Mehlman High Yield Practice Exam

In evaluating tPA eligibility for stroke, which timing concept is used?

Time Since Symptom Onset Time Since Hospital Arrival Time Until Emergency Department Visit Time Since Last Known Normal

Correct Answer:

Time Since Last Known Normal

Explanation:

The timing anchor used for deciding tPA eligibility is the moment the patient was last known to be normal. This matters because many stroke patients cannot report exactly when symptoms began, so using the last time they were normal provides a concrete start point to calculate the treatment window. For IV tPA, that window is based on elapsed time since that last normal moment, guiding whether the patient still qualifies within the permitted hours. Time since hospital arrival isn’t the deciding factor because a patient can arrive early or late relative to onset, and the key issue is how long ago symptoms started. Time since last known normal is preferred because it directly ties the treatment decision to the actual onset of symptoms, even when onset time is uncertain.

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