COTE Flashcards
AMTS questions
- “What is your age?”
- “What is the time to the nearest hour?”
- Give the patient an address, and ask them to repeat it at the end of the test (e.g. “42 West Street”)
- “What is the year?”
- “What is the name of this place?” or “What is your house number?”
- Can the patient recognise two persons (e.g. doctor, nurse)?
- “What is your date of birth?” (day and month sufficient)
- “In what year did World War 1 begin?”
- “Name the present monarch/prime minister/president”
- “Count backwards from 20 down to 1”
Falls factors
Intrinsic factors - sensory/proprioception
Extrinsic - envinromentla - lighting etc
Stressor - transient dizzyness orthostatic hypotension
“Why today”
and
“Why this person”
Key questions in syncope
situation prodrome loc collateral history recovery period
“Dizzyness” be more precise please
Vertigo - feeling the room spinning Disequlibrium - unsteadyness Lightheaded/syncope Mixed Other = malaise/weakness
“drop attack”
Fall iwth no prodrome - minimal loc of and rapid recovery. caused by arythmia/carotid sinus syndrome/orthostatic hypotension/cauda equina.
fall in bp orthostatically to be diagnostic
Systole 20mm/mg / Diastole 10mm/mg
Cautions for ACE -i
Renal disease
Hypotension
Hyperkalemia
Thrombolysis Stroke
44 fewer dead per 1000 treaed within 6 hours and 126 fewer dead per 1000 if within 3 hours.
Imaging must be done prior
Exclusions include: active bleeding site seizure at onset imparied coagulation severe strokes uncontrolled hypertension
Stroke aspirin dose
300mg can be given PR or NG as soon as haemorrage excluded.
Stroke severity scale?
Bamford
Bamford scale
stroke severity
Total anterior circulation stroke?
Total anterior circulation stroke (TACS)
A total anterior circulation stroke (TACS) is a large cortical stroke affecting the areas of the brain supplied by both the middle and anterior cerebral arteries.
All three of the following need to be present for a diagnosis of a TACS:
Unilateral weakness (and/or sensory deficit) of the face, arm and leg Homonymous hemianopia Higher cerebral dysfunction (dysphasia, visuospatial disorder)
Partial anterior circulation stroke (PACS)?
Partial anterior circulation stroke (PACS)
A partial anterior circulation stroke (PACS) is a less severe form of TACS, in which only part of the anterior circulation has been compromised.
Two of the following need to be present for a diagnosis of a PACS:
Unilateral weakness (and/or sensory deficit) of the face, arm and leg Homonymous hemianopia Higher cerebral dysfunction (dysphasia, visuospatial disorder)* *Higher cerebral dysfunction alone is also classified as PACS.
Posterior circulation syndrome (POCS)?
Posterior circulation syndrome (POCS)
A posterior circulation syndrome (POCS) involves damage to the area of the brain supplied by the posterior circulation (e.g. cerebellum and brainstem).
One of the following need to be present for a diagnosis of a POCS:
Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia
Lacunar stroke (LACS)?
Lacunar stroke (LACS) A lacunar stroke (LACS) is a subcortical stroke that occurs secondary to small vessel disease. There is no loss of higher cerebral functions (e.g. dysphasia).
One of the following needs to be present for a diagnosis of a LACS:
Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis
