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Medicine 4# Stroke

1. Stroke is best defined as:

A reversible neurological deficit
A neurological deficit due to vascular cell death
A traumatic brain injury
An inflammatory brain disease
Explanation:
Stroke is a neurological deficit attributed to brain, spinal cord, or retinal cell death caused by a vascular cause. :contentReference[oaicite:0]{index=0}

2. The most common type of stroke is:

Ischemic stroke
Intracerebral hemorrhage
Subarachnoid hemorrhage
Venous infarction
Explanation:
Cerebral infarction (ischemic stroke) accounts for about 88% of all strokes. :contentReference[oaicite:1]{index=1}

3. Transient ischemic attack (TIA) is characterized by:

Permanent tissue necrosis
Hemorrhagic infarction
Neurological dysfunction without acute infarction
Symptoms always lasting > 24 hours
Explanation:
TIA causes transient neurological dysfunction without tissue necrosis or acute infarction. :contentReference[oaicite:2]{index=2}

4. The 24-hour time limit for TIA is considered outdated because:

Symptoms rarely last that long
Hemorrhage is always present
CT is insensitive
MRI shows infarction even with symptoms < 24 h
Explanation:
MRI has shown that many patients with symptoms < 24 hours still have infarction, making the cutoff arbitrary. :contentReference[oaicite:3]{index=3}

5. According to TOAST classification, atrial fibrillation most commonly causes:

Cardio-embolic stroke
Large artery atherosclerosis
Lacunar stroke
Stroke of undetermined etiology
Explanation:
Atrial fibrillation predisposes to emboli arising from the heart, causing cardio-embolic stroke. :contentReference[oaicite:4]{index=4}

6. Which feature suggests large artery atherosclerotic stroke?

Pure motor hemiparesis
Cortical signs such as aphasia
Normal imaging
Brainstem infarct < 1.5 cm
Explanation:
Large artery strokes often present with cortical impairment such as aphasia or neglect. :contentReference[oaicite:5]{index=5}

7. Lacunar strokes are most commonly associated with:

Atrial fibrillation
Carotid stenosis > 70%
Small vessel occlusion
Cardiac thrombus
Explanation:
Lacunar strokes result from occlusion of small penetrating vessels. :contentReference[oaicite:6]{index=6}

8. Which is a classic lacunar syndrome?

Global aphasia
Visual neglect
Hemianopia
Pure motor hemiparesis
Explanation:
Pure motor hemiparesis is a classic lacunar syndrome. :contentReference[oaicite:7]{index=7}

9. The fastest initial imaging modality in suspected acute stroke is:

Non-contrast CT brain
MRI brain
CT perfusion
MR angiography
Explanation:
CT brain is rapid and essential to exclude hemorrhage in acute stroke. :contentReference[oaicite:8]{index=8}

10. The gold standard imaging for acute ischemic stroke is:

CT brain
MRI brain
Carotid Doppler
CT angiography
Explanation:
MRI is the gold standard and is sensitive for detecting acute ischemic strokes. :contentReference[oaicite:9]{index=9}

11. Ischemic penumbra refers to:

Irreversibly damaged brain tissue
Hemorrhagic transformation zone
Viable but functionally impaired tissue
Normal surrounding tissue
Explanation:
Penumbra is structurally intact but functionally impaired tissue that is potentially salvageable. :contentReference[oaicite:10]{index=10}

12. “Time is brain” implies that:

Neurons regenerate rapidly
Stroke recovery is immediate
Only hemorrhagic strokes progress
Millions of neurons die each minute
Explanation:
During stroke, approximately 2 million neurons die every minute without reperfusion. :contentReference[oaicite:11]{index=11}

13. The maximum standard time window for IV rtPA is:

4.5 hours
6 hours
12 hours
24 hours
Explanation:
IV thrombolysis with rtPA is recommended within 4.5 hours of last known well. :contentReference[oaicite:12]{index=12}

14. Mechanical thrombectomy is indicated when:

Small vessel occlusion is present
Proximal intracranial artery occlusion exists
Symptoms last < 1 hour
CT brain is normal
Explanation:
Mechanical thrombectomy is used for proximal intracranial large vessel occlusion. :contentReference[oaicite:13]{index=13}

15. Which condition mandates anticoagulation for secondary stroke prevention?

Lacunar stroke
Carotid stenosis
Atrial fibrillation
Small vessel disease
Explanation:
Atrial fibrillation requires anticoagulation to prevent cardio-embolic stroke. :contentReference[oaicite:14]{index=14}

16. Target LDL level for secondary stroke prevention is:

< 100 mg/dL
< 90 mg/dL
< 80 mg/dL
< 70 mg/dL
Explanation:
Guidelines recommend LDL lowering to < 70 mg/dL for secondary prevention. :contentReference[oaicite:15]{index=15}

17. Blood pressure target after stroke should be:

< 130/80 mmHg
< 150/90 mmHg
< 160/100 mmHg
< 140/90 mmHg only in diabetics
Explanation:
Optimal blood pressure control for secondary prevention is < 130/80 mmHg. :contentReference[oaicite:16]{index=16}

18. Carotid endarterectomy is recommended in:

Lacunar stroke
Large vessel atherosclerosis
Cardio-embolic stroke
Cryptogenic stroke
Explanation:
Carotid endarterectomy or stenting is used in significant large vessel atherosclerosis. :contentReference[oaicite:17]{index=17}

19. Stroke of undetermined etiology includes all EXCEPT:

Negative evaluation
Incomplete evaluation
Confirmed single cause
Two competing causes
Explanation:
Stroke of undetermined etiology excludes cases with a confirmed single cause. :contentReference[oaicite:18]{index=18}

20. Which investigation is essential in detecting occult atrial fibrillation?

CT brain
Carotid Doppler
Routine ECG only
Extended rhythm monitoring (Holter)
Explanation:
Extended rhythm monitoring improves detection of paroxysmal atrial fibrillation. :contentReference[oaicite:19]{index=19}