AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 65-year-old male presents with sudden onset of unilateral facial drooping, slurred speech, and weakness in his right arm. He denies headache or dizziness. His blood pressure is 160/90 mmHg. He has a history of hypertension and hyperlipidemia. What is the most critical immediate diagnostic consideration?
- AHypoglycemia
- BBell's Palsy
- CTransient Ischemic Attack (TIA)
- DIschemic Stroke
Show answer & explanationAnswer & explanation
Correct answer: D. Ischemic Stroke
The sudden onset of focal neurological deficits (facial drooping, slurred speech, arm weakness) in a patient with vascular risk factors strongly suggests an acute stroke. Given the duration, ischemic stroke is the most critical immediate consideration to guide rapid intervention.
Why the other options are wrong
- A. While hypoglycemia can cause neurological symptoms, the specific constellation of unilateral deficits makes stroke a higher priority.
- B. Bell's Palsy causes facial drooping but typically spares other neurological deficits and is not as acutely life-threatening.
- C. TIA symptoms resolve within 24 hours, but in the acute presentation, it's impossible to distinguish from a stroke without imaging, and treatment protocols are similar initially.
Acute Ischemic Stroke
A neurological deficit resulting from focal cerebral, spinal, or retinal infarction, caused by a sudden interruption of blood supply to the brain.
- Sudden onset of focal neurological deficits (FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911).
- Risk factors: hypertension, hyperlipidemia, diabetes, atrial fibrillation.
- Requires immediate imaging (CT brain) to rule out hemorrhage and guide treatment.
Memory trick: FAST: Face, Arm, Speech, Time to act for stroke.