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Cheat sheet

SCRN Cheat Sheet

Practice QuestionsStudy Guide

Anatomy + Pathophysiology

19%of exam

Vascular AnatomyStroke SyndromesStroke MimicsCore Concepts

Hyperacute Care

28%of exam

Code StrokeThrombolysisThrombectomyHyperacute Picker

Acute Care

28%of exam

MonitoringSafetyComplicationsQuality Metrics

Post-acute Care

13%of exam

RehabTransitionsCaregiver TeachingRehab Picker

Preventative Care

13%of exam

Risk FactorsMedicationsLifestylePrevention Picker

Quick Facts

Exam
SCRN
Owner
ABNN
Vendor
PSI
Questions
170 MCQ
Scored
150 scored
Pretest
20 unscored
Time
3 hours
Pass
Scaled 200
Validity
5 years
Eligibility
2080 stroke hours

Blueprint Counts

28 anatomy | 42 hyper | 42 acute

19 post-acute19 prevention150 scored20 pretest

Ischemic vs Hemorrhagic

Ischemic

  • Blocked vessel
  • Penumbra target
  • Reperfusion possible

Hemorrhagic

  • Bleeding vessel
  • Expansion risk
  • Reverse coagulopathy

Clot vs bleed

Exam Blueprint

Anatomy
28 scored
Hyperacute
42 scored
Acute
42 scored
Post-acute
19 scored
Prevention
19 scored
Knowledge
Define and recognize
Interpretation
Apply and compare
Evaluation
Select safest action

MCA vs ACA

MCA

  • Face/arm weakness
  • Aphasia or neglect
  • Lateral cortex

ACA

  • Leg weakness
  • Abulia/incontinence
  • Medial frontal

Arm vs leg

Vascular Anatomy

MCA
Face/arm, aphasia
ACA
Leg, abulia
PCA
Vision, memory
Basilar
Brainstem emergency
PICA
Wallenberg pattern
Circle Willis
Collateral ring
Carotid
Anterior circulation
Vertebrobasilar
Posterior circulation

Stroke Syndromes

Aphasia
Dominant hemisphere
Neglect
Nondominant parietal
Hemianopia
PCA or optic
Ataxia
Cerebellar sign
Diplopia
Posterior warning
Crossed signs
Brainstem lesion
Locked-in
Pontine injury
Abulia
ACA clue

Core Concepts

Core
Irreversible injury
Penumbra
Salvageable tissue
Edema
Swelling risk
CPP
MAP minus ICP
Autoregulation
Often impaired
Mimic
Nonvascular presentation
Neuroplasticity
Recovery mechanism
Herniation
Late danger

BE-FAST

Balance Eyes Face Arm Speech Time

Posterior cluesCall 911Time brainLKW matters

Alteplase vs Thrombectomy

Alteplase

  • IV thrombolytic
  • Eligibility screen
  • Bleeding risk

Thrombectomy

  • Endovascular procedure
  • LVO target
  • Imaging selection

Drug vs device

Hyperacute Picker

  1. New stroke signs→Activate stroke(Time brain)
  2. Unknown glucose→Check glucose(Mimic)
  3. Bleed possible→Noncontrast CT(First image)
  4. LVO suspected→CTA(Vessel imaging)
  5. Eligible AIS→Thrombolytic(Do not delay)
  6. BP too high→Lower BP(Before lytic)
  7. LVO confirmed→Thrombectomy(Team activation)
  8. Hemorrhage found→Bleed pathway(No lytic)

Code Stroke

BE-FAST
Recognition screen
LKW
Treatment clock
Glucose
Rule out mimic
NIHSS
Deficit severity
NCCT
Exclude hemorrhage
CTA
Find LVO
Labs
Do not delay
Telestroke
Remote expertise

Reperfusion Therapy

Alteplase
0.9 mg/kg
Max dose
90 mg
Bolus
10% first
Infusion
60 minutes
Tenecteplase
Single bolus
Window
Up to 4.5h
BP before
Below 185/110
BP after
Below 180/105

Thrombectomy

LVO
Primary target
ICA
Large vessel
M1
Common target
ASPECTS
Core estimate
Perfusion
Mismatch selection
Groin puncture
Procedure start
TICI
Reperfusion grade
24 hours
Selected patients

ABCDE Stroke

Airway Breathing Circulation Disability Exposure

Life threats firstThen NIHSSThen workflowThen teaching

NIHSS vs Swallow

NIHSS

  • Neuro severity
  • Trend deficits
  • Treatment communication

Swallow

  • Aspiration risk
  • Before PO
  • Diet safety

Severity vs aspiration

Acute Priority Picker

  1. Airway threatened→Escalate airway(ABC first)
  2. Neuro worsens→Urgent reassess(Bleed/edema)
  3. Before oral intake→Swallow screen(Aspiration)
  4. Immobile patient→VTE prevention(STK-1)
  5. Telemetry shows AF→Anticoag plan(STK-3)
  6. Neglect present→Safety setup(Affected side)
  7. Fever present→Treat source(Brain stress)
  8. Glucose high→Control glucose(Avoid lows)

Monitoring

Neuro checks
Trend changes
Vitals
Perfusion clues
Telemetry
Find AF
Swallow screen
Before PO
Oxygenation
Protect brain
Glucose
140-180 target
Temperature
Treat fever
I/O
Volume clues

Complications

sICH
Headache/worsening
Angioedema
Airway emergency
Aspiration
Dysphagia risk
Cerebral edema
ICP threat
DVT/PE
Immobility risk
Seizure
Cortical irritation
Depression
Screen early
Falls
Neglect risk

Quality Metrics

Door-needle
60 min goal
Door-puncture
90 min goal
STK-1
VTE prophylaxis
STK-2
Discharge antithrombotic
STK-3
AF anticoagulation
STK-5
Antithrombotic day two
STK-6
Statin discharge
STK-10
Rehab assessed

Rehab Team

PT walks | OT works | SLP talks

Swallow tooCaregiver trainsGoals functionalHome safety

IRF vs SNF

IRF

  • Intensive therapy
  • Medical oversight
  • Higher tolerance

SNF

  • Skilled nursing
  • Lower intensity
  • Longer recovery

Intensity determines placement

Rehab Picker

  1. Gait deficit→PT(Mobility)
  2. ADL deficit→OT(Function)
  3. Aphasia→SLP(Communication)
  4. Dysphagia→SLP(Swallow)
  5. High intensity→IRF(Daily therapy)
  6. Lower tolerance→SNF(Skilled care)
  7. Homebound→Home health(Home therapy)
  8. Work goal→Voc rehab(Return planning)

Rehab + Transitions

PT
Mobility/gait
OT
ADL function
SLP
Speech/swallow
PM&R
Rehab physician
IRF
Intensive rehab
SNF
Skilled rehab
Home health
Home-based services
Caregiver
Training required

Antiplatelet vs Anticoagulant

Antiplatelet

  • Platelet pathway
  • Noncardioembolic
  • Aspirin/clopidogrel

Anticoagulant

  • Clotting cascade
  • AF/cardioembolic
  • Bleeding teaching

Artery vs embolus

Prevention Picker

  1. Noncardioembolic AIS→Antiplatelet(Secondary)
  2. AF stroke→Anticoagulant(Embolic)
  3. Atherosclerosis→Statin(LDL lowering)
  4. Smoker→Cessation(Counsel/meds)
  5. Sleep apnea→CPAP eval(OSA)
  6. Severe carotid→Vascular consult(Symptomatic)
  7. Cryptogenic young→PFO eval(Selected)
  8. TIA/minor stroke→Rapid follow-up(Early recurrence)

Prevention

Hypertension
Top modifiable risk
AF
Anticoagulation issue
Diabetes
Glycemic control
Lipids
High-intensity statin
Smoking
Cessation counseling
OSA
Screen and treat
DAPT
Short selected use
PFO
Selected closure

Common Traps

Pretest trap

Every item counts ≠ Pretest unlabeled

Clock trap

LKW starts clock ≠ Arrival is metric

Glucose trap

Hypoglycemia mimics stroke ≠ Check before lytic

BP trap

Below 185/110 before ≠ Below 180/105 after

Swallow trap

Screen before PO ≠ NIHSS not swallow

Teaching trap

Unstable needs escalation ≠ Stable needs education

Antithrombotic trap

No early aspirin ≠ Post-lytic caution

Localization trap

MCA affects arm ≠ ACA affects leg

Last Minute

  1. 1.170 items; 150 scored
  2. 2.Passing point = scaled 200
  3. 3.Pace: about 64 sec/item
  4. 4.LKW drives treatment clock
  5. 5.Glucose before thrombolytic
  6. 6.NCCT excludes hemorrhage
  7. 7.Alteplase max 90 mg
  8. 8.BP <185/110 before lytic
  9. 9.BP <180/105 after lytic
  10. 10.LVO -> thrombectomy consult
  11. 11.Swallow screen before PO
  12. 12.AF stroke -> anticoagulation plan

ABNN SCRN Stroke Certified Registered Nurse

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