Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio > stroke > Flashcards

stroke Flashcards

1
Q

CNS infarction

A

brain, spinal cord, or retinal cell death due to ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ischemia

A

limited or loss of blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what evidence do you need for CNS infarction

A

pathological/imaging/objective evidence of cerebral, spinal cord, or retinal focal ischemic injury in a defined vascular distribution, or clinical evidence of cerebral, spinal cord, or retinal focal ischemic injury based on symptoms persisting >24 hours or until death, and other pathologies excluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

silent CNS infarction

A

imaging or neuropathologic evidence of CNS infarction, without a history of acute neurological dysfunction attributable to the lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ischemic stroke

A

an episode of neurological dysfunction caused by focal cerebral, spinal, or retinal infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

transient ischemic attack (“mini stroke”)

A

a transient episode of neurological dysfunction caused by focal cerebral, spinal, or retinal ischemia without acute infarction, typically lasting <1 hour (10% risk of stroke within 7 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

intracranial hemorrhage

A

a focal collection of blood within the brain parenchyma or ventricular system, not due to trauma (includes parenchymal hemorrhage after CNS infarction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

stroke due to ICH

A

rapidly developing signs of neurologic dysfunction due to a focal collection of blood within the brain parenchyma or ventricular system, not due to trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

subarachnoid hemorrhage

A

bleeding into the subarachnoid space (space btwn the arachnoid membrane and the pia matter of the brain or spinal cord)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

stroke due to SAH

A

rapidly developing signs of neurologic dysfunction and/or headache due to subarachnoid hemorrhage, not caused by trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

__% of strokes are ischemic

A

87

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

__% of strokes are hemorrhagic

A

10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

_% of strokes are due to SAH

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how can you tell the difference between hemorrhagic and ischemic stroke

A

dark is dead, white is blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

in a ______ stroke, hemorrhage/blood leaks into brain tissue

A

hemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

in a ____ stroke, a clot stops blood supply to an area of the brain

A

ischemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

modifiable risk factors for stroke

A

cigarette smoking, HTN, DM, dyslipidemia, AFib, carotid stenosis, structural heart disease, poor diet, obesity, physical inactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

non-modifiable risk factors for stroke

A

age, family history, race, sex, prior stroke/MI/TIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the time dependent cascade of ischemic changes in stroke

A

decreased energy production, increased glutamate receptors, increased intracellular Na, Cl, Ca, mitochondrial injury, cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

the severity of injury in stroke is determined by

A

site of stenosis or occlusion, cardiac function, collateral blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

the frontal lobe controls

A

motor output, short term memory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

the parietal lobe controls

A

sensory input

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

the occipital lobe controls

A

visual processing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

the temporal lobe controls

A

auditory processing, language recognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

the cerebellum controls

A

skeletal muscle contractions, balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

the brainstem controls

A

respiration, HR, BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ischemic penumbra

A

the part of the brain sandwiched between brain regions committed to die and those that receive enough blood to communicate: has the capacity to be salvaged, has compromised blood flow (collateral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

major risk for cardioembolic sources of stroke

A

AFib, mitral stenosis, prosthetic mechanical valve, recent MI, left ventricular thrombus, atrial myxoma, ineffective endocarditis, dilated cardiomyopathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

minor/unknown risk for cardioembolic sources of stroke

A

mitral valve prolapse, mitral annular calcification, patent foramen ovale, atrial septal aneurysm, calcific aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

clinical presentation and diagnosis of stroke

A

focal neurological deficit with abrupt onset of symptoms (in the absence of trauma) such as muscle numbness or weakness especially on one site of the body, trouble speaking, trouble seeing, and severe headache with no known cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the gold standard for stroke severity rating

A

NIHSS: national institutes of health stroke scale

32
Q

NIHSS score should be assessed within __ hours for all stroke patients

A

12

33
Q

what can the total NIHSS score predict

A

outcome, or presence of large vessel occlusion

34
Q

NIHSS score 0

A

no stroke

35
Q

NIHSS score 1-4

A

minor stroke

36
Q

NIHSS score 5-15

A

moderate stroke

37
Q

NIHSS score 15-20

A

moderate to severe stroke

38
Q

NIHSS score 21-42

A

severe stroke

39
Q

get a CT scan within ____ of arrival

A

25 minutes

40
Q

on the CT scan, an area of ischemia will look ___

A

dark

41
Q

on the CT scan, an area of hemorrhage will look

A

white

42
Q

treatment goals for stroke

A

restore normal cerebral blood flow as soon as possible, minimize neurologic damage, protect neurons by slowing the ischemic cascade

43
Q

supportive care for stroke

A

IV fluids (NS, dextrose, plasmalyte, LR), blood glucose, acetaminophen. NOTHING BY MOUTH (NPO)

44
Q

patient eligibility for fibrinolytics

A

> 18 years old, diagnosis of ischemic stroke, onset of symptoms <3 hours, no stroke or head trauma within 3 months, no major surgery within 14 days, no history of ICH, SBP <185, DBP< 110, no need for aggressive BP lowering to within goal, no known malignant intracranial neoplasm, no subarachnoid hemorrhage, no GI/urinary tract hemorrhage within 21 days, no arterial puncture within 7 days, no seizure at onset of stroke, INR <1.7 without anticoagulant, aPTT within normal range, platelets >100,000, blood glucose >50 mg/dl, no rapidly resolving symptoms, no active bleed, no known structural cerebral vascular lesion

45
Q

additional exclusion criteria if symptom onset 3-4.5 hours

A

> 80 years old, warfarin regardless of INR, baseline NIHSS score >25, history of both stroke and diabetes

46
Q

what does tPA stand for

A

tissue plasminogen factor

47
Q

administer tPA to eligible patients within ____ hours after start of stroke symptoms

A

3-4.5

48
Q

dosing for tpa

A

0.9 mg/kg: give 10% bolus over 1 minute, give the rest (90%) over 1 hour, max for any patient is 90 mg

49
Q

are other thrombotic agents recommended at the time of tpa

A

NO

50
Q

_______ is an option for MAJOR stroke if administered within 6 hours of symptom onset at an experienced stroke center

A

intra-arterial thrombolysis

51
Q

how to monitor after giving tpa

A

neuro assessments every 15 minutes during infusion, every 30 minutes for 6 hours, every 60 minutes for 16 hours. d/c infusion if severe headache, acute hypertension, n/v. check BP every 15 minutes for 2 hours, every 30 minutes for 6 hours, and every 60 minutes for 16 hours.

52
Q

avoid antiplatelets and anticoagulants for ____ hours after fibrinolytic

A

24-48

53
Q

additional pharmacotherapy monitoring for tpa

A

resolving of stroke symptoms, signs and symptoms of intracranial hemorrhage, side effects of individual agents used as applicable

54
Q

indications for antihypertensives in acute ischemic stroke

A

SBP> 180 &/or DBP >105 in patients given tpa; aortic dissection; acute MI; heart failure; acute renal failure; hypertensive encephalopathy

55
Q

antihypertensive options for stroke

A

labetalol, nicardipine, nitroprusside

56
Q

labetalol dosing

A

10-20 mg IV, may repeat or double dose every 10 minutes (max 300 mg)

57
Q

nicardipine dosing

A

5 mg/hr IV infusion, may titrate by 2.5 mg/hr every 5 minutes (max 15 mg/hour)

58
Q

nitroprusside dosing

A

0.5 mcg/kg/min IV infusion

59
Q

aim for ___% reduction in BP

A

10-15%

60
Q

algorithm for patients treated with thrombolytics

A

NS 75-100 mL/hr, NO heparin/warfarin/aspirin/clopidogrel/dipyridamole for 24 hours THEN start antithrombotic, brain CT or MRI after 24 hours of rtPA

61
Q

algorithm for patients not treated with thrombolytics

A

NS 75-100 mL/hr, antiplatelet (aspirin) should be ordered within first 24 hours of hospital admission, heparin/warfarin are NOT recommended until after 24 hours in cardioembolic state and patient is stable. repeat brain CT or MRI may be ordered 24-48 hours after stroke

62
Q

aspirin dose

A

initial dose of 325 mg recommended within 24-48 hours of stroke onset to decrease stroke recurrence risk and mortality

63
Q

heparin for stroke?

A

therapeutic anticoagulation w/ IV/SQ UFH/LMWH is NOT recommended for acute ischemic stroke treatment. is recommended low dose SQ UFH/LMWH for DVT/PE prophylaxis

64
Q

algorithm if patient is eligible for tPA and BP is >185/110

A

treat BP first before TPA, start ASA 24 hours after TPA

65
Q

algorithm if patient is eligible for tPA and BP is <185/110

A

start tPA, start ASA 24 hours after TPA

66
Q

algorithm if patient is not eligible for tPA

A

asa 325 mg daily & no anticoagulants within 24 hours, may consider after 24 hours

67
Q

complications with stroke

A

seizure, cerebral hemorrhage, cerebral edema, hemiplegia, aphasia, depression, sensory deficits

68
Q

hemiplegia

A

one sided muscle weakness/paralysis

69
Q

secondary prevention of stroke if non-cardioembolic (i.e. not AFib)

A

asa monotherapy, or asa 25 mg + dipyridamole 200 mg (aggrenox) bid, or clopidogrel 75 mg qd

70
Q

secondary prevention of stroke if cardioembolic (AFib)

A

DOAC, warfarin (target inr 2.5), ChA2DS2-VASc

71
Q

statin therapy

A

intense, atorvastatin 80 mg qd, regardless of cholesterol profile, is recommended for patients with TIA and ischemic stroke

72
Q

what to do if intracerebral hemorrhage

A

no standard treatment, treat hypertension, reverse anticoagulation, poor prognosis, mannitol to maintain serum osmolarity and arterial pressure

73
Q

warfarin reversal

A

FFP or PCCs (KCentra, Profilnine, FEIBA), vitamin K IV, recombinant activated factor VIIa (novoseven)

74
Q

dabigatran reversal

A

praxbind (idaracizumab)

75
Q

andfactor Xa inhibitor reversal

A

andexanet

Cardio (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions