American Board of Internal Medicine (ABIM) Certification Practice Exam

In cases of recent significant head trauma or ischemic stroke, what is the timeframe within which tPA cannot be administered?

1. 1 month

2. 3 months

3. 1 week

4. 2 weeks

The correct answer is: 3 months

The use of tissue plasminogen activator (tPA) is critically time-sensitive and is generally indicated within a specific timeframe following an ischemic stroke. In the context of recent significant head trauma, administering tPA is restricted within a window to minimize the risk of complications such as hemorrhage. The correct answer indicates that tPA cannot be administered if there has been recent significant head trauma or ischemic stroke within the past three months. This timeframe is established because recent head injuries may have resulted in intracranial bleeding, which could be exacerbated by the administration of tPA. This medication promotes the dissolution of blood clots, which is beneficial in acute ischemic stroke, but it also has the potential to cause bleeding in cases where the anatomy of the vasculature may be compromised due to prior trauma. The one-month and two-week options do not accurately reflect the established guidelines regarding the safe use of tPA post head trauma or ischemic stroke. The one-week option falls too short considering the potential lingering effects of head trauma or a recent ischemic event, which could still pose risks even after a week. Therefore, the three-month guideline serves to ensure patient safety by allowing enough time for any bleeding or complications related to the trauma or stroke to