Anatomy and Physiology
What is the primary organ affected by stroke?
What is The Brain
A PCP who initiates a statin medication for a patient whose medical history includes type 2 diabetes and hypertension would be providing what type of stroke care?
What is Primary Prevention
What is the main reason why a CT scan is the first imaging study done in acute stroke?
What is CT scans are more readily available in the majority of hospitals, are significantly quicker, and are reliable in ruling out hemorrhage.
The recommendations for establishment of Primary Stroke Centers were published in 2001. Who wrote these recommendations?
What is the Joint Commission.
How often should patients with insulin drips have their blood glucose checked?
What is every hour.
The most common cardioembolic source from stroke is:
What is Atrial fibrillation
Atrial fibrillation is a common cause of stroke because it can result in clots forming in the "quivering" atria; these clots can flow through through the cerebral circulation. Endocarditis can produce emboli, but the tricuspid valve is located in the right side of the heart, and any emboli formed there would flow to the pulmonary system, not to the cerebral circulation
All of the following are nonmodifiable risk factors for stroke except for which one?
a) Age
b) Gender
c) Atrial fibrillation
d) race/ethnicity
What is atrial fibrillation
Atrial fibrillation can be modified-either correction to normal sinus rhythm or rate control and protection from clot formation with an anticoagulant.
Your stroke patient has just been ordered to have a video fluoroscopic swallowing exam. What is the provider looking for?
What is evidence of aspiration.
A video fluoroscopic swallowing exam involves having the patient swallow contrast material while a visualization is done with fluoroscopic equipment.
During NIHSS scoring, your patient has intact sensation when each side is stimulated individually, but is unaware of being touched on the left side when both sides are stimulated simultaneously. What condition is apparent?
What is extinction.
Extinction is the result of parietal lobe damage and is characterized by the inability to discern stimulation on the side contralateral to the infarct when stimulated on both sides simultaneously.
For Mr. Paine, which prescribed home medication might be responsible for his dry, nonproductive cough?
What is Lisinopril.
Someone who cannot understand what is said to them has had an infarct in what part of the brain?
What is the Temporal Lobe
The temporal lobe is where Wernicke's area is. It is responsible for receptive speech. Someone with damage to this area might have trouble understanding written or spoken language.
Stroke incidence has remained steady at 800,000 new and recurrent strokes/year, despite the decrease in stroke among people aged 65 to 84 years old. Which age group has shown the biggest increase in stroke incidence?
What is individuals aged 25-44 years of age. A recently published review of 2000-2010 data has shown a surprising rise in stroke incidence in people aged 25-44 years. Contributing factors include increased prevalence of type 2 diabetes, high cholesterol as well as cigarette smoking and alcohol abuse.
Why is an echocardiogram done during acute hospital stays for acute stroke?
What is to rule out cardioembolic cause of stroke.
Up to 30% of ischemic strokes are cardiac related so an echocardiogram is an essential component of acute stroke workup.
What term refers to the loss of half of the field of view on the same side in both eyes?
What is homonymous hemianopsia.
Your patient just returned from having a CT angiogram. You might have an order to hold which medication for 48 hours?
What is Metformin.
Historically, metformin has been held after IV contrast to avoid kidney burden while the contrast was being excreted.
Locked-in syndrome refers to a stroke in which area of the brain?
What is the Pons.
The pons is located between the midbrain and medulla and serves as a communication and coordination center between the cerebrum and the cerebellum. Damage results in paralysis in the body and most of the facial muscles, but consciousness remains and the ability to perform certain eye movements is preserved.
You are providing discharge education for your 30-year-old female TIA patient. Her workup has not revealed a clear etiology for the TIA. Which of the following scenarios would be most concerning to you?
a) occasionally has 3-4 beers a day and she is a 1 pack-per-day smoker
b) Her husband asks if he needs to stop smoking marijuana in the same room
c) Her history includes that she takes a birth control pill and she is a 1 pack-per-day smoker
d) She asks you if she will need to take aspirin for the rest of her life because she hates feeling like an old lady.
The combination of birth control pills and smoking is proven to be a significant risk for stroke, so that is the most important factor to address.
The Brain Attack Coalition set separate standards for door-to-CT scan initiation and results. What is the standard for door-to-CT and door-to-results time recommendation?
What is door-to-CT in 25 minutes and door-to-results in 45 minutes
A small patent foramen ovale (PFO) is discovered on an ischemic stroke patient's echocardiogram. Minimal right to left shunting is seen with the Valsalva maneuver. What is the treatment for this patient?
What is aspirin and Warfarin
Headache occurs in up to 40% of patients taking this medication.
What is Dipyridamole/aspirin (Aggrenox).
A stroke between two adjacent cerebral arteries is known as a/an:
What is a Watershed infarct.
Watershed infarct refers to stroke in the watershed territory--the space between two adjacent cerebral arteries-which is supplied by tiny penetrating vessels that the first to collapse in the setting of hypoperfusion.
Over the decade 1998 through 2008, the rate of first stroke among people over age 65 years decreased by 30-40%. Increased use of which two treatments has been credited with contributing to this decline?
What is the control of cholesterol and hypertension
Control of cholesterol and hypertension has been the largest contributor to the reduced incidence of stroke in the older than 65-year age group.
A patient who had a cerebral angiogram this morning has become diaphoretic and is complaining of lower abdominal pain and back pain. Based on this information, what condition do you expect?
An uncommon, but serious complication of angiography is possible arterial tear, with bleeding into the retroperitoneal area. This would produce the symptoms of back pain and abdominal pain.
Which cranial nerve is being assessed when you ask your patient to raise their eyebrows?
What is cranial nerve VII.
CN VII, the facial nerve, is involved in smiling and raising eyebrows; CN III, the oculomotor nerve, is involved in eye movements; CN I, the olfactory nerve, is involved in smell; and CN XII, the hypoglossal nerve, is involved in tongue movement.
On what schedule will a patient who received alteplase have vital signs and neurologic checks monitored?
What is every 15 minutes for 2 hours, then every 30 minutes for 6 hours, then hourly for 16 hours.