American Board of Internal Medicine (ABIM) Certification Practice Exam

In the context of thrombolysis for ischemic stroke, any change in the neurologic examination should lead to a consideration of which complication?

1. Infection

2. Hemorrhage

3. Seizure activity

4. Oxygen desaturation

The correct answer is: Hemorrhage

In the context of thrombolysis for ischemic stroke, any change in the neurologic examination raises concerns about hemorrhage. Thrombolytic therapy, while beneficial in dissolving clots, carries with it the risk of intracerebral hemorrhage, particularly in the first few hours following treatment. Neurologic deterioration may signify a bleeding event, which can present as an acute change in motor function, speech, or level of consciousness. Monitoring for neurologic status is crucial in the immediate aftermath of thrombolysis. If a patient exhibits a decline in neurologic function, it is essential to assess for hemorrhagic complications, as timely recognition and intervention can significantly affect outcomes. Although other complications like infection, seizures, or oxygen desaturation may occur in patients post-stroke, they do not have the same immediate and critical association with changes in neurological exams in the setting of thrombolysis as does hemorrhage. Thus, the consideration of hemorrhage becomes paramount in these situations.