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Prite- Neurology > CVA > Flashcards

CVA Flashcards

1
Q

62 y/o M w/ DM is not making sense, saying “thar szing is phrumper zu stalking”. Normal
intonation but no one in the family can understand it. He verbally responds to Qs w similar
utterances but fails to successfully execute any instruction. (8x)

A

WERNICKE’S APHASIA

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2
Q

Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R
extremities and severe dysfluent aphasia, but CT at 1:30 PM has no acute lesion. Most
appropriate treatment: (4x)

A

tpa

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3
Q

Head CT w/ lens-shaped hyperdensity (x2)

A

EPIDURAL HEMATOMA

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4
Q

A life threatening complication of cerebellar hemorrhage is: (2x)

A

ACUTE HYDROCEPHALUS

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5
Q

A 72 yo patient had an embolic infarct in the middle cerebral artery territory. ECG shows no
structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion
on both carotid arteries. An EKG reveals AFib. Which of the following strategies has the best
likelihood of reducing recurrent strokes in this patient? (2x)

A

ANTICOAGULATION WITH WARFARIN

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6
Q

68 y/o pt w/ hypertension develops rapidly progressing right arm and leg weakness, with
deviation of the eyes to the left. Within 30 minutes of the onset of this deficit, pt became
increasingly sleepy. Two hours after the onset, the patient became unresponsive. On exam:
dense right hemiplegia, eyes deviated to the left, pupils: equal and reactive, a right facial
weakness to grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT
finding is most likely? (2x)

A

LEFT PUTAMINAL HEMORRHAGE

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7
Q

A pt has multiple stroke like symptoms of short duration over several days. And has new
onset symptoms for the last 90 minutes. CT scan shows no evidence of stroke or
hemorrhage. What is the appropriate treatment? (2x)

A

INTRAVENOUS THROMBOLYTIC AGENTS

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8
Q

70 y/o pt was hospitalized because of a middle cerebral artery stroke. The psychiatrist was
asked to evaluate the pt. The pt has non-fluent aphasia. Which most likely characterized the
pt’s interaction with the psychiatrist? (2x)

A

THE PT WAS ABLE TO FOLLOW THE

VERBAL REQUEST, “CLOSE YOUR EYES.”

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9
Q

Most common psychiatric presentation following a stroke? (2x)

A

DEPRESSION

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10
Q

Chiropractic adjustments are a known precipitant for which of the following acute
conditions? (2x)

A

VERTEBRAL ARTERY DISSECTION

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11
Q

The most common complication of temporal arteritis is caused by occlusion of the: (2x)

A

OPHTHALMIC ARTERY

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12
Q

The most common possible cause of a posterior cerebral artery infarct in 36 y/o F with hx of
migraine: (2x)

A

ocp

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13
Q

45 y/o with R hemiparesis, CT shows L internal capsule ischemic changes extending to
adjacent basal ganglia + old lacunar injury of R caudate head. LP – 65 wbcs (mostly
lymphocytes), 78 protein, 63 glucose, + reagin antibodies. Tx?

A

pcn

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14
Q

CT Head Large hypodensity on R frontal and parietal lobes

A

MCA STROKE W/ RESIDUAL L SIDED

WEAKNESS

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15
Q

Contralateral leg weakness with personality changes is an injury where

A

ACA

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16
Q

61 y/o with left frontal lobe damage secondary to cerebrovascular accident may be
predisposed to which psychiatric syndrome?

A

MDD

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17
Q

72 y/o pt had a lacunar infarct in the middle cerebral artery territory. Echo is normal.
Doppler studies of neck arteries reveal less than 50% occlusion on both carotid arteries.
EKG is normal. The best strategies to reduce recurrent stroke:

A

ANTIPLATELET THERAPY WITH ASPIRIN

AND DIPYRIDAMOLE

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18
Q

50 y/o pt recently began having VH of children playing. VH are fully formed, colorful and
vivid, but with no sound. Pt is not scared or disturbed, but rather amused. On exam, normal
language, memory, cranial nerves, no weakness or involuntary movement, no sensory
deficits. DTR: symmetric. CSF/UDS nml.

A

PCA ischemia

19
Q

Why would brains >65 years old or a history of alcoholism more susceptible to chronic
subdural hematoma?

A 
CORTICAL ATROPHY (LONGER DISTANCE
FOR BRIDGING VEINS TO BE DAMAGED)
20
Q

What is the most common manifestation of acute neurosyphilis?

A

STROKE

21
Q

65 y/o pt wakes up with right-sided hemiparesis and motor aphasia. Pt is immediately
brought to the emergency department and an evaluation is completed within 1 hour.
Neurological exam: no additional abnormalities. Head CT w/o contrast: no additional
abnormalities. Which is the appropriate next step in management?

A

asa

22
Q

Abnormal elevated metabolic findings associated with increased risk of stroke in patients
under 50

A

PLASMA HOMOCYSTEINE

23
Q

Acute onset of dense sensorimotor deficit in the contralateral face and arm, with milder
involvement of the lower extremity, associated with gaze deviation toward the opposite
side of the deficit, likely indicates occlusion of:

A

SUPERIOR DIVISION OF THE MCA

24
Q

CT scan with occipital and intraventricular hyper-intensities:

A

PARENCHYMAL HEMORRHAGE

25
Q

Which med has secondary prevention against embolic stroke in pts with A-fib?

A

ORAL WARFARIN

26
Q

As opposed to strokes caused by arterial embolism or thrombosis, those caused by cerebral
vein or venous sinus thrombosis are:

A

ASSOCIATED WITH SEIZURES AT ONSET

27
Q

Pt who 5 days ago experienced a ruptured aneurysm located in the left middle cerebral
artery develops a fluctuating aphasia and hemiparesis with no significant headaches.
Underlying event

A

vasospasm

28
Q

63 y/o with new onset aphasia and R hemiparesis, 2 days ago had milder/similar symptoms
that resolved in 30 minutes, yesterday had similar episode x 45 minutes. Current Sx started
1.5 hrs ago. CT shows no stroke or hemorrhage. Tx?

A

INTRAVENOUS THROMBOLYTIC AGENTS

29
Q

57 y/o diabetic pt =w/ HTN c/o several episodes of visual loss, “curtain falling” over his L
eye, transient speech and language disturbance, and mild R hemiparesis that lasted 2 hrs.
Suggests presence of what?

A

EXTRACRANIAL LEFT INTERNAL CAROTID

STENOSIS

30
Q

Head injury, LOC -> lucid interval x hours -> rapid progressing coma. Hemorrhage?

A

epidural

31
Q

Poststroke depression in 80 yo pt (R handed) is assoc w cognitive impairments that:

A

CORRELATE WITH LEFT HEMISPHERIC

INVOLVEMENT

32
Q

66 y/o M in ED w/ sudden occipital HA, dizziness, vertigo, N/V, unable to stand, mild
lethargy, slurred speech. Exam: small reactive pupils, gaze deviated to the R, nystagmus, w/
occasional ocular bobbing, R facial weakness, decreased R corneal reflex, truncal ataxia, b/l
hyperreflexia, b/l Babinski. Dx?

A

CEREBELLAR HEMORRHAGE

33
Q

50 y/o pt is in the ED for acute onset of neck pain radiating down the left arm, progressive
gait difficulty, and urinary incontinence. This test should be administered immediately:

A

MRI SCAN OF THE CERVICAL SPINE TO
EXCLUDE A DIAGNOSIS OF SPINAL CORD
COMPRESSION.

34
Q

In managing acute ischemic stroke, administer this within 48 hrs of onset of stroke for
beneficial effect in reducing risk of recurrent stroke, disability and death:

A

ASA

35
Q

70 y/o pt w/ attacks of “whirling sensations” w/n/v, diplopia, dysarthria, tingling of lips.
Occurs several times daily for 1 minute, severe that pt collapses and is immobilized when
symptoms start. No residual s/s, no tinnitus, hearing impairment, ALOC or association with
any particular activity. Dx?

A

VERTEBROBASILAR INSUFFICIENCY

36
Q

Vascular lesion most characteristic of sudden severe headache, vomiting, collapse, relative
preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness:

A

SUBARACHNOID HEMORRHAGE

37
Q

Head CT demonstrates which dx (grainy picture with diffuse speckling in posterior region,
unilateral)

A

SUBARACHNOID HEMORRHAGE

38
Q

Mental status changes after CABG, fluent speech and excellent comprehension, inability to
name fingers and body parts, right and left orientation errors inability to write down
thoughts and calculation, but with good reading comprehension:

A

AN EMBOLIC STROKE AFFECTING LEFT

ANGULAR GYRUS

39
Q

70 y/o F sudden onset paralysis R foot and leg. R arm and hand slightly affected. No aphasia
or visual field deficit. Over weeks found with loss of bladder control, abulia and lack of
spontaneity. Which vascular area:

A

L ACA

40
Q

Pts in a locked in state following basilar artery occlusion typically retain what movement?

A

? EYELIDS AND VERTICAL GAZE

41
Q

83 yo pt with mild HTN comes in with new onset headache and left hemiparesis. MRI shows
right parietal lobe hemorrhage, small occipital hemorrhage and evidence of previous
hemorrhage in right temporal and left parietal regions. What is likely etiology for these
findings?

A

AMYLOID ANGIOPATHY

42
Q

39 y/o pt with hx of multiple miscarriages develops an acute left sided hemiparesis. Work
up reveals elevated anticardiolipin titers and no other risk factors for stroke. Appropriate
intervention at this point is?

A

PLASMAPHERESIS

43
Q

In which arterial area would a stroke resolve in inability to read but preserved ability to
write?

A

pca

44
Q

71yo pt w/ Parkinson’s x3yrs p/w difficulties getting up, is not motivated to do anything,
has no interest in social events, and has “slowness” in thinking; although motor sx well
controlled on Sinemet, sx stable throughout day and no sadness, worthlessness, or SI.
Cognitive eval shows slow processing. What is most likely explanation?

A

APATHY

Prite- Neurology (14 decks)

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