Headache quiz – The Emergency Medicine Manual

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Created on July 13, 2025 By Bob Dunn

Headache quiz

This is a 10 question quiz of single best choice MCQs with 4 options.
The questions are randomly selected from a bank of 50 questions so will be different each time the quiz is taken.
Questions are of an ACEM Fellowship exam degree of difficulty.

1 / 10

1. The strongest predictor of the following for giant cell arteritis is

a) Jaw claudication

b) Age of 60 years

c) Diplopia

d) Bilateral headache

The strongest predictor of the listed items for giant cell arteritis is jaw (or limb) claudication. Headache is bilateral in only 50% of cases and age < 70 years actually makes the diagnosis less likely.

The strongest predictor of the listed items for giant cell arteritis is jaw (or limb) claudication. Headache is bilateral in only 50% of cases and age < 70 years actually makes the diagnosis less likely.

2 / 10

2. The most sensitive feature on neuroimaging for intracranial hypertension of the following is

a) Tortuosity of the optic sheaths

b) Increase CSF space in lateral wall of the cavernous sinus

c) Empty Sella sign

d) Trans falcine herniation

Tortuosity and thickening of the optic sheaths and flattening of the posterior sclera are the most common imaging findings in intracranial hypertension.

Tortuosity and thickening of the optic sheaths and flattening of the posterior sclera are the most common imaging findings in intracranial hypertension.

3 / 10

3. Which one of the following is a significant risk factor for Posterior reversible encephalopathy syndrome (PRES)?

a) Vitamin A toxicity

b) Immunosuppression

c) Ehrlers Danlos syndrome

d) Finnish ancestry

Immunosupression and renal impairment are the strongest risk factors for PRES. Finnish ancestry and Ehrlers Danlos are risk factors for SAH. Vitamin A toxicity is a risk factor for intracranial hypertension.

Immunosupression and renal impairment are the strongest risk factors for PRES. Finnish ancestry and Ehrlers Danlos are risk factors for SAH. Vitamin A toxicity is a risk factor for intracranial hypertension.

4 / 10

4. The most common type of neuroimaging abnormality in posterior reversible encephalopathy is

a) Bilateral, symmetrical subcortical cerebral oedema

b) Unilateral cortical cerebral oedema

c) Bilateral asymmetrical subcortical cerebral oedema

d) Unilateral subcortical oedema

The most common type of neuroimaging abnormality in posterior reversible encephalopathy is bilateral, symmetrical subcortical cerebral oedema.

The most common type of neuroimaging abnormality in posterior reversible encephalopathy is bilateral, symmetrical subcortical cerebral oedema.

5 / 10

5. Which one of the following would you least expect in a patient with Reversible cerebral vasoconstriction syndrome

a) Convexity SAH

b) An ESR of > 100 mm/hr

c) String of beads sign on CTA

d) Stroke like symptoms

The ESR is usually normal in patients with reversible cerebral vasoconstriction syndrome.

The ESR is usually normal in patients with reversible cerebral vasoconstriction syndrome.

6 / 10

6. The specificity of CSF xanthochromia measured by spectrophotometry for the diagnosis of SAH is approximately

a) 95%

b) 90%

c) 85%

d) 100%

The specificity of CSF xanthochromia measured by spectrophotometry for the diagnosis of SAH is approximately 85%. True positives usually also have at least 100 RBCs/mL.

The specificity of CSF xanthochromia measured by spectrophotometry for the diagnosis of SAH is approximately 85%. True positives usually also have at least 100 RBCs/mL.

7 / 10

7. The sensitivity of D dimer for cerebral venous sinus thrombosis is approximately

a) 30

b) 90%

c) 70%

d) 50%

The sensitivity of D dimer for cerebral venous sinus thrombosis is probably at least 90%, so can be used to exclude CSVT in low risk patients.

The sensitivity of D dimer for cerebral venous sinus thrombosis is probably at least 90%, so can be used to exclude CSVT in low risk patients.

8 / 10

8. Apart from elevated blood pressure and confusion, the only other positive physical finding in malignant hypertension is likely to be

a) Bilateral papilloedema

b) Bitemporal hemianopia

c) Neck stiffness

d) Parietal drift

Bilateral papilloedema may be the only other abnormal finding in malignant hypertension.

Bilateral papilloedema may be the only other abnormal finding in malignant hypertension.

9 / 10

9. The sensitivity of modern CT scanners for posterior reversible encephalopathy syndrome (PRES) is approximately

a) 50%

b) 10%

c) 80%

d) 20%

The sensitivity of modern CT scanners for posterior reversible encephalopathy syndrome (PRES) is approximately 80%. Commonly cited sensitivities as low as 20% are from studies using CT technology more than 20 years old when awareness of the features of PRES was much less.

The sensitivity of modern CT scanners for posterior reversible encephalopathy syndrome (PRES) is approximately 80%. Commonly cited sensitivities as low as 20% are from studies using CT technology more than 20 years old when awareness of the features of PRES was much less.

10 / 10

10. The sensitivity of a CT arteriogram for detecting features of a cerebral venous sinus thrombosis is approximately

a) 60%

b) 95%

c) 40%

d) 80%

The sensitivity of a CT arteriogram for detecting features of a cerebral venous sinus thrombosis (CVST) is approximately 95% and probably higher for the more common large sinus thromboses that are likely to present to the ED. Whilst a dedicated CTV is the investigation of choice in high risk patients for CVST, a negative CTA where there has been adequate filling of the venous sinuses effectively rules out a major CVST.

The sensitivity of a CT arteriogram for detecting features of a cerebral venous sinus thrombosis (CVST) is approximately 95% and probably higher for the more common large sinus thromboses that are likely to present to the ED. Whilst a dedicated CTV is the investigation of choice in high risk patients for CVST, a negative CTA where there has been adequate filling of the venous sinuses effectively rules out a major CVST.

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