03133 A NEURO OF DISEASE Friday, May 1, 2026 05:30pm - 08:30pm In Person
PH 100 BRASIER DJ (dbrasier).carnegie mellon university
PART 1: CEREBROVASCULAR DISEASE (Stroke)
Question 1: A patient presents with sudden left-sided weakness and neglect. The
stroke is likely located in the right:
A) Middle cerebral artery (MCA) territory
B) Anterior cerebral artery (ACA) territory
C) Posterior cerebral artery (PCA) territory
D) Vertebral artery territory
Answer: A) Middle cerebral artery (MCA) territory
Rationale: The MCA supplies the lateral hemisphere, including the motor and
sensory cortices. Left-sided weakness usually indicates a right-sided lesion.
Neglect is a classic sign of right parietal lobe damage.
Question 2: In Ischemic Stroke, the "ischemic penumbra" is defined as the area:
A) Already irreversibly infarcted and necrotic
B) Surrounding tissue that is hypoperfused but potentially salvageable
,C) Where hemorrhage has occurred due to reperfusion
D) Supplied by the Circle of Willis exclusively
Answer: B) Surrounding tissue that is hypoperfused but potentially salvageable
Rationale: The core is dead tissue, but the penumbra is at risk. The goal of acute
stroke intervention (thrombolytics/thrombectomy) is to save the penumbra
before it progresses to infarction.
Question 3: A patient with a "lacunar infarct" presents with pure motor
hemiparesis. This is most commonly due to:
A) Embolism from the heart
B) Atherosclerosis of the internal carotid artery
C) Hypertensive microangiopathy affecting deep penetrating arteries
D) Vasculitis
Answer: C) Hypertensive microangiopathy affecting deep penetrating arteries
Rationale: Lacunar infarcts (small, deep infarcts) are caused by occlusion of a
single penetrating branch of the MCA (e.g., lenticulostriate artery), usually
secondary to chronic hypertension or diabetes.
,Question 4: A patient exhibits "locked-in syndrome" following a stroke. The lesion
is localized to the:
A) Bilateral cerebral cortices
B) Basal ganglia
C) Ventral pons (Corticospinal and corticobulbar tracts)
D) Thalamus
Answer: C) Ventral pons (Corticospinal and corticobulbar tracts)
Rationale: The basilar artery supplies the pons. A ventral pontine stroke spares
the reticular activating system (patient is awake and can blink/ move eyes
vertically) but causes quadriplegia and anarthria (locked-in).
Question 5: The primary mechanism of brain injury in Subarachnoid Hemorrhage
(SAH), beyond the initial bleed, is:
A) Cerebral edema immediately at the site of impact
B) Vasospasm leading to delayed cerebral ischemia
C) Hypertensive emergency
D) Seizure activity
Answer: B) Vasospasm leading to delayed cerebral ischemia
, Rationale: Blood in the subarachnoid space irritates arteries, causing vasospasm
(usually days 3-14). This is a major cause of morbidity post-SAH.
Question 6: An Amaurosis Fugax (transient monocular blindness) suggests
localized atherosclerotic disease in the:
A) Posterior cerebral artery
B) Vertebrobasilar system
C) Internal carotid artery (ipsilateral eye)
D) Middle cerebral artery
Answer: C) Internal carotid artery (ipsilateral eye)
Rationale: The ophthalmic artery is the first branch of the internal carotid. An
embolus here causes temporary blindness in one eye.
Question 7: Which stroke mechanism is most associated with Atrial Fibrillation?
A) Lacunar infarct
B) Cardioembolic stroke (usually MCA occlusion)
C) Watershed infarct
D) Venous sinus thrombosis
PH 100 BRASIER DJ (dbrasier).carnegie mellon university
PART 1: CEREBROVASCULAR DISEASE (Stroke)
Question 1: A patient presents with sudden left-sided weakness and neglect. The
stroke is likely located in the right:
A) Middle cerebral artery (MCA) territory
B) Anterior cerebral artery (ACA) territory
C) Posterior cerebral artery (PCA) territory
D) Vertebral artery territory
Answer: A) Middle cerebral artery (MCA) territory
Rationale: The MCA supplies the lateral hemisphere, including the motor and
sensory cortices. Left-sided weakness usually indicates a right-sided lesion.
Neglect is a classic sign of right parietal lobe damage.
Question 2: In Ischemic Stroke, the "ischemic penumbra" is defined as the area:
A) Already irreversibly infarcted and necrotic
B) Surrounding tissue that is hypoperfused but potentially salvageable
,C) Where hemorrhage has occurred due to reperfusion
D) Supplied by the Circle of Willis exclusively
Answer: B) Surrounding tissue that is hypoperfused but potentially salvageable
Rationale: The core is dead tissue, but the penumbra is at risk. The goal of acute
stroke intervention (thrombolytics/thrombectomy) is to save the penumbra
before it progresses to infarction.
Question 3: A patient with a "lacunar infarct" presents with pure motor
hemiparesis. This is most commonly due to:
A) Embolism from the heart
B) Atherosclerosis of the internal carotid artery
C) Hypertensive microangiopathy affecting deep penetrating arteries
D) Vasculitis
Answer: C) Hypertensive microangiopathy affecting deep penetrating arteries
Rationale: Lacunar infarcts (small, deep infarcts) are caused by occlusion of a
single penetrating branch of the MCA (e.g., lenticulostriate artery), usually
secondary to chronic hypertension or diabetes.
,Question 4: A patient exhibits "locked-in syndrome" following a stroke. The lesion
is localized to the:
A) Bilateral cerebral cortices
B) Basal ganglia
C) Ventral pons (Corticospinal and corticobulbar tracts)
D) Thalamus
Answer: C) Ventral pons (Corticospinal and corticobulbar tracts)
Rationale: The basilar artery supplies the pons. A ventral pontine stroke spares
the reticular activating system (patient is awake and can blink/ move eyes
vertically) but causes quadriplegia and anarthria (locked-in).
Question 5: The primary mechanism of brain injury in Subarachnoid Hemorrhage
(SAH), beyond the initial bleed, is:
A) Cerebral edema immediately at the site of impact
B) Vasospasm leading to delayed cerebral ischemia
C) Hypertensive emergency
D) Seizure activity
Answer: B) Vasospasm leading to delayed cerebral ischemia
, Rationale: Blood in the subarachnoid space irritates arteries, causing vasospasm
(usually days 3-14). This is a major cause of morbidity post-SAH.
Question 6: An Amaurosis Fugax (transient monocular blindness) suggests
localized atherosclerotic disease in the:
A) Posterior cerebral artery
B) Vertebrobasilar system
C) Internal carotid artery (ipsilateral eye)
D) Middle cerebral artery
Answer: C) Internal carotid artery (ipsilateral eye)
Rationale: The ophthalmic artery is the first branch of the internal carotid. An
embolus here causes temporary blindness in one eye.
Question 7: Which stroke mechanism is most associated with Atrial Fibrillation?
A) Lacunar infarct
B) Cardioembolic stroke (usually MCA occlusion)
C) Watershed infarct
D) Venous sinus thrombosis
