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Cerebrovascular Diseases

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After administering intravenous recombinant tissue-type plasminogen activator (t-PA) without complication, prophylaxis for deep venous thrombosis with subcutaneous unfractionated heparin may be started

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(A) immediately

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(B) in 24 hours

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(C) in 4 days

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(D) in 7 days

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(E) in 10 days

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(B) Without the use of heparin prophylaxis, deep venous thrombosis (DVT) of a lower extremity may occur in up to half of patients with hemiplegic stroke. The highest incidence occurs between the second and seventh day poststroke. Elderly patients and those immobilized after stroke appear to be at highest risk. The greatest clinical concern related to proximal DVT is fatal pulmonary embolism (PE). Estimates of early deaths attributable to PE range from 13% to 25% and occur most frequently between the second and fourth week. Measures to prevent DVT should be routine for all patients with ischemic stroke admitted to the hospital. The use of low-intensity anticoagulation for DVT prophylaxis is recommended for all immobilized patients with stroke. Anticoagulants should not be used for 24 hours after administration of thrombolytic therapy. In patients with primary intracerebral hemorrhage, initiation of anticoagulation for DVT prophylaxis is often delayed for 3 to 4 days. However, definitive evidence to guide management after intracerebral hemorrhage is not available. (Barrett, 61–79)

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Ischemic penumbra tissue has a cerebral blood flow higher than

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(A) 3 mL/100 mg per minute

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(B) 5 mL/100 mg per minute

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(C) 7 mL/100 mg per minute

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(D) 10 mL/100 mg per minute

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(E) 15 mL/100 mg per minute

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(C) The ischemic penumbra presents tissue that is functionally impaired but structurally intact and, as such, potentially salvageable. It corresponds to a high cerebral blood flow (CBF) limit of 17 mL/100 mg per minute to 22 mL/100 mg per minute and a low CBF limit of 7 mL/100 mg per minute to 12 mL/100 mg per minute. Salvaging this tissue by restoring its flow to nonischemic levels is the aim of acute stroke therapy. (Jovin, 28–45)

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On magnetic resonance imaging (MRI), the area of diffusion/perfusion mismatch in acute stroke corresponds to the

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(A) area of the brain with irreversible ischemic damage

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(B) area of the brain with reversible ischemic damage

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(C) healthy brain tissue

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(D) hemorrhagic brain ...

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