Question

<sup>(1.2pts)
Question 1 - Bonnie is a 70-year-old woman who lives alone. One evening she felt lightheaded and dizzy. When her head began to ache, she decided to take an analgesic and go to bed early. The following morning, upon awakening, she was unable to move the bed sheets with her right arm. At this point, she was experiencing tingling sensations in her limbs, and she had difficulty keeping her balance. She dialed 911 for help, and by the time the ambulance arrived, she was confused and unable to articulate her words, although she knew what information the paramedics were asking of her. In the hospital, she was examined and treated for ischemic stroke. There are a variety of modifiable and non-modifiable risk factors for stroke. Which of the following would be considered modifiable risk factors for stroke? SELECT ALL THAT APPLY.

Hypertension

Smoking

Age

Race
  
Diabetes Mellitus Type 2

Hyperlipidemia

Family history</sup>

<sup>(1.1pts)
Question 2 - What would be the FIRST diagnostic test you would expect Bonnie to have when she arrives in the emergency department?

Echocardiogram

CT of the head

Fasting lipid panel

MRI/MRA</sup>

^{(1.1pts)
Question 3 - Stroke, or brain attack, involves brain tissue injury. Which of the following statements below is true, with regard to saving as many brain cells as possible?}

<sup>Since neurons can enter the cell cycle in times of significant stress, the main reason for prompt action in a stroke is to prevent related cardiac complications.


Once an individual has had a stroke, there is no chance to save brain cells. Working to restore circulation only serves to prevent the individual from having another stroke.

With ischemic stroke, there is usually a central core of dead or dying cells, surrounded by an ischemic area called the penumbra. Timely return of circulation could save the cells of the penumbra; without this, the area of dead tissue increases.

None of the above</sup>

^{(1.1pts)
Question 4 - Since Bonnie was diagnosed with an ischemic stroke, she would have suffered from ischemia. Match the terms hypoxia and ischemia to their definitions below.
Matching item   Matching item choices
Hypoxia- Deprivation of oxygen with maintained blood flow. Interferes with delivery of oxygen.
Ischemia- Cessation of blood flow, interfering with delivery of oxygen and glucose as well as the removal of metabolic waste. More dangerous to the brain.}

^{(1.1pts)
Question 5 - Place the steps below in order, demonstrating how someone with an ischemic stroke could develop cerebral edema.
(Click and drag to put the items in the correct order, or click here to reorder by entering numbers directly )
1
Ischemia leads to a lack of oxygen for the cell.
2
Cells switch into anaerobic metabolism.
3
Anaerobic metabolism creates a shortage of ATP.
4
The sodium-potassium-ATPase pump stops working due to the lack of ATP.
5
Sodium builds up inside the cell, and water follows.}

<sup>(1.1pts)
Question 6 - What type of aphasia was Bonnie demonstrating at the scene? Remember: she had a difficult time getting her words out, although she was comprehending the language fine.

Expressive or nonfluent aphasia.

Receptive of fluent aphasia.

Primary progressive aphasia.
  
Mixed aphasia.</sup>

^{(1.1pts)
Question 7 - Bonnie's condition deteriorates as a result of significant cerebral edema. Her ICP is 25. Her blood pressure is 90/40. Calculate her cerebral perfusion pressure (CPP). (Blank A, number only needed, round to nearest whole number). Is this adequate, or inadequate (Blank B)?
32
a.Enter your answer for question a.
inadequate
b.Enter your answer for question b.}

<sup>(1.1pts)
Question 8 - Given Bonnie's deteriorating condition, what would be important to include in your physical assessment? SELECT ALL THAT APPLY.   

Vital signs, watching for Cushing's triad.

Level of consciousness.

Pupil assessment.

Motor assessment.

Assessment for peripheral edema.</sup>

<sup>(1.1pts)
Question 9 - Bonnie tells you that she had similar symptoms 6 months ago, but the symptoms went away after about an hour. She didn't think it was necessary to go to the hospital since the symptoms went away. What did Bonnie experience 6 months ago?

AV malformation.

Another stroke (CVA).
  
Myocardial infarction (MI).
  
Transient ischemic attack (TIA).</sup>

Answer 1

1.Modifiable risk factors are that can be modified or changed by the person. In this scenario modifiable risk factors include :

• Hypertension :can be controlled by medicine and life style change
• Smoking :can be stopped
• Diabetes mellitus type 2 :can be controlled by medication
• Hyperlipidemia : can be controlled by medicine and lifestyle change

2.The first diagnostic test for Bonnie in emergency department is CT brain to distinguish ischaemic and hemorrhagic stroke and identity the area of tissue damage.

3.The true statement regarding saving as many brain cells is, :with ischaemic stroke, there is usually a central core of dead or dying cells surrounded by an ischaemic area called the penumbra. Timely return of circulation could save the cells of the penumbra, without this the area of dead tissue increases.

4.Hypoxia -Deprivation of oxygen with maintained blood flow. Interference with delivery of oxygen.

Ischemia -Cessation of blood flow., interfering with delivery of oxygen and glucose as well as the removal of metabolic waste. More dangerous to brain.