17/11

Question 1

What is the CHA2 DS2 VAS score system used for?

What does it stand for?

What will be done on the back of this?

Answer 1

Congestive heart failure/LV dysfunction
HTN
Age > 75 = 2
Diabetes
Stroke/TIA/throm-embolism = 2
Vascular disease
Age 65-74
Sex - female

Used to calculate if A/C is needed in AF

Men 1+ = AC
Women 2+ = AC

1. DOAC (direct oral AC) - rivoxaban/apixaban
2. Warfarin

Question 2

Management of haemorraghic vs ischaemic stroke

Prevention afterwards

Answer 2

Haemorraghic
- ABCDE
- reverse AC
- IV labetolol/GTN infusion if HTN
- Neurosurgery referal

Ischaemic
ASPIRIN IMMEDIATELY post exclusion of haemorrhagic - unless thrombolysing
< 4.5hrs = thrombolysis (as long as not severe HTN)
Thrombectomy <12hrs
Carotid scan after to assess extent

HALTSS - prevention
HTN meds
Aspirin - life long and clopidogrel for 6 months
Lipid lowering - statin
Tobacco - stop
Sugar - control diabetes
Surgery - carotid endoartectomy if carotid stenosis 70-90%

Question 3

Presentation of UMN vs LMN lesion?

Answer 3

UMN
- Hyperreflexia
- Hypertonia
- Muscle WEAKNESS
- Clonus - involuntary, rhythmic contractions

LMN
- Muscle ATROPHY
- -ve Babinski
- ABSENT reflexes
- fasiculations

Question 4

Describe the GCS

Answer 4

Eye opening
Spontaneous - 4
Voice - 3
Pain/pressure - 2
None - 1

Voice
Orientated - 5
Confused - 4
Words - 3
Sounds - 2
None - 1

Motor
- Obeys commands - 6
- Localising - 5
- Normal flexion - 4
- Abnormal flexion - 3
- Extension - 2
- None - 1