Cardio Stroke TIA ACS

Question 1

define stroke

Answer 1

sudden onset of rapidly developing focal or global neurological disturbance which lasts more than 24 hours or leads to death

Question 2

define TIA

Answer 2

transient (less than 24 hours) neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without evidence of acute infarction

Question 3

what are the three types of stroke?

Answer 3

ischaemic
haemorrhagic
silent

Question 4

85% of strokes are

Answer 4

ischaemic

Question 5

what occludes in an ischaemic injury

Answer 5

embolus afib or plaque rupture in coronary arteries

thrombus (atherosclerosis in brain)

Question 6

the main cause of intracerebral haemorrhage is

Answer 6

hypertension

Question 7

what can cause a stroke in trauma

Answer 7

carotid artery dissection

Question 8

what causes a stroke in pregnancy or cancers

Answer 8

cerebral venous thrombosis

Question 9

focal neurological deficits may include

Answer 9

Unilateral weakness or sensory loss.
Dysphasia.
Ataxia, vertigo, or incoordination.
Syncope.
Sudden transient loss of vision in one eye (amaurosis fugax). 
Homonymous hemianopia.
Cranial nerve defects.

Question 10

what else can cause a focal neurological deficit

Answer 10

hypoglycaemia 
drug toxicity 
vertigo 
syncope
migraine with aura 
MS
peripheral neuropathy 
infection 
encephalopathy 
tumour 
dementia 
spinal epidural haematoma

Question 11

what are the symptoms of a posterior circulation stroke?

Answer 11

acute vestibular syndrome — acute, persistent, continuous vertigo or dizziness with nystagmus, nausea or vomiting, head motion intolerance, and new gait unsteadiness

Question 12

Suspect ….. in anyone presenting with sudden severe headache and an altered neurological state until proven otherwise

Answer 12

subarachnoid haemorrhage

Question 13

what is first line imaging

Answer 13

ct head to assess stroke type

Question 14

how to manage ischaemic stroke acutely

Answer 14

alteplase (only if it can be given within 4.5 hours of symptom onset as long as haemorrhage has been excluded)
aspirin 300mg

Question 15

how do you treat a history of dyspepsia with aspirin

Answer 15

add ppi

Question 16

what is the long term management of ischaemic sttoke

Answer 16

75mg clopidogrel

statin 20-80mg

Question 17

what If clopidogrel is contraindicated

Answer 17

dipyridamole with aspirin

Question 18

if stroke with af

Answer 18

consider long term anticoags

Question 19

how do you manange a haemorrhagic stroke?

Answer 19

surgery to remove haematoma and relieve icp

Question 20

what should be done within 6 hours onset of haemorrhagic stroke

Answer 20

control hypertension

Question 21

what is stable angina

Answer 21

occurs predictably with physical exertion or emotional stress, last for no more than 10 minutes (usually less) and is relieved within minutes of rest, as well as sublingual nitrates

Question 22

what is unstable angina

Answer 22

new onset angina or abrupt deterioration in previously stable angina, often occurring at rest. Unstable angina usually requires immediate admission

Question 23

in someone with stable angina what test should you do

Answer 23

ecg

Question 24

when should a person call 999 with angina

Answer 24

chest pain - rest - gtn - take 2nd dose after 5 mins if pain not relieved - if not relieved after a further 5 mins - 999

Question 25

what is prescribed first line for angina

Answer 25

beta blocker or ccb

Question 26

all people with stable angina should also have

Answer 26

75mg aspirin

Question 27

people with stable angina and diabetes should b treated with

Answer 27

ace inhibitor

Question 28

people who are not adequately controlled by frist line therapy should be treated with

Answer 28

nicorandil

Question 29

how do you diagnose acs

Answer 29

ecg

serum troponins

Question 30

how do you manage a person with chest pain in a and e?

Answer 30

sit up

if acs - gtn/ aspirin/ ecg

Question 31

what is commonly used in replacement of clopidogrel

Answer 31

ticagrelor

Question 32

lmwh is indicated in acs. t/f

Answer 32

t

Question 33

long term management of acs

Answer 33

aspirin

beta blockers

Question 34

? considered for all patients, especially those with evidence of left ventricular dysfunction

Answer 34

ACE I