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Acute ischemic stroke — USMLE Step 2 CK MCQ

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ModerateEmergency MedicineAcute ischemic strokeUSMLE Step 2 CK

A 55-year-old White man comes to the hospital because of neurologic symptoms. History and focused examination are notable for sudden aphasia and right arm weakness within 90 minutes with no hemorrhage on CT. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate next step in management?

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

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Correct answer: B — Intravenous thrombolysis when eligible

The vignette describes Acute ischemic stroke, supported by sudden aphasia and right arm weakness within 90 minutes with no hemorrhage on CT. Intravenous thrombolysis when eligible is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: AHA/ASA Acute Ischemic Stroke Guideline