PAEA EMERGENCY MEDICINE EOR
PRACTICE SOLUTION STUDY SHEET
QUESTIONS AND DETAILED ANSWERS
●● what differentiates Bell's Palsy from stroke
Answer: Bell's Palsy HAS forehead involvement
●● s/sx of Bell's palsy
Answer: facial weakness, facial paralysis, or twitching, inability to keep
one eye closed or excessive tears, drooping corner of mouth, dry mouth,
and impaired taste
●● Treatment for Bell's palsy
Answer: -*Prednisone* 60mg for 5 days
-*Valcyclovir* 1000mg for 7 days
-artificial tears
-lacri lube at night
●● Define stroke
Answer: any disease process that interrupts blood flow to the brain. can
be ischemic or hemorrhagic
,●● gold standard diagnostic test for stroke
Answer: CT angiogram
●● S/sx of a stroke
Answer: -sudden numbness/weakness,
-sudden confusion/aphasia,
-memory deficit,
-visual deficit,
-dizzy,
-sudden HA with no cause
●● tPA MOA
Answer: enzyme that binds to fibrin in a newly formed clot and directly
converts plasminogen to plasmin
●● When can I use tPA?
Answer: ischemic stroke presenting within <3 hrs and CT head negative
●● Dosing of tPA
Answer: -*0.9 mg/kg IV*,
-max dose of *90 mg*.
-10% administered as bolus with rest infused over next 60 minutes
,●● How do you treat high BP with stroke?
Answer: -Nitroprusside (short half life, easy to titrate) or IV labetalol
●● What do you use for anticoagulation/antiplatelet therapy in stroke?
Answer: ASA (not in hemorrhagic), heparin for thrombosis
●● What do you do differently to treat hemorrhagic stroke?
Answer: Give prophylactic anticonvulsant like phenytoin because of
increased seizure risk, antiplatelet therapy contraindicated
●● Ischemic stroke is the most common type (87%) and has what signs
and symptoms?
Answer: No headache, not visible on CT without contrast until 6 hours
post stroke
●● What are the types of Ischemic Stroke?
Answer: 1. Thrombotic: narrowing of damaged vascular lumen by an in
situ process, usually clot.
2. Embolic (20%): obstruction of normal vascular lumen by
intravascular material from remote source
●● Types of Hemorrhagic Stroke
, Answer: 1. Intracerebral (10%): results from rupture of small arterioles
2. Subarachnoid (3%): rupture of arterial aneurysms (hemorrhage into
subarachnoid space)
●● Causes of Intracerebral hemorrhagic stroke are what?
Answer: HTN, amyloidosis, iatrogenic anticoagulation, vascular
malformations, cocaine use
●● Causes of Subarachnoid hemorrhagic stroke are what?
Answer: berry aneurysm rupture, vascular malformation rupture
●● Signs and symptoms of Intracerebral hemorrhagic stroke are what?
Answer: ICP rises, vasoconstriction-sweating
●● Signs and symptoms of Subarachnoid hemorrhagic stroke are what?
Answer: may be preceded by warning headache, neck/back pain, "worst
headache of my life," thunderclap, may have loss of consciousness
●● Treatment of Subarachnoid hemorrhage
Answer: surgery, control hypertension, analgesics
●● What is the name for the disease that beings following an operation,
a fracture, or vascular event such as stroke or heart attack?
PRACTICE SOLUTION STUDY SHEET
QUESTIONS AND DETAILED ANSWERS
●● what differentiates Bell's Palsy from stroke
Answer: Bell's Palsy HAS forehead involvement
●● s/sx of Bell's palsy
Answer: facial weakness, facial paralysis, or twitching, inability to keep
one eye closed or excessive tears, drooping corner of mouth, dry mouth,
and impaired taste
●● Treatment for Bell's palsy
Answer: -*Prednisone* 60mg for 5 days
-*Valcyclovir* 1000mg for 7 days
-artificial tears
-lacri lube at night
●● Define stroke
Answer: any disease process that interrupts blood flow to the brain. can
be ischemic or hemorrhagic
,●● gold standard diagnostic test for stroke
Answer: CT angiogram
●● S/sx of a stroke
Answer: -sudden numbness/weakness,
-sudden confusion/aphasia,
-memory deficit,
-visual deficit,
-dizzy,
-sudden HA with no cause
●● tPA MOA
Answer: enzyme that binds to fibrin in a newly formed clot and directly
converts plasminogen to plasmin
●● When can I use tPA?
Answer: ischemic stroke presenting within <3 hrs and CT head negative
●● Dosing of tPA
Answer: -*0.9 mg/kg IV*,
-max dose of *90 mg*.
-10% administered as bolus with rest infused over next 60 minutes
,●● How do you treat high BP with stroke?
Answer: -Nitroprusside (short half life, easy to titrate) or IV labetalol
●● What do you use for anticoagulation/antiplatelet therapy in stroke?
Answer: ASA (not in hemorrhagic), heparin for thrombosis
●● What do you do differently to treat hemorrhagic stroke?
Answer: Give prophylactic anticonvulsant like phenytoin because of
increased seizure risk, antiplatelet therapy contraindicated
●● Ischemic stroke is the most common type (87%) and has what signs
and symptoms?
Answer: No headache, not visible on CT without contrast until 6 hours
post stroke
●● What are the types of Ischemic Stroke?
Answer: 1. Thrombotic: narrowing of damaged vascular lumen by an in
situ process, usually clot.
2. Embolic (20%): obstruction of normal vascular lumen by
intravascular material from remote source
●● Types of Hemorrhagic Stroke
, Answer: 1. Intracerebral (10%): results from rupture of small arterioles
2. Subarachnoid (3%): rupture of arterial aneurysms (hemorrhage into
subarachnoid space)
●● Causes of Intracerebral hemorrhagic stroke are what?
Answer: HTN, amyloidosis, iatrogenic anticoagulation, vascular
malformations, cocaine use
●● Causes of Subarachnoid hemorrhagic stroke are what?
Answer: berry aneurysm rupture, vascular malformation rupture
●● Signs and symptoms of Intracerebral hemorrhagic stroke are what?
Answer: ICP rises, vasoconstriction-sweating
●● Signs and symptoms of Subarachnoid hemorrhagic stroke are what?
Answer: may be preceded by warning headache, neck/back pain, "worst
headache of my life," thunderclap, may have loss of consciousness
●● Treatment of Subarachnoid hemorrhage
Answer: surgery, control hypertension, analgesics
●● What is the name for the disease that beings following an operation,
a fracture, or vascular event such as stroke or heart attack?
