CVA: Continuum Deck

Question 1

% of strokes that are cardioembolic

Answer 1

20-30%

Question 2

Sources of embolic

Answer 2

any where proximal to the ischemic territory ( atria, ventricles, valves, aorta, extracranial cervical arteries

Question 3

Embolic strokes are more likely to cause what two things ?

Answer 3

seizures and hemorrhagic transformations

Question 4

Lab work up for cardioembolic stroke

Answer 4

CBC, BC, ESR, CRP, PT/INR, TSH, Lipids, Hypercoag (APC resistant)

Question 5

risk of stroke in a-fib w/o AC

Answer 5

5%

Question 6

Important scores in CE stroke

Answer 6

hasbled, chadsvasc

Question 7

Four main ACs

Answer 7

warfarin, dabigatrin (pradaxa), apixaban (eliquis), rivaroxaban (xarelto)

Question 8

AC with shortest half-life and once daily dosing

Answer 8

Xarelto (rivaroxaban) (5-9 hours)

Question 9

Renal dosing for ACs

Answer 9

Crcl <30 Dabigatran 75mg/d Crcl <50 Xarelto 15mg/d Creatine >1.5, age >80, <132 lbs Eliquis 2.5mg

Question 10

how many times would someone have to fall for the risk to outweigh the benefit for AC and subdural hematomas

Answer 10

295 times

Question 11

When to resume AC after stroke

Answer 11

14 days but bigger strokes may need 4 weeds but asa should be administered in the meantime

Question 12

atheroma definitions

Answer 12

>4mm, noncalcified, mobile components

Question 13

LKW (time not hours) +/- AC (take last dose ?)

Answer 13

First two critical questions

Question 14

Alert, commands, eyes, head/gaze deviation, limb position and presence of purposeful movements

Answer 14

Things to observe initially on the way to the CT

Question 15

LKW/AC ? , Vitals CAB and <185/110, glucose, Observe then NIH

Answer 15

Stroke alert first 5 steps

Question 16

PT/PTT/INR, Plt, CBC, CMP, troponins

Answer 16

You only need a glucose but order these 5 additional labs.

Question 17

BP, Glucose, and 2 IVs

Answer 17

Three things you need from the nurse first

Question 18

does the presentation make neuroanatomic sense ?

Answer 18

Key to stroke syndromes

Question 19

Acute focal infarction of the cerebral, spinal or retinal tissue.

Answer 19

What is stroke ?

Question 20

ACA/MCA syndrome, amoaurosis fugax/altitudinal field cuts

Answer 20

ICA syndrome S/Sx

Question 21

Right leg weak/numb, transcortical motor aphasia, ideomotor apraxia (i/l or c/l)

Answer 21

L ACA stroke S/Sxs

Question 22

Left leg weak/numb, motor neglect, ideomotor apraxia (i/l or c/l)

Answer 22

R ACA stroke S/Sxs

Question 23

Right face/arm >leg numb/weak, aphasia and left gaze preference

Answer 23

L MCA stroke S/Sxs

Question 24

Left Face/arm >leg numb/weak, left hemineglect, right gaze preference, agraph/astereo

Answer 24

R MCA stroke S/Sxs

Question 25

Right hemianopsia, alexia w/o agraphia, MIDBRAIN (WEBER) CN 3 I/L with mydriasis and hemiparesis

Answer 25

L PCA stroke S/Sxs

Question 26

left hemianopsia and/or Weber syndrome CN 3, mydriasis and hemiparesis

Answer 26

R PCA stroke S/Sxs

Question 27

I/L limb and gait ataxia

Answer 27

SCA stroke S/Sxs

Question 28

Vertigo, I/L deafness, and/or i/l facial weakness/ataxia

Answer 28

AICA stroke S/Sxs

Question 29

I/L limb and gait ataxia and/or Wallenberg syndrome (lateral medulla)

Answer 29

Vert/PICA

Question 30

Pontine with impaired lateral gaze, horizontal diplopia and dysconjugate gaze, dysarthria, locked in

Answer 30

Basilar

Question 31

dietary modification, exercise, ASA, statin, antihypertensive agent

Answer 31

5 proven stroke prevention strategies

Question 32

olive oil, fruits, vegetables, nuts and whole grains with moderate fish and poultry.

Answer 32

Mediterranean diet

Question 33

if CK \>4x NL then stop and recheck in 6 weeks then try a low dose high potency statin (rosuva\>lipitor with regards to SE profile)

Answer 33

Statin induced ck elevation approach

Question 34

\<140/90 (if lacunar then 130/90)

Answer 34

BP goals

Question 35

no

Answer 35

Is there a difference in outcomes base on minor ischemic str

Question 36

speech and motor

Answer 36

Stroke mimics are more likely if what two symptoms are absen

Question 37

10% highest in the first 24 hours)

Answer 37

What percent of people who present with TIAs will ahve recur

Question 38

50%

Answer 38

What amount of stenosis in a vessel places a patient at risk

Question 39

CHANCE and FASTER (ended d/t slow recruitment )

Answer 39

Two trials that used DAPT for 21 days after TIA/small stroke

Question 40

Aggressive medical therpy (DAPT 90 days) along \> stenting both groups took ASA however (reason for point trial)

Answer 40

SAMMPRIS

Question 41

1-8% and fronto/insular stroke and patient taking ace-i

Answer 41

Orolingual angioedema % and increased risk by 2 things

Question 42

within 2 hours give 50/50/10 (benadryl,ranitidine,dexamethasone) for severe cases ad 0.3 mg epinephrine IM`

Answer 42

When does angioedema occurr and what do you do ?

Question 43

within 36 hours of tPA/stroke (6.4%)

Answer 43

Definition of symptomatic ICH

Question 44

HT1 scattered petechiaeHT2 more confluent but heterogenousPH 1 vs 2 is 30% of infarct volume

Answer 44

Four types of HT per ECASSII

Question 45

10g cryopercipitate (if fibrinogen \<150 can repeat,alternatives are tranexamic acid 10mg/kg over 20 min or e-aminocaproic acid 5g)

Answer 45

Tx for concerning hemorrhagic conversion

Question 46

HERMES said no

Answer 46

Is there a difference in HT between thrombectomy vs tpa ?

Question 47

Dominant hemisphere NIH \>20 Nondominant NIH \<15\>80ml at 6 hours on dwi

Answer 47

NIH for malignant infarction ? DWI ml for fulminant edema ?

Question 48

Mannitol 0.5 to 1 g/kg every 4-6 hours with goal osml of 310-3203% Hypertonic Saline for goal sodium of 150-155

Answer 48

Rx for malignant infarcrtion ?

Question 49

\<60 y/o who deteriorate within 48 hours (mrs \<4

Answer 49

Indications for decompressive hemicraniectomy

Question 50

13-25% in weeks 2-4

Answer 50

Early deaths d/t stroke % for PE

Question 51

2-7

Answer 51

DVT risk on days

Question 52

ON PRESENTATION unless they get Tpa the 24 hours if ICH 1 to 4 days

Answer 52

When shoud DVT Ppx begin

Question 53

IV fluids and early NG tube

Answer 53

If patient fails swallow screen beyon dvt ppx what else shou

Question 54

70%

Answer 54

What percent of patients will have a fall in 6 months post s

Question 55

10% most in the first 24 hours

Answer 55

What percent of patients develop seizures ?

Question 56

\>5

Answer 56

Significant AHI for stroke risk ?

Question 57

55% and fluoxetine per FLAME trial improves motor recovery

Answer 57

Depression % and what can be done ?