Stroke

Question 1

WHO definition of stroke:
clinical syndrome consisting of rapidly developing clinical signs of focal/ global disturbance of cerebral function, lasting more than X hours or leading to death with no apparent cause other than that of Y

Answer 1

24
vascular origin

Question 2

TIA is referred to as a mini stroke and presents with the same signs and symptoms however these resolve within X hrs?

Answer 2

24

Question 3

what is the difference between a TIA and a stroke

Answer 3

what is the difference between a TIA and a stroke

Question 4

give the name of the tool that is used to assess patients for the prescence of stroke symptoms in the community setting?

Answer 4

fast

Face
Arms
Speech
Time

Question 5

how would you test face and check for facial weakness such as drooping?

Answer 5

ask px to smile

Question 6

how would you check arms for muscle weakness or numbness in one or both arms?

Answer 6

ask px to raise their arms above their head

Question 7

how would you assess a patients speech and identify that they have slurred speech or difficulty speaking?

Answer 7

ask a patient to repeat a sentence

Question 8

the majority of strokes are haemorrhagic or ischaemic?

Answer 8

ischaemic

Question 9

what tool is used in emergency settings for the recognition of stroke?

Answer 9

ROSIER

(Recognition of Stroke in the Emergency Room, or Rule Out Stroke In the Emergency Room).

Question 10

a score above x on the rosier scale indicates that stroke is likely

Answer 10

0

Question 11

name a scale that can be used to quantify stroke severity and treatment

Answer 11

NIHSS

Question 12

what is step one treatment for a suspected TIA

Answer 12

aspirin 300mg single dose and clopidogrel 300mg as single dose

Question 13

aspirin and clopidogrel should be commenced immediately for people that are suspected to have a tia unless antiplatelet therapy is contraindicated, list some contraindications that would apply

Answer 13

peptic ulcer disease, allergy

Question 14

what is the appropriate first step pharmacological management for tia in a patient that is already receiving 75mg aspirin daily?

Answer 14

300mg clopidogrel single dose OR ticagrelor 90mg bd for 21 days UNLICENSED

Question 15

what is step 2 treatment for a TIA

Answer 15

aspirin 75 OD and clopidogrel 75 OD 21 days

Question 16

what drug and dose regimen can be used instead of clopidogrel in step 2 of the pharmacological treatment of TIA

Answer 16

ticagrelor 90mg bd UNLIC

Question 17

what is step 3 treatment for a TIA

Answer 17

clopidogrel 75mg OD
(or ticagrelow 90mg bd)

lifelong

Question 18

for long term prevention of tia what can be used instead of clopidogrel or ticagrelor if patients are intolerant to either of these?

Answer 18

aspirin 75 mg od

Question 19

what other tests and considerations for someone with a TIA

Answer 19

MRI to check site of damage, lifestyle modifications, secondary prevention ASAP

Question 20

when a patient is admitted to a stroke unit what diagnostic investigation should be performed if the patient has any of the following:

indication for thrombolysis/ thrombectomy
anticoag pre admission
known bleeding
gcs < 13
unexplained/ fluctuating symp
papilloedema
neck stiffness/ fever
severe headache
hypoxic

Answer 20

non-enhanced CT

Question 21

for patients with acute stroke thrombolysis should be initiated with what drug?

Answer 21

alteplase

Question 22

alteplase can only be used for thrombolysis if the patient presents within x hrs of symptoms and haemorrhage

Answer 22

4.5h

Question 23

what is step 2 treatment for an acute stroke?

Answer 23

aspirin 300mg for 14 days with a PPI for gastro protection

Question 24

what is strep 3 treatment for an acute stroke?

Answer 24

clopidogrel 75mg OD long term, if person has AF commence on DOAC instead

Question 25

other non-pharmacological treatment for acute stroke

Answer 25

rehabilitation, lifestyle modifications

Question 26

when should a statin be commenced after an acute stroke?

Answer 26

not straight away but can be continued in those on one preadmission

Question 27

statins should be started post stroke for secondary prevention in patients presenting with

Answer 27

dyslipidaemia

Question 28

what 4 drugs/ parameters to cover for secondary prevention of a stroke?

Answer 28

antiplatelet: clop 75mg OD
statin
BP
blood glucose conc

Question 29

under what circumstances should antihypertensives only be commenced in the acute phase of stroke?

Answer 29

only in hypertensive emergency

Question 30

what is the blood pressure target for someone prior to thrombolysis which may then require the need for antihypertensives prior to the procedure

Answer 30

below 185/110

Question 31

test your knowledge…
On admission to hospital with a TIA, describe the initial immediate pharmacological management, and the ongoing antithrombotic treatment someone should receive thereafter

Answer 31

1. Give aspirin 300 mg as a single dose AND clopidogrel 300 mg as a single dose, THEN
2. Aspirin 75 mg once daily AND clopidogrel 75 mg once daily for 21 days, THEN
3. Clopidogrel 75 mg once daily OR ticagrelor 90 mg twice a day (unlicensed) indefinitely (aspirin 75 mg once daily can be used if intolerant to either of these).

Question 32

On admission to hospital with an ischaemic stroke (no AF), describe the initial immediate pharmacological management, and the ongoing antithrombotic treatment someone should receive thereafter.

Answer 32

1. Give aspirin 300 mg as a single dose for 14 days, THEN
2. Clopidogrel 75 mg once daily thereafter

Question 33

when do people need to tell the DVLA about a stroke?

Answer 33

only if they are having problems one month after