American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the time cutoff for administering tPA in patients with ischemic stroke?

3 hours
4.5 hours
6 hours
12 hours

The correct answer is: 4.5 hours

The time cutoff for administering tissue plasminogen activator (tPA) in patients with ischemic stroke is 4.5 hours. This timeframe is based on clinical studies which demonstrated that administering tPA within this window can significantly improve outcomes, such as minimizing neurological damage and improving overall recovery in patients experiencing an ischemic stroke. Administering tPA after 4.5 hours has not been shown to have the same positive impact and could potentially lead to increased risks of complications, such as intracranial bleeding. Therefore, guidelines recommend that all eligible patients must be treated within this time frame to maximize the chances of favorable recovery outcomes. While there are exceptional cases where tPA might be considered beyond this 4.5-hour window, such instances are not part of standard practice and require careful selection based on individual patient circumstances. The other time options fall outside the recommended guidelines for tPA and do not align with the evidence supporting its efficacy within the critical window of 4.5 hours.