APEX NIH STROKE SCALE GROUP B EXAMPREP
STUDY GUIDE 2026 PRACTICE QUESTIONS
AND SOLUTIONS
◉ What can be used to increase the HR in a transplanted heart?
What cannot be used? Answer: -Drugs that directly stimulate the SA
node
-Epi, isoproterenol, glucagon
-Atropine, glycopyrrolate, ephedrine can NOT be used
◉ Do you need to still give an anticholinergic when reversing a
patient with a transplanted heart? Answer: Yes - even though an anti
cholinesterase won't cause bradycardia, it will still cause other signs
of PNS activation elsewhere in the body
◉ What may be different about the EKG in a transplanted heart?
Answer: May see 2 P waves - one from the intrinsic SA node and one
from the donor heart (less common with modern techniques)
◉ Any reflex that requires ANS innervation will be disrupted in a
transplanted heart. What reflex remains intact? Why? Answer:
Bainbridge Reflex
,SA node stretch will directly increase the SA node's firing rate
◉ What is the most common cause of cardiac denervation in non-
cardiac surgery patients? Answer: Diabetes - diabetic autonomic
dysfunction
◉ Where do glomus tumors/glomangiomas arise from? Answer: -
Neural crest cells
-Grow in neuroendocrine tissues close to the carotid artery, aorta,
glossopharyngeal nerve, and middle ear
◉ Are glomangiomas usually benign or malignant? Answer: Benign
◉ What might glomus tumors release? Answer: Norepi, serotonin
and kallikrein, histamine or bradykinin
◉ If a glomangioma causes hypertension, what is it probably
secreting? Answer: Norepi
◉ If a glomangioma causes bronchoconstriction and hypertension,
what is it probably secreting? Answer: Serotonin and kallikrein,
similar to a carcinoid tumor
, ◉ If a glomanioma secretes serotonin and kallikrein, what
symptoms will you see? Answer: Bronchoconstriction, headache,
hypertension, flushing, and diarrhea
◉ If a glomangioma causes bronchoconstriction and hypotension,
what is it probably secreting? Answer: Histamine or bradykinin
◉ Why don't glomangiomas secrete epi? Answer: They lack the
enzyme that converts norepi to epi (phenylethanolamine N-
methyltransferase)
◉ If a glomangioma causes bronchoconstriction, headache,
hypertension, flushing, and diarrhea, what can be given as
treatment? Answer: Octreotide - treats carcinoid-like signs and
symptoms
(Octreotide is a hormone blocker. Carcinoid tumors release
hormones.)
◉ Cranial nerve dysfunction may occur with glomangiomas and
result in... Answer: swallowing impairment, aspiration, and airway
obstruction
◉ Surgical dissection of a glomangioma that has invaded the IJ
increases the risk of... Answer: air embolism
STUDY GUIDE 2026 PRACTICE QUESTIONS
AND SOLUTIONS
◉ What can be used to increase the HR in a transplanted heart?
What cannot be used? Answer: -Drugs that directly stimulate the SA
node
-Epi, isoproterenol, glucagon
-Atropine, glycopyrrolate, ephedrine can NOT be used
◉ Do you need to still give an anticholinergic when reversing a
patient with a transplanted heart? Answer: Yes - even though an anti
cholinesterase won't cause bradycardia, it will still cause other signs
of PNS activation elsewhere in the body
◉ What may be different about the EKG in a transplanted heart?
Answer: May see 2 P waves - one from the intrinsic SA node and one
from the donor heart (less common with modern techniques)
◉ Any reflex that requires ANS innervation will be disrupted in a
transplanted heart. What reflex remains intact? Why? Answer:
Bainbridge Reflex
,SA node stretch will directly increase the SA node's firing rate
◉ What is the most common cause of cardiac denervation in non-
cardiac surgery patients? Answer: Diabetes - diabetic autonomic
dysfunction
◉ Where do glomus tumors/glomangiomas arise from? Answer: -
Neural crest cells
-Grow in neuroendocrine tissues close to the carotid artery, aorta,
glossopharyngeal nerve, and middle ear
◉ Are glomangiomas usually benign or malignant? Answer: Benign
◉ What might glomus tumors release? Answer: Norepi, serotonin
and kallikrein, histamine or bradykinin
◉ If a glomangioma causes hypertension, what is it probably
secreting? Answer: Norepi
◉ If a glomangioma causes bronchoconstriction and hypertension,
what is it probably secreting? Answer: Serotonin and kallikrein,
similar to a carcinoid tumor
, ◉ If a glomanioma secretes serotonin and kallikrein, what
symptoms will you see? Answer: Bronchoconstriction, headache,
hypertension, flushing, and diarrhea
◉ If a glomangioma causes bronchoconstriction and hypotension,
what is it probably secreting? Answer: Histamine or bradykinin
◉ Why don't glomangiomas secrete epi? Answer: They lack the
enzyme that converts norepi to epi (phenylethanolamine N-
methyltransferase)
◉ If a glomangioma causes bronchoconstriction, headache,
hypertension, flushing, and diarrhea, what can be given as
treatment? Answer: Octreotide - treats carcinoid-like signs and
symptoms
(Octreotide is a hormone blocker. Carcinoid tumors release
hormones.)
◉ Cranial nerve dysfunction may occur with glomangiomas and
result in... Answer: swallowing impairment, aspiration, and airway
obstruction
◉ Surgical dissection of a glomangioma that has invaded the IJ
increases the risk of... Answer: air embolism
