COMAT NEUROLOGY LATEST UPDATED ACTUAL
FINAL EXAM PREP WITH 100 COMPLETE DETAILED
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH CERTIFIED RATIONALES
GRADED A+ JUST RELEASED!!!
1. A 67-year-old with hypertension awakens with right-
sided weakness and aphasia. NIHSS is 14. Non-contrast
head CT shows no hemorrhage. Last known well was 3
hours ago. What is the next step?
A) Aspirin 325 mg
B) tPA (alteplase) 0.9 mg/kg
C) Clopidogrel loading dose
D) Emergent carotid endarterectomy
Answer: B
Rationale: Acute ischemic stroke within 3–4.5 hours of last
known well without contraindications (no hemorrhage on
1
,CT) qualifies for IV tPA. Aspirin is delayed for 24 hours
post-tPA.
2. Which finding on MRI would most suggest a
cardioembolic source of stroke?
A) Single subcortical lacune
B) Multiple bilateral territorial infarcts
C) Watershed infarct between ACA and MCA
D) Isolated posterior cerebral artery infarct
Answer: B
Rationale: Cardioembolism (e.g., AF, valvular disease)
causes emboli to shower multiple vascular territories.
Lacunar strokes suggest small vessel disease; watershed
suggests hypoperfusion.
3. A 72-year-old with atrial fibrillation (not
anticoagulated) presents with sudden left hemiparesis
and neglect. CT head negative. Last seen normal 6 hours
2
,ago. What is the best management?
A) IV tPA
B) Mechanical thrombectomy if CTA shows large vessel
occlusion
C) Aspirin and observation
D) Heparin drip
Answer: B
Rationale: For anterior circulation large vessel occlusion,
mechanical thrombectomy is effective up to 24 hours in
selected patients (DAWN/DEFUSE-3 criteria). tPA is not
given after 4.5 hours.
4. A patient with acute stroke has dysarthria, left facial
droop, and left arm drift but can walk. What is the most
likely vessel occluded?
A) Right MCA (superior division)
B) Left MCA (inferior division)
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, C) Basilar artery
D) Right ACA
Answer: A
Rationale: Superior division MCA supplies motor cortex
for face and arm. Leg weakness suggests ACA or MCA
deep territory; here, sparing leg points to MCA.
5. Which of the following is a contraindication to IV tPA in
a patient with acute ischemic stroke?
A) Age >80 years
B) Glucose 180 mg/dL
C) History of prior stroke with diabetes
D) INR 2.5 on warfarin
Answer: D
Rationale: INR >1.7 (or >1.4 if on warfarin) is a
contraindication due to bleeding risk. Age >80 is not a
standalone contraindication.
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FINAL EXAM PREP WITH 100 COMPLETE DETAILED
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH CERTIFIED RATIONALES
GRADED A+ JUST RELEASED!!!
1. A 67-year-old with hypertension awakens with right-
sided weakness and aphasia. NIHSS is 14. Non-contrast
head CT shows no hemorrhage. Last known well was 3
hours ago. What is the next step?
A) Aspirin 325 mg
B) tPA (alteplase) 0.9 mg/kg
C) Clopidogrel loading dose
D) Emergent carotid endarterectomy
Answer: B
Rationale: Acute ischemic stroke within 3–4.5 hours of last
known well without contraindications (no hemorrhage on
1
,CT) qualifies for IV tPA. Aspirin is delayed for 24 hours
post-tPA.
2. Which finding on MRI would most suggest a
cardioembolic source of stroke?
A) Single subcortical lacune
B) Multiple bilateral territorial infarcts
C) Watershed infarct between ACA and MCA
D) Isolated posterior cerebral artery infarct
Answer: B
Rationale: Cardioembolism (e.g., AF, valvular disease)
causes emboli to shower multiple vascular territories.
Lacunar strokes suggest small vessel disease; watershed
suggests hypoperfusion.
3. A 72-year-old with atrial fibrillation (not
anticoagulated) presents with sudden left hemiparesis
and neglect. CT head negative. Last seen normal 6 hours
2
,ago. What is the best management?
A) IV tPA
B) Mechanical thrombectomy if CTA shows large vessel
occlusion
C) Aspirin and observation
D) Heparin drip
Answer: B
Rationale: For anterior circulation large vessel occlusion,
mechanical thrombectomy is effective up to 24 hours in
selected patients (DAWN/DEFUSE-3 criteria). tPA is not
given after 4.5 hours.
4. A patient with acute stroke has dysarthria, left facial
droop, and left arm drift but can walk. What is the most
likely vessel occluded?
A) Right MCA (superior division)
B) Left MCA (inferior division)
3
, C) Basilar artery
D) Right ACA
Answer: A
Rationale: Superior division MCA supplies motor cortex
for face and arm. Leg weakness suggests ACA or MCA
deep territory; here, sparing leg points to MCA.
5. Which of the following is a contraindication to IV tPA in
a patient with acute ischemic stroke?
A) Age >80 years
B) Glucose 180 mg/dL
C) History of prior stroke with diabetes
D) INR 2.5 on warfarin
Answer: D
Rationale: INR >1.7 (or >1.4 if on warfarin) is a
contraindication due to bleeding risk. Age >80 is not a
standalone contraindication.
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