Page 1 of 158
SCRN STROKE CERTIFIED REGISTERED
COMPREHENSIVE PRACTICE QUESTION
QUESTIONS WITH VERIFIED ANSWERS
AND DETAILED RATIONALES | ALIGNED
WITH ABNN SCRN BLUEPRINT | UPDATED
PER 2026 AHA/ASA GUIDELINES |
SECTION I: ANATOMY, PHYSIOLOGY, AND PATHOPHYSIOLOGY
## Cerebrovascular Anatomy & Circle of Willis
**Q1. A patient presents with right-sided hemiparesis, right-sided facial droop, and expressive
aphasia. Which cerebral artery is most likely occluded?**
A. Right middle cerebral artery (MCA)
B. Left middle cerebral artery (MCA)
C. Right anterior cerebral artery (ACA)
D. Left posterior cerebral artery (PCA)
**Correct Answer: B. Left middle cerebral artery (MCA)**
, Page 2 of 158
**Rationale:** The left MCA supplies the dominant (usually left) hemisphere's language areas,
including Broca's area (expressive speech) and Wernicke's area (receptive speech). Occlusion of
the left MCA produces contralateral right-sided motor and sensory deficits along with aphasia.
The right MCA would produce left-sided deficits with neglect rather than aphasia. ACA
occlusion primarily affects the lower extremities, and PCA occlusion affects vision and memory.
---
**Q2. Which vessel supplies the medial aspects of the frontal and parietal lobes, including the
motor and sensory areas for the contralateral leg?**
A. Middle cerebral artery
B. Anterior cerebral artery
C. Posterior cerebral artery
D. Basilar artery
**Correct Answer: B. Anterior cerebral artery (ACA)**
**Rationale:** The ACA supplies the medial surface of the frontal and parietal lobes, including the
homunculus representation of the contralateral lower extremity. ACA stroke classically presents
with contralateral leg weakness greater than arm/face weakness, often with abulia (apathy) and
urinary incontinence.
---
**Q3. The Circle of Willis provides collateral circulation between the anterior and posterior
circulations through which structure?**
A. Anterior communicating artery
, Page 3 of 158
B. Posterior communicating artery
C. Internal carotid artery
D. Vertebral artery
**Correct Answer: B. Posterior communicating artery**
**Rationale:** The posterior communicating arteries connect the internal carotid arteries (anterior
circulation) to the posterior cerebral arteries (posterior circulation), providing collateral flow
between the anterior and posterior circulations. The anterior communicating artery connects the
two anterior cerebral arteries across the midline.
---
**Q4. A patient presents with bilateral visual field defects, memory impairment, and
hallucinosis. Which vascular territory is most likely affected?**
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Lenticulostriate arteries
**Correct Answer: C. Posterior cerebral artery (PCA)**
**Rationale:** The PCA supplies the occipital lobe (primary visual cortex), temporal lobe
(memory structures including hippocampus), and thalamus. PCA stroke can cause contralateral
homonymous hemianopia, memory deficits, visual agnosia, and peduncular hallucinosis. The
lenticulostriate arteries (branches of MCA) supply the basal ganglia and internal capsule.
, Page 4 of 158
**Q5. Which artery supplies the lateral surface of the cerebral hemispheres, including the
primary motor and sensory cortices for the face and arm?**
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Anterior choroidal artery
**Correct Answer: B. Middle cerebral artery (MCA)**
**Rationale:** The MCA is the largest branch of the internal carotid and supplies the lateral
convexity of the hemispheres, including the motor and sensory homunculus representations for
the face and upper extremity. MCA territory strokes are the most common and produce
contralateral face and arm-predominant weakness.
---
**Q6. The vertebral arteries unite to form which major vessel at the level of the medulla?**
A. Basilar artery
B. Posterior cerebral artery
C. Anterior spinal artery
D. Circle of Willis
**Correct Answer: A. Basilar artery**
SCRN STROKE CERTIFIED REGISTERED
COMPREHENSIVE PRACTICE QUESTION
QUESTIONS WITH VERIFIED ANSWERS
AND DETAILED RATIONALES | ALIGNED
WITH ABNN SCRN BLUEPRINT | UPDATED
PER 2026 AHA/ASA GUIDELINES |
SECTION I: ANATOMY, PHYSIOLOGY, AND PATHOPHYSIOLOGY
## Cerebrovascular Anatomy & Circle of Willis
**Q1. A patient presents with right-sided hemiparesis, right-sided facial droop, and expressive
aphasia. Which cerebral artery is most likely occluded?**
A. Right middle cerebral artery (MCA)
B. Left middle cerebral artery (MCA)
C. Right anterior cerebral artery (ACA)
D. Left posterior cerebral artery (PCA)
**Correct Answer: B. Left middle cerebral artery (MCA)**
, Page 2 of 158
**Rationale:** The left MCA supplies the dominant (usually left) hemisphere's language areas,
including Broca's area (expressive speech) and Wernicke's area (receptive speech). Occlusion of
the left MCA produces contralateral right-sided motor and sensory deficits along with aphasia.
The right MCA would produce left-sided deficits with neglect rather than aphasia. ACA
occlusion primarily affects the lower extremities, and PCA occlusion affects vision and memory.
---
**Q2. Which vessel supplies the medial aspects of the frontal and parietal lobes, including the
motor and sensory areas for the contralateral leg?**
A. Middle cerebral artery
B. Anterior cerebral artery
C. Posterior cerebral artery
D. Basilar artery
**Correct Answer: B. Anterior cerebral artery (ACA)**
**Rationale:** The ACA supplies the medial surface of the frontal and parietal lobes, including the
homunculus representation of the contralateral lower extremity. ACA stroke classically presents
with contralateral leg weakness greater than arm/face weakness, often with abulia (apathy) and
urinary incontinence.
---
**Q3. The Circle of Willis provides collateral circulation between the anterior and posterior
circulations through which structure?**
A. Anterior communicating artery
, Page 3 of 158
B. Posterior communicating artery
C. Internal carotid artery
D. Vertebral artery
**Correct Answer: B. Posterior communicating artery**
**Rationale:** The posterior communicating arteries connect the internal carotid arteries (anterior
circulation) to the posterior cerebral arteries (posterior circulation), providing collateral flow
between the anterior and posterior circulations. The anterior communicating artery connects the
two anterior cerebral arteries across the midline.
---
**Q4. A patient presents with bilateral visual field defects, memory impairment, and
hallucinosis. Which vascular territory is most likely affected?**
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Lenticulostriate arteries
**Correct Answer: C. Posterior cerebral artery (PCA)**
**Rationale:** The PCA supplies the occipital lobe (primary visual cortex), temporal lobe
(memory structures including hippocampus), and thalamus. PCA stroke can cause contralateral
homonymous hemianopia, memory deficits, visual agnosia, and peduncular hallucinosis. The
lenticulostriate arteries (branches of MCA) supply the basal ganglia and internal capsule.
, Page 4 of 158
**Q5. Which artery supplies the lateral surface of the cerebral hemispheres, including the
primary motor and sensory cortices for the face and arm?**
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Anterior choroidal artery
**Correct Answer: B. Middle cerebral artery (MCA)**
**Rationale:** The MCA is the largest branch of the internal carotid and supplies the lateral
convexity of the hemispheres, including the motor and sensory homunculus representations for
the face and upper extremity. MCA territory strokes are the most common and produce
contralateral face and arm-predominant weakness.
---
**Q6. The vertebral arteries unite to form which major vessel at the level of the medulla?**
A. Basilar artery
B. Posterior cerebral artery
C. Anterior spinal artery
D. Circle of Willis
**Correct Answer: A. Basilar artery**
