Risk factors of stroke

Non modifiable:

  • Age – the risk of stroke is double every 10 years after 55 years old.
  • Sex – Generally, men have higher prevalence of stroke than women except in between 35-44 year-olds and over 85 year-olds when women have slightly greater age specific incidence than men.
  • Ethnicity/race
  • Family history of stroke – Both paternal and maternal stroke history will contribute to high risk. The risks also associated with genetic and environmental factors.

Modifiable:

  • High blood pressure (both systolic and diastolic)
  • Cigarrette smoking – Both active and passive smokers are considered major risk factors for stroke. For those who stop smoker for 5 years or longer, the risk are cthe same with non smokers.
  • Diabetes mellitus
  • Atrial fibrillation
  • Coronary heart disease
  • Hyperlipidemia
  • Obesity
  • Physical inactivity
  • Raised homocysteine levels
  • High dietary salt intake
  • Heavy alcohol consumption
  • Previous stroke
  • Transient ischemic attack
  • Oral contraceptive pills
  • Pregnancy

Related:

 

Reference:

  1. Clinical Practice Guidelines. Management of Ischaemic Stroke. June 2006. Ministry of Health Malaysia.

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MCQ medicine – set 11

Choose true/false for each statement given

Management of stroke

a) In normotensive patients, ACE inhibitor does not appear to reduce the risk of recurrent stroke.



b) Aspirin should be started after 48 hours of ischaemic stroke to avoid intracranial haemorrhage.



c) 100mg aspirin every other day is useful in the primary prevention of stroke in women above 65 years.



d) In young ischaemic stroke, aspirin should not be given unless the cause is identified.



e) Passive smoking is a major risk factor for stroke.



Bronchial asthma treatment and monitoring

a) PEFR monitoring should be done once daily in the morning to assess control.



b) It can lead to cor pulmonale.



c) Long acting beta 2 agonist is used for the prevention of exercise induced asthma.



d) Leukotriene modifier is used as an adjunct treatment in severe persistent asthma.



e) Anticholinergic is not helpful in exercised induced bronchospasm.



With regards of chronic obstructive pulmonary disease (COPD)

a) The rate of decline of lung function in smokers is dose and duration dependent.



b) Chronic bronchitis will present as hyperinflation on chest radiograph.



c) Anticholinergic is the preferred first line bronchodilator over beta 2 agonist.



d) Inhaled corticosteroid is used to prevent deterioration of lung function.



e) In advanced COPD, oxygen therapy prolongs survival.



Tuberculosis presentation and treatment

a) Individual with latent tuberculosis infection is in infectious state.



b) Cough is typically dry.



c) Lower lobe infiltrates are more commonly in elderly.



d) Pyrazinamide should be excluded in pregnancy.



e) Optic neuritis that is due to ethambutol is reversible.



Regarding secondary hypertension

a) The most common cause is renal vascular disease.



b) Sleep apnea is a cause.



c) Estrogen induced hypertension is reduced by taking low dose preparation.



d) In primary hyperaldosteronism, patient present with orthostatic hypotension.



e) In renal artery stenosis, duplex ultrasound is the definitive diagnostic test.





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