Brainscape's Knowledge GenomeTM

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


See full index

Nayla Foundations Exam 4 > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the left brain responsible for

A

logic
language
science and math
analytic thought

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

What is the right brain responsible for

A

intuition
creativity
art and music
holistic thought

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

What is a stroke

A

sudden focal neuro deficit due to interruption of blood flow, MC ischemia

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

What are modifiable stroke RF

A 
HTN
obesity
AFib
cardiac disease 
dyslipidemia 
high alcohol intake 
smoking
stress
diet
physical inactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are non-modifiable stroke RF

A 
age
gender
family history 
ethnicity
Hx CVA 
vascular anomaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Who has worse and more strokes and why

A

Black have worse
d/t RF of HTN, DM, obesity, smoking, and sickle cell anemia
Hispanic have more and at younger ages

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

What stroke test is 100% sensitive

A

Cincinnati pre-hospital stroke scale, when all 3 are present

  1. Facial droop (unilateral)
  2. Arm drift (unilateral)
  3. Abnormal speech
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Focal stroke symptoms include

A 
unilateral weakness
numbness and tingling 
vision loss
incoordination 
sudden speech changes/HA 
acute vision loss or double vision 
**NO PAIN**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the NIHSS

A 
measures the level of impairment due to stroke, need for TPA, if a change has occurred, and level of severity 
-7 minutes, 13 items 
-Min= 0 (normal) 
1-4 is minor
5-15 is moderate
>15-20 is severe
-Max= 42 (very severe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should a focused stroke PE include

A 
LOC 
language
strength
DTR
EOM
coordination
sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What patients have the best outcomes

A

Lacunar infarcts (small vessels)

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

Who has improved outcomes

A

Those who get earlier treatment

>24 hours has no benefit

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

What are the types of strokes

A

Focal brain dysfunction: ICH, ischemic stroke

Diffuse brain dysfunction: ICH, SAH

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

What is the MC vascular obstruction leading to thrombosis

A

Atherosclerosis

also GCA, hypercoaglable, vessel dissection

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

What are the 2 MC sources of emboli (smaller strokes than from thrombi)

A

Left cardiac chambers

artery to artery (thrombus detaches from ICA)

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

Embolic strokes usually become

A

hemorrhagic strokes

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

What are causes of an ischemic stroke

A

atherosclerosis (large vessel)
lacunar infarct (small vessel)
cardioembolic (AFib, MI, patent foramen ovale)

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

What is a TIA

A

sudden onset transient lack of blood and focal ischemia lasting <24 hours (usually 1 hr) with focal neuro symptoms
+/- permanent

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

What is an Acute Ischemia Stroke

A

sudden onset total interruption of blood to a part of the brain lasting >24 hours (usually >1 hr) w/ permanent focal neuro Sx

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

How have TIA guidelines been revised

A

No longer about time (<24 hr) but now about the amount of injury-
AHA now says a TIA is a transient episode of neuro dysfunction due to focal brain, S.C. or retinal ischemia WITHOUT acute infarct (1 hr time is not helpful to tissue infarct)

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

What is a patients short term stroke risk

A

> 10% will have a stroke in first 90 days after a TIA

of that 10% 1/4 to 1/2 will have a stroke in the first 2 days

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

What is the ABCD2 score

A

Better prediction of stroke risk s/p having just had a stroke- incorporates Cali and ABCD scores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Explain the ABCD2 scoring system

A

1 point: 60+, BP >140/90, DM, 10-59 min duration, speech impairment (no weakness)
2 points: Focal weakness, lasts 60+ min

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

Interpret ABCD2 risk scores

A

0-3: 1% stroke risk (in 2 days)
4-5: 4.1%
6-7: 8.1%

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

What is preferred imaging for a potential TIA

A

MRI (confirm focal ischemia)

+/- vessel imaging, heart eval, labs (based on AHA)

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

What is a class 1 Recommendation

A
  1. S/p TIA need MRI w/ DWI w/in 24 hours (CT if you cant do MRI)
  2. Noninvasive imaging of cervicocephalic vessels if susp. of TIA (CT head+neck)
  3. CT H+N to r/o stenosis (intracranial vasculature)- if abn, do cath angiography to confirm
  4. Susp. TIA= immediate evaluation!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are class 2 recommendations

A
  1. Use carotid US/MRA/CTA to view extracranial vasculature
  2. consider catheter angiography prior to endartectomy
  3. role of plaque characteristics and detection of microemboli not yet defined
  4. Do ECG asap after TIA
  5. EEG (or TEE) in susp. TIA if no other cause identified. (TEE for PFO/aortic arch)
  6. Routine blood tests for susp. TIA
  7. Hospitalize pt w/ TIA if they present w/in 72 hours, or if; ABCD2 >3, or ABCD2 0-2 and cant be worked up w/in 2 days/evidence of focal ischemic cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the Penumbra

A

zone of reversible ischemia (25-50% of normal CBF) around irreversible infarct.
Can salvage in first few hrs after ischemic stroke onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What can damage the penumbra

A

Hypoperfusion (lowering BP)
Hyperglycemia
fever
seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What happens during an AIS

A

BP increases d/t arterial occlusion and trying to perfuse the penumbra
Lowering BP starves the penumbra= worse outcome

31
Q

What are cerebral blood flow levels

A

50-60 is normal
20-30 is no electric activity
10 is neuron death

32
Q

What is a complication of restoring blood flow after an artery occlusion

A

Hemorrhage (red infarct) d/t Ischemic vessel rupture

anemic infarct; embolism breaks up and goes into one branch

33
Q

What is the acute Tx of TIA/AIS

A

Thrombolysis or thrombectomy

DONT decrease BP

34
Q

What is secondary prevention of AIS/TIA

A

anti-thrombotic therapy
vascular RF therapy
+/- carotid endartectomy or angioplasty

35
Q

What is your TPA window

A

3.5-4 hours (slight ICH risk)

36
Q

What is tPA inclusion criteria

A

18+ y/o

<4.5 hours from onset

37
Q

What is tPA exclusion criteria

A 
s/p stroke w/in 90 days 
Hx ICH 
brain cancer
SAH Sx 
glucose <50 
active bleeding/ hemorrhage 
Heparin w/in 48 hr/ on oral anticoags
Platelet <100
pregnant 
80+ y/o 
NIHSS 25+ 
BP > 185/110
38
Q

Explain BP in a stroke

A

BP distal to obstruction: low
overall BP: high
BP >200= high risk of stroke recurrence

39
Q

What are Vasopressors (ADH) used for

A

to keep BP high until deficits improve

40
Q

When SHOULD you decrease BP in AIS

A

AMI
CHF
aortic dissection
HTN encephalopathy

41
Q

What does AIS care consist of

A

Triage (10 min)- tPA criteria and prelabs, page stroke team
Med care (25 min)- O2, 2IV, NIHSS, ECG
CT/labs (45 min)
Tx (60 min)

42
Q

What is often used with tPA

A

Mechanical thrombolysis

  • MERCI is the cork screw
  • PENUMBRA is the clot aspiration
43
Q

What are predictors of hemorrhagic transformation

A 
**Size of infarct 
AFIB
NIHSS
hyperglycemia
thrombocytopenia
44
Q

What causes hemorrhagic strokes

A

**HTN

Vascular malformation

45
Q

How does a hemorrhagic stroke manifest

A

vessel rupture and surrounding tissue damage with high ICP symptoms

46
Q

What are key points with a hemorrhagic stroke

A

check non-con CT (blood?)
high mortality (50%)
monitor ICP
neurosurgery intervention

47
Q

What is a congenital AVM’s

A

defect delivering blood from an artery directly to a vein
bypassing the brain causes chronic ischemia
high risk of rupture due to weak dilated wall

48
Q

What is a cerebral aneurysm

A 
enlarged vessel due to a weak wall 
<5mm small
6-15 med
16-25 large
25+ massive
49
Q

What is the MC saccular aneurysm

A

berry aneurysm in the circle of willis (usually anterior communicating, also posterior communicating)

50
Q

How do you treat a cerebral aneurysm

A

endovascular coli/stent

surgical clip

51
Q

What causes a SAH

A
  1. Aneurysm in circle of willis

2. Congenital AVM

52
Q

How do SAH present

A

sudden increased ICP
+/- valsalva association
(not the same as ICH)

53
Q

How do you diagnose a SAH

A

CT non-con

Xanthochromia (yellow CSF after 1-2 hrs d/t hemolyzed blood)

54
Q

How do you treat SAH

A 
decrease ICP (stool softener, cough suppressant, anxiolytic, analgesics) 
CCB for vasospasm
55
Q

What is first tier testing for stroke patient

A

CBC BMP glucose PT/PTT +/- ESR

ECG, non-con CT

56
Q

What is second tier testing for stroke patient (usually neuro)

A 
Doppler US to carotids 
TTE or TEE 
MRI/MRA
CSF 
cerebral angiogram
57
Q

What is peri-stroke hyperglycemia associated with

A

worse clinical outcomes
(inpatient BG goal <150)
(outpatient HgbA1C goal <7)
(each 1% drop in HgbA1C= 12% decrease in stroke risk

58
Q

What possible complications can occur s/p stroke

A 
Aspiration (NPO until eval) 
DVT (compression) 
UTI (avoid cath) 
Constipation (laxatives for all)
UGI bleed (ppi/H2 antag) 
Fever (APAP +/- abx)
59
Q

What is post stroke depression

A

When Sx persist 1-2 wk after stroke

  • Give SSRI
  • If on warfarin, give Lexapro, celexa, zoloft
60
Q

What is secondary stroke prevention w/ RF modification

A

dont discontinue statins (LDL 100+, high dose)

61
Q

Is carotid endartectomy beneficial

A

YES if 70-99% stenosed

<6% complication rate

62
Q

When should a carotid angioplasty be used

A

high risk for restenosis, or contralateral artery occlusion

63
Q

Who benefit most from a carotid endartectomy

A

men
elderly
recent cerebral ischemia
ulcerated plaque

64
Q

What is secondary stroke prevention with lifestyle RF modification

A

alcohol <2oz men, <1oz women
stop smoking
CPAP
low sat fat diet, low Na, mediterranean diet
20+ min aerobic exercise 3+ days/wk
Normal BMI (18.5-24.9)
maintain HgbA1C <7, BP <120/80 (w/ ACE/ARB), LDL <70 (statin)

65
Q

What drugs can stroke pts take

A

antithrombotics

statins

66
Q

What drugs should stroke pts avoid

A 
estrogen
sympathomimetics
NSAID
ppi (if on plavix) 
-can take ppi in acute phase to prevent GI bleed
67
Q

What can mimic a stroke

A 
encephalitis 
hypoglycemia
migraine
seizure
TIA
toxic/metabolic 
tumor
conversion disorder
psychogenic cause
68
Q

A stroke in this area can cause unilateral weakness

A

ACA
MCA
anterior choroid artery to internal capsule
Basilar artery to midbrain and medulla oblongata

69
Q

A stroke in this area can cause unilateral loss of sensation

A

ACA
MCA
PCA to thalamus
Basilar artery to medulla oblongata

70
Q

A stroke in this area can cause visual deficits

A

MCA

71
Q

A stroke in this area can cause nystagmus

A

Basilar artery to pons and medulla oblongata

72
Q

A stroke to this area can cause aphasia

A

MCA

73
Q

A stroke to this area can cause ataxia

A

Basilar artery to pons

hemiataxia is medulla oblongata

74
Q

A stroke to this area can cause hypokinesia

A

Anterior choroid to basal ganglia

Nayla Foundations Exam 4 (15 decks)

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