Brainscape's Knowledge GenomeTM

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


See full index

Year 4 > Stroke 3 > Flashcards

Stroke 3 Flashcards

1
Q

reversal is only possible in what type of stroke?

A

ischaemic
only if done v quick
other than this, can only do secondary prevention to prevent another stroke

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

2 hyperacute treatments for ischaemic stroke?

A

thrombolysis (<4.5 hrs)

thrombectomy (<6 hrs)

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

types of secondary prevention?

A 
antiplatelets
anticoagulants
statins
anti hypertensives
diabetic management
lifestyle management
MDT approach to rehab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how do you choose secondary prevention?

A

determine what caused initial stroke and prevent it happening again

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

most important risk factor for stroke?

A

hypertension

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

types of antiplatelets?

A

aspirin
clopidogrel
dipyridamole MR
ticagrelor and prasugrel (not used much in stroke disease)

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

when are antiplatelets used?

A

only ischaemic stroke

small vessel events and atheroembolic infarcts/TIAs

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

risks of antiplatelets after ischaemic stroke?

A

haemorrhagic transformation

will cause inflammation and oedema which causes problems

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

what kinds of ischaemic stroke are antiplatelets used for?

A

only ones where clot has formed due to platelet aggregation rather than coagulation factors

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

how is aspirin used after ischaemic stroke?

A

300mg for at least 2 weeks
after 2 weeks can either continue aspirin but drop down to 75mg along and add dipyrimadole 200mg 2X day OR change to clopidogrel 75mg alone

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

what if genuine allergy to aspirin?

A

clopidogrel 300mg straight after stroke (single dose) then 75mg thereafter (clopidogrel much more potent)

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

if patient had smaller stroke with low neurological score, which option is used?

A

aspirin + clopidogrel

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

what kind of ischaemic strokes are anti-coagulants used for?

A 
large vessel
cardioembolic
paradoxical embolic 
venous infarcts 
(only clots formed of coagulation factors, not formed within arteries)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

types of anticoagulants?

A

heparin (fractioned and unfractioned)
warfarin
DOACs (factor 10 or factor 2 inhibitors)

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

is heparin used in stroke?

A

no

increases bleeding risk too much

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

most common stroke requiring A/C?

A

cardioembolic (from AF)

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

what does INR describe?

A

comparing clotting ability to normal

INR 2 = clot will take twice as long to clot as a normal person?

18
Q

DOACs vs warfarin?

A

DOACs have less risk of bleeding complications

19
Q

benefits of warfarin?

A

cheaper
all complications known about
has an antidote
effects can be measured quickly with INR so can thrombolyse warfarin patients if their INR is <1.5

20
Q

drawbacks of warfarin?

A

often INR blood testing
causes very variable INR
dose changes so difficult if any cognitive impairment present

21
Q

benefits of DOAC?

A

less risks
no blood tests needed
same dose every day

22
Q

drawbacks of DOAC?

A

anticoagulation effects dont last long so if you miss a single dose the INR can change within hrs
no quick blood test (effects measured with PTT which takes a long time) so if patient has an ischaemic stroke while taking DOAC you cant thrombolyse bc its too risky without knowing

23
Q

when do you start anticoagulation?

A

depends on size of stroke
small = quicker
large = later on (10-14 days after)

24
Q

management of BP after ischaemic stroke?

A

a lot of evidence for BP management after a few weeks

less evidence about whats best in acute phase so BP not really reduced in acute phase

25
Q

management of BP in haemorrhagic stroke?

A

more evidence for reducing BP in acute phase

reduces haematoma expansion and resultant brain damage

26
Q

why is BP not really managed often in acute phase?

A

bc high BP can help increase perfusion to the brain

controlled in some cases though (eg if patient is being thrombolysed after ischaemic stroke or if BP is extremely high)

27
Q

which antihypertensives are preferred in stroke?

A

ACEi / ARBs
thiazides
(non-selective beta blockers
(if theyre already on some antihypertensive regime which is controlling BP then dont change it after stroke)

28
Q

when are statins used in stroke?

A

atheroembolic/small vessel strokes

more likely to be associated with dyslipidaemia

29
Q

when might MRI be used?

A

if very short lived symptoms?

30
Q

how do you choose imaging type?

A

always do a CT, then do MRI if CT doesnt explain whats going on

31
Q

which scan is best to identify acute haemorrhage?

A

CT

MRI not good for acute haemorrhage

32
Q

how can acute infarcts be seen on CT/MRI?

A

only show on CT 4-5 hrs after (may see some hyperacute changes)
can see infarct within minutes in diffusion weighted MRI

33
Q

small infarcts on imaging?

A

CT can miss small infarcts esp if significant small vessel disease and in posterior fossa
MRI less likely to miss any sized infarcts

34
Q

which scan can differentiate between acute haemorrhage and acute infarcts the best after a few weeks?

A

CT unable to differentiate (esp if small)

MRI excellent at picking up old haemorrhages

35
Q

specific pathology on imaging?

A

CT shows fairly obvious pathology like large infarcts, SOLs, mets, large abscesses etc
MRI has excellent anatomical detail

36
Q

oedema on CT?

A

takes away variation in density

so cant differentiate between grey and white matter

37
Q

infarct on CT?

A

darker area

can have white spots in darker area if haemaorrhagic transformation present

38
Q

how can clot be seen on CT?

A 
hyperdense vessel (appears white)
usually only seen very soon after infarct before damage to brain can be seen
39
Q

diffusion sequence MRI is best for what?

A

showing ischaemic infarct
shows as bright white area
(uses diffusion of water)

40
Q

acute bleed on CT?

A

white

41
Q

long term bleed on CT?

A

black

Year 4 (83 decks)

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