Topel

Question 1

Timing 0-5 min

Answer 1

NIHSS
CT interpretation

Question 2

Timing 5-10 min

Answer 2

CTA interpretation
TNK / MER decision

Question 3

Timing 10-15 min

Answer 3

BP goals
Head of bed flat (ischemic) or >30 ° (hemorrhagic)
NS 75 ml/h or bolus 500 ml
Complete dysphasia screen
ASA +/- clopidogrel

Question 4

History for stroke

Answer 4

Right or left handed
What do they do for living
Have they had previous stroke? What deficits do they have?
Who is their PCP?
Smoke, drugs?
Where do they live? With whom? Support?

Question 5

Documentation

Answer 5

Natural or artificial lens?
EKG
Why do they have a medical problem- HTN, DM

Question 6

Interpretation of CTA

Answer 6

Vertebral dominance and patency
Basilar patency, circle of Willis, presence of fetal PC comm
Carotid patency
Cerebral vessels patency

Question 7

Metabolic syndrome

Answer 7

> 2
Triglycerides >150
HDL <40 m <50 fem
BMI >40 m >35 fem
BP >130/90
A1c >6.5%
Fasting glucose >100

Question 8

When to start insulin in an insulin naive patient

Answer 8

A1c>9
Fasting glucose >200

Question 9

How to start insulin in an insulin naive patient

Answer 9

0.2 units /kg of long acting or
10 units (whatever is less)