Week 8 stroke

Question 1

Stroke drugs

Answer 1

Atorvistatin (HmG-CoA reductase inhibitor)
Labetalol (Trandate) - beta blocker
ASA - antiplatelet
Heparin: unfractioned heparins
t-PA: Fibrinolytic therapy

Question 2

What is atorvistatin used for

Answer 2

Lower LDL and prevent plaque

Question 3

What is Labetalol (trandate) used for

Answer 3

Post stroke
lower BP

Question 4

what is ASA, Heparin and t-PA used for

Answer 4

Prevent/dissolve blood clots

Question 5

What does the Cerebellum do

Answer 5

Fine motor movement
Balance
Determines limb movement

Question 6

What does the brain stem do

Answer 6

Breathing
Heart rate
Blood Pressure
Alertness (A&O)
Temp
Swallowing

Question 7

What does the occipital lobe do

Answer 7

Vision
Colour perception

Question 8

What does Parietal lobe do

Answer 8

Knows left from right
Sensation
Reading
Body orientation

Question 9

What does frontal lobe do

Answer 9

Higher level thinking
Problem solve
Emotional traits
Reasoning (judgement)
Speaking
Voluntary motor activity

Question 10

What does the temporal lobe do

Answer 10

Language
Behaviour
Memory
Hearing

Question 11

Pressure, 5 senses and pain go to this part of the brain

Answer 11

Thalamus

Question 12

Smooth muscle sends signals to this part of the brain

Answer 12

Hypothalamus

Question 13

What are the menengies (types and purpose)

Answer 13

3 layers that protect the brain and spinal cord
1. Dura mater
2. Arachnoid
3. Pia mater

Question 14

How long does it take to see metabolic changes when oxygen is cut off such as strangulation

Answer 14

30 seconds

Question 15

How long does it take for lactic acid to be produced when oxygen is restricted

Answer 15

2 min

Question 16

How many min will cells start to die without oxygen

Answer 16

5 min

Question 17

If PaCo2 is high blood vessels in the brain do what

Answer 17

relax: dilation
To increase blood flow

Question 18

If PaO2 is too low blood vessels in the brain do what

Answer 18

relax: dilation
To increase blood flow

Question 19

If PaCo2 is too low the blood vessels in the brain do what

Answer 19

constrict
To decrease blood flow so that Co2 can build more

Question 20

If PaO2 is too high the blood vessels in the brain do what

Answer 20

constrict
To decrease blood flow so that O2 can slow down and levels lessen

Question 21

When there is not enough O2 then lactic acid is produced. This causes pH to do what

Answer 21

lower (too many H+)
Acidic environment

Question 22

When pH drops the blood vessels do this

Answer 22

Dilate
To get more O2 so that lactic acid production will slow down and stop creating too much H+

Question 23

What is a stroke

Answer 23

1. Not enough blood flow to the brain (ischemia)
2. Hemorrhage into the brain spaces (bleeding)

Question 24

What is the leading cause of disability in Canada

Answer 24

Stroke

Question 25

what are the 3 types of Ischemic stroke

Answer 25

1. TIA (transient ischemic attack) 2. Thrombotic 3. Embolic

Question 26

What are the 3 causes of an Ischemic stroke

Answer 26

Inadequate blood flow to the brain Artery occulsion (partial or full) heart failure/shock - systemic

Question 27

What is Ischemic penumbra

Answer 27

The zone around the core of ischemia but is still reversable if treated in time

Question 28

How many hours do we have to protect the penumbra area?

Answer 28

3 hours from the start of symptoms

Question 29

How many hours after ischemia will we see brain colour changes?

Answer 29

6-12 horus

Question 30

How many hours after an ischemic stroke do you see all the damage that has occured?

Answer 30

72 hours (3 days)

Question 31

What happens the few weeks after an ischemic stroke?

Answer 31

Macrophages get rid of dead tissue This causes scarring in the brain

Question 32

What are the three causes of TIA

Answer 32

1. carotid stenosis - narrow or occluded carotid artery 2. Atherolsclerosis - dislodged plaque travels 3. Atrial fibrillation - blood stasis - clot, travels to brain

Question 33

Aphasia

Answer 33

trouble with speech and/or language

Question 34

Dysarthria

Answer 34

slurred speech

Question 35

What are the main signs of TIA

Answer 35

1. Visual changes 2. Mobility issues 3. Sensory issues 4. Speech issues

Question 36

What is the associated cause of a thrombotic stroke?

Answer 36

atherosclerosis

Question 37

What are the associated causes of Embolic stroke ?

Answer 37

All Systemic and sudden 1. valvular heart disease 2. MI 3. infective endocarditis 4. rheumatic heart disease 5. congential heart defect 6. a-fib

Question 38

Examples of embolus responsible for Embolic stroke

Answer 38

1. fat embolus 2. air embolus 3. Tumour embolus 4. bacterial clumps 5. foreign bodies

Question 39

What is the most common cause of Ischemic stroke?

Answer 39

Atherosclerosis

Question 40

What are the 2 types of hemorrhagic stroke?

Answer 40

1. Intercerebral Hemorrhage 2. Sub arachnoid Hemorrhage

Question 41

What is intercerebral hemorrhage caused by?

Answer 41

ruptured arterial vessel

Question 42

what are the 2 associated causes of intercerebral hemorrhage

Answer 42

1. HTN * #1 2. Aterio-venous malformation

Question 43

What is a main symptom of intercerebral hemorrhage

Answer 43

Worst headache ever

Question 44

What is a subarachnoid hemorrhage caused by?

Answer 44

intercranial bleeding in to the space that is between the Pia mater (close to skull) and arachnoid layers (closer to brain)

Question 45

Subarachnoid hemorrahage is associated with

Answer 45

ruptured aneurysm

Question 46

What stroke type is most common in females?

Answer 46

Subarachnoid hemorrhage due to aneurysm

Question 47

Which type of stroke has the worst outcomes and what does it depend on?

Answer 47

Subarachnoid hemorrhage location in the brain is key

Question 48

Clinical manifestations of stroke

Answer 48

1. Sudden numb/weak on left side of body 2. Sudden confusion (LOC) 3. Speech difficulty and slurring 4. Vision issues 5. Ataxia 6. Sudden severe headache

Question 49

What are the typical deficits associated with stroke

Answer 49

1. motor function * most obvious 2. Communication 3. Cognition 4. Spacial- perceptual alterations 5. Elimination

Question 50

What are the complications of stroke we assess for?

Answer 50

1. Aspiration PN 2. DVT 3. UTI 4. Falls/injury 5. Dehydration 6. Constipation 7. Depression 8. Seizures

Question 51

What is the saying for stoke complications?

Answer 51

A Dirty Dog Danced Under Falling Star Constellations

Question 52

Anosognosia

Answer 52

not knowing (gnosia) anything is wrong (ano)

Question 53

Homonymous hemianopia

Answer 53

Field of vision loss on both eyes (so if left side of the right eye and left side of the left eye)

Question 54

Agnosia

Answer 54

Can't recognize what objects or people are

Question 55

Apraxia

Answer 55

Know what they want to do but can't (A) perform (praxia) the movement.

Question 56

Dysarthria

Answer 56

Slurring words

Question 57

Stuporous/stupor

Answer 57

Very deep sleep need repetitive vigourous stimulation

Question 58

Obtunded

Answer 58

Can't wake up very easily need less repetitive vigourous stimulation

Question 59

Lethargy

Answer 59

Drowsy but will wake up

Question 60

Mentation

Answer 60

What is their LOC - metal status

Question 61

Canadian Neurologic scale

Answer 61

Evalulation and monitoring of neurological status for stroke patients Acute stage (1-7 days) 8 items High number is good (less deficits)

Question 62

National Institute of Health Stroke Scale

Answer 62

15-item impairment scale evaluate neurologic outcome and degree of recovery for patients with stroke High # is bad - severe

Question 63

CT or MRI in stroke helps us determine

Answer 63

location of injury size of injury hemorrhagic or ischemic stroke

Question 64

Blood work in hyper acute stroke

Answer 64

CBC - hemoglobin INR/PTT/Platelets Blood sugar Renal/liver function - creatinine, urea, liver enzymes Lipid profile - try to prevent stroke

Question 65

Acute stroke priorities

Answer 65

1. When did it happen (time is brain) 2. Airway - RR, O2, protectives (cranial 9&10) 3. RR - is the brain driving breathing 4. circulation 5. Rapid neuro assess - LOC - GCS - FAST - Pupils (PERRLA) - speech/motor - hand grips/push pedals (cranials 9, 10, 12) 6. Blood sugar 7. 2nd neuro check

Question 66

How many days do we still see brain changes after ischemic stroke?

Answer 66

2-3 days