Transient ischemic attack: Heed the warning
INSTRUCTIONS Transient ischemic attack: Heed the warning
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Transient ischemic attack: Heed the warning
GENERAL PURPOSE: To provide information about evidence-based interventions for TIA and stroke. LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to: 1. Describe the signs and symptoms of TIA. 2. Discuss the diagnostic criteria for TIA. 3. Identify evidence-based strategies for TIA and stroke prevention.
© 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins.
- Which of the following best describes TIA?
- It results in tissue death visible on cerebral imaging.
- It's a transient episode of neurologic dysfunction.
- It results in cerebral infarction.
- It's characterized by a gradual onset of neurologic signs and symptoms.
- Which statement about TIA is correct?
- It affects more females than males.
- The incidence of TIA doesn't change with advancing age.
- It doesn't resolve spontaneously.
- It can be a precursor to stroke.
- A typical clinical feature of TIA is
- absence of nonspecific symptoms.
- symptom onset within days of the event.
- a history of similar episodes.
- gradual development of chest pain.
- A TIA involving the anterior cerebral artery circulation can manifest as
- bilateral blindness.
- The risk of a TIA progressing to stroke is highest with
- carotid artery stenosis.
- lacunar pathology.
- occlusion of small distal arteries.
- cardioembolic sources.
- Which statement about the NIHSS is accurate?
- It's a seven-item assessment tool.
- It's been shown to predict mortality in acute hemorrhagic stroke.
- It uses qualitative measures of neurologic deficits.
- It should be used with every patient with stroke-like signs and symptoms.
- One factor used to calculate the ABCD2 score is
- coronary artery disease.
- intracranial pressure.
- An ABCD2 score of 7 signifies
- a need for emergent carotid endarterectomy.
- no need for hospitalization.
- a low stroke risk.
- a high 2-day stroke risk.
- If your patient has a ABCD2 score of 4,
- the 2-day stroke risk is 40%.
- head and neck imaging is indicated in the ED.
- hospital admission is required.
- emergent carotid arteriography is indicated.
- Nonmodifiable risk factors for TIA and stroke include
- sedentary lifestyle.
- alcohol abuse.
- AHA Class I recommendations for TIA workup within 24 hours of symptom onset include all of the followingexcept
- brain CT.
- carotid angiography.
- craniocervical vessel MRA.
- brain MRI.
- After arrival in the ED, patients with stroke signs and symptoms should undergo a stat noncontrast CT scan within
- 25 minutes.
- 40 minutes.
- 60 minutes.
- 90 minutes.
- Which statement is correct about DWI?
- It's inferior to noncontrast CT for showing areas of infarcted brain tissue.
- It can't show infarcted brain tissue in small cerebral arterial territories.
- It's the best test for showing infarcted brain tissue in perforator cerebral arterial territories.
- It should be performed within 48 hours of symptom onset.
- Which is not an antiplatelet drug used to prevent secondary ischemic events?
- A target goal for aggressive stroke risk factor modification is
- BP less than 160/90.
- BP less than 140/90 in patients with diabetes.
- LDL less than 70 mg/dL.
- LDL greater than 90 mg/dL.
- Which risk factor should have the highest priority to prevent TIA and stroke?
- Atorvastatin therapy in patients with a recent TIA or stroke has been shown to
- have no effect on the incidence of fatal stroke.
- have a positive effect on the incidence of future TIAs.
- reduce the incidence of fatal or nonfatal stroke by 16%.
- reduce mortality by 61%.
- Which intervention has been shown to reduce stroke risk in symptomatic patients with a history of TIA or stroke and 70% to 99% carotid artery stenosis?
- carotid endarterectomy
- carotid artery stenting
- aortic valvuloplasty
- vena cava filter placement