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

a) String of beads sign on CTA

b) An ESR of > 100 mm/hr

c) Stroke like symptoms

d) Convexity SAH

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

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

2 / 10

2. The target systolic blood pressure for the treatment of aneurysmal subarachnoid haemorrhage is

a) < 140 mmHg

b) < 160 mmHg

c) < 120 mmHg

d) < 180 mmHg

The target systolic blood pressure for the treatment of aneurysmal subarachnoid haemorrhage is < 160 mmHg.

The target systolic blood pressure for the treatment of aneurysmal subarachnoid haemorrhage is < 160 mmHg.

3 / 10

3. 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.

4 / 10

4. The most common location of neuroimaging findings in PRES is

a) Parietal and occipital lobes

b) Superior frontal gyrus

c) Brainstem or spinal cord

d) Cerebellar vermis and cortex

The most common location of neuroimaging findings in PRES is in the parietal and occipital lobes which occurs in 75% of cases. A superior frontal sulcus pattern is seen in 25% of case, and other locations are rare (<5%).

The most common location of neuroimaging findings in PRES is in the parietal and occipital lobes which occurs in 75% of cases. A superior frontal sulcus pattern is seen in 25% of case, and other locations are rare (<5%).

5 / 10

5. Which one of the following best represents the preferred initial therapy of a non traumatic cerebral dural sinus thrombosis

a) Systemic anticoagulation

b) Systemic anticoagulation with unfractionated heparin and sBP control to < 140 mmHg

c) Systemic thrombolysis and sBP control to < 180 mmHg

d) Intrasinus thrombolysis and sBP control to < 140 mmHg

Systemic anticoagulation is the preferred initial therapy of a non traumatic cerebral dural sinus thrombosis, with interventional thrombolysis or clot retrieval usually being second line options. Blood pressure control is not usually indicated and can reduce cerebral perfusion due to the high intracerebral venous pressures.

Systemic anticoagulation is the preferred initial therapy of a non traumatic cerebral dural sinus thrombosis, with interventional thrombolysis or clot retrieval usually being second line options. Blood pressure control is not usually indicated and can reduce cerebral perfusion due to the high intracerebral venous pressures.

6 / 10

6. A normal CSF contains

a) < 5 x 10-6/mL lymphocytes and no neutrophils

b) < 15 x 10-6/mL lymphocytes and < 5 neutrophils

c) < 5 x 10-6/mL neutrophils and no lymphocytes

d) No lymphocytes or neutrophils

A normal CSF contains < 5 x 10-6/mL lymphocytes and no neutrophils.

A normal CSF contains < 5 x 10-6/mL lymphocytes and no neutrophils.

7 / 10

7. In hypertensive encephalopathy the diastolic blood pressure is usually greater than

a) 120mmHg

b) 140mmHg

c) 100mmHg

d) 130mmHg

The diastolic BP is usually > 130mmHg in malignant hypertension.

The diastolic BP is usually > 130mmHg in malignant hypertension.

8 / 10

8. Which one of the following antibiotics should not be used to treat suspected bacterial meningitis

a) Cefotaxime

b) Penicillin

c) Gentamicin

d) Vancomycin

Gentamicin is the antibiotic that should not be used to treat suspected bacterial meningitis as it does not cross the blood brain barrier.

Gentamicin is the antibiotic that should not be used to treat suspected bacterial meningitis as it does not cross the blood brain barrier.

9 / 10

9. Apart from hypertension, the most frequent feature of posterior reversible encephalopathy syndrome (PRES) is

a) Facial asymmetry

b) Headache

c) Seizures

d) Visual disturbance

Other than hypertension (in 85%), seizures are the most common feature of PRES and occur in about 75% of cases. The seizures can be focal and status epilepticus occurs in about 20% of cases. Headache occurs in about 50% of cases and visual disturbances in 40%. Unilateral focal neurological deficits are rare.

Other than hypertension (in 85%), seizures are the most common feature of PRES and occur in about 75% of cases. The seizures can be focal and status epilepticus occurs in about 20% of cases. Headache occurs in about 50% of cases and visual disturbances in 40%. Unilateral focal neurological deficits are rare.

10 / 10

10. The sensitivity of a modern plain CT brain for the detection of aneurysmal SAH within 48 hours of symptom in a patient with ongoing headache is approximately

a) 60%

b) 95%

c) 40%

d) 80%

The sensitivity of a modern plain CT brain for the detection of aneurysmal SAH within 48 hours of symptom in a patient with ongoing headache is approximately 95%. Plain CT sensitivity for aneurysmal SAH is a bit higher than for other causes, and is increased if the patient has ongoing headache, which is mostly due to blood in the CSF. The sensitivity of a modern plain CT brain for the detection of SAH is much higher than previously suggested due to better CT technology and reporting.

The sensitivity of a modern plain CT brain for the detection of aneurysmal SAH within 48 hours of symptom in a patient with ongoing headache is approximately 95%. Plain CT sensitivity for aneurysmal SAH is a bit higher than for other causes, and is increased if the patient has ongoing headache, which is mostly due to blood in the CSF. The sensitivity of a modern plain CT brain for the detection of SAH is much higher than previously suggested due to better CT technology and reporting.

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