MCQ Quiz: Health Disparities in Stroke

Stroke is a leading cause of death and disability, but its burden is not shared equally across all populations. Significant health disparities in stroke incidence, treatment, and outcomes exist based on race, ethnicity, geography, and socioeconomic status. These differences are often driven by complex social determinants of health, including access to care, control of risk factors, and systemic biases. For PharmD students and healthcare professionals, understanding the root causes of these inequities is the first step toward developing targeted interventions and providing more equitable care. This quiz will test your knowledge on the key factors contributing to stroke disparities and the strategies that can be employed to bridge the gap in patient outcomes.

1. Which racial/ethnic group in the U.S. has the highest incidence of stroke and the greatest stroke mortality rate?

• a) Non-Hispanic White Americans
• b) Non-Hispanic Black Americans
• c) Asian Americans
• d) Hispanic Americans

Answer: b) Non-Hispanic Black Americans

2. The “Stroke Belt” is a region in the United States with an unusually high stroke mortality rate. This region is primarily located in the:

• a) Pacific Northwest
• b) Northeast
• c) Midwest
• d) Southeast

Answer: d) Southeast

3. Which of the following is considered a social determinant of health (SDOH) that significantly impacts stroke risk?

• a) Genetic predisposition
• b) Age
• c) Socioeconomic status and neighborhood environment
• d) Blood type

Answer: c) Socioeconomic status and neighborhood environment

4. Studies have shown disparities in the administration of intravenous alteplase (tPA) for acute ischemic stroke. Which group has been found to be less likely to receive tPA?

• a) Patients arriving at designated stroke centers.
• b) Patients under 65 years of age.
• c) Female and minority patients.
• d) Patients with a high NIHSS score.

Answer: c) Female and minority patients.

5. A higher prevalence and lower control rates of which major stroke risk factor contribute significantly to the stroke disparity seen in Black Americans?

• a) Atrial fibrillation
• b) Hypertension
• c) Hyperlipidemia
• d) Migraine with aura

Answer: b) Hypertension

6. The concept of “food deserts,” or areas with limited access to affordable and nutritious food, is a social determinant of health that primarily increases the risk of stroke by contributing to:

• a) Head trauma.
• b) Poorly controlled hypertension, diabetes, and obesity.
• c) Genetic mutations.
• d) Air pollution.

Answer: b) Poorly controlled hypertension, diabetes, and obesity.

7. How can a pharmacist working in a community setting help address health disparities in stroke prevention?

• a) By refusing to fill prescriptions for patients from underserved areas.
• b) By providing blood pressure screenings and culturally competent counseling on medication adherence.
• c) By only stocking brand-name medications.
• d) By focusing only on patients with excellent insurance coverage.

Answer: b) By providing blood pressure screenings and culturally competent counseling on medication adherence.

8. Which of the following is a system-level barrier that contributes to disparities in acute stroke care?

• a) The patient’s personal preference for treatment.
• b) Longer emergency medical services (EMS) transport times for individuals in rural or underserved urban areas.
• c) The patient having a family history of stroke.
• d) The patient’s gender.

Answer: b) Longer emergency medical services (EMS) transport times for individuals in rural or underserved urban areas.

9. Low health literacy is a major contributor to health disparities. A patient with low health literacy may have difficulty with:

• a) Understanding medication instructions and appointment schedules.
• b) Recognizing stroke symptoms and knowing when to call 911.
• c) Navigating the complex healthcare system.
• d) All of the above.

Answer: d) All of the above.

10. Compared to men, women who have a stroke are more likely to:

• a) Be younger.
• b) Have better outcomes and less disability.
• c) Have their symptoms misattributed to other conditions like stress or migraine.
• d) Receive alteplase more quickly.

Answer: c) Have their symptoms misattributed to other conditions like stress or migraine.

11. The increased stroke risk in some Hispanic and Asian populations is often linked to a higher prevalence of which condition?

• a) Atrial fibrillation
• b) Intracranial atherosclerosis
• c) Carotid artery disease
• d) Sickle cell disease

Answer: b) Intracranial atherosclerosis

12. A pharmacist uses the “teach-back” method when counseling a patient on their new stroke prevention medications. This technique is particularly useful for addressing which barrier?

• a) High medication cost
• b) Lack of transportation
• c) Low health literacy
• d) Food insecurity

Answer: c) Low health literacy

13. Which of the following is an example of implicit bias in healthcare that could lead to stroke disparities?

• a) A hospital policy that requires all patients to be treated equally.
• b) A clinician unconsciously assuming a patient from a certain background is non-adherent and therefore not offering an advanced therapy.
• c) Using a certified medical interpreter for a patient with limited English proficiency.
• d) Screening all patients for hypertension regardless of race.

Answer: b) A clinician unconsciously assuming a patient from a certain background is non-adherent and therefore not offering an advanced therapy.

14. Disparities exist in post-stroke care. Which group is often less likely to be referred to inpatient rehabilitation services?

• a) Men
• b) Patients with high socioeconomic status.
• c) Black and Hispanic patients.
• d) Patients with private insurance.

Answer: c) Black and Hispanic patients.

15. A pharmacist is implementing a new MTM service in a clinic serving a diverse population. To ensure equitable care, the service should include:

• a) Providing materials only in English.
• b) Offering services only during standard business hours.
• c) Using professional medical interpreters and providing materials in multiple languages.
• d) Focusing outreach efforts only on affluent neighborhoods.

Answer: c) Using professional medical interpreters and providing materials in multiple languages.

16. The higher prevalence of sickle cell disease in the Black population is a risk factor for what type of stroke, particularly in children and young adults?

• a) Hemorrhagic stroke
• b) Ischemic stroke
• c) Transient ischemic attack
• d) Venous sinus thrombosis

Answer: b) Ischemic stroke

17. What role does health insurance status play in stroke disparities?

• a) It has no impact on care.
• b) Uninsured or underinsured patients may delay seeking care and have less access to secondary prevention medications and rehabilitation.
• c) Patients with public insurance receive better care than those with private insurance.
• d) All patients receive the same level of care regardless of insurance.

Answer: b) Uninsured or underinsured patients may delay seeking care and have less access to secondary prevention medications and rehabilitation.

18. Which of the following is a patient-level factor contributing to delays in seeking treatment for acute stroke symptoms?

• a) Efficient EMS systems.
• b) A lack of knowledge of stroke symptoms.
• c) Having a primary care physician.
• d) High socioeconomic status.

Answer: b) A lack of knowledge of stroke symptoms.

19. Culturally competent care in stroke management involves:

• a) Assuming all patients from a particular culture have the same beliefs.
• b) Ignoring the patient’s cultural background.
• c) Understanding and respecting how a patient’s cultural beliefs may impact their health decisions and communication style.
• d) Insisting that all patients adopt Western medical beliefs.

Answer: c) Understanding and respecting how a patient’s cultural beliefs may impact their health decisions and communication style.

20. The “Stroke Buckle,” a geographic area with the very highest concentration of stroke mortality, is a smaller region located within the larger Stroke Belt, primarily encompassing the coastal plains of:

• a) California and Oregon
• b) Florida and Texas
• c) North Carolina, South Carolina, and Georgia
• d) Maine and Vermont

Answer: c) North Carolina, South Carolina, and Georgia

21. A community pharmacist notices that many patients from a specific neighborhood are struggling to control their blood pressure. A potential social determinant contributing to this could be:

• a) A lack of safe places to walk or exercise in their neighborhood.
• b) The high cost of fresh produce at the only local grocery store.
• c) High levels of community stress.
• d) All of the above.

Answer: d) All of the above.

22. Studies show that Black and Hispanic patients are more likely to be discharged from the hospital to what location after a stroke, compared to White patients?

• a) An inpatient rehabilitation facility
• b) A skilled nursing facility or home without services
• c) A luxury recovery center
• d) Directly back to work

Answer: b) A skilled nursing facility or home without services

23. How does residential segregation contribute to stroke disparities?

• a) It ensures everyone has equal access to resources.
• b) It concentrates poverty and limits access to high-quality education, healthcare facilities, and healthy food options in certain neighborhoods.
• c) It has no effect on health outcomes.
• d) It promotes social cohesion, which reduces stroke risk.

Answer: b) It concentrates poverty and limits access to high-quality education, healthcare facilities, and healthy food options in certain neighborhoods.

24. To address disparities, public health campaigns about stroke symptoms (FAST) should be:

• a) Targeted only to hospital-based providers.
• b) Aired only on English-language television.
• c) Culturally tailored and disseminated through various channels to reach diverse communities.
• d) Focused only on the “Time” aspect of the acronym.

Answer: c) Culturally tailored and disseminated through various channels to reach diverse communities.

25. A pharmacist can advocate for health equity in stroke care by:

• a) Ignoring evidence of disparities.
• b) Supporting policies that improve access to care for underserved populations.
• c) Recommending only the most expensive treatments.
• d) Limiting the services offered at their pharmacy.

Answer: b) Supporting policies that improve access to care for underserved populations.

26. Which of these is a unique stroke risk factor that disproportionately affects women?

• a) Diabetes
• b) Smoking
• c) Preeclampsia and other hypertensive disorders of pregnancy
• d) High cholesterol

Answer: c) Preeclampsia and other hypertensive disorders of pregnancy

27. Lack of access to a “stroke-ready” hospital or primary stroke center is an example of what kind of disparity?

• a) Racial
• b) Gender
• c) Geographic
• d) Age-related

Answer: c) Geographic

28. A patient does not take their blood pressure medication because they believe their hypertension is caused by a spiritual imbalance, not a medical condition. This is an example of a barrier related to:

• a) Health literacy
• b) Cost of medication
• c) Health beliefs and cultural values
• d) Lack of transportation

Answer: c) Health beliefs and cultural values

29. The difference in health outcomes between groups that is avoidable and linked to social, economic, or environmental disadvantage is the definition of:

• a) Health equality
• b) A clinical trial
• c) A health disparity
• d) A standard of care

Answer: c) A health disparity

30. Which factor is NOT considered a social determinant of health?

• a) A patient’s genetic code.
• b) A patient’s educational level.
• c) A patient’s access to transportation.
• d) A patient’s housing stability.

Answer: a) A patient’s genetic code.

31. To improve outcomes for all, stroke systems of care should focus on:

• a) Building more hospitals only in wealthy areas.
• b) Standardizing protocols to ensure all patients receive evidence-based care, regardless of their background.
• c) Training only a select few paramedics on stroke recognition.
• d) Limiting the use of tPA to save money.

Answer: b) Standardizing protocols to ensure all patients receive evidence-based care, regardless of their background.

32. A patient with limited English proficiency is less likely to receive optimal stroke care due to:

• a) A lower pain tolerance.
• b) Communication barriers with healthcare providers.
• c) A higher likelihood of having private insurance.
• d) Genetic factors.

Answer: b) Communication barriers with healthcare providers.

33. A pharmacist is counseling a patient on a new statin. To address potential health literacy barriers, the pharmacist should:

• a) Use phrases like “dyslipidemia” and “HMG-CoA reductase inhibitor.”
• b) Say, “This medicine helps lower the bad cholesterol that can clog your blood vessels and cause a stroke.”
• c) Hand the patient the package insert and walk away.
• d) Tell the patient the information is too complicated for them to understand.

Answer: b) Say, “This medicine helps lower the bad cholesterol that can clog your blood vessels and cause a stroke.”

34. Higher rates of uncontrolled diabetes in some minority populations contribute to stroke risk through which mechanism?

• a) By causing direct rupture of cerebral aneurysms.
• b) By accelerating atherosclerosis and damaging small blood vessels.
• c) By improving cholesterol levels.
• d) By lowering blood pressure.

Answer: b) By accelerating atherosclerosis and damaging small blood vessels.

35. A key difference between health equality and health equity is that health equity focuses on:

• a) Giving everyone the exact same resources, regardless of need.
• b) Attaining the highest level of health for all people by addressing avoidable inequalities.
• c) Treating only one specific group of people.
• d) The biological differences between populations.

Answer: b) Attaining the highest level of health for all people by addressing avoidable inequalities.

36. Distrust in the healthcare system, often stemming from historical injustices and personal experiences with discrimination, is a significant barrier to care primarily affecting:

• a) All patients equally.
• b) Only young patients.
• c) Racial and ethnic minority groups.
• d) Only wealthy patients.

Answer: c) Racial and ethnic minority groups.

37. How can implicit bias training for healthcare providers help reduce stroke disparities?

• a) It can make providers aware of their unconscious biases, allowing them to make more objective clinical decisions.
• b) It teaches providers to treat all patients exactly the same, ignoring individual needs.
• c) It is not effective in changing behavior.
• d) It encourages providers to rely on stereotypes.

Answer: a) It can make providers aware of their unconscious biases, allowing them to make more objective clinical decisions.

38. Research shows that after a stroke, Black patients are less likely than White patients to receive a prescription for:

• a) Acetaminophen
• b) Anticoagulation for atrial fibrillation
• c) Antibiotics
• d) Saline nasal spray

Answer: b) Anticoagulation for atrial fibrillation

39. A community-based intervention to reduce stroke disparities might involve:

• a) Closing down local clinics.
• b) Setting up health screening and education events at community centers, churches, and barbershops.
• c) Increasing the price of fresh fruits and vegetables.
• d) Publishing research only in high-level scientific journals.

Answer: b) Setting up health screening and education events at community centers, churches, and barbershops.

40. The disproportionately high rate of end-stage renal disease (ESRD) in Black Americans is a major contributor to their increased risk of:

• a) Both ischemic and hemorrhagic stroke.
• b) Only hemorrhagic stroke.
• c) Only ischemic stroke.
• d) Only TIA.

Answer: a) Both ischemic and hemorrhagic stroke.

41. Which statement about gender and stroke is TRUE?

• a) Men have a higher lifetime risk of stroke than women.
• b) More women than men die from stroke each year.
• c) Atrial fibrillation is less common in women than men.
• d) Stroke symptoms are identical in men and women.

Answer: b) More women than men die from stroke each year.

42. A pharmacist identifies that a patient has not picked up their new anti-hypertensive medication due to a high co-pay. This is a barrier related to:

• a) Health beliefs
• b) Health literacy
• c) Access to care / socioeconomic factors
• d) Lack of motivation

Answer: c) Access to care / socioeconomic factors

43. A potential solution to the barrier in the previous question would be for the pharmacist to:

• a) Tell the patient the medication isn’t important.
• b) Investigate therapeutic alternatives on a lower formulary tier or assist with patient assistance programs.
• c) Ignore the problem.
• d) Lend the patient the money for the co-pay.

Answer: b) Investigate therapeutic alternatives on a lower formulary tier or assist with patient assistance programs.

44. The American Heart Association’s “Life’s Essential 8” are key measures for improving cardiovascular health and preventing stroke. Which of the following is included?

• a) Getting healthy sleep.
• b) Managing blood pressure.
• c) Eating healthy.
• d) All of the above.

Answer: d) All of the above.

45. A patient who is a recent immigrant may face what additional barrier to optimal stroke care?

• a) Language barriers.
• b) Lack of familiarity with the Western healthcare system.
• c) Cultural differences in understanding health and disease.
• d) All of the above.

Answer: d) All of the above.

46. To provide equitable care, a stroke center’s quality improvement committee should:

• a) Analyze their performance data to see if outcomes differ by race, ethnicity, or gender.
• b) Assume their care is equitable without looking at the data.
• c) Only look at data for the majority population.
• d) Focus only on financial metrics.

Answer: a) Analyze their performance data to see if outcomes differ by race, ethnicity, or gender.

47. A primary reason for the higher prevalence of uncontrolled hypertension in some populations is:

• a) A biological inability to respond to medication.
• b) A combination of factors including lower rates of medication adherence, less access to care, and social stressors.
• c) A preference for alternative medicine.
• d) Lack of effective medications.

Answer: b) A combination of factors including lower rates of medication adherence, less access to care, and social stressors.

48. Telehealth and telestroke services are promising tools for reducing which type of stroke disparity?

• a) Gender
• b) Racial
• c) Geographic
• d) Age-related

Answer: c) Geographic

49. A pharmacist providing MTM services to a patient from an underserved community should proactively screen for:

• a) Social determinants of health barriers like food insecurity and transportation issues.
• b) The patient’s favorite color.
• c) The patient’s political affiliation.
• d) The brand of car the patient drives.

Answer: a) Social determinants of health barriers like food insecurity and transportation issues.

50. The ultimate goal of studying and addressing health disparities in stroke is to:

• a) Document the differences in outcomes.
• b) Achieve health equity, where everyone has a fair and just opportunity to be as healthy as possible.
• c) Assign blame for poor outcomes.
• d) Prove that one group is healthier than another.

Answer: b) Achieve health equity, where everyone has a fair and just opportunity to be as healthy as possible.