Neurology_Cerebrovascular Diseases Flashcards
(153 cards)
1
Q
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
A
E) all of the answers are correct
1) epileptic seizures
2) supraorbital or occipital bruits
3) headache
4) subarachnoideal hemorrhage
2
Q
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
A) 1st, 2nd and 3rd answers are correct
1) 100-325 mg acetylsalicylic acid
2) 75 mg clopidogrel
3) 2x25 mg acetylsalicylic acid + 2x200 mg dipyridamole
3
Q
Make pairs!
Picture of a chronic, extended cerebral infarction
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
A
D) hypodens area with sharp border and dilation of the ventricle and the subarachnoid space next to the lesion
4
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
5
Q
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
A
C) the statement is true, but the explanation is false;
6
Q
What type of electrolyte abnormality may develop after subarachnoid haemorrhage?
A) hypokalaemia
B) hyponatraemia
C) both of them
D) none of them
A
B) hyponatraemia
7
Q
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
A) if the diastolic blood pressure exceeds 120 mmHg
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
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
A
C) 2nd and 4th answers are correct
2) cerebral contusion
4) rupture of arteriovenous malformation
10
Q
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
A
B) cardioembolic
11
Q
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
A) both the statement and the explanation are true and a causal relationship exists between them;
12
Q
Make pairs!
it causes subdural hematoma
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
A
E) damage of the bridging veins
13
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
14
Q
Match the statements.
the symptoms may refer to stroke in the dominant parietal lobe
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.
A
B) Agraphia with alexia, acalculia, finger agnosia, lower quadrant anopsia evolved, and the symptoms resolved within 2 days.
15
Q
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
A
B) both the statement and the explanation are true but there is no causal relationship between them;
16
Q
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
A
E) all of the answers are correct
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
17
Q
Make pairs!
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
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
A
C) occlusion of the transvere sinus
18
Q
Make pairs!
scalp edema, symptoms of increased intracranial pressure, epileptic seizures, disturbance of consciousness, coma might be present
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
A
B) thrombosis of superior sagittal sinus
19
Q
Match the symptoms with the site of the lesion
caused by a lesion of the lateral part of the medulla, part of the Wallenberg’s syndrome
A) ideomotor apraxia
B) amusia
C) dysarthria
D) Gerstmann’s syndrome
E) Horner’s syndrome
A
E) Horner’s syndrome
20
Q
What type of developmental disorder may be associated with congenital intracranial aneurysms?
A) endometriosis
B) ovarian cyst
C) diaschisis
D) polycystic kidney
A
D) polycystic kidney
21
Q
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
A
B) pons
22
Q
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
A
C) the statement is true, but the explanation is false;
23
Q
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)
A
B) cranial MRI
24
Q
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
A) cranial CT
25
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
26
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
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
27
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) for the measurement of intima-media thickness.
28
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
29
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;
30
Match the statements.
the clinical course and syndrome are specific for progressing stroke
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.
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.
31
Make pairs!
These belong to primary stroke prevention
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
A) quit smoking, diet, treatment of hypertension
32
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
D) diplopia, deafness
33
Match the statements.
the clinical course may refer to completed stroke
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.
D) Right sided homonymous hemianopsia was detected at the beginning, and pronounced limb ataxia, latent hemiparesis was still present 4 weeks later.
34
Make pairs!
Treatment of significant internal carotid artery stenosis
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
C) endarterectomy
35
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;
36
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
1) after myocardial infarction, especially with aneurysm formation
2) after arteficial heart valve implantation
3) coexistence of atrial fibrillation and high stroke risk
37
Make pairs!
ischemic lesion with hemorrhagic transformation (picture of hemorrhagic infarction)
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
C) there is extended cortical hypodens lesion with small, patchy hyperdens areas in CT scans
38
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
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
39
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
1) after TIA, if the stenosis of the internal carotid artery is larger then 70% measured by angiography
3) in case of repeated or crescendo TIA on the side of the exulcerated plaque or floating thrombus
40
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
B) Parinaud-syndrome
41
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
4) drug consumption
42
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
2) TIA
4) left ventricular
43
Match the following arteries and the statements!
its aneurysm may cause ipsilateral oculomotor nerve lesion
A) subclavian artery
B) posterior communicating artery
C) basilar artery
D) superficial temporal artery
E) superior cerebellar artery
B) posterior communicating artery
44
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
1) sudden onset of a severe, throbbing nuchal or frontal headache
3) neck stiffness
45
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
46
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.
47
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
48
Make pairs!
Treatment of space-occupying cerebellar hemorrhage
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
E) surgical intervention: partial resection, shunt implantation
49
Make pairs!
it can causes epidural hematoma
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
D) damage of the middle meningeal artery
50
Make pairs!
characteristic symptoms are paresis of the extraocular muscles, chemosis, retrobulbar pain
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
A) thrombosis of cavernous sinus
51
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
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
52
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
1) administration of wide spectrum antibiotics
2) mannitol
3) therapeutic dose of heparine, even if there is haemorrhagic transformation
53
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
1) cranial CT
3) CT-angiography or DSA (digital substractional angiography)
54
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) lesion of the III., IV., VI., V/1. cranial nerves
55
Match the following arteries and the statements!
its stenosis may cause subclavian steal syndrome
A) subclavian artery
B) posterior communicating artery
C) basilar artery
D) superficial temporal artery
E) superior cerebellar artery
A) subclavian artery
56
Match the statements.
the clinical course raises suspicion for cerebral tumor rather than stroke
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.
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.
57
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
58
With the help of which examination can the bleeding be seen immediately?
A) EEG
B) SPECT
C) CT
D) PET
C) CT
59
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
1) gastrointestinal ulcer
2) dementia, bad compliance
3) bacterial endocarditis
60
Make pairs!
hypertension induced destructive parenchymal cerebral hemorrhage that ruptured into the ventricules
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
B) hyperdens lesion in the territory of basal ganglia and in the lateral ventricle can be seen in CT scans
61
Match the following arteries and the statements!
its occlusion causes ipsilateral limb and gait ataxia
A) subclavian artery
B) posterior communicating artery
C) basilar artery
D) superficial temporal artery
E) superior cerebellar artery
E) superior cerebellar artery
62
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
1) headache
2) focal or generalized epileptic seizures
3) papilla edema
4) disturbance of consciousness
63
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
1) in urgent cases, when angiography helps in clinical decisions and treatments (e.g. subarachnoideal hemorrhage, local thrombolysis in acute large vessel occlusion)
3) to plan intra-arterial intervention like intraluminal angioplasty
64
The ischemic stroke occurs frequently:
A) after waking
B) after going to bed
C) in the summer
D) in the afternoon
A) after waking
65
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
1) neurogenic regulation
2) metabolic regulation
3) cerebral autoregulation
66
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
D) lower leg deep venous thrombosis without patent foramen ovale
67
Treatment of cerebral edema in ischemic stroke:
A) high-dose steroid
B) furosemid
C) mannitol
D) dextran
C) mannitol
68
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
69
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
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
70
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;
71
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
C) thromboembolisation of the ophthalmic artery (terminal branch) from the ulcerated plaque of the ipsilateral internal carotid artery
72
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
1) hemorrhage ruptures into the ventricles, the fourth ventricle is compressed
2) putaminal hemorrhage with huge midline shift
3) secondary pontine hemorrhage
73
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)
74
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
75
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
1) unilateral stenosis of the vertebral artery
3) cranial CT showed large acute ischemic lesion
76
Match the statements.
transient ischemic attack (TIA)
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.
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.
77
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
78
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
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
79
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
80
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
1) epileptic seizures
2) vomiting
3) disturbance of consciousness
4) cerebral edema
81
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
1) adhesion
2) aggregation
3) release reaction
4) platelet activation
82
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
1) cocaine, amphetamine abuse
2) leukaemia and other hematological diseases
3) hemostasis disorders
4) bleeding of primary brain tumor (glioblastoma multiforme)
83
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
84
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
85
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
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
86
Possible causes of lacunar infarction:
1) polycythemia vera
2) Heubner arteritis
3) microatheroma
4) microembolization
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
1) polycythemia vera
2) Heubner arteritis
3) microatheroma
4) microembolization
87
Match the following arteries and the statements!
the acute occlusion of this artery causes coma and bilateral pyramidal signs
A) subclavian artery
B) posterior communicating artery
C) basilar artery
D) superficial temporal artery
E) superior cerebellar artery
C) basilar artery
88
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
1) locked-in syndrome
3) sudden onset of coma, tetra-pyramidal signs
89
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
1) emotional lability
2) anxiety, anger
3) avoiding, aggressive behavior
90
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
91
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
1) after TIA
3) if auscultation reveals murmur over the carotid arteries
92
Match the following arteries and the statements!
this artery is swollen, painful and tender in giant cell arteritis
A) subclavian artery
B) posterior communicating artery
C) basilar artery
D) superficial temporal artery
E) superior cerebellar artery
D) superficial temporal artery
93
83 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
1) to assess cerebral vascular reserve capacity with Diamox-test
3) to examine diaschisis effect and assess prognosis
94
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
95
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
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)
96
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;
97
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
D) cortical blindness
98
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
99
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
4) alexia
100
Make pairs!
subcortical arteriosclerotic encephalopathy (Binswanger)
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
E) hypodensity in the periventricular white matter, cortical atrophy
101
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
2) increased deep reflexes with pyramidal signs
4) spastic muscle tone
102
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;
103
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
104
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
B) important potential collateral source in case of ipsilateral ICA occlusion
105
Match the symptoms with the site of the lesion
caused by a lesion of the pole of the superior temporal gyrus
A) ideomotor apraxia
B) amusia
C) dysarthria
D) Gerstmann’s syndrome
E) Horner’s syndrome
B) amusia
106
The ratio between carotid area and vertebrobasilar stroke:
A) 1:1
B) 1:3
C) 10:1
D) 1:10
E) 4:1
E) 4:1
107
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
108
Which localization is typical for intracerebral bleeding?
A) basal ganglia
B) thalamus
C) pons
D) cerebellum
A) basal ganglia
109
Make pairs!
Treatment of superior sagittal sinus thrombosis
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
D) administration of heparin and antiepileptic drugs
110
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) hemiparesis with dominance in the facial and brachial area
111
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
1) myelon lesion
2) epileptic seizure
3) extrapyramidal symptoms
4) cortical blindness
112
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
D) contralateral hyperkinesia
113
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;
114
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
2) lactic acid elevation
4) pH decrease
115
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) middle meningeal artery
116
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
1) fogging phenomenon
2) hypodensity
3) gyral contrast enhancement
4) usually there is no abnormality in the first hours of the ischemic event
117
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
118
Make pairs!
The CT examination was performed after the onset of ischemic stroke within 2 hours
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
A) there is no abnormality in CT scans
119
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
2) bacterial pneumonia
4) endocarditis
120
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
1) brainstem stroke symptoms
2) if cavernoma is suspected
3) suspected intracerebral haemorrhage in the early phase of pregnancy
121
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
1) vasospasm, leading to secondary ischemic damage
3) nonresorptive hydrocephalus
122
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
1) simultaneous treatment with carbamazepine
2) alcoholic hepatopathy
3) simultaneous administration of acetylsalicylic acid, or ticlopidine, or clopidogrel
4) extremely high blood pressure
123
For secunder stroke prevention acetylsalicilic acid (AS
A) 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;
124
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
1) cranial CT or MRI with venous CTA, or MRA
3) search for source of infection (in this case gynecologic source is likely)
125
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
2) transthoracic echocardiography (TTE)
4) transesophageal echocardiography (TEE), if TTE couldn’t detect the source of embolisation and if the origin of stroke was unknown in young patient
126
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
2) aortic coarctation
4) subclavian steal syndrome
127
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
1) in the contralateral hemisphere
3) in the contralateral cerebellum
128
Make pairs!
It is used for secundary stroke prevention in case of lacunar stroke
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
B) administration of clopidogrel, or acetylsalicyclic acid
129
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;
130
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) calcium influx
131
The mortality is the highest if the bleeding is localized in the:
A) thalamus
B) basal ganglia
C) brainstem
D) frontal lobe
C) brainstem
132
Match the symptoms with the site of the lesion
caused by damage of the left supramarginal gyrus in right-handed patients
A) ideomotor apraxia
B) amusia
C) dysarthria
D) Gerstmann’s syndrome
E) Horner’s syndrome
A) ideomotor apraxia
133
Match the symptoms with the site of the lesion
caused by a lesion of the left angular gyrus
A) ideomotor apraxia
B) amusia
C) dysarthria
D) Gerstmann’s syndrome
E) Horner’s syndrome
D) Gerstmann’s syndrome
134
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
A) 1., 2. and 3. answers are correct
1) cranial CT and CT-angiography
2) duplex scan ultrasound of the cervical arteries and transcranial Doppler
3) cardiological examination with echocardiography
135
The risk of stroke in hypertension:
A) 2–8x
B) 0,3–3x
C) 2x
D) 50x
A) 2–8x
136
Symptoms of vertebrobasilar insufficiency, EXCEPT:
A) diplopia
B) vertigo
C) dysarthria
D) alternating brainstem syndromes
E) apraxia
E) apraxia
137
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
1) exulcerated
2) haemorrhagic
3) heterogeneous
138
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
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
139
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
140
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
141
Symptoms of TIA, EXCEPT:
A) Transient unilateral blindness
B) Transient limb numbness
C) Transient aphasia
D) Transient loss of consciousness with epileptic seizure
D) Transient loss of consciousness with epileptic seizure
142
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
143
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
1) appears mostly daytime, during physical activity
3) sudden onset, rapid, progressive disturbance of consciousness
144
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) anterior cerebral artery and branches
145
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
146
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) participates in the absorption of CSF
147
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
2) hemorheologic changes
4) disturbance of microcirculation
148
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
149
Global cerebral ischemia causes irreversible cerebral damage after:
A) 20–25 min
B) 10–15 min
C) 3–5 min
D) 1–2 min
C) 3–5 min
150
Match the symptoms with the site of the lesion
caused by bilateral damage of the corticobulbar fibers
A) ideomotor apraxia
B) amusia
C) dysarthria
D) Gerstmann’s syndrome
E) Horner’s syndrome
C) dysarthria
151
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
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
152
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
1) deep vein thrombosis of the lower extremities, pulmonary embolism
2) bronchopneumonia
3) bed sore (decubitus)
4) urocystitis, pyelonephritis
153
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
E) thalamus-syndrome, thalamus-hand
