Which of the following is an ABSOLUTE contraindication to fibrinolytic therapy in a patient with STEMI when primary PCI is not available within 120 minutes?

• A Ischemic stroke occurring 14 months ago with full recovery
• B Blood pressure of 175/100 mmHg on presentation
• C Recent uncomplicated cataract surgery 3 weeks ago
• D Suspected acute aortic dissection ✓

Explanation

Suspected aortic dissection is an absolute contraindication because lytic therapy can precipitate fatal hemorrhage into the false lumen. Prior ischemic stroke beyond 3 months, severe hypertension below 180/110 mmHg, and remote minor surgery are relative contraindications only. Absolute contraindications also include any prior intracranial hemorrhage, active internal bleeding, and significant closed head trauma within 3 months.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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