Anna Bryant, a 65-year-old White female, is brought to the emergency department by her daughter, Pat. Ms. Bryant complains of right-sided weakness and a headache that started about 2 hours ago. Her daughter states she found her in bed early this morning and noticed she was having trouble speaking. Ms. Bryant has a history of type 2 diabetes mellitus, for which she takes metformin and rheumatoid arthritis, which she manages with naproxen. She used to smoke but quit 5 years ago. She does not drink alcohol or use illicit drugs.
Her vital signs are as follows: Temperature 99.0° F; heart rate 94 beats per minute and irregular; respirations 20 breaths per minute; blood pressure 150/90 mmHg; and oxygen saturation 95%. Upon assessment, Ms. Bryant is alert, but has trouble answering questions. Her speech is slurred, and she appears frightened.
1.Based on her manifestations which cerebral artery is likely affected?
a.Vertebral artery
b.Basilar artery
c.Posterior cerebral artery
d.Middle cerebral artery
2.Which type of stroke is Ms. Bryant likely having?
a.Ischemic embolic stroke
b.Ischemic thrombotic stroke
c.Subarachnoid hemorrhage
d.Intracerebral hemorrhage
3.Where in the brain is the lesion?
a.Right hemisphere
b.Left hemisphere
4.Based on her history and physical examination findings, what is a possible etiology for a stroke in Ms. Bryant?
a.Endocarditis
b.Rheumatoid arthritis
c.Atrial fibrillation
d.Illicit drug use
What diagnostic tests should be ordered in the acute phase? Select all that apply
c.12-lead electrocardiogram
d.Hemoglobin A1C
c.Noncontrast CT
d.Lipid profile
6.What are treatment strategies for this acute stroke? Select all that apply.
a.Intravenous thrombolytic therapy administration
b.Systemic cooling to decrease risk of cerebral edema
c.Antihypertensive agents to reduce mean arterial pressure to 80 (e.g., 100/70 mmHg)
d.Statin administration
