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Emergency Med Exam 1 > Stroke & Syncope > Flashcards

Stroke & Syncope Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Definition of stroke?

A

Neurologic dysfunction secondary to cerebral infarct as evidenced by neuro-imaging or signs of permanent injury

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2
Q

Definition of TIA?

A

Transient episode of neurologic dysfunction w/o evidence of infarct, initially defined as return to baseline in <24hrs

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3
Q

What is penumbra?

A

Ischemic but not infarcted tissue, potentially viable if circulation is restored promptly

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4
Q

General definition of stroke/TIA?

A

Interruption of blood supply to an area of the brain (results in deprivation of O2 and nutrients to brain cells)

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5
Q

What causes an ischemic stroke?

A

Cerebral artery blockage

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6
Q

What is a thrombotic stroke (type of ischemic stroke)?

A

Formation of clot (thrombus) w/in a cerebral artery, usually as a result of atherosclerosis

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7
Q

What is an embolic stroke (type of ischemic stroke)?

A

Clot forms away from brain and is swept through the bloodstream/lodges in narrower brain arteries

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8
Q

Common causes of embolic stroke (type of ischemic stroke)?

A

A. fib, carotid atherosclerosis, PFO (patent foramen ovale), endocarditis

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9
Q

What causes a hemorrhagic stroke?

A

Arterial leakage or rupture secondary to HTN, AVM (arteriovenous malformations), anticoagulants, or aneurysm

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10
Q

Where is the leakage located in an intracerebral hemorrhage (type of hemorrhagic stroke)?

A

Vessel w/in the brain

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11
Q

Where is the leakage located in an subarachnoid hemorrhage (type of hemorrhagic stroke)?

A

Vessel on the surface of the brain

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12
Q

What causes the leakage from an aneurysm, AVM, malignancy (types of hemorrhagic stroke)?

A

Causes other than vessels w/in the brain or surface of the brain

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13
Q

S/Sx of stroke?

A

Confusion, dysarthria, hemiparesis, unilateral weakness (extremity, face), unilateral numbness, headache, non-orthostatic dizziness, loss of coordination, ataxia, visual field defect, carotid bruit

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14
Q

How to distinguish stroke from Bell’s palsy?

A
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15
Q

Which stroke is generally associated with headaches?

A

Hemorrhagic

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16
Q

diagrams –> watch lecture

A
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17
Q

Stroke patient hx?

A

Time of onset important (<3 hrs?, if unknown use “last known well”), prior hx of stroke/any chronic deficits, recent head injury, changes in meds (including disruption of ASA/anticoag), alcoholism, seizure d/o, migraine, recent infection, DM

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18
Q

What is the cincinatti stroke scale (PE)?

A
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19
Q

What is the NIH stroke scale (PE)?

A
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20
Q

What is HINTS testing (PE)?

A
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21
Q

What is a lacunar infarct?

A
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22
Q

Does an isolated lacunar infarct involve cortical sx?

A
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23
Q

Classic lacunar infarct syndromes/sx?

A
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24
Q

What is a watershed infarct?

A
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25
Q

What does a watershed infarct mostly result from?

A
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26
Q

What can a watershed infarct present with?

A
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27
Q

Tx for Watershed infarct?

A
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28
Q

Work-up for stroke?

A
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29
Q

Treatment for ischemic stroke if definitive <4.5 hrs?

A
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30
Q

Door to needle time for ischemic stroke?

A
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31
Q

What to consider for MCA occlusion with ischemic stroke?

A
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32
Q

What to do if fibrinolysis is C/I with ischemic stroke?

A
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33
Q

tPA C/Is?

A
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34
Q

Goal when treating stroke?

A
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35
Q

Treatment for hemorrhagic stroke?

A
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36
Q

What is the BJH stroke dysphagia screen?

A
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37
Q

Discharge planning for stroke?

A
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38
Q

What is a carotid/vertebral artery dissection?

A
39
Q

Causes of carotid/vertebral artery dissection?

A
40
Q

S/Sx of carotid/vertebral artery dissection?

A
41
Q

Work-up for carotid/vertebral artery dissection?

A
42
Q

Tx for carotid/vertebral artery dissection?

A
43
Q

What is syncope?

A
44
Q

What is pre/near syncope?

A
45
Q

What is lightheadedness?

A
46
Q

50% of initial incident syncope will not have _______ ________

A

Identifiable cause

47
Q

Nature of syncope <65 y/o?

A
48
Q

Nature of syncope >65 y/o?

A
49
Q

Nature of syncope in children?

A
50
Q

Hx for syncope (if witness available/per pt)?

A
51
Q

Exam for syncope?

A
52
Q

DDX for syncope?

A
53
Q

What is neurally mediated syncope?

A
54
Q

Cause of neurally mediated syncope?

A
55
Q

How to dx neurally mediated syncope?

A
56
Q

What is orthostatic syncope?

A
57
Q

Cause of orthostatic syncope?

A
58
Q

How to dx orthostatic syncope?

A
59
Q

What is cardiovascular syncope?

A
60
Q

Cause of cardiovascular syncope?

A
61
Q

How to dx cardiovascular syncope?

A
62
Q

What is POTS (postural orthostatic tachycardia syndrome)?

A
63
Q

30% of POTS pts have syncope, with the remainder having what variety of sx?

A
64
Q

Cause of POTS?

A
65
Q

What is Hypovolemic POTS?

A
66
Q

What is neuropathic POTS?

A
67
Q

What is hyperadrenergic POTS?

A
68
Q

What is autoimmune POTS?

A
69
Q

What is mast cell degranulation POTS?

A
70
Q

Hx of pts with POTS?

A
71
Q

PE findings with POTS?

A
72
Q

Diagnostic criteria for POTS?

A
73
Q

What to use in syncope work up if hypovolemia suspected?

A
74
Q

Most useful tool in work-up for syncope?

A
75
Q

Labs for syncope workup?

A
76
Q

What to use in syncope work up if suspicion of cardiovascular obstructive pathology?

A
77
Q

What to use in syncope work up if trauma secondary to episode or ICB high on differential?

A
78
Q

What to use in syncope work up to r/o seizure if suspected by hx?

A
79
Q

What to use in work up for syncope is POTS is suspected?

A
80
Q

Is CXR usually done in the work up for POTS?

A
81
Q

Assess EKG for syncope for what?

A
82
Q

What is hypertrophic cardiomyopathy?

A
83
Q

Causes of hypertrophic cardiomyopathy?

A
84
Q

Average age of dx for hypertrophic cardiomyopathy?

A
85
Q

MC cause of sudden death in yound adults?

A

Hypertrophic cardiomyopathy

86
Q

S/Sx of hypertrophic cardiomyopathy?

A
87
Q

Work-up for hypertrophic cardiomyopathy?

A
88
Q

Tx for hypertrophic cardiomyopathy?

A
89
Q

EKG?

A
90
Q

Clinical decision making tools for syncope?

A
91
Q

Admit for syncope when?

A
92
Q

Tx ______ _______ if possible with syncope

A
93
Q

Tx for symptomatic bradycardia, Vfib, Vtach?

A

Pacemaker and/or AICD

94
Q

Management of POTS?

A

Emergency Med Exam 1 (5 decks)

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