Ischaemic stroke — MCCQE Part 1 MCQ

Correct answer: D — Activate acute stroke protocol with urgent brain imaging and reperfusion assessment

Activate acute stroke protocol with urgent brain imaging and reperfusion assessment is best because acute focal deficit within a treatment window needs stroke pathway activation. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Time of onset and anticoagulant status are critical early questions.

Reference: Canadian Stroke Best Practices 2025