ASC Post-Stroke Complications Management 2 — Questions and Answers
Question 1: A stroke patient develops a fever of 38.6°C on day 2 post-stroke. What is the MOST appropriate immediate intervention?
- Administer acetaminophen and investigate the source (Correct answer)
- Begin empiric broad-spectrum antibiotics immediately
- Apply cooling blankets without further workup
- Increase IV fluid rate to reduce fever
Correct answer: Administer acetaminophen and investigate the source
Post-stroke fever worsens neurological outcomes; acetaminophen should be given promptly while identifying the cause (aspiration pneumonia, UTI, DVT).
Question 2: Which post-stroke complication is MOST closely associated with high lesion burden in the insular cortex?
- Cardiac arrhythmias (Correct answer)
- Central post-stroke pain
- Spasticity
- Aphasia
Correct answer: Cardiac arrhythmias
Insular cortex injury disrupts autonomic cardiac regulation, predisposing to arrhythmias including atrial fibrillation and QT prolongation.
Question 3: A patient 3 weeks post-ischemic stroke presents with increasing leg swelling and dyspnea. Which diagnostic test should be ordered FIRST?
- Lower extremity duplex ultrasound (Correct answer)
- Chest X-ray
- D-dimer assay
- Echocardiogram
Correct answer: Lower extremity duplex ultrasound
Lower extremity DVT is common post-stroke due to immobility; duplex ultrasound is the gold-standard first-line test for DVT diagnosis.
Question 4: Central post-stroke pain (CPSP) most commonly follows infarction of which brain structure?
- Thalamus (Correct answer)
- Broca's area
- Cerebellum
- Basal ganglia
Correct answer: Thalamus
Thalamic infarction is the most frequent cause of CPSP, producing contralateral burning, aching, or allodynia.
Question 5: Which pharmacological agent is FIRST-LINE for treating post-stroke spasticity that interferes with function?
- Baclofen (Correct answer)
- Diazepam
- Dantrolene sodium
- Cyclobenzaprine
Correct answer: Baclofen
Baclofen acts on GABA-B receptors in the spinal cord and is the preferred first-line oral agent for post-stroke spasticity.
Question 6: A patient with a large left MCA infarct becomes agitated and confused on day 4. CT head shows no new hemorrhage. What is the MOST likely cause?
- Post-stroke delirium (Correct answer)
- Stroke recurrence
- Hypertensive encephalopathy
- Septic emboli
Correct answer: Post-stroke delirium
Post-stroke delirium peaks around day 3–5 and is driven by brain injury, sleep disruption, medications, and infection; negative CT supports this diagnosis.
Question 7: Which prophylactic measure has the STRONGEST evidence for preventing post-stroke aspiration pneumonia?
- Bedside swallowing screen before any oral intake (Correct answer)
- Routine prophylactic antibiotics for 72 hours
- Early nasogastric tube placement in all patients
- Routine chest physiotherapy beginning on admission
Correct answer: Bedside swallowing screen before any oral intake
Validated dysphagia screening before oral intake significantly reduces aspiration pneumonia rates and is a Joint Commission stroke certification requirement.
