Stroke and Neurology Practice Exam

Questions and Answers

What do you call a person with a stroke who seems unaware of their disability?

anosognosia

What area of the brain can cause internuclear ophthalmoplegia in a patient who presents with double vision?

brainstem

What is a watershed stroke?

Stroke between two adjacent cerebral arteries

At what rate is cerebrospinal fluid produced?

0.3-0.4 ml/min Signup and view all the answers

A patient with locked-in syndrome most likely had an infarct in which part of the brain?

pons (pontine) Signup and view all the answers

What does a lacunar infarct indicate?

In a small artery Signup and view all the answers

What is the most important point to emphasize in a community education program on strokes?

Activate EMS Signup and view all the answers

What is a risk factor for a spontaneous carotid dissection?

Connective tissue disease Signup and view all the answers

What is the most significant risk factor for stroke?

Hypertension Signup and view all the answers

At what age do one-fourth of all strokes occur in patients?

75 Signup and view all the answers

What condition is associated with an increased risk of stroke and mortality?

Atrial fibrillation Signup and view all the answers

What is an example of exclusion criteria for tPA administration?

Bleeding diathesis Signup and view all the answers

What findings are consistent with alterations in posterior cerebral circulation?

Ataxia and visual deficits Signup and view all the answers

What score is a predictor of a two-day risk for stroke following a TIA?

ABCD2 Signup and view all the answers

What sign indicates meningeal irritation during a physical examination?

Kernig's Sign Signup and view all the answers

What is the most sensitive and specific imaging technique for demonstrating acute infarction?

MR diffusion-weighted imaging Signup and view all the answers

What should a cerebral angiogram identify for a patient with SAH?

Identify the etiology of the bleed Signup and view all the answers

What diagnosis is a contraindication for performing a lumbar puncture?

SAH Signup and view all the answers

What does TTE best identify?

Ventricular thrombus Signup and view all the answers

What procedure would you expect for a woman with sickle cell disease undergoing preventative stroke diagnostic testing?

Transcranial doppler Signup and view all the answers

What is the goal of embolization for L AVM?

Occlusion of the deep arterial feeding vessels Signup and view all the answers

What symptoms may indicate a dural arteriovenous fistula?

Pulsatile tinnitus, headache, and visual disturbances Signup and view all the answers

In an MRI report describing a low flow, low pressure vascular lesion in the left temporal lobe, what is it likely to be?

Cavernous angioma Signup and view all the answers

What condition describes slow speech with inappropriate silences and audible inspirations?

Dysarthria Signup and view all the answers

What are primary nursing considerations when administering mannitol IV every 3 hours?

Serum osmolality, CPP goals, and fluid balance Signup and view all the answers

What is the primary laboratory testing/monitoring for heparin infusion?

APTT Signup and view all the answers

What is an adverse side effect of anticonvulsant therapy?

Alteration in mentation Signup and view all the answers

What estimated percentage of ischemic stroke patients receive tPA?

2-7% Signup and view all the answers

What is anisocoria?

Unequal size of the eye pupils Signup and view all the answers

What is apraxia?

Inability to perform purposeful actions as a result of brain damage Signup and view all the answers

What type of stroke is most likely when a patient presents with BP 260/140, methamphetamine use, chronic heavy ETOH use, and stroke-like symptoms?

Basal ganglia hemorrhage Signup and view all the answers

What factors may increase the likelihood of stroke in women taking oral contraceptives? (Select all that apply)

Age > 35 Signup and view all the answers

What does the Hunt vs Hess Score describe?

Severity of SAH and used as a predictor for patient prognosis Signup and view all the answers

What does the CHADS2 Score estimate?

Stroke risk in patients with atrial fibrillation Signup and view all the answers

What does the ABCD2 score predict?

Two-day risk of stroke following TIA Signup and view all the answers

What is a rare but potential complication of tPA administration?

Anaphylaxis Signup and view all the answers

What would a stroke patient with sodium of 128, low urine output, and weight gain likely have?

SIADH Signup and view all the answers

What is the most common cause of vertebral dissection?

Trauma Signup and view all the answers

What is cavernous angioma?

Blood vessel abnormality with clusters of tiny, abnormal, dilated vessels Signup and view all the answers

What is the discharge instruction for a patient who underwent carotid artery endarterectomy regarding taking aspirin?

Aspirin indefinitely and PLAVIX for at least 30 days Signup and view all the answers

What evidence-based standard is used to measure neurological functional improvement over time?

NIHSS Signup and view all the answers

What condition is sixth nerve palsy associated with?

Aneurysm in the cavernous sinus Signup and view all the answers

What symptoms may indicate a basilar artery aneurysm?

Third nerve palsy, sixth nerve palsy, and ataxia Signup and view all the answers

What are primary presentation symptoms of cerebral venous thrombosis? (Select all that apply)

Sixth nerve palsy Signup and view all the answers

What is the characteristics of MCA stroke?

Aphasia, Neglect, Contralateral sensory and motor loss Signup and view all the answers

What is the characteristics of ACA stroke?

Contralateral sensory and motor deficits affecting leg more than arms Signup and view all the answers

What is the characteristics of PCA stroke?

Contralateral visual field homonymous hemianopia and visual agnosia Signup and view all the answers

What is the characteristics of PICA stroke?

Wallenberg syndrome, dysphagia, dysarthria, dysphonia Signup and view all the answers

What is the characteristics of AICA stroke?

Lateral pontine syndrome results in vertigo, vomiting, nystagmus Signup and view all the answers

What is the characteristics of Basilar Stroke?

Coma, quadriparesis, ataxia, CN dysfunction Signup and view all the answers

What are the diagnostic indications for a lumbar puncture?

Measurement of CSF pressure, collection of CSF samples Signup and view all the answers

What is the sensitivity and specificity of MR diffusion-weighted imaging for acute infarction?

Sensitivity 88-100%, specificity 95-100% Signup and view all the answers

What are signs and symptoms specific to hemorrhagic strokes? (Select all that apply)

Worst headache of my life Signup and view all the answers

What type of stroke is nuchal rigidity associated with?

Aneurysmal SAH Signup and view all the answers

What is a dural AV fistula?

A direct connection between the meningeal artery and meningeal vein Signup and view all the answers

What is tinnitus?

Ringing sound in the ears Signup and view all the answers

What is the definition of cavernous angioma?

A hemangioma or series of adjacent capillaries with slow blood flow Signup and view all the answers

What are examples of stroke mimics? (Select all that apply)

CNS abscess or tumor Signup and view all the answers

What is the equivalent of 1 kg in pounds?

2.2 lbs Signup and view all the answers

Study Notes

Stroke and Neurological Conditions

Anosognosia: Condition where a stroke patient is unaware of their disability.
Internuclear Ophthalmoplegia: Caused by lesions in the brainstem affecting eye movements; characterized by double vision and preserved tracking.
Watershed Stroke: Occurs at the border zone between two cerebral arteries, often due to hypertension or hypoperfusion.
Cerebrospinal Fluid (CSF) Production: Normal rate is 0.3-0.4 ml/min.
Locked-In Syndrome: Typically results from an infarct in the pons, leading to complete paralysis except for eye movement.
Lacunar Infarct: Indicates a blockage in a small penetrating artery.
Stroke Education: Emphasis on activating EMS immediately can significantly improve outcomes.

Risk Factors and Signs

Spontaneous Carotid Dissection: Connective tissue diseases are notable risk factors.
Hypertension: Recognized as the most significant stroke risk factor.
Stroke Age Statistics: 25% of all strokes occur in individuals under 75.
Atrial Fibrillation: Associated with a heightened risk of stroke and mortality.

tPA Administration and Imaging

Exclusion Criteria for tPA: Includes conditions like bleeding diathesis.
Posterior Cerebral Circulation Symptoms: Ataxia and visual deficits suggest alterations in blood flow.
MR Diffusion-Weighted Imaging: Most sensitive and specific imaging for acute infarction; sensitivity 88-100%, specificity 95-100%.

Diagnosing and Monitoring

Kernig's Sign: Indicates meningeal irritation during physical examination.
ABCD2 Score: Used to predict the two-day risk of stroke after a transient ischemic attack (TIA).
Risk Mitigation in Sickle Cell Patients: Transcranial doppler studies are crucial for stroke prevention.
TTE Utilization: A transthoracic echocardiogram is effective for identifying ventricular thrombus.

Stroke Characteristics

Cerebral Venous Thrombosis Symptoms: Include headache, papilledema, diplopia, and sixth nerve palsy.
MCA Characteristics: Symptoms often include aphasia, neglect, and contralateral sensory/motor loss.
ACA Characteristics: Results in contralateral deficits in leg function more than arms; may present with abulia and incontinence.
PCA Characteristics: Symptoms feature visual field loss and visual agnosia; typically does not involve paralysis.
PICA and AICA Symptoms: PICA leads to Wallenberg syndrome, while AICA results in lateral pontine syndrome with vertigo and hearing loss.

Complications and Contraindications

Cautions with tPA: Anaphylaxis is a rare complication; continuous monitoring is necessary.
Monitor for SIADH: Characterized by low sodium, low urine output, and weight gain in stroke patients.
SAH Contraindications: Any patient with subarachnoid hemorrhage (SAH) is not suitable for lumbar puncture.

Miscellaneous

Dural Arteriovenous Fistula: Represents a direct connection between arteries and veins in the brain, causing symptoms like tinnitus.
Cavernous Angioma: Marked by clusters of abnormal blood vessels and potential for slow blood flow.
Stroke Mimics: Conditions that can resemble strokes include migraines, metabolic syndromes, and CNS tumors.

Measurements and Conversions

1 kg Conversion: Equivalent to 2.2 lbs.

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Description

Test your knowledge on neurological conditions and strokes with this practice exam. The quiz covers important terms and concepts such as anosognosia and internuclear ophthalmoplegia. Perfect for those studying neuroanatomy and stroke management.