Miscellaneous Surgical Procedures

Question 1

What should be the size of spinal needle for percutaneous ventricular tap in adults?
● A. 14 to 16 Ga
● B. 16 to 18 Ga
● C. 18 to 20 Ga
● D. 20 to 22 Ga
● E. 22 to 24 Ga

Answer 1

B. 16 to 18 Ga

Question 2

To drain subdural collections and to obtain fluid for diagnostic tests such as culture, repeat taps may be used, but surgery should be considered after how many taps?
● A. 2 to 3 taps
● B. 3 to 4 taps
● C. 4 to 5 taps
● D. 5 to 6 taps
● E. 6 to 7 taps

Answer 2

D. 5 to 6 taps

Question 3

Which of following is not considered a contraindication of lumbar puncture?
● A. Risk of tonsillar herniation
● B. Platelet count > 50,000/mm3
● C. Suspected aneurysmal SAH
● D. Infection at puncture site
● E. Complete spinal block

Answer 3

B. Platelet count > 50,000/mm3

Question 4

For estimating true total CSF protein content with a traumatic tap, what is the correction applied?
● A. Subtract 1 mg/100 mL of protein for every 1,000 RBC/mm3
● B. Subtract 10 mg/100 mL of protein for every 1,000 RBC/mm3
● C. Subtract 1 mg/100 mL of protein for every 500 RBC/mm3
● D. Subtract 1 mg/100 mL of protein for every 700 RBC/mm3
● E. Subtract 10 mg/100 mL of protein for every 100 RBC/mm3

Answer 4

A. Subtract 1 mg/100 mL of protein for every 1,000 RBC/mm3

Question 5

What is the mortality risk for delaying treatment of acute bacterial meningitis?
● A. Increase by 10% per hour
● B. Increase by 11% per hour
● C. Increase by 12% per hour
● D. Increase by 13% per hour
● E. Increase by 15% per hour

Answer 5

D. Increase by 13% per hour

Question 6

Which of the following factors are found not to affect the incidence of post LP H/A?
● A. Age of the patient
● B. Pregnancy
● C. Volume of fluid removed during LP
● D. Prior history of headache
● E. Needle size

Answer 6

C. Volume of fluid removed during LP

Question 7

What should be the trajectory for insertion of ventricular catheter from Kocher’s point?
● A. Toward nasion
● B. Toward ipsilateral medial canthus in coronal plane
● C. Toward contralateral medial canthus in coronal plane
● D. Toward ipsilateral medial canthus in AP plane
● E. Toward EAM in coronal plane

Answer 7

B. Toward ipsilateral medial canthus in coronal plane

Question 8

What should be the length of ventricular catheter inserted from Frazier burr hole with stylet initially?
● A. 3 cm
● B. 4 cm
● C. 5 cm
● D. 6 cm
● E. 7 cm

Answer 8

D. 6 cm

Question 9

Tip of VA catheter in children should be advanced up to which level?
● A. T4
● B. T5
● C. T6
● D. T8
● E. T10

Answer 9

E. T10

Question 10

All of following are considered locations for making an opening in the floor of the third ventricle during ETV except?
● A. In the midline
● B. In the region of the tuber cinereum
● C. Anterior to the infundibular recess
● D. Anterior to the mammillary bodies
● E. Anterior to the tip of the basilar artery

Answer 10

C. Anterior to the infundibular recess

Question 11

During sural nerve biopsy, sural nerve is differentiated by which point from lesser saphenous vein?
● A. Nerve has many branches at right angle
● B. Vein has branches at right angle
● C. Nerve lies superficial and posterior to vein
● D. Vein has branches at acute angle
● E. None of the above

Answer 11

B. Vein has branches at right angle

Question 12

What is the actual cable tension for titanium alloy cables for spine fusion?
● A. 20 lbs
● B. 30 lbs
● C. 40 lbs
● D. 60 lbs
● E. Depends on quality of bone

Answer 12

E. Depends on quality of bone

Question 13

Following are the contraindications of lumbar puncture except?
● A. Risk of tonsillar herniation (known or suspected intracranial mass or noncommunicating hydrocephalus)
● B. Infection in the region desired of lumbar puncture
● C. Coagulopathy
● D. Can be used without any hazard in suspected SAH
● E. Caution in patients with complete spinal block

Answer 13

D. Can be used without any hazard in suspected SAH

Question 14

The intercristal line passes through (in most adults) which of the following?
● A. At L4 spinous process
● B. Between L4 and L5 spinous processes
● C. Between L3 and L4 spinous processes
● D. At L5 spinous process
● E. Both A and B

Answer 14

E. Both A and B

Question 15

What is the desirable spinal needle size for diagnostic purpose?
● A. 16 G
● B. 18 G
● C. 20 G
● D. 22 G
● E. 24 G

Answer 15

C. 20 G

Question 16

What is the normal opening pressure in the left lateral decubitus position during performing an LP?
● A. 12.2 ± 3.4 cm H2O
● B. 14.2 ± 3.4 cm H2O
● C. 11 cm H2O
● D. 9 cm H2O
● E. 17 cm H2O

Answer 16

A. 12.2 ± 3.4 cm H2O

Question 17

In case of traumatic tap, how can we get WBC count that is other than peripheral blood in a nonanemic patient?
● A. By subtracting 1 WBC for every 500 RBC
● B. By subtracting 1 WBC for every 700 RBC
● C. By subtracting 1 WBC for every 100 RBC
● D. By subtracting 1 WBC for every 1000 RBC
● E. By subtracting 1 WBC for every 1200 RBC

Answer 17

B. By subtracting 1 WBC for every 700 RBC

Question 18

Which of the following are the differentiating points between traumatic tap and subarachnoid hemorrhage on LP?
● A. RBC count is less than 2,000/mm cube in traumatic tap while in case of SAH it is usually more than 1,00,000 RBC/mm cube
● B. Clearing of RBCs from the first tube to the last tube declines as CSF drains in case of traumatic tap, while in case of SAH, it changes little as CSF drains
● C. Ratio of WBC to RBC is similar to ratio in peripheral blood in case of traumatic tap, while it usually promotes leukocytosis in case of SAH
● D. Supernatant in case of traumatic tap is clear, while it is xanthochromic in case of SAH
● E. All of the above

Answer 18

E. All of the above

Question 19

Which of the following are the treatment options for headache after LP?
● A. Flat in bed for at least 24 hours
● B. Hydration per oral or IV
● C. Analgesics for headache
● D. Tight abdominal binder
● E. Deoxycortisone acetate 5 mg IM every 88 hours
● F. Caffeine sodium benzoate 500 mg in 2 mL IV every 8 hours up to 3 days max
● G. High-dose steroids
● H. Blood patch if refractory
● I. All of the above

Answer 19

I. All of the above

Question 20

Which of the following are the indications of lumbar catheter CSF drainage?
● A. To reduce CSF pressure at the site of CSF leak (e.g., dural breach during spine surgery or for spontaneous CSF fistula)
● B. To reduce intracranial pressure in case of communicating hydrocephalus
● C. To reduce CSF pressure to attempt to increase perfusion of the spinal cord, for example, during surgery for aortic abdominal aneurysms
● D. All of the above

Answer 20

D. All of the above

Question 21

Which of the following are the indications of ventricular catheterization?
● A. Intracranial pressure measurement
● B. Temporary CSF diversion in case of hydrocephalus when definite shunting is not immediately indicated or practical
● C. For management of infected shunt occasionally in case of meningitis when repeated LPs or a lumbar drain is not suitable
● D. For intrathecal drug administration
● E. All of the above

Answer 21

E. All of the above

Question 22

What are the VP shunt postoperative orders?
● A. Flat in bed to avoid overshunting and possible postoperative hematoma, with gradual mobilization
● B. If peritoneal end is new or revised, do not feed until bowel sound resumes
● C. Shunt series X-rays for future comparison
● D. All of the above

Answer 22

D. All of the above