Stroke Scales

Question 1

GCS

Answer 1

Best score is 15
Coma scale
Best eye response 
Best verbal response
Best motor response

Question 2

In GCS, a person with spontaneous eye opening would get a score of

Answer 2

4

Question 3

In GCS, a person who opens eyes in response to verbal command, speech, or shout would score

Answer 3

3

Question 4

In GCS a person who open eyes to pain would score

Answer 4

2

Question 5

In GCS a person who has absent eye opening scores

Answer 5

0

Question 6

Best verbal response in GCS, a person that is orientated would score

Answer 6

5

Question 7

Best verbal response in GCS with confused conversation but able to answer questions would score

Answer 7

4

Question 8

Best verbal response in GCS inappropriate responses but understandable responses would score

Answer 8

3

Question 9

Best verbal response in GCS incomprehensible speech would score

Answer 9

2

Question 10

Best verbal response in GCS with no speech would score

Answer 10

0

Question 11

Best motor response in GCS and can obey commands for movement would score

Answer 11

6

Question 12

Best motor response in GCS with purposeful movement to painful stimuli would score

Answer 12

5

Question 13

Best motor response GCS for pain withdrawal

Answer 13

4

Question 14

Best motor response GCS abnormal spastic flexion- decorticate posturing would score

Answer 14

3

Question 15

Best motor response in GCS for extension posturing - decerebrate would score

Answer 15

2

Question 16

Best motor response in GCS with no movement would score

Answer 16

1

Question 17

FOUR coma scale includes what?

Answer 17

Respirations and brainstem

Question 18

What’s the max NIHSS

Answer 18

42

Question 19

NIHSS of <3 usually correlates with

Answer 19

A good outcome

Question 20

Pts can usually be dc Home with a NIHSS

Answer 20

<5

Question 21

Discharge dispo for pts with a NIHSS 7-13

Answer 21

Usually rehab

Question 22

Dispo for pts with NIHSS >14

Answer 22

SNF

Question 23

What is considered a significant neurologic change on the NIHSS

Answer 23

2-4 points

Question 24

What are the NIHSS categories?

Answer 24

1a - LOC
1b - LOC questions
1c - LOC commands
2 - Best gaze
3 - Visual
4 - Facial palsy
5 - Motor arm
6 - Motor leg
7 - Limb ataxia
8 - Sensory
9 - Best language
10 - Dysarthria
11 - Extinction and inattention

Question 25

What is the ICH scale used for?

Answer 25

Intracerebral hemorrhages Predicts 30 day mortality and 12 month functional outcome

Question 26

Which scale is scored 1-6 and predicts 30 day mortality?

Answer 26

ICH scale

Question 27

What is assessed in a ICH scale

Answer 27

``` GCS ICH volume IVH Location Age ```

Question 28

What is the Hunt & Hess scale?

Answer 28

``` For subarachnoid hemorrhage Helps to make the decision of when to go to OR Used Roman numerals Score I - V Score is based on clinical findings ```

Question 29

In the hunt and Hess scale, scores of I - III

Answer 29

Have a better outcome but need OR quickly

Question 30

In the hunt Hess scale scores of IV - V

Answer 30

Have a worse outcome and must be stabilized before going to the OR

Question 31

A hunt Hess score of I would exhibit

Answer 31

Asymptomatic or mild HA

Question 32

A hunt Hess score of II would exhibit signs of

Answer 32

Moderate to sever HA with oculomotor palsy

Question 33

A hunt Hess score of III would exhibit

Answer 33

Confusion, drowsiness, or mild focal signs

Question 34

A hunt Hess score of IV would exhibit

Answer 34

Stupor bit can localize to pain

Question 35

A hunt Hess score of V would exhibit

Answer 35

Coma- posturing or no motor response

Question 36

What is the Fisher-Miller scale used for?

Answer 36

Measures volume of SAH BLOOD ON CT Predicts cerebral vasospasm Scoring is 1-4

Question 37

What is the ABCD2 score

Answer 37

- Score for TIA to predict the 90 day AIS risk | - Used to determine hospitalization need vs d/c and f/u

Question 38

On the ABCD a score of 1-3

Answer 38

1% 2 day risk | D/C

Question 39

On the ABCD risk a 4-5

Answer 39

4.1% 2 day risk 8-12% 90 day risk Admit

Question 40

A ABCD a score of 6-7 is

Answer 40

8.1% 2 day risk 17-22% 90 day risk Admit

Question 41

What’s the max score on a ABCD TIA risk score?

Answer 41

9

Question 42

What is the modified rankin used for?

Answer 42

Measures functional outcome

Question 43

What is the scale in modified rankin

Answer 43

0-6

Question 44

What is the Barthel Index

Answer 44

``` Stroke outcome scale Measures self care and mobility Correlates with infarcts volume Normal = 100 The lower the score the higher the disability ```

Question 45

What is measured in the Barthel Index

Answer 45

``` Bowel Bladder Grooming Toileting Feeding Transferring Mobility Dressing Stairs Bathing ```

Question 46

What is the FIM

Answer 46

``` Functional outcome scale Measures 18 ADLS Used in rehab Scored 1-7 1= total assist 7= independent ```