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 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) 95%

b) 40%

c) 80%

d) 60%

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.

2 / 10

2. The yearly rupture rate of a 7mm intracerebral aneurysm is approximately

a) 15%

b) 5%

c) 1%

d) 25%

The yearly rupture rate of a 7mm intracerebral aneurysm is approximately 1% (or less). Small aneurysms are common incidental findings and at very low risk of rupture.

The yearly rupture rate of a 7mm intracerebral aneurysm is approximately 1% (or less). Small aneurysms are common incidental findings and at very low risk of rupture.

3 / 10

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

a) An ESR of > 100 mm/hr

b) String of beads sign on CTA

c) Convexity SAH

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.

4 / 10

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

a) 50%

b) 20%

c) 10%

d) 80%

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.

5 / 10

5. To make the diagnosis of migraine, the headache must have a continuous duration of

a) 2 - 96 hours

b) 4 - 96 hours

c) 2 - 72 hours

d) 4-72 hours

To make the diagnosis of migraine, the headache must have a continuous duration of 4 - 72 hours, however migraines rarely last more than 48 hours so suspicion of other causes should be high in this group.

To make the diagnosis of migraine, the headache must have a continuous duration of 4 - 72 hours, however migraines rarely last more than 48 hours so suspicion of other causes should be high in this group.

6 / 10

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

a) Jaw claudication

b) Diplopia

c) Bilateral headache

d) Age of 60 years

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.

7 / 10

7. Which one of the following statements regarding CSF xanthochromia measured by spectrophotometry for the diagnosis of SAH is incorrect

a) False positives can occur from a traumatic tap.

b) False negatives can occur if the sample is taken within 4 hours of symptom onset

c) False positives in can occur in hyperbilirubinaemia

d) False negatives can occur if the CSF sample isn't shielded from the light

A traumatic tap should not cause CSF xanthochromia as there has not been sufficient time for blood in the CSF to be broken down to bilirubin products.

A traumatic tap should not cause CSF xanthochromia as there has not been sufficient time for blood in the CSF to be broken down to bilirubin products.

8 / 10

8. The range of opening CSF pressures on LP in a supine adult considered as normal is

a) 7-18 mm H2O

b) 12-25 cmH2O

c) 7-18 cmH2O

d) 5-15 cm H2O

The range of opening CSF pressures on LP in a supine adult considered as normal is 7-18 cm H20, although pressures as high as 25 cm H20 can be normal.

The range of opening CSF pressures on LP in a supine adult considered as normal is 7-18 cm H20, although pressures as high as 25 cm H20 can be normal.

9 / 10

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

a) 90%

b) 85%

c) 95%

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.

10 / 10

10. The target systolic blood pressure for the treatment of ischaemic stroke not receiving thrombolytic therapy or clot retrieval is

a) < 160 mmHg

b) < 140 mmHg

c) < 180 mmHg

d) < 220 mmHg

The target systolic blood pressure for the treatment of ischaemic stroke not receiving thrombolytic therapy or clot retrieval is < 220 mmHg

The target systolic blood pressure for the treatment of ischaemic stroke not receiving thrombolytic therapy or clot retrieval is < 220 mmHg

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