Stroke

Question 1

define stroke

Answer 1

rapidly developing symptoms/signs of loss of brain function with symptoms lasting over 24hrs

Question 2

strokes cause pain in their early stages T or F

Answer 2

F

Question 3

Hx q’s for stroke

Answer 3

time of onset symptoms before and now progression

Question 4

what symptoms would indicate an acute onset of stroke?

Answer 4

asymmetric facial/arm/leg weakness speech disturbance visual field defect

Question 5

stroke is not a diagnosis T or F

Answer 5

T

Question 6

2 main types of stroke

Answer 6

haemorrhage infarct

Question 7

4 main causes of infarct stroke

Answer 7

atheroembolic small vessel cardioembolic (clots from heart) other

Question 8

most common main type of stroke

Answer 8

infarct

Question 9

3 causes of haemorrhagic stroke?

Answer 9

structural abnormality eg tumour hypertensive amyloid angiopathy

Question 10

what conditions can cause small vessel infarct stroke

Answer 10

diabetes CVD cholesterol

Question 11

you can differentiate between a haemorrhagic or infarct stroke T or F

Answer 11

F, need imaging

Question 12

blood looks __ on imaging

Answer 12

white

Question 13

how would you identify an infarct stroke on imaging

Answer 13

hypoattenuation (dark changes) appears swollen/smudgy

Question 14

1st line imaging for a stroke

Answer 14

CT

Question 15

define TIA

Answer 15

loss of brain function lasting <24hrs, usually only an hour

Question 16

how would you assess TIA straight away

Answer 16

history carotid imaging ECG blood tests

Question 17

why would you do carotid imaging in a suspected stroke/TIA?

Answer 17

see if they have carotid stenosis

Question 18

why would you do blood tests in a suspected stroke/TIA

Answer 18

check cholesterol glucose for underlying diabetes

Question 19

Tx for carotid stenosis

Answer 19

carotid endarterectomy

Question 20

immediate drug management of stroke/TIA?

Answer 20

antiplatelets to stop thrombotic process statin

Question 21

management of an acute stroke

Answer 21

thrombolysis/thrombectomy imaging swallow assessment (risk of aspirating) nutrition/hydration antiplatelets + statin if infarct DVT prevention

Question 22

an infarct in the left side of the brain causes a __ sided weakness

Answer 22

right

Question 23

where is the abnormality here?

what kind of stroke is it?

Answer 23

left side of the brain around the middle

ischaemic stroke

Question 24

name the drug and dose used for antiplatelet cover in stroke

Answer 24

aspirin 300mg

Question 25

why is CT done?

Answer 25

to exclude a bleed

Question 26

if antiplatelets cannot be given PO, how should they be delivered?

Answer 26

NG tube first then PR if still cant

Question 27

DVT prophylaxis

Answer 27

stockings (pneumatic compression) LMWH

Question 28

if swallow screen is abnormal what is then done

Answer 28

assessment by speech and language therapist

Question 29

within what timeframe should a swallow screen be done?

Answer 29

4hrs of arrival

Question 30

if patient can't swallow what should be given

Answer 30

1. NG tube 2, PEG tube

Question 31

secondary prevention of stroke

Answer 31

lifestyle changes rehab carotid surgery antiplatelets if not cardioembolic statins anticoagulants if cardioembolic

Question 32

Ix for stroke

Answer 32

CT MRI carotid scan (only looks at neck) angiogram 24hr ECG ECHO

Question 33

what colour is a fibrin dependent thrombus?

Answer 33

red

Question 34

what colour is a platelet dependent thrombus?

Answer 34

white (plates are white)

Question 35

a cardioembolic stroke is ___ dependent an atheroembolic stroke is __ dependent

Answer 35

fibrin platelet

Question 36

is AF cardioembolic or atheroembolic

Answer 36

cardioembolic

Question 37

AF raises risk of what type of stroke?

Answer 37

iscahemic

Question 38

first line antiplatelet for non-acute stroke

Answer 38

clopidogrel

Question 39

how can you work out someone's stroke risk if they've got AF?

Answer 39

CHA2DS2VASC score

Question 40

maximum CHA2DS2VASC score?

Answer 40

9

Question 41

a patient with AF who gets a VASC score of 0 should be given prophylactic anticoagulation T or F

Answer 41

F

Question 42

AF patient with 1 VASC risk factor should get aspirin T or F

Answer 42

F, OAC preferred eg apixaban

Question 43

aspirin is as bad as warfarin for bleeding T or F

Answer 43

T

Question 44

what drug should never be used to treat cardioembolic stroke?

Answer 44

aspirin!

Question 45

worst type of stroke

Answer 45

total anterior circulation stroke