1 - 40 Flashcards
A 33-year-old man suffered the sudden onset of double vision, right-sided body
numbness, and gait difficulties. Over the next 3 months, neurologic deficits resolved
completely. Ten months after the first event, he developed an abrupt recurrence of
double vision, gait incoordination, as well as a sudden onset of left numbness and
left-sided hearing loss.
On neurologic examination. the patient’s is He has left-sided
abducens (VI). facial (VII)and vestibulocochlear (VIII) cranial nerve deficits and has
right-sided motor and sensory deficits. Figure 1 shows serial magnetic resonance
imaging examinations in this patient.
1. Based on the patient’s history, physical, and the most likely diagnosis
is:
A. pontine glioma
B. cavernous malformation
C. Criptococcal abscess
D. giant basilar aneurysm
E. none of the above
B. Cavernous Malformation
A 33-year-old man suffered the sudden onset of double vision, right-sided body
numbness, and gait difficulties. Over the next 3 months, neurologic deficits resolved
completely. Ten months after the first event, he developed an abrupt recurrence of
double vision, gait incoordination, as well as a sudden onset of left numbness and
left-sided hearing loss.
On neurologic examination. the patient’s is He has left-sided
abducens (VI). facial (VII)and vestibulocochlear (VIII) cranial nerve deficits and has
right-sided motor and sensory deficits. Figure 1 shows serial magnetic resonance
imaging examinations in this patient.
2. These brain stem lesions may present with of following EXCEPT:
A. hydrocephalus
B. cranial nerve deficits
C. progressive neurologic deficits
D. seizures
E. long tracts signs
D. Seizures
A 33-year-old man suffered the sudden onset of double vision, right-sided body
numbness, and gait difficulties. Over the next 3 months, neurologic deficits resolved
completely. Ten months after the first event, he developed an abrupt recurrence of
double vision, gait incoordination, as well as a sudden onset of left numbness and
left-sided hearing loss.
On neurologic examination. the patient’s is He has left-sided
abducens (VI). facial (VII)and vestibulocochlear (VIII) cranial nerve deficits and has
right-sided motor and sensory deficits. Figure 1 shows serial magnetic resonance
imaging examinations in this patient.
3. The best therapeutic option for this patient at this time is:
A. observation
B. radiosurgery
C. surgery
D. aspiration
E. embolization
C. Surgery
- A 6-month-old boy with hydrocephalus has a history of cardiac abnormalities and
seizures, and is blind. Computed tomographic scan of the head shows hypoplasia
of the cerebellar vermis with a posterior fossa cyst:in communication with the fourth
ventricle, hydrocephalus, and agenesis of the corpus callosum(Figure 4). You tell the
parents:
A. the child needs a VP shunt
B. after placement of a shunt, trapping of the fourth ventricle may occur, which would require a cystoperitoneal shunt
C. the child has a less than 5% chance of having normal intelligence
D. the child has an 87% chance of surviving to age 10 years
E. all above are true
E. All above are true
- A 75-year-old white male with a medical history significant for coronary artery
disease, myocardial infarction, and hypertension presents to the emergency department
after a 2-hour episode of right arm and face numbness and weakness, as well as slurring
of speech. General physical and neurologic examination are normal, except for a loud
left carotid bruit. A noncontrasted CT of the head is normal.
After the CT scan, the patient has an identical episode which resolves in 15 minutes.
What is the MOST useful diagnostic test to order next?
A, noninvasive carotid Doppler studies
B. contrast head CT scan
C. cerebral Angiogram
D. Magnetic resonance imaging
E. MRA
C. Cerebral Angiogram
- The patient in question 5 undergoes a carotid arteriogram(Figure 6) and is scheduled
for a carotid endarterectomy the following morning. That evening he becomes acutely
aphasic, with a right hemiplegia. His carotid bruit also disappears. What is the MOST
appropriate course of action?
A. emergency carotid endarterectomy - emergency head CT scan
C.emergency angiogram
D. heparinization
E. tissue plasminogen activator
A. Emergency Carotid Endarterectomy
7. A 17 year-old white male presents with a history of severe, progressive headaches and seizures. His neurologic examination is normal. Contrast and non contrast CT scans of the head show an extraparenchymal mass that is large, nonclacified, nonenhancing and low density. The mass has a clearly defined smooth border located near the left Sylvian fissure. Which of the following diagnoses is MOST likely: A. chronic SDH B. arachnoid cyst C. neoplastic cyst secondary to a glioma D. Intracranial abscess E. Meningioma with cystic degeneration
B. Arachnoid Cyst
- Which of the following are accepted treatments for arachnoid cysts?
A. shunting
B. excisionofthecystwall
C. establishment of communication with the subarachnoid space
D. observation
E. all of the above
E. All of the above
- Which of the following statements about the neurosurgical treatment of cerebral palsy is FALSE :
A. Intrathecal baclofen and selective dorsal rhizotomy may have a common mechanism of action in reduction of spasticity
B. Spastic diplegic former prematures who are ambulatory without aids often benefit from selective dorsal rhizotomy
C. selective dorsal rhizotomy for children with spastic diplegia has been shown to reduce the requirements for subsequent orthopedic surgery
D. Athetoid patients do not often benefit from selective dorsal rhizotomy
E. Disturbances of bladder function can complicate selective dorsal rhizotomy
C. selective dorsal rhizotomy for children with spastic diplegia has been shown to reduce the requirements for subsequent orthopedic surgery
10 A 2-month-oldchild is referred because of a bump on his forehead (Figure 10 A) The patient was exposed to phenytoin and valproate in utero. His delivery and his initial developmental and medical histories are unremarkable. The family brings with them a computed tomographic scan of the head (Figure 10B) Which of the following statements is TRUE?
A. This condition is infrequently associated with hypotelorism
B. The history of intrauterine drug exposure is irrelevant
C. The diagnosis is metopic synostosis
D. The condition is commonly associated with hypertelorism
E. Without treatment this condition commonly leads to mental retardartion
C. The diagnosis is metopic synostosis
- A 30-year-old woman is referred to your clinic with pain. She notes that her pain began 1 month ago with a “strange feeling in the face,” followed rapidly by brief electric-like sensations radiating from the jaw to the eye on the right. One week later she noted an identical pain on the left, sometimes occuring simultaneously with right-sided pain. She was placed on 600 mg carbamazepin per day by her referring physician with partial pain control. Her examination is unremarkable except for weakness in the left arm and leg, which has a giveaway quality. The first studies you order would include all of the following EXCEPT:
A, magnetic resonance image with and without contrast enhancement
B. electroencephalogram
C. complete blood count
D. psychological testing
E. Serum carbamazepin level
B. electroencephalogram
12. A 64-year-old male executive with diabetes controlled by oral medication comes to the emergency room on a Sunday morning with acutely increased pain in the right hip and thigh. The patient states that although he has had back pain for years, he has never experienced such severe pain in the leg. He was awakened that previous night with severe burning pain and lancinating jabs in the thigh associated with proximal leg weakness. Examination shows no atrophy but there is of hip flexion and knee extension. Straight leg raising is negative, but reverse straight leg raising (hip extension and knee flexion) is positive. Light touch and pinprick sensation are decreased on the anterior thigh. The knee jerk is absent. At this point the most likely diagnosis is: A. mononeuritis multiplex B. L3-4herniated nucleus pulposus C. acute herpetic neuralgia D. Guillain-Barre syndrome E. Diabetic amyotrophy
A. Mononeuritis Multiplex
13. The most significant risk factor for hemorrhage from a arteriovenousfistula is: A. size B. location C. venous outflow restriction D. drainage to cortical veins E. patient age
D. drainage to cortical veins
- An endovascular approach can be effective as primary or adjunctive therapy for all dural AV-fistulas EXCEPT for lesions involving the:
A. superior sagittal sinus
B. inferior petrosal sinus
C. anterior cranial fossa or ethmoidal groove
D. lateral sinus
E. none of the above
C. anterior cranial fossa or ethmoidal groove
15. A 14-year-old female presents with complaints of slowly progressive exophthalmus and mild diplopia. Examination revealed a palpable mass along the left supraorbital rim that is not tender or supple. The patient has full extraocular movements. A nonenhancing lesion is identified on cranial tomographic (CT) scan (Figure15).The most likely diagnosis is: A. optic nerve glioma B. Meningioma C. dermoid tumor D. pseudotumor E. sarcoma
C. dermoid tumor
- When resecting a mass involving the cavernous sinus, it is frequently important to obtain proximal control of the internal carotid artery. Although exposure of the internal carotid can be performed via neck dissection, exposure of the petrous carotid can be more advantageous, especially a vascular by pass is contemplated. Which of the followlng statements are FALSE regarding extradual exposure of petrous carotid after pterional craniotomy ?
A. The carotid canal, tensor tympani muscle, and eustachian tube are covered by a thin layer of bone and parallel to the greater superficial petrosal nerve.
B. The Greater superficial petrosal nerve is usually 4-6 mm medial to the foramen spinosum.
C. Occasionally, a portion of the petrous internal carotid lies uncovered by bone near the posterior border of V3
D. The petrous internal carotid artery lies medial to the tensor tympani muscle
E. Since excessive retraction of the be greater superficial petrosal nerve can be transmitted to V3, resulting in facial sensory deficits, the greater superficial petrosal nerve is cut when exposing the petrous carotid
E. Since excessive retraction of the be greater superficial petrosal nerve can be transmitted to V3, resulting in facial sensory deficits, the greater superficial petrosal nerve is cut when exposing the petrous carotid
