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Pre Reg Exam > Stroke > Flashcards

Stroke Flashcards

1
Q

What is stroke?

A

A life threatening condition caused by a sudden reduction of blood supply to brain tissue. Leads to brain cell damage

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2
Q

Types of stroke

A

Ishaemic stroke
Transient ischaemic attack
Haemorrhagic stroke

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3
Q

What causes ischaemic stroke?

A

Lack of blood supply to the brain

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4
Q

What is haemorhagic stroke?

A

Caused by bleeding in the brain

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5
Q

75% of stroke occur in what age group?

A

65 or older

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6
Q

Risk factors of stroke?

A

Hypertension
Diabetes
Smoking
Oral contraceptive
Atrial fibrillation
Previous stroke or TIA
Lifestyle, smoking, obesity and alcohol

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7
Q

What are the symptoms of stroke?

A

FAST!
F - Drooping of face on one side
A - arm weakness
S - speech difficulty
T - Time to call 999

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8
Q

What are the other symptoms of stroke?

A

Severe headache
Loss of consciousness
Vision problems

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9
Q

Types of haemorrhagic stroke?

A

Subarachnoid and intracerebral

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10
Q

What is subarachnoid haemorrhage

A

It is when blood vessel rupture and bleed in the space between the brain and skull

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11
Q

What is intracerebral haemorrhage

A

When blood vessel rupture and bleed within the brain tissues

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12
Q

What is the initial management of intracerebral haemorrhage

A

Surgery to remove hematoma and relieve intracranial pressure

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13
Q

What is the exclusion criteria for rapid bp in IH

A
  • people with large haematoma
  • underlying structural cause
  • glaucoma score < 6
  • undergoing early surgery to remove haematoma
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14
Q

When should you give rapid bp and what should you aim for in IH?

A
  • Systolic bp is 150 -220 within 6 hours onset of symptoms
  • Aim for 130-139 within one hour of trt and sustain for 7 days
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15
Q

Can aspirin and anticoagulants be used in intracerebral haemorrhage?

A

No they can’t

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16
Q

What should be avoided but can also be used in IH?

A

Statins, if the risks of vascular events outweighs IH

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17
Q

How long does TIA stroke last?

A

Last for a few mins or hours and fully resolved within 24 hours

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18
Q

What is the first treatment to take if TIA stroke suspected?

A

Aspirin unless contraindicated or have hypersensitivity to it

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19
Q

What is the first line treatment to give a pt with suspected TIA

A

Aspirin 300mg unless contraindicated or pt has hypersensitivity

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20
Q

What do you give people taking aspirin that develop dyspepsia?

A

A proton pump inhibitor

21
Q

What is another alternative of aspirin if contraindicated

A

Anti platelet eg
clopidogrel 75mg OD

22
Q

What is the long term management of TIA or ischaemic stroke without AF or paroxysmal

A

Clopidogrel 75mg OD

23
Q

If clopidogrel is contraindicated, what do you use?

A

Aspirin plus dipyridamole MR 200mg BD

24
Q

If aspirin and clopidogrel is contraindicated give what?

A

Dipyridamole 200 mr BD

25
Q

If clopidogrel and Dipyridamole

A

Aspirin 75mg OD

26
Q

What is the initial treatment of ischaemic stroke and when should it be given?

A

Alteplase or tenecteplase
Within 4.5hours onset of symptoms

27
Q

What is thrombolysis?

A

A procedure to break up blood clots and prevent it from

28
Q

What should pt with Ishaemic stroke get after thrombolysis

A

Start Antiplatelet (Aspirin) 300mg OD for 14 days
after 24hrs of thrombolysis or within 48hrs of those not receiving it or onset of symptoms

29
Q

What is the dose of aspirin after thrombolysis

A

Aspirin 300mg OD for 14 days

30
Q

When should you give dual therapy

A

When there is high right risk of TIA or those with intracranial stenosis

31
Q

What is the dual therapy that you can give?

A

aspirin + clopidogrel for up to 90 days
Or
Aspirin + ticagrelor for up to 30 days

32
Q

High intensity statins should be given to all patients after stroke onset regardless of serum cholesterol levels. True or False

A

True

33
Q

When do you start statins therapy,

A

48 hours after stroke onset

34
Q

List the high intensity statin given and what’s the aim of it? And for how long should you check reduction

A
  • 20-80mg daily Atorvastatin
  • Aim is to reduce the non HDL cholesterol by more than 40%
    -3 months
35
Q

When can you only give ezetimibe?

A

Pts who have familial hypercholesterolemia

36
Q

Can beta blockers be used in management of hypertension after stroke?

A

No unlesss indicated for co existing condition

37
Q

Anticoagulants can’t be given for long term management of recurrent stroke unless when there is AF. True or false

A

True

38
Q

Can you use anticoagulant in acute IS in pt who are in sinus rhythm?

A

No

39
Q

When can anticoagulants be used

A

Pts with AF
Pulmonary embolism
Dvt

40
Q

What should not be used in acute phase of ischaemic stroke

A

Warfarin

41
Q

When should you have your anticoagulant treatment stopped and for how long

A

If anticoagulant is used for prosthetic heart valve (risk of haemorrgahic transformation, disabling stroke, stop for 7 days and replace with aspirin

42
Q

What is the target bp in stroke?

A

<130/80mmhg

43
Q

Which ppi should be given in aspirin induced dyspepsia

A

Omeprazole 20mg OD

44
Q

When can you not give anticoagulants

A

In acute phase of Ischaemic stroke
Acute ischaemic stroke in sinus rythmm

45
Q

What should you not offer pre menstrual women with stroke or TIA

A

Combined oral contraceptive pills

46
Q

What should you give pre menopausal women with stroke or TIA

A

Progesterone only eg desogestrel
Non hormonal contraceptive methods

47
Q

What should you give pre menopausal women with stroke or TIA

A

Progesterone only eg desogestrel
Non hormonal contraceptive methods

48
Q

What should you give pre menopausal women with stroke or TIA

A

Progesterone only eg desogestrel
Non hormonal contraceptive methods

Pre Reg Exam (11 decks)

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