General Adult

Question 1

What time frame discriminates stroke from TIA?

Answer 1

No time frame; key is TIA is transient (usually 2-3 hours)

Question 2

Most common symptoms in vertebral artery dissection

Answer 2

• HA (69%)

- Posterior neck pain (46%)

Question 3

TPA exclusion criteria: within how many days of surgery are patient’s excluded?

Answer 3

14 days

Question 4

What is the pretreatment systolic pressure that pt must have before getting TPA?

Answer 4

185/110

Question 5

What INR must person have below to get TPA?

Answer 5

1.7

Question 6

Are pts on warfarin, ASA excluded from getting TPA?

Answer 6

No (unless INR >1.7)

Question 7

Does a certian platelet count exlude patients from TPA?

Answer 7

yes, if <100,000

Question 8

What if pt has been on heparin, can they get TPA?

Answer 8

not if heparin was within 48hours AND they have prolonged PTT

Question 9

Pt states they had GI bleed 4 weeks ago. Are they excluded from getting TPA?

Answer 9

No. GI bleeding or urinary tract bleeding excluded within 21 days

Question 10

Pt had MI 5 months ago. Excluded from TPA for stroke?

Answer 10

No. MI within 3 months excluded

Question 11

Pt had an intracranial hemorrhage after MVA 14 years ago. Are they excluded from getting TPA?

Answer 11

Yes. Any history of intracranial hemorrhage excluded

Question 12

Pt had head trauma 5 months ago. Excluded from getting TPA?

Answer 12

No. Head trauma within 3 months.

Question 13

O2 goal for stroke pt

Answer 13

> 92%

Question 14

What is BP goal for pt who is NOT a candidate get TPA?

Answer 14

<220/120 (we allow permissive hypertension)

Question 15

What is the risk of intracerebral hemorrhage with TPA and what is the mortality risk?

Answer 15

6.5%, 45% mortality

Question 16

What is the dose of TPA and how is it given?

Answer 16

0.9mg/kg (max 90mg); 10% as bolus, 90% over 1 hour

Question 17

Patient just given TPA a few hours ago and has worsening mental status

Answer 17

worry about intracerebral bleeding

Question 18

Treatment of TPA

Answer 18

ASA 325mg
Dipyridamole 400mg PO
Both within 24-48 hours

Question 19

What if pt on asa and needs TPA?

Answer 19

not a contraindication

Question 20

What is the role of heparin in stroke?

Answer 20

Currently has NO role in the acute management; neither does warfarin

Question 21

Goal BP in SAH

Answer 21

MAP < 130

Question 22

Treatment of ICP and dose

Answer 22

mannitol 0.25 to 1g/kg IV
must have functioning kidneys to work

-also, keep HOB at 30 deg with head midline to improve venous drainage of head

Question 23

Pt with SAH has high BP. How are you going to treat?

Answer 23

-labetalol 10-20mg over 1-2 min, titrate 2mg/min
OR
-nimodipine 60mg PO q4h

Question 24

What additional consultant, other than neuro, should be involved in cerebellar strokes?

Answer 24

neurosurgery-high risk for swelling with brainstem compression

Question 25

What if you are out in the country at a small hospital, pt had a stroke but not a candidate for TPA. What do you do?

Answer 25

transfer the pt. all patient with stroke should be admitted to specialized stroke units b/c show improved outcomes

Question 26

What scoring system predicts very early stroke risk after TIA?

Answer 26

ABCD2: - age >60 - BP >140/90 - Clinical feature (absent, speech impairment, unilateral weakness) - Duration - Diabetes

Question 27

Pt freaking out in ED. Chemical restrain go-to?

Answer 27

haldol 5mg, ativan 2mg (both can be PO, IV, or IM)

Question 28

Signs of feigned coma

Answer 28

- response to manual eye opening-should be little to no resistance - avoidance of gaze - nystagmus on coloric testing

Question 29

Comatose patient with "normal" head CT

Answer 29

consider basilar artery thrombosis

Question 30

Good test to distinguish sensory from motor ataxia?

Answer 30

heal down shin: - overshoot of knee or ankle-cerebellar disease - wavering course-sensory

Question 31

What does position sense in the toes test anatomically? What two neuro diseases should you consider?

Answer 31

Posterior Columns - tabes dorsalis (syphillis - B12 deficiency

Question 32

What is a positive Romberg sign?

Answer 32

pt falls over with eyes closed-suggests they rely on visual input for balance, so be concerned for posterior column OR vestibular disease If fall over with eyes open, concern for cerebellar lesion

Question 33

What is a motor ataxic gait?

Answer 33

broad based, unsteady

Question 34

What is a sensory ataxic gait?

Answer 34

abrupt movements and slapping of feet with each impact

Question 35

Foot drop cause

Answer 35

peroneal nerve palsy

Question 36

What can you do to expose subtle proximal or distal weakness?

Answer 36

walk on heels and toes

Question 37

What can you do to illicit subtle ataxia?

Answer 37

tandem walking (toe to heel)

Question 38

Which part of the brain does CT have trouble "seeing"?

Answer 38

posterior fossa, MRI better

Question 39

Name the disease: Loss of position sense in 2nd toe and + Romberg

Answer 39

B12 deficiency

Question 40

Name the disease: broad based gait, dementia, urinary incontinence

Answer 40

normal pressure hydrocephalus large ventricles on CT, out of proportion to sulcul atrophy drain CSF

Question 41

Attending tells you pt can't have B12 deficiency b/c doesn't have macrocytic anemia...you say

Answer 41

neuro symptoms often precede macrocytic anemia | -get a cobalamin level

Question 42

the other name for B12

Answer 42

cobalamin