Stroke MCQs With Answer

Stroke MCQs With Answer is a concise, Student-friendly learning resource tailored for B. Pharm students to master stroke pathophysiology, pharmacotherapy, and clinical management. This introduction emphasizes key topics such as ischemic versus hemorrhagic stroke, thrombolytics (alteplase), antiplatelets, anticoagulants, statins, blood pressure strategies, imaging, and secondary prevention. Questions focus on drug mechanisms, dosing, contraindications, complications, and evidence-based guidelines to build practical clinical reasoning. Ideal for exam prep and revision, these MCQs link pharmacology principles to real-world stroke care, helping students understand therapeutic choices and safety issues. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary immediate imaging modality to differentiate ischemic from hemorrhagic stroke?

• Non-contrast CT scan of the head
• Contrast-enhanced CT angiography
• Diffusion-weighted MRI
• Carotid Doppler ultrasound

Correct Answer: Non-contrast CT scan of the head

Q2. What is the maximum recommended IV alteplase (tPA) dose for acute ischemic stroke?

• 0.9 mg/kg (maximum 90 mg)
• 1.5 mg/kg (maximum 150 mg)
• 0.25 mg/kg (maximum 25 mg)
• 2.0 mg/kg (no maximum)

Correct Answer: 0.9 mg/kg (maximum 90 mg)

Q3. Which of the following is a major absolute contraindication to IV thrombolysis in acute ischemic stroke?

• Active internal bleeding
• History of controlled hypertension
• Diabetes mellitus
• Migraine with aura

Correct Answer: Active internal bleeding

Q4. Aspirin’s antiplatelet effect in stroke prevention is primarily due to inhibition of which enzyme?

• Cyclooxygenase-1 (COX-1)
• Thromboxane synthase
• Phospholipase A2
• ADP P2Y12 receptor

Correct Answer: Cyclooxygenase-1 (COX-1)

Q5. Which antiplatelet agent blocks the P2Y12 ADP receptor on platelets?

• Clopidogrel
• Aspirin
• Ticagrelor is not a P2Y12 inhibitor
• Warfarin

Correct Answer: Clopidogrel

Q6. For a patient with ischemic stroke who received IV tPA, when is it generally safe to start aspirin?

• 24 hours after thrombolysis, if follow-up CT shows no hemorrhage
• Immediately during tPA infusion
• Within 1 hour after tPA bolus
• Never if tPA was given

Correct Answer: 24 hours after thrombolysis, if follow-up CT shows no hemorrhage

Q7. Which pharmacologic class does dabigatran belong to?

• Direct thrombin (factor IIa) inhibitor
• Vitamin K antagonist
• Factor Xa inhibitor
• Antiplatelet agent

Correct Answer: Direct thrombin (factor IIa) inhibitor

Q8. In atrial fibrillation patients for stroke prevention, which is generally preferred over aspirin?

• Oral anticoagulation (e.g., DOAC or warfarin)
• High-dose statin
• Single antiplatelet therapy
• Low-dose beta blocker

Correct Answer: Oral anticoagulation (e.g., DOAC or warfarin)

Q9. What is the main pathophysiologic event in ischemic stroke?

• Cerebral artery occlusion leading to reduced cerebral blood flow and ischemia
• Primary rupture of a cerebral aneurysm
• Immunologic demyelination of neurons
• Diffuse metabolic encephalopathy

Correct Answer: Cerebral artery occlusion leading to reduced cerebral blood flow and ischemia

Q10. Which parameter is recommended to be controlled before giving IV tPA?

• Systolic blood pressure ≤185 mm Hg and diastolic ≤110 mm Hg
• Systolic BP <220 mm Hg only
• Fasting blood glucose <200 mg/dL only
• Pulse <100 bpm

Correct Answer: Systolic blood pressure ≤185 mm Hg and diastolic ≤110 mm Hg

Q11. Which lipid-lowering therapy is indicated for secondary prevention after ischemic stroke regardless of baseline LDL in most patients?

• High-intensity statin therapy
• Fibrate therapy
• Bile acid sequestrant only
• No lipid therapy recommended

Correct Answer: High-intensity statin therapy

Q12. Which clinical scale is commonly used to assess stroke severity at presentation?

• NIH Stroke Scale (NIHSS)
• Glasgow Coma Scale
• APACHE II
• Modified Rankin Score

Correct Answer: NIH Stroke Scale (NIHSS)

Q13. For acute large vessel occlusion in eligible patients, what intervention can be performed up to 24 hours in select cases?

• Mechanical thrombectomy
• Oral aspirin only
• Carotid endarterectomy immediately
• High-dose IV heparin infusion

Correct Answer: Mechanical thrombectomy

Q14. Which drug reverses warfarin anticoagulation most rapidly in major intracranial hemorrhage?

• Prothrombin complex concentrate (PCC)
• Vitamin B12
• Protamine sulfate
• Fresh frozen plasma is faster than PCC

Correct Answer: Prothrombin complex concentrate (PCC)

Q15. Which of the following is a common early complication of ischemic stroke?

• Hemorrhagic transformation
• Acute pancreatitis
• Peripheral neuropathy
• Nephrolithiasis

Correct Answer: Hemorrhagic transformation

Q16. Which medication class is contraindicated as initial monotherapy for secondary prevention in non-cardioembolic ischemic stroke when dual antiplatelet therapy is not indicated?

• Anticoagulants (unless atrial fibrillation present)
• Statins
• Antihypertensives
• Aspirin

Correct Answer: Anticoagulants (unless atrial fibrillation present)

Q17. What is the recommended acute management of blood pressure in ischemic stroke patients not receiving reperfusion therapy?

• Allow permissive hypertension up to ~220/120 mm Hg
• Lower BP immediately to <140/90 mm Hg
• Maintain BP at <120/80 mm Hg
• Stop all antihypertensive drugs permanently

Correct Answer: Allow permissive hypertension up to ~220/120 mm Hg

Q18. Which anticoagulant directly inhibits factor Xa?

• Rivaroxaban
• Dabigatran
• Warfarin
• Heparin has no effect on factor Xa

Correct Answer: Rivaroxaban

Q19. Which stroke subtype is most likely associated with sudden severe headache, vomiting, and decreased consciousness?

• Intracerebral or subarachnoid hemorrhage
• Lacunar ischemic stroke
• Transient ischemic attack
• Ischemic stroke due to small vessel disease

Correct Answer: Intracerebral or subarachnoid hemorrhage

Q20. Which factor increases the risk of hemorrhagic transformation after ischemic stroke?

• Use of thrombolytics and large infarct size
• Low serum cholesterol
• Prior statin therapy
• Young age

Correct Answer: Use of thrombolytics and large infarct size

Q21. Tenecteplase compared with alteplase in some trials is characterized by which feature?

• Single bolus administration and longer half-life
• Shorter half-life requiring infusion
• Complete lack of fibrinolytic activity
• Higher risk of hepatitis

Correct Answer: Single bolus administration and longer half-life

Q22. Which lab test is most important to check before administering IV tPA?

• Blood glucose and platelet count
• Serum creatinine only
• Liver enzymes only
• Serum potassium only

Correct Answer: Blood glucose and platelet count

Q23. Which secondary prevention measure reduces recurrent ischemic stroke risk in patients with carotid stenosis?

• Carotid endarterectomy or stenting in selected patients plus medical therapy
• Immediate anticoagulation for all
• High-dose vitamin supplements only
• No intervention is effective

Correct Answer: Carotid endarterectomy or stenting in selected patients plus medical therapy

Q24. Which drug is used to reverse the effects of dabigatran in life-threatening bleeding?

• Idarucizumab
• Vitamin K
• PCC is ineffective on dabigatran
• Protamine sulfate

Correct Answer: Idarucizumab

Q25. Which risk factor contributes most strongly to ischemic stroke incidence globally?

• Hypertension
• Asthma
• Hypothyroidism
• Low body weight

Correct Answer: Hypertension

Q26. What is the mechanism of action of tissue plasminogen activator (tPA)?

• Converts plasminogen to plasmin, promoting fibrin clot breakdown
• Inhibits platelet ADP receptors
• Blocks vitamin K epoxide reductase
• Directly activates factor X

Correct Answer: Converts plasminogen to plasmin, promoting fibrin clot breakdown

Q27. Which condition is classically labeled as a transient ischemic attack (TIA)?

• Focal neurological deficit resolving within 24 hours without acute infarction on imaging
• Permanent deficit lasting more than one week
• Generalized seizure activity only
• Non-focal dizziness due to vertigo

Correct Answer: Focal neurological deficit resolving within 24 hours without acute infarction on imaging

Q28. In acute ischemic stroke, which glucose management approach is recommended?

• Maintain blood glucose between ~140–180 mg/dL
• Allow glucose >300 mg/dL to improve brain energy
• Induce hypoglycemia <60 mg/dL
• Ignore glucose levels in acute phase

Correct Answer: Maintain blood glucose between ~140–180 mg/dL

Q29. Which class of drugs is recommended for long-term prevention of stroke in patients with symptomatic carotid atherosclerosis and no AF?

• Aspirin plus statin and BP control
• Long-term IV heparin
• High-dose corticosteroids
• Daily antibiotics

Correct Answer: Aspirin plus statin and BP control

Q30. Which is a common adverse effect of high-dose statin therapy relevant to stroke patients?

• Muscle pain and elevated CK
• Hypoglycemia
• Neutropenia
• Hypertensive crisis

Correct Answer: Muscle pain and elevated CK

Q31. Which is true regarding secondary prevention in lacunar infarcts due to small vessel disease?

• Antiplatelet therapy and risk factor control are mainstays
• All patients require long-term anticoagulation
• Antibiotics reduce recurrence
• Surgery is routinely indicated

Correct Answer: Antiplatelet therapy and risk factor control are mainstays

Q32. What medication is commonly used acutely to lower severely elevated blood pressure in intracerebral hemorrhage?

• IV labetalol or nicardipine infusion
• Oral ACE inhibitor only
• Subcutaneous insulin
• Oral aspirin

Correct Answer: IV labetalol or nicardipine infusion

Q33. Which monitoring is essential for a patient on warfarin to prevent stroke or bleeding complications?

• INR monitoring
• Daily fasting glucose
• Serum potassium
• Urine culture

Correct Answer: INR monitoring

Q34. Which statement about hemorrhagic stroke management is correct?

• Rapid reversal of anticoagulation and blood pressure control are priorities
• Initiate thrombolysis immediately
• Allow systolic BP to remain >220 mm Hg
• Antiplatelet agents should be started urgently

Correct Answer: Rapid reversal of anticoagulation and blood pressure control are priorities

Q35. What is the primary therapeutic goal in the hyperacute phase of ischemic stroke?

• Recanalization of occluded vessels to salvage penumbra
• Long-term rehabilitation only
• Immediate cholesterol lowering as the sole priority
• Dehydration of the patient

Correct Answer: Recanalization of occluded vessels to salvage penumbra

Q36. Which factor increases eligibility for endovascular thrombectomy in acute ischemic stroke?

• Large vessel occlusion on vascular imaging
• Small vessel lacunar infarct only
• Active systemic infection
• Uncontrolled bleeding diathesis

Correct Answer: Large vessel occlusion on vascular imaging

Q37. Which medication can be used to lower LDL cholesterol rapidly after ischemic stroke when statins are insufficient?

• PCSK9 inhibitors (e.g., evolocumab)
• Fibrates only
• Niacin is first-line acute therapy
• Oral bile salts are immediate LDL-lowering agents

Correct Answer: PCSK9 inhibitors (e.g., evolocumab)

Q38. Which sign suggests increased intracranial pressure in a stroke patient?

• Decreasing level of consciousness and papilledema
• Brisk reflexes only without other signs
• Isolated peripheral neuropathy
• Improved mental status

Correct Answer: Decreasing level of consciousness and papilledema

Q39. What is the role of hyperglycemia in acute stroke outcomes?

• It is associated with worse outcomes and increased infarct size
• It is protective for ischemic penumbra
• It has no effect on stroke outcomes
• Only hypoglycemia matters clinically

Correct Answer: It is associated with worse outcomes and increased infarct size

Q40. Which antiplatelet regimen has evidence for short-term use after minor stroke or high-risk TIA?

• Dual antiplatelet therapy with aspirin plus clopidogrel for 21 days
• Aspirin alone for 1 day only
• Warfarin indefinitely
• No antiplatelet therapy at all

Correct Answer: Dual antiplatelet therapy with aspirin plus clopidogrel for 21 days

Q41. Which metabolic derangement must be corrected emergently in stroke because it mimics stroke symptoms?

• Severe hypoglycemia
• Hypercholesterolemia
• Vitamin D deficiency
• Chronic anemia

Correct Answer: Severe hypoglycemia

Q42. Which medication impairs platelet function by irreversibly acetylating platelet cyclooxygenase?

• Aspirin (acetylsalicylic acid)
• Clopidogrel
• Ticagrelor
• Heparin

Correct Answer: Aspirin (acetylsalicylic acid)

Q43. What is the preferred acute antithrombotic strategy for cardioembolic stroke due to atrial fibrillation?

• Start anticoagulation (DOAC or warfarin) after assessing hemorrhagic risk and timing
• Aspirin only
• Dual antiplatelet therapy forever
• No antithrombotic therapy

Correct Answer: Start anticoagulation (DOAC or warfarin) after assessing hemorrhagic risk and timing

Q44. Which monitoring parameter helps detect hemorrhagic transformation after reperfusion therapy?

• Repeat neuroimaging (CT/MRI)
• Serum sodium only
• Chest X-ray
• Urine output

Correct Answer: Repeat neuroimaging (CT/MRI)

Q45. Which infectious complication is common in the early post-stroke period and can worsen outcomes?

• Pneumonia due to aspiration
• Urinary tract infection is never seen
• Skin fungal infection only
• Otitis externa exclusively

Correct Answer: Pneumonia due to aspiration

Q46. Which drug interaction increases bleeding risk when combined with anticoagulants or antiplatelets?

• Concurrent use of NSAIDs
• Concurrent use of vitamin C supplements
• Concurrent use of topical emollients
• Concurrent use of oral probiotics

Correct Answer: Concurrent use of NSAIDs

Q47. In secondary prevention, which lifestyle modification has the greatest impact on reducing stroke risk?

• Blood pressure control (hypertension management)
• Wearing compression stockings
• Daily sauna use only
• Avoiding all fruits

Correct Answer: Blood pressure control (hypertension management)

Q48. Which medication class is recommended for glycemic control in diabetic patients to reduce long-term vascular risk after stroke?

• Appropriate antihyperglycemic agents individualized to patient, with glycemic targets to reduce vascular risk
• Insulin only for all stroke patients
• Sulfonylureas should be avoided always
• Glycemic control is irrelevant to stroke prevention

Correct Answer: Appropriate antihyperglycemic agents individualized to patient, with glycemic targets to reduce vascular risk

Q49. Which laboratory abnormality increases risk of hemorrhage with tPA therapy?

• Platelet count <100,000/µL
• Mildly elevated ALT only
• Low hemoglobin without coagulopathy
• Hypernatremia

Correct Answer: Platelet count <100,000/µL

Q50. Which statement best describes the role of neuroprotective drugs in acute stroke currently?

• No neuroprotective agent has proven routine clinical benefit; supportive care and reperfusion are primary
• Many neuroprotective drugs are first-line therapies
• Neuroprotection replaces the need for reperfusion
• Neuroprotective drugs are universally recommended for all stroke patients

Correct Answer: No neuroprotective agent has proven routine clinical benefit; supportive care and reperfusion are primary

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