NIHSS Scoring
A patient has complete left arm paralysis but can move other limbs. The NIHSS motor arm score for the LUE would be what?
A. (1)
B. (7)
C. UN
D. (4)
D. (4) No movement
Weakness that predominantly affects the leg more than the arm suggest involvement of what artery?
A. ACA
B. MCA
C. ICA
D. Basilar
A. ACA
What imaging is required first when a patient develops focal neurologic deficits or “the worst headache of my life”
A. CTA- head and neck
B. MRI - brain without contract
C. NC-CT head
D. TCD
C. NC-CT head
Patients receiving thrombolytics must have what BP parameters for 24 hours?
A. SBP/DBP 180/105 mmHg
B. SBP/DBP 185/110 mmHg
A. SBP/DBP 160/105 mmHg
A. SBP/DBP 160/90 mmHg
A. SBP/DBP 180/105 mmHg
A nurse reports on COPD exacerbation patient, suddenly lost vision while eating lunch and only ate food on the left side of their plate. What is your next step?
A. Call Neurosurgery STAT
B. Activate stroke alert
C. Document in your note
D. Order STAT MRI to rule out stroke
B. Activate stroke alert
This finding would score a “2” on the gaze item on the NIHSS?
A. Complete Homonymous hemianopia
B. Partial Homonymous hemianopia
C. Unable to assess
A. Complete Homonymous hemianopia
What deficit is a classic sign of a PCA stroke?
A. Ipsilateral ptosis
B. Anosmia
C. Aphasia
D. Homonymous hemianopia
D. Homonymous hemianopia
A CT shows a basal ganglia hemorrhage. What do you suspect the etiology is?
A. Smoking
B. Migraines
C. Hypertension
D. Hyperlipidemia
C. Hypertension
After TNK administration, your patient develops tongue swelling, what do you suspect?
A. Hemorrhage of the brain
B. Kidney Failure
C. Angioedema
D. Pulmonary embolism
C. Angioedema
After a stroke alert and neurology assessment it is determined that the inpatient is a candidate for thrombolytics; as an IM resident at Guthrie what do you do next?
A. Administer TNK on the M/S floor
B. Order thrombolytic and admit to ICU
C. Escalate communication to a fellow or attending for thrombolytic care
D. Do nothing
C. Escalate communication to a fellow or attending for thrombolytic care
This NIHSS section evaluates comprehension, naming and repetition.
A. Dysarthria
B. Best Language assessment
C. Extinction and Inattention
B. Best Language assessment
A patient has clinical symptoms of “locked in syndrome” likely has ischemia in what area?
A. Left MCA
B. Ventral pons
C. Basilar
D. All of the above
B. Ventral pons
What is best practice for head of bed position to help reduce ICP?
A. Trendelenburg
B. HOB elevation 30 degrees
C. HOB flat supine
D. HOB elevation 90 degrees
B. HOB elevation 30 degrees
Clinical practice guidelines from the American Heart Association recommend what medications for blood pressure management for the patient with ischemic and/or hemorrhagic stroke.
A. Esmolol and Hydralazine
B. Labetalol and Hydralazine
C. Nicardipine and Labetalol
D. Labetalol and Atorvastatin
C. Nicardipine and Labetalol
What disability screening tool needs to be documented in the d/c summary for the stroke/ TIA patient?
A. Richmond agitation sedation scale (RASS)
B. Modified rankin scale (MRS)
C. Hestia score
D. ABCD2
B. Modified rankin scale (MRS)
400: What item in the NIHSS cannot be scored if the patient has notable weakness in an extremity?
A. Best Language
B. Inattention
C. Ataxia
D. Extinction
C. Ataxia
Contralateral upper extremity > lower extremity weakness, sensory loss with homonymous hemianopia and global aphasia typically indicates occlusion of this vessel?
A. Right MCA
B. Left MCA
C. Right PCA
D. Left PCA
B. Left MCA
Understanding clinical practice guidelines from the American Heart Association, what are the preferred BP guidelines for the patient with hemorrhagic stroke?
A. SBP 130-150 mmHg
B. SBP <160 mmHg
C. SBP <130 mmHg
D. SBP 180/ DBP 105
A. SBP 130-150 mmHg
Certain Large vessel occlusions may be treated with this procedure to remove the clot up to 24-48 hours in selected cases?
A. Mechanical Thrombectomy
B. Echocardiogram
C. Craniotomy
D. CABG
A. Mechanical Thrombectomy
What is the frequency of monitoring VS (BP) and Neuro checks for the post TNK ischemic stroke patient in the acute phase?
A. Q30 min x 8 hours then Q1 hr x 16 hours
B. Q15 min x 4 hours then Q4 hr x 20 hours
C. Q15 min x 2 hours, Q30 min x 6 hours then Q1 hr x 16 hours
D. Q1hr x 24 hours
C. Q15 min x 2 hours, Q30 min x 6 hours then Q1 hr x 16 hours
An ICU nurse is asking how to obtain the “Best gaze” item on an intubated patient on a propoful gtt, what do you tell them?
A. "It's ok, leave it blank".
B. "Hold propofol infusion x 15 minutes and perform oculocephalic reflex (dolls eyes)"
C. "Perform oculocephalic reflex"
D. "Perform visual threat"
B. "Hold propofol infusion x 15 minutes and perform oculocephalic reflex (dolls eyes)"
Where would you expect to localize a stroke with deficits including pure motor without sensory?
A. Lacunar infarct in internal capsule
B. Left MCA temporal lobe
C. Left lateral pons
A. Lacunar infarct in internal capsule
In aneurysmal SAH, this BP goal is often used prior to aneurysm securement.
A. SBP <160 mmHg
B. SBP <180 mmHg
C. SBP <130 mmHg
D. SBP <170 mmHg
A. SBP <160 mmHg
What is the ischemic cerebellar stroke most at risk for?
A. Hydrocephalus and Hemorrhagic conversion
B. Pituitary enlargement
C. AFIB in addition with STEMI
D. Cerebral edema and Herniation. Monitor in ICU for 72-96 hours
D. Cerebral edema and Herniation. Monitor in ICU for 72-96 hours
Why is hypotension (MAP <65 mmHg) dangerous in ischemic or hemorrhagic strokes?
A. Reduced collateral blood flow to the penumbra
B. Acute kidney injury
C. Risk of vasospasm
D. A and C
A. Reduced collateral blood flow to the penumbra