MCQ Quiz

1. The subarachnoid space is located between:

Arachnoid mater and pia mater

Dura mater and arachnoid mater

Dura mater and pia mater

Cortex and white matter

Explanation:
The subarachnoid space lies between the arachnoid and pia mater and contains CSF. :contentReference[oaicite:0]{index=0}

2. What percentage of subarachnoid hemorrhage cases are spontaneous?

10%

20%

50%

80%

Explanation:
About 80% of SAH cases are traumatic, while 20% are spontaneous. :contentReference[oaicite:1]{index=1}

3. The most common cause of spontaneous subarachnoid hemorrhage is:

Arteriovenous malformation

Vasculitis

Saccular (berry) aneurysm

Hypertensive bleed

Explanation:
Around 80% of spontaneous SAH cases are caused by rupture of a saccular (berry) aneurysm. :contentReference[oaicite:2]{index=2}

4. The classic presenting symptom of aneurysmal SAH is:

Gradual headache over days

Occipital headache relieved by rest

Headache with focal weakness only

Sudden severe “worst headache of life”

Explanation:
Sudden onset of severe headache is the hallmark presentation of SAH. :contentReference[oaicite:3]{index=3}

5. Which clinical sign indicates meningeal irritation in SAH?

Kernig’s sign

Babinski sign

Hoffmann sign

Romberg sign

Explanation:
Kernig’s and Brudzinski’s signs indicate meningeal irritation seen in SAH. :contentReference[oaicite:4]{index=4}

6. The investigation of choice for suspected acute SAH is:

MRI brain

Non-contrast CT brain

Lumbar puncture

CT angiography

Explanation:
Non-contrast CT brain is the standard initial imaging and is highly sensitive in acute SAH. :contentReference[oaicite:5]{index=5}

7. Xanthochromia in CSF usually appears after:

1 hour

3 hours

6 hours

24 hours

Explanation:
Xanthochromia appears after about 6 hours due to hemoglobin breakdown. :contentReference[oaicite:6]{index=6}

8. The main purpose of cerebral angiography in SAH is to:

Confirm presence of blood

Assess hydrocephalus

Grade severity of hemorrhage

Identify the cause and aneurysm anatomy

Explanation:
Angiography identifies the source of SAH and evaluates aneurysm size, shape, and neck. :contentReference[oaicite:7]{index=7}

9. The most implicated factor in aneurysm growth and rupture is:

Hypertension

Diabetes mellitus

Hyperlipidemia

Obesity

Explanation:
Hypertension is the most important factor in aneurysm initiation, growth, and rupture. :contentReference[oaicite:8]{index=8}

10. Most berry aneurysms occur in which circulation?

Posterior circulation

Anterior circulation (ICA)

Vertebrobasilar system

Spinal arteries

Explanation:
About 85–95% of aneurysms occur in the anterior circulation (ICA). :contentReference[oaicite:9]{index=9}

11. Which condition is strongly associated with berry aneurysms?

Diabetes mellitus

Rheumatoid arthritis

Autosomal dominant polycystic kidney disease

Multiple sclerosis

Explanation:
ADPKD is a known genetic association with intracranial aneurysms. :contentReference[oaicite:10]{index=10}

12. Which complication usually occurs after day 3 following SAH?

Rebleeding

Hydrocephalus

Seizures

Cerebral vasospasm

Explanation:
Cerebral vasospasm typically begins after day 3 and peaks at days 5–7. :contentReference[oaicite:11]{index=11}

13. Which drug is routinely used to prevent vasospasm after SAH?

Nimodipine

Phenytoin

Mannitol

Aspirin

Explanation:
Nimodipine is a calcium channel blocker used for vasospasm prevention. :contentReference[oaicite:12]{index=12}

14. Rebleeding after SAH carries a mortality rate of approximately:

20%

70%

40%

10%

Explanation:
Rebleeding is a devastating complication with a mortality rate around 70%. :contentReference[oaicite:13]{index=13}

15. The optimal definitive treatment for a wide-neck aneurysm is:

Medical management

Endovascular coiling

Surgical clipping

Radiotherapy

Explanation:
Wide-neck aneurysms are better managed with surgical clipping. :contentReference[oaicite:14]{index=14}

16. Endovascular coiling is preferred in:

Wide-neck aneurysms

Young patients only

Isolated traumatic SAH

Posterior circulation aneurysms

Explanation:
Coiling is preferred for posterior circulation and high-grade aneurysms. :contentReference[oaicite:15]{index=15}

17. A giant aneurysm is defined as size:

> 25 mm

10–25 mm

5–10 mm

< 5 mm

Explanation:
Giant aneurysms are defined as those larger than 25 mm. :contentReference[oaicite:16]{index=16}

18. Which complication makes patients vulnerable to trophic ulcers after SAH?

Seizures

Hydrocephalus

Vasospasm

Rebleeding

Explanation:
Hydrocephalus can complicate SAH and contributes to poor outcomes. :contentReference[oaicite:17]{index=17}

19. Early surgical intervention after SAH is advocated mainly to:

Reduce headache

Improve CT sensitivity

Reduce the risk of rebleeding

Prevent infection

Explanation:
Early surgery reduces the risk of rebleeding and facilitates vasospasm management. :contentReference[oaicite:18]{index=18}

20. Which group should undergo screening for intracranial aneurysms?

All hypertensive patients

All smokers

All elderly patients

Asymptomatic first-degree relatives

Explanation:
Screening of asymptomatic first-degree relatives is recommended, especially in familial cases. :contentReference[oaicite:19]{index=19}

Medicine 5# SAH