Emergency Medicine Board Review Sample Questions

The correct answer is E. Exchange transfusion

Explanation: Cerebrovascular events are a potential complication of sickle cell disease. For patients with acute ischemic stroke, exchange transfusion is indicated. Transfusion goals include decreasing hemoglobin S levels to <30% and a total hemoglobin level of 10g/dL. For adults with acute ischemic strokes, consider tissue plasminogen activator (tPA). tPA is not indicated or approved for use in pediatric patients. (A) Alteplase is a thrombolytic medication used in acute thromboembolic events, including pulmonary embolism, deep venous thrombosis, and acute coronary syndrome. Its use in acute ischemic strokes is not standard. In addition, thrombolytic therapy is not approved for pediatric use. (B) The appropriate treatment for a pediatric patient with acute ischemic stroke secondary to sickle cell disease is exchange transfusion, not heparin. (C) Obtaining an MRI will not add to the diagnosis and will delay definitive management. The diagnosis has already been confirmed by imaging, so further imaging is not indicated. (D) Tranexamic acid (TXA) is an antifibrinolytic agent used in the management of hemorrhage. Indications include acute traumatic hemorrhage, intraoperative blood loss, and obstetric hemorrhage. TXA is not used in ischemic events.