Keep mixing up non-contrast head CT first to rule out hemorrhage; IV alteplase/tenecteplase within 4.5h if BP < 185/110 and no contraindications in acute stroke tPA eligibility, bl

Hey guys, so I been doing timed random blocks all week and every single time acute stroke tPA eligibility, blood pressure targets, and secondary prevention shows up I freeze up. Specifically non-contrast head CT first to rule out hemorrhage; IV alteplase/tenecteplase within 4.5h if BP < 185/110 and no contraindications vs permissive hypertension up to 220/120 if not getting thrombolysis, and holding aspirin/heparin for 24h after tPA always gets me when I only have 60 seconds left on the clock.

In my head I keep falling for dropping blood pressure from 205/105 to 120/80 acutely in an ischemic stroke patient not receiving tPA. What clue in the vignette makes you jump straight to the right answer w/o overthinking?

Context: currently during sub-I night float downtime squeezing in 15 qs between pages.

Been there man, acute stroke tPA eligibility, blood pressure targets, and secondary prevention used to wreck my timing too until I simplified it. The biggest thing is echocardiogram, carotid duplex, telemetry for occult afib, high-intensity atorvastatin, and antiplatelet therapy before discharge. Once you lock onto non-contrast head CT first to rule out hemorrhage; IV alteplase/tenecteplase within 4.5h if BP < 185/110 and no contraindications first and then check permissive hypertension up to 220/120 if not getting thrombolysis, and holding aspirin/heparin for 24h after tPA, you automatically rule out 3 of the 5 choices in like 15 seconds.

Also watch out for dropping blood pressure from 205/105 to 120/80 acutely in an ischemic stroke patient not receiving tPA — test writers love throwing that in when you are during sub-I night float downtime squeezing in 15 qs between pages. If you just circle the vitals/labs and ask yourself whether non-contrast head CT first to rule out hemorrhage; IV alteplase/tenecteplase within 4.5h if BP < 185/110 and no contraindications is the primary driver, you will stop falling for the distractor.

Bruh dropping blood pressure from 205/105 to 120/80 acutely in an ischemic stroke patient not receiving tPA got me twice this week during sub-I night float downtime squeezing in 15 qs between pages lol. Writing non-contrast head CT first to rule out hemorrhage; IV alteplase/tenecteplase within 4.5h if BP < 185/110 and no contraindications at the top of my scratch pad before clicking an answer finally broke the habit.

Same here! English is my second language too and long stems on acute stroke tPA eligibility, blood pressure targets, and secondary prevention used to eat my clock during sub-I night float downtime squeezing in 15 qs between pages. Reading the last line + non-contrast head CT first to rule out hemorrhage; IV alteplase/tenecteplase within 4.5h if BP < 185/110 and no contraindications first makes it way faster.

Can confirm as a PGY-1 now, echocardiogram, carotid duplex, telemetry for occult afib, high-intensity atorvastatin, and antiplatelet therapy before discharge is not just high yield for the exam on acute stroke tPA eligibility, blood pressure targets, and secondary prevention during sub-I night float downtime, you literally use non-contrast head CT first to rule out hemorrhage; IV alteplase/tenecteplase within 4.5h if BP < 185/110 and no contraindications on the wards all the time squeezing in 15 qs between pages.

One extra clinical pearl for acute stroke tPA eligibility, blood pressure targets, and secondary prevention: whenever they mention permissive hypertension up to 220/120 if not getting thrombolysis, and holding aspirin/heparin for 24h after tPA during sub-I night float downtime, always double check the vitals and timeline bc dropping blood pressure from 205/105 to 120/80 acutely in an ischemic stroke patient not receiving tPA is their favorite way to trick people squeezing in 15 qs between pages.

If you are during sub-I night float downtime squeezing in 15 qs between pages, dont beat yourself up over acute stroke tPA eligibility, blood pressure targets, and secondary prevention misses rn — missing permissive hypertension up to 220/120 if not getting thrombolysis, and holding aspirin/heparin for 24h after tPA on qbank today means you will spot it immediately on exam day.

What helped me lock in acute stroke tPA eligibility, blood pressure targets, and secondary prevention during sub-I night float downtime squeezing in 15 qs between pages was making just 2 quick contrast cards comparing non-contrast head CT first to rule out hemorrhage; IV alteplase/tenecteplase within 4.5h if BP < 185/110 and no contraindications vs permissive hypertension up to 220/120 if not getting thrombolysis, and holding aspirin/heparin for 24h after tPA instead of re-reading the whole chapter.