Nb3 Clinical Stroke And Coma Lecture

Front 1

Carotid Symptoms in stroke include
weakness on which side?
what kind of visual loss?
Dominant and Nondominant hemisphere signs?

Back 1

Contralateral Weakness
Ipsilateral Monocular Visual Loss or Contralateral Hemianopia
Dominant- dysphasia
Non-dominant- neglect

Front 2

Vertebrobasilar Symptoms of stroke include
Motor/sensory?
Visual?
Gait?

Back 2

Unilateral or Bilateral long tract signs
Diplopia along with unilateral or bilateral visual field defects
Ataxia

Front 3

FDA approves rt-PA therapy if stroke onset is less than ___ hours
Blood Pressure is less than ___
There is no risk for

Back 3

Onset less than 3 hours
BP < 185/110
No risk for bleeding

Front 4

If a patient would be a tPA candidate if blood pressure were not too high, what can be given to bring it down?

Back 4

If it's over 185/110 can give labetolol to bring it down (can also use nitroglycerine though not common)

Front 5

How does Aspirin work

Back 5

Irreversibly inhibits COX1 and COX2, affects PGI2 and TXA2

Front 6

What kind of therapy is Dipyridamole used in and how does it work
Usually given with

Back 6

Antiplatelet therapy
Inhibits phosphodiesterase and adenosine reuptake
given with aspirin no increase in bleeding

Front 7

How do Thienopyridines (ticlopidine and clopidogrel) work

Back 7

irreversibly inhibit ADP induced exposure of fibrinogen binding

Front 8

Name appropriate first line antiplatelet therapies

Back 8

Aspirin
Aspirin with Dipyridamole
clopidogrel

Front 9

ASA/clopidogrel has a high risk of

Back 9

Hemorrhage

Front 10

Heparin is in the class of ___ and works by

Back 10

Class of Anticoagulants
works by increased inactivation of:
IXa-XIIIa
thrombin
Killikrein
AT III

Front 11

What reverses the action of heparin

Back 11

protamine

Front 12

How does Warfarin work

Back 12

inhibits synthesis of vitamin K dependent factors (II VII IX X protein C)

Front 13

How do you reverse warfarin

Back 13

vitamin K, FFP, or PCC

Front 14

How does Dibigatran work

Back 14

direct thrombin inhibitor

Front 15

What are the best indications for an anticoagulant

Back 15

secondary prevention of cerdioembolitc stroke
Primary stroke prevention in atrial fib

Front 16

Treatment for intracranial hemorrhage includes

Back 16

Antihypertensive therapy
Reversion of coagulopathy (use FFP/ vitamin K or PCC)

Front 17

hemorrhage is similar to ischemic stroke with the exception of these presentations

Back 17

Head ache, altered consciousness usually more prominent w hemorrhage

Front 18

Cheyne-Stokes is seen with

Back 18

Disorders of both hemispheres, seperation of brainstem respiratory centers from hemispheres

Front 19

Apneustic breathing is due to lesion in the

Back 19

low pons

Front 20

Cluster breathing due to lesion in the

Back 20

low pons, upper medulla

Front 21

Ataxic breathing may be due to lesion in the

Back 21

medulla

Front 22

With a thalamic lesion the pupils are

Back 22

small, uncreactive

Front 23

Describe pupils in pontine vs medullary lesion

Back 23

Pontine- pinpoint, reactive
Medulla- large unreactive

Front 24

If patient is comatose which oculovestibular eye movment is lost

Back 24

the fast phase of nystagmus

Front 25

In a comatose patient with an intact brain stem, which way do the eyes move with cold water irrigation in the ear

Back 25

Eyes move to side with cold water

Front 26

Presence of a gag and corneal reflex can indicate that the ___ is intact

Back 26

brainstem

Front 27

A permanent vegetative state is defined if it lasts how long following trauma and how long following nontrauma

Back 27

>1 yr if tramatic
> 3 months if nontraumatic