Brainscape's Knowledge GenomeTM

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


See full index

662 > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the difference between a hemorrhagic and Ischemic stroke?

A

Hemorrhagic - Bleeding occurs inside or around brain tissue Ischemic- A clot blocks blood flow to an area of the brain

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

Strokes cost a lot of money what are some of the reasons why?

A

Directs costs on hospitalization, skilled nursing care, medications, DME, Home health care. Indirectly- lost of productivity, loss of esteem

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

Stroke is brain attack damage is not unavoidable Stroke is an emergency Time=?

A

Brain

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

Reality Strokes are mostly____ Stroke requires ___ treatment Stroke can happen to anyone Stroke recovery is ____

A

Preventable emergency care recovery is life long

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

What are the symptoms of strokes?

A
  • Slurred speech, difficulty understanding others - Clumsy or numb legs or arms - One side of body affected - Headache, unusually severe Eyes: loss of sight (one or both) Dizziness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ischemic stroke is cause by?

A
  • Inadequate blood supply to the brain - Usually due to thrombotic or embolic arterial occlusion - Lack of blood flow causes cell death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Thrombotic Occlusion?

A

Thrombus forms in artery in brain

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

Embolism

A

Clot from outside of the brain, piece breaks loose and travels to the brain

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

Cell death at the core of an ischemic stroke is?U

A

Unavoidable

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

Outside of the core is ischemic penumbra which means?

A

Cells are still salvageable in this area but it is time sensitive, if perfusion is not restored cells will continue to die

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

WHat are the two classifications of Cerebral Ischemic Events?

A

Transient Ischemic attacks- perfusion is temporary Cerebral Infarction- 90% of pts have residual deficits

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

What are the 3 mechanisms of Ischemic Stroke?

L S E

A

Large vessel disease(Long Artherosclerosis + fast clot) Small vessel dx blood flow blocked by very small arterial vessel Embolism- Clot forms in body somewhere and travels to brain

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

Small vessel dx is linked to?

A

HTN

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

Embolism is usually caused by?

A

A fib- this dislodges clots

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

Non modifiable risk factors?

I am 55 and Im a dude Im half african american, Hispanic and Asian

A

Age, gender, Race (AA, Hispanic, Asian-pacific) Genetic factors, low birth weight

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

Modifiable risk factors?

A

HTN, A fib, DM, high cholesterol, Carotid stenosis, transient ischemic attacks or previous stroke Lifestyle: EtOH, Drugs, Cig smoking, Obesity, Physical activity, Atherogenic diet

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

Short term treatment goal of HTN?

A

reduce brain damage Re-establish perfusion Neuroprotection

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

Long term treatment

A

Reduce neurologic injury, Decrease mortality and long term diability, Prevent complications, prevent recurrence by reducing modifiable risks

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

Stroke Diagnosis?

A

1) Stabilize ABCs 2) Asses neurologic deficits 3) Get Hx - Single most important piece of information is time that stroke symptoms started 4) Brain imaging - Determine size, location, tissue effects of infarction, bleeding

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

Treatment of Acute Complications High Bp What drugs are used?

A

Many patients have elevated BP in first 24-48 hours Not treated unless systolic >220 or DBP >120 Low blood flow to the brain means more brain damage Labetalol, Nicardipine, Nitroprusside

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

Used nitroprosside if Diastolic is?

A

>140

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

Treatment of systemic Thrombolytics

A
  • Restore blood flow to ischemic areas of brain - Early treatment = better outcome - Very high risk of hemorrhage so decision to treat made with caution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Acute stroke treatment two agents recommended?

A

Tissue plasminogen activator within 4/5 hours of symptom onset ASA within 48 hours of symtom onset

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

Ateplase is the only FDA approved thrombolytic for acute treatment of ischemic stroke what is it? How does it increase good outcomes? How does it hurt outcomes?

A

tPA, pts are 30% more likely to have minimal or no disability Intracerebral hemorrhage in 6.4% vs placebo

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

When should ateplase be given, how is it administers, what should be avoided, what should you monitor?

A

Within 4.5 hours of symptom onset, IV bolus, Avoid anticoags and antiplat for 24 hours, and monitor Bp response and hemorrhage

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

Inclusion criteria for tPa Ateplase treatment?

Im 22 my friend my have neuro damage it happened within 4.5 hours

A

>= 18 Diagnosis of stroke causing meaningful neurologic deficit Clearly defined onset time of less than 4.5 hours before treatmetn

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

Exclusions for tPa Ateplase treatment?

A

Evidence of ICH on CT Minor or rapidly improving Sx Predispositon to bleeding, Heparin within the last 48 hours elevated aPTT, current warfarin use, Platelet count less than 100,000 Also Hx of ICH Witnessed seizure at same time as onset of stroke, Symptoms of SAH, GI or urinary tract hemorrhage within 21 days Active internal bleeding Stroke or serious head trauma within 3 months Major surgery or serious trauma within 14 days Recent arterial puncture ar non compressible site or LP within 7 days Acute MI SBP > 185 DBP > 110 at time of treatment

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

Sooner ateplase is given the greater the benefit. How is efficacy measured?

A

Improvement in current neurologic deficits Long term neuro status improvement

29
Q

Adverse effects of tPa

A

Bleeding - ICH and serious systemic bleeding - Easy bruising - Hematemesis - Black, tarry stool - Hematuria - Bleeding gums -Nosebleeds

30
Q

ASA treatment If received within ___ ? Continue for ___ weeks assess need for long term dose?

A

48 hours less likely to suffer recurrent stroke, death and disability 2 weeks 160- 325 mg/d

31
Q

Heparin?

A

Efficacy and safety not well established not recommended with current guidelines

32
Q

LMWH?

A

Not recommended

33
Q

Secondary stroke prevention ABCDE!

A

A- Antiplatelets and anticoag, aspirin, clopidogrel, warfarin B-blood pressure-lowering meds C- Cessation of cigs, cholesterol D- Diet and DM E-Exercise

34
Q

When is HTN treatment recommended?

A

>=140/90 Data supports use of diuretics and ACEIs outside of acute stroke period 7 days after

35
Q

Lipids

A

Statin with intensive lipid lowering effects

36
Q

Use antiplatelets if non-cardioembolic stroke

A

ASA- 50 - 325 Clopidogrel 75 ASA 25 and ER Dipyridamole 200 mg PO BID

37
Q

Clopidogrel has the potential for?

A

TTP purpura

38
Q

Cardioembolic stroke?

A

A-fib, Valvular Heart Disease, Prosthetic Heart valves

39
Q

A fib does what to chances of stroke?

A

Increase chances of stroke

40
Q

High risk level?

A

Oral anticoag

41
Q

Rivaraxaban a factor Xa inhibitor is indicated for?

A

reduced risk of stroke in a-fib

42
Q

Apixaban?

A

Reduce stroke risk in patients with A-fib

43
Q

Edoxaban?

A

Dont use in patients with CrCL > 95 mL/min

44
Q

Dagibatran

A

a-fib indication 150 mg BID >30 CrCL

45
Q

Mechanism of clot formation with a prosthetic valve?

A

Valve is perceived as foreign Change in norma endothelial surface Medium for attachment and proliferation of clotting factors

46
Q

Anticoag recommendations in pts with fake valves

A

Warfarin nothing else is recommended Recommendation is based on valve type mechanical or bioprosthetics INR range typically 2.5-3.5

47
Q

Assesing stroke risk

A
  • Tools are available, helps identify those who could benefit from intervention
48
Q

Framingham stroke profile?

A

Gender, age, SBP, DM, Smoking, A-fib, LVH, CVD

49
Q

HTN?

A

Screen for it, every 2 years more often in minority or old

50
Q

DM

A

Control BG Control Bp

51
Q

Exercise

A

>= 30 min of moderate intensity Low sodium diet and high fruits and veggies

52
Q

Oral contraceptives?

A

Can be harmful if other risks are present

53
Q

ASA is not recommended in?

A

Patients with low risk

54
Q

81 mg a day for?

A

Patients with high risk

55
Q

Transient Ischemic Attack?

A

Temporary reduction in perfusion to focal region of brain Short lived Caused by small clot breaking off of smaller one This may be the only warning of impending stroke

56
Q

Clinical presentation of TIA?

A

Involves loss of vison, motor deficit, sensory deficit, dysarthria, Lasts for less than 24 hours but usually less than 30 minutes So brief hard to diagnose

57
Q

TIA are directly proportional to?

A

Risk of stroke

58
Q

All pts with TIA should have long term?

A

Antiplatelet therapy

59
Q

Sebarachniod Hemorrhage (SAH) is a type of Hemorragic stroke

A

Bleeding into spaces between inner and middle layers of meninges Often due to trauma or cerebral aneuysm

60
Q

ICH Intra cerebral hemorrhage

A

Bleeding directly into brain parenchyma, often due to chronic uncontrolled HTN

61
Q

Subdural Hematoma?

A

Bleeding under dura, often result of head trauma

62
Q

Hemorrhagic stroke has 50% mortality at ___ days?

A

30 days

63
Q

Symptoms of Hemorrhagic stroke?

A

Sudden, severe headache, N/V, Photophobia, neck pain, Nuchal rigidity

64
Q

Patho of Hemorrhagic

A

Related to presence of blood in brain tissue or surrounding spaces Hematoma make continue to grow and enlarge after initial bleeding

65
Q

ICH

A

Weakened blood vessel walls Trauma, infection, congenital, HTN Blood slowly leaks from vessels or may suddenly rupture Anticoags, thrombolytics, sympathomimetics

66
Q

Risk factors for ICH?

A

HTN, Trauma, smokig, EtOH, Cerebral aneurysm

67
Q

Goals for ICH short term?

A

No standard pharm treatment, Rapid neurointensive treatment Manage increased intracranial pressure Manage Bp

68
Q

Long term?

A

Prevent complications prevent recurrent bleed

662 (24 decks)

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