Stroke Rehabilitation Exam ACTUAL
EXAM 2026/2027 | Stroke
Rehabilitation | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: Stroke Pathophysiology & Classification (Q1–Q8)
Q1: A 68-year-old male presents with sudden onset left-sided hemiparesis and aphasia. CT scan shows a
hyperdense lesion in the right hemisphere. Which type of stroke is most likely?
A. Embolic ischemic stroke
B. Lacunar infarct
C. Intracerebral hemorrhage [CORRECT]
D. Subarachnoid hemorrhage
Correct Answer: C
Rationale: A hyperdense lesion on non-contrast CT is the classic radiographic finding for acute
intracerebral hemorrhage (ICH), indicating fresh blood. ICH typically presents with sudden focal
neurological deficits and headache, unlike the more gradual onset of thrombotic strokes or the
thunderclap headache typical of subarachnoid hemorrhage.
Q2: A 72-year-old woman with atrial fibrillation develops acute right hemiparesis and aphasia. MRI
shows a large left MCA territory infarct. What is the most likely stroke mechanism?
A. Lacunar small vessel disease
B. Cardioembolic stroke [CORRECT]
C. Large artery atherosclerosis
D. Cryptogenic stroke
Correct Answer: B
Rationale: Atrial fibrillation creates blood stasis in the left atrial appendage, promoting thrombus
formation. Emboli from the heart typically lodge in large vessels like the MCA, producing large territorial
infarcts with cortical signs (aphasia, hemiparesis), which distinguishes cardioembolic from lacunar
mechanisms.
,Q3: During acute stroke evaluation, the interprofessional team discusses the "penumbra" concept.
Which statement best describes the ischemic penumbra?
A. Irreversibly infarcted tissue at the stroke core
B. Salvageable tissue surrounding the core that is hypoperfused but structurally intact [CORRECT]
C. Edematous tissue causing mass effect
D. Hemorrhagic transformation zone
Correct Answer: B
Rationale: The ischemic penumbra represents brain tissue with critically reduced blood flow
(approximately 10–20 mL/100g/min) that has lost electrical function but maintains cellular membrane
integrity. This tissue is viable for a limited time window and is the target for reperfusion therapies,
supporting the "time is brain" principle.
Q4: A 58-year-old hypertensive patient develops pure motor hemiparesis affecting the face, arm, and
leg equally. MRI shows a small subcortical lesion. Which vessel territory is most likely involved?
A. Middle cerebral artery cortical branch
B. Lenticulostriate artery [CORRECT]
C. Posterior cerebral artery
D. Anterior cerebral artery
Correct Answer: B
Rationale: Pure motor hemiparesis is the classic lacunar syndrome caused by occlusion of a single
penetrating small vessel, most commonly the lenticulostriate arteries supplying the internal capsule or
basal ganglia. These syndromes spare cortical functions like language and neglect.
Q5: Which characteristic distinguishes thrombotic from embolic ischemic stroke in terms of onset and
progression?
A. Embolic strokes have a stuttering, stepwise progression over hours to days
B. Thrombotic strokes typically present with maximal deficit at onset
C. Thrombotic strokes often show a stuttering or progressive course, while embolic strokes present
suddenly with maximal deficit [CORRECT]
D. Both types always present with identical temporal profiles
Correct Answer: C
Rationale: Thrombotic strokes result from in-situ thrombus formation on an atherosclerotic plaque,
,often producing a fluctuating or stepwise progression as collateral flow changes. Embolic strokes occur
when a pre-formed clot suddenly occludes a vessel, producing immediate maximal neurological deficit.
Q6: A patient presents with sudden severe headache, meningismus, and photophobia. CT shows blood
in the Sylvian fissure and basal cisterns. Which vessel abnormality is most commonly associated with
this presentation?
A. Lenticulostriate artery microaneurysm
B. Saccular (berry) aneurysm rupture [CORRECT]
C. Arteriovenous malformation
D. Cerebral amyloid angiopathy
Correct Answer: B
Rationale: Subarachnoid hemorrhage (SAH) classically presents with thunderclap headache and
meningismus due to blood irritating the meninges. The distribution of blood in the basal cisterns and
Sylvian fissure is characteristic of aneurysmal rupture, with saccular aneurysms at arterial bifurcations
(particularly the anterior communicating artery) being the most common cause of non-traumatic SAH.
Q7: Which factor most significantly increases the risk of hemorrhagic transformation in ischemic stroke
patients receiving reperfusion therapy?
A. Small infarct size
B. Low National Institutes of Health Stroke Scale (NIHSS) score
C. Large infarct with significant edema and delayed treatment [CORRECT]
D. Young age
Correct Answer: C
Rationale: Hemorrhagic transformation risk increases with larger infarct volumes, longer time to
treatment, uncontrolled hypertension, and hyperglycemia. Large infarcts have compromised blood-
brain barrier integrity, and delayed reperfusion allows ischemic endothelial damage that predisposes to
bleeding when flow is restored.
Q8: A patient with a history of hypertension and diabetes presents with a small deep infarct in the pons.
Which pathophysiological mechanism is most likely responsible?
A. Cardioembolism from atrial fibrillation
B. Lipohyalinosis of penetrating arterioles [CORRECT]
C. Carotid artery dissection
D. Hypercoagulable state
, Correct Answer: B
Rationale: Lacunar infarcts in deep brain structures (pons, internal capsule, basal ganglia, thalamus)
result from occlusion of penetrating arterioles due to lipohyalinosis—a pathological process of vessel
wall thickening and lumen narrowing caused by chronic hypertension and diabetes. This affects vessels
too small to be embolized by cardiac sources.
SECTION 2: Stroke Syndromes & Neuroanatomy (Q9–Q18)
Q9: A patient presents with right-sided weakness that is worse in the leg than the arm, along with
urinary incontinence and abulia. Which artery territory is affected?
A. Left middle cerebral artery
B. Left anterior cerebral artery [CORRECT]
C. Right posterior cerebral artery
D. Left vertebral artery
Correct Answer: B
Rationale: ACA territory infarcts classically produce leg-dominant weakness (due to medial frontal and
parietal lobe motor/sensory cortex representation), urinary incontinence (disruption of frontal
micturition control), and abulia (apathy and reduced initiative from medial frontal lobe involvement).
The ACA supplies the medial cerebral hemispheres.
Q10: A 65-year-old patient has sudden onset vertigo, diplopia, dysarthria, and crossed sensory findings
(right face, left body). Which vascular territory is involved?
A. Left middle cerebral artery
B. Right anterior cerebral artery
C. Vertebrobasilar (posterior circulation) [CORRECT]
D. Left carotid artery
Correct Answer: C
Rationale: Vertigo, diplopia, dysarthria, and crossed findings (ipsilateral cranial nerve deficits with
contralateral body deficits) are hallmark features of posterior circulation (vertebrobasilar) strokes. These
crossed signs indicate brainstem involvement, where cranial nerve nuclei and descending motor/sensory
tracts are in close proximity.
Q11: A patient with left MCA territory stroke demonstrates right hemiparesis, right hemisensory loss,
and left hemineglect. Where is the lesion most likely located?
EXAM 2026/2027 | Stroke
Rehabilitation | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: Stroke Pathophysiology & Classification (Q1–Q8)
Q1: A 68-year-old male presents with sudden onset left-sided hemiparesis and aphasia. CT scan shows a
hyperdense lesion in the right hemisphere. Which type of stroke is most likely?
A. Embolic ischemic stroke
B. Lacunar infarct
C. Intracerebral hemorrhage [CORRECT]
D. Subarachnoid hemorrhage
Correct Answer: C
Rationale: A hyperdense lesion on non-contrast CT is the classic radiographic finding for acute
intracerebral hemorrhage (ICH), indicating fresh blood. ICH typically presents with sudden focal
neurological deficits and headache, unlike the more gradual onset of thrombotic strokes or the
thunderclap headache typical of subarachnoid hemorrhage.
Q2: A 72-year-old woman with atrial fibrillation develops acute right hemiparesis and aphasia. MRI
shows a large left MCA territory infarct. What is the most likely stroke mechanism?
A. Lacunar small vessel disease
B. Cardioembolic stroke [CORRECT]
C. Large artery atherosclerosis
D. Cryptogenic stroke
Correct Answer: B
Rationale: Atrial fibrillation creates blood stasis in the left atrial appendage, promoting thrombus
formation. Emboli from the heart typically lodge in large vessels like the MCA, producing large territorial
infarcts with cortical signs (aphasia, hemiparesis), which distinguishes cardioembolic from lacunar
mechanisms.
,Q3: During acute stroke evaluation, the interprofessional team discusses the "penumbra" concept.
Which statement best describes the ischemic penumbra?
A. Irreversibly infarcted tissue at the stroke core
B. Salvageable tissue surrounding the core that is hypoperfused but structurally intact [CORRECT]
C. Edematous tissue causing mass effect
D. Hemorrhagic transformation zone
Correct Answer: B
Rationale: The ischemic penumbra represents brain tissue with critically reduced blood flow
(approximately 10–20 mL/100g/min) that has lost electrical function but maintains cellular membrane
integrity. This tissue is viable for a limited time window and is the target for reperfusion therapies,
supporting the "time is brain" principle.
Q4: A 58-year-old hypertensive patient develops pure motor hemiparesis affecting the face, arm, and
leg equally. MRI shows a small subcortical lesion. Which vessel territory is most likely involved?
A. Middle cerebral artery cortical branch
B. Lenticulostriate artery [CORRECT]
C. Posterior cerebral artery
D. Anterior cerebral artery
Correct Answer: B
Rationale: Pure motor hemiparesis is the classic lacunar syndrome caused by occlusion of a single
penetrating small vessel, most commonly the lenticulostriate arteries supplying the internal capsule or
basal ganglia. These syndromes spare cortical functions like language and neglect.
Q5: Which characteristic distinguishes thrombotic from embolic ischemic stroke in terms of onset and
progression?
A. Embolic strokes have a stuttering, stepwise progression over hours to days
B. Thrombotic strokes typically present with maximal deficit at onset
C. Thrombotic strokes often show a stuttering or progressive course, while embolic strokes present
suddenly with maximal deficit [CORRECT]
D. Both types always present with identical temporal profiles
Correct Answer: C
Rationale: Thrombotic strokes result from in-situ thrombus formation on an atherosclerotic plaque,
,often producing a fluctuating or stepwise progression as collateral flow changes. Embolic strokes occur
when a pre-formed clot suddenly occludes a vessel, producing immediate maximal neurological deficit.
Q6: A patient presents with sudden severe headache, meningismus, and photophobia. CT shows blood
in the Sylvian fissure and basal cisterns. Which vessel abnormality is most commonly associated with
this presentation?
A. Lenticulostriate artery microaneurysm
B. Saccular (berry) aneurysm rupture [CORRECT]
C. Arteriovenous malformation
D. Cerebral amyloid angiopathy
Correct Answer: B
Rationale: Subarachnoid hemorrhage (SAH) classically presents with thunderclap headache and
meningismus due to blood irritating the meninges. The distribution of blood in the basal cisterns and
Sylvian fissure is characteristic of aneurysmal rupture, with saccular aneurysms at arterial bifurcations
(particularly the anterior communicating artery) being the most common cause of non-traumatic SAH.
Q7: Which factor most significantly increases the risk of hemorrhagic transformation in ischemic stroke
patients receiving reperfusion therapy?
A. Small infarct size
B. Low National Institutes of Health Stroke Scale (NIHSS) score
C. Large infarct with significant edema and delayed treatment [CORRECT]
D. Young age
Correct Answer: C
Rationale: Hemorrhagic transformation risk increases with larger infarct volumes, longer time to
treatment, uncontrolled hypertension, and hyperglycemia. Large infarcts have compromised blood-
brain barrier integrity, and delayed reperfusion allows ischemic endothelial damage that predisposes to
bleeding when flow is restored.
Q8: A patient with a history of hypertension and diabetes presents with a small deep infarct in the pons.
Which pathophysiological mechanism is most likely responsible?
A. Cardioembolism from atrial fibrillation
B. Lipohyalinosis of penetrating arterioles [CORRECT]
C. Carotid artery dissection
D. Hypercoagulable state
, Correct Answer: B
Rationale: Lacunar infarcts in deep brain structures (pons, internal capsule, basal ganglia, thalamus)
result from occlusion of penetrating arterioles due to lipohyalinosis—a pathological process of vessel
wall thickening and lumen narrowing caused by chronic hypertension and diabetes. This affects vessels
too small to be embolized by cardiac sources.
SECTION 2: Stroke Syndromes & Neuroanatomy (Q9–Q18)
Q9: A patient presents with right-sided weakness that is worse in the leg than the arm, along with
urinary incontinence and abulia. Which artery territory is affected?
A. Left middle cerebral artery
B. Left anterior cerebral artery [CORRECT]
C. Right posterior cerebral artery
D. Left vertebral artery
Correct Answer: B
Rationale: ACA territory infarcts classically produce leg-dominant weakness (due to medial frontal and
parietal lobe motor/sensory cortex representation), urinary incontinence (disruption of frontal
micturition control), and abulia (apathy and reduced initiative from medial frontal lobe involvement).
The ACA supplies the medial cerebral hemispheres.
Q10: A 65-year-old patient has sudden onset vertigo, diplopia, dysarthria, and crossed sensory findings
(right face, left body). Which vascular territory is involved?
A. Left middle cerebral artery
B. Right anterior cerebral artery
C. Vertebrobasilar (posterior circulation) [CORRECT]
D. Left carotid artery
Correct Answer: C
Rationale: Vertigo, diplopia, dysarthria, and crossed findings (ipsilateral cranial nerve deficits with
contralateral body deficits) are hallmark features of posterior circulation (vertebrobasilar) strokes. These
crossed signs indicate brainstem involvement, where cranial nerve nuclei and descending motor/sensory
tracts are in close proximity.
Q11: A patient with left MCA territory stroke demonstrates right hemiparesis, right hemisensory loss,
and left hemineglect. Where is the lesion most likely located?
