Stroke

Question 1

Define the 5 main aspects of a stroke.

Answer 1

Rapidly developping
Focal signs
Symptoms lasting >24 hours
Loss of brain function
Vascular origin

Question 2

What important things should always be noted when someone has a stroke?

Answer 2

Time of onset
What were the symptoms
What are the symptoms now
How did the symptoms progress

Question 3

What scoring system is used to diagnose a stroke?

Answer 3

Rosier

Question 4

What score in the Rosier system makes a stroke likely?

Answer 4

> 0

Question 5

Stroke is the experience of persisting …… symptoms of ………….. disease

Answer 5

Neurological

Cardiovascular

Question 6

Stroke is a diagnosis?

Answer 6

FALSE

Question 7

Name the 3 most types of strokes in order of incidence.

Answer 7

Infarct
Haemorrhage
Subarachnoid haemorrhage

Question 8

Name the 3 subtypes of an infarct.

Answer 8

Atheroembolic
Cardioembolic
Small vessel

Question 9

How long does a TIA last?

Answer 9

<24 hours

Question 10

How long does a stroke last?

Answer 10

> 24 hours

Question 11

How do you determine between different types of stroke?

Answer 11

CT scan

Question 12

What 4 things should be done in the rapid assessment?

Answer 12

History
Carotid imaging
ECG
Blood tests

Question 13

Why is an ECG done?

Answer 13

To look for AF

Question 14

After a TIA, what should patients be started on to prevent a stroke?

Answer 14

Anticoagulation and anti platelet

Question 15

Why is DVT/PE a risk of a stroke?

Answer 15

After a stroke patient are usually bed bound and immobile

Question 16

What assessment is essential in the first 4 hours following a stroke?

Answer 16

Swallow assessment

Question 17

Why is a swallow assessment done?

Answer 17

To check if the patient swallow is still ok as if it is not they risk aspiration which can make them very unwell
Always think aspiration pneumonia

Question 18

What imaging should be done if a small infarct cannot be seen on CT?

Answer 18

MRI

Question 19

What must be given ASAP after a stroke?

Answer 19

300mg Aspirin

Question 20

What must you do before giving Aspirin or another anti platelet?

Answer 20

A CT to check that there has not been a bleed

Question 21

What is the gold standard way of reducing risk of DVT’s?

Answer 21

Intermittent pneumatic compression

Question 22

Why is heparin now given to prevent DVT?

Answer 22

Benefit is outweighed by bleeding risk

Question 23

What is done if swallow screen is abnormal?

Answer 23

Assessment by speech and language therapist

Question 24

When might an NG tube be used or textured diet and thickened fluids?

Answer 24

Abnormal swallow assessment

Question 25

What should patients with an acute stroke also be screened for?

Answer 25

Malnutrition

On admission and weekly after

Question 26

When should patients be referred to a dietician?

Answer 26

If NG tube or textured foods is needed

Question 27

Cardioembolic?

Answer 27

Fibrin dependant
‘Red thrombus’
HEART

Question 28

Atheroembolic?

Answer 28

Platelet dependant
‘White thrombus’
ACS

Question 29

What is the most common site of an atheroembolic stroke?

Answer 29

Carotid artery

Question 30

Small vessel?

Answer 30

Arteriosclerosis
Embolism
BRAIN

Question 31

What conditions are risk factors for small vessel stroke?

Answer 31

Diabetes

Hypertension

Question 32

What tests are done to find out the type of stroke?

Answer 32

CT or MRI

Question 33

What tests are done to find the cause of the stroke?

Answer 33

Carotid scan
Angiogram
ECG
ECHO
24 hour tape

Question 34

Name risk factors.

Answer 34

Smoking
Alcohol
BP
Glucose
Lipid profile

Question 35

What should be given if the stroke is cardioembolic/AF?

Answer 35

Anticoagulants

Question 36

When is anti platelets given?

Answer 36

When the stroke is not cardioembolic

Question 37

What is the first line anti platelet?

Answer 37

Clopidogrel

Question 38

When should a statin not be given?

Answer 38

AF

Question 39

AF is associated with a 5 fold increase of?

Answer 39

Ischaemic stroke