Stroke Flashcards
Some meningitis questions included (12 cards)
A patient may be at risk for a stroke. Which of the following statements regarding strokes is NOT correct?
a. 85% of strokes are due to intracranial haemorrhage.
b. Neurons are extremely vulnerable to hypoxic injury.
c. Cerebral infarction may result in a localised area of necrosis within the brain.
d. Strokes may present as transient ischaemic attacks i.e. the disturbance lasts less than 24 hours.
Answer: a
85% of stroke are ISCHAEMIC
- 4 min without O2 = Neurons begin to die
- Cerebral infarction = lack of blood supply leading to brain tissue death
Which one of the following statements regarding brain cell metabolism and vulnerability to hypoxic-ischaemic injury is NOT correct?
a. Cells in the cerebellar cortex are not susceptible to such stress.
b. Oxidative metabolism of glucose is the source of energy for brain cells.
c. Oligodendrocytes are vulnerable.
d. Neurons are vulnerable.
Answer: a
Cerebellar cortex cells, especially Purkinje cells, are highly vulnerable to ischaemic injury.
Which one of the following statements regarding stroke is NOT correct?
a. Injury to brain cells may be transient or permanent.
b. Neurological impairment is invariably focal in nature.
c. Damage to cells is the result of reduced blood and/or oxygen supply.
d. It is a major cause of death.
Answer: b
Not all strokes are not strictly focal
(“Invariably focal” = Always localised)
- Some strokes (especially ischaemic strokes) cause focal neurological impairment.
*Subarachnoid haemorrhages or large brainstem strokes can cause global symptoms - widespread neurological effects.
Which one of the following statements regarding stroke is NOT correct?
a. A transient ischaemic attack (TIA) is defined as a stroke lasting for up to 72 hours.
b. Completed stroke implies a stable neurological deficit.
c. Diabetes mellitus is associated with stroke.
d. Carotid artery disease is associated with stroke.
Answer: a
TIA = <24 hours
- Completed stroke = A stroke in which the neurological deficits have reached their maximum severity and are no longer progressing (plateaued).
Which one of the following statements regarding causes of stroke is NOT correct?
a. Accidental injection of air into a patient during an injection may result in air embolism and stroke.
b. Intracranial haemorrhage may be related to a patient taking anti platelet or anticoagulant medication.
c. Embolus from a deep vein thrombosis is commonly associated with stroke.
d. intracranial haemorrhage is responsible in the minority of cases.
Answer: c
DVT = Pulmonary embolism
DVT very rarely causes stroke
- Air embolism is also a rare occurrence but more plausible than DVT causing stroke (a).
Which one of the following statements regarding cerebral infarction is NOT correct?
a. Infarcts occurs in a distribution corresponding to specific vascular territory.
b. Head injuries are not associated with cerebral infarction.
c. Cerebral infarction is defined as a localised area of necrosis within the brain.
d. A small infarct may be clinically insignificant and ‘silent’.
Answer: b
Head injuries are associated with cerebral infarction.
- Head injuries: trauma can lead to vascular damage, arterial dissection, hypo perfusion, or brain swelling - all of which can impair blood flow and cause ischaemic infarction.
Which one of the following is NOT a risk factor for the development of meningitis?
a. Sinusitis
b. Fractured skull
c. Otitis externa
d. Mastoiditis
Answer: c
Otitis externa = infection of the OUTER ear canal - generally superficial infection and is NOT considered a direct or common risk factor for meningitis
- Sinusitis = inflammation of the sinuses is a know risk factor for meningitis - infections from the sinuses can spread to the meninges
*Fractured skull = fractures (especially to the base of the skull) that creates a CSF leak - provides a direct pathway for bacteria to enter the meninges - Mastoiditis = infection of the mastoid bone - located behind the ear and is connected to the middle ear - mastoiditis is a serious complication of middle ear infections can can spread to the brain - leading to complications like meningitis
Which of the following is NOT a consequence of meningitis?
a. Vasculitis which may lead to stroke
b. Damage to a cranial nerve
c. Breakdown of brain tissue and abscess formation
d. Damage to arachnoid granulations leading to decreased production of CSF
Answer: d
Increases production of CSF
* Arachnoid granulations are responsible for the REABSORPTION of CSF into the bloodstream.
* CSF is primarily produced by the choroid plexus.
* Damage to the arachnoid granulations would IMPAIR CSF REABSORPTION - leading to an INCREASE in CSF pressure (hydrocephalus)
- Vasculitis - stroke: Meningitis (bacterial) can cause inflammation of the blood vessels (vasculitis) within the brain - lead to narrowing or clotting of these vessels - stroke.
- Damage to cranial nerves: Cranial nerves pass through or near the meninges - inflammation and swelling associated with meningitis can compress or directly damage these nerves - neurological deficits
- Breakdown of brain tissue + abscess formation: Severe meningitis (bacterial) can lead to direct damage to brain tissue (cerebritis) and can progress to the formation of brain abscesses (localised collections of pus within the brain).
Which one of the following statements regarding types of stroke is NOT correct?
a. Ischaemic strokes are preventable i.e. risk factors are modifiable.
b. Most ischaemic strokes are the result of emboli that arise in the heart.
c. Atrial fibrillation is a cause of embolic strokes.
d. A secondary stroke is one that occurs as a result of vasospasm that follows a hemorrhagic stroke.
Answer: b
Thrombotic ischaemic strokes are more common
- Thrombotic stroke = Blood clot forms inside a diseased/damaged artery in the BRAIN
- Embolic stroke = Blood clot / small piece of plague formed in one of the arteries LEADING to the brain or in the HEART
Which one of the following statements regarding brain areas affected by stroke is NOT correct?
a. Speech is affected if the stroke involves Wernicke’s area.
b. Cranial nerve dysfunction is common with middle cerebral artery obstruction.
c. Watershed strokes are the result of hypo perfusion rather than total ischaemia.
d. Basilar artery strokes affect the brain stem.
Answer: b
Cranial nerve dysfunction = Basilar artery / Vertebral arteries obstruction
- Wernicke’s area = Language comprehension + Producing fluent but meaningless speech
- MCA obstruction = Motor function, sensory function, speech (Broca’s and Wernicke’s areas), and vision
- Basilar artery = runs along the ventral surface of the brainstem and gives off multiple branches that supply the pons, midbrain, and parts of the cerebellum and posterior cerebrum
- Basilar artery obstruction = damage to brainstem = affect consciousness, motor and sensory pathways, and multiple cranial nerves
Which one of the following statements regarding lacunar strokes is NOT correct?
a. Atheroma, atherosclerosis and intravascular thrombosis do not feature in the aetiology of this type of stroke
b. Lacunar strokes are a variant of ischaemic stroke
c. Walls of the vessel respond to high blood pressure by thickening
d. These are essentially small vessel strokes
Answer: a
Lacunar stroke is a subtype of thrombotic ischaemic stroke - clot caused by buildup of atherosclerosis/atheroma/intravascular thrombosis (thrombus/blood clot).
Lacunar strokes: Subtype of Thrombotic Ischaemic Stroke
- Occur in smaller vessels
- Hypertension - stress blood vessel walls = thicken as response
Which one of the following statements regarding pathophysiology of stroke is NOT correct?
a. With hemorrhagic stroke blood breakdown products cause vasospasm of arteries in the vicinity of the stroke
b. Malfunction and death of brain cells are the result of critical hypoxia
c. Malfunction and death of cells are the result of critical hypoglycaemia
d. With complete interruption of blood flow, brain cells start to die after 10-15min
Answer: d
Brain cells start to die after 3-5min in complete interruptions of blood flow
- (a) Vasospasm of surrounding arteries = secondary stroke
- Cell death = Lack of O2 + Glucose
