Anatomy + Pathophysiology
19%of exam
Hyperacute Care
28%of exam
Acute Care
28%of exam
Post-acute Care
13%of exam
Preventative Care
13%of exam
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
- New stroke signs→Activate stroke(Time brain)
- Unknown glucose→Check glucose(Mimic)
- Bleed possible→Noncontrast CT(First image)
- LVO suspected→CTA(Vessel imaging)
- Eligible AIS→Thrombolytic(Do not delay)
- BP too high→Lower BP(Before lytic)
- LVO confirmed→Thrombectomy(Team activation)
- 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
- Airway threatened→Escalate airway(ABC first)
- Neuro worsens→Urgent reassess(Bleed/edema)
- Before oral intake→Swallow screen(Aspiration)
- Immobile patient→VTE prevention(STK-1)
- Telemetry shows AF→Anticoag plan(STK-3)
- Neglect present→Safety setup(Affected side)
- Fever present→Treat source(Brain stress)
- 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
- Gait deficit→PT(Mobility)
- ADL deficit→OT(Function)
- Aphasia→SLP(Communication)
- Dysphagia→SLP(Swallow)
- High intensity→IRF(Daily therapy)
- Lower tolerance→SNF(Skilled care)
- Homebound→Home health(Home therapy)
- 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
- Noncardioembolic AIS→Antiplatelet(Secondary)
- AF stroke→Anticoagulant(Embolic)
- Atherosclerosis→Statin(LDL lowering)
- Smoker→Cessation(Counsel/meds)
- Sleep apnea→CPAP eval(OSA)
- Severe carotid→Vascular consult(Symptomatic)
- Cryptogenic young→PFO eval(Selected)
- 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
- 1.170 items; 150 scored
- 2.Passing point = scaled 200
- 3.Pace: about 64 sec/item
- 4.LKW drives treatment clock
- 5.Glucose before thrombolytic
- 6.NCCT excludes hemorrhage
- 7.Alteplase max 90 mg
- 8.BP <185/110 before lytic
- 9.BP <180/105 after lytic
- 10.LVO -> thrombectomy consult
- 11.Swallow screen before PO
- 12.AF stroke -> anticoagulation plan
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