AIM LEARNING CYCLE • KMU FINAL YEAR MBBS
KMU Past Paper Practice
Neuroscience-III | Topic 3 — Cerebrovascular Disorders: Ischemic Stroke, Hemorrhagic Stroke & SAH
20 original KMU-style A-Type Single Best Answer questions for examination practice; not verified historical past-paper questions.
MCQ 1
A 64-year-old man suddenly loses vision in the left halves of both visual fields. He has normal limb power and preserved speech. MRI shows a right occipital cortical infarct. Which artery is most likely occluded?
Right middle cerebral artery
Left anterior cerebral artery
Right posterior cerebral artery
Left internal carotid artery
Right anterior cerebral artery
Correct Answer: Right posterior cerebral artery
Explanation: The posterior cerebral artery supplies the occipital visual cortex; its infarction produces contralateral homonymous hemianopia.
MCQ 2
A 67-year-old woman develops abrupt vertigo, hoarseness, difficulty swallowing, left-sided limb ataxia and loss of pain sensation over the right side of her body. Which vascular syndrome best fits these findings?
Left lateral medullary infarction
Right anterior cerebral infarction
Left internal capsule infarction
Right occipital infarction
Left frontal cortical infarction
Correct Answer: Left lateral medullary infarction
Explanation: A lateral medullary (Wallenberg) infarct can affect vestibular, nucleus ambiguus, cerebellar and spinothalamic pathways.
MCQ 3
A 73-year-old man has sudden right leg weakness more marked than arm weakness, reduced spontaneous speech and urinary incontinence. MRI reveals a medial left frontal infarct. Which artery most likely supplies the affected region?
Left posterior cerebral artery
Right middle cerebral artery
Basilar artery
Left anterior cerebral artery
Right vertebral artery
Correct Answer: Left anterior cerebral artery
Explanation: The anterior cerebral artery supplies the medial frontal and parietal surfaces, including the leg motor area.
MCQ 4
A 60-year-old woman is brought with an abrupt inability to understand spoken words. She speaks fluent sentences that contain inappropriate words and cannot reliably follow commands. Which cortical dysfunction best explains this presentation?
Right frontal motor cortex damage
Dominant posterior temporal language cortex damage
Bilateral occipital cortex damage
Nondominant parietal cortex damage
Cerebellar vermis damage
Correct Answer: Dominant posterior temporal language cortex damage
Explanation: Receptive (Wernicke) aphasia follows dominant posterior temporal language-area damage, producing fluent but poorly understood language.
MCQ 5
A 76-year-old man has weakness after awakening. His family last saw him normal at 10 pm; symptoms are found at 6 am. MRI shows diffusion-positive tissue without a corresponding definite FLAIR lesion. What is the relevance of this imaging mismatch?
It proves a chronic completed infarction
It confirms active intracranial bleeding
It excludes benefit from any reperfusion
It diagnoses a cerebral aneurysm
It may support selection for thrombolysis in an otherwise eligible wake-up stroke
Correct Answer: It may support selection for thrombolysis in an otherwise eligible wake-up stroke
Explanation: Diffusion–FLAIR mismatch can indicate relatively recent ischemia and help select certain patients with unknown onset for reperfusion.
MCQ 6
A 65-year-old woman with acute right hemiparesis has an NIHSS score of 3, but her deficit prevents her from using her dominant hand for essential daily tasks. Which statement is most appropriate?
A low NIHSS always excludes disabling stroke
Stroke severity can be judged from GCS alone
A low NIHSS can coexist with a disabling deficit
Neurological imaging is unnecessary with low NIHSS
Aphasia and hand function are not clinically relevant
Correct Answer: A low NIHSS can coexist with a disabling deficit
Explanation: NIHSS is useful but does not fully reflect disability; even a low score may represent an important, potentially disabling deficit.
MCQ 7
A 59-year-old man develops acute right facial droop. He cannot close his right eye and has weakness of both the forehead and lower face on that side. He has no limb weakness or speech disturbance. What finding most strongly favors a peripheral facial nerve palsy over a typical cortical stroke?
Weakness of the ipsilateral forehead
Sudden onset of any facial weakness
Isolated asymmetry of the mouth
History of vascular risk factors
Reduced movement of the lower face
Correct Answer: Weakness of the ipsilateral forehead
Explanation: Peripheral seventh-nerve palsy usually affects the whole ipsilateral face, including forehead closure; cortical facial weakness often spares the forehead.
MCQ 8
A 62-year-old woman with severe headache and vomiting has a non-contrast CT showing hyperdense blood tracking through the cortical sulci and basal cisterns without a dominant intraparenchymal hematoma. Which compartment contains the bleeding?
Epidural space
Subdural space
Brain ventricular ependyma
Subarachnoid space
Deep cerebral white matter
Correct Answer: Subarachnoid space
Explanation: Blood outlining sulci and basal cisterns indicates subarachnoid hemorrhage rather than a primary parenchymal hematoma.
MCQ 9
A 71-year-old man with an acute cortical infarction has a CT showing low attenuation, loss of the insular ribbon and subtle narrowing of nearby sulci. Which interpretation is most appropriate?
Typical appearance of a mature intracranial calcification
Early ischemic parenchymal change
Definite evidence of bacterial meningitis
Normal appearance excluding infarction
Pathognomonic appearance of a brain tumor
Correct Answer: Early ischemic parenchymal change
Explanation: Loss of gray–white differentiation and the insular ribbon are early CT clues to ischemia in an MCA territory.
MCQ 10
A 63-year-old man has a transient episode of right arm weakness and dysphasia that resolves before reaching hospital. CT excludes hemorrhage. Duplex imaging identifies severe symptomatic left internal carotid stenosis. What intervention may reduce future stroke risk in an appropriately selected patient?
Empirical prolonged corticosteroids
Routine aneurysm clipping
Lumbar CSF drainage
Intravenous thrombolysis after symptoms resolve
Carotid revascularization after specialist assessment
Correct Answer: Carotid revascularization after specialist assessment
Explanation: For selected patients with symptomatic high-grade extracranial carotid stenosis, timely carotid revascularization reduces recurrent stroke risk.
MCQ 11
A 66-year-old patient with suspected stroke is alert but has dense right hemiplegia. Another patient is drowsy but moves all limbs symmetrically. Which statement about the NIHSS and GCS is most accurate?
Both scores measure identical neurological domains
GCS is specifically designed to quantify aphasia
NIHSS measures focal deficits whereas GCS describes consciousness
NIHSS is solely a measure of respiratory function
GCS is the preferred measure of visual neglect
Correct Answer: NIHSS measures focal deficits whereas GCS describes consciousness
Explanation: NIHSS assesses multiple focal stroke deficits, while GCS assesses eye, verbal and motor responsiveness as a measure of consciousness.
MCQ 12
A 54-year-old woman with aneurysmal subarachnoid hemorrhage becomes increasingly confused and develops a new focal deficit five days later. There is no major fresh bleed. Which bedside and vascular assessments are important while determining the cause?
Repeat neurological examination and evaluation for delayed cerebral ischemia
Routine bone density measurement and serum calcium
Elective nerve conduction studies without reassessment
Only a single discharge GCS recorded at admission
Outpatient visual acuity testing after several weeks
Correct Answer: Repeat neurological examination and evaluation for delayed cerebral ischemia
Explanation: New deficits after SAH require immediate serial neurological evaluation and investigation for delayed cerebral ischemia and other complications.
MCQ 13
A 75-year-old man with a large ischemic hemispheric infarct becomes drowsier two days after admission. Imaging demonstrates pronounced swelling, ventricular compression and substantial midline shift. What is the most appropriate next principle of care?
Discharge because edema is an expected benign finding
Start routine thrombolysis again
Avoid repeat examinations until day seven
Urgent neurocritical and neurosurgical assessment for malignant edema
Give unrestricted oral fluids without swallow assessment
Correct Answer: Urgent neurocritical and neurosurgical assessment for malignant edema
Explanation: Malignant infarct edema can cause life-threatening mass effect; urgent specialist assessment may identify candidates for decompression.
MCQ 14
A 68-year-old woman recovering from an acute stroke develops fever and oxygen desaturation after repeatedly coughing during meals. Which preventive approach should have been prioritized before oral intake?
Routine antibiotic prophylaxis for every stroke
Swallow screening and appropriate feeding precautions
Daily therapeutic anticoagulation irrespective of indication
Immediate removal of all mobility assistance
Prolonged fasting without nutritional planning
Correct Answer: Swallow screening and appropriate feeding precautions
Explanation: Early dysphagia assessment identifies aspiration risk and guides safe food, fluids and alternative feeding arrangements.
MCQ 15
A 57-year-old man arrives with sudden severe headache, neck pain and photophobia. CT confirms subarachnoid bleeding. He has no traumatic injury. Which vascular investigation can help identify a treatable aneurysm?
Plain cervical-spine radiograph
Electroencephalography
Carotid pulse examination alone
Peripheral venous Doppler ultrasound
CT angiography of intracranial arteries
Correct Answer: CT angiography of intracranial arteries
Explanation: CT angiography visualizes intracranial vessels and can identify a ruptured aneurysm for definitive management planning.
MCQ 16
A 79-year-old woman with atrial fibrillation arrives with acute hemiparesis. Imaging shows a large established cerebral infarct. Which factor is particularly important in deciding when to begin anticoagulation for prevention of recurrence?
Her fasting calcium concentration alone
Presence of chronic osteoarthritis
Infarct extent and hemorrhagic transformation risk
Number of antihypertensive brands used
Whether the patient has a remote migraine history
Correct Answer: Infarct extent and hemorrhagic transformation risk
Explanation: The timing of anticoagulation after cardioembolic stroke is individualized according to infarct size, imaging and bleeding risk.
MCQ 17
A 45-year-old man presents after sudden severe headache with brief loss of consciousness. His CT brain is positive for subarachnoid blood, and his ECG shows transient ST–T changes with mild troponin elevation. Which interpretation is most clinically appropriate?
Acute neurological injury can produce cardiac stress changes
The CT finding must be a false positive
A cardiac abnormality excludes subarachnoid hemorrhage
These ECG findings prove a chronic epilepsy syndrome
No cardiac monitoring is needed in such patients
Correct Answer: Acute neurological injury can produce cardiac stress changes
Explanation: SAH may trigger catecholamine-related cardiac abnormalities; clinicians should assess the heart without disregarding the proven cerebral bleed.
MCQ 18
A 72-year-old patient with an acute hemorrhagic stroke develops a progressively falling GCS, an irregular breathing pattern and a new dilated poorly reactive pupil. Which action is most appropriate?
Schedule routine outpatient CT in a month
Encourage the patient to walk unassisted
Continue observation without escalating care
Immediately stabilize and escalate for suspected herniation
Begin a planned course of speech therapy only
Correct Answer: Immediately stabilize and escalate for suspected herniation
Explanation: Falling consciousness with pupillary and respiratory changes is a neurological emergency consistent with raised intracranial pressure or herniation.
MCQ 19
A 63-year-old woman has a small ischemic stroke and is medically stable but is unable to walk safely because of neglect and impaired judgment. Which discharge decision best reflects safe stroke care?
Arrange discharge without assessment because motor power is preserved
Assess mobility, cognition, home safety and rehabilitation needs
Use an isolated strength test as the sole discharge criterion
Assume neglect resolves whenever the CT becomes normal
Avoid discussing follow-up with the family
Correct Answer: Assess mobility, cognition, home safety and rehabilitation needs
Explanation: Stroke discharge planning must account for cognitive and perceptual deficits, mobility, home safety and needed multidisciplinary support.
MCQ 20
A 61-year-old man recovering from stroke asks whether medication alone can prevent all future strokes. He continues to smoke and rarely takes his antihypertensive medicines. Which counselling message is most appropriate?
Medicines make lifestyle changes unnecessary
Smoking is unrelated to stroke recurrence
Blood pressure control matters only during hospitalization
Stopping all activity prevents another stroke
Adherence and sustained modification of vascular risk factors are both essential
Correct Answer: Adherence and sustained modification of vascular risk factors are both essential
Explanation: Secondary prevention combines prescribed therapy with smoking cessation, blood pressure control and other sustained risk-factor changes.
