Block 13 Stroke Epilepsy Syncope MCQ's

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Block 13 Stroke Epilepsy Syncope MCQ

Questions and Answers
  • 1. 

    Which of the following areas is not involved in language for a person who is left-dominant?

    • A.

      Left dorsolateral prefrontal cortex

    • B.

      Left opercular gyrus

    • C.

      Left angular gyrus

    • D.

      Right planum temporal

    • E.

      Right primary auditory cortex

    Correct Answer
    A. Left dorsolateral prefrontal cortex
    Explanation
    A person who is left-dominant typically has language functions localized in the left hemisphere of the brain. The left dorsolateral prefrontal cortex is not directly involved in language processing but is responsible for executive functions such as working memory, decision-making, and cognitive control. Therefore, it is the area that is not involved in language for a left-dominant individual.

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  • 2. 

    As a resident physician you are viewing an angiogram, which illustrates the occlusion of the Anterior Cerebral Artery supplying the right hemisphere.  Because of this information, you know that the patient will have a deficit in which of the following?

    • A.

      Motor and sensory function in the right lower limb

    • B.

      Motor and sensory function in the left lower limb

    • C.

      Motor and sensory function in the right upper limb

    • D.

      Motor and sensory function in the left upper limb

    • E.

      Motor and sensory function in the upper and lower limbs

    Correct Answer
    B. Motor and sensory function in the left lower limb
    Explanation
    Based on the information provided, the occlusion of the Anterior Cerebral Artery supplying the right hemisphere would result in a deficit in motor and sensory function in the left lower limb. This is because the Anterior Cerebral Artery supplies blood to the motor and sensory areas of the opposite side of the body. Therefore, when it is occluded on the right side, it affects the left side of the body, specifically the lower limb.

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  • 3. 

    Four weeks after a stroke that left a 66-year-old female patient paralyzed in the right lower half of the face only; she presented to her doctor with inability to clearly identify taste sensation on the left side of her tongue while still retaining the ability to respond emotionally to especially noxious substances. The doctor checked this complaint by giving her quinine to taste. Although she couldn’t specifically describe the taste of quinine, she reacted to the taste in a way that suggested disgust. Which of the following best explains the pathophysiology of this presentation?

    • A.

      The stroke affected the primary somatosensory cortex and caused loss of conscious taste sensation

    • B.

      The stroke affected the cingulate gyrus and compromised patient’s emotional response to taste

    • C.

      The stroke affected the premotor cortex and compromised the patient’s psychomotor response to taste

    • D.

      The stroke affected the tractus solitarius in the brainstem and compromised conscious taste perception

    • E.

      The stroke damaged the insula while sparing the limbic cortex

    Correct Answer
    E. The stroke damaged the insula while sparing the limbic cortex
    Explanation
    The insula is responsible for processing taste sensations, while the limbic cortex is involved in emotional responses. In this case, the patient was unable to clearly identify taste sensations on the left side of her tongue, suggesting damage to the insula. However, she was still able to respond emotionally to the taste of quinine, indicating that the limbic cortex was spared. This explains the patient's presentation of being unable to describe the taste but reacting with disgust, supporting the answer choice.

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  • 4. 

    A 64 year old lady has the worst headache of her life. She is brought to the hospital with photophobia and vomiting as well. On examination she has positive Kernig’s and Brudzinski’s signs and bilateral extension on plantar reflex. Lumbar puncture shows blood, thoroughly mixed with CSF. CT scan shows: The most likely diagnosis is:

    • A.

      Glioblastoma of parietal lobe

    • B.

      Medulloblastoma

    • C.

      Ruptured berry aneurysm

    • D.

      Meningitis

    • E.

      Encephalitis

    Correct Answer
    C. Ruptured berry aneurysm
    Explanation
    The given symptoms of the worst headache of her life, photophobia, vomiting, positive Kernig's and Brudzinski's signs, bilateral extension on plantar reflex, and blood thoroughly mixed with CSF on lumbar puncture, are consistent with a ruptured berry aneurysm. A ruptured berry aneurysm can cause a sudden and severe headache, along with other neurological symptoms such as photophobia, vomiting, and signs of meningeal irritation like positive Kernig's and Brudzinski's signs. The presence of blood in the CSF indicates bleeding, which is commonly seen with a ruptured aneurysm. The CT scan may also show signs of bleeding in the brain.

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  • 5. 

    This previously healthy 32 year old female presented to the emergency room with the acute onset of a very severe headache.  She reported no history of head trauma.  She was taking no medications.  Her vital signs were normal.  These two axial images from a computed tomography scan of her head demonstrate that she which of the following abnormalities:

    • A.

      Subdural hematoma

    • B.

      Subarachnoid bleed

    • C.

      Epidural hematoma

    • D.

      Intraparenchymal bleed

    • E.

      Hydrocelphalus

    Correct Answer
    B. Subarachnoid bleed
    Explanation
    The correct answer is subarachnoid bleed. The axial images from the computed tomography scan of the patient's head show signs of bleeding in the subarachnoid space, which is the area between the arachnoid membrane and the pia mater. This type of bleeding can be caused by various factors such as ruptured aneurysms, head trauma, or arteriovenous malformations. It is characterized by a sudden, severe headache and can be life-threatening if not treated promptly.

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  • 6. 

    A 35 year old patient, with a past history of three spontaneous abortions and who is now using oral contraceptive pills, develops acute onset of left sided weakness and numbness with difficulty speaking.  Of the following, what is mostly likely her problem?

    • A.

      Thrombotic stroke due to hypercoagulable state

    • B.

      Embolic stroke due to cholesterol embolus

    • C.

      Lacunar stroke due to fibrinoid necrosis

    • D.

      Watershed stroke due to hypotension

    • E.

      Transient ischemic attack due to OCP induced vasospasm

    Correct Answer
    A. Thrombotic stroke due to hypercoagulable state
    Explanation
    The patient's history of three spontaneous abortions suggests a hypercoagulable state, which increases the risk of thrombotic events such as stroke. The acute onset of left sided weakness, numbness, and difficulty speaking are consistent with the symptoms of a stroke. Therefore, the most likely problem in this case is a thrombotic stroke due to the patient's hypercoagulable state.

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  • 7. 

    Postmortem examination of a 46-year-old Caucasian man, who died suddenly, reveals the brain changes shown for your evaluation below. Which of the following is the most likely cause of the shown changes?

    • A.

      Thrombosis or embolism of the left middle cerebral artery

    • B.

      Rupture of a berry aneurysm

    • C.

      Rupture of a Charcot-Bouchard aneurysm

    • D.

      Rupture of the bridging veins

    Correct Answer
    C. Rupture of a Charcot-Bouchard aneurysm
    Explanation
    The most likely cause of the shown changes is rupture of a Charcot-Bouchard aneurysm. Charcot-Bouchard aneurysms are small, microaneurysms that occur in the small penetrating arteries of the brain. They are commonly associated with chronic hypertension and can lead to hemorrhage in the brain parenchyma, resulting in the shown changes on postmortem examination. Thrombosis or embolism of the left middle cerebral artery would typically present with different findings, such as infarction in the territory supplied by that artery. Rupture of a berry aneurysm would typically present with subarachnoid hemorrhage. Rupture of the bridging veins would typically present with subdural hemorrhage.

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  • 8. 

    Cingulate (subfalcine) herniation is most likely complicated by

    • A.

      Infarction in the frontal lobe.

    • B.

      Infarction in the temporal and parietal lobe.

    • C.

      Infarction in the occipital lobe.

    • D.

      Infarction in the brain stem and cerebellum.

    Correct Answer
    A. Infarction in the frontal lobe.
    Explanation
    Cingulate (subfalcine) herniation occurs when the cingulate gyrus, a part of the brain, is forced under the falx cerebri, which is the membrane that separates the two cerebral hemispheres. This herniation can compress the anterior cerebral artery, leading to decreased blood flow to the frontal lobe. When blood flow is compromised, it can result in infarction, or tissue death, in the frontal lobe. Therefore, infarction in the frontal lobe is the most likely complication of cingulate herniation.

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  • 9. 

    “Lucid interval” is a characteristic clinical presentation of

    • A.

      Intracerebral hematoma

    • B.

      Subdural hematoma

    • C.

      Subarachnoid hemorrhage

    • D.

      Epidural hematoma

    Correct Answer
    D. Epidural hematoma
    Explanation
    A "lucid interval" refers to a temporary period of consciousness and normal behavior following a head injury, which is then followed by a deterioration in neurological status. This is a characteristic clinical presentation of an epidural hematoma, which is a collection of blood between the skull and the outermost layer of the brain (dura mater). In an epidural hematoma, the bleeding typically occurs from a torn artery, causing rapid accumulation of blood and increased pressure on the brain. This can lead to a brief period of consciousness before the symptoms worsen.

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  • 10. 

    A 62-year-old male was found unconscious on a city sidewalk and was brought by paramedics to an emergency room. It could not be determined how long he had been on the sidewalk before he was found. On physical examination the patient was comatose with a flaccid right hemiplegia. What do these images from the computed tomography scan of his head show?

    • A.

      Acute ischemic cerebrovascular accident

    • B.

      Subdural hematoma

    • C.

      Intraparenchymal hemorrhage

    • D.

      Epidural hematoma

    • E.

      Malignant-appearing brain tumor

    Correct Answer
    A. Acute ischemic cerebrovascular accident
    Explanation
    The images from the computed tomography scan of the patient's head show signs of an acute ischemic cerebrovascular accident. This is indicated by the presence of a flaccid right hemiplegia, which suggests a loss of motor function on the right side of the body. Acute ischemic cerebrovascular accidents, also known as ischemic strokes, occur when there is a blockage or clot in a blood vessel supplying the brain, leading to a lack of blood flow and oxygen to the affected area. This can result in neurological symptoms such as weakness or paralysis on one side of the body.

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  • 11. 

    A child, aged 6, is experiencing a short episode of lip-smacking, accompanied with abundant sweating. When the episode is over, he describes that he had a “scary feeling in his belly”. The mother didn’t notice any interruption in the eye contacts she was making with her child. This is highly suggestive of which of the following?

    • A.

      Simple partial seizure

    • B.

      Complex partial seizure

    • C.

      Non convulsive generalized seizure

    • D.

      Myoclonic generalized seizure

    • E.

      Atonic generalized seizure

    Correct Answer
    A. Simple partial seizure
    Explanation
    Based on the given information, the child is experiencing a short episode of lip-smacking and sweating, accompanied by a "scary feeling in his belly". The fact that the mother didn't notice any interruption in eye contact suggests that the child did not lose consciousness during the episode. These symptoms are characteristic of a simple partial seizure, which is a seizure that affects only one part of the brain and does not cause loss of consciousness.

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  • 12. 

    Dick John is an 8-year-old male. His school grades have been dropping since entering middle school. His teacher reported observing him have many episodes of sitting still, inattentiveness and staring into space distractedly (number averages 20 – 60 per school day). When Dick’s parent took him to see a neurologist, the neurologist explained that Dick was being troubled with a type of seizure that is common in children. Which of the following seizure types best describes Dick’s seizures?

    • A.

      Distributed (Generalized) seizure of the absence type

    • B.

      Distributed (Generalized) seizure of the tonic-clonic type

    • C.

      Localized (Partial) seizure of the simple type

    • D.

      Localized (Partial) seizure of the complex type

    • E.

      Localized (Partial) seizure with secondary generalization

    Correct Answer
    A. Distributed (Generalized) seizure of the absence type
    Explanation
    Dick's seizures are best described as distributed (generalized) seizures of the absence type. This is evident from the symptoms described, such as sitting still, inattentiveness, and staring into space distractedly. These are classic symptoms of absence seizures, which are a type of generalized seizure.

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  • 13. 

    Your friend, a 28-year-old nurse, is talking with you on the phone.  In mid-sentence, she pauses, says 2-3 unintelligible words, then you hear lip smacking sounds for about 15 seconds.  After a pause lasting a few more seconds, your friend says, confused, “I’m sorry.  What happened?   I have to go now” and she hangs up.  What is your diagnosis?

    • A.

      Dissociative episode

    • B.

      Absence seizure

    • C.

      Vasovagal attack

    • D.

      Complex partial seizure

    Correct Answer
    D. Complex partial seizure
    Explanation
    Based on the given scenario, the correct diagnosis is a complex partial seizure. This is indicated by the sudden pause in speech, followed by unintelligible words and lip smacking sounds, which are characteristic symptoms of a complex partial seizure. The confusion and abrupt end to the conversation further support this diagnosis. A complex partial seizure is a type of seizure that originates in a specific area of the brain and can cause altered consciousness and abnormal behaviors or movements.

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  • 14. 

    Joan is 45 years old. She is brought to Emergency having passed out in the street. She was witnessed having jerky movements and was incontinent. It is now 45 minutes since this happened and Joan has had another two episodes on the way to hospital and yet another as she arrives. Her best pharmacological management would MOST LIKELY BE INITIATED by:

    • A.

      Oxygen and gentle restraint

    • B.

      Observation only

    • C.

      Oral diazepam

    • D.

      Valproic acid IM

    • E.

      IV thiamine diazepam

    • F.

      Oral ethosuximide

    Correct Answer
    E. IV thiamine diazepam
    Explanation
    Given the information provided, Joan's symptoms suggest that she may be experiencing seizures. The jerky movements and incontinence are indicative of a seizure disorder. The fact that she has had multiple episodes in a short period of time further supports this diagnosis. The best pharmacological management for seizures would involve a combination of thiamine and diazepam administered intravenously. Thiamine is a vitamin that can help prevent brain damage associated with seizures, while diazepam is a commonly used anticonvulsant medication. Administering these medications intravenously would allow for rapid absorption and effectiveness in controlling the seizures.

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  • 15. 

    An elderly female complains of “passing out” when she gets out of bed.  Her most likely diagnosis is

    • A.

      The side effect of sleeping medication

    • B.

      Carotid sinus syndrome

    • C.

      Transient ischemic attacks

    • D.

      Vertebrobasilar insufficiency

    Correct Answer
    D. Vertebrobasilar insufficiency
    Explanation
    Vertebrobasilar insufficiency refers to a reduced blood flow to the posterior part of the brain, which can cause symptoms such as dizziness, lightheadedness, and even fainting. In this case, the elderly female experiences "passing out" when she gets out of bed, suggesting a positional component to her symptoms. This is consistent with vertebrobasilar insufficiency, as changes in position can further compromise blood flow to the brain. The other options, such as side effects of sleeping medication, carotid sinus syndrome, and transient ischemic attacks, do not specifically explain the positional nature of her symptoms.

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  • 16. 

    Which of the following is common to simple motor seizures and not complex seizures?

    • A.

      Rarely have sustained spasm (tonic)

    • B.

      Arise in precentral gyrus (motor cortex) and affect the ipsilateral trunk and limbs

    • C.

      Start in multiple foci

    • D.

      May end up with Todd’s paralysis

    Correct Answer
    D. May end up with Todd’s paralysis
    Explanation
    Simple motor seizures and complex seizures are both types of seizures that occur in the brain. Simple motor seizures typically involve brief, involuntary muscle movements, while complex seizures involve altered consciousness and may include additional symptoms such as confusion or staring spells. One key difference between the two is that simple motor seizures rarely have sustained spasm (tonic), meaning that the muscle movements are usually brief and not prolonged. On the other hand, complex seizures can sometimes result in Todd's paralysis, which is a temporary weakness or paralysis that occurs after the seizure. This weakness typically affects the same side of the body that was involved in the seizure.

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  • 17. 

    Which of the following pathologic conditions is most likely associated with syringohydromyelia?

    • A.

      Chiari type I malformation

    • B.

      Chiari type III malformation

    • C.

      Dandy-Walker malformation

    • D.

      Chiari type II malformation

    Correct Answer
    D. Chiari type II malformation
    Explanation
    Syringohydromyelia is most commonly associated with Chiari type II malformation. This is a condition where the cerebellum and brainstem herniate through the foramen magnum, causing obstruction of the flow of cerebrospinal fluid (CSF). The obstruction leads to the formation of a fluid-filled cavity or syrinx within the spinal cord, known as syringohydromyelia. Chiari type II malformation is often seen in infants with spina bifida, a birth defect where the spinal column fails to close properly. It is characterized by a combination of hydrocephalus, myelomeningocele, and syringohydromyelia.

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  • Current Version
  • Mar 22, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Aug 29, 2012
    Quiz Created by
    Chachelly
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