skip to main content

IV Thrombolysis for Stroke — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyNeurologyIV Thrombolysis for StrokeRACP Adult Medicine

A 65-year-old man presents 2 hours after sudden onset of right hemiparesis and aphasia. CT brain shows no haemorrhage. NIHSS is 12 (moderate-severe). BP is 175/95 mmHg. He has no contraindications to thrombolysis. What is the most appropriate acute treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — IV alteplase (0.9 mg/kg, 10% bolus then 60 min infusion)

Acute ischaemic stroke within 4.5 hours of onset, NIHSS ≥4, no haemorrhage on CT, and no contraindications is an indication for IV alteplase (0.9 mg/kg, max 90 mg: 10% bolus, remainder over 60 minutes). Door-to-needle time <60 minutes is the target. BP must be <185/110 before and <180/105 during/after thrombolysis. Aspirin is withheld for 24 hours post-thrombolysis.

Reference: Stroke Foundation Australia – 2024 – Acute Stroke Guidelines