skip to main content

Acute Ischaemic Stroke — RACP Adult Medicine MCQ

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

ModerateNeurologyAcute Ischaemic StrokeRACP Adult Medicine

A 70-year-old man presents with acute onset right-sided weakness and dysphasia. His NIHSS score is 14. CT brain shows no haemorrhage. He is within 2 hours of symptom onset. According to current Australian stroke guidelines, which thrombolytic agent is preferred?

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

Reveal the answer and explanation

Correct answer: B — Tenecteplase 0.25 mg/kg

The NSW ACI clinical practice guide (December 2025) identifies tenecteplase as the first-line and preferred IV thrombolysis agent for acute ischaemic stroke. It is given as a single IV bolus of 0.25 mg/kg (maximum 25 mg), which is simpler to administer than alteplase's 60-minute infusion. Non-inferiority to alteplase has been demonstrated in multiple trials.

Reference: NSW ACI – 2025 – IV Thrombolysis for Acute Ischaemic Stroke Clinical Practice Guide