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NP School > Neuro > Flashcards

Neuro Flashcards

1
Q

What condition is characterized by an acute onset of neurological deficits that gradually improve over time?

A
  • Transient Ischemic Attack
  • Bell’s Palsy (face only)
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2
Q

Which conditions can mimic stroke like symtoms?

A
  • BG < 60mg/dl
  • Bells Palsy
  • migraines
  • psych disorders
  • infections
  • seizures
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3
Q

How long do TIA symptoms usually last?

A

< 1hr

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4
Q

TIA symptoms r/t carotid artery blockage?

A
  • transient monocular visual loss
  • aphasia
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5
Q

What is the gold standard test for stroke?

A

rapid assessment

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6
Q

What imaging studies are done when a stroke is suspected?

A
  • CT head w/out contrast
  • CT angiography brain and neck
  • MRI brain (see changes w/in 30min)
  • TEE (aortic arch, LA, PFO)
  • CXR (evaluate cardiomyopath)
  • ekg
  • Echo
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7
Q

When should an MRA brain and neck be done on a suspected stroke patient?

A

when CT is contraindicated, MRA does not need contrast

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8
Q

When should a carotid US de done for a patient with a suspected stroke?

A

if MRA and CTA are contraindicated

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9
Q

What labs should be drawn on a suspected stroke patient?

A
  • BG
  • troponin
  • E-lytes (to see if Na, K are low)
  • CBC (anemia, polycythemia)
  • PT/INR (hypercoagulopathy)
  • BUN/Creatinine (renal sufficiency)
  • lipid panel
  • toxicology screen
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10
Q

What are the 2 main types of strokes?

A
  • Ischemic
  • Hemorrhagic
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11
Q

What are the types of the ischemic strokes?

A
  • thrombotic
  • embolic
  • cryptogenic
  • lacuner
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12
Q

What are the types/causes of hemorrhagic strokes?

A
  • intracranial hemorrhage (ICH)
  • subarachnoid hemorrhage (SAH)
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13
Q

Which type of stroke is associated with “a severe HA that radiates down the neck?
- worst headache of a patients life

A

subarachnoid hemorrhage

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14
Q

What is the most commonly occluded vessel and cause of ischemic stroke?

A

middle cerebral artery (MCA)

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15
Q

What should the BP in a patient prior to and during administration of tPA thrombolytic?

A
  • Prior: SBP < 185 and DBP < 110
  • During: SBP <180 and DBP < 105
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16
Q

Which medications are recommended for BP control prior to and during administration of tPA?

A
  • labetolol 10-20mg IV push
  • nicardipine (cardene) gtt
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17
Q

What timeframe after symptom onset should alteplase be started in a stroke patient?

A

< 4.5 hrsW

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18
Q

What are contraindications for thrombolytic therapy in stroke patients?

A
  • current ICH/SAH
  • active bleeding
  • head trauma/surgery < 3 months
  • severe uncontrolled HTN
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19
Q

What is the dosing for Alteplase?

A

-0.9mg/kg (max 90mg) admin over 1hr
- 10% given as bolus with other 90% given over an hr

20
Q

Why are nitroprusside or nitrogylcerin not given to a patient with a hemorrhagic stroke?

A
  • both cause vasodilation, which can increase the intracranial pressure
21
Q

What is the reversal agent for heparin?

A

protamine

22
Q

What is the reversal agent for warfarin (coumadin)?

A

Vitamin K

23
Q

What is Apixaban brand name?

A

Eliquis

24
Q

What class of medication is apixaban (eliquis)?

A

Factor Xa inhibitor

25
Q

What class of medication is rivaroxaban (xarelto)

A

Factor Xa inhibitor

26
Q

What is the brand name for rivaroxaban?

A

Xarelto

27
Q

What is hydrocephalus?

A

blockage of CSF flow resulting in dilation of the brain ventricles

28
Q

How much CSF does the brain produce?

A

500ml/day

29
Q

What are the s/s of hydrocephalus in an adult?

A
  • cognitive decline
  • HA (initially in am)
  • neck pain
  • vomitting (bad in the am)
  • blurred or double vision
  • upward gaze
  • drowsiness
  • unsteady gai
30
Q

Why is a CT scan of the brain done in a suspected stroke patient?

A

to rule out structural causes
- SDH
- ICH
- brain tumor

30
Q

In a suspected stroke patient, whey is an brain MRI better than a CT scan?

A
  • MRI is more sensitive in detecting early pathological changes
  • MRI shows changes seen < 30min
  • CT shows changes 6-8hrs
30
Q

An MRI is the preferred imaging study for which type of strokes?

A

lacunar stroke and TIA

30
Q

What is a lacunar stroke?

A

a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked

30
Q

What is the term for a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked?

A

Lacunar stroke

30
Q

How long does it take for pathological changes following or during a stroke in the brain to appear on an CT scan?

A

6-8 hrs

30
Q

In a stroke patient with A-Fib or Flutter lasting > 48hrs , which anticoagulant should be administered and for what timeframe when planning for a cardioversion?

A
  • Warfarin
  • factor Xa inhibitor
  • direct thrombin inhibitor
  • given for at least 3 weeks prior to and 4 weeks following a cardioversion
30
Q

What is the other name for aspirin?

A

acetylsalicylic acid

30
Q

What is the 1st line therapy medication to reduce the risk of stroke in patients with TIA?

A

aspirin (acetylsalicylic acid)

30
Q

How long does it take for pathological changes following or during a stroke in the brain to appear on an MRI?

A

< 30 min

31
Q

What is the dosing for aspirin when used to prevent strokes in patients with TIA?

A

180mg x 5 days then 81mg QD

31
Q

What medication is recommended in patients with LDL <100 and < 75 y/o?

A
  • high intensity statin therapy
  • 80mg atorvastatin
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NP School (7 decks)

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