Return to Scenario ListShow Learning Points most relevant to Phase 1:

Stroke / TIA / sudden onset unilateral weakness

Clinical Discipline(s)/Organ System(s)
Nervous System, Neurology, Radiology
Progress Test Topic(s)
A 55 year old NZ European man collapsed at work with sudden onset of right-sided weakness. His wife tells you that recently he has had short episodes where he 'can't find the right words'. He has hypertension that is reasonably well controlled and has been a lifelong smoker.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy of the cerebral circulation
   - Physiology of neural motor/sensory pathways (including visual, auditory) and higher mental function
   - Pathogenesis of atherosclerosis
   - Cell function and effects of ischaemia
   - Pathophysiology of transient ischaemic attack (TIA) and stroke
   - Classification of stroke
   - Pharmacology of antihypertensives, antiplatelet agents, anticoagulants, lipid lowering agents, thrombolytic agents
Clinical and Communication Skills 
   - History from a patient with new onset focal neurology; features distinguishing central and peripheral neurological lesions
   - Perform and record a focused examination to localise the neurological lesion; identify possible source of emboli
   - Acute management of stroke and TIA; indication for urgent imaging of the brain; consideration of stroke thrombolysis and primary radiological intervention
   - Inhospital management of stroke and TIA; use of antiplatelet drugs for secondary prophylaxis; inhospital care from stroke unit
   - Role of physiotherapy, occupational and speech therapy in management of stroke patients
   - Indications and interpretation of common investigations for stroke aetiology: electrocardiogram, coagulation screen, carotid doppler USS, CT angiogram, MR angiogram, and venous duplex scans
   - Pharmacological management of cardiovascular risk factors: antihypertensives, antiplatelets, anticoagulants, lipid lowering agents, nicotine replacement therapy
   - Indications for, and principles of, carotid endarterectomy
   - Management of common early and late stroke complications
Personal and Professional Skills 
   - Empathise with a patient focusing on reintegration with society
   - Helping the patient and family/whānau deal with life changing news
   - Legal considerations of power of attorney
   - ABC (ask, brief advice, cessation support) approach to smoking cessation
Hauora Māori 
   - Health discrepancies between Māori and non-Māori - the barriers to healthcare for Māori
   - Smoking prevalence among Māori adults - culturally appropriate smoking cessation programmes
Population Health 
   - Epidemiology of stroke and TIA in New Zealand
   - Prevention strategies and number needed to treat principles in stroke prevention
   - Provision of stroke services on a national scale
Conditions to be considered relating to this scenario
stroke (ischaemic infarction or bleeding), transient ischaemic attack, Bell's palsy, hypoglycaemia, focal epilepsy, migraine
Less common but 'important not to miss'
carotid artery dissection, venous sinus thrombosis, intracranial space-occupying lesion, malignant hypertension
vasculitis, Todd's palsy, multiple sclerosis, phaeochromocytoma, somatisation disorder, giant cell arteritis, syphilis