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neurosurgery inbr > chapter 6 neurosurgery > Flashcards

chapter 6 neurosurgery Flashcards

22
Q

QUESTIONS 62-69

Directions: Match each of the following questions with the most likely fracture pattern (letterhead) depicted in Figure 6.62-6.69Q, using each answer once, more than once, or not at all.

  1. Median nerve damage, paralysis of hypothenar muscles, some thenar muscles, and most of the deep muscles of the hand; flexion and adduction of wrist spared
A

C

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23
Q

QUESTIONS 62-69

Directions: Match each of the following questions with the most likely fracture pattern (letterhead) depicted in Figure 6.62-6.69Q, using each answer once, more than once, or not at all.

  1. Can be associated with brachial plexus injuries
A

A

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23
Q

QUESTIONS 62-69

Directions: Match each of the following questions with the most likely fracture pattern (letterhead) depicted in Figure 6.62-6.69Q, using each answer once, more than once, or not at all.

  1. Most likely to cause combined radial, medial, and ulnar nerve injuries
A

C

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23
Q
  1. A 9-year-old girl presented to her pediatrician with headaches and a bitemporal field cut. Her MRI is depicted below (Figure 6.70Q). Which of the following would be true regarding the endocrine outcome after surgical resection of this tumor?

A. There is a 30% chance that she will develop diabetes insipidus
B. The most serious and disabling problem is the development of obesity, which occurs in about 50% of these patients after surgery
C. Approximately 90% of patients will not require maintenance corticosteroid and thyroid replacement
therapy
D. Approximately 10% of patients will require growth
hormone replacement therapy
E. The endocrine outcome after surgery is very
unpredictable

A
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24
Q
  1. A 42-year-old female was recently diagnosed with spontaneous intracranial hypotension. All of the following are frequently associated with this problem EXCEPT?

A. The headaches often resemble a post-lumbar puncture headache
B. MRI scans with contrast may reveal enhancement of
the dura over the cerebral and cerebellar convexities
C. Spontaneous improvement is rarely seen, since CSF
leaks are often identified adjacent to nerve roots
D. Spinal fluid may reveal elevated protein and pleocytosis
E. Analgesics containing caffeine may be helpful

A

A. The headaches often resemble a post-lumbar puncture headache

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24
Q
  1. All of the following lesions are appropriate for stereotactic radiosurgery EXCEPT?

A. A 3-cm3 arteriovenous malformation in the brainstem
B. A 1-cm right frontal and 2-cm left parietal metastatic
carcinoma from the lung
C. Recurrent glioblastoma of the left temporal lobe (2 cm3)
D. A 1-cm cavernoma of the right caudate nucleus that
previously hemorrhaged
E. Bilateral thalamic arteriovenous malformations (3 cm3)

A

D. A 1-cm cavernoma of the right caudate nucleus that
previously hemorrhaged

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24
Q
  1. All of the following would reduce pain conduction or a
    patient’s reaction to pain EXCEPT?

A. Stimulation of the periaqueductal gray
B. Prefrontal lobotomy
C. Cingulotomy
D. Hippocampectomy
E. Ventrolateral cordotomy

A

B. Prefrontal lobotomy

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25
Q
  1. A 34-year-old female is involved in a motor vehicle collision, suffers a severe closed head injury (Figure 6.74QJ, and develops a significant posttraumatic tremor in the right arm. Although posttraumatic tremors are generally difficult to manage, which surgical procedure may help control tremors, which are otherwise refractory to medical therapy?

A. Thalamic stimulation
B. Subthalamic nucleus stimulation
C. Motor cortex stimulation
D. Capsulotomy
E. Multiple subpial transections

A

C. Motor cortex stimulation

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25
Q
  1. A 36-year-old female has a complex aneurysm that
    requires the use of cardiac arrest and profound hypothermia during surgery. All of the following are potential physiologic effects of profound hypothermia EXCEPT?

A. Increased blood viscosity
B. Hyperglycemia
C. Decreased corticosteroid release
D. Complement-mediated pneumonitis
E. Hypercoagulable state

A

D. Complement-mediated pneumonitis

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25
Q
  1. What is the most common physical manifestation of the abnormality depicted by the angiogram below (Figure 6.76QJ?

A. Neck pain
B. Cervical bruit
C. Contralateral arm weakness or numbness
D. Dysesthesia
E. Transient vision loss

A

D. Dysesthesia

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26
Q
  1. Refer to Figure 6.77-6.79Q, What is the most likely diagnosis?

A. Echinococcus infection
B. Neurocysticercosis
C. Cryptococcus infection
D. Cytomegalovirus infection
E. Trichinosis

A

A. Echinococcus infection

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26
Q
  1. This patient is most likely to present with?

A. Headaches
B. Obtundation
C. Cranial nerve palsies
D. Fevers
E. Seizure

A

E. Seizure

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26
Q
  1. This disorder is caused by

A. Borrelia burgdorferi
B. Echinococcus granulosa
C. Toxoplasma gondii
D. Treponema pallidum
E. Taenia solium

A

B. Echinococcus granulosa

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27
Q
  1. What is the most likely diagnosis depicted by the angiogram below (Figure 6.80Q)?

A. Blue rubber bleb nevus syndrome
B. Vein of Galen aneurysm
C. Carotid-cavernous fistula
D. Intracranial hemangioblastoma of infancy
E. Sinus pericranii

A

B. Vein of Galen aneurysm

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27
Q
  1. The posterior interosseous nerve supplies all of the
    following muscles EXCEPT?

A. Supinator
B. Extensor carpi ulnaris
C. Abductor pollicis longus
D. Extensor digitorum
E. Pronator quadratus

A

E. Pronator quadratus

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27
Q
  1. The ability to create irregularly shaped radiosurgical
    volumes is important to achieve conformal irradiation of
    target tissue. Which of the following techniques can be
    employed to create such plans?

A. Combine multiple isocenters of irradiation in different
planes
B. Individual isocenters can be weighted variably to
change their relative shape
C. Individual radiation beams can be blocked to restrict
dose away from critical structures, such as the optic
chiasm
D. A and B only
E. All of the above

A

E. All of the above

28
Q
  1. A 45-year-old female undergoes a C5-6 and C6-7 anterior cervical discectomy and fusion. Postoperatively, she awakens with a Horner’s syndrome. The most likely etiology of this finding was related to damage of what structure(s)?

A. Sympathetic nerves running along the carotid artery
during neck dissection
B. Injury of the Tl nerve root during the discectomy
C. Interruption of the sympathetic chain located on the
anterior surface of the longus colli muscles
D. Spinal cord injury during surgery
E. A small hypothalamic infarct during surgery

A

B. Injury of the Tl nerve root during the discectomy

28
Q
  1. A left-sided approach decreases the risk of recurrent
    laryngeal nerve palsy during anterior cervical procedures,
    but at lower levels in the neck a left-sided approach runs therisk of injuring what structure?

A. Inferior laryngeal nerve
B. Thyrocervical artery
C. Thoracic duct
D. C5 nerve root
E. Dominant cardiac accelerator nerves

A
28
Q
  1. Degenerative spondylolisthesis is most common at what level in the lumbar spine?

A. Ll-2
B. L2-3
C. L3-4
D. L4-5
E. L5-S1

A

E. L5-S1

29
Q
  1. A 72-year-old female with rheumatoid arthritis is found to have a reducible atlantoaxial dislocation after 36 hours of cervical traction. There is minimal ventral compression from pannus formation, no cranial settling, and no foramen magnum stenosis noted on MR scan. What is the best treatment strategy for this patient?

A. Transarticular screw fixation and fusion if the lateral
atlantal masses are intact with good-quality bone
B. Transoral odontectomy followed by posterior occipital-
cervical decompression and fusion
C. Laminectomy
D. Transoral odontectomy followed by observation
E. Halo placement

A

E. Halo placement

29
Q
  1. The ideal bone graft provides all of the following ele-
    ments for successful healing EXCEPT?

A. Osteoconductive matrix
B. Osteoinductive factors
C. To support viable osteogenic cells
D. Structural support

A

C. To support viable osteogenic cells

29
Q
  1. Interfering with uptake of which ion into cells during
    severe closed head injury has resulted in a significant clinical benefit?

A. Ga2*
B. Na*
c. cr
D. K*
E. None of the above

A

c. cr

30
Q
  1. Surgical therapies used for dystonia have traditionally
    included all of the following EXCEPT?

A. Peripheral denervation
B. Pallidotomy
C. Thalamotomy
D. Dorsal column stimulation
E. Motor cortex stimulation

A

D. Dorsal column stimulation

30
Q
  1. All of the following surgical procedures have been
    employed to treat neuropsychiatric illness and behavioral
    disorders EXCEPT?

A. Arcuate fasciculotomy
B. Subcaudate tractotomy
C. Limbic leukotomy
D. Anterior capsulotomy
E. Anterior cingulotomy

A

A. Arcuate fasciculotomy

30
Q
  1. The superior semicircular canal projects into the floor of the middle cranial fossa as what structure often seen during a subtemporal approach for acoustic neuroma resection?

A. Arcuate eminence
B. Tegmen tympani
C. Vestibule
D. Vertical crest
E. Vestibular prominence

A

E. Vestibular prominence

31
Q

QUESTIONS 92-94

Scenario: A 45-year old male undergoes a subtemporal approach for tumor resection with elevation of the dura from the middle fossa floor and petrous bone.

  1. Structures visible on the floor of the middle cranial
    fossa during this exposure may include all of the following EXCEPT?

A. Middle meningeal artery
B. Trigeminal nerve (V3)
C. Lesser superficial petrosal nerve
D. Hypoglossal nerve
E. Greater superficial petrosal nerve

A

E. Greater superficial petrosal nerve

31
Q

QUESTIONS 92-94

Scenario: A 45-year old male undergoes a subtemporal approach for tumor resection with elevation of the dura from the middle fossa floor and petrous bone.

  1. Postoperatively, the patient has decreased lacrimation on the ipsilateral side. What is the most likely etiology of this problem?

A. Lesser petrosal nerve injury
B. Greater petrosal nerve injury
C. Geniculate ganglion injury
D. Chorda tympani injury
E. Injury of Jacobson’s nerve

A

E. Injury of Jacobson’s nerve

31
Q

QUESTIONS 92-94

Scenario: A 45-year old male undergoes a subtemporal approach for tumor resection with elevation of the dura from the middle fossa floor and petrous bone.

  1. During surgery, additional exposure is needed to access the upper petroclival region for tumor resection. Which maneuver may assist the surgeon in accomplishing this task?

A. Further drilling of Glasscock’s triangle
B. Additional exposure through Kawase’s quadrilateral
C. Further drilling of the arcuate eminence
D. Identifying Trautmann’s triangle and exposing
medially to this landmark
E. Modifying the approach by utilizing a presigmoid
corridor

A

A. Further drilling of Glasscock’s triangle

32
Q
  1. What is the most likely mechanism accounting for the
    Cushing response?

A. Herniation of the cerebellar tonsils through the foramen magnum
B. Brainstem distortion
C. Large hemispheric insult
D. Hypoxia of the brainstem
E. Posterior fossa mass

A

A. Herniation of the cerebellar tonsils through the foramen magnum

32
Q
  1. What is the most common clinical manifestation of the abnormality depicted on the angiogram below (Figure 6.96-6.97QJ?

A. Hoarseness
B. Dysphagia
C. Unilateral tongue atrophy
D. Palpable neck mass
E. Hypertension

A

D. Palpable neck mass

32
Q
  1. Clinicians must be aware of what endocrine comorbidity in evaluating patients with this tumor?

A. Diabetes insipidus
B. Pheochromocytoma
C. Hyperprolactinemia
D. Phenylketonuria
E. None of the above

A

B. Pheochromocytoma

33
Q
  1. A 45-year-old male has a long history of epilepsy from seizure foci originating in the right premotor cortex and extending into the adjacent motor cortex. His seizures have remained refractory to a variety of antiepileptic drugs, and he was referred to a neurosurgeon to discuss surgical options. EEG recordings reveal a seizure focus in the left
    premotor region that extends to the adjacent motor cortex. Which of the following surgical procedures may be performed concomitantly during lesionectomy to avoid major injury to the motor cortex and help control his seizures?

A. Topectomy
B. Limited lesionectomy
C. Motor cortex stimulation
D. Multiple subpial transections
E. Vagal nerve stimulation

A

B. Limited lesionectomy

33
Q
  1. What is the most common neurologically related complication after vagal nerve stimulator placement?

A. Facial numbness
B. Bradycardia
C. Dysphonia
D. Hypotension
E. Short-lived arrhythmia

A

D. Hypotension

34
Q
  1. Which of the following statements concerning stabil-
    ization of the lumbar spine with segmental pedicle screw
    fixation is correct?
    A. The lateral stability is significantly enhanced if the
    pedicle screw angle is 30 degrees or greater
    B. The use of transfixation increases the rotational but
    not the lateral load stability of the construct
    C. Without a transfixator, the vertebral column is stable
    in lateral load
    D. None of the above
    E. All of the above
A

D. None of the above

35
Q
  1. The borders of the lateral recess include all of the following EXCEPT?

A. Pedicle
B. Superior articular facet
C. Inferior articular facet
D. Vertebral body
E. Spinal canal/thecal sac

A

A. Pedicle

neurosurgery inbr (3 decks)

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