9: Stroke

Question 1

What is a stroke?

Answer 1

Rapidly developing loss of brain function due to a vascular event

Question 2

Loss of brain function due to a stroke can be ___ or ___.

Answer 2

focal

global

Question 3

What score is used to diagnose a stroke in A&E?

Answer 3

ROSIER score

Question 4

What are the two main types of stroke?

Answer 4

Infarction

Haemorrhage

Question 5

What does a CT head of an

a) infarction stroke
b) haemorrhagic stroke

look like?

Answer 5

a) Affected area is darker, smudged

b) Blood is lucent i.e bright white

Question 6

What is a TIA?

Answer 6

Transient ischaemic attack

i.e mini stroke

Question 7

What is the difference between a TIA and a stroke?

Answer 7

Time frame

TIA < 24hrs ongoing symptoms, stroke > 24hrs

Question 8

What does TIA increase your risk of?

Answer 8

Stroke

Question 9

___ intervention is key to reducing the risk of stroke following a TIA.

Answer 9

Early

Question 10

How is suspected stroke investigated?

Answer 10

Imaging (CT or MRI scan)

Cardio investigations - blood pressure, ECG, carotid scans, angiograms…

Lifestyle - blood glucose, cholesterol, take a smoking history

Question 11

What must be assessed before offering a stroke patient food or water?

Answer 11

Swallowing

To ensure patient doesn’t aspirate

Question 12

What is an emergency intervention which can be given to a patient acutely suffering a stroke?

Answer 12

Thrombolysis

Question 13

Which classes of drug are given to patients to reduce the likelihood of another stroke?

Answer 13

Statins

Antiplatelets e.g aspirin, clopidogrel, ticagrelor

Anticoagulants e.g warfarin, apixaban, LMWH

Question 14

Which imaging modes are better for picking up

a) haemorrhages
b) infarcts?

Answer 14

a) CT

b) MRI

Question 15

Which antiplatelet drug is given for infarcts?

Answer 15

Aspirin

Question 16

What cardio disease does immobility increase your risk of?

Answer 16

DVT

> MI, stroke…

Question 17

Why isn’t LMWH given for DVT prophylaxis in stroke patients?

Answer 17

Increases bleeding risk

Question 18

What is used as DVT prophylaxis in stroke patients?

Answer 18

Pneumatic compression stockings

Intermittently expand and contract to push blood along

Question 19

Why can patients aspirate following a stroke?

Answer 19

Impaired swallow

Question 20

How can patients be assisted with feeding if they have an impaired swallow following a stroke?

Answer 20

NG feeding

Thicker, textured food

Parenteral nutrition

Question 21

How are stroke patients assessed for malnutrition?

Answer 21

MUST score

Question 22

What is a red thrombus?

Where are they formed?

Which drugs are effective for breaking them up?

Answer 22

Clot formed mainly of red blood cells and fibrin

Found in areas of low pressure and blood status e.g heart

AntiCOAGULANTS - warfarin, apixaban

Question 23

What is a white thrombus?

Where are they formed?

Which drugs are effective for breaking them up?

Answer 23

Clot formed mainly of platelets

High pressure circulation e.g the arteries

AntiPLATELETS - aspirin, clopidogrel, ticagrelor

Question 24

Patients who have had MIs, strokes etc. often have hypertension in the days following their event.

What drugs are given to control this and when?

Answer 24

Antihypertensives i.e ACE inhibitor, amlodipine at around 10 days post-event

Question 25

What

a) lifestyle advice
b) medication

is given to stroke patients for secondary prevention?

Answer 25

a) Stop smoking, exercise, diet…

b) Statin, antiplatelet, anticoagulant

Question 26

Which arrythmia increases your risk of MI and stroke?

Answer 26

Atrial fibrillation

Question 27

What scoring system is used to estimate a patient’s risk of stroke?

Answer 27

CHA2D vasc score

revise from 1st year

Question 28

What scoring system is used to estimate a patient’s risk of bleeding while on anticoagulation?

Answer 28

HASBLED

Question 29

What type of diet is thought to be cardioprotective?

Answer 29

Mediterranean diet

high in starchy food, fruit and veg; low in meat