4 Stroke

Question 1

Medical risk factors 6

Answer 1

Hypertension 
AF
Chol
IHD
Artery disease
HRT? (Unsure but not recommended)

Question 2

Non modifiable risk factors 5

Answer 2

Age
Gender
Family history
Genetic conditions
Afro-carabbean

Question 3

Risk assessment tool for stroke is called…..

Answer 3

Chadsvasc

Question 4

Risk assessment score for PE/DVT is called

Answer 4

Well’s

Question 5

3 primary prevention of stroke treatments

Pharmacological

Answer 5

Lipid lowering drugs
Control of hypertension
Anticoagulation with other risk factors such as AF

Question 6

Primary prevention treatments non-pharmacological

3

Answer 6

Diet, exercise, weight management

Somking
Reduce alcohol intake

Question 7

Pateints with AF are …. times more likely to have a stroke

Answer 7

Five

Question 8

Chadsvasc do you score someone for hypertension if it is controlled?

Answer 8

Yesssss

Question 9

Modifiable risk factors 5

Answer 9

Smoking
Alcohol
Raised bmi
Fatty diet
Sedentary

Question 10

Which to initiate first, OAC or anti hypertensives in AF

Answer 10

Anti hypertensives

Question 11

What is first line treatment for AF

Answer 11

RATE CONTROL
Beta blocker
Or
Rate limiting CCB

Question 12

What is second line for AF

Answer 12

Dual therapy:
Beta blocker plus digioxin

NOT BETA BLOCKER WITH CCB - heart block
(You could use CCB and digoxin in think…)

Question 13

Third line for AF

Answer 13

RYHTHM CONTROL
Elective DC conversion 
• Bisoprolol 
• Amiodarone 
• Flecainide or Sotolol 
• Dronedarone?

Question 14

Amioderone shown to be benifical with warfarin but….

Answer 14

There is a interaction so INR is likely to be unstable while loading

Question 15

What score is used to assess risk of stroke post Tia?

Answer 15

Abcd2

Question 16

Post Tia would would also check

Answer 16

Heart rate (for AF)
Glucose
BP
You might ct scan if you suspect another problem 
Smoking status

Question 17

What to do if someone with AF presents with a stroke

Answer 17

You still need to rule out the bleed so withhold antiplatelets and anticoagulants

Question 18

Therapies to prevent recurrent Stoke 6

Answer 18

Antiplatelets
Blood pressure
Statins
Carteroid endarterectomy 
Anticoagulants (with AF)
A smoking

Question 19

What long term anti platelet is given for stroke

Answer 19

Clopidogrel

Question 20

Post stroke what to change from aspirin to something else

Answer 20

After 14 day change to anticoagulants if with AF
(If without AF they should just have clopidogrel,

NO FUCKING ANTICOAGULANTS)

Question 21

When after a stroke can you start messing with other patient meds

Answer 21

48 hours

Question 22

Bonus stuff to assess in stroke?

Answer 22

SALT for swallow

Question 23

Stroke in diabetic patient? 2

Answer 23

Remember to rule out hypo

Consider VRIII if they can’t eat

Question 24

Why don’t we treat BP in the first two weeks after stroke?

Answer 24

We don’t want to reduce cerebral perfusion as this could result in brain damage.
If they are normally on anti hypertensives you could continue unless hypo.

Question 25

What do you do about the risk of DVT during admission for a stroke?

Answer 25

There are special guidelines so you might use these.

Question 26

Medicines you would expect for ACS Event?

Answer 26

Aspirin
Clop for one year
Beta blocker
Statin
Ace