TIA and minor stroke — KFP-style written assessment

KFP 1 (10 marks)

A 66-year-old woman develops left facial droop and arm weakness lasting 20 minutes, fully resolved on arrival. BP 152/94 mmHg; glucose 7.1 mmol/L; ECG shows sinus rhythm. ABCD2 = 3. ^[1]

1. Interpret the score and state what it does NOT tell you. (3) ^[1]
2. What did EXPRESS demonstrate about the urgency of her pathway? (4) ^[6]
3. Which single bedside test must precede any diagnostic labelling in suspected TIA? (1) ^[1]
4. She drives a private car. Advise her about driving. (2) ^[7]

Model answers

1. ABCD2 = 3 (age 60+ no; BP yes; speech/weakness — she had weakness but it's resolved; duration 10–59 min = 1... scoring uses features at presentation: with weakness 2 + duration 1 + BP 1 = 4 if weakness counted). Either way: the score stratifies two-day risk (0–3: 1.0%; 4–5: 4.1%; 6–7: 8.1%) but measures priority, not diagnosis — it cannot exclude TIA, ignores posterior circulation, and says nothing about mechanism. Specialist assessment within 24 hours proceeds regardless. ^[1]
2. EXPRESS: accelerating clinic assessment from a median of 3 days to under 1 day and first prescription from 20 days to 1 day cut 90-day recurrent stroke from 10.3% to 2.1% (adjusted HR 0.20) without increasing bleeding — urgency itself is the treatment. ^[6]
3. Blood glucose — hypoglycaemia reproduces focal deficits exactly and must be excluded in every suspected event. ^[1]
4. Group 1 drivers stop driving for one month after TIA/stroke, resuming only with satisfactory recovery, without notifying the authority; document the advice. ^[7]