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Flashcards in Neurology Deck (280)
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61

If TIA and carotid 90% inoperable wtd?

Stent

62

Pt with TIA and cardid US with <50% wtd?

ASA + dipyrimadamole OR plavix

63

Pt h/o TIA no PAD - best management

ASA - can add ACE+- indapamide to decrease recurrence

64

Pt has TIA on ACEi, ASA and statin

d/c ASA and start Plavix
don't use both unless has CAD with stent also

65

Endartectomy vs stent

Endartectomy better mortality, less stroke,
Stent better with high carotid bifurcation

66

Pt with TIA found to have afib

start warfarin

67

Pt with CA going for CABG - what other w/u needed?

Carotid US
If significant stenosis - carotid endarectomy FIRST

68

Pt with diplopia, dyarthria, dizziness - dx with verebrobasilar ischemia wtd?

ASA
Establish dx of vertebrobasilar ischemia with MRA posterior cranial vessels

69

Pt has occasional epistaxis esp when sneezing dx?

vWF dz

70

TPA criteria

Ischemic stroke with clearly defined sx onset
No IC bleed on HCT
<270 minutes sx onset to TPA

71

Exclusion crtieria for TPA

Rapidl improving sx
Stroke or head trauna/major 3 months
Major surgery w/in 14 days
Suspected SAH despite normal CT head
SBP>185/>110
on A/C
PT>15, plt400

72

65yo M woke up in AM and THEN had stroke CT neg for bleed - presents within 3 to 4.5 hrs

TPA

73

70yo M h/o afib pw sudden onset wk one side CT neg wtd?

TPA
ASA 24-48 hrs later

74

65yo M found in AM in bed with stroke

NO TPA since duration unknown

75

Pt with ischemic stroke, time onset 60 min CT no bleed, BP 200/120 wtd?

Labetoll iV when BP <185.110 then TPA

76

Pt not taking HTN meds x 1 week - BP in office 240/130, h/a visual distrubances with hemianopsia, aura, cortical blindness MRI shows white matter edema in parieto-occiptal regions

Posterior Reversible Encephalopathy syndrome (PRES)
Started on nitroprusside - BP 140/90
-> taper nitroprusside

77

Pt with hemorrhagic stroke when should anti-HTN be started

BP>190/100

78

Pt with uncomplicated ischemic stroke not eligible for TPA when to start antiHTN

BP>220/120

79

Pt with ischemic stroke post tPA when to start anti-HTN

BP>170/100

80

ACA stroke

wk leg/foot WITH sensory loss
urinary incontinence
Primitive reflexes

81

MCA stroke

Parietal lboe (dominant)
acalculia, agraphia, Lt/Rt disorientation, finger agnosia, tactile agnosia, paresthesia
Temporal Lobe - aphasia
Pariet laobe Right (non-dominant)
-spatial neglect
Unable to dress

82

PCA stroke

U/L homonymous hemianopia
I/L 3rd N palsy - webers' syndrome
contralateral sensory abn

83

Lateral Medullary Syndrome (wallengberg)

I/L loss pain/temp from face
I/L palsy upper and lower face
I/L loss of lacrimationa nd salivation
I/L loss of taste anti 2/3 tongue
Vertigo, nystagmus, nausea, vomiting
Tending to fall to same side, wavy images
Hoarseness, dysphagia

84

Medial Medullary syndrome

Contralateral hemoparesis adn parastesia
affected eye looks down and toward nose
I/L tongue palsy

85

Basilar artery stroke

Hemiparesis, involutary shaking movement
Bulbar muscles invovlement with loss of fxn in throat - unable to move tongue - only eye movements present and called LCOKED IN SYDROME
Quadriplegia

86

Pt with right sided hemiplegia and sensory defeits - r hemianopsia and aphasia

L MCA

87

Pt with L foot and leg wk, urinary incontinence

R ACA

88

Pt with R side sensory abn, ptosis L eye, pupillary dilation

L PCA

89

Pt with diplopia, dysartria one sided wk with priorbital numbness and shakign/shivery moveemnts of affected limbs

Basilar artery

90

Pt with quadriplegia, cnat speak can't put tongue out, eye movements ok

Basilar artery