1. This legend refers to Babinski's sign, which is pathological in adults but normal in infants. 2. Neurons damaged by hypoxia or trauma can discharge nitric oxide, free radicals, glutamate, or GABA. 3. The thalamus is most vulnerable in hypoxic-ischemic encephalopathy. 4. Most deaths following middle cerebral artery occlusion in older patients occur between the end of the first week and 10 days. 5. The window of opportunity for rescuing the ischemic penumbra through reperfusion is 3 to 4 hours.

2. 1) Full name of this legend.
(hint: a sign named after this guy is pathological in adult while normal in infant.)

3. 2) Neurons damaged by hypoxia or trauma discharge:
• NO
• Free radicals
• Glutamate
• GABA

4. 3) Which of the following is most vulnerable in HIE?
• The thalamus
• The caudate nucleus
• The substantia nigra
• The inferior olive

5. 4) Most deaths following MCA occlusion in older patients
occur:
• During the 1st day
• During the 3rd to 4th days
• Between the end of the 1st week and 10 days
• Mortality is the same in all periods

6. 5) Restoring circulation to the ischemic penumbra can limit
brain damage in an ischemic infarct. The window of
opportunity for rescuing the penumbra is:
• 1 to 2 hours
• 3 to 4 hours
• 5 to 6 hours

7. 6) Fusiform aneurysms of the basilar artery cause:
• Thrombosis with ischemic infarction of the pons
• Rupture with subarachnoid hemorrhage
• Both
• Neither. They are usually asymptomatic

8. 7) The persistent vegetative state may result from extensive
damage of:
• The hippocampus and amygdala
• The cerebral cortex and thalamus
• The nucleus basalis
• The reticular activating substance of the brainstem

9. 8.) Intracranial arterial aneurysms can cause all of the
following except:
• Mass-like lesions
• Pontine hemorrhage
• Hydrocepalus
• Cranial nerve deficits

10. 9). Stroke is the cutting off of the vital blood and oxygen
supply to the brain cells. The brain controls everything we
do. The new term we call a stroke to suggest urgency is:
• "Heart Attack“
• "Brain Attack“
• "Lung Clot

11. 10) The respirator brain is caused by:
• A direct action of the respirator
• Hypoxia
• Autolysis
• Inflammation

12. 11) Risk factors for cerebral arterial occlusion and
ischemic infarction include:
• Elevated homocysteine
• Factor V Leiden
• Both

13. 12) 70-year-old man with a history of HTN, A fib and DM2
presents with right hemiplegia and right facial palsy in the
emergency admissions unit. Indications for brain imaging
within the first hour of admission are likely to include:
• Current drug history of warfarin.
• Signs of partial anterior circulation syndrome (PACS)
beginning 8 h before admission.
• Severe headache.
• Papilloedema on initial fundoscopic examination in the
emergency room
• Glasgow Coma Score (GCS) of 12 out of 15.

14. 13) For most of the following patients, surgical removal of an
intracranial hemorrhage (ICH) with craniotomy is indicated
or should be considered. For which patients is routine
evacuation with craniotomy NOT recommended?
Patients with supratentorial ICH who are within 96 hours of
ictus
Patients with lobar clots within 1 cm of the surface
Patients with cerebellar hemorrhage > 3 cm in diameter who
are deteriorating neurologically
Patients with brainstem compression or ventricular
obstruction resulting from hemorrhage

15. 14) What is the approximate 7-day risk for stroke after
Transient ischemic attack (TIA)?
0.05%
1%
5%
20%
40%

16. 15) Is it true that aspirin has been shown to be
an effective primary preventive agent for
ischemic stroke in women but not in men?
Yes
No

17. 16) What is the annual risk for stroke among patients with
atrial fibrillation but no history of anticoagulation or
cerebrovascular disease?
0.1% to 0.2%
2.5% to 4%
8% to 10%
15% to 20%

18. 17) Anterior cerebral arterial occlusion can cause
• Contralateral lower leg weakness
• Motor aphasia
• Hemianopia
• Hemianesthesia of opposite half of face

19. 18)A 45-year-old woman presents to the emergency roomwith
the worst headache of her life. A lumbar puncture reveals
many red blood cells, and the head CT shows a
subarachnoid hemorrhage. Intracranial CT angiography
reveals a left posterior communicating aneurysm. What
is the most appropriate treatment for this patient?
Watchful waiting
Craniotomy and clipping of the aneurysm
Endovascular coiling
Hypothermia

20. 19) A 70-year-old man with a history of smoking
and hypertension is seen in urgent care 3 hours after
awakening with firstever acute vertigo, vomiting, and
imbalance in the absence of headache or other focal
neurologic or otologic symptoms. Vertigo persists even while
sitting upright with his head still. He is unable to walk
unassisted due to ataxia. Which physical examination test
is most useful in this setting to differentiate between acute
vestibular neuritis and cerebellar infarction?
• Head impulse test (HIT)
• Dix-Hallpike test
• Cover testing for skew deviation
• Romberg test
• Examination for Babinski sign

21. 20) A 41-year-old woman sees you for a 3-year history of
spontaneous episodes consisting of vertigo, nausea, vomiting, and
imbalance, each lasting hours to a few days. She has had a total of
10 attacks and reports a concurrent headache with 3 of them; she
usually has associated photophobia. Sometimes the episodes seem
triggered by missed meals, stress, or menses. She feels well
between attacks. You elicit a lifelong history of motion sickness
and a 20-year history of occasional migraine headaches without
aura. Her grandmother had Ménière disease, and 2 family members
have migraine. Question What is the most likely cause of this
patient's recurrent spontaneous episodes of vertigo?
• A Vestibular migraine (VM)
• B Ménière disease
• C Vertebrobasilar insufficiency
• D Superior canal dehiscence syndrome
• E Basilar-type migraine