General

Question 1

L5 radiculopathy

I

Answer 1

I
Weakness with inversion
Big toe sensory

Question 2

Common Peroneal Nerve

E

Answer 2

E

Weakness of eversion

Question 3

Nerve injury/plexus injury

Answer 3

Lacerations 
-repair in 72 hours 
-blunt lacerations in 2 weeks
-blunt injures/stretch = EMG and NCS in 1 month then repeat in 3 months 
—

Question 4

Carotid endarterectomy

Answer 4

—asymptomatic >60% and healthy <75yo = CEA (ACAS), complication rate <3%

—symptomatic >50-69%, healthy =CEA
—symptomatic >70% = CEA, complication rate <6%

Question 5

Symptomatic carotid stenosis

Answer 5

• retinal TIA
• cortical TIA
• non-disabling stroke with CT or MRI abnormality

consider CEA after minimum 1 week for more disabling stroke

Question 6

Stenting for carotid stenosis

Answer 6

• significant cardiac disease (symptomatic)
• advanced age >80y symptomatic
• ipsilateral radiation
• recurrent stenosis after CEA
• tandem lesions
• poor surgical anatomy
• contralateral RLN palsy

Question 7

Pelvic incidence

Answer 7

-fixed parameter
= perpendicular to sacral line center to the femoral head — angle between
40-65 degrees

PI =SS + PT
LL = PI +/- SS

Question 8

Sacral Slope

Answer 8

= horizontal line posterior and angle between sacral line

Range 10-30

Question 9

Pelvic Tilt

Answer 9

-variable
= find center sacral line, draw perpendicular to femoral heads, draw vertical line = angle between vertical line and line to femoral heads
-range 30-50

Question 10

Spinal AVM

Answer 10

1) DAVF
- thoracic and lumbar location
- low myelopathy
- MRI and A + spinal angiogram
- radicular artery at the nerve sleeve
- whet clip intradural on the arterialized vein at the sleeve
- pre ICG and post ICG
- treat surgically

Question 11

Spinal AVM

Answer 11

2) perimedullary
- upper extremities and SAH
- MRI/A and spinal Angio to include sacral, VA, and external carotid
- posterior or anterior location
- surgery for posterior, endovascular for anterior
- spinal artery to spinal vein without nidus

Question 12

Spinal AVM

Answer 12

3) intramedullary
- same as perimedullary
- nidus,complex
- treat endovascular

Question 13

ASIA grading

Answer 13

A - comlplete
B - motor complete sensory incomplete
C - motor <3
D - motor > 3
E - normal

Question 14

Cervical spine 2 column theory

Answer 14

Anterior column = ALL-PLL
posterior column >PLL

SLICS

Question 15

Vertebral segments

4

Answer 15

SC -c5/6 TF
c5/6 TF - c2
C2 -dura
Intradural

Question 16

Odontoid fractures

Answer 16

Type 1
Type 2
Type 2a - comminuted type 2
Type 3

Nonunion 21x higher for non surgical type 2

• 6mm displacement
• 10degrees angulation

Question 17

Treatment of burst fracture

Answer 17

CC 50%
LOH 40%
Kyphosis 30 degrees
Neuro deficit

TLICS

Question 18

Cervical myotomes

Answer 18

C5 -deltoid
C6-bicep
C7 -tricep
C8 -grip

Exiting nerve root is lower number

Question 19

Types of spondylolisthesis

Answer 19

D2P2IT

• dysplastic (congenital)
• degenerative
• post-surgical
• pathologic
• isthmic (pars defect)
• traumatic (non-pars)

Graded 1-5

Question 20

Radiosensitive tumors

Answer 20

SCLC
lymphoma 
Multiple myeloma
Breast
Prostate

Question 21

Brain infections

Answer 21

Hematogenous 
-step viridans
Sinus
-strep Milleri
Postop 
-staph aureus 

Treat 6-8 weeks IV antibiotics
No MRI before 3 months
Watch out for moth-eaten bone flap/resorption

Question 22

Stupp Protocol for GBM

Answer 22

6 weeks RT at 2gy for 30 treatments = 60
+ concomitant Temodar 7days x30
+ 4 week rest then 6 28 day cycles with temodar on days 1-5

MRI w 3 months

Question 23

CC fistula

Answer 23

1) direct 
—transarterial occlusion 
2) indirect ICA 
3) indirect ECA
4) indirect ICA/ECA

Question 24

Borden classification of cranial dural AVF

Answer 24

1) direct drainage into sinus (observed)
2) sinus and cortical vein reflux
3) cortical reflux only

Commonly retromastoid bruit and location at transverse sigmoid junction

Question 25

Cranial meningioma and hemagiopericytoma

-angiogram considerations

Answer 25

All cranial meningioma get a formal Angio for possible embo except olfactory groove as feeders are ant post ethmoid arteries

Question 26

Neural axis MRI in brain tumors

Answer 26

-All posterior fossa tumors get neural axis MRIs
—medulloblastoma, ependymoma, pilocytic astrocytoma, hemangioblatoma, metastasis

—consider axis MRI in malignant pineal region tumors and other malignant ventricular lesions

Question 27

Rupture rate of unruptuted aneurysms ISUIA

5 year rupture rate

Answer 27

Size
<7, 7-12, 12-25, >25mm

Anterior circulation
—0 2.5 15 40

Posterior circulation
—

Question 28

Ruptured aneurysms (SAH)
- re-rupture rate

Answer 28

4% rate day 1
1% days 2-14
50% at 6 months
3%/yr thereafter

Question 29

Tic Douloreux

v

Answer 29

1) tegretol and topamax
2) perc rhizotomy RF or balloon, 3) SRS
4) MVD

ALL have similar outcomes and complication rate BUT V1 #1 is MVD

SCA most common culprit

Question 30

Hemifacial spasm

Answer 30

1) tegretol
2) MVD

PICA
—

Question 31

Brachial plexus

Answer 31

-c5 6 7 8 T1
5 roots, 3 trunks, 6 divisions, 3 cords, 5 TBs
-MAMRU
-EDTSI

Question 32

Brachial plexus
MAMRU
EDTSI
Innervation

Answer 32

• musculocutaneous - elbow weakness 567
• axillary - deltoid weakness 56
• median - thumb weakness 56781
• radial - supinate weakness 56781
• ulnar - intrinsic interossei weakness 781