[MCQ] Subarachnoid hemorrhage (SAH)- Part 2

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Subarachnoid hemorrhage (SAH)- Part 2

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Congratulations - you have completed Subarachnoid hemorrhage (SAH)- Part 2. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

In a case of SAH who also has aphasia, hemiparesis, or visuospatial neglect, which artery is possibly involved ?

A	Anterior communicating artery
B	Posterior communicating artery
C	Anterior cerebral artery
D	Middle cerebral artery

Question 2

In a case of SAH who also has retinal and subhyaloid hemorrhage, which artery is possibly involved ?

A	Anterior communicating artery
B	Posterior communicating artery
C	Anterior cerebral artery
D	Any of the above

Question 3

Clinical scale of Hunt and Hess is used in ?

A	Bacterial meningitis
B	HIV dementia
C	Subarachnoid hemorrhage
D	Multiple sclerosis

Question 3 Explanation:

Initial clinical manifestations of SAH can be graded by Hunt-Hess or World Federation of Neurosurgical Societies (WFNS) classification.

Question 4

Which of the following is not a cause of delayed neurologic deficit in SAH ?

A	Infection
B	Hydrocephalus
C	Vasospasm
D	Hyponatremia

Question 4 Explanation:

There are four major causes of delayed neurologic deficits in SAH. They are rerupture, hydrocephalus, vasospasm, and hyponatremia.

Question 5

Peak incidence of rerupture of an untreated aneurysm following SAH is within ?

A	1 day
B	3 days
C	7 days
D	14 days

Question 5 Explanation:

Incidence of rerupture of an untreated aneurysm in the first month following SAH is ~30% with the peak in the first 7 days.

Question 6

Chronic hydrocephalus after SAH manifests as ?

A	Gait difficulty
B	Incontinence
C	Impaired mentation
D	All of the above

Question 6 Explanation:

Chronic hydrocephalus may develop weeks to months after SAH and manifest as gait difficulty, incontinence, or impaired mentation.

Question 7

Delayed vasospasm in SAH is due to ?

A	Hypertension
B	Hyperviscosity
C	Clotted blood & its breakdown products on artery
D	All of the above

Question 7 Explanation:

Delayed vasospasm is due to direct effects of clotted blood & its breakdown products on artery

Question 8

Signs of cerebral ischemia due to vasospasm following SAH is most often on which day ?

A	Day 1
B	Day 3
C	Day 7
D	Day 14

Question 8 Explanation:

Signs of cerebral ischemia appear 4 to 14 days after SAH, most often at 7 days.

Question 9

In most cases of SAH, focal vasospasm is preceded by ?

A	Headache
B	Seizure
C	Decline in mental status
D	Vomiting

Question 9 Explanation:

In most SAH cases, focal vasospasm is preceded by decline in mental status.

Question 10

Hyponatremia following SAH is due to ?

A	Inappropriate secretion of vasopressin
B	Secretion of atrial natriuretic factors
C	Secretion of brain natriuretic factors
D	All of the above

Question 10 Explanation:

Hyponatremia following SAH or “cerebral salt-wasting syndrome” develop in first 2 weeks due to inappropriate secretion of vasopressin & secretion of atrial and brain natriuretic peptides. It should not be treated with free-water restriction as this may increase risk of stroke. It clears over 1 to 2 weeks.

Question 11

Incidence of symptomatic vasospasm in MCA & ACA is high when early CT scans show subarachnoid clots of what size in basal cisterns ?

A	> 2 x 3 mm
B	> 3 x 3 mm
C	> 4 x 3 mm
D	> 5 x 3 mm

Question 12

Incidence of symptomatic vasospasm in MCA & ACA is high when early CT scans show blood layer of what thickness in the cerebral fissures ?

A	> 0.1 mm
B	> 0.25 mm
C	> 0.6 mm
D	> 1 mm

Question 12 Explanation:

High incidence of symptomatic vasospasm in MCA & ACA is observed when early CT scans show subarachnoid clots >5 x 3 mm in basal cisterns or layers of blood >1 mm thick in cerebral fissures. CT scans less reliably predict vasospasm in vertebral, basilar or posterior cerebral arteries

Question 13

Xanthochromic CSF in SAH usually lasts for ?

A	1 to 4 days
B	1 to 2 weeks
C	1 to 3 weeks
D	1 to 4 weeks

Question 13 Explanation:

Xanthochromic CSF in SAH peaks in intensity at 48 hours and lasts for 1 to 4 weeks.

Question 14

Secondary to intracranial hemorrhage, which of the following ECG finding is unusual ?

A	Prolonged QRS complex
B	Increased QT interval
C	“Peaked” or deeply inverted symmetric T waves
D	Serious ventricular dysrhythmias

Question 14 Explanation:

Prolonged QRS, increased QT interval & prominent “peaked” or deeply inverted symmetric T waves occur secondary to intracranial hemorrhage. Serious ventricular dysrhythmias are unusual

Question 15

In endovascular treatment of aneurysms, coils are made of ?

A	Platinum
B	Silver
C	Gold
D	Steel

Question 15 Explanation:

Newer endovascular technique involves placing platinum coils within aneurysm via a femoral artery catheter to enhance thrombosis & over time is walled-off from circulation.

Question 16

Intracranial hypertension following aneurysmal rupture occurs secondary to all except ?

A	Subarachnoid blood
B	Parenchymal hematoma
C	Systemic hypertension
D	Loss of vascular autoregulation

Question 16 Explanation:

Intracranial hypertension following aneurysmal rupture occurs secondary to subarachnoid blood, parenchymal hematoma, acute hydrocephalus, or loss of vascular autoregulation.

Question 17

Which of the following are poor prognostic signs in SAH ?

A	High ICP refractory to treatment
B	Rerupture of untreated aneurysm in 1st month of SAH
C	Vasospasm causing symptomatic ischemia & infarction
D	All of the above

Question 17 Explanation:

High ICP refractory to treatment is a poor prognostic sign. Rerupture is associated with a 60% mortality and poor outcome. Vasospasm following SAH causes symptomatic ischemia and infarction and is a major cause of delayed morbidity and death.

Question 18

In treatment of SAH, intracranial pressure should be maintained at ?

A	< 5 mm Hg
B	< 10 mm Hg
C	< 15 mm Hg
D	< 20 mm Hg

Question 18 Explanation:

In general, ICP should be maintained at <20 mm Hg.

Question 19

In treatment of SAH, cerebral perfusion pressure (CPP) should be maintained at ?

A	30 - 40 mm Hg
B	40 - 50 mm Hg
C	50 - 60 mm Hg
D	60 - 70 mm Hg

Question 19 Explanation:

In treatment of SAH, cerebral perfusion pressure should be maintained at 60 - 70 mm Hg.

Question 20

Which of the following drugs is most suited to lower raised blood pressure in patients with acute SAH ?

A	Nifedipine
B	Amlodipine
C	Nicardipine
D	Any of the above

Question 21

Which of the following drugs is most suited to lower raised blood pressure in patients with acute SAH ?

A	Labetalol
B	Esmolol
C	Nicardipine
D	Any of the above

Question 21 Explanation:

Patients with acute SAH should have blood pressure lowered to a normal range with nonvasodilating agents such as nicardipine, labetalol, or esmolol.

Question 22

“Triple-H” therapy in SAH refers to all except ?

A	Hypertension
B	Hemodilution
C	Hypervolemia
D	Hyperventilation

Question 22 Explanation:

“Triple-H” therapy in SAH includes hypertension, hemodilution and hypervolemia and is achieved by volume expansion.

Question 23

In SAH, if symptomatic vasospasm persists despite optimal medical therapy, which drug is then used ?

A	Intravenous nitroglycerine
B	Intraarterial papaverine
C	EACA
D	Intravenous phenylephrine

Question 23 Explanation:

If symptomatic vasospasm persists despite optimal medical therapy, intraarterial vasodilators & percutaneous transluminal angioplasty are considered. Vasodilators like verapamil & nicardipine do not last > 8-24 hours. Intraarterial papaverine is an effective vasodilator, but neurotoxic

Question 24

Which of the following is a complication of correction of marked hyponatremia of several days’ duration ?

A	Cortical venous thrombosis
B	Hydrocephalus
C	Central pontine myelinolysis
D	All of the above

Question 24 Explanation:

Care must be taken not to correct serum sodium too quickly in patients with marked hyponatremia of several days’ duration as central pontine myelinolysis may occur.

Question 25

“Pentobarb coma” refers to ?

A	Coma due to accidental ingestion of barbiturates
B	Coma due to barbiturates given for induction of anesthesia
C	High-dose barbiturates for refractory elevated ICP
D	Any of the above

Question 25 Explanation:

High-dose barbiturate therapy for refractory elevated ICP is termed “pentobarb coma”.

Question 26

Emergent treatment of elevated ICP is most quickly achieved by which of the following ?

A	Ventriculostomy
B	Hyperventilation
C	High-dose barbiturates
D	Hypothermia

Question 26 Explanation:

Emergent treatment of elevated ICP is most quickly achieved by intubation and hyperventilation to bring PaCO2 level to 30-35 mm Hg.

Question 27

Heritable connective-tissue disorders associated with presence of intracranial aneurysm and subarachnoid hemorrhage include ?

A	Polycystic kidney disease
B	Ehlers–Danlos syndrome (type IV)
C	Pseudoxanthoma elasticum
D	All of the above

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See all quizzes of Subarachnoid hemorrhage (SAH) at here:

1 In a case of SAH who also has aphasia, hemiparesis, or
visuospatial neglect, which artery is possibly involved ?
A. Anterior communicating artery
B. Posterior communicating artery
C. Anterior cerebral artery
D. Middle cerebral artery
2 In a case of SAH who also has retinal and subhyaloid hemorrhage,
which artery is possibly involved ?
A. Anterior communicating artery
B. Posterior communicating artery
C. Anterior cerebral artery
D. Any of the above
3 Clinical scale of Hunt and Hess is used in ?
A. Bacterial meningitis
B. HIV dementia
C. Subarachnoid hemorrhage
D. Multiple sclerosis

4 Which of the following is not a cause of delayed neurologic deficit
in SAH ?
A. Infection
B. Hydrocephalus
C. Vasospasm
D. Hyponatremia

5 Peak incidence of rerupture of an untreated aneurysm following
SAH is within ?
A. 1 day
B. 3 days
C. 7 days
D. 14 days

6 Chronic hydrocephalus after SAH manifests as ?
A. Gait difficulty
B. Incontinence
C. Impaired mentation
D. All of the above

7 Delayed vasospasm in SAH is due to ?
A. Hypertension
B. Hyperviscosity
C. Clotted blood & its breakdown products on artery
D. All of the above

8 Signs of cerebral ischemia due to vasospasm following SAH is
most often on which day ?
A. Day 1
B. Day 3
C. Day 7
D. Day 14

9 In most cases of SAH, focal vasospasm is preceded by ?
A. Headache
B. Seizure
C. Decline in mental status
D. Vomiting

10 Hyponatremia following SAH is due to ?
A. Inappropriate secretion of vasopressin
B. Secretion of atrial natriuretic factors
C. Secretion of brain natriuretic factors
D. All of the above

11 Incidence of symptomatic vasospasm in MCA & ACA is high
when early CT scans show subarachnoid clots of what size in
basal cisterns ?
A. > 2 x 3 mm
B. > 3 x 3 mm
C. > 4 x 3 mm
D. > 5 x 3 mm
12 Incidence of symptomatic vasospasm in MCA & ACA is high
when early CT scans show blood layer of what thickness in the
cerebral fissures ?
A. > 0.1 mm
B. > 0.25 mm
C. > 0.6 mm
D. > 1 mm

13 Xanthochromic CSF in SAH usually lasts for ?
A. 1 to 4 days
B. 1 to 2 weeks
C. 1 to 3 weeks
D. 1 to 4 weeks

14 Secondary to intracranial hemorrhage, which of the following
ECG finding is unusual ?
A. Prolonged QRS complex
B. Increased QT interval
C. “Peaked” or deeply inverted symmetric T waves
D. Serious ventricular dysrhythmias

15 In endovascular treatment of aneurysms, coils are made of ?
A. Platinum
B. Silver
C. Gold
D. Steel

16 Intracranial hypertension following aneurysmal rupture occurs
secondary to all except ?
A. Subarachnoid blood
B. Parenchymal hematoma
C. Systemic hypertension
D. Loss of vascular autoregulation

17 Which of the following are poor prognostic signs in SAH ?
A. High ICP refractory to treatment
B. Rerupture of untreated aneurysm in 1st month of SAH
C. Vasospasm causing symptomatic ischemia & infarction
D. All of the above

18 In treatment of SAH, intracranial pressure should be maintained
at ?
A. < 5 mm Hg
B. < 10 mm Hg
C. < 15 mm Hg
D. < 20 mm Hg

19 In treatment of SAH, cerebral perfusion pressure (CPP) should be
maintained at ?
A. 30 – 40 mm Hg
B. 40 – 50 mm Hg
C. 50 – 60 mm Hg
D. 60 – 70 mm Hg

20 Which of the following drugs is most suited to lower raised blood
pressure in patients with acute SAH ?
A. Nifedipine
B. Amlodipine
C. Nicardipine
D. Any of the above
21 Which of the following drugs is most suited to lower raised blood
pressure in patients with acute SAH ?
A. Labetalol
B. Esmolol
C. Nicardipine
D. Any of the above

22 “Triple-H” therapy in SAH refers to all except ?
A. Hypertension
B. Hemodilution
C. Hypervolemia
D. Hyperventilation

23 In SAH, if symptomatic vasospasm persists despite optimal
medical therapy, which drug is then used ?
A. Intravenous nitroglycerine
B. Intraarterial papaverine
C. EACA
D. Intravenous phenylephrine

24 Which of the following is a complication of correction of marked
hyponatremia of several days’ duration ?
A. Cortical venous thrombosis
B. Hydrocephalus
C. Central pontine myelinolysis
D. All of the above

25 “Pentobarb coma” refers to ?
A. Coma due to accidental ingestion of barbiturates
B. Coma due to barbiturates given for induction of anesthesia
C. High-dose barbiturates for refractory elevated ICP
D. Any of the above

26Emergent treatment of elevated ICP is most quickly achieved by
which of the following ?
A. Ventriculostomy
B. Hyperventilation
C. High-dose barbiturates
D. Hypothermia

27 Heritable connective-tissue disorders associated with presence of
intracranial aneurysm and subarachnoid hemorrhage include ?
A. Polycystic kidney disease
B. Ehlers–Danlos syndrome (type IV)
C. Pseudoxanthoma elasticum
D. All of the above

[MCQ] Subarachnoid hemorrhage (SAH)- Part 2

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Subarachnoid hemorrhage (SAH)- Part 2

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