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PRPS Block 2 > Stroke > Flashcards

Stroke Flashcards

1
Q

Strokes affect 1 in _ men and 1 in _ women?

A

1 in 5 men

1 in 6 women

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2
Q

Describe an ischaemic stroke?

A

Blood clot blocks an artery which carries blood to the brain.

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3
Q

What are the 2 ways clots can be formed to cause an ischaemic stroke?

A

Atherosclerosis gradually blocking arteries
or
embolus becoming lodged.

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4
Q

What % of strokes are ischaemic?

A

85%

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5
Q

Which category of stroke do TIA’s fall into -ischaemic or haemorrhagic?

A

Ischaemic

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6
Q

What is a haemorrhagic stroke?

A

Bleeding from a ruptured blood vessel in or around brain.

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7
Q

What causes tissue damage in haemorrhagic stroke?

A
  • Lack of nutrients to tissue

- compression of surrounding brain by leaked blood.

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8
Q

What causes tissue damage in ischaemic stroke?

A

lack of oxygen and nutrients to tissue.

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9
Q

What % of strokes are haemorrhagic?

A

15%

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10
Q

Which stroke has greater mortality?

A

Haemorrhagic - 40% of all deaths despite only making up 15% of strokes.

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11
Q

Which cause of ischaemic stroke is more common - atherosclerosis or embolism?

A

atherosclerosis - 50% ischaemic strokes

embolism - 20%.

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12
Q

What is the most common cause of embolic stroke?

A

AF

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13
Q

What type of haemorrhage causes bleeding within the brain?

A

primary intracerebral haemorrhage

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14
Q

What type of haemorrhage causes bleeding on the surface the brain?

A

subarachnoid haemorrhage

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15
Q

What is the most common cause of blood vessel rupture which causes the stroke?

A

Hypertension

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16
Q

What are the 4 main areas of primary prevention of a stroke?

A

Hypertension
Smoking
Dyslipidaemia
Cardiac disease

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17
Q

What is the limit defined for hypertension ?

A

> 140/90 mmHg

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18
Q

What is the biggest risk factor for reducing stroke?

A

Hypertension

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19
Q

What risk does smoking bring to stroke?

A

Smokers have double the risk to non-smokers and heavy smokers (>40/day) have double the risk of light smokers (<10/day)

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20
Q

What marker for dyslipidaemia is measured in preventing stroke?

A

LDL:HDL ratio

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21
Q

What risk of stroke does AF carry?

A

Increased risk 5-fold.

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22
Q

What are 4 key lifestyle interventions for preventing stroke?

A

Healthy diet
Regular exercise
Weight management
Alcohol intake

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23
Q

List some common symptoms of a stroke?

A
  • facial palsy and drooping
  • numbness, weakness or paralysis on one side of the body.
  • sudden blurred vision or loss of sight in 1/both eyes.
  • sudden memory loss or confusion.
  • dizziness or a sudden fall
  • severe headache
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24
Q

What is a key marker of a TIA compared to a stroke?

A

Symptoms resolve in 24h

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25
Q

What is FAST for strokes and what does it mean?

A

Face - can they smile, any drooping?
Arm - can they raise both arms and keep them up?
Speech - can they speak clearly?
Time - any of three signs - call 999.

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26
Q

What system is used to assess patients with a stroke presentation?

A

ABCD2

27
Q

In the ABCD2 scoring system - what does A mean?

A

Age
>60 = 1
<60 = 0

28
Q

In the ABCD2 scoring system - what does B mean?

A

BP

140 systolic or >90 diastolic

29
Q

In the ABCD2 scoring system - what does C mean?

A

unilateral weakness = 2
speech disturbance = 1
other = 0

30
Q

In the ABCD2 scoring system - what does the first D mean?

A

Duration
>60mins = 2
10-59 mins = 1
<10mins = 0

31
Q

In the ABCD2 scoring system - what does the second D mean?

A

diabetes = 1

32
Q

What patients should have brain imagine within 1 hour?

A
  • severe headache at symptom onset
  • on anticoagulant, bleeding tendency or need thrombolysis.
  • reduced consciousness or fluctuating symptoms
33
Q

What investigations should be done in someone with a stroke?

A
  • bloods - FBC, LFT, ESR, U&E’s
  • ECG and BP
  • Assess impairment and swallowing
  • blood glucose
    + oxygen saturation
  • routine observations, hydration and nutrition
  • carotid imagine or echo
34
Q

Thrombolysis can be offered to patients who have 3 characteristics?

A
  • confirmed time of onset of symptoms <4.5h
  • Had imaging to confirm ischaemic stroke
  • no known C/I to thrombolysis
35
Q

What is the only drug licensed for thrombolysis?

A

alteplase

36
Q

What is the dose of alteplase in thrombolysis?

A

0.9mg/kg (max 900mg dose)

37
Q

How is alteplase given?

A

10% iv bolus 90% IV infusion

38
Q

What does BP need to be for thrombolysis?

A

<180/110

39
Q

How should aspirin be used in acute stroke?

A

Give 300mg immediately after excluding haemorrhagic stroke - if thrombolysis is done - wait 24h before aspirin.

40
Q

When should DAPT be given?

A

Evidence shows benefit if started within 24h - then continue for 10-21d then stop aspiring and continue clopidogrel.

41
Q

4 areas of 2nd prevention for strokes?

A

Antiplatelets
Anticoagulants
Antihypertensives
Statins

42
Q

when is the stroke risk greatest for stroke survivors?

A

in the next 30days post stroke.

43
Q

Should statins be given in haemorrhagic stroke?

A

No - increase the risk of haemorrhagic stroke.

44
Q

What is the alternative if clopidogrel is not tolerated?

A

Aspirin 75mg o
+
Dipyridamole MR 200mg BD

45
Q

When should patient be started on anticoagulant therapy if indicated?

A

14 days after stroke onset.

46
Q

What is the target INR for patients on warfarin post stroke?

A

2-3

47
Q

Define the CHAsDSVASc score criteria?

A 
CHF
HTN
Age >75 (2)
Diabetes 
Stroke/TIA previously
Vascular disease
Age 65-74
Sex - female
48
Q

Define the HAS-BLED score criteria?

A 
HTN - untreated - sys >160 
Abnormal renal/hep function
Stroke history 
Bleeding risk 
Labile INR
Elderly >65
Drugs which predispose bleeding or alcohol excess.
49
Q

What is 1st line antihypertensive for patients aged >55?

A

CCB - amlodipine etc.

50
Q

What is 1st line antihypertensive for patients <55 or afro-carribean?

A

ACE-I - higher renin level.

51
Q

What is target BP post stroke?

A

<130/80 ideally.

52
Q

What is the preferred statin for secondary prevention and when should it be started?

A

Atorva 80mg o

wait 48h

53
Q

In what 3 categories is the risk:benefit ratio poorer for carotid endarterectomy surgery?

A
  • younger patient
  • longer from onset of symptoms
  • less severe stenosis at the heart.
54
Q

Define the ABCDE of 2nd prevention of stroke?

A 
A - antiplatelets  
B - antihypertensives - keep BP <140/85 
C - cholesterol lowering
D - diabetes control 
E - exercise
55
Q

What is the relationship between COC?

A

Relative risk of ischaemic stroke doubled when COC is used.

56
Q

What is the relationship between antipsychotics in elderly and stroke?

A

Increase the risk of stroke - typical less than atypical and greater in dementia.

57
Q

Which NSAIDs have the greatest and least risk of causing adverse CV events including stroke?

A

Highest - rofecoxib and diclofenac

Lowest - naproxen

58
Q

List 5 non-modifiable risk factors for stroke?

A 
Age
Gender
Ethnicity
Family history 
Previous stroke/TIA
59
Q

List 8 modifiable risk factors for stroke?

A 
Hypertension 
Smoking status
Waist-to-hip ratio
Diabetes
Cardiac disease
Inactivity 
Alcohol 
Depression
60
Q

List 8 types of problems people can have post-stroke?

A
  • limb weakness = reduced mobility?
  • incontinence
  • dysphagia
  • aphasia - speak/read/write or understand language.
  • depression/fatigue
  • pain
  • spasticity
  • cognitive imapirment
61
Q

Every 5kg/m2 is associated with what % increase in stroke mortality?

A

40%

62
Q

A reduction in LDL cholesterol by 1.0mmol/L can reduce stroke risk by __ %?

A

20%

63
Q

Stroke is the __ most common cause of death in Scotland?

A

3rd

PRPS Block 2 (7 decks)

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