SSM SCRN Review Questions with Answers Latest Update 2024 Test-Assured Success, Exams of Humanities

Download SSM SCRN Review Questions with Answers Latest Update 2024 Test-Assured Success and more Exams Humanities in PDF only on Docsity!

SSM SCRN Review Questions with Answers Latest Update

2024 Test-Assured Success

Stroke Risk Factors - Correct Answer Age Gender (men >women) Genetics Stroke Primary Prevention - Correct Answer Tobacco cessation Blood pressure reduction Stroke Secondary Prevention - Correct Answer Prevention of another stroke Targets treatment for change once disease is present i.e. Blood Pressure control, LDL control, recognition of S/S stroke Frontal Lobe Functions - Correct Answer Regulates personality and affect Impulsivity and judgement Abstract thinking Conjugate eye movements Frontal Lobe Precentral Gyrus - Correct Answer AKA Motor Strip Broca's area: Articulation, speed and rhythm of speech Parietal Lobe Functions - Correct Answer Somatosensory cortex: Interpretation of: Pain, temperature, light touch, vibration, two-point discrimination, proprioception Temporal Lobe - Correct Answer Functions: Hearing, Memory, Learning Wernicke's area - Correct Answer located in Temporal lobe responsible for understanding spoken language Occiptal lobe - Correct Answer Functions: Vision The right half of the occiptal lobe interprets information received from the right half of both the right and left eyes (and vice versa) Cerebrum - Correct Answer Made up of Basial ganglia and Limbic system Basial ganglia - Correct Answer Coordinates movement Limbic system - Correct Answer Amygdala, Cingulate gyrus, Hippocampus Amygdala and Cingulate gyrus - Correct Answer Memory and emotion

Hippocampus - Correct Answer Memory and learning Diencephalong - Correct Answer Thalmus, Hypothalmus, Pituitary and pineal gland Thalamus - Correct Answer Receives input from cerebral cortex and acts as relay center Hypothalamus - Correct Answer Hunger Thirst Autonomic functions Endocrine functions Pituitary and pineal gland - Correct Answer Hormonal modulation Sleep-wake cycle Spinothalamic Tract - Correct Answer An ascending pathway of the spinal cord. It is responsible for the transmission of pain, temperature, and crude touch to the somatosensory region of the thalamus. Corticospinal tract - Correct Answer A descending tract of the spinal cord which contains bundles of axons which originate in the cerebral cortex and descend to synapse within the brainstem or spinal cord. The neurons are called "upper motor neurons". Cerebellum - Correct Answer Coordination of motor function: Rapid alternating movements Balance and Position sense Brain Stem - Correct Answer Medulla, Midbrain, Pons Medulla - Correct Answer Foramen magnum to the pons CN XII, IX, X, XI Corticospinal tracts- pyramids: decussate and cross midline Midbrain - Correct Answer Coordinates Eye Movement, some reflexes related to hearing and vision CN II, III, IV Pons - Correct Answer Between medulla and midbrain CN VI, VII, VIII, V message center between cerebellum and cerebrum Cranial Nerve I - Correct Answer Olfactory-smell Cranial Nerve II - Correct Answer Optic- transmits visual information, visual fields, deficit=hemianopsia

Cranial Nerve III - Correct Answer Occularmotor- eyeballs look up deficit=diplopia, strabismus, ptosis, pupil dilation Cranial Nerve IV - Correct Answer Trochlear- move eyeball down and in deficit=diplopia, strabismus Cranial Nerve V - Correct Answer Trigeminal-sensation to the skin of the face, muscles of mastication deficit=decreased facial sensation Cranial Nerve VI - Correct Answer Abducens- move eyball down and out deficit=strabismus Cranial Nerve VII - Correct Answer Facial- facial muscle innervation deficit= facial droop or weakness Cranial Nerve VIII - Correct Answer Acoustic- hearing and balance deficit= spinning, dizziness Cranial Nerve IX - Correct Answer Glossopharyngeal- oral sensation, taste, salvation Cranial Nerve X - Correct Answer Vagus- parasympathetic innervation to multiple organs deficit= increased blood pressure, increased heart rate, difficulty swallowing Cranial Nerve XI - Correct Answer Spinal Accessory- Shoulder Elevation and head turning deficit= winged scapula, difficulty shrugging shoulders Cranial Nerve XII - Correct Answer Hypoglossal- tongue movement deficit= tongue fasiculation, atrophy, weak tongue movement How much of the body's oxygen supply does the brain require? - Correct Answer 20% of body's oxygen supply How much of the cardiac output does the brain require? - Correct Answer 15% of cardiac output Anterior circulation - Correct Answer originates from carotid arteries Posterior circulation - Correct Answer originates from vertebral arteries Circle of Willis (COW) - Correct Answer merge of anterior and posterior circulation

Large vessel strokes - Correct Answer Carotid, vertebral, COW, ACA, MCA, PCA ischemic stroke: occlusion occurs due to thrombus or embolus ICH: hemorrhage occurs at junctions and vessel turns SAH: Aneurysms form at vessel junctions and turns Small vessel strokes - Correct Answer smaller branching vessels Ischemic stroke: occlusion occurs due to atherosclerosis or other pathology ICH: Hemorrhage occurs due to amloyid angiopathy, tumor or vascular malformation Carotid Artery - Correct Answer major structure branching from aortic arch Symptoms from Carotid Artery Stroke - Correct Answer Aphasia if dominant side Contralateral neglect if non-dominat side motor and sensory loss face, are and leg on contralateral side visual field deficit contralateral to occluded carotid artery Anterior Circulation is made up of what arteries? - Correct Answer Anterior Cerebral Artery (ACA) Middle Cerebral Artery (MCA) Posterior Cerebral Artery (PCA) Anterior Cerebral Artery Supplies - Correct Answer 5 segments A1-A3 commonly discussed Supplies: Frontal lobe, olfactory cortex, corpus callosum, leg motor cortex Symptoms of ACA stroke? - Correct Answer Major symptoms: Apathy, abulia and disinhibition Conjugate eye deviation Contralateral motor/sensory loss leg>arm Middle Cerebral Artery - Correct Answer Major structures: M1-M Large cerebral territory Speech and language Motor and sensory cortex Gaze Basal ganglia and internal capusle Symptoms of MCA Stroke? - Correct Answer Major stroke symptoms: Aphasia (dominant hemisphere) Neglect (non-dominant hemisphere) Forced eye deviation/gaze preference Contralateral homonymous heminaopsia Contralateral motor/sensory loss face/arm>leg Posterior Cerebral Artery (PCA) - Correct Answer Major structures:

Occiptial lobe Midbrain Thalamus Corpus Callosum Symptoms of PCA stroke? - Correct Answer Major stroke symptoms: contraleral loss of pain temp and senstation visual field loss Horner's syndrome Weber's syndrome Perinaud's syndrome Horner's Syndrome - Correct Answer Ptosis, miosis and dilation lag Ipsilateral impaired flushing and sweating Weber's syndrome - Correct Answer Midbrain stroke from PCA or BA infarct Contralateral weakness of upper and lower extremities (corticospinal tract) Ipsilateral gaze wekaness (craninal nerve 3) Also known as Lateral medullary syndrome Perinaud's Syndrome - Correct Answer Also know as dorsal midbrain syndrome Vertical gaze palsy- sun setting sign Pupils mid-dilated, light dissociation Convergence-retraction nystagmus Wallenberg Syndrome - Correct Answer Verterbral or PICA stroke Ipsilateral CN V involvement (sensory, pain, temp loss on ipsilateral face) Ipsilateral ataxia (cerbellum) Nystagmus, N/V, vertigo Horner syndrome Posterior Circulation is made up of what arteries? - Correct Answer Verterbral arteries Basilar artery Anterior Inferior Cerbellar Artery (AICA) Posterior Inferior Cerbellar Artery (PICA) Posterior inferior Cerbellar artery stroke symptoms? - Correct Answer Major structure=major symptoms Horner syndrome Wallenberg syndrome Ipislateral limb ataxia Decrease pain and temperature sensation contralateral body Anterior Inferior Cerbellar Artery - Correct Answer Major structure=major symptoms Ipsilateral deafness

Ipsilateral facial motor/sensory loss Ipsilateral limb ataxia Decreased pain and temperature senstation contralateral body Basilar Artery Stroke Symptoms - Correct Answer Decreased LOC Facial paresis Occulomotor difficulties facial paresis Ataxia Quadraparesis Causes Millard-Gubler syndrome or Ventral-pontine syndrome S/S of Anterior Circulation Left dominate hemisphere - Correct Answer Left gauze preference Right visual field deficit Right hemipaersis Right hemisensory loss S/S of Anterior Circulation Right non dominant hemisphere - Correct Answer Right gauze preference Left visual field deficit Left hemiparesis Left hemisensory loss Neglect/inattention S/S Posterior Circulation in Brainstem - Correct Answer Nystagmus Diplopia, disconjucate gaze, gaze palsy Dysarthria, dysphagia Vertigo, tinnitus Hemiparesis, quadriplegia senssory loss in hemibody or all 4 limbs Decreased LOC Hiccups, abnormal respirations Lucunar stoke - Correct Answer small vessel stroke Approximately 25% of strokes How much does CSF does the body produce an hour? - Correct Answer Approximately 20ml/hr Where is CSF produced? - Correct Answer Chorid plexus in the lateral, third and fourth ventricles What are some stroke mimics? - Correct Answer Toxic metabolic (glucose, Na+) Indigestions (tylenol, opioid, lithium) Seizure and Todd's parlaysis

Migraines Degenerative Neurological Disorders (MS) EMS Management of Stroke - Correct Answer Maintain 02sat >94% Administer NS HOB flat if hypotensive Glucose check IV access Treat SBP> NPO Cincinnati pre-hosptial stroke scale includes? - Correct Answer Facial Droop Arm Weakness Speech Los-Angeles pre-hospital stroke scale includes? - Correct Answer Facial weakness Arm strength Grip Blood Glucose Phase 1 of Stroke Care? - Correct Answer Emergency/Hyperacute First 3-24 hours Phase 2 of Stroke Care? - Correct Answer Acute Care 24-72 hours How long does an ED doc have to see a stroke patient? - Correct Answer Less than 10 min How long does the stroke team have to evaluate a stroke patient upon arrival to the ED? - Correct Answer Less than 15 min How soon does a CT need to be done for a stroke patient upon arrival to the hospital? - Correct Answer Less than 25 min How long does the stroke team have to get the CT read for a stroke patient? - Correct Answer Less than 45 min How long does the ED have to administer tPA for a stroke patient? - Correct Answer Less than 60 min How fast does the stroke patient need to be admitted to a stroke unit from the ED? - Correct Answer Less than 3 hours Hunt and Hess Score - Correct Answer 0 Unruptured aneurysm 1 Asymptomatic or mild headache and slight nuchal ridgidty

1a No acute meningeal or brain reaction, but fixed neurological deficit 2 Cranial Nerve palsy 3 Mild focal deficit, lethargy or confusion 4 Stupor, moderate to severe hemiparesis 5 Deep coma, decerebrate rigidity Fischer Score - Correct Answer I No subarchnoid blood seen on CT II Diffuse or vertical layers of SAH<1mm thick III Diffuse clot and/or vertical layer>1mmthick IV Intracerberal or intraventricular clot with diffuse or no subarchnoid blood What are the components of an ICH score? - Correct Answer GCS ICH volume IVH Location Age An ICH score of 0 gives the patient what mortality risk? - Correct Answer No mortality An ICH score of 5 or 6 gives the patient what mortality risk? - Correct Answer 100% mortality A Fischer Score of 1 means what? - Correct Answer No subarachnoid blood on CT A Fischer Score of 4 means what? - Correct Answer Intracerebral or intraventrucular clot with diffuse or no subarachnoid blood What is an ABCD2 score? - Correct Answer Risk assessment tool which predicts short-term stroke risk after a TIA. What are the components of an ABCD2 score? - Correct Answer Age > Blood Pressure SBP > 140 OR DBP > 90 Clinical Features of TIA : Unilateral weakness OR Speech impairment Duration of TIA Diabeties What does an ABCD2 score of 0-3 mean? - Correct Answer 1% 2 day stroke risk, may not require hospitalization What does an ABCD2 score of 4-5 mean? - Correct Answer 2 day stroke risk of 4% Hospital observation justified What does an ABCD2 score of 6-7 mean? - Correct Answer 2 day stroke risk of 8% Hospital observation worthwhile

What is the standard tPA dose? - Correct Answer 0.9mg/kg, max dose of 90mg 10% of total dose administered in IV bolus over 1-2 minutes Remaining 90% of dose administered over 1 hour tPA treatment window time period? - Correct Answer 4.5 hours in most patients Relative tPA exclusion criteria? - Correct Answer Age> Severe stroke measured by NIHSS> Oral antigoagulant use regardless of INR History of diabetes with poor ischemic stroke Goal time frame to administer tPA? - Correct Answer Less than 60 min Possilbe side effects of tPA? - Correct Answer ICH - stat head CT if change in LOC Orolingual angioedema Blood pressure parameters for initiation of tPA? - Correct Answer 185/ What are the BP parameters for 24 hours after tPA administration? - Correct Answer Less than 180/ What is an elevated BP after tPA associated with? - Correct Answer Spontaneous ICH What is the time frame for VS and neuro checks post tPA? - Correct Answer every 15 min x 2 hours every 30 min x 6 hours every 1 hour x 16 hours What is a cause of secondary brain injury? - Correct Answer Hypoxia Goal of temperature management after stroke or injury? - Correct Answer Maintain normalthermia Fever associated with poor outcomes What kind of fluids should be avoided after stroke or injury to the brain? - Correct Answer Hypotonic Fluids 5% Dextrose, 0.45% saline exacerbates cerebral edema When should a swallow assessment be completed for stroke patients? - Correct Answer Prior to any PO intake If a patient has a large vessel occlusion and received IV tPA without improvement after 60 min, what is the next step? - Correct Answer Consider Intra-arterial thrombolysis delivered by catheter directly to clot

Door to catheter across clot goal time? - Correct Answer 90-120 minutes What are the priorities of ICH Recognition? - Correct Answer Detection: S/S of stroke and CT imaging Frequency of Neuro assessment and vital sign assessment ED priorities for ICH management? - Correct Answer BP management Identification and reversal of coagulopathy Management of elevated ICP Prep for emergent intervention if appropriate Nursing management of elevated ICP? - Correct Answer HOB elevation Neutral head position Why do we drain CSF for strokes? - Correct Answer Stroke causes hydrocephalus draining CSF reduces pressure inside head How much CSF does the body produce per hour? - Correct Answer 20ml/hr How much CSF is circulating at any given time? - Correct Answer 125-150ml 20% in lateral ventricles How does Mannitol work to decrease ICP? - Correct Answer Osmotic diuretic pulls fluid from the cerebrum into vascular compartment Monitor: Sodium, Bun, Cr, serum osmolality How does hypertonic saline (3%) work to decrease ICP? - Correct Answer Pulls fluid into vascular space Monitor: chemistries every 4-6 hours How does CO2 regulation decrease ICP? - Correct Answer Decrease CO2= cerebral vasoconstriction Associated with hypo-perfusion Used as very short term rescue therapy Benefits of Barbiturate coma therapy? - Correct Answer Decreased cerebral metabolic rate and oxygen consumption decrease cerebral blood volume decrease excitation neurotransmitter release When is it appropriate to use Barbiturate coma to decrease ICP? - Correct Answer Used when patient has been non responsive to other ICP treatment modalities What are the risks associated with Barbiturates? - Correct Answer Direct myocardial depressant

Hypotension via venous dilation and pooling What are the benifits of a craniectomy? - Correct Answer Removal of bone flap allow for swelling effective at reducing ICP Questionable impact on long term outcome What organ metabolizes most contrast mediums? - Correct Answer Liver What is the most important intervention to protect the kidneys after contrast administration? - Correct Answer Hydration (specifically pre-procedural) What are the indications of a CT Angiogram? - Correct Answer Quick vessel imaging Detection of thrombus or vascular abnormality Vasospasm monitoring in SAH 3D reconstruction of vessel anatomy What are the benefits of CT Perfusion? - Correct Answer Reflects time and speed of blood flow to brain tissue Identifies oligemina (pneumbra) and infarct associated with acute ischemic stroke Non-invasive Differentiates between no flow and low flow states Indication for MRI? - Correct Answer More sensitive for ischemia from time of onsest Better detection of ischemia in brainstem, cerebellum and other small structures Pretest care for MRI? - Correct Answer Safety evaluation: Presence of metal Anxiety and agitation Ability to undergo 1-2 hour test with minimal supervision Indication for MR Angiogram? - Correct Answer Detect high grade atherscolerotic lesions of brain vessels Detect arterial dissection (Carotid and Vertebral) What is the indication for Diagnostic Cerebral Angiogram? - Correct Answer Gold standard for: Aneurysm AVM Fistula Large Vessel occulsion Risks associated with Diagnostic Cerebral Angiogram? - Correct Answer Clot formation

Vessel perforation Insertion site hematoma Post Cerebral Angiogram Care - Correct Answer Lay flat and extremity extended x 6 hours Assessment of catheter site and pulses on extremity When is an EEG indicated? - Correct Answer Gold standard for seizures Generally more adjunctive aid rather than diagnostic What kind of patients should you ask for a Carotid Duplex? - Correct Answer Used in screening of high risk patients. When detected, confirmatory tests with better sensitivity and specificity may be ordered: CTA of neck, MRA of neck, catheter angiography When would you consider using a Transcranial Doppler? - Correct Answer For an acute ischemic stroke revascularation and subarachnoid hemrrohage ( trends velocities over time, large vessel vasospasm) What do antithrombotics do? - Correct Answer Stop the development of a thrombus 2 Categories: Anticoagulants (slow the clotting cascade) Antiplatelets (prevent platelet activation and aggregation) What are the indications of antiplatelets? - Correct Answer Primary Prevention of ischemic stroke Secondary prevention of stroke after stroke What are some examples of antiplatelet drugs? - Correct Answer Aspirin (COX inhibitor) Ticlopidine and Clopidogrel (ADP antagonists)Abciximab (GP IIb/IIIa Inhibitor) What are some examples of anticoagulants? - Correct Answer Heparin and low molecular weight heparin Warfarin Dabigatran (Pradaxa) Riveroxaban (Xarleto) Apixaban (Elquis) How do thiazide diuretics lower the blood pressure? - Correct Answer Inhibit reabsorption of Na and CL ions in distal tubules in the kidney How do ACE inhibitors lower the blood pressure? - Correct Answer Blocks the conversion of anigiotension I to II thereby lowering arteriolar resistance and increasing venous capacity, decreasing cardiac output, index and volume

How do Calcium Channel Blockers lower the blood pressure? - Correct Answer Prevents calcium from crossing into cells thereby causing arterial vasodilation and smooth muscle relaxation How do beta blockers lower the blood pressure? - Correct Answer Slows HR and decreases Cardiac output by blocking B1 receptors in the heart How do ARB's lower the blood pressure? - Correct Answer Vasodilates (due to blocking of angiotension II) What is the mechanism of action of Dobutamine? - Correct Answer Increases contractility and cardiac output **Monitor HR as may cause tachyarrythmias How does Epi gtt raise my BP? - Correct Answer Vasoconstriction (will also increase HR) How does Levophed work? - Correct Answer Raises my blood pressure by vasoconstriction What is the mechanism of action of Neosynephrine? - Correct Answer Alpha 1 agonist results in blood pressure increase without significant heart rate effect How do statins lower cholesterol? - Correct Answer Inhibits cholesterol synthesis in the liver Increases LDL uptake Therefore, less circulating cholesterol for atherosclerosis plague production What effect to statins have, other than lowering cholesterol? - Correct Answer Exerts anti-inflammatory properties by improving endothelial function What class of drug is Nimodipine? - Correct Answer Calcium channel blocker How does Nimodipine improve outcomes in SAH patients? - Correct Answer Prevention of vasospams How does manitol work to lower ICP? - Correct Answer Osmotic diuretic- draws fluid into the vascular space for excretion by the kidneys Why do we give hypertonic saline? - Correct Answer Decrease cerebral edema Decreases elevated ICP How does hypertonic saline work? - Correct Answer increases serum sodium creating osmotic pull to bring fluid into the vessels

What type of drug is Dilantin and how does it work? - Correct Answer Anticonvulsant Works by blocking high frequency firing of action potentials (blocks NA) What kind of drug is Keppra and what is used to treat? - Correct Answer Anticonvulsant- used to treat seizures by inhibiting Ca movement What kind of drug is Danrolene? - Correct Answer Muscle relaxant used to treat malignant hyperthermia What kind of drug is Baclofen? - Correct Answer GABA agonist used to treat spasticity What is Gabapentin used to treat? - Correct Answer Neuropathic pain or seizures