Stroke Diagnosis and Management (3) Flashcards

0
Q

What is the first task in treating a pt presenting with acute focal neurological deficits?

A

Stabilize the vital signs

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

What should be the presumptive dx until proven otherwise in presentation of acute focal neurological deficits?

A

Stroke

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

What are three key points to obtain in the history of a patient presenting with acute focal neuro deficits?

A
  1. Time of symptom onset (last time patient felt/ observed to be normal)
  2. Symptom progression
  3. If headache is present; if so, how severe?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What two things should be focused on in the PMHx?

A
  1. Stroke risk factors

2. Medications

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

What are three things to ask about in the FHx?

A

History of:

  1. Vascular disease
  2. HTN
  3. Hyperlipidemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What three things should be focused on in the social history?

A

Use of:

  1. Tobacco
  2. EtOH
  3. Illicit drugs (cocaine, amphetamines)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 4 things to look for in the workup of potential stroke victim during the physical exam?

A
  1. HR and rhythm
  2. BP in both arms
  3. Check for carotid bruits
  4. Peripheral vascular exam
  • looking for any possible etiology of the stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the goal of a complete neurological exam in a possible stroke victim?

A

Determine the anatomical location of the stroke and the vascular territory involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If stroke is highly likely, what is one of the first things that need to be determined?

A

Whether it is ischemic or hemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are 7 things that are part of routine laboratory evaluation of possible stroke victims?

A
  1. EKG
  2. CXR (evaluate heart size)
  3. CBC with diff
  4. CMP
  5. Lipid profile
  6. Clotting times
  7. Head CT without contrast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is head CT without contrast very sensitive for?

A

Very sensitive for hemorrhagic stroke, so if negative can effectively rule them out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why are head CT w/o contrast not very good at picking up ischemic stroke?

A

They can’t reliably detect evolving infarcts until 6-12 hours, so if they stroke is relatively new, it will be false negative

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

What imaging modality is the best tool for detecting early ischemic stroke?

A

Diffusion weighted MRI (DWI) –> is better than CT and MRI FLAIR at detecting early ischemic changes

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

What test should be done if vasculitis is suspected (like in the elderly especially)?

A

ESR; also FANA

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

What are five other additional labs that my be run, depending on clinical suspicion of stroke etiology?

A
  1. RPR
  2. Coag profile
  3. Viscosity tests
  4. Homocysteine levels
  5. Urine drug screen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment for acute stroke if patient presents less than 4.5 hours from onset of symptoms?

A

IV tPA

16
Q

How should stroke be treated if patient presents between 4.5 - 6 hours of symptom onset?

A

Intra-arterial tPA

17
Q

What is treatment for stroke if patient presents over 8 hours after onset of symptoms?

A

Retrieve the clot with intra-arterial retrieving device

18
Q

When should vascular stenting or endarterectomy be performed as part of stroke prophylaxis?

A

When stenosis is affecting over 70% of artery lumen

19
Q

What is Rx tx for atherothrombotic stroke?

A

Anti-platelet drugs (aspirin, etc.)

20
Q

What is Rx tx for cardioembolic stroke?

A

Anti-coagulants

21
Q

What are prophylactic treatments of stroke generally aimed at?

A

Aimed at control of comorbid conditions that are risk factors for stroke –> meds to control HTN, DM, hyperlipidemia; also increase physical activity and stop smoking