Endovascular Neurosurgery

Question 1

What is evaluation of flow through the posterior communicating arteries by vertebral injection with simultaneous common carotid artery compression in the neck called?
● A. Allcock test
● B. Wada test
● C. Froin’s
● D. Queckensdest’s
● E. Widal

Answer 1

A. Allcock test

Question 2

Reversal of aspirin can be achieved with which of the following?
● A. Protamine sulfate
● B. Vitamin K
● C. RBC transfusion
● D. FFPs
● E. Platelets

Answer 2

E. Platelets

Question 3

According to weight-based protocol, heparin is given as 70 units/kg followed by maintenance intravenous dose of how much (units/kg/h)?
● A. 18
● B. 22
● C. 25
● D. 28
● E. 30

Answer 3

A. 18

Question 4

Lidocaine overdose is reversed with which of the following given intravenously?
● A. Calcium
● B. Potassium
● C. Magnesium
● D. Albumin
● E. Lipid emulsion

Answer 4

E. Lipid emulsion

Question 5

Which aneurysm feature is a not a high risk for rupture?
● A. Irregular shape
● B. Size > 7 mm
● C. Aspect ratio > 2.7
● D. Posterior circulation
● E. 10-mm cavernous segment aneurysm

Answer 5

E. 10-mm cavernous segment aneurysm

Question 6

For chemical spasmolysis to treat vasospasm, what is the drug of first choice?
● A. Verapamil
● B. Nimodipine
● C. Beta blockers
● D. Steroids
● E. Alpha blockers

Answer 6

A. Verapamil

Question 7

Which of the following is the hallmark for aggressive dural arteriovenous fistula (DAVF)?
● A. Cortical venous reflux
● B. Intracerebral hemorrhage
● C. Focal neurological deficit
● D. Increased intraocular pressure
● E. Audible bruit

Answer 7

A. Cortical venous reflux

Question 8

The method of choice for carotid-cavernous fistula (CCF) is transarterial embolization with which of the following?
● A. Coil
● B. Clip
● C. Onyx
● D. NCBA
● E. PVA

Answer 8

A. Coil

Question 9

Which of the following is not included in the 5 Ds of vertebrobasilar insufficiency?
● A. Diplopia
● B. Dysarthria
● C. Defective vision
● D. Drop attacks
● E. Diastematomyelia

Answer 9

E. Diastematomyelia

Question 10

Which of the following statements regarding risk of cerebral angiography is incorrect?
● A. Arterial dissection can occur because of it
● B. Perforation of artery or aneurysm can occur during the procedure
● C. Air embolism is the most common complication of cerebral angiography
● D. Cerebral angiography can also cause embolic thrombus
● E. There can also be puncture site complications like hematoma formation or embolism distal to puncture site

Answer 10

C. Air embolism is the most common complication of cerebral angiography

Question 11

Indications and case selection of aspirin include diagnostic cerebral angiography, coil embolization of aneurysms, stent complications, balloon test occlusion, or therapeutic occlusion of large arteries. What is the maximum dose of aspirin that is used in 1 day?
● A. 275 mg
● B. 300 mg
● C. 325 mg
● D. 350 mg
● E. 375 mg

Answer 11

C. 325 mg

Question 12

Daily dose of clopidogrel is 75 mg. Following are the indications of clopidogrel use except?
● A. Coil embolization of wide neck cerebral aneurysms where stent will be used
● B. Stent implantation
● C. Therapeutic occlusion of large arteries
● D. Parent artery coil prolapse or herniation
● E. Thrombus or clot on coil phenomena
● F. All of the above

Answer 12

F. All of the above

Question 13

Heparin is used in embolization of brain AVM or dural AVF, cervical or intracranial angioplasty, intra- or extracranial stent implantation, or balloon test occlusion of carotid, vertebral, or other large cerebral arteries. Which of the following is used for
reversal of heparin?
● A. FFPs
● B. Warfarin
● C. Protamine sulfate
● D. Steroids
● E. Analgesics

Answer 13

C. Protamine sulfate

Question 14

All of the following are included in the exclusion criteria of tissue plasminogen activator except?
● A. History of previous intracranial hemorrhage
● B. Recent intracranial or intraspinal surgery
● C. Diagnosis of ischemic stroke with onset of symptoms in less than or equal to 3 hours
● D. Intracranial neoplasm, AVM, or aneurysm
● E. Active internal bleeding or elevated blood pressure

Answer 14

E. Active internal bleeding or elevated blood pressure

Question 15

What is the intravenous dose of tissue plasminogen activator?
● A. 0.7 mg/kg
● B. 0.9 mg/kg
● C. 1.1 mg/kg
● D. 1.3 mg/kg
● E. 1.5 mg/kg

Answer 15

B. 0.9 mg/kg

Question 16

Which of the following is used for reversal of tissue plasminogen?
● A. Cryoprecipitate
● B. Tranexamic acid
● C. Protamine sulfate
● D. FFPs
● E. All of the above

Answer 16

A. Cryoprecipitate

Question 17

Which of the following are the factors that affect the selection of aneurysm for treatment?
● A. Ruptured or unruptured aneurysms (ruptured aneurysms need to be treated urgently)
● B. Symptoms other than rupture like cranial nerve palsy or loss of vision or ischemia as aneurysms causing these kind of symptoms are at increased risk of rupture
● C. Large aneurysms (size more than 7–10 mm) are more likely to rupture than small aneurysms
● D. An irregular-shaped aneurysm is at increased risk of rupture than a spherical saccular aneurysm
● E. All of the above

Answer 17

E. All of the above

Question 18

Which of the following are the endovascular options for treatment of neurosurgical patients?
● A. Coiling
● B. Coiling with stenting
● C. Balloon-assisted coiling
● D. Dual catheter technique
● E. All of the above

Answer 18

C. Balloon-assisted coiling

Question 19

Following are the treatments of aneurysmal rupture during coiling except?
● A. Inflate balloon if balloon-assisted coiling
● B. Immediately lower blood pressure
● C. Immediately anticoagulation is given
● D. An extraventricular drainage
● E. All of the above

Answer 19

E. All of the above