Which of the following is not a contraindication for the use of tissue plasminogen activator (PA) in the treatment of stroke?

Recent thoracic surgery within the past week

Uncontrolled hypertensive crisis

Age over 65 years

Head trauma with active cerebral hemorrhage

Answer and Explanation

The Correct Answer is C

A. Recent thoracic surgery within the past week:
Recent surgery, especially in the thoracic region, is a contraindication for the use of tissue plasminogen activator (tPA) in stroke treatment. tPA is a thrombolytic agent that dissolves clots, but it also increases the risk of bleeding, including in areas where surgery has recently occurred. Using tPA in this situation can potentially lead to life-threatening bleeding complications.

B. Uncontrolled hypertensive crisis:
Uncontrolled hypertension is a contraindication for tPA. High blood pressure can increase the risk of hemorrhagic transformation (bleeding into the brain) when using thrombolytic therapy like tPA. A hypertensive crisis (typically systolic BP > 185 mmHg or diastolic BP > 110 mmHg) must be managed and brought under control before administering tPA to minimize the risk of bleeding complications.

C. Age over 65 years:
While age over 65 years may increase the risk of complications from tPA, it is not an absolute contraindication for its use. Guidelines for tPA administration in stroke patients typically focus more on factors like time from symptom onset (usually within 4.5 hours), the presence of contraindications like recent surgery or uncontrolled hypertension, and the overall clinical condition. Age itself is not a reason to withhold tPA unless other risk factors are present.

D. Head trauma with active cerebral hemorrhage:
Head trauma with active cerebral hemorrhage is a definitive contraindication for tPA. Since tPA is a clot-busting drug, it can worsen bleeding in the brain, especially in cases where there is ongoing hemorrhage from trauma. This significantly increases the risk of severe neurological damage and even death, so tPA should not be administered in such situations.

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Correct Answer is B

Explanation

A) "The test will use a catheter to assess for blocked coronary arteries": This statement is incorrect. An echocardiogram does not involve the use of a catheter. It is a non-invasive imaging test that uses sound waves (ultrasound) to create images of the heart's structure and function. Assessing for blocked coronary arteries typically requires a different procedure, such as a coronary angiogram, which involves the use of a catheter.

B) "The test can show how well your heart pumps blood.": This is the correct statement. An echocardiogram is primarily used to assess how well the heart is functioning, including how effectively it pumps blood. It can provide detailed images of the heart's chambers, valves, and blood flow, helping to evaluate conditions such as heart failure, valve dysfunction, and other structural issues that may impair the heart’s ability to pump blood efficiently.
C) "The test will show proteins in the blood from damaged heart muscle.": This statement is incorrect. An echocardiogram does not measure blood proteins or markers from damaged heart muscle. Blood tests, such as troponin levels, are used to detect proteins released from heart muscle after injury, such as in a heart attack. The echocardiogram focuses on the heart's structure and function, not the chemical markers in the blood.

D) "The test shows the electrical activity of the heart from multiple angles.": This statement is inaccurate. The electrical activity of the heart is assessed by an electrocardiogram (ECG or EKG), not an echocardiogram. An ECG records the heart's electrical signals, while an echocardiogram uses sound waves to visualize the heart's anatomical structure and function.

A. Pernicious anemia B. Blood loss anemia C. Sickle cell anemia D. Aplastic anemia

Correct Answer is B

Explanation

A. Pernicious anemia:
Pernicious anemia is primarily caused by a deficiency in vitamin B12, often due to a lack of intrinsic factor needed for absorption in the gut. It typically presents with symptoms like weakness, fatigue, and neurological manifestations such as numbness or tingling. However, the client’s presentation does not suggest a vitamin B12 deficiency or neurological signs. Additionally, pernicious anemia is not typically associated with heavy menstrual periods,
which are more indicative of blood loss anemia.

B. Blood loss anemia:
Blood loss anemia is the most likely diagnosis in this case, especially in the context of heavy menstrual periods, which can cause significant blood loss over time. The client’s hemoglobin level of 6.9 g/dL indicates severe anemia, which is consistent with the cumulative effects of chronic blood loss. This type of anemia results from a decrease in red blood cell count due to bleeding, which can lead to symptoms like weakness, fatigue, and pallor.

C. Sickle cell anemia:
Sickle cell anemia is a genetic condition characterized by abnormally shaped red blood cells, which can lead to hemolysis and episodes of pain. While it can cause symptoms like fatigue and weakness, sickle cell anemia typically presents earlier in life and is more associated with episodes of severe pain and organ damage. Additionally, the patient’s history does not mention episodes of pain or other hallmark signs of sickle cell disease, such as swelling in the hands or feet or recurrent infections.

D. Aplastic anemia:
Aplastic anemia occurs when the bone marrow fails to produce enough blood cells, including red blood cells, white blood cells, and platelets. It presents with symptoms like weakness, fatigue, frequent infections, and bruising. Although this client does have anemia, the lack of additional signs (such as petechiae, infections, or bleeding) makes this diagnosis less likely. Aplastic anemia is also usually diagnosed with bone marrow biopsy, which is not suggested by this client's presentation.

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Which of the following is not a contraindication for the use of tissue plasminogen activator (PA) in the treatment of stroke?

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