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Stoke & Vascular > Stroke Rehab > Flashcards

Stroke Rehab Flashcards

1
Q

Where is Broca’s located?

A

inferioir frontal gyrus
Frontal lobe

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2
Q

Where is Wernicke’s area located?

A

superior temporal gyrus
Temporal lobe

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3
Q

What lung is likely to aspirate?

A

Right - angle & larger bronchus

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4
Q

What is subluxation of the shoulder & why does it happen in stroke?

A

Dislocation - happens as muscle no longer takes the wait

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5
Q

What is baclofen? What is it used for?

A

It is a GABA agnoist and is used to reduced spacitiy

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6
Q

Where is the cerebellar located?

A

Posterior inferior region
supplied by;
superior cerebellar artery - basialr
inferior anterior - from basialr
inferior posterior artery - from the vertebral artery

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7
Q

What produces the CSF?

A

choroid process

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8
Q

What is the key difference in cerebellar strokes?

A

They are ipsilateral - they affect the side they are on

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9
Q

What does the cerebellum do?

A

Coordination & balance

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10
Q

What would you see in examination

A

Nystagmus - rhythmic oscilations
Rub leg up & down shin
Touch nose to your finger - they would miss - potenitally tremor

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11
Q

What is a VP shunt

A

Ventricular-Peritoneum shunt
Used to allow CSF to leave the skull down to the peritoneum

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12
Q

What does hydrocephalus look like on a CT?

A

blockage in 4th ventricle in the base - so lateral ventricles look wider
Increased ventricular pressure causes the septum pellucidum to look thinner

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13
Q

What is the MOA of edoxaban, rivaroxaban, apixaban?

A

Factor Xa inhibitor
this inhibits cleavage of prothrombin to thrombin

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14
Q

What predisposes to Intracerebral bleed?

A
  • HTN
  • Trauma
  • After Thrombolysis
  • Cerebral amyloid angiopathy
  • Charcot-Bouchard Aneurysm
  • Alcholism - damage to the liver affecting coagulation
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15
Q

What is the ‘antidote’ of direct inhibitors of factor Xa

A

Andexanet alfa

Xa inhibtors - rivaroxban, apixaban, edoxaban

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16
Q

What is the MOA of Dabigatran & its ‘antidote’?

A

Direct inhibitor of factor IIa
Both clot-bpund & free thrombin
antidote- Idarucizumab

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17
Q

What is the MOA of Warfarin?

A

Inhibits the reduction of Vit K
prevents the y-carboxylation of glutamate so inhibits factos II, VII, IX & X

to remember; II plus VII = IX and then X

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18
Q

What is the MOA of Heparin?

A

Accelarates the action of antithrombin III increasing inactivation of factors IIa and Xa
Smaller effect on IXa, XIa & XIIa

19
Q

What is another name for factor IIa

A

Thrombin

20
Q

What is the MOA of low-molecular weight heparin

e.g. dalteparin

A

Accelarates the action of antithrombin III increasing inactivation of factor Xa

21
Q

What monitoring is needed with Warfarin?

A

INR
this is derived from Prothrombin time

22
Q

How is Heparin given? Why?

A

BY SC or IV due its short halflife of 40-90 min

23
Q

What monitoring is needed in Heparin?

A

Dosage is adjusted according to activated partial thromboplastin time (APTT)

24
Q

What is a heparin or dalteparin overdose treated with?

A

Protamine sulfate

25
Q

What are 2 key side effects of anticoagulants?

A

Bleeding
Thrombocytopaenia

26
Q

What do you do in major bleeding when on Warfarin?

A

Stop Warfarin
Administer IV Vit K
Prothrombin complex or fresh plasma

27
Q

What do you do in high INR 5-8 on Warfarin?

A

Stop Warfarin
5-8 with minor bleeding - give slow IV of Vit K
5-8 with no bleeding - withhold a few doses & reduce maintenance dose
Restart Warfarin when INR <5

28
Q

What do you do if INR >8 on Warfarin?

A

> 8INR with no bleeding
Stop warfarin & give oral vit K
8INR with minor bleeding
Stop Warfarin, give a slow IV of Vit K

Dose of Vit K can be repeated in 24hrs if INR still high
Restart Warfarin when INR <5

29
Q

What is the MOA of Aspirin?

A

COX inhibtor in the prostaglandin synthesis pathway.
Lowdoseinhbits COX-1 and so platelet aggregation (TXA2)
At larger doses it can also inhibt COX-2

30
Q

What are oral thienopyridines?

A

Clopidogrel, Ticagrelor, Ticlopidine, Prasugrel#
They selectively inhibt adenosine diphosphate-induced platelet aggregation

31
Q

How do anticoagulants work?

A

They act at different sites of the coagulation cascade

32
Q

What is a carotid endartecetomy?

A

Carotid stenosis is removed using a fogarty catheter to reduce risk of stroke

33
Q

What must apply for a carotid endarterectomy?

A
  • high degree of internal carotid artery stenosis - more than 50%
  • Patient is expected to survive 2 years
  • less than 3/5% of stroke or death
34
Q

What drugs should a patient be on post stroke?

A
  • Clopidogrel 75mg OD
    Aspirin if not tolerated
  • Atorvastatin 20-80mg OD
  • If secondary to Afib - Warfarin or DOAC - 2 weeks post stroke
  • Antihypertensive if HTN - 2 weeks post stroke
35
Q

Who is considered for Carotid endarterectomy?

A

Patients who have had a stroke or TIA

36
Q

What lifestyle advice should you offer post stroke?

A
  • increased physical activity - stroke rehab programme
  • Smoking cessation
  • Diet - low salt, reduced saturated facts, fish twice a week
  • reduce alcohol intake
37
Q

What is dysphagia?

A

difficulties swallowing

38
Q

What is spasticity?

A

increased tone & reflexesdue to loss of inhibtion in upper motor neurons

39
Q

What is a risk due to dysphagia?

A

An Aspiration Pneumonia
Difficulties in swallowing leads to food & drink entering the airway

40
Q

How should Dysphagia be managed?

A

SALT assessment within 72hrs
Barium swallow or Fibreoptic evaluation of swallow

41
Q

What are alternative methods of feeding?

A
  • NG tube with Bridle
  • Percutaneous endoscopy gastrostomy (PEG)
  • Radiologically inserted percutaneous gastrostomy (RIG)
42
Q

Why is there an increased risk of DVT post stroke?

A

Motor weaknes leads to venous stasis in the lower limbs.
This can also lead to a PE

43
Q

How can Spasticity be managed?

A

Stretching affected limbs
Splints
Baclofen
Botox

Stoke & Vascular (5 decks)

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