American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is NOT one of the criteria that would exclude a patient from receiving tPA in the 3-4.5 hour window?

1. Age > 80

2. Diabetic with a previous stroke

3. NIHSS > 25

4. No history of stroke

The correct answer is: No history of stroke

To understand why the answer is D, it's essential to recognize the criteria that guide the administration of tissue plasminogen activator (tPA) for acute ischemic stroke. The primary concern in administering tPA lies in the risk of hemorrhagic complications versus the opportunity to improve patient outcomes through thrombolysis. When evaluating patients for tPA, specific characteristics or prior conditions can raise concerns regarding the appropriateness of administering this treatment. Age over 80 is a known factor that may increase the risk of complications with tPA. Similarly, having a diabetic history along with a previous stroke indicates a higher likelihood of adverse outcomes, thus making these patients potentially ineligible for tPA treatment, particularly within the 3-4.5 hour window. A high NIHSS score, which indicates a severe stroke, can also be a criterion for exclusion, as it correlates with an increased risk of bleeding complications. Contrastingly, having no history of stroke does not inherently place a patient at risk for complications from tPA administration. In fact, a lack of prior cerebrovascular events may indicate a better prognosis and lower risk for additional complications, making it a criterion that does not disqualify a patient from treatment. Therefore, D accurately reflects a condition that