Stroke Flashcards
Which 2 of the following blood vessels provide blood to the circle of willis in the brain?
1 - external carotid artery
2 - internal carotid artery
3 - vertebral artery
4 - subclavian artery
2 - internal carotid artery
3 - vertebral artery
- forms dual supply incase of ischaemia
There are 3 main arteries that arise from the circle of willis. Which of the following is not one of these?
1 - anterior cerebral artery
2 - posterior cerebral artery
3 - anterior communicating artery
4 - middle cerebral artery
3 - anterior communicating artery
The 3 main arteries that come of the circle of willis are the anterior, posterior and middle cerebral arteries. Of these which supplies the temporal and parietal lobes?
- middle cerebral artery
The 3 main arteries that come of the circle of willis are the anterior, posterior and middle cerebral arteries. Of these which supplies the frontal lobes and superior medial parietal lobes?
- anterior cerebral artery
The 3 main arteries that come of the circle of willis are the anterior, posterior and middle cerebral arteries. Of these which supplies the following:
- Medial surface of parietal lobe
- Medial and inferior surface of temporal lobe including hippocampal formation
- Occipital lobe
Thalamus, hypothalamus and subthalamic nuclei - Midbrain
- posterior cerebral artery
What is a stroke?
1 - blood clot in cerebral arteries
2 - sudden loss of cerebral function >24h
3 - sudden loss of cerebral function <24h
4 - sudden loss of cerebral and cardiac function
2 - sudden loss of cerebral function >24h
- essentially a specific location in the brain
In a stroke how long do the symptoms generally present for?
1 - 1-2 hours
2 - 6-8 hours
3 - 12-16 hours
4 - >24 hours or death
4 - >24 hours or death
What are the 2 most common causes of a stroke?
1 - ischaemic stroke
2 - traumatic stroke
3 - stress induced stroke
4 - hemorrhagic stroke
1 - ischaemic stroke
4 - hemorrhagic stroke
2 - Ischemia (inadequate blood flow(
The 2 most common forms of a stroke are ischaemic and hemorrhagic stroke. Which of these is the most common?
- ischaemic stroke
- accounts for >75% of strokes
The 2 most common causes of a stroke are spontaneous haemorrhage and Ischemia (inadequate blood flow) stroke. Which 2 of the following are the 2 main causes of an ischemia stroke?
1 - thrombosis
2 - embolus
3 - drug induced
4 - trauma
1 - thrombosis
- plaque forms and occludes cerebral artery
2 - embolus
- mass in the blood that moves to the cerebral artery and occludes the artery
How long do transient Ischemia attacks (TIA) last for?
1 - <6 hours
2 - <12 hours
3 - <24 hours
4 - >24 hours
3 - <24 hours
- acute with symptoms for <24 hours
- >24 hours is a full stroke
- loss of function can be focal (specific part of brain) cerebral for ocular (eye) and then relieve itself
A transient Ischemia attack (TIA) is an acute attack with symptoms lasting for <24 hours. What are the 2 most common causes?
1 - thrombosis
2 - embolus
3 - drug induced
4 - trauma
1 - thrombosis
- plaque forms and occludes cerebral artery
2 - embolus
- mass in the blood that moves to the cerebral artery and occludes the artery
Does a transient ischaemic attack (TIA) occur in isolation with no risks?
1 - yes just a mini stroke with no consequences
2 - increases the risk of a full stroke
3 - increases risk of dementia
4 - increases the risk of vasculitis
2 - increases the risk of a full stroke
- highest risk within days of TIA
- risk reduces only 3 months following subsidence of the symptoms
What does acute stroke syndrome refer to?
1 - where symptoms of a stroke are present
2 - symptoms of a stroke align with other syndromes
3 - symptoms lasting <24h so difficult to distinguish between TIA and full stroke
4 - all of the above
3 - symptoms lasting <24h so difficult to distinguish between TIA and full stroke
How many people a year are affected by strokes?
1 - 10,000
2 - 100,000
3 - 150,000
4 - 200,000
3 - 150,000
- increases with age and men slightly more likely
What % of people who have a stroke is fatal within the year of the stroke?
1 - 10%
2 - 25%
3 - 45%
4 - 75%
2 - 25%
What % of people who have a stroke then live with severe disability?
1 - 10%
2 - 25%
3 - 33%
4 - 75%
3 - 33.3%
What % of people who have a stroke are <65 years of age?
1 - 10%
2 - 25%
3 - 50%
4 - 75%
2 - 25%
What % of people who have a stroke has previously been preceded by a transient ischemic attack?
1 - 10%
2 - 20%
3 - 50%
4 - 75%
2 - 20%
What are the costs of stroke to the UK per year?
1 - £900,000
2 - £9 million
3 - £90 million
4 - £9 billion
4 - £9 billion
What % of <65 year old survivors of a stroke are unable to return to work?
1 - 15%
2 - 30%
3 - 45%
4 - 70%
4 - 70%
An intracranial haemorrhage is a bleed within the cranium, BUT not in the brain, so NOT a stroke. What % of strokes are intracranial haemorrhage?
1 - 10%
2 - 20%
3 - 50%
4 - 75%
1 - 10%
What % of strokes are subarachnoid (bleeding in space around the brain, essentially between the subarachnoid and pia mater) haemorrhage?
1 - 10%
2 - 5%
3 - 50%
4 - 75%
2 - 5%
- sub = below
- between subarachnoid and pia mater
Which of the following are risk factors for a stroke?
1 - age
2 - hypertension
3 - AF
4 - diabetes
5 - dyslipidaemia
6 - smoking and alcohol
7 - migraines
8 - social class
9 - birth weight
10 - all of the above
10 - all of the above
Patients with AF have a significant risk of a stroke. What % of patients with strokes are in AF?
1 - 0.2%
2 - 2%
3 - 20%
4 - 50%
3 - 20%
- with no anticoagulation AF increases stroke by x5
Which scoring tool is used to stratify the risk of a stroke in patients with AF?
1 - CHA2DS2-VASc score
2 - CURB score
3 - Q-risk score
4 - Modified Glasgow scale
1 - CHA2DS2-VASc score
Which of the following would typically be performed in a patient suspected of having a stroke?
1 - GCS
2 - ABCDE
3 - Neurological examination
4 - National Institutes of Health Stroke Scale (NIHSS)
5 - all of the above
5 - all of the above
Which of the following are the most common causes of an ischemic attack?
1 - Large vessel-vessel thromboembolism
2 - Cardioembolic events (AF, endocarditis)
3 - Small vessel disease (diabetes, hypertension)
4 - all of the above
4 - all of the above
- Large vessel-vessel thromboembolism = 50%
- Cardioembolic events = 20%
- Small vessel disease = 25%
An intracranial hemorrhage (ICH), also known as a intracranial bleed is bleeding within the skill and not the brain specifically. What group of patients is most at risk to an ICH?
1 - diabetics
2 - hypertensives
3 - obese
4 - previous cancer
2 - hypertensives
- high pressure increases the risk of haemorrhage
- vessels under high pressure are more likely to rupture
intracranial haemorrhage is bleeding within the cranium. A subclass of this is a subarachnoid hemorrhage (ICH). Where does this type of haemorrhage occur?
1 - between dura matter and cranium
2 - between dura and subarachnoid matter
3 - between subarachnoid and pia matter
4 - below the pia matter
3 - between subarachnoid and pia matter
- sub = below
- so bleeding below the subarachnoid and pia mater
- not in the brain though
In an intra-cerebral haemorrhage, is it the superficial or deep structures that are affected?
- deep structures
- commonly cerebral hemispheres such as basal ganglia, thalamus
– typically small haemorrhages, often associated with hypertension
What is a septic emboli?
- an infected blood clot
- such as sinusitis (swollen and inflamed sinuses)
Subarachnoid haemorrhage is bleeding into the space between the arachnoid and pia mater meninges. What is one of the most common causes of this?
1 - intracranial aneurysm
2 - head trauma
3 - infection
4 - medication
1 - intracranial aneurysm
- rupture of an intracranial aneurysm (weak blood vessel that bursts) or vascular malformation
Subarachnoid haemorrhage is is bleeding into the space between the arachnoid and pia mater meninges. The most common causes are a rupture of an intracranial aneurysm (weak blood vessel that bursts) or vascular malformation. What is the most common symptom of a subarachnoid haemorrhage?
1 - muscle weakness on one side of the body
2 - paralysis
3 - fever
4 - intense headache
4 - intense headache
- bleeding increases pressure in the brain that presents as an intense headache
- described as a thunderclap headache
Subarachnoid haemorrhage is bleeding into the space between the arachnoid and pia mater layers of the meninges. One of the most common causes is a rupture of an intracranial aneurysm (weak blood vessel that bursts) or vascular malformation. The most common symptom of a subarachnoid haemorrhage is a severe acute headache, called a thunderclap headache. What can happen if this is missed?
1 - nothing artery eventually clots
2 - patient may have a permanent headache
3 - continue bleeding increases ICP causing brain damage and even death
4 - all of the above
3 - continue bleeding increases ICP causing brain damage and even death
The following are all clinical features if which main artery was occluded?
1 - Contralateral hemiplegia and facial weakness
2 - Contralateral sensory loss
3 - Dysphasia (dominant hemisphere)
4 - Contralateral neglect (especially non-5 - dominant parietal lobe)
6 - Dysarthria, dysphagia
7 - Eye deviation away from affected side
1 - anterior cerebral artery
2 - middle cerebral artery
3 - vertebral artery
4 - posterior cerebral artery
1 - anterior cerebral artery
The following are all clinical features if which main artery was occluded?
1 - Vertigo, vomiting
2 - Ataxia
3 - Dysarthria, dysphagia
4 - Ophthalmoplegia, diplopia
5 - Homonymous hemianopia
6 - Altered consciousness
7 - Cranial nerve palsies
1 - anterior cerebral artery
2 - middle cerebral artery
3 - vertebral artery
4 - posterior cerebral artery
4 - posterior cerebral artery
Why is addressing hypertension an important modification of risk stroke?
- patients with hypertension are at increased risk of intracranial haemorrhages
How can being aware and treating atrial fibrillation reduce the risk of a stroke?
1 - being aware of the cause of blood clots reduces the risk of stroke
2 - treating the cause of the blood clots reduced the risk of stroke
3 - thinning blood reduces the risk of clots
4 - all of the above
4 - all of the above
- essentially allows treatment so virchow’s triad does not occur
Why is addressing carotid artery disease (CAD) (stenosis) an important modification of risk stroke?
- stenosis due to CAD can reduced blood flow
- internal coronary artery supplies the brain, so this would reduce blood flow
Why is addressing diabetes an important modification of risk stroke?
1 - hyperglycaemia can damage blood vessels
2 - hyperglycaemia can increase blood viscosity
3 - hyperglycaemia increases the risk of atherosclerosis
4 - all of the above
4 - all of the above
- better diabetes control = reduced risk of stroke
Why is addressing obesity an important modification of risk stroke?
- lots of risk factors for stroke
- increased risk of CVD, diabetes and hypertension
- all increase the risk of stroke
When you suspect a stroke, what imaging modality must be used?
1 - 1st CT and/or MRI imaging
2 - ultrasound
3 - PET scan
4 - all of the above
1 - 1st CT and/or MRI imaging
When you suspect a stroke, what imaging modality must be used when we would want to investigate vascular pathology?
1 - CT
2 - MRI imaging
3 - MRI angiogram
4 - ultrasound
3 - MRI angiogram
- MRI that focusses on blood vessels
When you suspect a stroke, what imaging modality must be used if we suspect carotid stenosis due to a potential thrombosis?
1 - CT
2 - MRI imaging
3 - MRI angiogram
4 - carotid doppler
4 - carotid doppler
- doppler would identify a blockage of an blood vessel
When you suspect a stroke, what modality must be used if we suspect atrial fibrillation?
1 - ECG
2 - MRI imaging
3 - MRI angiogram
4 - carotid doppler
1 - ECG and cardiac monitoring
- blood pressure monitoring
- full blood counts
The Oxfordshire Community Stroke Project (OCSP) Classification for strokes is a classification system that is a simple clinical classification method that predicts the site and size of the infarct on cerebral tomography (CT). What does total anterior circulation syndrome mean?
1 - partial anterior circulation is affected
2 - entire anterior circulation supplying one side of the brain is affected
3 - entire anterior and posterior circulation is affected
4 - all of the above
2 - entire anterior circulation supplying one side of the brain is affected
- caused by large cortical stroke
- very serious affect on carotid artery
Based on the Oxfordshire Community Stroke Project (OCSP) classification a total anterior circulation syndrome (TACS) is a large cortical stroke that affects the entire anterior circulation supplying one side of the brain is affected. In addition to CT imaging, how many of the following MUST be present to be diagnosed with a TACs?
1 - unilateral weakness (and/or sensory deficit) of the face, arm and leg
2 - Homonymous hemianopia (loss of one half of visual field)
3 - Higher cerebral dysfunction (dysphasia, visuospatial disorder)
4 - all of the above
homonymous visual = vision lost in one eye
4 - all of the above
A partial circulation syndrome (PACS) is a classification of the Oxfordshire Community Stroke Project (OCSP). What is this?
1 - partial anterior circulation is affected
2 - entire anterior circulation supplying one side of the brain is affected
3 - entire anterior and posterior circulation is affected
4 - all of the above
1 - partial anterior circulation is affected
A partial anterior circulation syndrome (PACS) is a classification of the Oxfordshire Community Stroke Project (OCSP), where there is an infarct affecting part of the anterior circulation. To be diagnosed with PACS, how many of the following must be present?
1 - unilateral weakness (and/or sensory deficit) of the face, arm and leg
2 - Homonymous hemianopia (loss of one half of visual field)
3 - Higher cerebral dysfunction (dysphasia, visuospatial disorder)
1 - all 3
2 - 2 of them
3 - 1 of them
homonymous visual = vision lost in one eye
2 - 2 of them
- BUT the presence of Higher cerebral dysfunction (dysphasia, visuospatial disorder) is often used to confirm a diagnosis of PACS
A lacunar stroke (LACS) is a classification of the Oxfordshire Community Stroke Project (OCSP). What is this?
1 - stroke affecting tissue, resembling a lacuna
2 - stroke affecting the lacunae blood vessels
3 - occlusion of blood vessels in the penetrating arteries in deep brain structures
4 - all of the above
3 - occlusion of blood vessels in the penetrating arteries in deep brain structures
- common type of ischaemic stroke
- can affect the basal ganglia
A lacunar stroke (LACS) is a classification of the Oxfordshire Community Stroke Project (OCSP), which is where there is occlusion of the blood vessels in the penetrating arteries in deep brain structures. How many of the following must be present to diagnose LACS?
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis
1 - all 4
2 - 3 or more
3 - 2 or more
4 - 1 or more
4 - 1 or more
Ataxic = co-ordination, balance and speech
hemiparesis = one side of the body
A posterior circulation stroke syndrome (POCS) is a classification of the Oxfordshire Community Stroke Project (OCSP). What is this?
1 - partial anterior circulation is affected
2 - entire anterior circulation supplying one side of the brain is affected
3 - entire anterior and posterior circulation is affected
4 - infarct in posterior circulation aspect of the brain (cerebellum and brainstem)
4 - infarct in posterior circulation aspect of the brain (cerebellum and brainstem)
A posterior circulation stroke syndrome (POCS) is a classification of the Oxfordshire Community Stroke Project (OCSP), which is due to an infarct in posterior circulation aspect of the brain (cerebellum and brainstem). How many of the following must be present to diagnose POCS?
- Cranial nerve palsy and a contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder (inability to bring eyes together)
- Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
- Isolated homonymous hemianopia (able to see from just one side of the eye)
1 - all 4
2 - 3 or more
3 - 2 or more
4 - 1 or more
4 - 1 or more
There are some salient points in Acute Stroke Management, which essentially means the faster a stroke is treated the better the clinical outcome. Plasminogen activators (tPA) are one key treatment that should be used acutely. What are tPAa?
1 - serine protease catalysing the activation of plasmin
2 - degrading embolisms
3 - degrading fibrinogen directly
4 - inhibiting coagulation of blood
1 - serine protease catalysing the activation of plasmin
- plasmin starts fibrinolysis, breakdown of fibrin
- more active plasmin means less risk of clots causing a stroke
Tissue plasminogen activator (tPa) are released from endothelial cells to activate plasmin, which can then initiate fibrinolysis. In acute ischaemic stoke presentation, how soon do tPa’s this need to be given to reduce disability?
1 - <1 hour from stroke
2 - <2 hours from stroke
3 - <3 hours from stroke
4 - <4.5 hours from stroke
4 - <4.5 hours from stroke
Where should all patients with a suspected stroke be admitted to?
1 - GP
2 - emergency department
3 - ICU
4 - stroke ward
4 - stroke ward
In a subset (10%) of acute ischaemic stroke patients who demonstrate radiographic evidence of a proximal anterior circulation large vessel occlusion (proximal middle cerebral or distal internal carotid) within 6 hours of symptom onset, what treatment can offer distinct benefit?
1 - Plasminogen activators (tPA
2 - aspirin
3 - MRI angiogram
4 - mechanical thrombectomy
4 - mechanical thrombectomy
- minimally invasive technique to remove the blood clot
Which of the following is NOT a common differentials that could present as a stroke?
1 - Space occupying lesion
2 - Seizure
3 - Bells palsy
4 - Migraine (e.g. hemiplegic)
5 - Functional neurological disorder
3 - Bells palsy
What is bells palsy?
1 - damage to CN VIII affecting hearing and balance
2 - damage to CN II causing hemiparesis
3 - damage to CN VII causing partial facial weakness on one side of face
4 - damage to CNI affecting smell
3 - damage to CN VII causing partial facial weakness on one side of face
- unknown aetiology, but likely to be infection
- sudden onset affecting whole side of the face
In addition to addressing the physical aspects of a stroke, what else must be taken into account in a patient who has had a stroke?
1 - psychiatric
2 - social
3 - biological
4 - family
1 - psychiatric
- post-stroke psychiatric co-morbidities
- associated with decreased likelihood of returning to work, poorer quality of life and long term disability
Patients who have suffered a stroke are more likely to suffer from phobic anxiety disorders. What are these?
1 - fear specific to childhood
2 - fear of a traumatic event
3 - overwhelming and debilitating fear of a specific object/ situation etc…
4 - all of the above
3 - overwhelming and debilitating fear of a specific object/ situation etc…
What is homonymous hemianopia?
1 - complete loss in one eye
2 - loss of temporal fields in both eyes
3 - loss of nasal and temporal visual fields
4 - loss of everything except the macula
3 - loss of nasal and temporal visual fields
- e.g.: left eye loses nasal field and right eye loses temporal field
- hemi = greek for half
- an = greek for without
- opsia = greek for seeing
What does dysphasia mean?
1 - partial loss of language
2 - inability to understand speech
3 - loss of language when speaking
4 - loss of language and ability to speak
1 - partial loss of language
- dys = greek for difficult
- phaots = spoken
Dysphasia means means partial loss of language. Which 2 parts of the brain is crucial for speech?
1 - brodmann areas 22, 44 and 45
2 - brodmann areas 1, 2 and 3
3 - brodmann areas 4 and 17
4 - brodmann area 6
1 - brodmann areas 22, 44 and 45
- Wernicke’s area = brodmann area 22
- Brocas area = brodmann areas 44 and 45
A patient presents with sudden onset right sided weakness and dysphasia, dense right face/arm/leg weakness, sensory loss, severe mixed dysphasia and right homonymous. Out of the following, which diagnosis would she have?
1 - Total anterior circulation syndrome (TACS)
2 - Partial anterior circulation stroke (PACS)
3 - Lacunar strokes (LACS)
4 - Posterior Circulation Stroke Syndromes (POCS)
1 - TACS because she has all 3 clinical presentations
1 = unilateral motor weakness
2 = higher cortical deficit
3 = homonymous visual field defect
A patient presents with sudden onset right sided weakness and dysphasia, dense right face/arm/leg weakness, sensory loss, severe mixed dysphasia and right homonymous and is diagnosed with Total anterior circulation syndrome (TACS). She attends A&E within an hour of the symptoms starting, from the following treatments, which would be most appropriate?
1 - Aspirin and IV fluids and admit to stroke ward
2 - Thrombolysis only (plasminogen activator (tPA))
3 - Thrombectomy only
4 - Thrombolysis and thrombectomy
2 - Thrombolysis only with plasminogen activator (tPA)
- only good if within the first 4.5 hours of symptoms starting
Does the image below show an ischaemic or haemorrhagic stroke?
- haemorrhagic stroke
- white area is a bleed
Does the image below show an ischaemic or haemorrhagic stroke?
- blood clot so ischaemic
A patient presents with a left temporoparietal haemorrhage, and presents with speech disturbance, loss of balance on the right side and right homonymous hemianopia. She also has a history of hypertension, atrial fibrillation and is on warfarin. What is likely to be causing the haemorrhage?
1 - trauma from a fall
2 - hypertension
3 - obesity
4 - infection
2 - hypertension
- increased pressure in brain due to hypertension
- bleed made worse by blood thinning (warfarin)
A patient presents with a left temporoparietal haemorrhage, and presents with speech disturbance, loss of balance on the right side and right homonymous hemianopia. She also has a history of hypertension, atrial fibrillation and is on warfarin. Increased pressure in brain due to hypertension has likely made the blood vessels weak, hence the haemorrhage, and the bleed is made worse by blood thinning (warfarin). Which if the following are important treatment options must be used on this patient?
1 - Aspirin and IV fluids and admit to stroke ward
2 - Thrombolysis only (plasminogen activator (tPA))
3 - prothrombin complex, vitamin K and surgery
4 - Thrombectomy
3 - prothrombin complex, vitamin K and surgery
- surgery to relieve the pressure
In the image below, we can see an embolism. Which of the following would this be based on the image below?
1 - Total anterior circulation syndrome (TACS)
2 - Partial anterior circulation stroke (PACS)
3 - Lacunar strokes (LACS)
4 - Posterior Circulation Stroke Syndromes (POCS)
3 - LACS as its small in deep brain tissue
- pure motor function would be affected
- deep brain tissue affected
If a patient presents with the following, which type of stroke is this likely to be?
- Pure motor deficit
- Pure sensory deficit
- Ataxic hemiparesis
- Sensorimotor stroke
- Dysarthria-clumsy hand syndrome
1 - TACS
2 - PACS
3 - LACS
4 - POCS
3 - LACS
In the image below, we can see an embolism due to a Lacunar strokes (LACS). We know this because the presenting patient only had motor function affected and we can see it is in the deep brain tissue that is affected. The patient was fine the night before but found collapsed the next day, what would be his initial treatment option?
1 - Aspirin and IV fluids and admit to stroke ward
2 - Thrombolysis only (plasminogen activator (tPA))
3 - prothrombin complex, vitamin K and surgery
4 - Thrombectomy
1 - Aspirin and IV fluids and admit to stroke ward
- aspirin at 300mg
- > 4.5h so no to tPA
- > 6h and not proximal anterior circulation large vessel occlusion so no to thrombectomy
In a patient who has had a large stroke or is a low risk of a TIA, which of the following medications should they be given
1 - aspirin @ 300mg for 2 weeks followed by aspirin or clopidogrel at 75mg/day long term
2 - edoxaban long term
3 - clopidogrel and aspirin at 75mg long term
4 - B-blocker
1 - aspirin @ 300mg for 2 weeks followed by aspirin or clopidogrel at 75mg/day long term
In a patient who has had a small stroke or is a high risk of a TIA, which of the following medications should they be given
1 - aspirin @ 300mg for 2 weeks followed by aspirin or clopidogrel at 75mg long term
2 - edoxaban long term
3 - clopidogrel and aspirin at 75mg for 3 weeks then clopidogrel @ 75mg long term
4 - apirin and clopidogrel @ 75mg/day
3 - clopidogrel and aspirin at 75mg for 3 weeks then clopidogrel @ 75mg long term
If a patient has had a small stroke or TIA and has AF, how soon should they start on anti-coagulation therapy?
1 - immediately
2 - 24 hours
3 - 3-7 days
4 - 14 days
1 - immediately
If a patient has had a moderate stroke and has AF, how soon should they start on anti-coagulation therapy?
1 - immediately
2 - 24 hours
3 - 3-7 days
4 - 14 days
3 - 3-7 days
If a patient has had a large stroke and has AF, how soon should they start on anti-coagulation therapy?
1 - immediately
2 - 24 hours
3 - 3-7 days
4 - 14 days
4 - 14 days
In a patient who has had a stroke, aggressive BP lowering medications need to be used. What is the target BP?
1 - 130/80
2 - 140/85
3 - 150/90
4 - 160/95
2 - 140/85
- 130/80 if diabetic
In a patient who has had a stroke, aggressive lipid lowering medications need to be used. What dosage of atorvastatin should be used?
1 - 5mg
2 - 10mg
3 - 20mg
4 - 80mg
4 - 80mg
What does photophobic mean?
- photo = light
- phobia = fear of
- sensitivity to light
What can we see on the head CT-scan below?
1 - migraine
2 - TACS
3 - embolism
4 - haemorrhage
1 - migraine
What is a collateral history?
- information about the patient from the patient’s known contacts
If a patient presents with dysphasia (speech difficulty) and sensitivity to light, and has been off work previously due to severe headaches, is this likely to be a stroke or migraine?
- migraine
- can mimic a stroke
- can be triggered by stress, change of diet, hormonal changes, weather, alcohol etc
A 45 year old patient presents with left facial weakness involving the whole of left side of face, including the forehead and with incomplete closure of left eye. Has had a recent infection of sinuses and symptoms have been present for a few days. Is the diagnosis likely to be some form of a stroke or bells palsy?
- bells palsy
- affects CN VII (7) the facial nerve
- damage to or in infection of CN VII can cause bells palsy
- we can distinguish because bells palsy is a lower motor neuron problem
Although the cause of bells palsy is unknown, what is the most common precipitating factor that it has been linked with it?
1 - viral infection of sinuses
2 - trauma
3 - stroke
4 - hypertension
1 - viral infection of the sinuses
What does the image below show?
1 - TACS
2 - PACs
3 - left occipital tumour
4 - haemorrhage
3 - left occipital tumour
- can see different structure in occipital region
What are some of the most common things that can mimic a stroke that we need to be aware of?
- Seizures
- Tumour
- Migraine
- Bells palsy
- Hypoglycaemia
- Infection (and cerebral hypoperfusion)
- Subdural haemorrhage
- Functional disorder
- all of the above
- all of the above
What is aphasia?
1 - partial loss of language
2 - inability to understand speech
3 - loss of language when speaking
4 - loss of language and ability to speak
3 - loss of language when speaking
The following are all clinical features if which main artery was occluded?
1 - Vertigo, vomiting
2 - Ataxia
3 - Dysarthria, dysphagia
4 - Ophthalmoplegia, diplopia
5 - Homonymous hemianopia
6 - Altered consciousness
7 - Cranial nerve palsies
1 - anterior cerebral artery
2 - middle cerebral artery
3 - vertebral artery
4 - posterior cerebral artery
When trying to distinguish between an infarct and haemorrhage on a MRI, which appears hypo and hyperdense?
- infarct = hyperdense so appears brighter
- haemorrhage = hypodense so appears darker
When trying to distinguish between an infarct and haemorrhage on a CT, which appears hypo and hyperdense?
- infarct = hypodense so appears darker
- haemorrhage = hyperdense so appears brighter
