A few things about strokes
1. We invariably consider the possibility of a cerebellar stroke when patients have acute onset ataxia of gait or limb incoordination. Can you deduce which artery is involved (based on additional neurological signs) in this cerebellar stroke presentation: The patient has nausea, vertigo, dysphagia and dysarthria, loss of pain and temperature sensations on one side of the face and opposite side of the body?
Options are: A. Superior cerebellar artery. B. Posterior cerebral artery. C. Posterior inferior cerebellar artery.
2. What do you suspect when a patient has had a stroke but presents with paraplegia or quadriplegia and has loss of sensations in both affected limbs, incontinence of bowel and bladder and pain in the back and limbs with no cranial nerve involvement?
Options are: A. Spinal cord stroke. B. Brain stem stroke. C. Subcortical white matter stroke
3. Which of the following are directly related to patients who have had a subarachnoid hemorrhage? (More than one answer is possible).
B. Beta blockers
C. Xanthochromia of CSF
D. Endovascular coiling
4. Which one of the following can be a cause of intracerebral hemorrhage in elderly patients?
Options are: A. Cortical vein thrombosis. B. Cerebral amyloid angiopathy. C. Cirrhosis liver.
5. In which type of stroke do we use heparin even though the stroke is associated with evidence of minor bleeding?
Options are: A. Cortical vein thrombosis. B. Cerebral amyloid angiopathy. C. Brain stem stroke
6. When will you start antihypertensive treatment in a patient with a stroke due to bleeding into the brain?
A. When the BP is more than 220mm Hg systolic
B. When the BP is more than 200mm Hg systolic
C. When the BP is more than 180mm Hg systolic
D. When the BP is more than 160mm Hg systolic
7. Thrombolytic therapy with Alteplase (recombinant tissue type plasminogen activator) is recommended for ischemic strokes within 4.5 hours of onset. In which of the following situations will you prefer NOT to use rtPA? More than one answer is acceptable.
A. When the patient is more than 80 years old
B. When the patient has a residual disability due to a previous stroke many years ago.
C. When the patient had suffered a stroke within the past 3 months
8. When does the cerebral edema that occurs after a cerebral hemorrhage reach its peak?
Options are: A. On the first day. B. On the fifth day. C. On the fourteenth day.
9. When patients who are on warfarin develop a cerebral hemorrhage, we give them Vitamin K and fresh frozen plasma to reduce the volume of bleeding. What can we give to reduce the volume of bleeding in patients with cerebral hemorrhage who are not on warfarin?
A. Activated Factor VII
B. Activated Factor VIII
C. Activated Factor X
10. Dysphagia is a common problem after stroke. When is it usually appropriate to insert a nasogastric tube for feeding after a stroke?
Options are: A. After 2 hours. B. After 36 hours. C. After 72 hours.
11. Regarding recovery after a stroke, which of the following statements are correct?
A. Proximal movements recover better than distal movements
B. Distal movements recover better than proximal movements
C. Lower limbs recover better than upper limbs
D. Upper limbs recover better than lower limbs