Stroke 2019

Question 1

The single most important non-modifiable risk factor for stroke worldwide is

Answer 1

Age

Question 2

Which modifiable risk factor is the leading cause of stroke

Answer 2

Hypertension

Question 3

The vascular supply of the lower limb motor strip is supplied by which cerebral artery

Answer 3

Anterior

Question 4

Poor prognosis for upper limb motor recovery following a stroke include

Answer 4

Complete arm paralysis at onset

Question 5

The bobath and Brunnstrom Approach to movement therapy differ primarily in their approach to

Answer 5

Primitive movements

Question 6

Constraint induced therapy requires that patients

Answer 6

Be able to voluntarily move their fingers

Question 7

Following a stroke, DTRs increase within

Answer 7

48 hours

Question 8

Infarction of which blood vessel causes ipsilateral facial and contralateral body loss to pain and temperature sensation, horner’s syndrome, ataxia, vertigo and dysphagia

Answer 8

Posterior inferior cerebellar artery

Question 9

Which of the following studies is the standard of care for imaging in acute stroke

Answer 9

CT scan

Question 10

In the setting of a high clinical suspicion for SAH, with a negative head CT scan, what diagnostic test should you perform next?

Answer 10

Spinal tap

Question 11

In a patient without symptoms of carotid artery stenosis, ordering a carotid US is justified by which of the following additional clinical indicators?

Answer 11

Asymptomatic patient with carotid bruit

Question 12

After an embolism stroke, which diagnostic study is the standard of care to evaluate for secondary prevention of recurrent stroke?

Answer 12

Echocardiogram

Question 13

Which factor is associated with improved outcomes in hemorrhagic stroke patients?

Answer 13

Hemorrhage in the parietal lobe less than 3 cm

Question 14

Your stroke patient has weakness affecting the hand and foot more than the proximal muscles on the same side. Sensation and cognition are intact. This person most likely has a stroke in which contralateral area?

Answer 14

Internal capsule

Question 15

A patient presents for evaluation of shoulder pain in his hemiplegic upper limb following a recent stroke. On assessment of the limb, you note hyperesthesia, unusual sweating, shoulder ROM loss, and early dystrophic changes of the skin and nails of the hand. Radiographs show patchy, periarticular demineralization in the upper limb joints except the elbow. What is the most effective treatment for this condition, in additional to intensive rehab

Answer 15

Sympathetic blockade of the stellate ganglion

Question 16

Hemorrhagic strokes caused by HTN are typically located in the

Answer 16

Cerebellum

Question 17

A patient has a right 3rd CN palsy, left side loss of pain and temperature, left side loss of joint position, and left side ataxia. Where is the brainstem stroke most likely located.

Answer 17

Right tegmentum of midbrain

Question 18

Which one of the following deficits is most likely due to a posterior cerebral artery stroke

Answer 18

Alexia without agraphia

Question 19

Akinetic mutism (Abulia) with paratonia is most likely to occur from a stroke involving the

Answer 19

Anterior cerebral artery

Question 20

Following stroke, which region of the hemiplegic upper limb demonstrates the same direction of movement in both extensor and flexor synergy patterns?

Answer 20

Fingers

Question 21

A 72 year old woman with a stroke has dysphagia and cannot proceed with MBS because she is too unstable to leave the ICU. A FEES is recommended. THe FEES study will be able to directly visualize:

Answer 21

Vocal cord function

Question 22

An 80 year old man presents with mild expressive aphasia and slight right sided weakness. Symptoms resolve within 15 minutes. he is diagnosed with TIA. Carotid US demonstrates 70-99% occlusion of the left ICA and 50-70% occlusion of the Right ICA. What is the most appropriate recommendation regarding carotid endarterectomy

Answer 22

Left carotid endarterectomy only

Question 23

A patient presents with a hoarse voice and trouble swallowing. You suspect the CNS structure involved that accounts for these symptoms is in the

Answer 23

Nucleus ambiguous

Question 24

In patients with chronic spasticity in the wrists and fingers after a stroke, which localization method is preferred for botulinum toxin injection therapy

Answer 24

US and electrical stimulation

Question 25

Which of the following mechanisms represents the mechanism of action of botulinum toxin in the treatment of spasticity

Answer 25

Pre-synaptic acetylcholine blockade

Question 26

Botulinum toxin A works by cleaving which presynpatic translocation protein

Answer 26

SNAP 25

Question 27

The technique for needle placement for botulinum toxin injections that requires the most practice is:

Answer 27

US

Question 28

Intrathecal NaCl often decreases spasticity by wwhat mechanism?

Answer 28

It acts as a GABA agonist to inhibit gamma motor neuron activity and decrease muscle spindle sensitivity to spinal reflexes.