TIA vs Stroke Quiz
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Questions and Answers

What is the main difference between a TIA and a stroke?

  • TIAs are associated with permanent cerebral infarction, whereas strokes are not.
  • TIAs are brief episodes of neurological dysfunction without permanent damage, while strokes cause lasting deficits or death. (correct)
  • Strokes are brief episodes, while TIAs last longer than 24 hours.
  • There is no difference; both are classified the same way.
  • Which of the following is NOT a common cause of ischemic stroke?

  • Cardio-embolic events
  • Small vessel disease
  • Hypoperfusion
  • Hyperthyroidism (correct)
  • Which of the following conditions is most likely to lead to a cardio-embolic stroke?

  • Carotid artery stenosis
  • Atrial fibrillation (correct)
  • Intracranial atherosclerosis
  • Hypovolemia
  • Which of the following stroke types is the most common?

    <p>Ischemic stroke</p> Signup and view all the answers

    Which of the following conditions can lead to hypoperfusion, causing ischemic stroke? A) Septal defects B) Carotid artery stenosis C) Heart failure with reduced ejection fraction (HFrEF) D) Atrial fibrillation

    <p>Heart failure with reduced ejection fraction (HFrEF)</p> Signup and view all the answers

    Which of the following is a non-modifiable risk factor for stroke?

    <p>Age</p> Signup and view all the answers

    Which of the following conditions is considered a genetic factor that increases stroke risk?

    <p>Ehlers-Danlos syndrome</p> Signup and view all the answers

    Which of the following would add 2 points to the ABCD2 score when calculating stroke risk after a TIA?

    <p>Duration of symptoms &gt;60 minutes</p> Signup and view all the answers

    What is the maximum score on the ABCD2 score for assessing stroke risk after a TIA?

    <p>6</p> Signup and view all the answers

    Which of the following modifiable risk factors increases the likelihood of stroke?

    <p>Hypertension</p> Signup and view all the answers

    Which of the following factors contributes 2 points to the ABCD2 score when calculating stroke risk after a TIA?

    <p>Duration of symptoms &gt; 60 minutes</p> Signup and view all the answers

    If a TIA lasts for 30 minutes, what score would be added to the ABCD2 score for the duration of symptoms?

    <p>1</p> Signup and view all the answers

    What is the score added to the ABCD2 score for a patient with unilateral weakness during a TIA?

    <p>2</p> Signup and view all the answers

    Which of the following would contribute 1 point to the ABCD2 score?

    <p>History of diabetes</p> Signup and view all the answers

    If a patient’s blood pressure during a TIA is recorded as 145/95, how many points would be added to the ABCD2 score for blood pressure?

    <p>1</p> Signup and view all the answers

    A patient with a TIA presents with speech disturbance lasting 8 minutes. How many points will be added to the ABCD2 score for the clinical feature of speech disturbance?

    <p>1</p> Signup and view all the answers

    If a patient is younger than 60 years, how many points would be added to the ABCD2 score for age?

    <p>0</p> Signup and view all the answers

    What is the purpose of the ABCD2 score?

    <p>To assess the risk of stroke after a TIA</p> Signup and view all the answers

    What is the ABCD2 score for a 55-year-old patient with right-sided weakness and speech disturbance lasting 10 minutes, a blood pressure of 130/80, and a full recovery?

    <p>3</p> Signup and view all the answers

    Which of the following is a potential long-term risk after a TIA, even without intervention?

    <p>30-40% of patients with ischemic stroke have had a previous TIA</p> Signup and view all the answers

    Which symptom is NOT typically associated with a TIA?

    <p>Severe headache with vomiting</p> Signup and view all the answers

    Which of the following is an example of a symptom associated with a vascular territory affected by a stroke?

    <p>Monocular blindness (amaurosis fugax)</p> Signup and view all the answers

    Which of the following is the first step in thinking about a stroke diagnosis?

    <p>Identifying the vascular event</p> Signup and view all the answers

    A TIA patient presents with unilateral weakness and slurred speech lasting 5 minutes. What is the most likely vascular territory affected?

    <p>Carotid artery</p> Signup and view all the answers

    Which of the following is a common symptom of a TIA affecting the anterior cerebral artery?

    <p>Unilateral weakness or heaviness</p> Signup and view all the answers

    Which symptom is characteristic of a TIA affecting the vertebrobasilar system?

    <p>Diplopia (double vision)</p> Signup and view all the answers

    Which symptom could indicate a TIA affecting the middle cerebral artery?

    <p>Hemianopia (loss of vision in half of the visual field)</p> Signup and view all the answers

    Which of the following is a common symptom of a TIA in the carotid artery distribution?

    <p>Amaurosis fugax (temporary loss of vision in one eye)</p> Signup and view all the answers

    Which symptom is commonly associated with a TIA affecting the posterior cerebral artery?

    <p>Visual disturbance (homonymous hemianopia)</p> Signup and view all the answers

    Which of the following symptoms is associated with a TIA affecting the brain's frontal lobe? A) Ataxia B) Hemispatial neglect C) Dysphasia D) Monocular blindness

    <p>Dysphasia</p> Signup and view all the answers

    Which of the following is characteristic of Total Anterior Circulation Syndrome (TACS)? A) Homonymous hemianopia B) Pure motor deficit C) Pure sensory deficit D) Clumsy-hand syndrome Answer: A) Homonymous hemianopia Explanation: TACS is caused by a large ischemic stroke in the middle cerebral artery (MCA) territory, affecting major areas of the brain. It is characterized by contralateral motor and/or sensory deficits, higher cortical dysfunction (e.g., aphasia, agnosia), and visual field deficits such as homonymous hemianopia (loss of vision in the same visual field of both eyes).

    <p>Homonymous hemianopia</p> Signup and view all the answers

    Which artery is primarily involved in a stroke leading to Total Anterior Circulation Syndrome (TACS)?

    <p>Middle cerebral artery (MCA)</p> Signup and view all the answers

    In Lacunar Circulation Syndrome (LACS), which of the following is most commonly seen?

    <p>Pure motor deficit or pure sensory deficit</p> Signup and view all the answers

    Which of the following is NOT a symptom of Posterior Circulation Syndrome (POCS)?

    <p>Dysphagia</p> Signup and view all the answers

    Stroke affecting the PCA (posterior cerebral artery) can result in which of the following visual deficits?

    <p>Homonymous hemianopia</p> Signup and view all the answers

    Which syndrome is characterized by two out of three symptoms from TACS but with partial vascular involvement (MCA or ACA)?

    <p>Partial Anterior Circulation Syndrome (PACS)</p> Signup and view all the answers

    Which symptom is characteristic of brainstem lesions in stroke?

    <p>Dysphagia</p> Signup and view all the answers

    Which syndrome is likely to cause cerebellar symptoms like ataxia, staccato speech, and dizziness?

    <p>POCS</p> Signup and view all the answers

    In a stroke caused by a small perforating artery, which of the following is most likely?

    <p>Pure motor or sensory deficit</p> Signup and view all the answers

    Which artery is typically involved in Posterior Circulation Syndrome (POCS) leading to brainstem or cerebellar symptoms?

    <p>Vertebral artery</p> Signup and view all the answers

    Which of the following is a characteristic feature of non-fluent (expressive) aphasia?

    <p>Difficulty understanding and producing speech</p> Signup and view all the answers

    Which area of the brain is typically involved in fluent (receptive) aphasia?

    <p>Wernicke's area (posterior part of the left temporal lobe)</p> Signup and view all the answers

    Dysarthria, a speech disorder characterized by impaired articulation, can result from dysfunction of which of the following?

    <p>Facial nerve, cerebellum, or pyramidal/extrapyramidal systems</p> Signup and view all the answers

    Which of the following is a feature of lateral medullary syndrome (Wallenberg's syndrome)?

    <p>Ipsilateral Horner's syndrome</p> Signup and view all the answers

    Which of the following deficits is characteristic of medial medullary syndrome?

    <p>Contralateral limb paralysis and proprioceptive loss</p> Signup and view all the answers

    Which of the following deficits is characteristic of medial medullary syndrome?

    <p>Contralateral limb paralysis and proprioceptive loss</p> Signup and view all the answers

    Which of the following symptoms would you expect in a patient with lateral medullary syndrome affecting the brainstem?

    <p>Dysphagia, nystagmus, ataxia</p> Signup and view all the answers

    What is the most likely cause of dysphagia and Horner's syndrome in a stroke patient?

    <p>Lateral medullary syndrome</p> Signup and view all the answers

    Which of the following is a sign of an ipsilateral brainstem lesion in a stroke?

    <p>Ipsilateral cranial nerve palsy</p> Signup and view all the answers

    A lesion in the vertebral artery would most likely result in which of the following symptoms?

    <p>Ipsilateral cranial nerve palsy and ataxia</p> Signup and view all the answers

    In a stroke affecting Broca's area, which of the following would be most impaired?

    <p>Ability to speak clearly and construct sentences</p> Signup and view all the answers

    Which of the following is NOT a common symptom of a TIA or stroke? A) Sudden unilateral weakness B) Severe headache C) Sudden speech disturbance D) Sudden vision loss in one eye

    <p>Severe headache</p> Signup and view all the answers

    Which of the following should NOT be considered when diagnosing TIA or stroke?

    <p>Gradual progression of symptoms</p> Signup and view all the answers

    Which of the following would NOT be suggestive of a TIA or stroke?

    <p>Acute confusion without focal deficits</p> Signup and view all the answers

    A patient presents with sudden right-sided weakness and slurred speech. These symptoms are most likely to indicate:

    <p>A TIA or stroke in the left hemisphere</p> Signup and view all the answers

    In a patient presenting with a suspected TIA or stroke, what is the most important part of the history to determine eligibility for acute treatments?

    <p>The time of onset of symptoms</p> Signup and view all the answers

    Which of the following is characteristic of a TIA affecting the posterior circulation?

    <p>Diplopia (double vision)</p> Signup and view all the answers

    What is the most common duration for symptoms in a TIA?

    <p>5-15 minutes</p> Signup and view all the answers

    Which symptom would most likely be associated with a stroke affecting the frontal lobe (Broca's area)?

    <p>Dysphasia (expressive aphasia)</p> Signup and view all the answers

    Which of the following symptoms suggests a posterior circulation stroke involving the brainstem?

    <p>Ataxia and vertigo</p> Signup and view all the answers

    If a TIA presents with contralateral loss of pain and temperature sensation, which tract is most likely affected?

    <p>Spinothalamic tract</p> Signup and view all the answers

    Why is it important to ask whether the patient woke up with their symptoms when assessing for a stroke or TIA?

    <p>It may suggest the event started earlier and was unnoticed, affecting treatment options</p> Signup and view all the answers

    Time of onset of symptoms in a patient presenting with a suspected stroke or TIA is important because: A) It determines whether the patient has had previous strokes B) It helps decide eligibility for acute treatments, such as thrombolytics C) It allows identification of the vascular territory affected D) It clarifies whether the symptoms are related to metabolic disturbances

    <p>It helps decide eligibility for acute treatments, such as thrombolytics</p> Signup and view all the answers

    If a patient presents with multiple and intermittent symptoms, this is most likely to suggest:

    <p>A seizure disorder</p> Signup and view all the answers

    When assessing a stroke or TIA, the duration of symptoms is crucial. Most TIAs last: A) Less than 1 minute B) 5-15 minutes C) 30-60 minutes D) Several hours

    <p>5-15 minutes</p> Signup and view all the answers

    The presence of loss of consciousness or syncope in a patient with neurological symptoms is most likely to suggest: A) Stroke or TIA B) A cardiac event or syncope due to arrhythmia C) A vestibular disorder D) A migraine

    <p>A cardiac event or syncope due to arrhythmia</p> Signup and view all the answers

    When taking a history of a suspected stroke or TIA, it is important to expand upon all the symptoms the patient reports because:

    <p>All of the above</p> Signup and view all the answers

    What does the NIHSS (National Institutes of Health Stroke Scale) primarily assess in stroke patients?

    <p>The severity of neurological deficits</p> Signup and view all the answers

    In the NIHSS assessment, which domain primarily evaluates motor function in stroke patients?

    <p>Motor arm and leg function</p> Signup and view all the answers

    A higher NIHSS score typically indicates: A) A less severe stroke B) A more severe stroke with higher disability C) A stroke involving the posterior circulation D) A stroke with less functional impairment

    <p>A more severe stroke with higher disability</p> Signup and view all the answers

    Which of the following assessments in the NIHSS is primarily focused on language deficits?

    <p>Speech</p> Signup and view all the answers

    The NIHSS is particularly useful in assessing strokes in the anterior circulation territory, but it does not assess:

    <p>Posterior circulation strokes</p> Signup and view all the answers

    In the NIHSS, a higher score is typically assigned to which of the following? (Select one)

    <p>Motor deficits</p> Signup and view all the answers

    In a hyperacute stroke setting, what is the primary purpose of using the NIHSS?

    <p>To determine the eligibility for hyper-acute treatments</p> Signup and view all the answers

    What is the GOLD standard imaging modality for evaluating a TIA?

    <p>MRI-brain</p> Signup and view all the answers

    Which of the following is NOT part of the standard investigation for a TIA?

    <p>Cerebrospinal fluid analysis</p> Signup and view all the answers

    Which imaging modality is recommended to assess for potential infarction or previous stroke in a patient presenting with TIA symptoms?

    <p>Non-contrast CT-brain</p> Signup and view all the answers

    In a patient with a suspected TIA, which blood test is crucial to assess for risk factors?

    <p>HbA1c and fasting lipid profile</p> Signup and view all the answers

    What is the primary goal of imaging in the investigation of stroke?

    <p>Confirm the diagnosis and identify contraindications to thrombolysis and thrombectomy</p> Signup and view all the answers

    Which of the following is used to assess for embolic sources in patients with suspected stroke?

    <p>Transthoracic echocardiogram</p> Signup and view all the answers

    In patients with a TIA, which of the following investigations is used to screen for atrial fibrillation as a potential cause?

    <p>Holter monitor</p> Signup and view all the answers

    What should be included in the workup for a TIA regarding the cardiovascular system?

    <p>All of the above</p> Signup and view all the answers

    Which investigation is recommended to assess for a potential septal defect, such as a PFO, in a patient with a suspected stroke or TIA?

    <p>Transoesophageal echocardiogram</p> Signup and view all the answers

    Which of the following is essential in the acute setting for both stroke and TIA to determine treatment options?

    <p>All of the above</p> Signup and view all the answers

    What is the primary purpose of a non-contrast CT-brain in a patient presenting with acute stroke symptoms?

    <p>To establish if there is evidence of hemorrhage</p> Signup and view all the answers

    What does a CT-angiogram of the aortic arch to the vertex help identify in an acute stroke presentation?

    <p>Large vessel occlusion amenable to intervention</p> Signup and view all the answers

    Which of the following investigations is important for screening the patient for thrombolysis eligibility in the acute setting?

    <p>Coagulation screen</p> Signup and view all the answers

    What is a contraindication for thrombolysis in ischemic strokes based on coagulation studies?

    <p>INR &gt;1.7</p> Signup and view all the answers

    In a patient presenting with acute right-sided weakness and speech disturbance, when should the stroke team be called?

    <p>As soon as the patient presents to the hospital</p> Signup and view all the answers

    In the hyperacute setting, which of the following is an important part of the initial assessment?

    <p>Check capillary glucose</p> Signup and view all the answers

    What should be assessed using the NIHSS in a hyperacute stroke presentation?

    <p>Severity of symptoms, including weakness and speech disturbance</p> Signup and view all the answers

    What is the role of a CT-Perfusion scan in the hyperacute stroke setting?

    <p>To evaluate brain tissue at risk and inform treatment decisions</p> Signup and view all the answers

    For a patient with acute stroke symptoms, why is a 12-lead ECG performed?

    <p>To assess for signs of atrial fibrillation or other arrhythmias that may contribute to stroke</p> Signup and view all the answers

    Which of the following is an important bedside assessment in the subacute management of ischemic stroke? A) Swallow assessment B) MRI-Brain C) Full neurological examination D) ECG

    <p>Swallow assessment</p> Signup and view all the answers

    What is the purpose of using a Holter monitor in the subacute phase of stroke management?

    <p>To assess for arrhythmia or ischemia</p> Signup and view all the answers

    Which of the following blood tests is used to evaluate the risk of stroke recurrence in the subacute phase?

    <p>Fasting lipid profile</p> Signup and view all the answers

    When is a transthoracic echocardiogram indicated in the subacute management of ischemic stroke?

    <p>To evaluate atrial size and valves</p> Signup and view all the answers

    What is the role of a transoesophageal echocardiogram in ischemic stroke management? A) To assess for a patent foramen ovale (PFO) or septal defects B) To monitor brain perfusion C) To detect carotid artery stenosis D) To evaluate blood glucose levels

    <p>To assess for a patent foramen ovale (PFO) or septal defects</p> Signup and view all the answers

    What imaging study is considered the gold standard for assessing infarction size in the subacute phase of ischemic stroke?

    <p>MRI-brain</p> Signup and view all the answers

    Which of the following is a contraindication to thrombolysis in ischemic stroke?

    <p>INR &gt;1.7</p> Signup and view all the answers

    Which of the following is an absolute contraindication to thrombolysis for ischemic stroke?

    <p>Current anticoagulation therapy</p> Signup and view all the answers

    In which of the following scenarios can thrombolysis be administered up to 9 hours from symptom onset?

    <p>When there is no evidence of hemorrhage on non-contrast CT and CT-perfusion is used</p> Signup and view all the answers

    If there is no evidence of blood during a stroke screening, what is the appropriate management?

    <p>Immediate thrombolysis (tPA) if within the 4.5-hour window</p> Signup and view all the answers

    What platelet count is considered an absolute contraindication for thrombolysis in ischemic stroke?

    <p>Platelet count &lt;100,000</p> Signup and view all the answers

    If a CT-angiogram shows a clot in the left MCA (middle cerebral artery), what is the appropriate treatment if symptoms began less than 24 hours ago?

    <p>Thrombectomy (mechanical retrieval of the clot under radiological guidance)</p> Signup and view all the answers

    For thrombectomy to be considered in a patient with large vessel occlusion, the patient should have a Modified Rankin Scale score of:

    <p>&lt;2</p> Signup and view all the answers

    Thrombectomy is indicated for large vessel occlusion if the time from symptom onset is: a) <6 hours, b) <12 hours, c) <24 hours, d) <48 hours.

    <p>&lt;24 hours</p> Signup and view all the answers

    A 60-year-old patient presents with right-sided weakness and aphasia, with symptoms that began 6 hours ago. A CT-angiogram shows a large vessel occlusion in the left middle cerebral artery (MCA). The patient has a Modified Rankin Scale score of 1 (independent in daily activities). What is the most appropriate next step in management?

    <p>Thrombectomy</p> Signup and view all the answers

    A 45-year-old patient presents with sudden-onset left-sided weakness and dysarthria. A CT scan shows no evidence of hemorrhage, and a CT-angiogram shows a clot in the left MCA. The patient is outside the 24-hour window from symptom onset. What is the most appropriate management?

    <p>No intervention</p> Signup and view all the answers

    A 70-year-old patient presents with a history of sudden-onset right hemiplegia and dysphasia. A CT-angiogram reveals a large vessel occlusion in the left MCA. The patient is within 10 hours of symptom onset, but their Modified Rankin Scale score prior to the stroke was 3 (requiring some assistance with daily activities). What is the best management option?

    A) Thrombectomy B) Thrombolysis with tPA C) Medical management with anticoagulation D) Supportive care and observation

    <p>Thrombolysis with tPA</p> Signup and view all the answers

    A patient presents with acute ischemic stroke and is diagnosed with a left MCA occlusion. The non-contrast CT brain shows no evidence of hemorrhage. The patient receives intravenous tPA within 4.5 hours of symptom onset. What is the next step in management post-thrombolysis?

    <p>Repeat CT scan at 24 hours to check for hemorrhagic transformation</p> Signup and view all the answers

    Which of the following statements is true regarding TIA and stroke?

    <p>All of the above.</p> Signup and view all the answers

    A patient with ischemic stroke presents more than 24 hours after symptom onset and a non-contrast CT scan shows no hemorrhage. What is the appropriate initial management for this patient?

    <p>Aspirin (with or without Clopidogrel depending on symptom severity)</p> Signup and view all the answers

    What is the primary difference between a TIA and a stroke?

    <p>A TIA is temporary and resolves quickly, while a stroke causes lasting damage.</p> Signup and view all the answers

    A patient with ischemic stroke is started on aspirin following the absence of hemorrhage on CT at 24 hours. What additional treatment is recommended to stabilize the plaque in this patient?

    <p>High-dose statin therapy (e.g., atorvastatin 80mg)</p> Signup and view all the answers

    A 70-year-old patient presents with sudden-onset severe headache and left-sided weakness. A non-contrast CT scan of the brain reveals evidence of blood in the left frontal lobe. What is the first step in managing this patient?

    <p>Assess airway, breathing, and circulation (ABCD)</p> Signup and view all the answers

    Which of the following actions should be taken immediately if a hemorrhagic stroke patient is found to be on anticoagulation therapy?

    <p>Stop anticoagulation and attempt to reverse it</p> Signup and view all the answers

    Which of the following reversal agents is used to reverse the effects of warfarin in a hemorrhagic stroke patient?

    <p>Vitamin K +/- Fresh frozen plasma or prothrombin complex concentrate</p> Signup and view all the answers

    A patient on heparin therapy presents with a hemorrhagic stroke. What is the most appropriate agent for reversing the effects of heparin?

    <p>Protamine</p> Signup and view all the answers

    Which of the following is used to reverse the effects of Dabigatran in a hemorrhagic stroke patient?

    <p>Idarucizumab</p> Signup and view all the answers

    In a hemorrhagic stroke patient who is on factor Xa inhibitors, what agent should be used for reversal?

    <p>Andexanet alfa</p> Signup and view all the answers

    A 65-year-old patient with a spontaneous intracerebral hemorrhage (ICH) presents with neurological deterioration. A non-contrast CT shows a basal ganglia hemorrhage. What is the next step in management?

    <p>Consult neurosurgeons for possible surgical intervention</p> Signup and view all the answers

    What is the target blood pressure for a patient with hemorrhagic stroke in the acute phase?

    <p>140-160 mmHg systolic</p> Signup and view all the answers

    Which of the following conditions would make a patient eligible for surgical evacuation of a hemorrhagic stroke hematoma?

    <p>Supratentorial hemorrhage with impending herniation</p> Signup and view all the answers

    Which of the following is NOT a reason to consider surgical intervention in a hemorrhagic stroke patient?

    <p>Spontaneous resolution of the hemorrhage</p> Signup and view all the answers

    Which of the following is NOT a reason to consider surgical intervention in a hemorrhagic stroke patient?

    <p>Spontaneous resolution of the hemorrhage</p> Signup and view all the answers

    What is the purpose of performing minimally invasive neurosurgery (e.g., neuroendoscopic surgery or stereotactic procedures) in patients with supratentorial intracerebral hemorrhage?

    <p>To provide a less invasive alternative to conventional craniotomy</p> Signup and view all the answers

    In patients with supratentorial intracerebral hemorrhage, how is the hematoma evacuated in minimally invasive neurosurgery?

    <p>Stereotactic placement of a drainage catheter followed by passive evacuation with thrombolytic infusion</p> Signup and view all the answers

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