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PAR3011 - MEDICAL > Week 4 > Flashcards

Week 4 Flashcards

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USMLE® Step 1 flashcards
1
Q

Where does most brain blood flow come from?

A

80% from internal carotid arteries which feed the circle of willis

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2
Q

what brain circulation feeds optic nerves, frontal, parietal and temporal loads?

A

Anterior circulation

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3
Q

What part of brain circulation provides 20% of the supply?

A

Posterior circulation

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4
Q

What parts of the brain does the basilar arteries feed?

A

gives off arteries to the cerebellum, brain stem, thalamus, occipital lobe, temporal lobe

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5
Q

what area is responsible for touch, proprioception, pain, itching, tickle, thermal?

A

Primary somatosensory area

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6
Q

what area is responsible for controlling voluntary muscle contractions?

A

Primary motor area

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7
Q

what area is responsible for control of sequential contraction of specific muscle eg writing, speaking

A

Premotor area

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8
Q

what area is responsible for speaking and understanding speech?

A

Broca’s area

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9
Q

what area is responsible for recognition of shape, colour and movement of visual stimuli

A

primary visual area

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10
Q

what area is responsible for interpreting the meaning of speech and recognising spoken word

A

Wernicke’s area

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11
Q

how much of the bodies volume does the brain represent?

A

2%

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12
Q

how much cardiac output does the brain require?

A

15-20% of total resting cardiac output to supply needed glucose and O2 for normal metabolism

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13
Q

Define a stroke?

A

Any disturbance of cerebral function (>24hours) caused by abnormalities of blood vessels

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14
Q

What are the 3 types of stroke

A
  • Hemorrhagic stroke
  • Ischaemic stroke (can be thrombotic of embolic clots or hypoperfusion)
  • Transient ischaemic attack
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15
Q

WHat are the causes of an ischaemic stroke?

A
  • thrombotic
  • embolic
  • hypo perfusion
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16
Q

what are the caused of a hameorrhagic stroke?

A
  • intercerebral
  • subarachnoid
  • extradural
  • subdural
17
Q

what percentage of strokes do ischaemic strokes account for?

A

85%

18
Q

what is the most common cause of ischaemic stroke?

A

atheroscleoris

19
Q

what are some common sites of ischaemic strokes?

A
  • carotid bifurication
  • origin of MCA
  • both ends of basilar artery
20
Q

How quickly does cell death occur with ischaemic stroke?

A

1.9milli/min

21
Q

what causes 50% of all haemorrhagic strokes?

A

hypertension

  • accelerates atherosclerosis
  • other damaging effects
22
Q

what are some S&S for Subarachnoid Haemorrhgae?

A
  • sever sudden onset headache
  • neck stiffness
  • photophobia
  • low back pain (due to inflammatory response)
  • Nausea & vomitting (increased ICP & Meningeal irritation
  • May have altered LOC
  • 10-25% suffer siezures

Some people have symptoms up to 10-20 days before rupture

23
Q

What is GRADE ONE of the 5 grades of subarachnoid hamorrhage?

A

– Grade I: Mild headache with or without meningeal irritation

24
Q

What is GRADE TWO of the 5 grades of subarachnoid hamorrhage?

A

Grade II: Severe headache and a nonfocal examination, with or without mydriasis

25
Q

What is GRADE THREE of the 5 grades of subarachnoid hamorrhage?

A

Grade III: Mild alteration in neurologic examination, including mental status

26
Q

What is GRADE FOUR of the 5 grades of subarachnoid hamorrhage?

A

Grade IV: Obviously depressed level of consciousness or focal deficit

27
Q

What is GRADE FIVE of the 5 grades of subarachnoid hamorrhage?

A

Grade V: Patient either posturing or comatose

28
Q

what is a TIA?

A

TIA is a transient episode of cerebral or retinal dysfunction (amaurosis fugax)
• Results from inadequate supply of blood to the brain
• Lasts less than 1 hour
• A stroke warning sign

29
Q

What are symptoms of a TIA?

A

– Temporary hemipegia (unilateral weakness)
– Hemiparesis (altered sensation on one side of the body)
– Dysphagia or aphasia (difficulty or inability to speak)
– Visual loss
– Ataxia (altered balance or co-ordination)
– Vertigo

30
Q

AFter a TIA, what is the liklinhood that a patient will have a stroke?

A

20%

half of those will occur within 48 hours

31
Q

If you have a stroke on your right side of your brain ,wjhat symtoms may you show?

A

– Problems with movement on the left side of the body
– Lack of feeling on the left side of the body
– Trouble thinking clearly, solving problems or
concentrating
– Impulsive behaviour
– Trouble estimating distance, size, position, or shapes
– Decreased facial expression or difficulty maintaining
eye contact

32
Q

If you have a stroke on your LEFT side of your brain ,wjhat symtoms may you show?

A

– Problems with movement or no movement on
the right side
– Lack of feeling to the right side of the body
– Trouble speaking, understanding what others
are saying
– Trouble reading, writing or listening

33
Q

If you have a stroke on your CEREBELLUM of your brain ,wjhat symtoms may you show?

A 
– Dizziness
– Loss of balance
– Loss of co‐ordination
– Slurred speech
– Nausea & vomiting
34
Q

If you have a stroke on your BRAIN STEM of your brain ,wjhat symtoms may you show?

A

• The brain stem connects the 2 hemispheres
with the spinal chord. As a result a stroke in the
brain stem may affect both sides of the body.

• The brain stem also helps control speech,
swallowing, eye movements, breathing, heart
rate & blood pressure.

• Some of the changes in a brain stem stroke
include:
– Coma
– Total paralysis of both sides of the body
– Problems with speech
– Problems swallowing
– Double vision
– Nausea & vomiting
– Hiccups
35
Q

What are some clinical features of a stroke?

A
  • limb weakness or paralysis
  • facial paralysis
  • sensory loss
  • slurred speech (dysarthria)
  • Inappropriate or jumbled speech (dysphasia)
  • Visual loss (hemianopia)
  • Gaze deviation
  • Poor balance, unsteady gait (ataxia)
  • Difficulty swallowing (dysphagia)
  • Double vision (diplopia)
  • 80-90% have some motor deficit at stroke onset
36
Q

What are some stroke mimics?

A
  • Electrolyte disturbances (Na+, K+, Ca2+)
  • Hypoglycaemia or hyperglycaemia
  • Seizures (absence, post ictal states)
  • CNS infections (encephalitis)
  • Brain tumour
  • Syncope
  • Middle ear (vestibular) disorders
  • Stress
  • Migraine
  • Systemic infection (sepsis)
  • Intoxication (drugs or alcohol)
  • Trauma (subdural haematoma)
37
Q

What is the national institute of stroke scales?

A

 Used for all patients with a stroke.
 Is a tool used to assess 11 elements of neurological impairment.
 Originally used as a research tool is now the Gold Standard for stroke measurement.
 It measures neurological function and helps to determine stroke severity

38
Q

what is the criteria for thrombolysis

A

– Clear onset of ischaemic stroke symptoms within the
preceding 4.5hrs

– Measurable and clinically significant deficit as assessed
by the Medical Registrar in discussion with either the
stroke Physician or the Physician on call.

– Pt’s CT does not show haemorrhage or non‐vascular
cause of stroke.

PAR3011 - MEDICAL (32 decks)

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