Cerebrovascular diseases Flashcards
1
Q
Epidural hematoma is caused by the rupture of:
A) middle meningeal artery
B) choroidal anterior artery
C) middle cerebral artery
D) superficial temporal artery
A
A) middle meningeal artery
2
Q
The importance of external carotid artery is:
A) important for the blood flow supply of posterior scala
B) important potential collateral source in case of ipsilateral ICA occlusion
C) participates in blood supply of brainstem
D) its occlusion results in amaurosis fugax
E) supplies the frontobasal part of the brain
A
B) important potential collateral source in case of ipsilateral ICA occlusion
3
Q
The ratio between carotid area and vertebrobasilar stroke:
A) 1:1
B) 1:3
C) 10:1
D) 1:10
E) 4:1
A
E) 4:1
4
Q
The role of sagittal superior sinus:
A) participates in the absorption of CSF
B) collects the blood of sagittal inferior sinus
C) transfers the blood of confluent sinus
D) collects the blood of transverse and cavernous sinus
A
A) participates in the absorption of CSF
5
Q
The risk of stroke in hypertension:
A) 2–8x
B) 0,3–3x
C) 2x
D) 50x
A
A) 2–8x
6
Q
Symptoms of TIA, EXCEPT:
A) Transient unilateral blindness
B) Transient limb numbness
C) Transient aphasia
D) Transient loss of consciousness with epileptic seizure
A
D) Transient loss of consciousness with epileptic seizure
7
Q
The ischemic stroke occurs frequently:
A) after waking
B) after going to bed
C) in the summer
D) in the afternoon
A
A) after waking
8
Q
Cerebral blood flow in the penumbra (region around the ischemic core):
A) 0–10 ml/min/100 g brain tissue
B) 10–20 ml/min/100 g brain tissue
C) 55–60 ml/min/100 g brain tissue
D) 100-120 ml/min/100 g brain tissue
A
B) 10–20 ml/min/100 g brain tissue
9
Q
Global cerebral ischemia causes irreversible cerebral damage after:
A) 20–25 min
B) 10–15 min
C) 3–5 min
D) 1–2 min
A
C) 3–5 min
10
Q
Which mechanism plays the most important role in the ischemic cascade?
A) calcium influx
B) potassium influx
C) sodium influx
D) decrease of monoamine level
A
A) calcium influx
11
Q
The carotid ultrasound is recommended in acute stroke, EXCEPT:
A) for the measurement of intima-media thickness.
B) to diagnose carotid occlusion/stenosis.
C) to determine the plaque characteristic: in case of ulcerated or inhomogenous plaque, endareterectomy could be suggested instead of stenting.
D) because it is the optimal method to detect carotid floating thrombus.
A
A) for the measurement of intima-media thickness.
12
Q
Symptoms of vertebrobasilar insufficiency, EXCEPT:
A) diplopia
B) vertigo
C) dysarthria
D) alternating brainstem syndromes
E) apraxia
A
E) apraxia
13
Q
These diseases could result in cardiogenic stroke, EXCEPT:
A) atrial fibrillation
B) endocarditis
C) bicuspidal and aortic valve diseases
D) lower leg deep venous thrombosis without patent foramen ovale
E) after MI
A
D) lower leg deep venous thrombosis without patent foramen ovale
14
Q
Typical symptoms of transient global amnesia, EXCEPT:
A) loss of anterograde memory
B) the patient is alert
C) shorter than 24 hours
D) cortical blindness
E) unknown cause
A
D) cortical blindness
15
Q
Cause of amaurosis fugax:
A) giant cell arteriitis
B) migraine with scotoma
C) thromboembolisation of the ophthalmic artery (terminal branch) from the ulcerated plaque of the ipsilateral internal carotid artery
A
C) thromboembolisation of the ophthalmic artery (terminal branch) from the ulcerated plaque of the ipsilateral internal carotid artery
16
Q
Cortical lesion is probable in case of stroke in the territory of the internal carotid artery, if:
A) hemiparesis with dominance in the facial and brachial area
B) if the severity of the paresis is similar on the upper and lower limb
C) visual field defect is also seen
D) permanent vertigo develops
A
A) hemiparesis with dominance in the facial and brachial area
17
Q
Which is NOT part of the symptoms of the unilateral occlusion of the anterior cerebral artery and its branches?
A) urinary and fecal incontinence
B) contralateral lower limb dominant hemiparesis
C) changes in behaviour and character
D) gnostic disturbance
A
D) gnostic disturbance
18
Q
Which is NOT part of the symptoms in case of occlusion of the middle cerebral artery (M1)?
A) contralateral severe hemiparesis
B) homonymous hemianopia
C) conjugate deviation of eyes
D) hemihypaesthesia
E) thalamus-syndrome, thalamus-hand
A
E) thalamus-syndrome, thalamus-hand
19
Q
Which artery’s circulation disturbance causes the following symptoms: apathy, liberation reflexes, disturbance of attention, perseveration and echolalia?
A) anterior cerebral artery and branches
B) perforating branches of the middle cerebral artery
C) anterior choroidal artery
D) superior terminal branch of the middle cerebral artery
A
A) anterior cerebral artery and branches
20
Q
NOT part of Weber-syndrome:
A) ipsilateral oculomotor nerve lesion
B) contralateral hemiparesis
C) contralateral increase deep tendon reflexes with pyramidal signs
D) contralateral hyperkinesia
A
D) contralateral hyperkinesia
21
Q
Disturbance of gaze (vertical upwards), with vertical nystagmus is typical in:
A) Benedikt-syndrome
B) Parinaud-syndrome
C) Nothnagel-syndrome
D) Raymond- (ventral pontine) syndrome
A
B) Parinaud-syndrome
22
Q
The cause of pseudobulbar palsy:
A) bilateral lesion of the corticobulbar fibers
B) lesion of the cranial nerves in the medulla oblongata
C) lesion of the dentate nucleus
D) lesion of the peripheral nerves responsible for articulation (speech) and swallowing
A
A) bilateral lesion of the corticobulbar fibers
23
Q
Symptoms of occlusion of the superior cerebellar artery (lateral superior pontine syndrome), EXCEPT:
A) ipsilateral limb and truncal ataxia
B) dizziness, nystagmus
C) contralateral hypaesthesia, decreased vibration and joint position sensation
D) diplopia, deafness
A
D) diplopia, deafness
24
Q
Symptoms of cavernous sinus thrombosis:
A) lesion of the III., IV., VI., V/1. cranial nerves
B) lesion of the IX–XII. cranial nerves
C) lesion of the III., V., VI., VII. cranial nerves
D) Gradenigo-syndrome develops
A
A) lesion of the III., IV., VI., V/1. cranial nerves
25
What does Hunt and Hess Scale grade 4 stand for?
A) somnolence, confusion, mild neurological symptoms
B) deep coma, decerebration
C) stupor, moderate or severe hemiparesis, vegetative disturbance
D) severe headache, nuchal rigidity, cranial nerve palsy
C) stupor, moderate or severe hemiparesis, vegetative disturbance
26
What score will the patient get on Glasgow Coma Scale in case of fatal intracerebral bleeding if:
the patient does not open his eye to any stimuli, does not respond to loud verbal stimulus, no movement reaction is seen?
A) 0
B) 3
C) 1
D) 2
B) 3
27
Which artery’s aneurysm may cause unilateral oculomotor nerve palsy?
A) posterior communicating artery
B) anterior communicating artery
C) ophthalmic artery
D) posterior cerebral artery
A) posterior communicating artery
28
What type of electrolyte abnormality may develop after subarachnoid haemorrhage?
A) hypokalaemia
B) hyponatraemia
C) both of them
D) none of them
B) hyponatraemia
29
Which localization is typical for intracerebral bleeding?
A) basal ganglia
B) thalamus
C) pons
D) cerebellum
A) basal ganglia
30
The mortality is the highest if the bleeding is localized in the:
A) thalamus
B) basal ganglia
C) brainstem
D) frontal lobe
C) brainstem
31
What type of developmental disorder may be associated with congenital intracranial aneurysms?
A) endometriosis
B) ovarian cyst
C) diaschisis
D) polycystic kidney
D) polycystic kidney
32
Where the bleeding is localized in case of the following symptoms: eye-balls in the midline, bilateral miosis and pupils react poorly to light?
A) thalamus
B) pons
C) cerebellum
D) putamen
B) pons
33
With the help of which examination can the bleeding be seen immediately?
A) EEG
B) SPECT
C) CT
D) PET
C) CT
34
If the patient has symptoms of definite brainstem lesion and 6 hours after the symptom onset cranial CT excluded bleeding, which examination will help the diagnosis?
A) within 24–72 hours repetition of cranial CT with posterior scala programme
B) cranial MRI
C) auditory evoked potential (BAEP)
D) transcranial Doppler sonography (vertebral artery, basilar artery, posterior cerebral artery)
B) cranial MRI
35
Which examination should be done first when ictal cerebral symptoms develop?
A) cranial CT
B) transcranial ultrasound
C) echocardiography
D) Doppler-ultrasonography of the carotid arteries
A) cranial CT
36
On cranial CT in the so called watershed area hypodens lesion is detected, with hyperdense petechia. This is typical for:
A) bleeding
B) chronic infarct
C) fresh infarct
D) haemorrhagic infarct
E) cavernoma
D) haemorrhagic infarct
37
The following symptoms are typical for the occlusion of the ………. artery: short after backpain (but not ictally) flaccid paraplegia with dissociated disturbance of sensation (deep sensation is preserved), urinary and bowel incontinence.
A) posterior spinal artery
B) sulcocommissural artery
C) anterior spinal artery
D) none of them
C) anterior spinal artery
38
On auscultation of the carotid arteries no bruit can be heard in case of:
A) aortastenosis
B) 70% stenosis of the carotid artery
C) occlusion of the carotid artery
D) inbleeded atherosclerotic plaque
C) occlusion of the carotid artery
39
Duplex ultrasonography (duplex scan) is essential in the diagnosis and screening of cerebrovascular diseases. What functions are covered with this name?
A) two dimensional („real time”) picture, B mode picture, and it is possible to measure flow velocity with Doppler effect
B) colour picture
C) indicates flow direction
D) shows the source of embolus
A) two dimensional („real time”) picture, B mode picture, and it is possible to measure flow velocity with Doppler effect
40
By evaluating the severity of stenosis with duplex scan the measurement of velocity of the systolic and diastolic blood flow is necessary. When should one suspect more than 90% stenosis of the internal carotid artery?
A) if the systolic peak velocity is 110–120 cm/s
B) if the diastolic peak velocity is less than 40 cm/s
C) if the diastolic peak velocity is more than 100 cm/s
D) if the systolic velocity is less than110, diastolic less than 40 cm/s
C) if the diastolic peak velocity is more than 100 cm/s
41
Alternating sensory /motor syndrome is typical of:
A) brainstem lesion
B) bilateral internal carotid artery occlusion
C) occlusion of the posterior cerebral artery
D) occlusion of the posterior choroidal artery
A) brainstem lesion
42
When an internal carotid artery stenosis haemodinamically is significant examined with duplex scan ultrasonography?
A) more than 40%-stenosis in cross section
B) more than 20% decrease of diameter
C) more than 30% decrease of the diameter
D) more than 70% stenosis in cross section
D) more than 70% stenosis in cross section
43
What are the important side effects of ticlopidine?
A) thrombin time will be doubled
B) neutropenia, especially in the first 3 months
C) thrombocyte aggregation inhibition
D) vertigo
B) neutropenia, especially in the first 3 months
44
Lowering of elevated blood pressure in acute ischemic stroke is not recommended, except:
A) if the diastolic blood pressure exceeds 120 mmHg
B) if systolic blood pressure is 180 mmHg
C) if the symptoms improve dramatically
D) if the ultrasound test does not reveal significant internal carotid artery stenosis
A) if the diastolic blood pressure exceeds 120 mmHg
45
From the onset of ischemic stroke symptoms, systemic thrombolysis can be indicated:
A) within 6 hours
B) within 12 hours
C) within 24 hours
D) within 4.5 hours
D) within 4.5 hours
46
In acute ischemic stroke, based on various clinical studies, the following systemic thrombolytic agent has the best effect, with minimal bleeding complications:
A) urokinase
B) rt-PA (recombinant tissue - plasminogen activator)
C) streptokinase
D) ancrod
B) rt-PA (recombinant tissue - plasminogen activator)
47
Treatment of cerebral edema in ischemic stroke:
A) high-dose steroid
B) furosemid
C) mannitol
D) dextran
C) mannitol
48
How can the functional status in patient with cerebrovascular disease be evaluated?
A) with Mathew Scale
B) with Barthel index
C) with Canadian Stroke Scale
D) with Orgogozo Scale
E) with combined use of Unified and Motor Score Scales
B) with Barthel index
49
Mechanisms involved in regulation of cerebral blood circulation:
1) neurogenic regulation
2) metabolic regulation
3) cerebral autoregulation
4) no-reflow phenomenon
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
50
The following(s) play(s) important role in development of stroke:
1) occlusion of external carotid artery
2) hemorheologic changes
3) lack of development of trigeminal primitive artery
4) disturbance of microcirculation
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
51
What are the non-modifiable risk factors for stroke?
1) stress
2) TIA
3) alcoholism
4) left ventricular hypertrophy
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
52
What are the modifiable risk factors for stroke?
1) previous stroke
2) myocardial infarct
3) peripherial artery disease
4) drug consumption
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
D) only 4th answer is correct
53
After blood vessel wall damage, which mechanisms play a role in coagulation?
1) adhesion
2) aggregation
3) release reaction
4) platelet activation
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
54
Which biochemical changes are typical in acute ischemic lesion?
1) NAD / NADH elevation
2) lactic acid elevation
3) oxygen release in tissue decreases as compensation
4) pH decrease
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
55
The diaschisis could occur:
1) in the contralateral hemisphere
2) in the ipsilateral putamen, in case of frontal lesion
3) in the contralateral cerebellum
4) in the brainstem
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
56
Consequence(s) of subarachnoid haemorrhage:
1) vasospasm, leading to secondary ischemic damage
2) diaschisis effect
3) nonresorptive hydrocephalus
4) chronic subdural bleeding
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
57
Characteristics of Transient Ischemic Attack (TIA):
1) 10% of cerebrovascular diseases
2) in half the cases, the symptoms last for less than 30 minutes
3) in these patients the rate of myocardial infarction is high
4) with CT scan, lacunar infarction rate is above 50%
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
58
Possible causes of subarachnoid hemorrhage:
1) rupture of bridging veins
2) cerebral contusion
3) immunogenic vasculitis
4) rupture of arteriovenous malformation
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
59
Possible causes of intraparenchymal hemorrhage:
1) cocaine, amphetamine abuse
2) leukaemia and other hematological diseases
3) hemostasis disorders
4) bleeding of primary brain tumor (glioblastoma multiforme)
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
60
Possible causes of lacunar infarction:
1) polycythemia vera
2) Heubner arteritis
3) microatheroma
4) microembolisation
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
61
Symptoms of hypertensive encephalopathy:
1) epileptic seizures
2) vomiting
3) disturbance of consciousness
4) cerebral edema
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
62
Symptoms caused by occlusion of the inferior branches of middle cerebral artery:
1) contralateral hemianopsia, rarely quadrant anopsia
2) Wernicke- (sensory) aphasia in case of lesion in the dominant hemisphere
3) contralateral transient or mild faciobrachial paresis
4) motor (Broca-) aphasia in case of lesion in the dominant hemisphere
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
63
Characteristic clinical features of the medial medullary lesion (Jackson-syndrome):
1) ipsilateral peripheral hypoglossal lesion
2) contralateral hemiparesis
3) the syndrome is caused by occlusion of the anterior spinal artery and paramedian arteries
4) contralateral tactile and proprioceptive hypesthesia
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
64
Characteristic clinical features of the basilar artery occlusion:
1) locked-in syndrome
2) severe gnostic dysfunction
3) sudden onset of coma, tetra-pyramidal signs
4) apraxia
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
65
Clinical features of the lateral medullary lesion (Wallenberg syndrome):
1) dysphagia, dysarthria
2) vertigo, nystagmus
3) algetic- and thermo-hypesthesia on the ipsilateral face and contralateral body
4) Horner’s triad on the ipsilateral side of the lesion
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
66
Clinical features of the thalamic lesion:
1) hemihypaesthesia with hemihyperkinesia
2) the basic joints are in flexion position, the interphalangeal joints are in extension postion
3) hyperpathy -burning, shooting pain that is difficult to localise, occurs in attacks and can hardly be influenced by medicines
4) Millard–Gubler syndrome
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
67
The following symptoms are always characteristic for central type of lesion:
1) increased abdominal reflexes
2) increased deep reflexes with pyramidal signs
3) anarthria
4) spastic muscle tone
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
68
Which symptom is not characteristic for the Gerstmann syndrome?
1) left-right confusion
2) finger agnosia
3) acalculia
4) alexia
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
D) only 4th answer is correct
69
In cases of cerebral venous (sinus) thrombosis, the following symptoms may develop:
1) headache
2) focal or generalized epileptic seizures
3) papilla edema
4) disturbance of consciousness
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
70
Possible causes of cerebral venous (sinus) thrombosis:
1) use of oral contraceptive pills
2) purulent otitis or sinusitis (purulent middle ear infection, or purulent infection of paranasal sinuses)
3) postpartum septic state
4) hypertension
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
71
The most important symptoms of cerebral aneurysm rupture:
1) sudden onset of a severe, throbbing nuchal or frontal headache
2) gradually developing headache, dizziness
3) neck stiffness
4) focal neurological signs are already present at the onset of the disease
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
72
What can cause septic aneurysm in the middle cerebral artery?
1) dissection
2) bacterial pneumonia
3) viral infection
4) endocarditis
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
73
Arteriovenous malformation is suspected in case of the following symptoms and complaints:
1) epileptic seizures
2) supraorbital or occipital bruits
3) headache
4) subarachnoideal hemorrhage
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
74
Intracerebral hemorrhage is associated with poor prognosis if:
1) the patient is over 70 years of age
2) concomitant cardiopulmonal disease is present
3) severe disturbance of consciousness, i.e. coma develops
4) there is a wide, non-reactive pupil on the side of the lesion
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
75
Intracerebral hemorrhage has extremely poor prognosis if the following abnormalities can be seen on cranial CT scan:
1) hemorrhage ruptures into the ventricles, the fourth ventricle is compressed
2) putaminal hemorrhage with huge midline shift
3) secondary pontine hemorrhage
4) small thalamic hemorrhage with no rupture into the ventricle and lacunar infarctions on the contralateral side to the lesion
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
76
Which of the following statements is (are) typical for intracranial hemorrhage?
1) appears mostly daytime, during physical activity
2) appears during sleep, symptoms are recognized after waking up
3) sudden onset, rapid, progressive disturbance of consciousness
4) TIA in the past medical history
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
77
Which of the following diseases can be diagnosed by blood pressure measurement?
1) stenosis of the internal carotid artery
2) aortic coarctation
3) TIA
4) subclavian steal syndrome
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
78
Signs of cerebral ischemia with cranial CT scan:
1) fogging phenomenon
2) hypodensity
3) gyral contrast enhancement
4) usually there is no abnormality in the first hours of the ischemic event
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
79
Cranial MRI is suggested in the following cases:
1) brainstem stroke symptoms
2) if cavernoma is suspected
3) suspected intracerebral haemorrhage in the early phase of pregnancy
4) in subarachnoidal hemorrhage to examine the cerebral glucose metabolism
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
80
Indication of cerebral SPECT in stroke:
1) to assess cerebral vascular reserve capacity with Diamox-test
2) to detect intracranial hemorrhage in the early phase
3) to examine diaschisis effect and assess prognosis
4) to detect aneurysms, if angiography is negative
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
81
MR-angiography (MRA) is suitable to:
1) assess the degree of large vessel stenosis
2) confirm large vessel (carotid, vertebral, basilar artery) occlusion
3) detect and follow-up aneurysms
4) diagnose arteriovenous malformation (AVM)
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
82
Indication of cerebral angiography:
1) in urgent cases, when angiography helps in clinical decisions and treatments (e.g. subarachnoideal hemorrhage, local thrombolysis in acute large vessel occlusion)
2) in cerebral contusion to localize the source of the bleeding
3) to plan intra-arterial intervention like intraluminal angioplasty
4) to localise sub- and epidural hematoma
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
83
Lacunar infarcts are seen by cranial CT in a young female patient in the MCA territory. MRI confirms the vascular origin of the lesions. The patient has unremarkable medical history, with no heart disease. Which diagnostic steps could be useful during the work-up?
1) transosephageal echocardiography (TEE) to assess the heart and the ascendent aorta
2) lactate test, if it is pathological muscle biopsy to rule out mitochondrial encephalopathy (MELAS)
3) detailed immunological tests to rule out immune mediated vasculitis
4) screening tests for haemostasis to rule out thrombophilia
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
84
Which are the major psychological factors that hinder the effective rehabilitation after stroke?
1) emotional lability
2) anxiety, anger
3) avoiding, aggressive behavior
4) mania
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
85
Possible neurological complication of cardiac surgery:
1) myelon lesion
2) epileptic seizure
3) extrapyramidal symptoms
4) cortical blindness
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
86
In which of the following case(s) should carotid duplex ultrasound examination be ordered?
1) after TIA
2) in case of cerebral haemorrhage to predict the prognosis
3) if auscultation reveals murmur over the carotid arteries
4) on the 7. day after subarachnoid bleeding to check for vasospasm
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
87
Transcranial Doppler ultrasound (TCD) examination has to be ordered:
1) to monitor vasospasm after subarachnoid bleeding
2) for emboli detection, if cardiogen stroke is suspected
3) to determine the cerebrovascular reserve capacity with acetazolamide test before carotid endarterectomy
4) in case of vacular lesion in the territory of the middle cerebral artery
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
88
Which plaque type(s) is (are) considered as source of embolisation on B-mode ultrasound image?
1) exulcerated
2) haemorrhagic
3) heterogeneous
4) homogeneous
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
89
Therapy in secondary stroke prevention (daily intake):
1) 100-325 mg acetylsalicylic acid
2) 75 mg clopidogrel
3) 2x25 mg acetylsalicylic acid + 2x200 mg dipyridamole
4) 3x400 mg pentoxifylline
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
90
Which of the following examination(s) is (are) needed if cardiogenic stroke is suspected:
1) detailed haematologic examination
2) transthoracic echocardiography (TTE)
3) blood pressure monitoring for 24 hours
4) transesophageal echocardiography (TEE), if TTE couldn’t detect the source of embolisation and if the origin of stroke was unknown in young patient
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
91
Indication(s) for carotid endarteriectomy:
1) after TIA, if the stenosis of the internal carotid artery is larger then 70% measured by angiography
2) if the internal carotid artery is occluded on either side
3) in case of repeated or crescendo TIA on the side of the exulcerated plaque or floating thrombus
4) in case of acute stroke
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
92
Vascular surgery is NOT suggested in the following case(s):
1) unilateral stenosis of the vertebral artery
2) significant internal carotid artery stenosis and contralateral internal carotid artery occlusion in case of symptomatic stenosis
3) cranial CT showed large acute ischemic lesion
4) symptomatic, 90% stenosis of the internal carotid artery
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
93
Anticoagulant treatment is NOT suggested in the following case(s):
1) gastrointestinal ulcer
2) dementia, bad compliance
3) bacterial endocarditis
4) dilated cardiomyopathy
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
94
Anticoagulant treatment is indicated in the following case(s):
1) after myocardial infarction, especially with aneurysm formation
2) after arteficial heart valve implantation
3) coexistence of atrial fibrillation and high stroke risk
4) tachycardia
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
95
In case of anticoagulation treatment, the risk of bleeding is increased in the following case(s):
1) simultaneous treatment with carbamazepine
2) alcoholic hepatopathy
3) simultaneous administration of acetylsalicylic acid, or ticlopidine, or clopidogrel
4) extremely high blood pressure
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
96
Most important complication(s) of cerebrovascular diseases:
1) deep vein thrombosis of the lower extremities, pulmonary embolism
2) bronchopneumonia
3) bed sore (decubitus)
4) urocystitis, pyelonephritis
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
97
Match the following arteries and the statements!
A) subclavian artery
B) posterior communicating artery
C) basilar artery
D) superficial temporal artery
E) superior cerebellar artery
NEU - 1.104 - its occlusion causes ipsilateral limb and gait ataxia
NEU - 1.105 - its aneurysm may cause ipsilateral oculomotor nerve lesion
NEU - 1.106 - its stenosis may cause subclavian steal syndrome
NEU - 1.107 - the acute occlusion of this artery causes coma and bilateral pyramidal signs
NEU - 1.108 - this artery is swollen, painful and tender in giant cell arteriitis
104- E
105- B
106- A
107- C
108- D
98
Make pairs!
A) thrombosis of cavernous sinus
B) thrombosis of superior sagittal sinus
C) occlusion of the transvere sinus
D) damage of the middle meningeal artery
E) damage of the bridging veins
NEU - 1.109 - it causes subdural hematoma
NEU - 1.110 - the soft tissue over the mastoid process is swollen and focal epileptic seizure, lesion of the IX-XI. cranial nerves, disturbance of consciousness might be present
NEU - 1.111 - it can causes epidural hematoma
NEU - 1.112 - scalp edema, symptoms of increased intracranial pressure, epileptic seizures, disturbance of consciousness, coma might be present
NEU - 1.113 - characteristic symptoms are paresis of the extraocular muscles, chemosis, retrobulbar pain
109- E
110- C
111- D
112-B
113- A
99
Make pairs!
A) quit smoking, diet, treatment of hypertension
B) administration of clopidogrel, or acetylsalicyclic acid
C) endarterectomy
D) administration of heparin and antiepileptic drugs
E) surgical intervention: partial resection, shunt implantation
NEU - 1.114 - It is used for secundary stroke prevention in case of lacunar stroke
NEU - 1.115 - Treatment of superior sagittal sinus thrombosis
NEU - 1.116 - Treatment of space-occupying cerebellar hemorrhage
NEU - 1.117 - These belong to primary stroke prevention
NEU - 1.118 - Treatment of significant internal carotid artery stenosis
114- B
115- D
116- E
117- A
118- C
100
Make pairs!
A) there is no abnormality in CT scans
B) hyperdens lesion in the territory of basal ganglia and in the lateral ventricle can be seen in CT scans
C) there is extended cortical hypodens lesion with small, patchy hyperdens areas in CT scans
D) hypodens area with sharp border and dilation of the ventricle and the subarachnoid space next to the lesion
E) hypodensity in the periventricular white matter, cortical atrophy
NEU - 1.119 - hypertension induced destructive parenchymal cerebral hemorrhage that ruptured into the ventricules
NEU - 1.120 - The CT examination was performed after the onset of ischemic stroke within 2 hours
NEU - 1.121 - Picture of a chronic, extended cerebral infarction
NEU - 1.122 - ischemic lesion with hemorrhagic transformation (picture of hemorrhagic infarction)
NEU - 1.123 - subcortical arteriosclerotic encephalopathy (Binswanger)
119- B
120- A
121- D
122- C
123- E
101
Match the symptoms with the site of the lesion
A) ideomotor apraxia
B) amusia
C) dysarthria
D) Gerstmann’s syndrome
E) Horner’s syndrome
NEU - 1.124 - caused by a lesion of the pole of the superior temporal gyrus
NEU - 1.125 - caused by bilateral damage of the corticobulbar fibers
NEU - 1.126 - caused by a lesion of the lateral part of the medulla, part of the Wallenberg’s syndrome
NEU - 1.127 - caused by damage of the left supramarginal gyrus in right-handed patients
NEU - 1.128 - caused by a lesion of the left angular gyrus
124- B
125- C
126- E
127- A
128- D
102
Match the statements.
A) Speech disturbance and mild right sided hemiparesis developed and resolved within 3 minutes. On cranial CT, lacunar infarctions are seen on the right side.
B) Agraphia with alexia, acalculia, finger agnosia, lower quadrant anopsia evolved, and the symptoms resolved within 2 days.
C) Moderate hemiparesis developed in several hours in the patient admitted with mild left sided hemiparesis, next day hemiplegia evolved and the patient became somnolent and incontinent.
D) Right sided homonymous hemianopsia was detected at the beginning, and pronounced limb ataxia, latent hemiparesis was still present 4 weeks later.
E) Occasionally, the patient complained of severe headache and nausea, which relieved and reoccured, on fundoscopy spontaneous venous pulsation was missing, on the right side brisk deep tendon reflexes were found.
NEU - 1.129 - the clinical course may refer to completed stroke
NEU - 1.130 - transient ischemic attack (TIA)
NEU - 1.131 - the clinical course raises suspicion for cerebral tumor rather than stroke
NEU - 1.132 - the symptoms may refer to stroke in the dominant parietal lobe
NEU - 1.133 - the clinical course and syndrome are specific for progressing stroke
129- D
130- A
131- E
132- B
133- C
103
The patient has to be transported to a stroke center when the symptoms of an acute stroke begin because high blood pressure has to be reduced immediately.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
C) the statement is true, but the explanation is false;
104
After transient ischemic attack the patient should undergo cerebrovascular checkup, because brain cancer can be in the backgroud of TIA-like symptoms.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
B) both the statement and the explanation are true but there is no causal relationship between them;
105
If the patient is likely to have a brain haemorrhage, cranial MRI should always be done first, because CT cannot differentiate brain haemorrhage and brain ischemia.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
E) both the statement and the explanation are false
106
For secunder stroke prevention acetylsalicilic acid (ASA) is used, because this medication always inhibits platelet aggregation in every patient.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
C) the statement is true, but the explanation is false;
107
Occipital lobe damage causes homonymous hemianopsia, because this symptom is present only in case of occipital lobe injury.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
C) the statement is true, but the explanation is false;
108
Transcranial colour-coded duplex ultrasound can detect the flow in the middle cerebral artery, because the temporal bone never hinders the transcranial Doppler examination.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
C) the statement is true, but the explanation is false;
109
The occlusion of the external carotid artery usually does not cause neurological symptoms, because it has no collateral connection with the internal carotid artery.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
C) the statement is true, but the explanation is false;
110
Hemiparesis is always caused by the lesion in the internal capsule, because the damage of the corticospinal tract always causes central type of paresis.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D) the statement is false, but the explanation itself is true
111
In case of a sudden, twinge pain in the frontal and nuchal area during strain, rupture of an intracerebral aneurism should be suspected, because subarachnoidal bleeding could cause cardiac arrythmia.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
B) both the statement and the explanation are true but there is no causal relationship between them;
112
In case of post-stroke depression antidepressant drugs should be used, because depression can inhibit rehabilitation.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
A) both the statement and the explanation are true and a causal relationship exists between them;
113
In case of patients with leukaemia, who have low platelet count, lumbar tap is not performed, because subarachnoidal bleeding may occur.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
A) both the statement and the explanation are true and a causal relationship exists between them;
114
In case of endocarditis lenta anticoagulation therapy is needed, because cerebral embolisation can develop.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D) the statement is false, but the explanation itself is true
115
ECG monitoring in acute phase of stroke is necessary, because stroke may cause cardiac arrythmia.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
A) both the statement and the explanation are true and a causal relationship exists between them;
116
In case of intracranial arterial occlusion, the lactic acid level raises, NADH/NAD ratio decreases, because superoxide radicals play important role in damaging the mitochondrial membrane.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
B) both the statement and the explanation are true but there is no causal relationship between them;
117
Before cardiac surgery duplex scan ultrasound of carotid vessels and transcranial Doppler examination (and vascular reconstructive surgery in case of severe carotid stenosis) are necessary, because significant stenosis of extra- and intracranial arteries may result in cerebral hypoperfusion and thus severe neurological symptoms during surgery.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
A) both the statement and the explanation are true and a causal relationship exists between them;
118
The most likely diagnosis is:
After waking up at 6 a.m., a 74-year-old male patient’s wife noticed that her husband couldn’t speak and was unable to move his right extremities. She saw him last at 2 a.m. when her husband went to the toilet and was symptom-free. She called the family doctor, who measured 180/110 mmHg blood pressure and 88/min heart rate. They called the ambulance and arrived at the hospital by 8 a.m. Status: pulmonary emphysema, fundoscopy showed hypertensive retinopathy, right sided central facial palsy, right sided hypotonic, severe hemiparesis predominantly in upper extremities, increased deep tendon reflexes, complete motoric, severe sensoric aphasia. ECG: atrial fibrillation. Electrolytes and blood sugar levels were within the normal ranges.
A) arteriosclerotic encephalopathy
B) ischemic lesion in the territory of the left middle cerebral artery
C) hypertensive encephalopathy
D) Biswanger’s disease
B) ischemic lesion in the territory of the left middle cerebral artery
119
Choose the relevant investigations.
After waking up at 6 a.m., a 74-year-old male patient’s wife noticed that her husband couldn’t speak and was unable to move his right extremities. She saw him last at 2 a.m. when her husband went to the toilet and was symptom-free. She called the family doctor, who measured 180/110 mmHg blood pressure and 88/min heart rate. They called the ambulance and arrived at the hospital by 8 a.m. Status: pulmonary emphysema, fundoscopy showed hypertensive retinopathy, right sided central facial palsy, right sided hypotonic, severe hemiparesis predominantly in upper extremities, increased deep tendon reflexes, complete motoric, severe sensoric aphasia. ECG: atrial fibrillation. Electrolytes and blood sugar levels were within the normal ranges.
1) cranial CT and CT-angiography
2) duplex scan ultrasound of the cervical arteries and transcranial Doppler
3) cardiological examination with echocardiography
4) SPECT examination (single-photon emission computer-tomography)
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only the 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
120
Regarding the treatment, the onset of symptoms is important. When can we count surely the onset of symptoms?
After waking up at 6 a.m., a 74-year-old male patient’s wife noticed that her husband couldn’t speak and was unable to move his right extremities. She saw him last at 2 a.m. when her husband went to the toilet and was symptom-free. She called the family doctor, who measured 180/110 mmHg blood pressure and 88/min heart rate. They called the ambulance and arrived at the hospital by 8 a.m. Status: pulmonary emphysema, fundoscopy showed hypertensive retinopathy, right sided central facial palsy, right sided hypotonic, severe hemiparesis predominantly in upper extremities, increased deep tendon reflexes, complete motoric, severe sensoric aphasia. ECG: atrial fibrillation. Electrolytes and blood sugar levels were within the normal ranges.
A) 6 a.m.
B) mean time between 2 a.m. and 6 a.m., that is 4 a.m.
C) 2 a.m.
D) the time when the patient went to the bed in the previous evening
C) 2 a.m.
121
What is the most probable origin of stroke?
After waking up at 6 a.m., a 74-year-old male patient’s wife noticed that her husband couldn’t speak and was unable to move his right extremities. She saw him last at 2 a.m. when her husband went to the toilet and was symptom-free. She called the family doctor, who measured 180/110 mmHg blood pressure and 88/min heart rate. They called the ambulance and arrived at the hospital by 8 a.m. Status: pulmonary emphysema, fundoscopy showed hypertensive retinopathy, right sided central facial palsy, right sided hypotonic, severe hemiparesis predominantly in upper extremities, increased deep tendon reflexes, complete motoric, severe sensoric aphasia. ECG: atrial fibrillation. Electrolytes and blood sugar levels were within the normal ranges.
A) hemodynamic
B) cardioembolic
C) atherothrombotic
D) artery to artery embolisation
B) cardioembolic
122
Which neurological disease could it be?
A 24 years old, primipara woman had strong headache and fever 3 days after delivery. Although the fever was relieved by antipyretic drugs, she became somnolent and developed left sided focal motoric seizure with secondary generalisation. A few hours later the seizures repeated. dministration of 1 mg intravenous clonazepam stopped the seizures. Neurologist found left sided hemiparesis, increased deep tendon reflexes and disturbance of consciousness (somnolence). Prominent scalp edema was also noticed.
A) subarachnoidal bleeding due to aneurysm rupture
B) cerebral embolisation
C) cerebral sinus (venous) thrombosis
D) cerebral hypoxia associated with pneumonia
E) postpartum deep vein thrombosis with cerebral embolization
C) cerebral sinus (venous) thrombosis
123
Which investigations should be done in order to verify the diagnosis?
A 24 years old, primipara woman had strong headache and fever 3 days after delivery. Although the fever was relieved by antipyretic drugs, she became somnolent and developed left sided focal motoric seizure with secondary generalisation. A few hours later the seizures repeated. dministration of 1 mg intravenous clonazepam stopped the seizures. Neurologist found left sided hemiparesis, increased deep tendon reflexes and disturbance of consciousness (somnolence). Prominent scalp edema was also noticed.
1) cranial CT or MRI with venous CTA, or MRA
2) duplex ultrasound examination of cervical arteries
3) search for source of infection (in this case gynecologic source is likely)
4) lumbar puncture, CSF can be bloody
A) number 1, 2 and 3 answers are correct
B) number 1 and 3 answers are correct
C) number 2 and 4 answers are correct
D) only the number 4 answer is correct
E) all answers are correct
B) number 1 and 3 answers are correct
124
Which is the correct treatment?
A 24 years old, primipara woman had strong headache and fever 3 days after delivery. Although the fever was relieved by antipyretic drugs, she became somnolent and developed left sided focal motoric seizure with secondary generalisation. A few hours later the seizures repeated. dministration of 1 mg intravenous clonazepam stopped the seizures. Neurologist found left sided hemiparesis, increased deep tendon reflexes and disturbance of consciousness (somnolence). Prominent scalp edema was also noticed.
1) administration of wide spectrum antibiotics
2) mannitol
3) therapeutic dose of heparine, even if there is haemorrhagic transformation
4) carotid endarterectomy
A) number 1, 2 and 3 answers are correct
B) number 1 and 3 answers are correct
C) number 2 and 4 answers are correct
D) only the number 4 answer is correct
E) all answers are correct
A) number 1, 2 and 3 answers are correct
125
What is the most likely diagnosis?
A 42 years old man lifted a heavy timber made of concrete when he suddenly developed a severe, intolerable headache at the occipital and forehead regions. Hypertension was known in his medical history which was treated by oral medications. He lied down, but his symptoms became worse, furthermore, nausea and photophobia also developed. He became somnolent during transport to neurology ward. Moving the head aggarvated his headache. The neurologist found neck stiffness, increased deep tendon reflexes on both sides. There was no paresis. Blood pressure: 180/100 Hgmm, heart rate: 98/bpm.
A) intracerebral bleeding
B) arteriovenous malformation
C) haemorrhagic infarct
D) subarachnoidal haemorrhage caused by rupture of intracranial aneurysm
D) subarachnoidal haemorrhage caused by rupture of intracranial aneurysm
126
Which investigations can verify the diagnosis?
A 42 years old man lifted a heavy timber made of concrete when he suddenly developed a severe, intolerable headache at the occipital and forehead regions. Hypertension was known in his medical history which was treated by oral medications. He lied down, but his symptoms became worse, furthermore, nausea and photophobia also developed. He became somnolent during transport to neurology ward. Moving the head aggarvated his headache. The neurologist found neck stiffness, increased deep tendon reflexes on both sides. There was no paresis. Blood pressure: 180/100 Hgmm, heart rate: 98/bpm.
1) cranial CT
2) magnetencephalography
3) CT-angiography or DSA (digital substractional angiography)
4) SPECT
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
B) 1st and 3rd answers are correct
127
Which severe complication may be caused by subarachnoidal bleeding?
A 42 years old man lifted a heavy timber made of concrete when he suddenly developed a severe, intolerable headache at the occipital and forehead regions. Hypertension was known in his medical history which was treated by oral medications. He lied down, but his symptoms became worse, furthermore, nausea and photophobia also developed. He became somnolent during transport to neurology ward. Moving the head aggarvated his headache. The neurologist found neck stiffness, increased deep tendon reflexes on both sides. There was no paresis. Blood pressure: 180/100 Hgmm, heart rate: 98/bpm.
A) pneumonia
B) deep vein thrombosis
C) cerebral vasospasm
D) urocystitis because of bladder catheterisation
C) cerebral vasospasm
128
What can be the diagnosis?
A 64 years old, heavy drinker man suddenly collapsed on the street. He lost his consciousness and his face became red. His friend mentioned that the patient had hypertension, however, he did not take any medication. The ambulance team measured 240/120 mmHg blood pressure. Endotracheal intubation was performed because the patient vomited and his respiration was not stable. He had neck stiffness and pain stimulus induced tetraextension in the extremities. His left pupil was dilated and the light reacion on the left side was almost absent. The blood sugar was 14 mmol/L and ECG showed bradycardia.
A) right hemispheric intracerebral bleeding
B) pons haemorrhage
C) cerebellar haemorrhage
D) left hemispheric intracerebral bleeding with mass effect
E) none of them
D) left hemispheric intracerebral bleeding with mass effect
129
Which urgent investigation is needed?
A 64 years old, heavy drinker man suddenly collapsed on the street. He lost his consciousness and his face became red. His friend mentioned that the patient had hypertension, however, he did not take any medication. The ambulance team measured 240/120 mmHg blood pressure. Endotracheal intubation was performed because the patient vomited and his respiration was not stable. He had neck stiffness and pain stimulus induced tetraextension in the extremities. His left pupil was dilated and the light reacion on the left side was almost absent. The blood sugar was 14 mmol/L and ECG showed bradycardia.
A) cranial SPECT
B) cranial CT
C) skull X-ray
D) None of them because of the severe symptoms.
B) cranial CT
