CVA

Question 1

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)

Answer 1

WERNICKE’S APHASIA

Question 2

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)

Answer 2

tpa

Question 3

Head CT w/ lens-shaped hyperdensity (x2)

Answer 3

EPIDURAL HEMATOMA

Question 4

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

Answer 4

ACUTE HYDROCEPHALUS

Question 5

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)

Answer 5

ANTICOAGULATION WITH WARFARIN

Question 6

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)

Answer 6

LEFT PUTAMINAL HEMORRHAGE

Question 7

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)

Answer 7

INTRAVENOUS THROMBOLYTIC AGENTS

Question 8

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)

Answer 8

THE PT WAS ABLE TO FOLLOW THE

VERBAL REQUEST, “CLOSE YOUR EYES.”

Question 9

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

Answer 9

DEPRESSION

Question 10

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

Answer 10

VERTEBRAL ARTERY DISSECTION

Question 11

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

Answer 11

OPHTHALMIC ARTERY

Question 12

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

Answer 12

ocp

Question 13

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?

Answer 13

pcn

Question 14

CT Head Large hypodensity on R frontal and parietal lobes

Answer 14

MCA STROKE W/ RESIDUAL L SIDED

WEAKNESS

Question 15

Contralateral leg weakness with personality changes is an injury where

Answer 15

ACA

Question 16

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

Answer 16

MDD

Question 17

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:

Answer 17

ANTIPLATELET THERAPY WITH ASPIRIN

AND DIPYRIDAMOLE

Question 18

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.

Answer 18

PCA ischemia

Question 19

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

Answer 19

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

Question 20

What is the most common manifestation of acute neurosyphilis?

Answer 20

STROKE

Question 21

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?

Answer 21

asa

Question 22

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

Answer 22

PLASMA HOMOCYSTEINE

Question 23

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:

Answer 23

SUPERIOR DIVISION OF THE MCA

Question 24

CT scan with occipital and intraventricular hyper-intensities:

Answer 24

PARENCHYMAL HEMORRHAGE

Question 25

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

Answer 25

ORAL WARFARIN

Question 26

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

Answer 26

ASSOCIATED WITH SEIZURES AT ONSET

Question 27

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

Answer 27

vasospasm

Question 28

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?

Answer 28

INTRAVENOUS THROMBOLYTIC AGENTS

Question 29

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?

Answer 29

EXTRACRANIAL LEFT INTERNAL CAROTID | STENOSIS

Question 30

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

Answer 30

epidural

Question 31

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

Answer 31

CORRELATE WITH LEFT HEMISPHERIC | INVOLVEMENT

Question 32

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?

Answer 32

CEREBELLAR HEMORRHAGE

Question 33

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:

Answer 33

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

Question 34

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:

Answer 34

ASA

Question 35

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?

Answer 35

VERTEBROBASILAR INSUFFICIENCY

Question 36

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

Answer 36

SUBARACHNOID HEMORRHAGE

Question 37

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

Answer 37

SUBARACHNOID HEMORRHAGE

Question 38

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:

Answer 38

AN EMBOLIC STROKE AFFECTING LEFT | ANGULAR GYRUS

Question 39

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:

Answer 39

L ACA

Question 40

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

Answer 40

? EYELIDS AND VERTICAL GAZE

Question 41

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?

Answer 41

AMYLOID ANGIOPATHY

Question 42

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?

Answer 42

PLASMAPHERESIS

Question 43

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

Answer 43

pca

Question 44

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?

Answer 44

APATHY