In this short, I break down the five stroke questions I see on every USMLE exam—Step 1, Step 2, and Step 3—and these are the exact ones that decide pass or fail. First, when they give you sudden focal deficits (facial droop, arm weakness), the “first test” is not MRI and it’s not treatment—it’s a non-contrast CT head. I use CT because it’s fast and it rules out hemorrhage, and you cannot give thrombolytics if there’s bleeding. Next, I hit the classic acute ischemic stroke algorithm: if CT shows no hemorrhage and you’re within 4.5 hours, IV thrombolytic therapy is the move—but only after you check contraindications. That’s where students get trapped by picking tPA automatically when the stem includes recent surgery, active bleeding, prior intracranial hemorrhage, or BP >185 systolic. Then I walk through artery localization (MCA vs ACA vs PCA, plus vertebrobasilar “crossed” findings), lacunar syndromes from chronic HTN small-vessel lipohyalinosis, and finally secondary prevention: anticoagulate for atrial fibrillation cardioembolic strokes, and use antiplatelet therapy (aspirin ± clopidogrel) when there’s no AF. My goal is simple—make your stroke questions automatic with a clean, active-learning framework.