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General Adult Flashcards

1
Q

What time frame discriminates stroke from TIA?

A

No time frame; key is TIA is transient (usually 2-3 hours)

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2
Q

Most common symptoms in vertebral artery dissection

A
  • HA (69%)

- Posterior neck pain (46%)

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3
Q

TPA exclusion criteria: within how many days of surgery are patient’s excluded?

A

14 days

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4
Q

What is the pretreatment systolic pressure that pt must have before getting TPA?

A

185/110

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5
Q

What INR must person have below to get TPA?

A

1.7

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6
Q

Are pts on warfarin, ASA excluded from getting TPA?

A

No (unless INR >1.7)

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7
Q

Does a certian platelet count exlude patients from TPA?

A

yes, if <100,000

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8
Q

What if pt has been on heparin, can they get TPA?

A

not if heparin was within 48hours AND they have prolonged PTT

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9
Q

Pt states they had GI bleed 4 weeks ago. Are they excluded from getting TPA?

A

No. GI bleeding or urinary tract bleeding excluded within 21 days

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10
Q

Pt had MI 5 months ago. Excluded from TPA for stroke?

A

No. MI within 3 months excluded

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11
Q

Pt had an intracranial hemorrhage after MVA 14 years ago. Are they excluded from getting TPA?

A

Yes. Any history of intracranial hemorrhage excluded

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12
Q

Pt had head trauma 5 months ago. Excluded from getting TPA?

A

No. Head trauma within 3 months.

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13
Q

O2 goal for stroke pt

A

> 92%

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14
Q

What is BP goal for pt who is NOT a candidate get TPA?

A

<220/120 (we allow permissive hypertension)

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15
Q

What is the risk of intracerebral hemorrhage with TPA and what is the mortality risk?

A

6.5%, 45% mortality

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16
Q

What is the dose of TPA and how is it given?

A

0.9mg/kg (max 90mg); 10% as bolus, 90% over 1 hour

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17
Q

Patient just given TPA a few hours ago and has worsening mental status

A

worry about intracerebral bleeding

18
Q

Treatment of TPA

A

ASA 325mg
Dipyridamole 400mg PO
Both within 24-48 hours

19
Q

What if pt on asa and needs TPA?

A

not a contraindication

20
Q

What is the role of heparin in stroke?

A

Currently has NO role in the acute management; neither does warfarin

21
Q

Goal BP in SAH

A

MAP < 130

22
Q

Treatment of ICP and dose

A

mannitol 0.25 to 1g/kg IV
must have functioning kidneys to work

-also, keep HOB at 30 deg with head midline to improve venous drainage of head

23
Q

Pt with SAH has high BP. How are you going to treat?

A

-labetalol 10-20mg over 1-2 min, titrate 2mg/min
OR
-nimodipine 60mg PO q4h

24
Q

What additional consultant, other than neuro, should be involved in cerebellar strokes?

A

neurosurgery-high risk for swelling with brainstem compression

25
Q

What if you are out in the country at a small hospital, pt had a stroke but not a candidate for TPA. What do you do?

A

transfer the pt. all patient with stroke should be admitted to specialized stroke units b/c show improved outcomes

26
Q

What scoring system predicts very early stroke risk after TIA?

A

ABCD2:

  • age >60
  • BP >140/90
  • Clinical feature (absent, speech impairment, unilateral weakness)
  • Duration
  • Diabetes
27
Q

Pt freaking out in ED. Chemical restrain go-to?

A

haldol 5mg, ativan 2mg (both can be PO, IV, or IM)

28
Q

Signs of feigned coma

A
  • response to manual eye opening-should be little to no resistance
  • avoidance of gaze
  • nystagmus on coloric testing
29
Q

Comatose patient with “normal” head CT

A

consider basilar artery thrombosis

30
Q

Good test to distinguish sensory from motor ataxia?

A

heal down shin:

  • overshoot of knee or ankle-cerebellar disease
  • wavering course-sensory
31
Q

What does position sense in the toes test anatomically? What two neuro diseases should you consider?

A

Posterior Columns

  • tabes dorsalis (syphillis
  • B12 deficiency
32
Q

What is a positive Romberg sign?

A

pt falls over with eyes closed-suggests they rely on visual input for balance, so be concerned for posterior column OR vestibular disease

If fall over with eyes open, concern for cerebellar lesion

33
Q

What is a motor ataxic gait?

A

broad based, unsteady

34
Q

What is a sensory ataxic gait?

A

abrupt movements and slapping of feet with each impact

35
Q

Foot drop cause

A

peroneal nerve palsy

36
Q

What can you do to expose subtle proximal or distal weakness?

A

walk on heels and toes

37
Q

What can you do to illicit subtle ataxia?

A

tandem walking (toe to heel)

38
Q

Which part of the brain does CT have trouble “seeing”?

A

posterior fossa, MRI better

39
Q

Name the disease: Loss of position sense in 2nd toe and + Romberg

A

B12 deficiency

40
Q

Name the disease: broad based gait, dementia, urinary incontinence

A

normal pressure hydrocephalus
large ventricles on CT, out of proportion to sulcul atrophy
drain CSF

41
Q

Attending tells you pt can’t have B12 deficiency b/c doesn’t have macrocytic anemia…you say

A

neuro symptoms often precede macrocytic anemia

-get a cobalamin level

42
Q

the other name for B12

A

cobalamin

Adults (9 decks)

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