stroke osce

Question 1

what is a stroke?

Answer 1

focal global disturbance of cerebral function lasting more than 24 hours, with no other apparent causes other than vascular origin

Question 2

risk factors?

Answer 2

AF, heart failure, HTN, diabetes, MI

Question 3

infarction make up what percentage ?

Answer 3

85%

Question 4

haemorrhage make up what percentage

Answer 4

15

Question 5

most haemorrhagic strokes due to ?

Answer 5

rupture of berry aneurysm

Question 6

what are berry aneurysms associated with?

Answer 6

polycystic kidney disease

Question 7

how does a stroke present?

Answer 7

sudden (over minutes)

Question 8

quick, easy way of recognising a stroke advertised to public?

Answer 8

FAST 
face 
arms 
speech 
time

Question 9

what examination should you do?

Answer 9

Pulse (rate ad rythym) 
BP 
heart murmurs and bruits 
assess conscious level 
exclude hypo

Question 10

differential for a stroke?

Answer 10

space occupying lesion, trauma, epilepsy, migraine

Question 11

where should patients suspected of having a stroke be admitted to ?

Answer 11

specialised stroke unit

Question 12

aftercare of a stroke?

Answer 12

secondary care, psychosocial issues, aids and appliances,

Question 13

seondary prevention of ischaemic stroke

Answer 13

given drugs to reduce change of having another stroke
in particular, lower blood pressure, statin to keep cholesterol down, possible carotid endarectomy
if in AF - anticoagulation

Question 14

what should all patients have within a week?

Answer 14

carotid imaging and offered endarectomy if necessary

Question 15

TIA defintion ?

Answer 15

focal or global disturbance lasting less than 24 hours

Question 16

risk scoring for TIA?

Answer 16

ABCD2

Question 17

what does ABCD2 stand for?

Answer 17

age 
blood pressure
clinical features 
diabetes 
duration

Question 18

a patient is at high risk if ABCD2 score of?

Answer 18

4 or more

Question 19

if they have an ABCDD score of more than 4, what management should they get?

Answer 19

should get specialist assessment within 24 hours

Question 20

if lower ABCD2 score, what should you do?

Answer 20

specialist assessment within a week

Question 21

investigations for stroke?

Answer 21

bloods 
ecg 
echo 
brain imaging 
carotid dopplers

Question 22

when do you start secondary prevention?

Answer 22

once haemorrhagic has been ruled out

Question 23

what is given as secondary prevention ?

Answer 23

aspirin

start anti coagulation if identified potential causes of thromboemboli