Case 1

The 58-year-old female patient entered the emergency room because of sudden weakness on the left side of her face and arm. her husband said she had a mess at that time. Symptom progresses for about 40 minutes before full recovery. a history of mild COPD. At the time she had no fever, pulse 76 bpm, HA135 / 85 mmHg, sp02 96% room air and 8.8 mmol / L glucose.

a Definition of a transient ischemic attack (TIA).

b ABCD2 scale and stroke risk in 7 days according to you calculate

c In addition to the ABCD2-scale assessment criteria, include two additional criteria for the evaluation of TIA patients.

d You discharge the patient. Name the next 3 steps of treatment, including your advice before sending the patient home

Case 2

The 74-year-old male patient was taken to the ambulance by an ambulance because he was suddenly half weak about 90 minutes earlier. he is still awake but has weak half of his face and right hand. he has only THA, is taking amlodipine. At 37.2 ° C, pulse 98 bpm, blood pressure 210/108 mmHg, sp02 96% room air. CT in Figure Figure 5.1.

Figure 5.1

a The ambulance team called in advance to announce the patient’s FAST score. What is the exact score for this patient?

b What can be fake stroke and need immediate emergency elimination in bed?

c List six questions to evaluate the ROSIER scale (1 part of the ROSIER stroke scale assessment).

d Describe an abnormality on the CT scan of the patient’s skull (Figure 5.1).

e Summary of main pros and cons of fibrinolytic consumption in stroke patients

Case 3

68-year-old female patient entered the emergency room because of occipital pain and was unable to stand up about 2 hours ago. history of asthma and type 1 diabetes. She remained awake, pulse 66l / p, irregular, blood pressure 189/108 mmHg, sp02 91% room air, glucose 16.7. CT skull shown in Figure 5.2

Figure 5.2

a Abnormal description on CT film (Figure 5.2).

b 4 clinical signs you should expect to have when examining this patient

c Include the 3 steps to take in managing this patient

d You are invited to visit this patient. The level of consciousness has decreased and is currently unable to open the eyes, the pain stimulates just whine, unable to right away when the pain stimulates. How many GSC scores do you rate the patient?

e 2 complications of this condition can lead to a deterioration of the patient

Case 4

35-year-old female patient entering the emergency. She had been not feeling well since yesterday, had severe headache with vomiting, and was afraid she had meningitis. at 37.6 ° C, still alert, feeling very tired with headache.

a Name the three most common triggers of meningitis in adults

b Name the four clinical signs that warn you having increased intracranial pressure are contraindicated in CSF

c Cranial CT reads normally the patient has a cerebrospinal fluid puncture and samples sent for testing. The results are below.

BC 870 / mm3 lymphocytes

Microorganism type not found

Protein 0.8 g / dl

Glucose 3/4 of plasma concentration

d Determination of abnormality in the cerebrospinal fluid result. preliminary diagnosis?

e What more tests do you take on the cerebrospinal fluid to find the possible cause of the severe headache?

Case 5

The 18-year-old female patient admitted to the emergency room for 3 convulsions while in school, was taken by an ambulance. she failed to regain consciousness between seizures and when she entered the emergency room she began to regain consciousness. She has no history of epilepsy

a Have your immediate treatment prior to toxicology or testing?

b 2 reasons to rule out bed emergencies.

c Outline the medications in the order you will use them to manage the seizure (medication, dose, route of administration).

d Name 3 causes (other than the 2 you mentioned in point b.) That caused seizures in a young patient with no history of epilepsy. [3] Once you’ve got your seizures under control, what tests will you do in the emergency room to find the cause?

Case 6

The 67-year-old male patient has pain below the lower back and has difficulty walking. normal history

a Include 5 red flags, if there are signs of danger causing back pain

b You suspect that you have a pulp compression should undergo a neurological examination. How to distinguish a problem in an upper motor neuron (UMN) from a lower motor neuron (LMN) in the lower limb?

c How will you feel in this patient?

d You find that the muscle strength is only 2/5. Let’s define a level 2/5 on an MRC scale

e What acute tests are needed in this patient to support the diagnosis of myelosuppression?

Case 7

The room nurse calls you to manage antiemetics for patients with vestibular disorders. You come to see that a 48-year-old female patient is awake but lying on her head 30 degrees above the edge of the bed, still vomiting. The examination results are completely normal

a Describe 2 symptoms of true vestibular disorder

b Include 4 symptoms from the history and examination to distinguish central or peripheral vestibular disorders

c Name 2 causes that suggest chronic hearing loss related to vestibular syndrome.

d How to distinguish vertigo caused by a sudden change in position from vestibular neuritis (labyrinthitis)?

e How would you treat vestibular neuritis?

Name the two groups of medications you are taking and examples of the medicine you will prescribe with the advice you would advise the patient?

Case 8

The 76-year-old male patient in the emergency room gradually decreased mobility. You think the patient seems to have parkinson’s

a 3 main symptoms of parkinson’s disease? b describes anomalous gait common in this group of patients.

c In addition to idiopathic Parkinson’s disease, name two other causes of parkinson’s disease

d Name the two drugs, mechanism of action to improve mobility in parkinson’s patients.

e Assuming the patient does not need to be hospitalized immediately, you will be treated

Case 1

a A transient ischemic attack (TIA) is defined as a sudden onset of focal nerve onset that resolves on its own within 24 hours. however, TIA and stroke are actually interrelated, distinguished by duration. Half of TIAs lasting more than 30-60 minutes are seen in subclinical patients, so a TIA can be defined as a focal neurologic condition that improves symptoms within 30 to 60 minutes.

b In the patient diagnosed with TIA, the ABCD2 score was assessed to be consistent with a high risk of developing an early stroke. Calculate ABCD2 based on the patient’s clinical symptoms and the time when symptoms appeared (Box 5.1):

Box 5.1 The ABCD2 score Age> 60 years 1 point
Blood pressure> 140/90 mmHg 1 point
Clinical characteristics: Unilateral weakness 2 points
Language disorder 1 point
Duration of the disease: 10−60 minutes 1 point
> 60 minutes 2 points
Diabetes 1 point

Therefore, according to the ABCD2 scale, the score is 3 (weak one side = 2 VND and time 40 minutes = 1 VND). ABCD2 is used to predict stroke risk over the next 2 and 7 days: 1

Table 5.1

ABCD2 score 2-day stroke risk (%) 7-day stroke risk (%)
0−3 1.0 1.2
4−5 4.1 5.9
6−7 8.1 11.7

patients with 3-point ABCD2 have a 1% risk of stroke within 7 days of having TIA symptoms. The protocol differs but the NICE guidelines for stroke and TIA2 divide patients into low risk (ABCD2 1-3 points) and high risk (ABCD2 score> = 4) and recommend patients at high risk of early stroke. Hospital should be immediately hospitalized or need evaluation and early intervention by specialist staff

c Other factors in TIA patients with a high risk of stroke include, for example, more than 1 TIA within 7 days (the TIA level increases), and factors that require intervention such as right atrial fibrillation with immediate anticoagulation. TIA patients with signs of headache, or taking warfarin, may also need to be hospitalized to rule out cerebral hemorrhage.

d NICE recommends stroke and TIA2 recommends the following management in patients diagnosed with TIA who are discharged from hospital:

● Take antiplatelet immediately. first dose of 300 mg aspirin: oral immediately and continuously for 1 week before reducing to 75mg daily. patients taking aspirin during TIA symptoms may add dipyridamole (eg, persantin retard 200 mg bd). aspirin allergy or intolerance can start clopidogrel and a specialist consultation as soon as possible within 7 days.

● The patient is advised to return to the hospital immediately if symptoms recur

● Finally, patients should advise against driving until they have been evaluated by a stroke specialist

Leave a Reply