Stroke and Palliative Care

Question 1

what drugs can be given for symptomatic Tx in palliative care
- pain/SOB, distress, nausea/agitation, resp secretions

Answer 1

pain/SOB&raquo_space; morphine

distress&raquo_space; midazolam

nausea/agitation&raquo_space; levomepromazine

resp secretions&raquo_space; buscopan

Question 2

what drugs can be given for agitation

Answer 2

levomepromazine 10mg and midazolam 10mg

Question 3

what is the definition of a stroke

Answer 3

Rapidly developing Sx and/or signs of focal [or global] loss of brain function for > 24 hours or leading to death

Question 4

what are the different strokes

Answer 4

cardioembolic

atheroembolic

artheriosclerosis

Question 5

what is the main feature of a cardioembolic stroke

Answer 5

Fibrin dependent “red thrombus”

Question 6

what is the main feature of atheroembolic stroke

Answer 6

Platelet dependent “white thrombus”

Question 7

what is the frontal lobe responsible for

Answer 7

Personality
Emotional Response
Social behaviour

Question 8

what would a lesion in the frontal lobe result in

Answer 8

Disinhibition
Lack of initiative
Antisocial behaviour
Impaired memory
Incontinence
Grasp reflexes
Anosmia

Question 9

what is the DOMINANT side of the parietal lobe responsible for

Answer 9

Calculation
Language
Planned movement
Appreciation of size, shape, weight and texture

Question 10

what would a lesion in the DOMINANT side of the parietal lobe result it

Answer 10

Dyscalculia
Dysphasia
Dyslexia
Apraxia
Agnosia
Homonymous hemianopiaq

Question 11

what is the NON-DOMINANT side of the parietal lobe responsible for

Answer 11

Spatial orientation

Constructional skills

Question 12

what would a lesion in the NON-DOMINANT side of the parietal lobe result it

Answer 12

Neglect of non-dominant side
Spatial disorientation
Constructional apraxia
Dressing apraxia
Homonymous hemianopia

Question 13

what is the role of the occipital lobe

Answer 13

analysis of vision

Question 14

what would a lesion in the occipital lobe result it

Answer 14

Homonymous hemianopia
Hemianopic scotomas
Visual agnosia
Impaired face recognition (prosopagnosia)
Visual hallucinations (lights, lines, zig-zags)

Question 15

what is the role of the DOMINANT side of the Temporal lobe

Answer 15

Auditory perception
Speech, language
Verbal memory
Smell

Question 16

what would a lesion in the DOMINANT side of the temporal lobe result it

Answer 16

Dysphasia
Dyslexia
Poor Memory
Complex hallucinations (smell, sound, vision)
Homonymous hemianopia

Question 17

what is the role of the NON-DOMINANT side of the temporal lobe

Answer 17

Auditory Perception
Music, tone sequences
Non-verbal memory (faces, shapes, music)
Smell

Question 18

what would a lesion in the NON-DOMINANT side of the temporal lobe result it

Answer 18

Poor non-verbal memory
Loss of musical skills
Complex hallucinations (smell, sound, vision)
Homonymous hemianopia

Question 19

what is the Tx for acute ischaemic stroke

Answer 19

1st line = thrombolyse
- IV tPA

2nd line = endovascular therapy

Question 20

what is associated with a 5 times increased risk of ischaemic stroke

Answer 20

Atrial Fibrillation

Question 21

what is used to assess a person with AF risk of stroke

Answer 21

CHA2DS2VASc score

Question 22

how does the CHA2DS2VASc score work

Answer 22

Congestive HF = 1 pt
Hypertension = 1pt
Age >75 = 2pts
Diabetes = 1pt
Stroke/TIA/thrombotic = 2pts
Vascular disease = 1pt
Age 64-75 = 1pt
Sex i.e. Female = 1pt 

Total = 9

Question 23

what is the breakdown for management due to CHA2DS2VASc score

Answer 23

0 = no therapy, can give aspirin
1 = aspirin 75-325 mg daily
> 2 = oral anti coagulation

Question 24

what is used to calculate the risk of bleeding on aspirin

Answer 24

HAS-BLED bleeding score

Question 25

what is HAS-BLED score

Answer 25

Hypertension = 1pt
Abnormal renal and liver function = 1 or 2pt
Stroke = 1pt
Bleeding = 1pt
Labile INRs = 1pt
Elderly > 65 = 1pt
Drugs or alcohol = 1 or 2pt

Total = 9