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Year 4 TCDs > Ageing: TIA > Flashcards

Ageing: TIA Flashcards

1
Q

What is a TIA?

A

Patient has stroke symptoms that resolve completely within 24h of onset

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2
Q

What is a crescendo TIA?

A

2+ episodes of TIA within a week and usually requires urgent specialist evaluation.

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3
Q

List 7 TIA mimics

A
  1. Syncope
  2. Atypical seizures (unilateral weakness following = Todd Paresis)
  3. Migraine
  4. Temporal arteritis
  5. Retinal hemorrhage/detachment
  6. Hypoglycemia (consider if on gliclazide or insulin)
  7. Labyrinthine disorders presenting with vertigo
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4
Q

The GP feels from the results and the history that Mr Banerjee has had a TIA and he explains this to him. He prescribes aspirin 300mg daily. According to the NICE guidance (available in Guidance and Resources), what should the GP do now? (1)

A

Refer urgently to a TIA clinic to be seen within 24h

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5
Q

What are the 5 most important investigations that should be performed in TIA clinic?

A
  1. Height, weight, BMI
  2. ECG (screen for AF)
  3. Carotid artery ultrasound doppler (determine suitability for carotid endarterectomy)
  4. Bloods (FBC, U&E, Lipids, LFTs)
  5. Blood glucose
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6
Q

What scoring system is used to assess stroke risk?

A

CHAD2VASC

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7
Q

What scoring system is used to assess major bleeding risk?

A

HAS-BLED

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8
Q

What is the appropriate management for a patient that has just had a TIA?

A
  1. Start on anticoagulation (warfarin)
  2. Manage BP (amlodipine) aiming for BP < 130/80mmHg
  3. Start statin (simvastatin)
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9
Q

How long must you not drive after having a TIA?

A

4 weeks

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10
Q

What is the most important step to consider in someone with a new intracranial hemorrhage that’s on warfarin?

A

Give prothrombin complex to reverse his anticoagulation

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11
Q

What are the components of the Glasgow Coma Scale?

A

Eyes = 4

  • open spontaneously
  • open to verbal command
  • open to pain
  • dont open

Motor response = 6

  • obeys command
  • localises to pain
  • withdraws from pain
  • flexion to pain
  • extension to pain
  • no motor response

Verbal response = 5

  • orientated
  • confused
  • inappropriate words
  • incomprehensible sounds
  • no verbal response
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12
Q

What 2 areas of the brain are affected by a stroke affecting the anterior cerebral artery?

A
  1. Frontal area

2. Parasagittal area

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13
Q

What are the 2 signs of a R anterior cerebral artery infarct?

A
  1. Behavioural changes

2. Weakness more likely in the legs than arms

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14
Q

What are the 3 signs of a L anterior cerebral artery infarct?

A
  1. Speech disturbances
  2. Behavioural changes
  3. Weakness more likely in the legs
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15
Q

What 2 areas of the brain are affected by a stroke affecting the middle cerebral artery?

A
  1. Fronto-parietal cortex

2. Subcortical structures

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16
Q

What are the 2 signs of a R middle cerebral artery infarct?

A
  1. Neglect

2. L motor + sensory deficits (weakness more likely in face than arm/leg)

17
Q

What are the 3 signs of a L middle cerebral artery infarct?

A
  1. Dysphasia
  2. R visual field defect
  3. R motor + sensory deficits (weakness more likely in face than arm/leg)
18
Q

What 4 areas of the brain are affected by a stroke affecting the posterior cerebral artery?

A
  1. Upper midbrain
  2. Occipital cortex
  3. Thalamus
  4. Medial temporal lobe
19
Q

What are the 2 signs of a posterior cerebral artery infarct?

A
  1. Visual field deficits

2. Motor or sensory loss

20
Q

What are 8 risk factors for stroke?

A
  1. Diabetes
  2. Hypertension
  3. Hyperlipidemia
  4. Smoking
  5. Prior stroke/TIA
  6. PVD/CAD
  7. AF
  8. Asymptomatic carotid stenosis
21
Q

What are 6 vascular risk factors for stroke?

A
  1. Ischemic heart disease
  2. Hypertension
  3. Carotid stenosis
  4. Smoking
  5. Diabetes
  6. Peripheral vascular disease
22
Q

What are the 4 thrombotic risk factors for stroke?

A
  1. Atrial fibrillation
  2. Clotting disorders
  3. Combined OCP
  4. Polycythemia
23
Q

List 6 sources of emboli for a stroke?

A
  1. Carotid artery plaque rupture (most common)
  2. Thrombus from heart (in AF patients)
  3. Infective endocarditis
  4. Vasculitis
  5. Atrial myxoma
  6. Paradoxical emboli from R side of circulation (PDA, PFO)
24
Q

Mrs Kerry Jones is a 24 year old teacher who sees her GP with an episode of left arm weakness. She does not take the oral contraceptive pill. She describes the weakness as coming on over 30 minutes and improving after 2 hours and it was associated with a gradual onset headache and visual disturbance. She is now symptom free. Which of the following is the most likely diagnosis?

A

Migraine

25
Q

Mrs Fatima Begum is a 78 year old who presents with a history of a sudden onset of unresponsiveness followed by a dense left sided weakness. She is transferred urgently to hospital and has a CT brain, which is normal. Her blood sugar is normal. The drowsiness and weakness improve over the next 12 hours. What is the most likely diagnosis?

A

Seizure

26
Q

Mr Bill Drummond is a 60 year man who presents to TIA clinic having had a 30 minute episode of right leg weakness and difficulty speaking. Which artery is most likely to be have been affected?

A

L anterior cerebral artery

Year 4 TCDs (16 decks)

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