Neurology
Final Test Review
(Questions & Solutions)
2025
1
,1. A 68-year-old man awakes with right hemiparesis and global aphasia.
Noncontrast CT is negative for hemorrhage. He was last normal 90
minutes ago. Next step?
A) Administer IV tPA
B) Start aspirin and observe
C) Obtain MRI before treatment
D) Lower his blood pressure immediately
ANS: A
Rationale: IV thrombolysis within 3–4.5 hours of ischemic stroke onset
improves outcomes and is indicated if no hemorrhage.
2. A 55-year-old with atrial fibrillation on warfarin presents with acute
left‐sided weakness. INR is 2.5. CT shows left MCA infarct. Best secondary
prevention?
A) Resume warfarin once stable
B) Switch to aspirin only
C) Start a direct thrombin inhibitor
D) Discontinue all anticoagulation
ANS: A
Rationale: Therapeutic warfarin should be resumed to prevent
cardioembolic stroke in AF patients once risk of hemorrhagic
transformation is low.
3. A 45-year-old with sudden “worst headache” and nuchal rigidity. CT
shows subarachnoid blood. Next diagnostic step?
A) CT angiography
B) Lumbar puncture
C) MRI brain
D) Carotid Doppler
ANS: A
Rationale: In SAH confirmed on CT, CTA identifies aneurysm location
before surgical or endovascular therapy.
2
, 4. A 62-year-old woman has transient right‐arm weakness lasting 10
minutes. Carotid duplex shows 80% left ICA stenosis. Best management?
A) Carotid endarterectomy
B) Aspirin alone
C) Stenting of right ICA
D) Warfarin
ANS: A
Rationale: Symptomatic ≥70% carotid stenosis merits endarterectomy to
reduce stroke risk.
5. A 35-year-old postpartum woman develops headache and seizures.
MRI shows superior sagittal sinus thrombosis. First‐line therapy?
A) Low-molecular-weight heparin
B) IV dexamethasone
C) Decompressive craniectomy
D) Aspirin
ANS: A
Rationale: Anticoagulation with LMWH is indicated even with
hemorrhagic infarcts in cerebral venous sinus thrombosis.
6–8. Closed Head Injuries
6. A 28-year-old sustains a concussion with brief LOC. He reports
headache and dizziness but normal CT. Management?
A) Cognitive and physical rest with gradual return
B) Immediate initiation of NSAIDs and exercise
C) Hospitalization for 7 days
D) Emergent neurosurgical decompression
ANS: A
Rationale: Mild TBI without intracranial lesions is managed with rest and
monitored, with gradual return to activity.
7. A 50-year-old in a motor‐vehicle crash develops progressive confusion
24 hours after a head injury. CT shows a crescent‐shaped hyperdensity
3
Final Test Review
(Questions & Solutions)
2025
1
,1. A 68-year-old man awakes with right hemiparesis and global aphasia.
Noncontrast CT is negative for hemorrhage. He was last normal 90
minutes ago. Next step?
A) Administer IV tPA
B) Start aspirin and observe
C) Obtain MRI before treatment
D) Lower his blood pressure immediately
ANS: A
Rationale: IV thrombolysis within 3–4.5 hours of ischemic stroke onset
improves outcomes and is indicated if no hemorrhage.
2. A 55-year-old with atrial fibrillation on warfarin presents with acute
left‐sided weakness. INR is 2.5. CT shows left MCA infarct. Best secondary
prevention?
A) Resume warfarin once stable
B) Switch to aspirin only
C) Start a direct thrombin inhibitor
D) Discontinue all anticoagulation
ANS: A
Rationale: Therapeutic warfarin should be resumed to prevent
cardioembolic stroke in AF patients once risk of hemorrhagic
transformation is low.
3. A 45-year-old with sudden “worst headache” and nuchal rigidity. CT
shows subarachnoid blood. Next diagnostic step?
A) CT angiography
B) Lumbar puncture
C) MRI brain
D) Carotid Doppler
ANS: A
Rationale: In SAH confirmed on CT, CTA identifies aneurysm location
before surgical or endovascular therapy.
2
, 4. A 62-year-old woman has transient right‐arm weakness lasting 10
minutes. Carotid duplex shows 80% left ICA stenosis. Best management?
A) Carotid endarterectomy
B) Aspirin alone
C) Stenting of right ICA
D) Warfarin
ANS: A
Rationale: Symptomatic ≥70% carotid stenosis merits endarterectomy to
reduce stroke risk.
5. A 35-year-old postpartum woman develops headache and seizures.
MRI shows superior sagittal sinus thrombosis. First‐line therapy?
A) Low-molecular-weight heparin
B) IV dexamethasone
C) Decompressive craniectomy
D) Aspirin
ANS: A
Rationale: Anticoagulation with LMWH is indicated even with
hemorrhagic infarcts in cerebral venous sinus thrombosis.
6–8. Closed Head Injuries
6. A 28-year-old sustains a concussion with brief LOC. He reports
headache and dizziness but normal CT. Management?
A) Cognitive and physical rest with gradual return
B) Immediate initiation of NSAIDs and exercise
C) Hospitalization for 7 days
D) Emergent neurosurgical decompression
ANS: A
Rationale: Mild TBI without intracranial lesions is managed with rest and
monitored, with gradual return to activity.
7. A 50-year-old in a motor‐vehicle crash develops progressive confusion
24 hours after a head injury. CT shows a crescent‐shaped hyperdensity
3
