APEX NIH Stroke Scale Certification Exam
2026| Comprehensive Exam Compilation for
Guaranteed Pass
What blood pressure reading is considered high risk for stroke?
Greater than 140/90
What cholesterol level is classified as high risk?
Greater than 240 or 200-239
What is the recommended daily limit for alcohol consumption to reduce stroke risk?
No more than one alcoholic drink per day
what is the mainstay of acute therapy for stroke?
tPA (alteplase)
T/F: most patients don't arrive to the ED in time to receive tPA
true
what is the time window that tPA needs to be given in?
within 4.5 hours of onset of symptoms
,what is the most disabling side effect of stroke therapy?
ICH
what are 2 hallmark signs of stroke?
one-sided weakness and drooping face
secondary prevention of stroke involves controlling/managing risk factors, ____ ____, and the
use of ___ ____ in all patients
educating patients, antithrombotic agents (most patients will also receive a statin and a BP
lowering agent)
Stroke may be a result of cerebrovascular (____) or cardioembolic (____) sources. The final
result of both thrombus formation and embolism is an arterial ____ -> decreased cerebral blood
flow and ischemia distal to the occlusion. Thrombosis may take place in a few minutes or hours
or even days to fully evolve. A large vessel can take longer to become occluded than a smaller
vessel and there may be warning signs. One of the most important warning signs is a ____.
thrombotic, a. fib, occlusion, TIA
where are pharmacologic interventions most likely to be effective in stroke?
penumbra (that zone is supplied with blood by collateral arteries but if their perfusion is not re-
established quickly then the cells in the penumbra will die too b/c collateral circulation is
inadequate to maintain the oxygen demand)
headache is more common with ___ stroke
,hemorrhagic
what are 5 factors associated with increased stroke risk?
advanced age, DM, symptoms more than 10 minutes, weakness, and impaired speech
ABCD^2 is a simple score used to identify individuals at high early risk of stroke after TIA, what
are the 5 categories?
age, BP, clinical features, duration of symptoms, daibetes
how do you manage TIA?
manage risk factors (same as for ischemic stroke)
name 4 non-modifiable risk factors for ischemic stroke
age, race (black & hispanic), family history of stroke/TIA, prior stroke/TIA
name 11 modifiable risk factors for ischemic stroke
HTN, smoking, DM, asymptomatic carotid disease, dyslipidemia, sickle cell disease, a. fib,
dietary factors, physical inactivity, CAD, HF
this is the #1 modifiable risk factors for stroke
HTN
, how should you prevent a stroke in a patient who has HTN
follow JNC 7 guidelines for treating HTN according to compelling indications
this is the most common arrhythmia associated with stroke
a. fib
how do you prevent stroke in patients with a. fib?
antithrombotics (rate control has not been shown to prevent stroke)
how do you predict annual risk of stroke in patients with a. fib?
CHADS2
recent data confirms that ___ is superior to ASA therapy for stroke prevention in patients with a.
fib
warfarin
trials of stroke prevention in a. fib patients found _______ to have a significantly higher risk of
bleeding than warfarin or ASA monotherapy
ASA+clopidogrel (don't use it b/c we are dealing with patients who we worry about bleeding in)
this agent is historically the best for prevention of stroke in a. fib
2026| Comprehensive Exam Compilation for
Guaranteed Pass
What blood pressure reading is considered high risk for stroke?
Greater than 140/90
What cholesterol level is classified as high risk?
Greater than 240 or 200-239
What is the recommended daily limit for alcohol consumption to reduce stroke risk?
No more than one alcoholic drink per day
what is the mainstay of acute therapy for stroke?
tPA (alteplase)
T/F: most patients don't arrive to the ED in time to receive tPA
true
what is the time window that tPA needs to be given in?
within 4.5 hours of onset of symptoms
,what is the most disabling side effect of stroke therapy?
ICH
what are 2 hallmark signs of stroke?
one-sided weakness and drooping face
secondary prevention of stroke involves controlling/managing risk factors, ____ ____, and the
use of ___ ____ in all patients
educating patients, antithrombotic agents (most patients will also receive a statin and a BP
lowering agent)
Stroke may be a result of cerebrovascular (____) or cardioembolic (____) sources. The final
result of both thrombus formation and embolism is an arterial ____ -> decreased cerebral blood
flow and ischemia distal to the occlusion. Thrombosis may take place in a few minutes or hours
or even days to fully evolve. A large vessel can take longer to become occluded than a smaller
vessel and there may be warning signs. One of the most important warning signs is a ____.
thrombotic, a. fib, occlusion, TIA
where are pharmacologic interventions most likely to be effective in stroke?
penumbra (that zone is supplied with blood by collateral arteries but if their perfusion is not re-
established quickly then the cells in the penumbra will die too b/c collateral circulation is
inadequate to maintain the oxygen demand)
headache is more common with ___ stroke
,hemorrhagic
what are 5 factors associated with increased stroke risk?
advanced age, DM, symptoms more than 10 minutes, weakness, and impaired speech
ABCD^2 is a simple score used to identify individuals at high early risk of stroke after TIA, what
are the 5 categories?
age, BP, clinical features, duration of symptoms, daibetes
how do you manage TIA?
manage risk factors (same as for ischemic stroke)
name 4 non-modifiable risk factors for ischemic stroke
age, race (black & hispanic), family history of stroke/TIA, prior stroke/TIA
name 11 modifiable risk factors for ischemic stroke
HTN, smoking, DM, asymptomatic carotid disease, dyslipidemia, sickle cell disease, a. fib,
dietary factors, physical inactivity, CAD, HF
this is the #1 modifiable risk factors for stroke
HTN
, how should you prevent a stroke in a patient who has HTN
follow JNC 7 guidelines for treating HTN according to compelling indications
this is the most common arrhythmia associated with stroke
a. fib
how do you prevent stroke in patients with a. fib?
antithrombotics (rate control has not been shown to prevent stroke)
how do you predict annual risk of stroke in patients with a. fib?
CHADS2
recent data confirms that ___ is superior to ASA therapy for stroke prevention in patients with a.
fib
warfarin
trials of stroke prevention in a. fib patients found _______ to have a significantly higher risk of
bleeding than warfarin or ASA monotherapy
ASA+clopidogrel (don't use it b/c we are dealing with patients who we worry about bleeding in)
this agent is historically the best for prevention of stroke in a. fib
