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SSP 2014 > STROKE > Flashcards

STROKE Flashcards

1
Q

score to determine hospital admission in TIA

A

TIA ABCD2 score

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2
Q

TIA score to warrant admission

A

more than 3

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3
Q

T or F: Medication is more important than BP lowering in primary stroke prevention

A

F

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4
Q

SBP reduction in stroke

2mmHg
3mmHg
5mmHg

A

6,8, 14%

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5
Q

First major trial to see effect of anit-HPN in stroke

(indapamide vs pla, 30% RRR

A

PATS (post stroke anti-HPN study)

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6
Q

PRoGRESS

A

ACE inhibitor-based management in BP lowering for secondary stroke prevention

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7
Q

No difference in SBP of 130 or 150 in composite outcome of stroke, MI and vascular death

A

SPS3

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8
Q

Which is associated with higher risk of stroke?

Pre-DM or DM

A

Pre DM

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9
Q

RR of stroke among pts with DM

A

1.6x higher

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10
Q

in rTPA treated pts, OR of ICH in DM vs non-DM

A

6.73

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11
Q

BP target for primary prevention of stroke among DM pts

A

<140/90

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12
Q

elderly + ischemic stroke + secondary prevention stroke: increased risk

A

60%

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13
Q

Lipid index associated with inc rsik of stroke

A

LDL

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14
Q

Mechanisms of statins for stroke prevention

A
  1. dec inflammation
  2. promote angiogenesis/neurogenesis
  3. upregulate tPA
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15
Q

risk reduction of 80 mg/day of atorvastatin vs pla in SPARCL

A

16%

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16
Q

risk of stroke within 2 weeks from recent MI

A

5%

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17
Q

stroke highest in MI of whot myocardial wall

A

anetro apical, by 20%

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18
Q

risk of stroke in pts with MI and thrombus

A

10-20%

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19
Q

risk reduction of stroke for pts with thrombus on ASA vs ASA+Warfarain

A

19% vs 29%

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20
Q

duration of treatment of pts with CVD and mural thrombus

A

3 mos

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21
Q

indications of anti-coagulation in pts with MI

A

AF, EF less than 28%, LV thrombi

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22
Q

associated with inc risk of stroke and arterial emobolization with LA appendage thrombus or LV mural thrombus

A

restrictive CM

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23
Q

risk of stroke in vlavular heart dse

A

no ASA: 4x
on ASA: 2x
on VKA: 1x

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24
Q

kind of stroke associated with MVP

A

TE (2%)

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25
Q

risk of CVD among pts with prosthetic heart valve without AF

A

20%

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26
Q

INR for diff generation of valves accdg to ESC

A 
1st gen 3-4.5
2nd gen: 3-3.5
2nd gen in the aortic position: 2.5-3
mechanical prosthetic valves: 2.5-3.5
bio-prosthetic: 2-3
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27
Q

stroke reduction in pts with asymptomatic carotid artery stenosis (more than 60%)

A

11.8% in medical vs 6.4% in CEA+medical

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28
Q

ARR of pts >70% CAS with Sx

A

5.6 for 2 years if surgery done in 2weeks

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29
Q

CEA vs stenting+ angioplasty on periprocedural stroke and MI

MI less in: ______
stroke greater in _______

A

angioplasty

CEA

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30
Q

CREST:

risk for stroke&raquo_space; ______

risk for MI»>________

A

CAS

CEA

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31
Q

Incidence of ICAD in asians

A

37%

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32
Q

trial showing that 3.5% risk of stroke among asymptomatic pts with ICAD

A

WASID

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33
Q

Findings of WASID trial:

A

ASA is more effective vs Warf in stroke prevention (19.7 vs 17.2%)

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34
Q

Antiplateletet trials with outcomes relating tp neuroimaging and TCD in ICAD

A

TOSS

TOSS2

CLAIR

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35
Q

ASA + Cilos (100BID)&raquo_space;>ASA in prevention of ICAD as seen in MRA at 6 mos

A

TOSS

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36
Q

ASA+ Cilos=== Clopid (non-significant trend)

A

TOSS II

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37
Q

risk of stroke among pts with PAOD

A

40%

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38
Q

trial that men with PAOD have 4 to 5 times higher risk of stroke than without PAOD

A

Atherosclerosis risk in Communities

ARIC

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39
Q

_________ indicated for pts with asymptomatic LE PAD to reduce cardiovascular ischemic events

A

ASA

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40
Q

_______ improve walking distance in pts with LE PAD

A

Cilost 100 BID

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41
Q

TRIAL

Acute ischemic stroke within 48hrs

ASA: 300
Hep: 5000u BID
Hep: 12,500 BID
ASA+HEP

ASA: fewer strokes
HEP: fewer deaths/recurrent stroke

A

IST

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42
Q

TRIAL

AIS within 48hrs

ASA vs PLA for 4 weeks

ASA: reduced stroke and vascular death

A

CAST

Chinese Acute stroke Trial

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43
Q

TRIAL

AIS within 24 hrs minor ischemic stroke

Clopid 300 LD then Clopid 75mg OD+ ASA 75mg OD for 21d then Clopid for 90d

vs ASA for 90d

recurrent stroke
Clopid-ASA: 8.2%
ASA:11.7%

A

CHANCE

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44
Q

TRIAL

AIS of less than NIHSS 15

ASA 300 vs Cilos 200 for 90d

non-inferiority outcome

A

CAIST

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45
Q

for every 1C inc in temp, RR of death increases by____-

A

2

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46
Q

hypothermia reduces infarct size by

A

44%

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47
Q

mechanisms of Citicoline

A

for membrane repair
inhibits PLA2
reduces cytokines and free radicals

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48
Q

TRIAL

AIS within 12 hrs

IV Cerebrolysin 30cc for 10d vs pla

no diff in functional outcome
Post hoc: favorable trend in NIHSS more than 12

A

CAISTA

cerobrolysin in AIS in Asia

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49
Q

TRIAL

mod to severe stroke within 24hrs

Citicoline 1g IVq12 for 6 weeks

A

ICTUS

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50
Q

TRIAL

AIS, intermediate severity

NeuroAID 4x TID for 90d

A

no diff in MRS

Trend of benefit: if given more than 48hrs

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51
Q

Dose of Heparin in AIS, CE_____

aPTT levels

A

600-800 u/hr

1.5x to 2.5x the control

52
Q

Contraindications for RTPA in stroke

A

Contraindications to Tissue Plasminogen Activator in Stroke SHIP BLAST

S: Stroke in last 3 months
H: Head injury in last 3 months
I : Intracranial hemorrhage
P: PT > 15 sec
B: BP > 185/110
L: Lumbar puncture in last 7 days
A: Anticoagulants use / Arterial puncture in last 7 days
S: Surgery within last 14 days
T: Thrombocytopenia < 100,000
53
Q

during RTPA, SBP of >230 or DBP >121-140, give _______

A

LAbetalol 20 mg IV for 1 hr
Nicard 5 mg/hr
Nitroprusside

54
Q

What to give in ICH post thrombolysis

A

cryoppt: 6-8u
Platelet: 6-8u

55
Q

exclusion criteria for rtpa at 4.5 hrs

A

> 80 y/o
on OACs
NIHSS >25
hx of ischemic stroke and DM

56
Q

TRIAL

AIS <3 hrs
RTPA vs PLA

outcome: RTPA group are 30% more likely than controls to have min disability at 3 mos

A

NINDS

57
Q

TRIALS

AIS <6 HRS
TPA: 1.1mg/kg vs PLA

109 protocol violations

A

ECASS

58
Q

TRIALS

AIS <6 HRS
TPA: 0.9 mg/kg vs PLA

no diff in outcome at 3 mos

A

ECASS II

59
Q

ATLANTIS A

AIS <6 HRS
TPA: 0.9 mg/kg vs PLA

A

no diff in outcome at 1 and 3 mos.

Inc ICH to those treated in 5-6 hrs

60
Q

TRIALS
ATLANTIS B

AIS <6 HRS
TPA: 0.9 mg/kg vs PLA

A

no diff in outcome at 3 mos.

risk of ICH higher in rtpa

61
Q

TRIALS

AIS in 3 hrs

RTPA 0.6 mg/kg

36.9 achieved MRS of 0-1 in 3 months

A

J-ACT

62
Q

TRIALS

AIS in 3-4.5 hrs
TPA: 0.9 mg/kg vs PLA

TPA group had favorable outcome in 3 mos

no sign diff in ICH in both groups

A

ECASS III

63
Q

TrIals for BP control in ICH

A

INTERACT

ATACH

64
Q

TRIAL

rend to less hematoma growth in 24 hrs with BP goal of less than 140

A

INTERACT

65
Q

TRIAL

Early BP lowering in ICH with Nicardipine is safe

A

ATACH

66
Q

TRIAL

SBP lowering to <140 vs <180 within 6 hrs

A

no difference in primary outcome bet two groups

67
Q

In hemicraniectomy, when should the flap be replaced

A

12 weeks

68
Q

In hemicraniectomy, decrease in ICP from

removal of flap:
removal of dura:

A

15%

70%

69
Q

improvement of MR in decompressive vs medical

A

67-84%

20-30%

70
Q

TRIALS FOR HEMICRANIECT

A

DESTINY, DECIMAL, HAMLET, HEADFIRST, HEMMI, DESTINY II

71
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: symptomatic atherosclerosis on ASA 50-1500 mg/day

O: 23% odds reduction in stroke, MI, death

A

ATC

antiplatelet trialist collaboration

72
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: pts with TE stroke
I: Ticlodipine 250mg BID vs PLA
O: Tic reduced MI, stroke, death by 30%

A

CATS

Canadian American Ticlodipine Study

73
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: pts with recent TIA/stroke
I: Ticl 250 BOD vs ASA 1300 mg/d
O: Tic reduced risk of stroke by 12% vs ASA

A

TASS

Tic ASA stroke study

74
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: pts with atherosclerotic dse
I: ASA 325 vs Clopid 75
O: Clopid reduced ischemic stroke vs ASA by 8.7%

A

CAPRIE

Clopid vs ASA at Risk for Ischemic events

75
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: pts with TIA or stroke + RF
I: ASA-Clopid vs Clopid
O: no diff in outcome, worst bleeding in combu

A

MATCH

76
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: pts with clinical events or RF
I: ASA-Clopid vs ASA
O: No sig diff in outcome but trend to benefit in symptomatic pts

A

CHARISMA

77
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: pts with symptomatic lacunar infarction
I: ASA 325+ Clopid75 vs ASA 325
O: 3.4 yrs, recurrent stroke no diff bet groups

A

SPS3

78
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: Hx of cerebral infraction
I: PLA vs Cilos 100BID
O: Cilos reduced stroke by 41.7%

A

CSPS

79
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: Hx of CVS in 26 weeks
I: Cilos vs ASA in 1-5 yrs
O: non-inferior, headache tachycardia and diarrhea more in Cilos

A

CSPS2

80
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: stroke, TIA
I: ASA+ Dypiridamole 225mg/d vs PLA
O: ASA+DYP reduced stroke by 33%

A

ESPS1

81
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: stroke, TIA
I: ASA 25 BID vs ER-DP 200BID vs PLA
O: ASA+DYP:37% ASA 18% DYP: 16%

A

ESPS2

82
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: recent stroke, TIA
I: ASA 30-325 mg/d +DYP vs ASA
O: Stroke, MI, death dec by 20% in ASA_DYP

A

ESPRIT

83
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: CVD in the past 120 days
I: ASA+DYP vs CLOPD
O: similar recurrent rate of stroke

A

PROFESS

84
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: stroke TIA in the past 6 mos
I: ASA 325 vs Triflusal 600 for 30 mos
O: similar efficacy, Triflusal lesser bleeding

A

TACIP

85
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: stroke TIA in the past 6 mos
I: ASA 325 vs Triflusal 600 for 28 mos
O: no diff in outcome

A

TAPIRSS

86
Q

TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION

P: isch stroke, non-CE
I: Warf INR (1.4-2.8) vs ASA 325
O: no diff in outcomes

A

WARSS

87
Q

Reduction of stroke in NVAF CE CVD
ASA:______
Warf:______

A

24 vs 64%

88
Q

Time on Ther range for Warf to be effective: _______

A

> 60%

89
Q

Mechanism of NOAC

Dabig:
Rivarox
Apix

A

DTI
Xa Inh
Xa Inh

90
Q

Half life

Dabig:
Rivarox
Apix

A

14-17 hrs
5-9hrs
8-15 hrs

91
Q

Studies of NOAC

Dabig:
Rivarox
Apix

A

RELY
ROCKET-AF
ARISTOTLE

92
Q

for HR AF, CHADSVASC >2, alternative if VKA not available

A

ASA+CLOPID

93
Q

Crea clearance for which NOACs not indicated

A

<30

94
Q

Correlates with serum levels of NOACS

aPTT
PT

A

Dabig, Rivarox

95
Q

for ICH

score that predicts hospital admission

A

FUNC

96
Q

Sn of CT in SAH

12 hrs
24 hrs
6 days

A

98-100
93
57-85

97
Q

if angiography negative for aneurysm, repeat in_____

A

7-14d

98
Q

May be reasonable to reduce vasospasm

A

MgSO4

99
Q

MR for AVM per bleed

A

10%

100
Q

bleeding risk for unruptured AVM

A

2-4%

101
Q

ICH lifetime risk in pt with AVM

A

105-pt’s age

102
Q

DWI signal can be seen as early as________

A

30 mins

103
Q

ADC map continues to decrease in intensity upto _____ from stroke

A

3-5 days

104
Q

Types of CRPS

Type 1:
Type 2

A

after illness/injury without overt damage

after distal nerve damage

105
Q

% of stroke pts who develop post stroke pain

A

10.6%

106
Q

First line of Tx for CSPS

A

LTG, AMitryptyline

107
Q

First line of Tx for CSPS in elderly

A

Nortriptyline

108
Q

treatment of CRPS post stroke

A

Bisposphanates

Short course of prednisolone 30mg/d upto 12 weeks

109
Q

post stroke epilepsy is highest in what subtypes of stroke?

A

multiple stroke: 7.7%
ICH:4.3
SAH: 4.2

110
Q

which has a higher onset of SE and mortality, early vs late onset Sz

A

early

111
Q

recurrence rate of late onset Sz in 5 yrs

A

50%

112
Q

Prevalence of post stroke dementia
p 1 yr:
every yr after:
at 25 yrs:

A

30%
inc by 7%
48%

113
Q

Imaging findings assctd with edema

A

silent infarcts
WMIC
Global and medial temp lobe atrophy

114
Q

Imaging to detect multiple lobal hemorrhages characteristic of CAA

A

MRI with GRE

115
Q

Incidence of SITY-STROKE

A

10-14%

116
Q

MC cause of SITY

A

Arteriopathies

117
Q

SITY after prolonged immobilization/ Valsalva

A

PFO

118
Q

MC cause of thrombophilia associated with SITY

A

APAS

119
Q

MC cause of ICH-SITY

A

AVM, cavernous angioma

120
Q

MC cause of ICH-SITY

A

AVM, cavernous angioma

others: HPN, CVT, MAP

121
Q

duration of Tx of carotid artery dissection

A

3-6 mos

122
Q

OCP if with RF for stroke

A

PO contraceptives

123
Q

secondary stroke prevention for pts with APAS

A

ASA

124
Q

Targery HbS for patients with sickle cell dse.

If BT cant be done, may give ____

A

<30%

HU

125
Q

recent stroke + hyperhomocysteinemia

A

folate

SSP 2014 (1 decks)

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