Stroke Flashcard 2
Rationale
B. Rationale: The NINDS recommends the following interventions once a suspected stroke patient has reached the ED: (1) general assessment (10 minutes), (2) neurologic assessment with CT scan (20 minutes), (3) CT scan interpretation (45 minutes), (4) fibrinolytic therapy (60 minutes), and (5) admission to stroke unit (180 minutes). (Case: Suspected Stroke)
Question
According to the National Institute of Neurological Disorders and Stroke (NINDS), the critical timeframe for obtaining a head CT scan for a patient with a suspected stroke after arrival in the emergency department is:
a. 10 minutes
b. 20 minutes
c. 45 minutes
d. 60 minutes
Answer
b. 20 minutes
Rationale
A. Rationale: Intracranial hemorrhage is a potential adverse effect of fibrinolytic therapy. Bleeding may occur anywhere in the body and may range from minor to major.
Question
Adverse effects of fibrinolytic therapy in stroke may include:
A. Intracranial hemorrhage
B. Hypertension
C. Tachycardia
D. Hypokalemia
Answer
A. Intracranial hemorrhage
Rationale
B. Rationale: An abnormal arm lift is seen when one arm does not move, or one arm drifts downward in comparison with the other.
Question
An abnormal arm drift is when one arm drifts up and the other arm drifts down.
a. True
b. False
Answer
b. False
Rationale
A. Rationale: Acute stroke is the sudden loss of function secondary to decreased blood perfusion in some parts of the brain. This causes symptoms such as slurred speech, facial drooping, or weakness in the extremities. Sometimes, the patient will have difficulty with comprehension or speech.
Question
An acute ischemic stroke is made apparent by the sudden loss of function:
a. Secondary to decreased perfusion in some parts of the brain
b. Secondary to extravasation of blood into the intracranial spaces
c. Following a traumatic brain injury
d. Due to the iatrogenic effects of anesthetics or intracranial surgery
Answer
a. Secondary to decreased perfusion in some parts of the brain
Rationale
A. Rationale: Approximately 80% of strokes are ischemic, and these patients are potentially eligible for fibrinolytic therapy if they meet qualifications. About 20% of strokes are hemorrhagic, and anticoagulants and fibrinolytic therapy should be avoided in these patients.
Question
Approximately what percentage of strokes are ischemic, making these patients eligible for fibrinolytic therapy?
A. 80%
B. 50%
C. 60%
D. 20%
Answer
A. 80%
Rationale
D. Rationale: Hyperglycemia is associated with worse clinical outcomes in patients with acute ischemic stroke, although there is no evidence to show that control of glucose levels improves outcomes. Seizure prophylaxis is not recommended, but treating seizures followed by administering anticonvulsants to prevent further seizures is recommended. Oxygen should be administered to maintain an SPO2 ≥ 94%. Beta-blockers may be used to control blood pressure in patients who are potential candidates for reperfusion therapy.
Question
Choose the CORRECT statement regarding general stroke care:
A. Seizure prophylaxis is recommended for patients with acute ischemic stroke.
B. All patients with ischemic stroke should have oxygen administered at 15 L/min to optimize cerebral oxygenation.
C. Beta-blockers are contraindicated in patients with acute ischemic stroke.
D. Hyperglycemia is associated with worse clinical outcomes in patients with acute ischemic stroke.
Answer
D. Hyperglycemia is associated with worse clinical outcomes in patients with acute ischemic stroke.
Rationale
D. Rationale: Do not give aspirin until the CT scan has ruled out hemorrhage.
Question
ED providers should do all of the following except:
a. Obtain a 12-lead ECG
b. Perform a neurologic assessment using the NIH Stroke Scale
c. Activate the stroke team
d. Give aspirin
Answer
d. Give aspirin
Rationale
B. Rationale: Exclusion criteria include age > 80 years and a history of both diabetes and prior ischemic stroke.
Question
Exclusion criteria for rTPA in patients with stroke include:
a. Age > 70 years
b. NIHSS > 25
c. History of diabetes
d. All of the above
Answer
b. NIHSS > 25
Rationale
B. Rationale: The exclusion criteria include heparin received with 48 hours.
Question
Exclusion criteria for rTPA treatment in patients with stroke include all of the following except:
a. Arterial puncture at non compressible site within previous 7 days
b. Administration of heparin within 7 days
c. Blood glucose concentration of < 50 mg/dL
d. CT scan demonstrates multilobar infarction (hypodensity > 1/3 of cerebral hemisphere)
Answer
b. Administration of heparin within 7 days
Rationale
B. Rationale: A patient presenting with facial droop, arm weakness, and abnormal speech will have an 85% chance of having an acute stroke.
Question
Facial droop, arm weakness, and abnormal speech are clinical signs of an acute stroke. When all three symptoms are present, what is the probability that the patient is likely to have acute stroke?
a. 72%
b. 85%
c. 93%
d. 99%
Answer
b. 85%