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Neurology 1 > Case 16 - Overview > Flashcards

Case 16 - Overview Flashcards

1
Q

what is the first thing to do in cases of suspected stroke

a.give aspirin
b.refer to TIA clinic
c.CT

A

c.CT

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2
Q

what investigation is organised by the TIA clinic

a.CT brain
b.NIHSS assessment
c. carotid doppler ultrasound

A

c. carotid doppler ultrasound
+/- MRI brain
carotid doppler done to show any thrombus formation and calculate risk of future stroke

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3
Q

following TIA which drug is given 300mg daily starting in the ED

a.low molecular weight heparin
b.warfarin
c.aspirin
d. dabigatran
e.clopidogrel

A

c.aspirin

antiplatelet drug

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4
Q

what is done if the carotid arteries are narrowed due to a build up of fatty deposits

a.CT brain
b.NIHSS assessment
c. carotid doppler ultrasound
e.carotid endarterectomy

A

e.carotid endarterectomy

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5
Q

symptoms of a TIA usually last a few mins to hour and fully resolve within….

a.24 hrs
b.48 hrs
c.1 week
d.1 month

A

a.24 hrs

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6
Q

the majority of strokes are…

a.ischaemic
b.haemorrhagic

A

b.haemorrhagic

only way to tell them apart is by a ct brain

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7
Q

causes of ischaemic stroke

A

large artery atherosclerosis
cardioembolic
small vessel occlusion
other

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8
Q

occlusion of the proximal MCA or ICA is defined as which type of stroke

a.total anterior circulation stroke
b.partial anterior circulation stroke
c.lacunar stroke
d.posterior circulation stroke

A

a.total anterior circulation stroke

weakness of at least 2 of face arms and legs
homonymous hemianopia
higher cerebral deficit (dysphagia and dyspraxia)

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9
Q

occlusion of the branches of the MCA is defined as which type of stroke

a.total anterior circulation stroke
b.partial anterior circulation stroke
c.lacunar stroke
d.posterior circulation stroke

A

b.partial anterior circulation stroke

2 FROM THE 3 TAC criteria
( weakness of face/arms/legs + homonymous hemianopia + higher cerebral deficit)

or restricted motor or sensory deficits

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10
Q

ataxic hemiparesis

A

weakness and ataxia on the same side

ataxia = poor coordination

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11
Q

ataxic hemiparesis is associated with which type of stroke

a.total anterior circulation
b.partial anterior circulation
c.lacunar
d.posterior circulation

A

c.lacunar

pure motor
pure sensory
sensorimotor
ataxix hemiparesis

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12
Q

a lacunar stroke occurs where

a.proximal MCA or ICA
b. MCA branches
c,basal ganglia or pons
d.brainstem , cerebellar or occipital lobes

A

d.brainstem , cerebellar or occipital lobes

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13
Q

a stroke affecting the brainstem, cerebellar or occipital lobes or PCA / vertebrobasillar arteries is classified as what

a.total anterior circulating
b.partial anterior circulating
c.lacunar
d.posterior circulation stroke

A

d.posterior circulation stroke

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14
Q

what is the main risk factor for stroke

a.hypertension
b.age
c.male sex
d.hyperlipidaemia
e.previous stroke
f.smoking

A

a.hypertension

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15
Q

differential diagnoses to consider in cases of stroke

A

seizures
mass lesions
migraine
hypoglycaemia
neuropathies
MS
meningitis

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16
Q

examination in cases of tia

A

inspection
loc
speech
higher mental function
cranial nerve exam
peripheral nerve exam

17
Q

investigations in cases of TIA

A

vitals : BP, O2, HR,RR
blood glucose
Hb, platelets, renal function (if giving antiplatelets)
fasting lipids
ecg
neuro - ct
vascular - doppler ultrasound

18
Q

what should be performed immediately if stroke is suspected

a.MRI
b.CT
c.ECG
d.carotid endarterectomy
e.carotid doppler ultrasound

A

b.CT

19
Q

why is a ct brain done immediately in cases of suspected stroke

a.rule out ischaemia
b.location of stroke
c.rule out haemorrhage
d.check severity

A

c.rule out haemorrhage

20
Q

which of these vessels circulation is not shown in a CT angiogram

a.carotid
b.vertebral
c.cerebral
d.cerebellar

A

d.cerebellar

21
Q

what does penumbra imply

a.salvage of cells surrounding the infarcted core is possible

b.salvage of cells surrounding the infarcted core is not possible

A

a.salvage of cells surrounding the infarcted core is possible

22
Q

ischaemic tissue potentially destined for infarction but not yet irreversibly injured is known as what

a.infarcted core
b.penumbra

A

b.penumbra

23
Q

at which point post large vessel ischaemic stroke does treatment hold more of a risk of harm than benefit

a.0-90 mins
b.90-180 mins
c.181-270 mins
d.271-360 mins
e.350-400 mins

A

d.271-360 mins

24
Q

alteplase, reteplase and tenecteplase

A

tissue plasminogen activator

cause conversion of plasminogen to plasmin which then dissolves blood clots

25
Q

IV tissue plasminogen activator is given within how many hours of symptom onset

a.1 hr
b.2 hrs
c.3.5 hrs
d.4.5 hrs

A

d.4.5 hrs

26
Q

after giving IV tpA when is a CT repeated

a.24 hrs
b.48 hrs
c.1 week
d.1 month

A

a.24 hrs

27
Q

contraindications to TPA

A

recent surgery
recent stroke
liver disease , pancreatitis
warfarin with INR> 1.7 or on NOACs (Xa inhibitors have Xa in the name)
GCS<8
high BP

28
Q

thrombectomy can be performed in patients with an ischaemic stroke due to a clot in a large artery (internal carotid/ proximal middle cerebral) and an NIH stroke score of 6 or more , within how many hours of symptom onset

a.asap
b.2 hrs
c.4.5 hrs
d.6 hrs

A

d.6 hrs

29
Q

which group is indicated for thrombectomy

a.wake up strokes
b.day time unwittnessed strokes

A

a.wake up strokes

30
Q

aspirin is given 300mg po daily for 2 weeks following stroke after how long can the dose be reduced to 75 mg daily

a.1 week
b. 2 weeks
c. 3 weeks
d.4 weeks
e.5 weeks

A

b. 2 weeks

31
Q

if a patient is given tissue plasminogen activator how long is aspirin withheld for

a, 24 hrs
b.36 hrs
c.48 hrs
d. 55 hrs

A

a, 24 hrs

32
Q

what is given first aspirin or tpa

a. tpa
b.aspirin

A

a. tpa

if patient given tpa aspirin started 24 hrs later

33
Q

what is used for the prevention of stroke / tia caused by cardioemboli eg atrial fibrillation

a.antiplatelets eg aspirin
b.anticoagulants eg lmwh,warfarin, lmwh

A

b.anticoagulants eg lmwh,warfarin, lmwh

34
Q

in an acute stroke anti coagulation is usually not started for how long

a. 24 hrs
b.within 4.5 hrs
c.within 6 hrs
d.after 2 weeks

A

d.after 2 weeks

35
Q

where is large vessel atherosclerosis preceding a stroke most commonly found

a.carotids and vertebral arteries
b.intracranial arteries
c.thrombus formation
d.thromboembolism

A

a.carotids and vertebral arteries

36
Q

where is large vessel atherosclerosis preceding a stroke most commonly found

a.carotids and vertebral arteries
b.intracranial arteries
c.thrombus formation
d.thromboembolism

A

a.carotids and vertebral arteries

37
Q

what is the most likely route cause of a cardioembolic stroke

a.AF, recent MI, valve disease
b.aortic atherosclerosis
c.endocarditis
d.cardiac tumours

A

a.AF, recent MI, valve disease

38
Q

most lacunar strokes are caused by what

a.atrial fibrillation
b.large vessel atherosclerosis
c.lipohyalinosis

A

c.lipohyalinosis

39
Q

patients with stable neurological symptoms from recent acute non disabling stroke or TIA with carotid stenosis should be assessed and referred for what

a.ct brain
b.doppler ultrasound

A

Neurology 1 (44 decks)

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