Mixed Deck — All ASC Topics Flashcards

When educating a patient about recognizing TIA symptoms, which mnemonic should the stroke coordinator prioritize?

Answer: FAST (Face drooping, Arm weakness, Speech difficulty, Time to call 911)

The FAST mnemonic is the validated public health tool for stroke symptom recognition and has been widely adopted in US stroke education campaigns.

Which GWTG-Stroke achievement award recognizes consistent top performance on all stroke quality measures over a 24-month period?

Answer: Gold Plus Quality Achievement Award

The GWTG-Stroke Gold Plus Quality Achievement Award recognizes hospitals that achieve 85% or higher compliance on all stroke measures for at least 24 consecutive months.

What is the NIHSS score range that generally indicates a moderate-to-severe stroke?

Answer: 5–15

NIHSS scores of 5–15 indicate moderate stroke severity, while 16–20 is moderately severe and >20 is severe stroke.

A stroke survivor with aphasia wants to return to work. Which community resource should the stroke coordinator prioritize connecting them with?

Answer: State vocational rehabilitation services

State vocational rehabilitation services provide job counseling, assistive technology, and job placement support for individuals with communication and other disabilities.

Which of the following is the MOST common cause of death in the first 30 days after ischemic stroke?

Answer: Aspiration pneumonia and other medical complications

Medical complications, especially aspiration pneumonia, deep vein thrombosis, and pulmonary embolism, are the leading causes of early post-stroke mortality.

A diabetic patient post-stroke has an HbA1c of 9.2%. What is the primary glycemic management goal for stroke prevention?

Answer: Moderate glycemic control targeting HbA1c <7–8% while avoiding hypoglycemia

Moderate glycemic control (HbA1c <7–8%) is recommended for diabetic stroke survivors, balancing cardiovascular benefit against hypoglycemia risk.

A stroke program's certification requires documented evidence of multidisciplinary stroke team meetings. What is the minimum recommended frequency according to TJC standards?

Answer: Quarterly

Joint Commission stroke certification standards require multidisciplinary performance improvement meetings at least quarterly.

Which element is REQUIRED in a root cause analysis (RCA) conducted after a delayed tPA administration?

Answer: Identification of contributing system and process factors

RCA must identify contributing system and process factors — not individual blame — to produce actionable improvements.

When a ASC professional encounters an unfamiliar challenge in evidence-based stroke protocols, what is the recommended first course of action?

Answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

A post-stroke patient has a serum sodium of 126 mEq/L on day 5 with euvolemia. What is the MOST likely diagnosis?

Answer: Syndrome of inappropriate antidiuretic hormone (SIADH)

SIADH is the most common cause of hyponatremia after stroke, characterized by low serum osmolality, concentrated urine, and euvolemia.

For acute ischemic stroke patients receiving IV tPA who also have a large vessel occlusion (LVO), what is the evidence-based approach?

Answer: Administer IV tPA and proceed immediately to thrombectomy ('drip-and-ship' or 'mothership')

Current evidence supports administering IV tPA followed by immediate mechanical thrombectomy for eligible LVO patients, as IV tPA may partially recanalize clot and improve collaterals.

Per evidence-based stroke protocols, what is the recommended target time from stroke symptom onset to groin puncture for mechanical thrombectomy?

Answer: ≤90 minutes

AHA/ASA guidelines recommend a target onset-to-puncture time of ≤90 minutes when the patient arrives directly to a thrombectomy-capable center.

When assessing a stroke survivor's readiness for community reintegration, which domain of the ICF framework is most relevant?

Answer: Participation (life roles and social involvement)

Community reintegration is best captured by the ICF participation domain, which addresses involvement in life situations such as work, family roles, and community activities.

Which tool is often used for identifying process gaps?

Answer: Root Cause Analysis (RCA).

Root Cause Analysis (RCA) is a structured problem-solving method used to identify the fundamental, underlying causes of problems or incidents, rather than just addressing symptoms. In healthcare, it's particularly useful for investigating adverse events or process failures to prevent recurrence. By systematically delving into the 'why' behind an issue, RCA helps pinpoint specific process gaps and inform effective corrective actions.

What is the role of antiplatelet therapy in stroke prevention?

Answer: Prevent clot formation.

Antiplatelet therapy, commonly involving medications like aspirin, works by inhibiting the aggregation of platelets, which are blood cells involved in clotting. By preventing platelets from sticking together and forming clots, these drugs reduce the risk of blockages in blood vessels that can lead to ischemic strokes. This therapy is a cornerstone of secondary stroke prevention for individuals at risk.

A spoke hospital asks whether their telestroke neurologist can prescribe controlled substances for stroke-related pain remotely. Under the Ryan Haight Act, what is required?

Answer: An in-person medical evaluation is required before prescribing controlled substances via telemedicine, with limited exceptions

The Ryan Haight Act generally requires an in-person evaluation before prescribing controlled substances via telemedicine, though emergency exceptions exist.

Which CT angiography finding indicates tandem occlusion, a configuration that generally predicts worse outcomes and influences endovascular strategy?

Answer: Ipsilateral cervical ICA occlusion combined with intracranial vessel occlusion

Tandem occlusion describes ipsilateral cervical ICA occlusion combined with intracranial occlusion, requiring a dual treatment strategy and associated with worse reperfusion rates.

When should stroke rehabilitation begin?

Answer: As early as medically stable.

Early initiation of stroke rehabilitation is crucial for maximizing recovery and leveraging the brain's neuroplasticity during its most receptive phase. Beginning therapy as soon as a patient is medically stable helps prevent secondary complications like muscle atrophy, contractures, and deconditioning. This approach capitalizes on the critical window for recovery, leading to better long-term functional outcomes and reduced disability.

A patient with acute stroke undergoes MR angiography. Which technique best evaluates collateral blood flow without contrast injection?

Answer: Time-of-flight (TOF) MRA

TOF MRA relies on flow-related enhancement without contrast, making it ideal for assessing vessel patency and collateral flow when contrast is contraindicated.

A spoke hospital's telestroke data shows that tPA is being administered at an average of 78 minutes door-to-needle. Which specific process step most commonly causes delays in telestroke DTN time?

Answer: Delay between CT scan completion and telestroke neurologist notification

Delays in notifying the telestroke neurologist after CT completion are a frequently identified bottleneck in reducing door-to-needle times.