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Neurology > Cerebrovascular Diseases > Flashcards

Cerebrovascular Diseases Flashcards

1
Q

Patient with sudden pain on the left side of the neck, miosis of the left pupil and
ptosis of the left eyelid and hemiplegia on the right side. What is the most likely
cause?
a. dissection of the internal carotid artery
b. embolism of the a. cerebri media
c. bleeding in the basal ganglia

A

a. dissection of the internal carotid artery

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2
Q

The most common location of a ‘hypertensive’ brain haemorrhage is:
a. basal ganglia and thalamus
b. Little Brains
c. Brainstem
d. frontal lobe cortex

A

a. basal ganglia and thalamus

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3
Q

We will stabilise ‘soft’ plaque in the internal carotid artery with high doses:
a. ACE inhibitors
b. aspirin and clopidogrel
c. statins
d. nimodipina

A

c. statins

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4
Q

Temporal arteritis will be confirmed by:
a. laboratory tests that show anaemia and accelerated SR
b. CT heads
c. MR of the head
d. temporal artery biopsy

A

d. temporal artery biopsy

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5
Q

Temporal arteritis sometimes accompanies:
a. fibromyalgia
b. polymyositis
c. rheumatic polymyalgia
d. rheumatoid arthritis

A

c. rheumatic polymyalgia

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6
Q

Therapy of choice for temporal arteritis is:
a. non-steroidal anti-inflammatory drugs
b. corticosteroids
c. opiates
d. common analgesic

A

b. corticosteroids

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7
Q

Female, right occipital headache, onset the previous day after exercise. Her sister
had breast carcinoma. On examination, dysarthria, nystagmus, ataxia. What is the
most likely diagnosis?
a. breast carcinoma
b. vertebrobasilar artery dissection
c. atherosclerotic cerebellar stroke
d. none of the above

A

c. atherosclerotic cerebellar stroke

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8
Q

The most important secondary prevention after stroke in a 75-year-old retired man
with hyperlipidaemia, arterial hypertension, diabetes mellitus and 80% narrowing of
the symptomatic internal carotid artery:
a. aspirin
b. statin
c. endarterectomy of a narrowed symptomatic artery
d. warfarin

A

c. endarterectomy of a narrowed symptomatic artery

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9
Q

An 81-year-old pensioner is receiving warfarin after suffering a cardio-embolic
stroke. The target INR is:
a. 1,0-1,4
b. 1,5-1,9
c. 2,0-2,5
d. 2,6-3,0

A

c. 2,0-2,5

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10
Q

Antihypertensives that have been shown to be successful in secondary stroke
prevention include:
a. ACE inhibitors
b. diuretics
c. calcium antagonists
d. beta blockers

A

a. ACE inhibitors

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11
Q

An 81-year-old lady is aphasic, plegic on the right, fed by nasogastric tube, and does
not participate in rehabilitation one month after a stroke. Where to discharge her:
a. natural spa for rehabilitation
b. regional patient for further treatment
c. SOCHA
d. nursing home

A

d. nursing home

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12
Q

Early treatment of temporal arteritis is important because:
a. relieving unbearable headaches
b. preventing rheumatic polymyalgia
c. prevention of anterior ischaemic optic neuropathy
d. all of the above

A

c. prevention of anterior ischaemic optic neuropathy

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13
Q

A patient comes in with paraplegia and is treated for hypertension and lipids, and
has no sensory loss around her belly button. What is it?
a. spinal cord infarction
b. lacunar stroke
c. brain stem infarction
d. subarachnoid haemorrhage

A

a. spinal cord infarction

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14
Q

A young man with sudden loss of vision in one eye and occipital headache. What does
he have?
a. amaurosis fugax and vertebral artery dissection

A

a. amaurosis fugax and vertebral artery dissection

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15
Q

Prophylactic treatment in a patient with deep vein thrombosis with motor paresis
after stroke:
a. low molecular weight heparin
b. heparin
c. warfarin
d. aspirin

A

a. low molecular weight heparin

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16
Q

The day after thrombolysis for stroke, the patient is given:
a. aspirin
b. aspirin and dipyridamole
c. aspirin, dipyridamole, statins and antihypertensives, as he has had so far
d. aspirin, dipyridamole, statins and antihypertensives so that the
pressure is below 140/80 mmHg

A

d. aspirin, dipyridamole, statins and antihypertensives so that the
pressure is below 140/80 mmHg

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17
Q

Subarachnoid haemorrhage is most likely in:
a. 28-year-old patient who had the worst headache of her life and had some
migraine symptoms before
b. 60-year-old patient with the worst sudden headache of his life, with a
runny nose and tears
c. A 26-year-old patient with a sudden headache, vomiting and slowly
losing consciousness

A

c. A 26-year-old patient with a sudden headache, vomiting and slowly
losing consciousness

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18
Q

A 78-year-old pensioner with atrial fibrillation, hyperlipidaemia and high blood
pressure will be prescribed which secondary therapy after a stroke?
a. aspirin
b. aspirin and dipyridamole
c. warfarin

A

c. warfarin

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19
Q

An 18-year-old overweight pregnant woman is diagnosed with benign intracranial
hypertension after MRI and lumbar puncture. What is the treatment of choice?
a. lumbar puncture
b. prednisone
c. caesarean section
d. induction of labour
e. vitamin A

A

a. lumbar puncture

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20
Q

The risk of venous sinus thrombosis is not significantly increased:
a. in pregnancy
b. in patients with antiphospholipid syndrome
c. in patients with hyperlipidaemia
d. in dehydrated people

A

c. in patients with hyperlipidaemia

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21
Q

No increased risk of venous thrombosis is expected for:
a. protein C deficiency
b. Protein S deficiency
c. antithrombin III deficiency
d. factor VIII deficiency

A

d. factor VIII deficiency

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22
Q

The person at greatest risk of stroke will have:
a. African American
b. Sweden
c. Chinese
d. Italian

A

a. African American

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23
Q

Thrombolysis with t-PA, if there is no visible infarction on CT, is indicated in:
a. 88-year-old pensioner who woke up an hour ago with left-sided hemiplegia
b. 45-year-old lawyer with mild left paresis, onset 1 hour ago,
improving
c. 66-year-old elderly man with atrial fibrillation on warfarin with rightsided hemiplegia of 1 hour’s duration
d. A 73-year-old hyperlipidaemic pensioner with 1-hour right-sided
hemiplegia

A

d. A 73-year-old hyperlipidaemic pensioner with 1-hour right-sided
hemiplegia

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24
Q

The gentleman has acute impairment of strength in his left arm and speech
difficulties. His wife says that he has had a loss of vision in his right eye for 10 min
three times in the last month. What is the cause of the loss of vision?
a. retinal vein thrombosis
b. ischaemia a. centralis retinae
c. ischaemia of the a. cerebri posterior
d. ischaemia of the a. cerebri mediae

A

b. ischaemia a. centralis retinae

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25
Q

The lady suddenly experienced severe pain
behind her right orbit. We also noticed that the
right pupil was 2 mm narrower and that there
was a slight ptosis on the right. The pupillary
reflexes are normal on both sides. Which
structure is the defect?
a. CN. III
b. Optic nerve
c. Optical chiasma
d. Th1 root
e. superior cervical ganglion

A

d. Th1 root
e. superior cervical ganglion

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26
Q

How long does a TIA usually last?
a. 20 min
b. 1 hour
c. 12 hours
d. 24 hours

A

a. 20 min

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27
Q

A middle-aged gentleman feels a dull pain on the left side of his head, radiating a
little to the right. There was no nausea or vomiting. Blood tests showed ^SR and mild
anaemia. Extensive investigations did not confirm the presence of malignancy,
lymphoma, leukaemia. What is the most likely diagnosis?
a. classic migraine
b. temporal arteritis
c. glioblastoma multiforme

A

b. temporal arteritis

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28
Q

Temporal arteritis is treated by:
a. warfarin
b. methylprednisolone
c. NSAIDS
d. plasmapheresis

A

b. methylprednisolone

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29
Q

The pathogenetic mechanism of cerebral infarction is:
a. atherosclerosis of the great vessels of the brain
b. cardioembolism
c. occlusion of small lacunar vessels
d. fat embolism
e. all of the above

A

e. all of the above

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30
Q

Which of the risk factors is most strongly associated with intracerebral haemorrhage?
a. raised cholesterol
b. anticoagulant medicines
c. age over 60
d. diabetes mellitus
e. arterial hypertension

A

e. arterial hypertension

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31
Q

What does NIHSS stand for?
a. risk of stroke in someone with
atrial fibrillation
b. assessing the prognosis of a
stroke patient
c. risk of stroke in someone with
SAH

A

b. assessing the prognosis of a
stroke patient

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32
Q

Chlorpyridogel and aspirin are given together. Their action may be synergistic.
a. both statements are correct
b. both statements are incorrect
c. the first statement is correct, the second statement is incorrect
d. the first statement is incorrect, the second statement is correct
e. both statements are correct and causally linked

A

e. both statements are correct and causally linked

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33
Q

What is the main mechanism of cell death in the first few minutes after a heart attack?
a. Excitotoxicity
b. Inflammation
c. Necrosis
d. Repolarisations

A

a. Excitotoxicity

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34
Q

Sudden onset of visual impairment in a patient with 95% stenosis of the right
internal carotid artery is most likely.
a. transient loss of vision in the right eye
b. left-sided homonymous hemianopsia

A

a. transient loss of vision in the right eye
b. left-sided homonymous hemianopsia

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35
Q

What is a common location of lacunar ischaemic stroke?
a. frontal cortex
b. internal capsule
c. insula
d. Brainstem

A

b. internal capsule

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36
Q

In a patient with newly diagnosed atrial fibrillation who has suffered a TIA, we will decide to:
a. antiplatelet treatment
b. anticoagulation treatment
c. statin treatment
d. we don’t give him preventive treatment

A

b. anticoagulation treatment

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37
Q

In a patient with suspected subarachnoid haemorrhage, the most important thing to do is:
a. emergency head CT
b. analgesic therapy
c. MRI of the head
d. intravenous thrombolysis

A

a. emergency head CT

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38
Q

What characterises the clinical picture of intracerebral haemorrhage?
a. Sudden onset of focal neurological symptomatology

A

a. Sudden onset of focal neurological symptomatology

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39
Q

Which is the least common location of intracerebral haemorrhage?
a. putamen
b. thalamus
c. mesencephalon
d. lobar haemorrhage

A

c. mesencephalon

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40
Q

The most common mechanism of cerebellar damage in the penumbra:
a. Excitotoxicity

A

a. Excitotoxicity

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41
Q

Mechanical revascularisation is an option:
a. No more than 6 hours after the onset of symptoms, only if CT
angiography shows a large intracranial artery occlusion and if CT
shows no ischaemia

A

a. No more than 6 hours after the onset of symptoms, only if CT
angiography shows a large intracranial artery occlusion and if CT
shows no ischaemia

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42
Q

CT imaging is the imaging modality of choice for the diagnostic management of
patients with acute ischaemic stroke. The advantages are accessibility and speed.
a. both statements are correct
b. both statements are incorrect
c. the first statement is correct, the second is incorrect
d. the first statement is incorrect, the second is correct

A

a. both statements are correct

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43
Q

A CT scan of the brain in the emergency department is done at:
a. a person who has Glasgow coma scale less than 12
b. a man with suspected subarachnoid haemorrhage
c. a person with clinical signs of head trauma
d. a man with signs of a fresh stroke

A

a. a person who has Glasgow coma scale less than 12
b. a man with suspected subarachnoid haemorrhage
c. a person with clinical signs of head trauma
d. a man with signs of a fresh stroke

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44
Q

Who is most likely to have a subarachnoid haemorrhage?
a. 38-year-old patient with sudden onset of brief loss of
consciousness, severe headache with vomiting and confusion

A

a. 38-year-old patient with sudden onset of brief loss of
consciousness, severe headache with vomiting and confusion

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45
Q

Which laboratory abnormality is most suggestive of gigantocellular temporal
arteritis?
a. positive antinuclear antibodies
b. elevated alkaline phosphatase
c. normochromic normocytic anaemia
d. increased SR
e. elevated CRP

A

d. increased SR

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46
Q

A 33-year-old administrator presented with sudden severe headache, vomiting, mild
meningismus, but no signs of focal neurological deficits. What is correct? The
neurologist should:
a. perform an MRI on the patient, if negative, a CT scan, if negative, a
puncture, then blood tests, especially SR and leucocytes
b. first perform a CT scan on the patient, if negative, an MRI, if negative,
puncture, then blood tests, especially SR and leukocytes
c. first perform a CT scan on the patient, if it is negative, puncture her
d. first perform a CT scan on the patient, if this is negative, do not puncture her
at all, but check for signs of inflammation in her blood and if negative refer
her to a neurosurgeon
e. refer the patient to a neurosurgeon immediately, within three hours at the latest

A

c. first perform a CT scan on the patient, if it is negative, puncture her

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47
Q

How many times atrial fibrillation increases the chance of having a stroke:
a. 2x
b. 3x
c. 5x
d. 10x

A

c. 5x

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48
Q

What can cause CVI in an adolescent?
a. Moya-moya
b. dissection of a vein
c. fibromuscular dysplasia
d. all of the above

A

d. all of the above

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49
Q

What is not a contraindication to thrombolysis:
a. antiplatelet therapy
b. anticoagulant therapy
c. bleeding into the intestine
d. surgery a few days ago

A

a. antiplatelet therapy

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50
Q

In deep lacunar infarction, only in exceptional cases are:
a. aphasia
b. hemiparezo
c. hemiataxia
d. sensory loss after hemitipus

A

a. aphasia

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51
Q

What doesn’t belong in Wallenberg
syndrome:
a. ipsilateral defect of CN XII
b. ipsilateral ataxia
c. ipsilateral Horner
d. contralateral pain and temperature dropout

A

a. ipsilateral defect of CN XII

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52
Q

A 68-year-old maths professor with diabetic arterial hypertension says he had shiny
circles in front of his left eye, which quickly spread to the right half of his field of
vision. After half an hour, the circles disappeared. He had no headache. He did:
a. migraine aura
b. transient ischaemic attack
c. focal epileptic seizure
d. cardiogenic presyncope

A

a. migraine aura

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53
Q

What is the most dangerous factor for stroke?
a. artificial valves
b. atrial fibrillation

A

a. artificial valves

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54
Q

What visual impairment is most likely to be caused by a stroke?
a. bitemporal haemianopsia
b. temporary bilateral blindness
c. homonymous hemianopsia

A

c. homonymous hemianopsia

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55
Q

The gentleman has a left ACM stroke. What kind of speech disorder does he have?
a. aphasia
b. dizartrijo
c. Dysphonia
d. All

A

a. aphasia

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56
Q

Mr 67 years old, dizziness, vomiting, nystagmus of grade 3 with rapid phase to
the left, does not change direction when moving, little rotatory movement - the
picture at least corresponds:
a. Meniere’s disease
b. BPPV
c. infarction of the terminal branch of a. vestibularis
d. vestibular neuritis
e. cerebellar infarction

A

e. cerebellar infarction

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57
Q

Where is the least common site of intracranial haemorrhage?
a. putamen
b. thalamus
c. internal capsule
d. cerebellum
e. Occipital chain

A

d. cerebellum

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58
Q

Which risk factor is most controllable in heart attack?
a. hypertension

A

a. hypertension

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59
Q

Miss - 22 years old, fallen, unresponsive, looking to the right, waving her right
arm, where is the lesion?
a. infarction of the left a. cerebri media
b. left frontal
c. right frontal
d. Brainstem
e. this is not explained by a single lesion

A

c. right frontal

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60
Q

Secondary prevention of ischaemic stroke:
a. RR < 140/85 mmHg, statins regardless of cholesterol, aspirin
b. RR < 140/85 mmHg, statins for LDL > 3.5, aspirin, dipyridamole
c. RR < 140/85 mmHg, statins regardless of cholesterol, anticoagulants
d. endarterectomy for occlusion > 90%
e. anticoagulants for the treatment of paroxysms of atrial fibrillation
regardless of CHADS2 score

A

d. endarterectomy for occlusion > 90%

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61
Q

I would do thrombolysis in:
a. a patient taking warfarin who has an INR of 2.6
b. a patient who had heart surgery a week ago
c. a patient who failed to answer the phone and was called 2 hours after he
failed to answer the phone
d. patient with left arm plegia and hypoesthesia, taking aspirin, CT scan
after 3h shows ischaemia
e. patient on warfarin with INR 1.2, plegia of both left limbs, CT scan
after 2.5h shows no ischaemia

A

e. patient on warfarin with INR 1.2, plegia of both left limbs, CT scan
after 2.5h shows no ischaemia

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62
Q

How many strokes per year in the EU?
a. 4000

A

a. 4000

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63
Q

Public health claims about stroke (each slightly modified):
a. 1. cause of disability, 2. cause of mortality, incidence is rising in the
developed world

A

a. 1. cause of disability, 2. cause of mortality, incidence is rising in the
developed world

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64
Q

You should suspect venous sinus thrombosis when:
a. a woman 3 weeks after giving birth with a headache who vomits
b. 26-year-old woman on the contraceptive pill vomits, has
headaches and is somnolent
c. a cyclist three days after a hard race who vomits, has a headache and is confused
d. a patient with inoperable lung cancer who has headache and vomiting
e. all of the following

A

e. all of the following

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65
Q

What doesn’t belong in a stroke:
a. subdural haematoma
b. SAH
c. ischaemic heart attack
d. haemorrhagic infarction
e. intracerebral haemorrhage

A

a. subdural haematoma

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66
Q

The most common complication of systemic vasculitis?
a. mononeuritis multiplex
b. cap
c. 3 things that have nothing to do with vasculitis

A

a. mononeuritis multiplex

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67
Q

Which form of stroke is most likely to cause loss of consciousness:
a. ischaemic infarction ACM
b. ischaemic heart attack ACP
c. small intra-hemispheric haemorrhage without extension into the ventricles
d. massive SAH

A

d. massive SAH

68
Q

The most common causes of intracerebral haemorrhage in a 75-year-old are:
a. hypertension
b. acquired coagulopathy
c. congenital coagulopathy
d. amyloid angiopathy
e. brain tumour
f. arteriovenous malformation
g. Illicit drugs
h. berry aneurysm

A

a. hypertension
b. acquired coagulopathy
d. amyloid angiopathy
e. brain tumour

69
Q

What is not true about berry aneurysms?
a. present at birth

A

a. present at birth

70
Q

A patient with atrial fibrillation is treated with warfarin as it is an antiplatelet
drug.
a. both statements are correct
b. both statements are incorrect
c. the first statement is correct, the second is incorrect
d. the first statement is incorrect, the second is correct

A

c. the first statement is correct, the second is incorrect

71
Q

The following cells in the brain are most sensitive to ischaemia:
a. pyramidal cells in CA1 of the hippocampus
b. Purkinje cells in the cerebellum
c. granule cells in the visual cortex
d. cells in the nuclei of MŽ
e. cells in the gyrus dentatus

A

a. pyramidal cells in CA1 of the hippocampus
b. Purkinje cells in the cerebellum

72
Q

The most common is parenchymal haemorrhage in:
a. putamen
b. Pons
c. cerebellum
d. Cortex

A

a. putamen

73
Q

90% blockage of the internal carotid artery, the most common cause of cerebral
ischaemia in this case:
a. haemodynamic
b. thromboembolism
c. thrombosis
d. a+b
e. a+c

A

d. a+b

74
Q

Venous sinus thrombosis, what is not a risk factor:
a. malignant diseases
b. hereditary CVD
c. otitis media

A

b. hereditary CVD

75
Q

Why does a lady with an infarction of the inferior branch of the a. cerebri media with aphasia
have no hearing impairment?
a. because the cochlear nuclei emit in both hemispheres
b. because this artery does not supply the hearing area

A

a. because the cochlear nuclei emit in both hemispheres

76
Q

A 73-year-old female smoker with arterial hypertension presents to the emergency
neurology clinic with transient right arm weakness and speech disturbance lasting 4
minutes. This is the first time this has happened to her. The neurological status on
examination is completely within normal limits. We have to:
a. perform digital subtraction angiography of the carotid arteries immediately
b. we will only take action if the event happens again
c. start antiplatelet and statin treatment immediately, and have head
imaging (CT) and carotid artery imaging (ultrasound) and an internal
medicine examination
d. preventive therapy for cerebrovascular events should be
introduced only after diagnostic treatment
e. perform an MRI of the head to rule out demyelination

A

c. start antiplatelet and statin treatment immediately, and have head
imaging (CT) and carotid artery imaging (ultrasound) and an internal
medicine examination

77
Q

Carotid stenosis is the cause of stroke in:
a. 5%
b. 10%
c. 30-50%
d. 80%

A

b. 10%

78
Q

Therapy of systemic vasculitis:
a. corticosteroids

A

a. corticosteroids

79
Q

CHA2 DS2 -VASc is a scale for:
a. risk of haemorrhagic stroke in a patient with atrial fibrillation
b. levels of disability after stroke
c. risk of ischaemic stroke in patients with atrial fibrillation
d. risk of ischaemic stroke in a patient with TIA
e. the degree of disability of the patient after subarachnoid haemorrhage

A

c. risk of ischaemic stroke in patients with atrial fibrillation

80
Q

Intravenous thrombolysis is indicated:
a. if less than 3 hours have elapsed since the onset of the stroke and the CT scan is
unremarkable
b. if less than 4.5 hours have elapsed since the onset of the stroke and the CT shows
signs of infarction
c. if less than 4.5 hours have elapsed since the onset of the stroke and
the prefusion CT is unremarkable
d. if less than 4.5 hours have elapsed since the onset of the stroke and the CT
scan is unremarkable

A

d. if less than 4.5 hours have elapsed since the onset of the stroke and the CT
scan is unremarkable

81
Q

The most dangerous risk factor for ICH:
a. smoking
b. obesity
c. too high cholesterol
d. Alcohol
e. care

A

e. care

82
Q

What is not a risk factor for ischaemic stroke?
a. aspirin therapy
b. Leiden V factor mutation
c. antiphospholipid syndrome
d. systemic lupus erythematosus

A

a. aspirin therapy

83
Q

Clinical picture of intracerebral haemorrhage?
a. severe headache
b. sudden onset of focal signs
c. arterial hypertension
d. a+c
e. none of the above

A

e. none of the above

84
Q

An asymptomatic patient diagnosed with atrial fibrillation:
a. anticoagulant treatment if CHADS2 is more than 0
b. anticoagulant treatment if CHADS2 is more than 1
c. anticoagulant treatment if CHADS2 is more than 2
d. antiplatelet therapy if CHADS2 is more than 0
e. antiplatelet therapy if CHADS2 is more than 1

A

c. anticoagulant treatment if CHADS2 is more than 2

85
Q

Patient with INR = 2, when to use thrombolysis:
a. within 3 hours if CT shows ischaemia
b. within 3 hours if CT shows no ischaemia
c. within 4.5 hours if CT shows ischaemia
d. within 4.5 hours if CT shows no ischaemia
e. will not be used at all, regardless of the CT image

A

e. will not be used at all, regardless of the CT image

86
Q

The biggest risk factor for intracerebral haemorrhage is:
a. hypertension
b. smoking
c. male sex
d. anticoagulant medicines

A

a. hypertension

87
Q

The endoarterial procedure for 80% internal carotid stenosis will be decided mainly
on the basis of:
a. care
b. plaque stability and arterial tortuosity
c. a previous history of stroke in the narrowed artery

A

c. a previous history of stroke in the narrowed artery

88
Q

Image of a blood vessel in hypertension:
a. arteriosclerosis
b. arteriolosclerosis
c. atherosclerosis
d. arteriolohyalinosis
e. none of the above

A

d. arteriolohyalinosis

89
Q

What to give one day after thrombolysis:
a. statins, aspirin and clopidogrel or dipyridamole,
antihypertensives up to a blood pressure of 139/85 mmHg
b. statins, without antiplatelet protection, antihypertensives as previously
taken

A

a. statins, aspirin and clopidogrel or dipyridamole,
antihypertensives up to a blood pressure of 139/85 mmHg

90
Q

Transient loss of vision due to a circulatory disorder is called:
a. amaurosis fugax

A

Transient loss of vision due to a circulatory disorder is called:

91
Q

Temporal arteritis, what doesn’t apply?
a. proven by biopsy
b. corticosteroids help
c. may cause blindness in one eye
d. causes increased intracranial pressure

A

d. causes increased intracranial pressure

92
Q

Partially closed a. carotis interna, what occurs:
a. short-term visual field loss in one eye
b. visual field loss in both eyes
c. bitemporal haemianopsia
d. binacial haemianopsy

A

a. short-term visual field loss in one eye

93
Q

A cardiac patient after catheterisation with sudden loss of sensation on the left
side of the body and face. Where is the defect?
a. thalamus
b. internal capsule
c. Pons
d. spinal cord
e. and then some

A

a. thalamus

94
Q

Which investigation is mandatory before thrombolysis of a cerebral artery?
a. CT heads
b. MRI of the head
c. Ultrasound of the jugular veins
d. perfusion head CT

A

a. CT heads

95
Q

What doesn’t cause hemiparesis within a few weeks?
a. TIA
b. subdural abscess
c. brain tumour

A

a. TIA

96
Q

Possible consequences of a hypotensive episode:
a. hydranencephaly
b. infarction of the marginal vascular territories
c. parietal haemorrhagic infarction
d. massive intracerebral haemorrhage
e. subarachnoid haemorrhage

A

b. infarction of the marginal vascular territories

97
Q

The most common cause of intracerebral haemorrhage in a previously healthy 20 year
old?
a. protective anticoagulant therapy
b. berry aneurysms
c. hypertension
d. arteriovenous malformations

A

d. arteriovenous malformations

98
Q

In most areas of the brain, ischaemia critical for neurons occurs when
cerebral blood flow is reduced to:
a. 100 ml/100 g/min
b. 80 ml/100 g/min
c. 50-60 ml/100 g/min
d. 20-30 ml/100 g/min
e. 10 ml/100 g/min

A

e. 10 ml/100 g/min

99
Q

Cerebellar damage in ischaemic stroke is not:
a. it is definitive at the moment of creation
b. has a pith where cells are more severely affected and a penumbra
where cells are less severely affected
c. can progress in time
d. can spread in space
e. caused by various processes of tissue damage

A

a. it is definitive at the moment of creation

100
Q

I do not count tissue damage in ischaemic stroke as one of the processes:
a. energy depletion and excitotoxicity
b. peri-infarct depolarisation
c. inflammation
d. cell death
e. degeneration

A

e. degeneration

101
Q

Which investigation should be performed before thrombolysis treatment in a
stroke patient?
a. CT
b. CT angiography
c. diffusion-weighted magnetic resonance imaging
d. lumbar puncture
e. any of the following

A

a. CT

102
Q

The most common location of intracerebral haemorrhage is:
a. medulla oblongata
b. mesencephalon
c. thalamus and striatum
d. premotor cortex
e. Occipital chain

A

c. thalamus and striatum

103
Q

The most important risk factor for stroke that we can influence is:
a. smoking
b. obesity
c. arterial hypertension
d. elevated cholesterol
e. unhealthy diet and lack of exercise

A

c. arterial hypertension

104
Q

Ischaemic stroke is the most likely:
a. 35-year-old patient with the worst headache of her life, which
developed within 15 minutes of a flash in front of her eyes
b. 24-year-old patient with sudden severe headache with vomiting, becoming
increasingly drowsy
c. A 30-year-old patient with progressive severe headache, fever,
photophobia and vomiting
d. 57-year-old patient with sudden onset left hemiparesis and
mild headache
e. 47-year-old patient with the worst headache of his life, who has been
suffering from an increasing headache for several days and can’t remember
the beginning well

A

d. 57-year-old patient with sudden onset left hemiparesis and
mild headache

105
Q

It is not a risk factor for venous sinus thrombosis:
a. migraine
b. taking oral contraceptives
c. dehydration
d. cancer
e. sinus inflammation

A

a. migraine

106
Q

In a patient with symptomatic carotid disease, we will prescribe the following
on the day after the TIA:
a. high-dose statin, aspirin
b. statin according to cholesterol level, aspirin and dipyridamole
c. statin according to cholesterol level, clopidogrel
d. high-dose statin, clopidogrel, antihypertensive until blood pressure is
reduced to 139/85 mm Hg
e. high-dose statin, clopidogrel, antihypertensives as previously taken

A

d. high-dose statin, clopidogrel, antihypertensive until blood pressure is
reduced to 139/85 mm Hg

107
Q

Cardioembolic ischaemic stroke is most likely:
a. patient with gradual onset of paresis on the left side
b. patient with sudden loss of consciousness and right limb haemiparesis
c. patient with headache, vomiting and stiff neck
d. patient with sudden onset motor aphasia and right limb
hemiparesis
e. patient with isolated motor hemiparesis on the right

A

d. patient with sudden onset motor aphasia and right limb
hemiparesis

108
Q

The visual impairment typical of a stroke patient is:
a. bitemporal haemianopsia
b. sudden transient loss of vision in one eye
c. Transient blindness in both eyes
d. reduced visual acuity in one eye
e. red conjunctiva in one eye

A

b. sudden transient loss of vision in one eye

109
Q

What percentage of carotid disease
is caused by ICH?
a. 10-20%
b. 20-50%
c. 80-90%
d. carotid disease does not cause IMK

A

a. 10-20%

110
Q

Where is the lowest risk of atheroembolism?
a. unstable plaque in the a. carotis interna
b. previous TIA
c. hypertension
d. angina pectoris

A

c. hypertension

111
Q

Incidence of stroke:
a. 1/100.000
b. 10/100.000
c. 100/100.000
d. 200/100.000

A

d. 200/100.000

112
Q

Heart attack in the ACA area. What is most affected?
a. of the year
b. leg
c. image
d. speech

A

b. leg

113
Q

The noise above the carotid artery will be found at:
a. TIA
b. Migraines
c. epilepsy

A

a. TIA

114
Q

Patient, paresis of the right hand,
unable to perform the finger-to-nose test.
Defects in the epigastrium:
a. left a. cerebri anterior
b. left a. cerebri medii
c. left a. cerebri posterior
d. basilar arteries
e. none of the following

A

d. basilar arteries

115
Q

What not to do in the acute phase of a heart attack?
a. lower blood pressure to below 140/90 mmHg
b. intravenous thrombolysis if the patient is a candidate
c. mechanical revascularisation, if the patient is a candida

A

a. lower blood pressure to below 140/90 mmHg

116
Q

Patient with sudden right limb haemiraparesis, arms more affected than
legs. Unable to speak. Where is the lesion?
a. left a. cerebri anterior
b. left a. cerebri media
c. left a. cerebri posterior
d. basilar artery
e. none of the above

A

b. left a. cerebri media

117
Q

The patient fell and tore his a. meningeo medio. What is the consequence?
a. epidural haematoma
b. subdural haematoma
c. bleeding into the brain parenchyma
d. subarachnoid haemorrhage

A

a. epidural haematoma

118
Q

Right patient with infarction in the area of a. cerebri media on the right. What not
can we find?
a. neglect syndrome
b. deviations of the view to the right
c. deviation of the view to the left
d. hemiparesis on the left

A

c. deviation of the view to the left

119
Q

Heparin is the drug of choice for stroke prevention in patients with atrial
fibrillation. It takes longer than warfarin to take effect.
a. both statements are correct
b. both statements are incorrect
c. the first statement is correct, the second is incorrect
d. the first statement is incorrect, the second is correct

A

b. both statements are incorrect

120
Q

What is not a risk factor for venous sinus thrombosis?
a. contraceptive use p.o.
b. hypertension
c. prolonged effort
d. otitis media

A

b. hypertension

121
Q

When should we decide on invasive treatment in a patient with 70%
occlusion of the left carotid artery?
a. if the plaque is unstable and the artery is tortuous
b. after an episode of left hemiplegia lasting 1 hour
c. after a transient loss of vision on the left lasting 5 minutes
d. if deterioration is observed on ultrasound after one year

A

c. after a transient loss of vision on the left lasting 5 minutes

122
Q

After a TIA due to carotid occlusion, how will we treat?
a. a statin if he has high cholesterol, aspirin
b. statin regardless of cholesterol, clopidogrel, antihypertensives as before
c. statin regardless of cholesterol, clopidogrel, antihypertensives up
to 139/89 mmHg

A

c. statin regardless of cholesterol, clopidogrel, antihypertensives up
to 139/89 mmHg

123
Q

For a stroke patient who came very early after the stroke, we do:
a. CT heads
b. MRI of the head
c. DSA
d. CT, CTp CTA

A

d. CT, CTp CTA

124
Q

A large thrombus in a cerebral vein is most successfully removed by:
a. some transcranial ultrasound
b. thrombolysis
c. intra-arterial with micro-tools

A

c. intra-arterial with micro-tools

125
Q

Dissection of the carotid arteries:
a. is a common cause of stroke in young people
b. it occurs most often after severe trauma
c. it can occur with minimal manipulation

A

a. is a common cause of stroke in young people

126
Q

It is not a risk factor for deep vein thrombosis:
a. taking oral contraceptives
b. jaundice in the neonatal period
c. immobilisation
d. pregnancy

A

b. jaundice in the neonatal period

127
Q

Bleeding is least common in:
a. of the mesencephalon
b. ponsu
c. cerebellum
d. thalamus

A

a. of the mesencephalon

128
Q

We are treating a patient with temporal arteritis. How can we best
objectively check whether the treatment is helping?
a. with re-biopsy of the temporal lobe
b. by monitoring SR
c. by monitoring CRP
d. with clinical picture

A

b. by monitoring SR

129
Q

The ABCD scale2 does not include information on:
a. diabetes
b. .
c. hypertension
d. Consciousness
e. duration of symptoms

A

a. diabetes

130
Q

The minimum required in a patient with suspected SAH is:
a. CT heads
b. analgesics
c. lumbar puncture to exclude bleeding if CT scan did not show it
d. lumbar puncture because it may be bacterial meningitis

A

c. lumbar puncture to exclude bleeding if CT scan did not show it

131
Q

The most characteristic feature of a patient with lacunar strokes is:
a. right hemiparesis and dysarthria
b. other options also seemed plausible

A

a. right hemiparesis and dysarthria

132
Q

Which test can prove an intracranial aneurysm?
a. CT heads
b. CT angiography
c. MR of the head
d. transcranial Doppler examination

A

b. CT angiography

133
Q

The most sensitive diagnostic test for detecting intracranial aneurysms is:
a. CT angiography
b. transcranial Doppler examination
c. MR angiography
d. digital subtraction angiography

A

d. digital subtraction angiography

134
Q

Which cerebral artery is most commonly involved in aneurysms?
a. a. cerebri anterior
b. a. cerebri media
c. a. cerebri posterior
d. a. carotis interna

A

a. a. cerebri anterior

135
Q

A 60-year-old right-wing teacher fell ill 10 days ago with the worst acute
headache of his life. On examination, positive meningeal signs are found,
neurological examination is normal. A head CT shows no pathological changes.
What will be the patient’s corpus luteum?
a. bloody
b. xantokromen
c. Colourless
d. moten

A

b. xantokromen

136
Q

The treatment for an aneurysm is:
a. surgical and endovascular
b. Surgical
c. endovascular

A

a. surgical and endovascular

137
Q

Obstructive hydrocephalus after SAC is treated with:
a. external ventricular drainage
b. mannitol
c. furosemide
d. corticosteroids

A

a. external ventricular drainage

138
Q

Vasospasm after SAK is treated with s/z:
a. nimodipine,
b. furosemide,
c. captopril,
d. propranolol,
which is:
e. calcium channel blockers
f. beta blockers
g. diuretics
h. ACE inhibitors

A

a. nimodipine,
e. calcium channel blockers

139
Q

After SAH, the patient starts complaining of severe headache, drowsiness
and nausea. Doppler ultrasound does not confirm vasospasm. Follow-up CT
due to:
a. obstructive hydrocephalus
b. ischaemic heart attack
c. recurrence of subarachnoid haemorrhage

A

a. obstructive hydrocephalus

140
Q

A patient with a sudden severe headache (the worst of his life) and a stiff
neck. Which investigation do we do?
a. CT and lumbar puncture
b. DSA
c. MRI and MR angiography

A

a. CT and lumbar puncture

141
Q

A sudden severe headache in the occipital area, spreading to the whole head, is likely:
a. subarachnoid haemorrhage
b. migraine
c. meningitis
d. ischaemic heart attack

A

a. subarachnoid haemorrhage

142
Q

A 23-year-old student became increasingly lethargic 1 week after SAH, severe
headache, vomiting, no focal neurological deficits. A follow-up head CT scan is
decided on suspicion of:
a. subarachnoid haemorrhage again
b. ischaemic stroke
c. obstructive hydrocephalus
d. intracerebral haematoma

A

c. obstructive hydrocephalus

143
Q

In a patient with SAH, the aneurysm is most commonly at:
a. a. cerebri media
b. a. communicans anterior
c. a. ophtathalmici
d. a. cerebellaris posterior inferior

A

b. a. communicans anterior

144
Q

The first few hours after SAH are the most dangerous for the patient:
a. recurrence of subarachnoid haemorrhage
b. vasospasm & heart attack
c. pain
d. hydrocephalus
e. a, b, d

A

e. a, b, d

145
Q

Patient most likely to have SAH:
a. sudden loss of consciousness, then severe headache, vomiting
b. woman, flashes in front of eyes, after 15 minutes the worst headache of her life
c. a gentleman who has had a headache for several days, which is getting worse, and
has no recollection of when it started
d. mild headache and sudden haemiparesis

A

a. sudden loss of consciousness, then severe headache, vomiting

146
Q

Why is diagnosis and therapy after SAH necessary?
a. Increased ICP
b. dangers of vasospasm
c. risk of re-bleeding
d. cerebral ischaemia
e. bleeding

A

c. risk of re-bleeding

147
Q

Where is the most common intracerebral haemorrhage due to amyloid angiopathy?
a. putamen
b. Pons
c. cerebellum
d. temporal cortex

A

a. putamen

148
Q

She is admitted for SAK and develops haemiparesis a few days later. What is the cause?
a. frontal lobe irritation in the context of a first subarachnoid haemorrhage
b. recurrence of subarachnoid haemorrhage
c. obstructive hydrocephalus
d. vasospasm

A

d. vasospasm

149
Q

A bilateral aneurysm of the a. carotis interna can cause:
a. bitemporal haemianopsias
b. binazal haemianopsias
c. homonymous hemianopsias
d. bilateral central scotoma

A

b. binazal haemianopsias

150
Q

When is endovascular treatment (mechanical revascularisation) indicated
after TIA?
a. within 4.5 hours after the onset of symptoms if CT does not show ischaemia
b. within 4.5 hours of symptom onset if CT shows ischaemia
c. within 6 hours after the onset of symptoms if the CT scan does not show
ischaemia
d. within 6 hours of the onset of symptoms, if a large artery in the anterior
cerebral circulation is found to be blocked

A

c. within 6 hours after the onset of symptoms if the CT scan does not show
ischaemia
d. within 6 hours of the onset of symptoms, if a large artery in the anterior
cerebral circulation is found to be blocked

151
Q

Evidence: leucocytes 250/μL, erythrocytes 150,000/μL, glucose 5.8
mmol/L, proteins elevated. What is it most likely?
a. subarachnoid haemorrhage
b. tick-borne meningitis
c. bacterial meningitis

A

a. subarachnoid haemorrhage

152
Q

Where is the most likely site of an intracerebral haemorrhage due to hyalinosis:
a. Pons
b. thalamus
c. lobar at the subcortical-cortical border
d. mesencephalon
e. cerebellum

A

b. thalamus

153
Q

What is the most common cause of stroke?
a. care
b. atherosclerosis of the intracranial veins
c. cardioembolisms
d. hypertension
e. small vessel disease

A

b. atherosclerosis of the intracranial veins

154
Q

A 78-year-old right-handed gentleman with aphasia is brought to the clinic.
His wife says he has suffered a stroke. What else are you sure to find on
examination?
a. hemiparesis right
b. paresis of the left arm
c. homonymous hemianopsia on the right

A

a. hemiparesis right
c. homonymous hemianopsia on the right

155
Q

We use plastic myrcospirals for mechanical revascularisation of acute
ischaemic stroke. These spirals can be used to remove the clot from the cerebral
artery.
a. both statements are correct
b. both statements are incorrect
c. the first statement is correct, the second statement is incorrect
d. the first statement is incorrect, the second statement is correct

A

b. both statements are incorrect

156
Q

What is the key to maintaining a constant flow through the brain?
a. constant mean arterial pressure
b. constant intracranial pressure
c. changing vascular resistance in the brain
d. constant vascular resistance in the brain

A

c. changing vascular resistance in the brain

157
Q

CHADS2 in a patient with asymptomatic atrial fibrillation. How do we
intervene?
a. if the patient has > 1 point, give them a new generation anticoagulant
b. if the patient has < 1 point, give them a new generation anticoagulant
c. if the patient has > 1 point, give aspirin
d. if the patient has < 1 point, give aspirin

A

a. if the patient has > 1 point, give them a new generation anticoagulant

158
Q

Brain endothelium:
a. continuously emits NO
b. physiologically, the endothelium is antithrombotic, anti-inflammatory and antiplatelet
c. neurovascular coupling
d. all of the above

A

a. continuously emits NO

159
Q

What is the most common sign of SAH?
a. headache
b. sudden onset of focal neurological signs
c. meningeal signs
d. a+b
e. a+c
f. b+c

A

e. a+c

160
Q

Patient with ischaemia of the right internal carotid artery. What do we find?
a. hemiplegia and left hemianaesthesia (arm > leg) and aphasia
b. left hemiplegia, anosognosia and apraxia of dressing
c. hemiplegia and left hemianaesthesia (arm < leg), aphasia and abulia
d. no symptoms

A

d. no symptoms

161
Q

What is not the case with Penumbra:
a. flow rate less than 10 ml/100g/min
b. flow rate between 10 and 25 ml/100g/min
c. metabolism is still preserved
d. can potentially be solved
e. electrical and ionic failure

A

a. flow rate less than 10 ml/100g/min

162
Q

Sudden onset of visual disturbance in a patient with atrial fibrillation is most likely:
a. homonymous hemianopsia
b. bitemporal haemianopsia
c. Transient blindness in both eyes
d. transient loss of vision in one eye
e. a or d

A

e. a or d

163
Q

Interventional radiology can treat all aneurysms. Surgical treatment of
aneurysms is being abandoned.
a. both statements are correct
b. both statements are incorrect
c. the first statement is correct, the second statement is incorrect
d. the first statement is incorrect, the second statement is correct

A

b. both statements are incorrect

164
Q

What is considered cerebral blood flow (CBF) autoregulation?
a. the main control mechanism of FCH is mechanoregulation, which is
independent of arterial
b. Mechanical and chemoregulation of BMD is important during
metabolic disturbances
c. mechanoregulation works independently of chemoregulation

A

b. Mechanical and chemoregulation of BMD is important during
metabolic disturbances
c. mechanoregulation works independently of chemoregulation

165
Q

The most important predictor of outcome in cerebral ischaemia is:
a. blood pressure value
b. care
c. time since onset of symptoms

A

c. time since onset of symptoms

166
Q

The most important risk factor for subarachnoid haemorrhage is:
a. arterial hypertension
b. care
c. genetics

A

a. arterial hypertension

Neurology (22 decks)

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