Physician CME Questions

81. In detection of intracerebral hemorrhage, GRE-MRI is:

A. inferior to NCCT
B. equivalent to NCCT in all areas
C. equivalent to NCCT in detection of acute ICH and superior in detection of chronic hemorrhage and hemorrhagic transformation
D. superior to NCCT in detection of acute ICH and equivalent in detection of chronic hemorrhage and hemorrhagic transformation

82. Which of the following is correct regarding the use of DWI-MRI in the evaluation of acute stroke?

A. DWI should only be obtained acutely instead of NCCT if it does not unduly delay the administration of tPA in eligible patients.
B. DWI can detect ischemic changes within minutes of the onset of ischemia.
C. DWI has been shown to be the most sensitive and specific method for early detection of ischemia.
D. All of the above are true.

83. What is the current role of perfusion imaging (CTP or MRP) in evaluation of acute stroke?

A. Current guidelines do not recommend for or against the use of perfusion imaging in the evaluation of acute stroke.
B. Perfusion imaging is an experimental imaging modality and its use has been abandoned in the evaluation of acute stroke.
C. Perfusion imaging should be obtained in all stroke patients as perfusion-derived parameters are a critical factor in the decision to administer tPA.
D. Diffusion/perfusion maps can be constructed using data solely from perfusion imaging.

84. Which of the following statements is true regarding the ability of MRA to detect cerebrovascular arterial lesions?

A. MRA is better than CTA for detecting intracranial lesions.
B. MRA and CTA are essentially equal in detecting extracranial lesions.
C. MRA is less accurate than Doppler ultrasound in detecting extracranial lesions.
D. Nonenhanced MRA is as accurate as gadolinium-enhanced MRA in detecting extracranial stenosis.

85. Ultrasound methods, such as carotid duplex ultrasound and transcranial Doppler, are not useful in the evaluation of an acute stroke.

A. true
B. false

86. Which of the following is the best imaging modality to evaluate an acute ischemic stroke?

B. Non-contract CT
C. Perfusion-weighted MRI
D. Diffusion-weighted MRI

87. If access to MRI is not available, which of the following imaging modalities is most accurate in detecting acute ischemic stroke?

D. contrast-enhanced CT

88. Outpatient management is permitted for which of the following TIA patients according to current recommendations? Assume that neurological symptoms have resolved in all patients, and DWI-MRI did not show evidence of acute ischemia in any of the cases.

A. a patient presenting within 4 hours of TIA with ABCD2 score of 3 and reliable follow-up in less than 24 hours
B. a patient presenting within 1 hour of TIA with ABCD2 score of 2 and reliable follow-up within 48 hours
C. an undomiciled patient presenting within 12 hours of TIA with ABCD2 score of 1
D. a patient presenting with ankle sprain, indicating that an episode of TIA occurred within the past 24 hours with an ABCD2 score of 6. Patient has not been evaluated for this episode but is reliable for immediate follow-up.

89. Which of the following is a contraindication for administration of intravascular tPA in the 3- to 4.5-hour window, but not in the initial 3 hours?

A. NIHSS of 22
B. patient age of 75
C. BP of 190/110
D. use of oral anticoagulant with INR of 1.2

90. Which of the following statements regarding intra-arterial thrombolysis for acute ischemic stroke is not true?

A. The only agent shown effective in a randomized trial is prourokinase.
B. If both are available, intra-arterial thrombolysis is recommended as a primary treatment over intravenous rtPA.
C. Intra-arterial thrombolysis can be used for both vertebral and basilar artery occlusions.
D. Similar to intravenous rtPA, intra-arterial thrombolysis is associated with a 4 to 5 times increased rate of intracranial hemorrhage compared with control.

CME Answer Key

81. C; 82. D; 83. A ; 84. B; 85. B; 86. D; 87. C; 88. B; 89. D; 90. B


In the February 28, 2011 issue, answer choice C in question 59 should read: The optic nerve should be measured at 3 mm behind the globe.

In the March 28, 2011 issue, the case presentation on page 93 should read, "An occlusion in the left PCA is visualized on MRA."