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Confidential adolescent care — USMLE Step 2 CK MCQ

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HardEthics, patient safety, quality improvementConfidential adolescent careUSMLE Step 2 CK

A 72-year-old right-handed woman develops sudden expressive aphasia and right arm weakness 90 minutes before arrival. Noncontrast head CT shows no hemorrhage, and CT angiography shows no large-vessel occlusion. Blood pressure is 174/96 mm Hg, glucose is 112 mg/dL, and she takes no anticoagulant. Her symptoms remain disabling. Which is the most appropriate next step?

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Correct answer: C — Administer intravenous thrombolytic therapy now

This patient has a disabling acute ischemic stroke, no hemorrhage, no listed contraindication, and presentation well within the 4.5-hour intravenous-thrombolysis window. Alteplase or tenecteplase should be administered promptly according to the local protocol. A low or moderate NIH Stroke Scale score would not justify withholding treatment when aphasia and dominant-arm weakness are functionally disabling. Aspirin is appropriate when thrombolysis is not given, but it is not a substitute for reperfusion in an eligible patient. Advanced perfusion imaging can guide selected late-window treatment but should not delay thrombolysis in this standard window. Mechanical thrombectomy requires an appropriate arterial occlusion. Her pressure is below the 185/110 mm Hg threshold that must be reached before intravenous thrombolysis; 160/90 is not the treatment cutoff. Blood pressure should then be maintained below the post-thrombolysis limit.

Reference: American Heart Association/American Stroke Association. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: Top Things to Know. Published January 26, 2026. https://professional.heart.org/en/science-news/2026-guideline-for-the-early-management-of-patients-with-acute-ischemic-stroke/top-things-to-know