DECK PT Flashcards
- Q. What is a transient ischemic attack? What makes it different from a stroke?
A. Focal, sudden onset ischemia (often due to thromboembolism from carotids)
B. Neurological deficit that lasts < 24 hours with complete clinical recovery
C. Causes: Thromboembolism from carotids, cardioembolism, hyperviscosity e.g. polycythaemia
- Q. What is amaurosis fugax?
A. When emboli passes into the retinal artery - “a curtain descending over my field of vision”
Q. What score predicts the risk of stroke after TIA?
A. ABCD2 score: Age > 60 (1), Blood pressure > 140/80 (1), Clinical features:unilateral weakness (2)
or speech impairment without weakness (1), Duration of sx > 60 mins (2), 10-59 mins (1), Diabetes
(1)
- Q. How should TIAs is managed?
A. Ix: ABCD2 score, carotid doppler (no brain changes with TIA - may MRI to look for other existing
infarcts)
B. Tx: 1st line clopidogrel (P2Y12 inhibitor), carotid endarterectomy if stenosis
- Q. What symptoms is an occlusion of the vertebral and basilar arteries likely to produce?
A. Nystagmus, vertigo, dysphagia, ataxia, vomiting, horner’s syndrome
- Q. What symptoms is an occlusion of the cerebellar arteries likely to produce?
A. Vertigo, headache, ataxia, vomiting
Q. What is the most common cause of haemorrhagic stroke?
A. HTN: Charcot-Bouchard’s aneurysms -most often in the basal ganglia due to chronic hypertension
B. Also lobar hemorrhagic strokes due to cerebral amyloid angiopathy (often in elderly)
C. Others: metastatic tumours, AV malformations, hemorrhagic transformation from infarct, anticoag
e.g. warfarin
- Q. How are ischaemic and haemorrhagic strokes differentiated clinically? Describe the treatment for both
A. CT brain (MRI, carotid doppler, cerebral angiography, ECHO, ECG - AF)
B. Ischaemic: 1. Thrombosis IV alteplase < 4.5 hours 2. Aspirin for 2 weeks then clopidogrel
C. Haemorrhagic: 1. BP control with B-blocker, Beriplex if warfarin related bleed, clot evacuation
D. + rehab: physio, OT, SALT,
E. + RF management: antihypertensives, statins
Q. What is the most common cause of subarachnoid haemorrhage? What conditions is it
associated with?
A. Subarachnoid haemorrhage: caused by berry aneurysm causing spontaneous bleed into the
subarchnoid space (or AV malformation, idiopathetic) - where is it likely to occur?
B. Associated with PKD, coarction of the aorta, Ehler’s Danos syndrome
C. Berry aneurysms at bifurcation of arteries - 40% at the anterior communicating artery, posterior
communicating (20)
Q. How is subarachnoid haemorrhage investigated? Managed?
A. CT head (white star shape)
B. LP: wait 12 hours, xanthochromia (yellow) - breakdown of HB → bilirubin
C. Neurosurgery
D. CCB: nimodipine reduces vasospasm and morbidity for cerebral ischemia
Q. Name 3 triggers of migraines, what is the treatment?
A. CHOCOLATE: chocolate, cheese, hangovers, oral contraceptive pill, caffeine, organsms, lie ins,
alcohol, travel, exercise - also by noise and lights
B. Acute: oral triptan e.g. sumatriptan and NSAID
C. Prophylaxis: BB e.g. propanolol
Q. Name 3 triggers of tension headache, what is the treatment?
A. Causes: fumes/smells, stress, noise, concentrated visual effort
B. Tx: reassurance, stress relief, short term analgesia e.g. paracetamol
Q. Name 3 features of cluster headache, what is the tx?
A. Unilateral, occurs in clusters, lasts 15-160 mins, ‘alarm clock’ headache, more common in smokers
and males
B. 100% oxygen (not in COPD), sumatriptan onset
C. Prevention: verapamil
Q. Name 3 features of giant cell arteritis, what conditions can cause it? Ix? Tx?
A. GCA: tenderness, pain in jar, loss of vision, non-pulsatile temporal arteries
B. SS: weight loss, fatigue, proximal muscle pain
C. Secondary causes: SLE, RA, HIV
D. Ix: increased ESR, temporal artery biopsy
E. Tx: high dose steroids e.g. IV methylprednisolone
- Q. Trigeminal neuralgia - Ix? Tx?
A. Ix: MRI, Tx: carbamazepine
