front 1 A patient becomes hypotensive during surgery and afterward has
bilateral proximal arm and leg weakness with relatively spared distal
function. This pattern most strongly suggests: | back 1 B. Watershed infarction |
front 2 A patient with border-zone ischemia has “man-in-the-barrel” syndrome.
Which body regions are most characteristically involved? | back 2 C. Trunk and proximal limbs |
front 3 A patient develops impaired higher-order visual processing after a
border-zone stroke. Which watershed territory is most likely
involved? | back 3 A. ACA-MCA border zone |
front 4 A clot forms in the left atrium, travels distally, and occludes a
cerebral artery. This is best classified as a: | back 4 C. Embolic infarct |
front 5 A cerebral artery becomes occluded by a clot forming directly on an
atherosclerotic plaque in that same vessel. This is a: | back 5 B. Thrombotic infarct |
front 6 Large-vessel cerebral infarcts are most often caused by: | back 6 C. Emboli or thrombosis |
front 7 A stenotic lesion in which vessel may form thrombi that embolize to
the MCA, ACA, and ophthalmic artery territories? | back 7 B. Internal carotid artery |
front 8 A patient has complete occlusion of one internal carotid artery but
remains asymptomatic because of collateral flow. Which vessels most
likely provide that collateral circulation? | back 8 A. AComm and PComm |
front 9 Sudden posterior neck pain and occipital
headache followed by posterior circulation ischemia most
strongly suggests: | back 9 C. Vertebral dissection |
front 10
TIAs or infarcts in the anterior circulation are most
associated with which dissection? | back 10 C. Carotid dissection |
front 11 Which veins mainly drain the superficial portions of the cerebral
hemispheres? | back 11 A. Superficial veins |
front 12 Which structure mainly receives drainage from the deep
cerebral veins? | back 12 B. Great vein of Galen |
front 13 The superior sagittal sinus drains into the: | back 13 C. Transverse sinuses |
front 14 A dural venous sinus descends and exits the skull through the jugular
foramen, continuing as the internal jugular vein. Which sinus is
this? | back 14 C. Sigmoid sinus |
front 15 The cavernous sinus drains into the transverse sinus through
the: | back 15 B. Superior petrosal sinus |
front 16 The cavernous sinus drains directly into the internal jugular vein
through the: | back 16 A. Inferior petrosal sinus |
front 17 Deep cerebral structures drain through the internal cerebral veins
and basal veins of Rosenthal to reach the: | back 17 C. Great cerebral vein |
front 18 The great vein of Galen joins with the inferior sagittal sinus to
form the: | back 18 A. Straight sinus |
front 19 The superior sagittal, straight, and occipital sinuses meet at
the: | back 19 B. Confluence of sinuses |
front 20 A postpartum woman presents with severe headache and signs of
increased intracranial pressure. Which diagnosis should be especially
considered? | back 20 B. Sagittal sinus thrombosis |
front 21 Imaging of a suspected superior sagittal sinus thrombosis shows a
contrast-filling defect within the sinus. This is the: | back 21 B. Empty delta sign |
front 22 In the dominant hemisphere, watershed infarcts may produce which
language syndrome? | back 22 C. Transcortical aphasia |
front 23 On the sensorimotor homunculus, the face and hand areas are located
mainly on the: | back 23 B. Lateral convexities |
front 24 On the sensorimotor homunculus, the leg area lies mainly within
the: | back 24 C. Interhemispheric fissure |
front 25 Which hemisphere is usually most important for attention to
contralateral body and space? | back 25 B. Nondominant right hemisphere |
front 26 A patient has a right parietal lesion and ignores the left side of
space. This deficit most directly reflects damage to the: | back 26 B. Nondominant association cortex |
front 27 Primary visual cortex representing the contralateral visual hemifield
lies along the: | back 27 B. Calcarine fissure |
front 28 A patient with severe carotid hypoperfusion develops
aphasia that is preserved repetition with
impaired spontaneous speech. Which mechanism best explains
this? | back 28 A. Dominant watershed infarction |
front 29 A patient has nonfluent speech with preserved comprehension after a
dominant frontal infarct. Which cortical region is most likely
involved? | back 29 B. Inferior frontal gyrus |
front 30 A stroke adjacent to primary auditory cortex causes fluent but
nonsensical speech and impaired comprehension. Which region is
affected? | back 30 D. Superior temporal gyrus |
front 31 The vertebral arteries arise directly from which vessels? | back 31 A. Subclavian arteries |
front 32 The ACA and MCA are terminal branches of the: | back 32 C. Internal carotid artery |
front 33 The two anterior cerebral arteries connect anteriorly through
the: | back 33 B. Anterior communicating artery |
front 34 Which vessel links anterior and posterior circulations? | back 34 D. Posterior communicating artery |
front 35 A vessel courses forward in the interhemispheric fissure, then sweeps
back over the corpus callosum. Which artery is this? | back 35 C. Anterior cerebral artery |
front 36 Which pair represents the two main cortical branches of the Anterior
cerebral artery (ACA)? | back 36 D. Pericallosal and callosomarginal |
front 37 Contralateral leg-predominant weakness with medial cortical sensory
loss most strongly suggests infarction of the: | back 37 B. Anterior cerebral artery |
front 38 Within the Sylvian fissure, which artery divides
into superior and inferior divisions? | back 38 A. Middle cerebral artery |
front 39 A patient has ischemia of cortex above the Sylvian fissure
involving lateral frontal regions near the central
sulcus. Which branch is most likely occluded? | back 39 C. Superior division MCA |
front 40 Infarction of cortex below the Sylvian fissure involving lateral
temporal and parietal regions most likely involves the: | back 40 D. Inferior division MCA |
front 41 Most of the dorsolateral convexity of the brain is supplied by
the: | back 41 D. Middle cerebral artery |
front 42 A patient with infarction of the medial occipital cortex and inferior
temporal lobe most likely has occlusion of the: | back 42 A. Posterior cerebral artery |
front 43 Chronic hypertension affecting lenticulostriate vessels most
classically leads to: | back 43 C. Lacunar infarct and ICH |
front 44 The anterior choroidal artery most commonly arises from the: | back 44 D. Internal carotid artery |
front 45 A patient develops pure motor hemiparesis from a lacune involving
the posterior limb of the internal capsule. Which
vascular territory best fits? | back 45 B. Lenticulostriate or anterior choroidal |
front 46 The recurrent artery of Heubner usually arises from the: | back 46 A. Proximal anterior cerebral artery |
front 47 In the acute phase of a large MCA territory infarct, the eyes
typically show: | back 47 D. Ipsilesional gaze preference |
front 48 A typical ACA syndrome becomes much larger. Which additional motor
deficit may then occur? | back 48 C. Contralateral hemiplegia |
front 49 A dominant ACA infarct is most associated with: | back 49 B. Transcortical motor aphasia |
front 50 A nondominant ACA infarct is most likely to cause: | back 50 A. Contralateral neglect |
front 51 A right PCA infarct most classically produces: | back 51 C. Left homonymous hemianopia |
front 52 A patient can write normally but cannot read after infarction of the
left occipital cortex and splenium. This syndrome is: | back 52 D. Alexia without agraphia |
front 53 Sudden internal carotid occlusion or hypotension in severe carotid
stenosis most predisposes to which watershed infarct? | back 53 B. MCA-ACA watershed |
front 54 Which structure is classically supplied by the anterior choroidal
artery? | back 54 C. Posterior limb internal capsule |
front 55 Which structure is classically supplied by the recurrent artery of
Heubner? | back 55 B. Head of caudate |
front 56 Which paired arteries chiefly supply the anterior circulation? | back 56 C. Internal carotid arteries |
front 57 Before entering the foramen magnum, the vertebral arteries ascend
through the cervical: | back 57 D. Transverse foramina |
front 58 After entering the skull, the paired vertebral arteries join to form
the: | back 58 B. Basilar artery |
front 59 In the neck, the first internal carotid segment is relatively: | back 59 B. Vertical |
front 60 As the internal carotid enters the temporal bone, it becomes
the: | back 60 A. Petrous segment |
front 61 The carotid siphon is located within the internal carotid: | back 61 C. Cavernous segment |
front 62 Just after the ICA enters the dura, a branch arises
from the bend, passes with the optic nerve through the optic foramen,
and supplies the retina. Which vessel is this? | back 62 A. Ophthalmic artery |
front 63 After arising from the top of the basilar, which artery curves back
to supply medial occipital cortex and inferior-medial temporal
lobes? | back 63 C. Posterior cerebral artery |
front 64 Infarction of the recurrent artery of Heubner would most likely
involve the: | back 64 D. Head of caudate |
front 65 Thalamoperforator territories primarily involve the thalamus and may
extend into the: | back 65 C. Posterior limb capsule |
front 66 A patient with a large acute MCA infarct has a conjugate gaze
preference: | back 66 A. Toward the lesion |
front 67 An ACA infarct most classically causes UMN weakness and cortical
sensory loss affecting the: | back 67 D. Contralateral leg |
front 68 When adjacent arterial territories are both underperfused, the border
zone between them is most vulnerable to: | back 68 C. Watershed infarction |
front 69 The typical duration of a TIA is closest to: | back 69 A. 10 minutes |
front 70 Transient loss of consciousness without focal
deficits is most commonly caused by cardiogenic: | back 70 B. Syncope |
front 71 Headache is more common in: | back 71 D. Posterior circulation infarcts |
front 72 On examination, carotid stenosis may produce a whooshing sound that
continues into diastole and is best described as a: | back 72 C. Bruit |
front 73 A patient with carotid stenosis and
ipsilateral transient monocular blindness is
classified as having: | back 73 B. Symptomatic carotid stenosis |
front 74 The mainstay of treatment for symptomatic carotid stenosis is
carotid: | back 74 D. Endarterectomy |
front 75 Complete carotid occlusion may remain asymptomatic if collateral flow
is adequate through the anterior or posterior: | back 75 A. Communicating arteries |
front 76 Minor trauma, coughing, or sneezing may cause an intimal tear that
allows blood to track into the vessel wall, producing a: | back 76 C. Dissection |
front 77 A patient with carotid dissection develops an ipsilateral partial
ptosis and miosis. Which syndrome is most likely present? | back 77 B. Horner syndrome |
front 78 Which symptom is especially characteristic of vertebral
dissection? | back 78 D. Posterior neck pain |
front 79 Superficial cerebral veins drain mainly into the superior sagittal
sinus and the: | back 79 A. Cavernous sinus |
front 80 Ultimately, nearly all cerebral venous drainage reaches the: | back 80 B. Internal jugular veins |
front 81 The internal carotid artery and cranial nerves III, IV, V1, V2, and
VI pass through the: | back 81 C. Cavernous sinus |
front 82 The cavernous sinus drains into the transverse sinus through
the: | back 82 A. Superior petrosal sinus |
front 83 The cavernous sinus drains directly toward the internal jugular vein
through the: | back 83 D. Inferior petrosal sinus |
front 84 The superior sagittal, straight, and occipital sinuses join at
the: | back 84 C. Confluence of sinuses |
front 85 A dominant frontal lesion causes nonfluent aphasia. Relative to the
articulatory area of primary motor cortex, Broca area lies: | back 85 B. Anterior |
front 86 The posterior communicating artery directly links the internal
carotid artery to the: | back 86 D. Posterior cerebral artery |
front 87 Which artery supplies most of the anterior medial
frontal and anterior parietal cortex,
including the medial sensorimotor region?
| back 87 A. Anterior cerebral artery |
front 88 Hypertensive lipohyalinosis affects small vessels arising from the
initial MCA before it enters the Sylvian fissure. Which vessels are
these? | back 88 C. Lenticulostriate arteries |
front 89 When thrombosis causes a large-vessel cerebral
infarct, it most often involves which proximal
arteries? | back 89 D. Vertebral, basilar, carotid |
front 90 Deep cerebral drainage reaches the great vein of Galen through the
internal cerebral veins and the basal veins of: | back 90 A. Rosenthal |
front 91 Superior sagittal sinus thrombosis is especially associated with
which patient group? | back 91 C. Pregnant or postpartum women |
front 92 A carotid bruit from stenosis is best detected by: | back 92 B. Bell below jaw angle |
front 93 A patient with carotid stenosis has contralateral arm weakness from a
TIA. This carotid disease is classified as: | back 93 D. Symptomatic stenosis |
front 94 After the cervical segment, the internal carotid enters the temporal
bone as the: | back 94 A. Petrous segment |
front 95 The ophthalmic artery usually arises from the internal carotid: | back 95 C. After dural entry bend |
front 96 Besides thalamoperforators, which vessels also help
supply the thalamus and may reach the posterior
limb of the internal capsule? | back 96 B. Thalamogeniculate and posterior choroidal |
front 97 The recurrent artery of Heubner supplies not only the head of the
caudate but also parts of the anterior putamen, globus pallidus,
and: | back 97 B. Internal capsule |
front 98 A patient has right face and arm weakness, right
cortical sensory loss, and nonfluent aphasia. Which
artery is most likely occluded? | back 98 B. Left MCA |
front 99 A patient can write but cannot read after infarction of the left
occipital cortex and splenium. Which artery is most likely
involved? | back 99 D. Left PCA |
front 100 A patient has contralateral leg-predominant
weakness, abulia, and urinary incontinence after a frontal
stroke. Which artery is most likely involved? | back 100 A. ACA |
front 101 A small deep infarct causes pure motor hemiparesis
from posterior limb internal capsule injury. Which
vessels are most classically involved? | back 101 C. Lenticulostriates |
front 102 A patient has left neglect, left face-arm
weakness, and eyes deviated to the right.
Which artery is most likely occluded? | back 102 A. Right MCA |
front 103 A ventral pontine infarct leaves a patient conscious but quadriplegic
with preserved vertical eye movements. Which artery is most likely
involved? | back 103 D. Basilar artery |
front 104 A patient has hoarseness, dysphagia, vertigo, ipsilateral facial pain
loss, and contralateral body pain loss. Which artery
is most likely involved? | back 104 B. PICA |
front 105 A patient has facial paralysis, loss of
lacrimation, decreased taste, vertigo, and
ipsilateral hearing loss. Which artery is most
likely involved? | back 105 C. AICA |
front 106 A patient develops sudden painless monocular blindness from retinal
ischemia. Which artery supplies the affected structure? | back 106 D. Ophthalmic artery |
front 107 After profound hypotension, a patient develops bilateral proximal arm
and leg weakness with relatively spared distal strength. Which infarct
pattern is most likely? | back 107 A. ACA-MCA watershed |
front 108 A patient with border-zone ischemia has impaired higher-order
visual processing rather than pure field loss. Which
territory is most likely involved? | back 108 C. MCA-PCA watershed |
front 109 A patient has transient monocular blindness and
later contralateral hemispheric TIAs from the same neck lesion. Which
artery is the most likely source? | back 109 B. Internal carotid Transient monocular blindness = amaurosis fugax. Usually from retinal ischemia via opthalmic artery |
front 110 A patient has a right homonymous hemianopia with relatively preserved
motor strength after a cortical stroke. Which artery is most likely
involved? | back 110 A. Left PCA |
front 111 A patient has dysmetria, nausea, dysarthria, and gait
ataxia without facial paralysis or hearing loss. Which artery
is most likely involved? | back 111 D. SCA |
front 112 A patient has pure sensory stroke localizing to the thalamus. Which
arterial territory is most likely involved? | back 112 C. PCA perforators |
front 113 A patient has fluent but nonsensical speech, poor comprehension, and
a right superior quadrantanopia. Which artery is most likely
involved? | back 113 B. Left MCA |
front 114 A dominant frontal medial infarct causes leg weakness and
transcortical motor aphasia. Which artery is most likely
involved? | back 114 D. Dominant ACA |
front 115 Severe carotid hypoperfusion causes border-zone ischemia with
proximal limb weakness. Which upstream vessel is most likely
diseased? | back 115 B. Internal carotid |
front 116 A patient has contralateral hemiparesis from a deep infarct involving
the posterior limb of the internal capsule and globus pallidus. Which
artery is most likely involved? | back 116 C. Anterior choroidal |
front 117 A patient has vertigo, dysphagia, hoarseness, ipsilateral Horner
syndrome, and ipsilateral limb ataxia. Which artery is most likely
involved? | back 117 A. PICA |
front 118 A patient has contralateral hemiparesis,
contralateral vibration loss, and
ipsilateral tongue weakness from a medial medullary
infarct. Which artery is most likely involved? | back 118 D. Anterior spinal artery |
front 119 A patient has just ipsilateral limb ataxia and
dysarthria. Which artery is most likely
involved? | back 119 C. SCA |
front 120 A patient with amaurosis fugax is found to have a stenotic neck
vessel that can also embolize to ACA and MCA territories. Which artery
is most likely involved? | back 120 B. Internal carotid |