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Semester 5 PMNM Exam 5 > CVA > Flashcards

CVA Flashcards

1
Q

___ leading cause of death

A

5th

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2
Q

After the scalp is the ___ ___

A

dura mater

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3
Q

After dura mater is the

A

arachnoid mater

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4
Q

After arachnoid mater is the

A

pia mater

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5
Q

Circle of willis is located where

A

subarachnoid space

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6
Q

Anterior cerebral artery comes off of what and goes where

A

internal carotid artery and goes up to the front of the brain

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7
Q

Anterior cerebral artery feeds into

A

the inside - it gets the frontal lobes but mostly runs along the inside of the brain

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8
Q

Middle cerebral artery feeds where

A

up the outside of the brain

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9
Q

Posterior cerebral artery feeds where

A

the back of the brain

impacts the posterior cranial nerves - gagging, swallowing

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10
Q

If there is an injury to the right side of the brain where does the patient exhibit symptoms

A

the left - everything crosses at the thalamus

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11
Q

The majority of people are which brain dominant

A

left

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12
Q

Spending money on shoes and brain deviation

A

left - math side

right - creative, the story you make up

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13
Q

Brain injury - it is really all about

A

blood flow AND the Kreb cycle!

Need oxygen and glucose

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14
Q

Kreb cycle

A

1 molecule of glucose and a lot of oxygen goes through Kreb and result is 32 ATP - leads to happy productive cells

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15
Q

If can’t get oxygen to cell we default to what

A

anaerobic metabolism - get 2 ATP and lactic acid - leads to cellular swelling and then death and K comes out and other bad things now out of the cell

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16
Q

Brain needs constant supply of

A

O2 and glucose and the only way to get it is from blood

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17
Q

Volume and pressure concept

A

Brain, Blood, CSF
Brain tissue 80%, others 10% each
If something extra comes in, something has to get kicked out

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18
Q

Autoregulation can

A

Optimize blood flow to brain tissues by manipulating pressures - can shunt blood and CSF out of the skull

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19
Q

What if all of the CSF and blood that can be shunted is out but still not enough space>

A

brain tissue will get shunted out (CSF first and then venous blood)
Called herniation syndrome and is not compatible with life

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20
Q

What if brain tissue becomes ischemic -

A

inflammatory response kicks in - dying tissue will get bigger

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21
Q

Two ways for a stroke to occur

A

Ichemic

Hemorrhagic

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22
Q

Ischemic stroke

A

something is in the way of the vessel and cuts flow

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23
Q

Hemorrhagic stroke

A

hole in the vessel and blood comes out

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24
Q

Most common type of strok

A

Ischemic! then hemorrhagic and then subarachnoid

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25
Q

Ischemic stroke can be

A

thrombotic

embolic

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26
Q

Thrombotic ischemic stroke

A

grow a plaque and a clot around the plaque

27
Q

Embolic ischemic stroke

A

flick off a piece of the clot or plaque and goes into arterial system

28
Q

Risk factors for CVA

A

High cholesterol, smoking, sedentary, age, diet, genetics, sex, obesity, ethnicity, A fib, atherosclerosis, HPTN, diabetes, valvular heart disease, sickle cell disease

29
Q

Common symptoms of CVA

A

Speech, facial droop, one side weaker than other, sensation loss on one side, confusion, trouble talking, thinking, walking

30
Q

Headache as a symptom of CVA

A

not for ischemic but yes for hemorrhagic

31
Q

Blood on brain tissue =

A

BAD

PAIN

32
Q

Anterior cerebral artery - calling 911

A

Can’t walk to phone, but can call 911

33
Q

Anterior cerebral artery - what will you see

A

LE weakness

Incontinence

34
Q

Middle cerebral artery - calling 911

A

Can walk to the phone but can’t speak to 911

35
Q

Middle cerebral artery - what will you see

A

Facial and arm weakness

Aphasia

36
Q

Aphasias can be __ or __

A

Brocas - expressive

Wernickes - receptive

37
Q

Brocas motor or expressive aphasia - where is brocas

A

back of frontal lobe

38
Q

Brocas motor or expressive aphasia - what do you see

A

Words come out but broken speech, they can understand you and they know what they want to say but they can’t say it correctly
Often they are frustrated patients because they can’t get their words out

39
Q

Wernickes or fluent aphasia or receptive aphasia - where is it

A

front of temporal

40
Q

Wernickes or fluent aphasia or receptive aphasia - what do you see

A

speech is good and they can get words out but they don’t have meaning or make sense

41
Q

Posterior circulation CVA - calling 911

A

too dizzy to walk to the phone and can’t see all of the numbers on the phone to call 911

42
Q

Posterior circulation CVA s/s

A

5Ds Dizzy, diplopia, dysarthria, dysphagia, dystaxia

43
Q

Dysarthria is what

A

the muscles don’t work

44
Q

Hemianopsia is what

A

Part of the visual field is cut

45
Q

Neglect is what

A

Don’t recognize a part of their body as their own

46
Q

Apraxia is what

A

Give them an object that they would normally use and they don’t know how to use it - like meal with spoon and fork

47
Q

Treating an acute CVA - first need to figure out if

A

hemorrhagic or ischemic

48
Q

Treating acute CVA - CT scan - if normal think

A

ischemic

49
Q

Treating an acute CVA - after determine if ischemic or hemorrhagic then what

A

Consider their symptoms

50
Q

FAST

A

Face
Arms
Speech
Time

51
Q

NIHSS stroke scale includes what additionally

A

vision, language

52
Q

How is the NIHSS scored

A

serially
Initially to determine if candidate for fibrinolytics
and then serially to see if worked

53
Q

Inclusion criteria for tPA

A

Onset of sx 3 hrs (up to 4.5) prior
Ischemic stroke
Measureable neuro deficit
18 yrs or older

54
Q

Absolute exclusion criteria for tPA

A

Intracranial hemorrhage, hx of it
Uncontrolled HPTN (185, 110)
Head trauma or CVA within 3 months
Coagulopathy

55
Q

Relative exclusion criteria for tPA

A 
OVer 75 yrs
Mild sx or very severe like coma
Recent surgery
Recent GI bleed
Seizure
56
Q

What can be done if the patient can’t be given the drugs

A

Intra-arterial fibrinolysis
Embelectomy
Coiling of aneurysm

57
Q

What can be done post acutely for CVAs

A

Control comorbidities like HPTN, Diabetes, Heart Disease

THERAPY! PT, OT, Speech

58
Q

Prognosis

A 
Depends
Ischemic better than hem
NIHSS less than 10 is better after 1 yr
25% left with disability
25% stroke again within 5 yrs
59
Q

Where does the circle of willis live

A

in the subarachnoid space

60
Q 
Which is NOT a risk factor for stroke
A fib
Oral contraceptives
Smoking
Hx of bleeding ulcer
A

Hx of bleeding ulcer

61
Q

Stroke patient has Wernickes aphasia - you would expect all of the following except
They dont always follow directions
Speech is halting and garbled
Confident that they are understood by you
Fluent speech but doesnt make sense

A

Speech is halting and garbled

62
Q

You received consult to work with left sided MCA stroke - what symptoms do you expect

A

Right sided arm weakness

Aphasia

63
Q 
Which is an absolute contraindication for tPA
Hx of peptic ulcer
BP 170/100
Last time seen normal over 12 hrs prior
Age 65
A

Last time seen normal over 12 hours prior

Semester 5 PMNM Exam 5 (4 decks)

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