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  • Describe the different types, and pathophysiology, of stroke
  • Describe the characteristics feature of the different types of stroke
  • Describe current diagnostic and management approaches for stroke

Stroke

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Question 1
A 55YO, right handed male, presents to ED after falling off his push-bike. He complained of sudden loss of balance and weakness in his left lower limb that caused the fall. He has a 25yr pack history, moderately-managed T2DM and examination is notable for a homonymous hemianopia and a new-onset stammer.

Which of the following is the most appropriate diagnosis?
A
Migraine aura
B
Meningioma
C
Total anterior circulation syndrome
D
Partial anterior circulation syndrome
E
Lacunar circulation syndrome
Question 2
Based on the diagnosis offered in (1) which arteries may be implicated?
Select all that may apply
A
ACA
B
MCA
C
PCA
D
AICA
E
PICA
Question 3
On CT head a patient is noted to have an historic infarct to the rostral-most portion of the posterior limb of the left internal capsule.

Which of the following presentations would be best matched?
A
Expressive aphasia
B
Hemispatial neglect
C
Paraesthesia of the right hand
D
Paresis of the right trunk
E
Weakness and altered sensation to the contralateral lower limb
Question 4
Hemispatial neglect is correlated to which structural deficit?
A
Supramarginal gyrus
B
Superior parietal lobule
C
Angular gyrus
D
Primary somatosensory cortex
E
Fusiform cortex
Question 5
A patient has a notable history of POCS two months prior. 

Which of the following clinical features is the patient least likely to present with?
A
Weakness of the hands, arms and forearms on both sides
B
Loss of fine touch and temperature bilaterally in the C5-T1 dermatomes
C
An inability to comprehend the meaning of written words
D
Inability to abduct the right and left globe intentionally
E
Tremor that halts on cessation of movement
Question 6
Which of the following signs is not indicative of a POCS?
A
Homonymous hemianopsia
B
Dysmetria
C
Resting tremor
D
Dysdiadochokinesia
E
Bilateral altered sensation to the feet
Question 7
The thalamocortical pathway of the basal ganglia is inhibited by which structure directly?
A
Putamen
B
Caudate
C
Premotor cortex
D
Subthalamic nucleus
E
Globus pallidus internus
Question 8
A patient presents with unilateral arm and leg sensory loss, coughing due to an inability to effectively swallow his saliva and facial asymmetry (droop). The paramedics decide he is “FAST positive” and elect to give him a medication pre-hospitally.

What is principle mechanism of the administered drug?
A
Monoamine oxidase inhibitor
B
Thromboxane inhibitor
C
Inhibitor of acetylcholinesterase (AChE)
D
Potentiate of GABAa receptors
E
Recombinant tissue plasminogen activator
Question 9
A patient presents to ED and you are asked to assess his Glasgow Coma Scale. When you ask them to “open their eyes”, they do so. When asked “where they are”, they respond “kites!”. The patient is seen to flex their elbow and wrists shortly after application of nail-bed pressure.

Which is the most appropriate result?
A
E3V1M4
B
E3V3M3
C
E3V3M4
D
E3V3M4
E
E3V4M4
Question 10
Which of the following is not a commonly recognised stroke mimic?
A
Meningioma
B
Meningitis
C
Cerebral abscess
D
Generalised seizure
E
Migraine aura
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