Facharzt FMH Neurologie Practice Questions - Facharzt FMH für Neurologie Spécialiste FMH en neurologie Exam - Facharzt FMH Neurologie Practice Questions - Facharzt FMH für Neurologie Spécialiste FMH en neurologie Exam

Question 1

A 68-year-old man presents to the emergency department 1 hour and 45 minutes after the sudden onset of right-sided hemiparesis and global aphasia (NIHSS 16). Non-contrast head CT shows no acute intracranial hemorrhage and an ASPECTS score of 9 (subtle hypoattenuation in the lentiform nucleus). Blood pressure is 172/94 mmHg, blood glucose is 6.2 mmol/L (112 mg/dL), and platelet count is 240,000/mcL. He takes aspirin 100 mg daily for primary prevention. According to European Stroke Organisation (ESO) and Swiss Neurological Society guidelines, what is the most appropriate immediate medical management?

Initiate intravenous thrombolysis with alteplase (0.9 mg/kg) or tenecteplase (0.25 mg/kg) immediately while proceeding to CT angiography Withhold intravenous thrombolysis because the patient is taking daily aspirin and administer clopidogrel 300 mg loading dose Administer intravenous labetalol to lower systolic blood pressure below 140 mmHg before considering thrombolysis Defer systemic thrombolysis and perform primary catheter angiography for intra-arterial thrombectomy alone

Correct Answer:

Initiate intravenous thrombolysis with alteplase (0.9 mg/kg) or tenecteplase (0.25 mg/kg) immediately while proceeding to CT angiography

Question 2

A 62-year-old woman awakens at 07:00 with severe left-sided hemiparesis and spatial neglect. She was last seen in her normal state of health at 22:30 when going to sleep. She arrives at the stroke center at 08:30. Multimodal brain MRI demonstrates acute diffusion restriction in the right middle cerebral artery (MCA) territory on diffusion-weighted imaging (DWI) without corresponding signal hyperintensity on fluid-attenuated inversion recovery (FLAIR) imaging. CT/MR angiography reveals no large vessel occlusion. Based on the WAKE-UP trial and current ESO guidelines, what is the best management strategy?

Withhold intravenous thrombolysis and administer aspirin 300 mg orally, as symptom onset was >4.5 hours ago Administer intravenous thrombolysis with alteplase based on the positive DWI-FLAIR mismatch Initiate therapeutic dose low-molecular-weight heparin (LMWH) for non-large vessel wake-up stroke Perform emergency stereotactic burr-hole craniostomy to relieve impending cerebral edema

Correct Answer:

Administer intravenous thrombolysis with alteplase based on the positive DWI-FLAIR mismatch

Question 3

A 74-year-old man presents 14 hours after last being seen well with a severe right middle cerebral artery stroke syndrome (NIHSS 18). CT perfusion and CT angiography reveal an occlusion of the right proximal M1 segment, an ischemic core volume (rCBF 6.0 s) of 110 mL (mismatch volume 92 mL, mismatch ratio 6.1). His baseline modified Rankin Scale (mRS) score was 0. According to the DAWN and DEFUSE-3 criteria, what is the most appropriate next step?

Conservative supportive care on the stroke unit, as the 6-hour therapeutic window for mechanical intervention has elapsed Intravenous thrombolysis with tenecteplase 0.40 mg/kg Immediate endovascular mechanical thrombectomy Urgent superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery

Correct Answer:

Immediate endovascular mechanical thrombectomy

Question 4

A 58-year-old woman presents 10 hours after the acute onset of dysarthria, quadriplegia, bilateral horizontal gaze palsy, and fluctuating consciousness (NIHSS 22, pc-ASPECTS 8). CT angiography demonstrates an acute occlusion of the mid-basilar artery. Advanced perfusion neuroimaging confirms extensive salvageable tissue in the brainstem and cerebellum. Based on recent randomized trials (BAOCHE and ATTENTION), what is the definitive recommended treatment?

High-dose intravenous heparin infusion with target aPTT of 70–90 seconds alone Immediate intravenous nimodipine infusion combined with hypervolemic hemodilution therapy Bilateral vertebral artery angioplasty without stent placement or clot retrieval Endovascular mechanical thrombectomy with or without bridging thrombolysis

Correct Answer:

Endovascular mechanical thrombectomy with or without bridging thrombolysis

Question 5

A 65-year-old man presents 2 hours after the acute onset of a right basal ganglia intracerebral hemorrhage (ICH volume 22 mL, no intraventricular extension). On arrival, his Glasgow Coma Scale (GCS) score is 13, and his initial blood pressure is 205/115 mmHg. He is not receiving any anticoagulant therapy. According to European Stroke Organisation (ESO) and INTERACT-2/ATACH-2 guidelines, what is the target systolic blood pressure (SBP) and recommended management strategy?

Smoothly lower systolic blood pressure to a target range of 130–140 mmHg using intravenous titratable agents such as labetalol, urapidil, or nicardipine Maintain systolic blood pressure above 180 mmHg to preserve cerebral perfusion pressure around the hematoma Rapidly reduce systolic blood pressure to below 110 mmHg within the first 30 minutes using sodium nitroprusside Withhold all antihypertensive therapy for the first 48 hours unless systolic blood pressure exceeds 240 mmHg

Correct Answer:

Smoothly lower systolic blood pressure to a target range of 130–140 mmHg using intravenous titratable agents such as labetalol, urapidil, or nicardipine

Question 1

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Prepare with the Facharzt FMH Neurologie Practice Questions - Facharzt FMH für Neurologie Spécialiste FMH en neurologie Exam practice quiz. This question bank includes 100 questions covering year-old, woman, presents, left, and demonstrates. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Facharzt FMH Neurologie Practice Questions - Facharzt FMH für Neurologie Spécialiste FMH en neurologie Exam

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