Intraoperative Dyes, OR Equipment, Surgical Hemostasis, and Bone Extenders

Question 1

Owing to risk of developing paraparesis, quadriplegia, multiple cranial nerves, dementia, and hydrocephalus, which of the following dyes must not be used as stain in neurosurgical procedures?
● A. Indigo carmine
● B. Methylene blue
● C. Flourescien
● D. Indocyanine green
● E. Gentian violet

Answer 1

B. Methylene blue

Question 2

For children below 3 years of age, the knob of Mayfield head holder clamp housing the tension spring and gauge is tightened up to how much?
● A. 20 to 30 lbs
● B. 30 to 40 lbs
● C. 40 to 50 lbs
● D. 50 to 60 lbs
● E. Not applicable

Answer 2

E. Not applicable

Question 3

Microfibrillar collagen promotes adhesion and aggregation of platelets and leads to chemical hemostasis. It is rendered ineffective if platelets count is how much?
● A. < 50,000/mL
● B. < 40,000/mL
● C. < 30,000/mL
● D. < 20,000/mL
● E. < 10,000/mL

Answer 3

E. < 10,000/mL

Question 4

Which of the following is an important imaging view of MRI to identify L5–S1 disk space for preoperative localization of level by identifying sacral ala?
● A. Sagittal view
● B. Coronal view
● C. Axial view
● D. Both A and B
● E. Both A and C

Answer 4

C. Axial view

Question 5

If best osteoconductive and osteogenic properties are required, which bone graft is preferable?
● A. Cancellous bone graft
● B. Cortical bone graft
● C. Vascularized autograft
● D. Bone marrow aspirate
● E. Devascularized bone graft

Answer 5

A. Cancellous bone graft

Question 6

Bone growth stimulators are indicated to be used in all of following conditions except?
● A. Diabetes
● B. Inflammatory arthritis
● C. Systemic vascular disease
● D. Malignancy
● E. Cigarette smokers

Answer 6

D. Malignancy

Question 7

Which of the following dural substitutes is absorbable, retains suture, and can be used with dural sealant?
● A. Tutopatch®
● B. Neuro-Patch®
● C. DuraGen®
● D. Durepair®
● E. DuraMatrix®

Answer 7

A. Tutopatch®

Question 8

What is the lateral limit of safe region for posterior iliac crest bone graft in order to protect superior cluneal nerves crossing iliac crest?
● A. 3 cm
● B. 5 cm
● C. 6 cm
● D. 8 cm
● E. 9 cm

Answer 8

D. 8 cm

Question 9

Indigo carmine is a blue dye that can be used intrathecally to locate CSF leaks. Fluorescein is another dye which can be used intrathecally or IV. Fluorescein is used in diluted form because it can cause which of the following side effects?
● A. Brain stem herniations
● B. Increased ICP
● C. Seizures
● D. Blindness
● E. Memory impairment

Answer 9

C. Seizures

Question 10

A patient is given IT dye after which he/she develops quadriplegia, multiple cranial nerve palsy, dementia, and hydrocephalus. Which dye is given to this patient?
● A. Indigo carmine
● B. Methylene blue
● C. Fluorescein
● D. Indigo cyanine
● E. Ultravist

Answer 10

B. Methylene blue

Question 11

For spine cases, the ideal location of observer’s eye piece is directly opposite the surgeon. For intracranial work, the observer’s eye piece is placed to the right of the operators except in which of the following cases where it is placed to the left?
● A. Transsphenoidal surgery
● B. Right posterior fossa craniotomy in lateral oblique position
● C. For supine position surgery with head tilt toward one side
● D. For craniotomy of posterior fossa in prone position
● E. Both A and B

Answer 11

E. Both A and B

Question 12

Pin-based head fixation include the Mayfield head holder or head frame. Following are the indications for pin stabilization except?
● A. Craniotomy for most intracranial vascular operations
● B. Craniotomy for most tumor operations especially if there is need of retractor system that attaches to the Mayfield head holder
● C. When intraoperative image guidance system is used
● D. For craniotomy in patients less than 3 years of age
● E. In cervical spine often used for posterior cervical operations

Answer 12

D. For craniotomy in patients less than 3 years of age

Question 13

Which of the following are the complications of pin head fixation?
● A. Malposition of pins through unintended anatomic structure like pinna, orbit, superficial artery, or poor fixation by not properly placing pins close to the equator
● B. Skin penetration by pins which can cause injury to intracranial structures
● C. Skin necrosis or skull fracture
● D. Slippage of any of the joints or connections to the OR table or clamp breakage or bleeding from pin site
● E. All of the above

Answer 13

E. All of the above

Question 14

All of the following are included in the mechanical means of hemostasis except?
● A. Bone wax use
● B. Ligature
● C. Use of monopolar or bipolar cautery
● D. Use of silver clips (hemoclips)
● E. None of the above

Answer 14

C. Use of monopolar or bipolar cautery

Question 15

All of the following are means of chemical hemostasis except?
● A. Gelatin sponge
● B. Oxidized cellulose
● C. Bone wax
● D. Microfibrillar collagen
● E. Thrombin

Answer 15

C. Bone wax

Question 16

All of the following are included in the allograft for use as dural substitutes except?
● A. Reconstituted material like processed gelatin
● B. Processed intact natural materials like ovine or bovine
● C. Fascia lata or galea or pericranium
● D. Synthetic materials like polyesterurethane
● E. Biosynthetic materials like cellulose

Answer 16

C. Fascia lata or galea or pericranium

Question 17

Which of the following are the components of bone graft that are important for fusion?
● A. Osteoinduction which is recruitment of mesenchymal cells and the stimulation of these cells to develop into osteoblast or osteoclasts
● B. Osteogenesis which is formation of new bone by host or graft mesenchymal stem cells
● C. Osteoconduction which is the structure of the graft that acts as a scaffold upon which new bone and blood vessels form
● D. Mechanical stability which is the structural anatomical biomechanical support
● E. All of the above

Answer 17

E. All of the above

Question 18

Which of the following bone graft material has the best osteogenic property?
● A. Cancellous graft
● B. Cortical autograft
● C. Bone marrow aspirate
● D. Vascularized autograft
● E. Demineralized bone matrix

Answer 18

A. Cancellous graft