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Circle of Willis

Quiz by Jenny Ousley

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6 questions
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  • Q1

     A 62 year old man is brought to the emergency department by his wife because of numbness and tingling on the left side of his face and over his right upper and lower extremities. The patient also has been having difficulty swallowing. The patient’s wife says his voice has been sounding more hoarse than normal. Physical examination shows a nondistressed man with an ataxic gait, the left pupil is constricted with partial drooping of the eyelid, and there is a loss of the gag reflex. There is decreased sensory and pain sensation on the left side of the face, and the upper and lower extremities on the right side. Which of the following arteries would most likely be occluded?

    Anterior spinal artery

    Basilar artery

    Anterior inferior cerebellar artery (AICA)

    Posterior inferior cerebellar artery (PICA)

    Middle cerebral artery (MCA)

    120s
  • Q2

    A 65 year old man comes to the emergency department because of a severe headache that started 2 hours ago. He has a history of tension headaches, but they have never been this intense. His other medical problems include type 2 diabetes and hypertension. He has a 25-pack year smoking history and drinks 2-3 beers a day. His pulse is 110/bpm and blood pressure is 150/90 mmHg. He is awake, alert and oriented. Neurologic exam shows his strength is 3/5 in his left leg and 5/5 in his right leg. There is a decreased sensation in his entire left lower limb. Motor and sensory sensation in his upper limb and face was 5/5 bilaterally. HIs vision is not impaired and CNs II-XII are intact. A CT scan of the head shows an area of hypodensity in his right frontal lobe. Injury to which of the following arteries would most likely explain this patient’s current condition?

    Posterior cerebral artery (PCA)

    Basilar artery

    This patient is likely to have a subarachnoid hemorrhage secondary to a ruptured berry aneurysm. Subarachnoid hemorrhages present acutely as “the worst headache of my life.” The junction between the ACA and anterior communicating artery in the circle of willis is the most common location for saccular aneurysms. Furthermore, this patient experienced hemiparesis and decreased sensation in his left leg, contralateral to the area of hemorrhage noticed on CT scan. The ACA provides blood supply to the anteromedial surface of the brain, which contains the motor and sensory cortices representing the lower limb. A stroke in this region of the brain will result in contralateral paralysis and sensory loss to the lower limb. The MCA supplies the motor and sensory cortices representing the upper limb and face. A stroke in this region would result in contralateral paralysis and loss of sensation. As the MCA also supplies Wernicke’s area and Broca’s area, aphasia and hemineglect can occur. The PCA supplies, among other things, the occipital lobe and a stroke would result in vision impairment. Contralateral hemianopsia with macular sparing is a common complication of PCA stroke. Occlusion of the posterior communicating artery can lead to oculomotor nerve palsy. Injury to the basilar artery can result in “locked in syndrome”; complete paralysis of voluntary muscles of the body except the extraocular muscles. 

    Posterior communicating artery 

    Anterior cerebral artery (ACA)

    Middle cerebral artery (MCA)

    120s
  • Q3

    A 63 year old man is brought to the emergency department because of a right lower extremity weakness, specifically difficulty getting out of bed. He has a history of type 2 diabetes mellitus and hypertension. His temperature is 37 degrees C (98.6 F), pulse is 112/min and irregular, respirations are 16/min and blood pressure is 145/90 mmHg. Physical exam of the right lower extremity shows motor power of 1/5, deep tendon reflexes (DTR) are 3+ on the right with a positive Babinski sign on the right. Left lower extremity exam shows motor power of 5/5, DTR 2+ and an absent Babinski sign. An occlusion of which of the following vessels is the most likely cause of these symptoms?

    Right MCA

    Right PCA

    Right PICA

    Left internal carotid artery

    Left ACA

    120s
  • Q4

    A 35 year old man is brought to the emergency department because of a sudden onset of a severe headache. The patient says that it is the worst headache of his life. The patient says that it is the worst headache of his life. Physical exam shows a man that is 6’6” tall with hypermobile joints and subluxation of the lens superior and temporally. A CT scan of the head shows a ruptured berry aneurysm. Which of the following is the most common site for a berry aneurysm within the circle of willis?

    MCA and posterior communicating

    PCA and posterior communicating

    AICA and vertebral artery

    ACA and anterior communicating

    ACA and MCA

    120s
  • Q5

    A 65 year old man is brought to the emergency department because of an acute onset of headache and weakness. The patient was resting on his couch when the symptoms started 1 hour ago. He has a 20 year history of hypertension, type 2 diabetes mellitus and hyperlipidemia. His pulse is 90/min, respirations are 17/min, and blood pressure is 155/95 mmHg. Physical exam shows dysarthria and right sided facial weakness. Biceps tendon reflex is 3+ and there is ⅖ strength in the right arm. There is also decreased pinprick and temperature sensation over the right side of the body. A CT scan of the head shows an ischemic stroke. What vessel was most likely occluded in this patient?

    ACA

    MCA

    PICA

    AICA

    PCA

    120s
  • Q6

    A 15 year old boy is brought to the emergency department because of fever, nausea, vomiting and abdominal pain. His parents say that their child has been feeling unwell for the past 2 days and has not been able to attend school. History includes type 1 diabetes mellitus. His blood pressure is 110/75 mmHg, temperature is 38.3 C (101 F), respirations are 25/min, and SPO2 is 97% on room air. Physical exam shows a young man who is somnolent. Respiratory exam shows rapid short breaths. Urine dipstick is positive for ketones. Blood serum studies show hyperglycemia, metabolic acidosis and severe hyponatremia. The diabetic ketoacidosis protocol is initiated. Two days later the patient develops weakness of the upper and lower extremities, hallucinations, and tremors. The region affected in this condition is supplied by which of the following vessels?

    PCA

    PICA

    Superior cerebellar artery

    Basilar artery

    Vertebral artery

    120s

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