering** prevents secondary ischemia in the penumbra. *Hemorrhagic transformation; reverse anticoagulation immediately* - While **hemorrhagic transformation** is a risk, true blood usually demonstrates higher density earlier and is associated with rapid clinical decline and **midline shift**. - Reversing anticoagulation without confirming blood on a follow-up **dual-energy CT** or MRI may lead to **stent thrombosis** or re-occlusion. *Cerebral edema from large infarction; emergent decompressive hemicraniectomy* - **Cerebral edema** typically peaks between 72–96 hours post-stroke; a presentation within 4 hours is too acute for **malignant MCA syndrome**. - While edema causes lethargy, the hyperdensity on CT more specifically points toward **contrast staining** or blood rather than simple cytotoxic edema. *Reperfusion injury; start high-dose corticosteroids and osmotic therapy* - **Corticosteroids** are not indicated for stroke-related edema or reperfusion injury as they do not improve outcomes and may increase **infection risk**. - **Osmotic therapy** is reserved for patients with clear clinical or radiologic signs of **elevated intracranial pressure**, not isolated hyperdensity on CT. *Recurrent arterial occlusion; emergent repeat angiography and thrombectomy* - **Recurrent occlusion** usually presents with a sudden recurrence of the original **focal neurological deficits** (e.g., hemiplegia, aphasia) rather than progressive lethargy. - The presence of **hyperdensity** in the stroke territory on CT is specifically indicative of material (contrast or blood) being present, which is not a feature of a simple **re-occlusion**.

Stroke US Medical PG Question 9: An 80-year-old woman with atrial fibrillation presents 2 hours after acute ischemic stroke. NIHSS is 22. Imaging shows large left MCA territory infarction involving >1/3 of MCA territory with basilar artery occlusion. She lives alone but was independent before this event. Her family requests all possible interventions. Evaluate the management approach considering benefits versus risks.

• A. Comfort measures only given poor prognosis and age
• B. Thrombolysis alone as thrombectomy unlikely to benefit with established large infarction
• C. Proceed with thrombolysis and thrombectomy given the therapeutic window
• D. Thrombectomy only for basilar occlusion, avoid thrombolysis due to large infarction (Correct Answer)
• E. Delay intervention and repeat imaging in 6 hours to assess progression

Stroke Explanation: ***Thrombectomy only for basilar occlusion, avoid thrombolysis due to large infarction*** - Intravenous **thrombolysis (IV alteplase)** is generally contraindicated or highly risky when imaging shows an established infarction involving **>1/3 of the MCA territory** due to the high risk of **hemorrhagic transformation**. - **Basilar artery occlusion** is a life-threatening emergency with a broader treatment window; mechanical **thrombectomy** can be lifesaving and is indicated even if thrombolysis is withheld. *Comfort measures only given poor prognosis and age* - Age is not a primary contraindication for intervention, especially since the patient was **independent** prior to the event (low **pre-stroke mRS**). - Family requests all possible interventions, and **basilar occlusion** has a catastrophic natural history that may be mitigated by mechanical intervention. *Thrombolysis alone as thrombectomy unlikely to benefit with established large infarction* - Thrombolysis is dangerous in this context due to the **large infarct volume** seen on imaging, which increases the likelihood of fatal **intracerebral hemorrhage**. - Thrombolysis is notably less effective for large vessel occlusions compared to **mechanical thrombectomy**, which is the gold standard for **basilar artery** recanalization. *Proceed with thrombolysis and thrombectomy given the therapeutic window* - While the patient is within the 4.5-hour window for thrombolysis, the presence of **established early ischemic changes** (>1/3 MCA territory) is a relative contraindication. - Attempting both increases the risk of **secondary hemorrhage** in the damaged MCA territory without providing significant additional benefit over thrombectomy alone for the **basilar occlusion**. *Delay intervention and repeat imaging in 6 hours to assess progression* - Delaying treatment in the setting of **basilar artery occlusion** is inappropriate, as "time is brain" and outcomes worsen significantly with every minute of **brainstem ischemia**. - Immediate decision-making is required based on the initial imaging, which already confirmed the **large-vessel occlusion** needing intervention.

Stroke US Medical PG Question 10: A 58-year-old woman with history of TIA 3 weeks ago presents with acute ischemic stroke. Imaging reveals new right MCA infarction and severe (70-99%) symptomatic right carotid stenosis. She received alteplase 6 hours ago with partial improvement. Her NIHSS improved from 14 to 8. Analyze the optimal timing for carotid revascularization.

• A. Wait 4-6 weeks to reduce hemorrhagic transformation risk
• B. Carotid stenting immediately after thrombolysis
• C. Emergent carotid endarterectomy within 24 hours
• D. Carotid endarterectomy within 2 weeks of symptom onset (Correct Answer)
• E. Medical management only due to recent thrombolysis

Stroke Explanation: ***Carotid endarterectomy within 2 weeks of symptom onset*** - For patients with **symptomatic carotid stenosis** (70-99%), early revascularization within **2 weeks** (ideally within 48 hours to 7 days) provides the maximum benefit in preventing recurrent stroke. - Current guidelines suggest that once the patient is **neurologically stable** and the infarct size is not massive, the risk of recurrence outweighs the risk of **hemorrhagic transformation**. *Wait 4-6 weeks to reduce hemorrhagic transformation risk* - This represents older clinical practice; modern evidence shows the risk of **recurrent stroke** is highest in the first 2 weeks, making this delay dangerous. - Waiting this long is only typically reserved for patients with a **large territory infarct** (high NIHSS) or those at very high risk for bleeding complications. *Carotid stenting immediately after thrombolysis* - Immediate stenting right after **alteplase** administration increases the risk of **intracranial hemorrhage** and local bleeding at the access site due to systemic fibrinolysis. - While **Carotid Artery Stenting (CAS)** is an alternative, it is generally not preferred over **Carotid Endarterectomy (CEA)** in older patients unless specific surgical contraindications exist. *Emergent carotid endarterectomy within 24 hours* - Performing surgery within the first 24 hours after **thrombolytic therapy** carries a significant risk of **hemorrhagic transformation** of the fresh infarct. - Most surgeons prefer to wait at least **24-48 hours** post-alteplase to ensure the fibrinolytic effects have resolved and the patient's neurological status is stable. *Medical management only due to recent thrombolysis* - Medical management alone is insufficient for **symptomatic stenosis >70%**, as the risk of a disabling stroke remains high without mechanical intervention. - **Dual antiplatelet therapy** and statins are vital, but they serve as an adjunct to, rather than a replacement for, **surgical revascularization** in fit patients.

Stroke Flashcard 1 of 4

Question: Medi-_____ is state/federal assistance for people with limited income/resources

Answer: caid

Stroke Flashcard 2 of 4

Question: Which healthcare payment model involves physicians receiving a set amount per patient assigned to them per period of time? _____

Answer: Capitation

Stroke Flashcard 3 of 4

Question: Which healthcare payment model involves patients paying for all expenses associated with a single incident of care with a single payment? _____

Answer: Global payment

Stroke Flashcard 4 of 4

Question: Stroke ≤ 3 hrs = _____ Stroke > 3 hrs = _____

Answer: tPA

Extra Information:  https://onlinemeded.org/spa/neurology/stroke/acquire?ref=anki