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Block 8 Week 4 > Lopaz-Stroke prevention > Flashcards

Lopaz-Stroke prevention Flashcards

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1
Q

Stroke is the (blank) leading cause of death in the US

A

4th

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2
Q

76% of strokes are (blanK) events and subsequent events are common

A

first

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3
Q

What is a TIA?

A

transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia w/o acute infarction

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4
Q

Most TIAs last (blank) minutes, If the symptoms last hour, more likely than no there will be (Blank)

A

15

infarcted tissue

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5
Q

Stroke can be in the (blank) or (blank) or (blank)

A

brain, spinal cord, retina

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6
Q

A (Blank) infarction produces no symptoms

A

silent

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7
Q

What is the best tx for stroke?

What are the 2 categories for stroke risk factors?

A

dont have one

-non modifiable and modifiable

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8
Q

What are the non-modifiable stroke risk factors?

A
  • age
  • low birth weight
  • ethnicity (black, some hispanics)
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9
Q

If you have a (blank) with ischemic stroke then you risk of stroke increases significatioy.

A

first degree relative

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10
Q

If you have a hx of ischemic stroke before the age of (blank) this is a bad sign and you will get another most likey

A

65

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11
Q

(blank) aneurysms are a risk for stroke

A

intracranial aneurysms

  • 8% individuals w AD polycystic kidney disease
  • 7% individuals w cervical fibromuscular dysplasia
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12
Q

What is the most important risk factor for stroke?

A

Hypertension

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13
Q

What is a stroke?

A

brain, spinal cord or retinal cell death attributable to ischemia, based on pathological, imaging and/or clinical evidence of permanent injury
silent infarctions produce no symptoms*

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14
Q

If you are black or hispanic what are you more likely to get and what will the result be?

A

more likely to get a stroke and die from it

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15
Q

Family history increases the risk of stroke by (blank) percent

A

30%

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16
Q

What type of aneurysm is associated with getting strokes? What individuals get these types of aneurysms?

A

Intracranial aneurysm

  • 8% individuals w AD polycystic kidney disease
  • 7% individuals w cervical fibromuscular dysplasia
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17
Q

WHo should you do screenings on for stoke?

A

-people with more than 2 first degree releatives with Subarachnoid hemorrhages or intracranial aneurysms
OR
-in patients w/ AD polycytic kidney disease and SAH or more than 1 relative w/ AD polycystic kidney disease and intracranial aneurysm

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18
Q

What are modifieable risk factors?

A 
Physical inactivity
Dyslipidemia
HTN
DM
Diet
Obesity
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19
Q

Physically active people have (blank) percent lower mortality than the least active

A

25-30%

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20
Q

What will physical activity do that helps prevent stroke?

A
  • reduces plasma fibrinogen
  • reduces platelet activity
  • elevates t-PA activity
  • elevates HDL
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21
Q

How much physical activity should adults do to prevent stroke?

A

40 min 3-4 days a week of moderate to vigorous intense aerobic physical activity

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22
Q

Tx with (blank) reduces the risk of stroke in patients w or at high risk for athersclerosis. SOOO plaque characteristics may improve w. (blank)

A

statins

statins

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23
Q

Each 1% reduction in total cholestero is associated w/ (blank) percent reduction in the risk of stroke

A

0.8%

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24
Q

SHould we worry that statins will increse the risk of intracerebral hemorrhage?

A

NO

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25
Q

What is the primary prevention of ischemic stroke in patients with high 10-year risk for CV events?
Is niacin helpful? is Fibric acid?

A

lifestyle changes and statins
not established
not established

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26
Q

What race is especially sensitive to the BP-raising effect of high salt intake, low potassium level, and suboptimal diet?

A

blacks

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27
Q

There is a strong diverse releationship between servings of (blank) and subsequent stroke

A

fruits and vegies

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28
Q

Increased intake of (blank), primarily from citrus fruits, has been associated with reduced risk of ischemic strokes

A

flavonoids

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29
Q

Higher intake of (blank) has been associated with a higher risk of stroke. Reduced intake of this ion and increased intake of this ion is indicated for a lower risk of stroke.

A

red meat

sodium, potassium

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30
Q

What is the best kind of diet?

A

high content of fruits,vegies,nutes
low fat dairy
reduced sat fats
(DASH style diet, Mediterranean diet)

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31
Q

The higher the (blank) is, the greater the risk of stoke. This is the MOST important RISK FACTOR for stroke

A

BP

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32
Q

Individuals who are normotensive at 55y of age have a (blank) lifetime risk for developing HTN

A

90%

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33
Q

More than 2/3rds of people over the age of (blank) have HTN

A

65

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34
Q

Bp control can be achieved in most individuals, but most patients require therapy (Blank) drug

A

more than one

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35
Q

What is the most important, modifiable risk factor for stroke?

A

HTN

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36
Q

(blank) treatment is the most effective strategy to prevent both ischemic and hemorrhagic stroke

A

HTN treatment

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37
Q

What is the target treatment of blood pressure?

A

less than 140/90 mm Hg

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38
Q

Where is the greater prevalence of obesity in the us? What is the linkage between obesity and stroke?

A

greater than 60 year olds and adolescents

More obese, more likely to get stroke

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39
Q

What races have the highest rates of obesity?

A

blacks, mexian-americans and all hispanics

lowest rates in whites

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40
Q

Having what disease more than doubles the risk for stroke?

What percent of adult Americans have this?

A

diabetes mellitus

8.2%

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41
Q

(blank) percent of patients w/ DM will die of stroke.

A

20%

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42
Q

(blank) reduces platelet sensitivity to aspirin

A

hyperglycemia

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43
Q

What should you give your patients with diabetes?

A

statins (to lower risk of first stroke)

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44
Q

cigarette smoking (blank) the risk of stroke. And (blank) fold increased the risk for subarachnoid hemorrhage

A

doubes

2-4

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45
Q

There are synergisitic effects between the use of (blank) and smoking on the risk of stroke

A

Oral contraceptives (OCs)

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46
Q

Is exposure to environmental tobacco smoke (second-hand) a risk factor for heart disease?

A

yes

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47
Q

Is there a linear-dose response relationship between tobacco smoke and stroke?

A

no there is a smoke exposure threshold

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48
Q

Bans on cigarette smoking are associated with a reduction in the risk of (blank)

A

stroke

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49
Q

Smoking as little as a single cigarette increase (blank and blank) and decreases (blank)

A
  • heart rate, mean BP

- arterial distensibility

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50
Q

Both active and passive cigarette smoking exposure is associated w the development of (Blank)

A

atherosclerosis

51
Q

What is the most effective med for smoking cessation?

A

varenicicline

more cost effective than nicotine replacement therapy

52
Q

There is a (blank) fold increase risk of ischemic stroke resulting from embolism from (blank).
THis accounts for (blank) percent of ALL ISCHEMIC strokes (even higher fraction in the very elderly)

A

4-5
A fib
10%

53
Q

(blank) percent of all strokes are ischemic.

A

85%

The rest are hemorrhagic

54
Q

What is the CHADS2 for?

A

A fib stroke risk

55
Q

How is the CHADS2 formatted?

A 
Scored 0-6
1 point each given for
CHF
HTN
Age >75
DM
2 point for
-prior stroke or TIA

0 points - low risk (0.5%-1.7%)
1 point- moderate risk (1.2%-2.2%)
greater than 1 point- high risk (1.9%-7.6%)

56
Q

What is the CHADS2VASc?

A 
modifies CHADS2 by adding an age category
-1 point for age 65-74
-2 point for age greater than 75
And adding 1 point each for
-vascular disease
-female sex
57
Q

What are considered “vascular diseases” in the CHAD2DS2VASc?

A
  • peripheral artery disease
  • MI
  • Aortic plaque
58
Q

On the CHA2DS2VASc, what percentage of patients get a 0,1,2,3,4?

A 
0 - 0.84%
1 - 1.79%
2 – 3.67%
3 – 5.75%
4 – 8.18%
59
Q

What is the HAS-BLED?

A

Estimates risk of major bleeding for patients on anticoagulation to assess risk-benefit in atrial fibrillation care.

60
Q

What is the format of HAS-BLED?

A 
Score greater than 2 associated w major bleeding
1 point each for
HTN
Abnormal renal function
Abnormal liver function
Prior stroke
Prior major bleeding/bleeding predisposition
INR in therapeutic range 65
Use of anti-platelets or NSAIDs
Excessive alcohol use
`
61
Q

How do you treat a fib?
What is the target INR?
What is the risk reduction of stroke after tx?

A

adjust-dose warfarin
INR 2-3
64%

62
Q

Taking warfarin will reduce your chance of dying by (blank) percent

A

26%

63
Q

(blank) reduces stroke severity and post-stroke mortality

A

Warfarin

64
Q

(blank ) reduces stroke by 39% w aspirin

A

warfarin

65
Q

A study was done comparing New Anticoagulants to warfarin, are they better or worse than warfarin?

A

BETTER! had a lower hazard ratio

66
Q

What is this:

  • oral direct thrombin inhibitor
  • twice-daily dosing
  • renal clearance 80%
A

Dabigatran

67
Q

What is this

  • Direct factor Xa inhibitor
  • once daily
  • renal clearance 33%
A

Rivaroxaban

68
Q

What is this:

  • Direct factor Xa inhibitor
  • Twice-daily dosing
  • Renal clearance 25%
A

Apixaban

69
Q

What is this:

  • Direct factor Xa inhibitor
  • Once-daily dosing
  • Renal clearance 35%
A

Edoxaban

70
Q

What are the advantages of NOACs?

A
  • fixed dose
  • no blood monitoring
  • fewer drug interaxns than warfarin
  • lower risk of ICH
71
Q

What are the disadvantages of NOACs?

A
  • Lack of reversing agent

- Short half-life

72
Q

T or F

Warfarin-related ICH mortality is very high despite the availability of reversing agents

A

T

73
Q

What are some reversing agents for warfarin?

A

Aripazine
Andexanet
Idarucizumab

74
Q

T or F

Aspiring offers modest protection against stroke

A

T

75
Q

Should you give aspirin in conjunction with warfarin?

A

not for AF and stable Coronary Artery Disease

76
Q

TO prevent vascular events, which is better, aspirin alone or aspirin in conjunction with plavix?

A

combo is superior to aspirin alone (but more bleedings)

77
Q

TO prevent vascular events, which is better, plavix with aspirin or warfarin?

A

Wafarin is superior to combo

78
Q

T or F

Cardioversion, rate control, rhythm control do not protect AF patients against stroke

A

T

79
Q

If you have a CHA2DS2VASc greater than 1, is anticoagulation recommended?

A

YES

80
Q

if you have a CHA2DS2VASc score 0-1, is anticoagulation recommended?

A

aspirin may be considered but is not necessary

81
Q

(blank) is reasonable for patients with ST elevated MI and asymptomatic L ventricular mural thrombi

A

anticoagulant therapy

82
Q

(blank) may be considered for patients w/ ST elevated MI and anterior apical akinesis/hypokinesis

A

anticoagulant therapy

83
Q

HOw does warfarin or aspirin affect cardiac ejection fraction? Is warfarin or aspirin better at reducing ischemic stroke?

A
  • reduces it by 35%

- reduces ischemic stroke EVEN BETTER THAN ASPIRIN

84
Q

Are you more or less likely to bleed using warfarin rather than aspirin?

A

more likely

85
Q

Valvular heart disease can cause strokes. YOu are more likley to get an embolism if you have (blank) disease or if you have a (blank) valve

A

rheumatic valve disease

prosthetic

86
Q

When should you give anticoagulation to a patient with valvular heart disease?

A
  • mitral stenosis + prior embolic event, even if sinus rhythm
  • mitral stenosis w L atrial thrombus
87
Q

When do you give aspirin in valvular heart disease?

A

mitral valve prolapse w TIA

88
Q

When do you give aspirin in valvular heart disease?

A
  • mitral regurgitation
  • AF
  • L atrial thrombus
89
Q

What is the most common cardiac tumor?

What percentage of these tumors will embolize?

A

Myxoma

30-40%

90
Q

(blank) percent of patients w/ fibroelastoma present w stroke/TIA

A

50%

91
Q

In Aortic Atherosclerosis, plaques greater than (blank) mm are associated with increased risk of stroke

A

4

92
Q

Is anticoagulation indicated in mitral stenosis?

A

yes

Even if sinus rhythm and if L atrial thrombus

93
Q

What 2 things are indicated in all mitral valve replacements?

A

Warfarin and aspirin

94
Q

What do you perform on all atrial myxomas?

A

surgical excision

95
Q

What do you give for aortic or mitral bioprosthesis?

A

aspirin

96
Q

What do you give for patients with heart failure?

A

either ASA or warfarin

97
Q

What do you give for ST elongated MI?

A

warfarin

98
Q

What do you give for asymptomatic L ventricular mural thrombus or anterior apical akinesis/dyskinesis?

A

Warfarin

99
Q

What shouldn’t you give to patients with PFO for primary prevention of stroke?

A

Anti-thrombotic therapy or catheter-based closure

100
Q

Should you screen for asymptomatic carotid artery stenosis? What should you give these patients?

A

no

daily statins and ASA

101
Q

Should you give asymptomatic carotid artery stenosis patients surgery?

A

no!

102
Q

Sickle cell disease is inherited how? what causes it? what is the major complication of this?

A

AR
altered Hb beta chain
stroke

103
Q

WHen will a Sickle cell disease patient most like get a stroke?

A

in childhood,

prevalence of stroke by age 20 is 11%

104
Q

Velocity greater than 200 cm/sec by transcranial doppler (TCD) is associated with stroke rates of (Blank) percent/ year

A

10%

105
Q

Annual TCD are recommened for sickle cell patients between ages (blank-blank) years

A

2-16

106
Q

In sickle cell disease, what is the only intervention proven to decrease stroke rates?

A

periodic red cell transfusion

target is reduction of Hb s <30%

107
Q 
What are these:
Migraine
Metabolic Syndrome
Alcohol consumption
Drug abuse
Sleep-disordered breathing
Hyperhomocystenemia
Hypercoagulability
Inflammation and infection
Antiplatelet agents/aspirin
A

less well-documented risk factors for stroke

108
Q

What is associated with stroke in young women less than 45 years old who are smokers, and use oral contraceptives?

A

migraine w aura

109
Q

Increased frequency of migraines w/ auras is correlated with increased risk of (blank) and (blank)

A

stroke

ICH

110
Q

How can you reduce the frequency of migrain auras in women who take OCs?

A

use different ones, estrogen only ones

111
Q

Heavy alcohol use is a risk factor for all types of (blank).

A

stroke

112
Q

There is a linear association between alcohol consumption and the risk of (blank)

A

intracranial hemorrhage

113
Q

What drugs are associated with increased risk of stroke and why?

A
  • all sympathomimetics, cannabis, heroin
  • BP elevations, cerebral vasospasm, vasculitis, endothelial dysfunction, increased blood viscosity, platelet aggregation
114
Q

(blank) percent of adults have sleep apnea.
Sleep apnea is an independent (blank)
How do you treat it?

A

4%
stroke risk factor
CPAP

115
Q

Hyperhomocysteinemia is a risk for stroke, can you reduce this risk?

A

no, reduction in homocysteine does not decrease stroke risk

116
Q

Acquired and hereditary hypercoagulable states (thrombilias) are associated w (blank)

A

venous thrombosis

117
Q

The 2 most common genetic causes of thrombolia are (blank and blank). Are these commonly asociated with arterial ischemic stroke?

A
  • Factor V leiden mutation
  • G20210A prothrombin mutation

no, rarely

118
Q

Is inflammation a risk factor for stroke?

A

yes, inflammation has pro-thrombotic effects

-patients w/ inflammatory conditions, such as RA or SLE should be considered at risk of stroke

119
Q

T or F

There is risk but no benefit of asa for the prevention of a first stroke in the general population

A

T, dont use ASA for stroke prevention

120
Q

Aspirin is useful for (blank) prevention but not for stroke prevention

A

MI

121
Q

The use of (blank) for CV prophylaxis is reasonable for people with a 10 year risk greater than 10% (not specific for stroke)

A

aspirin

122
Q

For primary stroke prevention, Aspirin might be considered in patients with (blank or blank)

A

DM or Chronic kidney disease (not severe kidney disease)

123
Q

T or F

Aspirin is not useful for preventing a first stroke in low-risk individuals.

A

T

Block 8 Week 4 (8 decks)

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