neuroradiology

Question 1

1. Which of the following is a risk factor for clinically evident neurologic complications
   in the first 24 hours after cerebral angiography?
   I. age over 70 years
2. duration of angiogram over 90 minutes
3. history of transient ischemic attack (TIA) or stroke
   IV. history of systemic hypertension
   A. I, 11, 111
   B. 1, I11
   C. 11, IV
   D. IV
   E. all of the above

Answer 1

Jawabannya : E

Morris p. 63. Other risk factors include patients with more than 50 to 70%
stenosis of the cerebral vessels, patients whose angiograms require a higher
volume of contrast, and patients referred for subarachnoid hemorrhage or
who are immediately postoperative.

Question 2

2. The most common nonneurologic complication of cerebral angiography via
   femoral artery approach is

A. angina
B. allergic reaction
C. hematoma
D. myocardial infarction (MI)
E. pseudoaneurysm

Answer 2

jawabannya : B

Morris p. 72: Significant hematoma formation occurs at a rate of approximately
6.9 to 10.7%. Angina, allergic reaction. and myocardial infarction (MI)
all occur with an incidence of less than 1 to 2%. Pseudoaneurysms are rare.
occurring 0.05 to 0.55% of the time.

Question 3

3. Branches of the meningohypophysial trunk include the

I. tentorial artery
11. inferior hypophysial artery
111. dorsal meningeal artery
IV. superior hypophysial artery

A. I, 11, 111
B. I, 111
C. 11, IV
D. IV
E. all of the above

Answer 3

Jawabannya : A

Osb p. 87. The meningohypophysial trunk, the largest and most proximal branch
of the cavernous carotid artery, typically has three branches: the tentorial artery
(of Bernasconi and Cassanari), the dorsal meningeal artery, and the inferior
hypophysial artery (the inferolateral trunk). The superior hypophysial artery
is a branch of the supraclinoid carotid artery.

Question 4

For questions 4 to 6, match the persistent anastomoses with the description. Each
response may be used once, more than once, or not at all.

A. cervical intersegmental artery
B. proatlantal intersegmental artery
C. primitive hypoglossal artery
D. primitive otic artery
E. primitive trigeminal artery

4. the most comrrlbn of the persistent anastomoses
5. petrous internal carotid artery to the basilar artery
6. proximal cavernous internal carotid artery to basilar artery

Answer 4

Jawabannya :

4. E,
5. D,
6. E.

For questions.4-6 see Apuzzo pp. 749-754.

Question 5

7. The precentral cerebellar vein usually drains into the

A. internal cerebral vein
B. lateral mesencephalic vein
C. posterior mesencephalic vein
D. straight sinds
E. vein of Galen

Answer 5

Jawabannya : E

Osb p. 233. The precentral cerebellar vein is a midline vessel that courses
medially over the brachium pontis, parallels the roof of the fourth ventricle,
and curves upward behind the inferior colliculus and precentral lobule of the
vermis to drain into the vein of Calen.

Question 6

8. Anterior temporal lobe masses characteristically displace the

A. anterior choroidal artery laterally
B. anterior choroidal artery medially
C. anterior choroidal artery upward
D. posterior choroidal artery downward
E. posterior choroidal artery upward

Answer 6

Jawabannya B

Osb p. 318.

Question 7

For questions 9 to 14, match the blood products with their appearance on magnetic
resonance imaging (MRI). Each response may be used once, more than once, or not
at all.

A. isointense on TI, isointense to hyperintense on T2
B. hyperintense on Tl and T2
C. hypointense on Tl and T2
D. isointense on TI, hypointense on T2
E. hyperintense on TI, hypointense on T2
F. hypointense on TI, hyperintense on T2

9. oxyhemoglobin (0-24 hours)
10. deoxyhemoglobin (1-3 days)
11. intracellular methemoglobin (3-14 days)
12. extracellular methemoglobin (>2 weeks)
13. nonparamagnetic heme pigments
14. hemosiderin around periphery

Answer 7

Jawabannya

9. A,
10. D,
11. E,
12. B,
13. F,
14. C.

For questions 9-14 see ACR Trauma case 811.

Question 8

For questions 15 to 23, match the branch of the internal carotid artery with the
statement that best describes it.

A. caroticotympanic artery
B. inferior hypophysial trunk
C. inferolateral trunk
D. mandibulovidian artery
E. McConnell’s capsular vessels
F. tentorial artery

15. potential supply to vascular tumors of the middle ear
16. vestigial hyoid artery
17. common supply to juvenile angiofibromas
18. also called the artery of Bernasconi and Cassanari
19. Together with the inferior hypophysial artery, these vessels supply the
    pituitary gland.
20. Together with the caroticotympanic artery, it is a branch of the petrous internal
    carotid artery.
21. anastomoses with the superior hypophysial artery
22. remnant of the embryonic dorsal ophthalmic artery
23. provides important branches to some of the cranial nerves

Answer 8

For questions 15-23 see Morris pp. 117-130.

Jawabannya :

15. A,
16. A,
17. D,
18. F,
19. E,
20. D,
21. B,
22. C,
23. C.

Question 9

24. The correct order of the named segments of the anterior choroidal artery is

A. cisternal segment, plexal point, plexal segment
B. cisternal segment, plexal segment, plexal point
C. plexal point, cisternal segment, plexal segment
D. plexal point, plexal segment, cisternal segment
E. plexal segment, plexal point, cisternal segment

Answer 9

Jawabannya : A

Osb pp. 100-101. The anterior choroidal artery (AChA) is best seen on the anteroposterior angiogram arising from the medial internal carotid artery. The cisternal AChA curves medially and posteriorly around the uncus. An
abrupt “kink is seen at the plexal point where the AChA enters the choroidal fissure. The plexal AChA then courses through the temporal horn.

Question 10

25. In the most common anatomic variation, the named branches of the proximal
    right subclavian artery from proximal to distal are

A. internal mammary artery, thyrocervical trunk, vertebral artery, costocervical trunk
B. internal mammary artery, vertebral artery, thyrocervical trunk, costocervical trunk
C. vertebral artery, internal mammary artery, costocervical trunk, thyrocervical trunk
D. vertebral artery, internal mammary artery, thyrocervical trunk, costocervical trunk
E. vertebral artery, thyrocervical trunk, internal mammary artery. costocervical trunk

Answer 10

Jawabannya : D

Morris p. 101. Although this is the most common variation, others include the
inferior thyroid artery sharing a common trunk with the vertebral artery,
the vertebral artery from the thyrocervical trunk, the vertebral artery from
the proximal common carotid artery, and the vertebral artery from the
subclavian artery distal to the thyrocervical trunk.

Question 11

26. The most common site of origin of the recurrent artery of Heubner is the

A. A1 segment,
B. A2 segment
C. internal carotid artery
D. Ml segment
E. M2 segment

Answer 11

Jawabannya : B

Osb p. 120. The recurrent artery of Heubner (one of the medial striate
arteries) takes origin from the A2 segment 34 to 50% of the time, from the
A1 segment 17 to 45% of the time, and from the anterior communicating
artery 5 to 20% of the time.

Question 12

27. lntracranial hypotension related to leakage or removal of cerebrospinal fluid
    (CSF) is most closely associated with which magnetic resonance finding?

A. diffuse dural enhancement
B. ependymal enhancement
C pneumocephalus
D. slitlike ventricles
E. ventriculomegaly

Answer 12

Jawabannya : A

Yock p. 333. This enhancement is thought to represent an increase in blood
volume in the dura. Inferior displacement of the structures in the posterior
fossa may accompany this finding in such cases of intracranial hypotension.

Question 13

28. Which of the following imaging characteristics is least likely for pleomorphic
    xanthoastrocytoma?

A. calcification
B. cyst formation
C. multiple lesions
D. superficial location
E. temporal lobe location

Answer 13

Jawabannya : C

Yock p. 72. This variant of astrocytoma usually presents as a large single mass in a
young patient with a long history of seizures. The other options listed are typical.

Question 14

29. Choroid plexus papillomas in children are most common in the

A. fourth ventricle
B. left lateral ventricle
C. right lateral ventricle
D. third ventricle

Answer 14

Jawabannya : B

Yock p. 204. This propensity to lateralize has not been explained. These large
bulky tumors usually arise in the tri

Question 15

30. Choroid plexus papillomas in adults occur most commonly in the

A. fourth ventricle
B. left lateral ventricle
C. right lateral ventricle
D. third ventricle

Answer 15

Jawabannya : A

Yock pp. 204-205. These tumors in the adult population are often found at
the caudal aspect of the fourth ventricle and frequently calcify

Question 16

31. Which one of the following white matter lesions usually initially involves the
    parieto-occipital regions?

A. adrenoleukodystrophy
B. Canavan’s disease
C. metachromatic leukodystrophy
D. multiple sclerosis
E. Schilder’s disease

Answer 16

Jawabannya : A

Yock p. 252. The lesions of adrenoleukodystrophy are usually symmetrical,
begin in the parieto-occipital region, and spread anteriorly.

Question 17

For questions 32 to 37, match the description with the malformation.

A. Chiari l malformation
B. Chiari II malformation
C. both
D. neither

32. caudal displacement of cerebellar tonsils
33. Beaking of the midbrain tectum is characteristic.
34. A meningomyelocoele is virtually always present.
35. Medullary kinking is seen.
36. Occipital or high cervical encephalocele is present.
37. usually presents in young adulthood

Answer 17

For questions 32-37 see Yock pp. 520-521. Chiari I malformations consist of inferior displacement of the cerebellar tonsils through the foramen magnum. They usually occur in early adulthood. In Chiari II malformations, the caudal displacement of the hindbrain is more severe, with beaking of the tectum and medullary kinking often seen. Myelomeningoceles are virtually always present. Chiari II malformations usually present in infancy. Chiari III malformations display the most severe displacement of posterior fossa structures and are often associated with a high cervical or occipital meningocele.

Jawabannya :

32. C,
33. B,
34. B,
35. B,
36. D,
37. A.

Question 18

38. The term bovine arch refers to

A. bi-innominate arteries
B. left common carotid artery origin from the aortic arch
C. left common carotid artery origin from the right brachiocephalic trunk
D. right aortic arch
E. right subclavian artery distal to the left subclavian artery

Answer 18

Jawabannya : C

Morris pp. 99-101. The left common carotid artery usually arises from the aortic arch distal to the right brachiocephalic artery. In the bovine arch variant, the left common carotid artery arises from the proximal right brachiocephalic artery. Variant A is rare. A right aortic arch may be incidental or associated with congenital heart disease. Variant E is associated with Down syndrome

Question 19

39. The differential diagnosis of colpocephaly, or dilatation of the posterior portion of the lateral ventricles, includes

I. agenesis of the corpus callosum
II. Leigh’s disease
III. periventricular leukomalacia
IV. Hallervorden-Spatz disease

A. I, II. Ill
B. I, III
C. II, IV
D. IV
E. all of the abov

Answer 19

Jawabannya : B

Yock pp. 367.525. Agenesis of the corpus callosum and periventricular leukomalacia can both result in olpocephaly. Leigh’s disease and Hallervorden-Spatz disease can both cause symmetric lesions of the globus pallidus but are not associated with colpocephaly.

Question 20

40. Schizencephaly is essentially a

A. demyelinating illness
B. disease that first develops in the elderly
C. disorder of neuronal migration
D. neurodegenerative disorder
E. psychiatric disorder

Answer 20

Jawabannya C

Yock pp. 540-522. The cleft of schizoencephaly can be unilateral or bilateral,
but it usually involves the region near the central sulcus. Patients can present
with seizures or focal deficits

Question 21

41. The differential diagnosis of optic nerve thickening includes

I. optic nerve sheath meningioma
II. orbit4 pseudotumor
III. optic nerve glioma
IV. Graves’ disease

A. I,II,III
B. I, III
C. II. IV
D. IV
E. all of the above

Answer 21

Jawabannya E

Yock p. 305. Optic nerve thickening may be caused by nonneoplastic processes
like Graves’ disease, orbital pseudotumor, optic neuritis, papilledema, and vascular
malformations, or by tumors like gliomas, meningiomas, lymphomas,
leukemia, and metastases

Question 22

42. The most common primary benign tumor of the adult orbit is (a)

A. cavernous hemangioma
B. dermoid cyst
C. lymphangioma
D. optic nerve glioma
E. sarcoidosis

Answer 22

Jawabannya : A

Y p. 1373. Cavernous hemangiomas of the orbit are usually well demarcated,
vascular, intraconal lesions with smooth or lobulated borders

Question 23

43. Which of the following is a branch of the ophthalmic artery?

A. anterior ethmoidal artery
B. posterior ethmoidal artery
C. both
D. neither

Answer 23

Jawabannya : C

Morris pp. 135-137. The ethmoidal arteries are branches of the ophthalmic artery. They supply a portion of the anterior cranial fossa and the mucosa of the nasal septum. During embolization of the internal maxillary artery, dangerous potential anastomoses from the sphenopalatine branches of the internal maxillary to branches of the ophthalmic artery.

Question 24

44. Which of the following set of findings on a lumbar MRI scan performed immediately after contrast injection is most characteristic of a recurrent disk
    herniation and epidural fibrosis, respectively?

A. a rim of enhancement in the recurrent disk, diffuse enhancement in the fibrosis
B. a rim of enhancement in the fibrosis, diffuse enhancement in the recurrent disk
C a rim of enhancement in the recurrent disk, no enhancement in the fibrosis
D. diffuse enhancement in the recurrent disk, no enhancement in the fibrosis
E. no enhancement of either the recurrent disk or fibrosis

Answer 24

Jawabannya : A

Yock pp. 582-583. Scar tissue contains vascular granulation tissue that
enhances more diffusely than a residual or recurrent disk.

Question 25

45. Lesions in diffuse axonal injury are commonly found in the I. corpus callosum II. gray-white junction III. rostra1 brainstem IV. temporal lobe A. I, II, III B. I. III C. II, IV D. IV E. all of the above

Answer 25

Jawabannya : A GIT p. 1426

Question 26

46. Acute subarachnoid hemorrhage is more difficult to diagnose on MRI than on computed tomography (m)be cause A. Extracellular methemoglobin is isointense on TI and R. B. Hemosiderin is isointense on TI and T2. C. Most radiologists are not familiar with the appearance of acute subarachnoid hemorrhage on MRI. D. The high oxygen tension in the subarachnoid space prevents conversion of oxyhemoglobin to deoxyhemoglobin. E. The low oxygen tension in the subarachnoid space prevents conversion of deoxyhemoglobin to oxyhemoglobin.

Answer 26

Jawabannya : D GlT pp. 1437-1438.

Question 27

47. Which of the following is true of the choroidal blush? A. It is an indicator of the choroidal plexus in the lateral ventricle. B. It is best seen on the anteroposterior projection. C. It is from the posterior ethmoidal branches of the ophthalmic artery. D. Its configuration is usually a thin, dense crescent. E. Its presence usually indicates an elevated intraocular pressure.

Answer 27

Jawabannya D ## Footnote Morris p. 137. The choroidal blush signifies the choroidal plexus of the eye and is supplied by the ciliary branches of the ophthalmic artery. It is characteristically seen as a thin crescent on the lateral projection of the internal carotid angiogram. Its absence can be an indirect sign of elevated intraorbital or intraocular pressure

Question 28

For questions 48 to 109, match the figure with the most appropriate response 48. The most likely etiology of this neonate's pathology is A. astrocytoma B. metastatic tumor C. Staphyloc~ccuas ureus D. Citrobacter

Answer 28

Jawabannya D CNBR Fig. 3-24A, p. 177. Large neonatal brain abscesses are usually caused by Citrobacter, Bacteroides, hoteus, and various gram-negative bacilli

Question 29

For questions 49 to 54, identify the lesions. 49. A eosinophilic granuloma B. epidermoid cyst C. fibrous dysplasia D. hemangioma E. multiple myeloma F. osteoma

Answer 29

Jawabannya C Burg 3 Fig. 1.1, p. 2. (Courtesy of Dr. John A. Goree, Durham, NC.) Note involvement of the left facial bones.

Question 30

For questions 49 to 54, identify the lesions. 50. A eosinophilic granuloma B. epidermoid cyst C. fibrous dysplasia D. hemangioma E. multiple myeloma F. osteoma

Answer 30

Jawabannya : A Burg Fig. 1.12, p. 5. (Courtesy of Dr. John A. Goree, Durham, NC.) A discrete radiolucent area is seen

Question 31

For questions 49 to 54, identify the lesions. A eosinophilic granuloma 51. B. epidermoid cyst C. fibrous dysplasia D. hemangioma E. multiple myeloma F. osteoma

Answer 31

Jawabannya : D Burg 3 Fig. 1.38, p. 22. The honeycomb pattern is characteristic.

Question 32

For questions 49 to 54, identify the lesions. 52 A eosinophilic granuloma B. epidermoid cyst C. fibrous dysplasia D. hemangioma E. multiple myeloma F. osteoma

Answer 32

Jawabannya : F Burg Fig. 1.52, p. 21. A discrete high-density lesion with smooth contours is seen.

Question 33

For questions 49 to 54, identify the lesions. 53. A eosinophilic granuloma B. epidermoid cyst C. fibrous dysplasia D. hemangioma E. multiple myeloma F. osteoma

Answer 33

Jawabannya : E Burg 3 Fig. 1.90, p. 48. Multiple round discrete lesions are characteristic.

Question 34

For questions 49 to 54, identify the lesions. 54. A eosinophilic granuloma B. epidermoid cyst C. fibrous dysplasia D. hemangioma E. multiple myeloma F. osteoma

Answer 34

Jawabannya : B Burg Fig. 1.96, p. 37. (Courtesy of Dr. John A. Goree, Durham, NC.) The scalloped border and sclerotic rim are characteristic.

Question 35

55. A. hemangioblastoma B. juvenile pilocytic astrocytoma C. cysticercosis D. medulloblastoma

Answer 35

Jawabannya : C CNBR Fig. 3-32B, p. 184. The smooth and thin-walled intraventricular cyst with a mural nodule is classic for cysticercosis.

Question 36

56. A. fetal origin of the posterior cerebral artery B. moyamoya disease C. persistent acoustic artery D. persistent hypoglossal artery E. persistent trigeminal artery

Answer 36

Jawabannya : A CNBR Fig. 1-5. A fetal origin of the posterior cerebral artery from the internal carotid circulation is seen in about 20% of anatomic dissections.

Question 37

57. A. corpus callosum lipoma B. craniopharyngioma C. giant aneurysm D. glioblastoma multiforme E. growing skull fracture

Answer 37

Jawabannya : A CNBR Fig. 3-127A. Peripheral calcification is common in these lipomas.

Question 38

58. A. cysticercosis B. infarct C. low-grade astrocytoma D. mycotic aneurysm E. neurocytoma

Answer 38

Jawabannya A CNBR Fig. 3-32A. A small ring-enhancing lesion surrounded by a zone of low density is typical of cysticercosis.

Question 39

59. A. multifocal glioblastoma multiforme (GBM) B. multiple sclerosis C. metastatic carcinoma D. neurocytoma E. tuberous sclerosis

Answer 39

Jawabannya : E CNBR Fig. 3-176A. Shown are giant-cell subependymal astrocytomas of tuberous sclerosis. These hamartomatous lesions in the subependymal region are sometimes called "candle guttering."

Question 40

60. A. ganglioglioma B. S. aureus C. herpes simplex virus D. lymphoma

Answer 40

Jawabannya : C CNBR Fig. 3-36C, p. 189. The inflammation of the mesial temporal lobe with diffuse edema is most characteristic of herpes encephalitis. There is often associated hemorrhage

Question 41

61. A. aqueductal stenosis B. brainstem astrocytoma C. Chiari malformation D. pituitary tumor E. polymicrogyria

Answer 41

Jawabannya : B CNBR Fig. 3-66A. Diffuse enlargement of the pons is seen.

Question 42

62. A. congestive heart failure B. fever and chills C. headaches D. hemiparesis E. subarachnoid hemorrhage

Answer 42

Jawabannya : C CNBR Fig. 140B. The signal intensity of colloid cysts is variable on either TI- or T2-weighted MRI. Short TI values (hyperintense images) reflect proteinaceous material. These masses arise from the anterior roof of the third ventricle.

Question 43

63. A. arteriovenous malformation (AVM) B. cavernous hemangioma C. CBM D. metastatic carcinoma E. tuberculoma

Answer 43

Jawabannya : B CNBR Fig. 3-235D. The dark halo of decreased signal is caused by iron in hemosiderin in this T2-weighted MRI. This is an almost diagnostic image of a cavernous hemangioma.

Question 44

64. A. astrocytoma B. Chiari malformation C. diskitis D. metastatic disease E. syringomyelia

Answer 44

Jawabannya : A CNBR Fig. 3-267A. The diffuse fusiform widening of the cord with variable signal intensity is consistent with a diffuse or fibrillary astrocytoma.

Question 45

65. associated with all, but a. renal cell carcinoma b. ash-leaf macules c. shagreen pathces d. cardiac rhabdomyoma

Answer 45

Jawabannya A CNBR Fig. 3-53B, p. 207. The enhancing intraventricular mass near the foramen of Monro is a subependymal giant-cell astrocytoma that is associated with tuberous sclerosis. The right ventricular calcified mass is a subependymal tuber. Renal cell carcinoma is associated with von Hippel-Lindau syndrome

Question 46

66. A.astrocytoma B. ependymoma C. meningioma D. myelomeningocele E. tuberculosis

Answer 46

Jawabannya : B CNBR Fig. 3-266. The discrete lobulated appearance of the myxopapillary ependymoma is illustrated. These tumors originate from the conus medullaris or filum terminale

Question 47

67. A. aneurysmal bone cyst B. hemangioma C metastatic disease D. osteomyelitis E. radiation change

Answer 47

jawabannya : B GlT Fig. 85.10, p. 1299. The typical polka-dot appearance of a hemangioma of the vertebral body is seen.

Question 48

68.The most appropriate treatment for a patient with multiple ischemic events and the accompanying angiogram is A. carotid endarterectomy B. encephalomyosynangiosis C heparinization D. superficial temporal artery to middle cerebral artery bypass E. no treatmen

Answer 48

Jawabannnya : C CNBR Fig. 3-200A. The angiogram illustrates a carotid dissection. The internal carotid gradually tapers distal to its origin: the "string sign."

Question 49

69. A. AVM B. low-grade astrocytoma C. multiple sclerosis D. normal CI' E. sagittal sinus thrombosis

Answer 49

Jawabannya : E McKhann Fig. 165. This contrast fl scan illustrates the "empty delta sign" suggestive of sagittal sinus thrombosis. The triangle develops because of enhancement of vascular channels around the occluded sinus

Question 50

70. A. astrocytoma B. arachnoid cyst C. abscess D. metastatic tumor

Answer 50

Jawabannya : B CNBR Fig. 3-142, p. 256. This low-intensity extra-axial mass without surrounding edema is consistent with an arachnoid cyst. The most common location is the middle fossa

Question 51

71. A patient with low back pain only and the accompanying radiograph should undergo (a)? A. a-guided biopsy B. metastatic workup C. multilevel decompressive laminectomy D. radiation therapy E. serum antigen testing

Question 52

72. A. calcified disk herniation B. epidural hematoma C. meningioma D. metastatic tumor E. ossification of the posterior longitudinal ligament

Answer 52

Jawabannya E CNBR Fig. 3-292A. Ossification of the posterior longitudinal ligament is a common cause of cervical myelopathy in patients of Asian descent. Fibrosis and hyperplasia develop initially, followed by calcification. The ossification may be diffuse or localized, and may involve the dura

Question 53

73. A. disk herniation B. diskitis C. ependymoma D. meningioma E. metastatic tumor

Answer 53

Jawabannya : A This postmyelogram CT illustrates a left-sided, partially calcified herniated soft disk.

Question 54

74. A. astrocytoma B. diastematomyelia C. ependymoma D. lipoma E. meningioma

Answer 54

Jawabannya B GIT Fig. 170.4, p. 2587. The split cord malformation and cartilaginous septum can be seen. Patients may present with signs of a tethered cord or kyphoscoliosis

Question 55

75. A. craniopharyngioma B. chordoma C. pituitary adenoma D. Rathke's cleft cyst

Answer 55

Jawabannya : C ## Footnote CNBR Fig. 3-114A, p. 240. The tumor fills and expands the sella and also extends to the suprasellar space. Craniopharyngiomas are more likely to be mainly suprasellar. Rathke's cleft cysts should be cystic, and not usually this large with upward extension (though they may be). Chordomas usually involve more bony invasion of the clivus.

Question 56

76. A. arachnoid cyst B. Dandy-Walker malformation C. epidermoid cyst D. porencephaly E. vein of Calen aneurysm

Answer 56

Jawabannya : B CNBR Fig. 3-15B. A hypoplastic vermis, high transverse sinus, and cystic dilatation of the fourth ventricle are characteristic of the Dandy-Walker malformation.

Question 57

77. A. arachnoid cyst B. ependymoma C. lipomyelomeningocele D. meningioma E. neurenteric cyst

Answer 57

Jawabannya : C CNBR Fig. 3-250. A subcutaneous lipoma that extends into the low-lying tethered spinal cord is seen.

Question 58

78. A. has developmental cysts B. has multiple cafk au lait lesions C. is asymptomatic D. was recently diagnosed with lung cancer E. was thrown from a motorcycle

Answer 58

Jawabannya : E GlT Fig. 190.6, p. 2867. The classic appearance of pseudomeningoceles from lower cervical nerve root avulsion is seen in this myelogram

Question 59

79. A. AVM B. carotid occlusion C. dural AVM D. meningioma E. moyamoya disease

Answer 59

Jawabannya : D CNBR Fig. 3-92. This lateral venous phase angiogram shows the tumor stain of a convexity meningioma.

Question 60

80. A. glioblastoma B. lymphoma C. Fahr's disease D. herpes simplex virus

Answer 60

Jawabannya : B ## Footnote CNBR Fig. 3-138B. pp. 253,293. Bilateral periventricular enhancing masses are most consistent with lymphoma. They usually enhance quite brightly. Fahr's disease is idiopathic basal ganglia calcification and should be low-intensity on MRI. Herpes simplex virus (HSV) infection usually involves the temporal Lobes. Glioblastoma may be multicentric, but this picture is most likely a lymphom

Question 61

81. A. disk herniation B. epidural abscess C. meningioma D. metastatic disease E. radiation change

Answer 61

Jawabannya : B CNBR Fig. 3-273A, B. An epidural infection is iso- or hypointense to the cord on TI-weighted, and hyperintense on R-weighted and proton density unenhanced MRls. With contrast, the solid portion of the abscess or the periphery of a liquid collection enhances

Question 62

82. The lesion shown is associated with A. Ehlers-Danlos disease B. endocarditis C. fibromuscular dysplasia D. radiation therapy E. renal cysts

Answer 62

Jawabannya : E CNBR Fig. 3-99C. Cerebellar hemangioblastomas (tumor stain is seen in this arterial phase) are associated with renal and pancreatic cysts.

Question 63

83. A. dural AVM B. moyamoya disease C. sagittal sinus thrombosis D. subdural hematoma E. vein of Calen aneurysm

Answer 63

Jawabannya E CNBR Fig. 3-231A, B. Lateral basilar angiogram shows early filling of the vein of Galen. Vein of Galen aneurysms usually present with high-output cardiac failure in the neonate. They also may present with hydrocephalus in the infant, or subarachnoid hemorrhage, epilepsy, or mental retardation in the older child (adult).

Question 64

84. A. chordoma B. diskitis C. metastatic disease D. neurofibroma E. normal lumbosacral radiograph

Answer 64

Jawabannya : B CNBR Fig. 3-271A. Erosion of the inferior anterior L5 end plate is noted. Plain film abnormalities in diskitis may not become evident for weeks. They include irregularities of the end plate, loss of disk space height, and bony sclerosis

Question 65

85. A. human immunodeficiency virus (HN) B. glioma C. rapid correction of hyponatremia D. methotrexate toxicity

Answer 65

Jawabannya : C CNBR Fig. 3-183, p. 281. Central pontine myelinolysis is associated with the rapid correction of hyponatremia and usually occurs in malnourished or alcoholic patients

Question 66

86. The etiology of the process shown is A. developmental B. iatrogenic C. infectious D. neoplastic E. traumatic

Answer 66

Jawabannya : A CNBR Fig. 3-255. This CT shows the bony spur of diastematomyelia. Each hemicord is enclosed in its own dural sheath

Question 67

87. A. AVM B. fusiform aneurysm C. misplaced shunt catheter D. schizencephaly E. venous malformation

Answer 67

Jawabannya : E CBNR Fig. 3-237B. A linear or curvilinear structure with a nidus from which emenates numerous small vein is the typical MRI appereance of a venous angioma. The angiographic appereance is that of a caput medusae

Question 68

88. This 8-year-old boy who presented with headaches, nausea and vomiting ismost likely to have a(n) A. astrocytoma B. Dandy-Walker cyst C. hemangioblastoma D. medulloblastoma E. metastatic tumor

Answer 68

Jawabannya : A CBNR fig 3-50D. the brightly enhanching mural nodule in a large cyst is the typical appereance of the cerebella astrocytoma in this age of group. A cerebellar hemangioblastoma, which would be more common in an adult, may also have this appearance on MRI.

Question 69

89. A. acoustic neuroma B. chordoma C. giant-cell tumor D. glomus jugulare E. meningioma

Answer 69

Jawabannya : D GlT Fig. 67.7B, p. 1011. The heterogeneous "salt and pepper" appearance of the glomus jugulare tumor is appreciated. These relatively rare tumors arise from rests of paraganglionic tissue along the jugular bulb. Glomus typanicum tumors occur in the middle ear.

Question 70

90. A. no intervening normal brain B. usually multiple C. often associated with cavernous malformation D. frequently hemorrhage

Answer 70

Jawabannya : C CNBR Fig.3-237A, p. 331. Venous malformations consist of a large draining cortical vein receiving a collection of medullary veins (caput medusae). There usually is intervening normal brain, unlike with arteriovenous malformations (AVMs) and capillary telangiectasias. They are usually single, unlike capillarytelangiectasias. They rarely hemorrhage and are often found along with cavernous malformations.

Question 71

For questions 91 to 99, identify the vessels. Each response may be used once, more than once, or not at all. A. anterior caudate vein B. atrial vein C. basal vein of Rosentha D. internal cerebral vein E. septal vein F. terminal vein G. thalamostriate vein H. vein of Galen I. venous angle 91. structure 1 92. structure 2 93. structure 3 94. structure 4 95. structure 5 96. structure 6 97. structure 7 98. structure 8 99. structure 9

Answer 71

For questions 91-99 see Osb 1 Fig. 11-18, p. 345 Jawabannya : 91. E, 92. A, 93. F, 94. G, 95. B, 96. C, 97. H, 98. D, 99. I.

Question 72

100. A. hemangioblastoma B. lymphoma C. meningioma D. myxopapillary ependymoma E. schwannoma

Answer 72

Jawabannya : C CNBR Fig. 3-264-A. Large schwannomas usually show more heterogeneous contrast enhancement.

Question 73

101. The axial postcontrast MRI shown was obtained in a patient with A. acquired immunodeficiency syndrome (AIDS) B. Chiari malformation C. disk disease D. neurofibromatosis E. severe spinal cord trauma

Answer 73

Jawabannya : A Yock case 1148, p. 702. Cytomegalovirus (CMV) is a frequent cause of polyradiculitis and myelitis in patients with acquired immunodeficiency syndrome (AIDS). The pial enhancement seen is characteristic of this condition.

Question 74

102. A. giant-cell tumor B. osteoblastoma C. aneurysmal bone cyst D. osteoid osteoma

Answer 74

Jawabannya : D CNBR Fig. 3-257, p. 343. The lytic lesion with surrounding sclerosis and a central nidus is classic for osteoid osteoma. These usually present with pain that resolves with aspirin.

Question 75

103. This Post Contrast T1-weighted MRI illustrates? A. abscesses B. gliomatosis cerebri C. metastatic disease D. multiple infarcts E. neurofibromatosis type 2

Answer 75

Jawabannya : E CNBR Fig. 3-175. The bilateral acoustic neuromas and multiple meningiomas are consistent with neurofibromatosis type 2.

Question 76

104. This postcontrast TI -weighted MRI illustrates a(n) A. aneurysm B. colloid cyst C GBM D. meningioma E. metastasis

Answer 76

Jawabannya : D Yock case 47, p. 29. A parafalcine meningioma is shown.

Question 77

105. A. abscess B. artifact C. hemangioblastoma D. infarct E. metastasis

Answer 77

Jawabannya : D Yock case 580, p. 360. A gyriform pattern of contrast enhancement in the distribution of the left anterocerebral artery (ACA) is suggestive of subacute infarction.

Question 78

106. A. aneurysm B. AVM C. infarct D. normal angiogram E. persistent trigeminal artery

Answer 78

Jawabannya : C Osb 1 Fig. 9-38A, p. 283. Occlusion of the central sulcus artery is shown.

Question 79

107. A. type 11 fracture B. usually requires surgery C. requires traction D. treated with external orthosis

Answer 79

Jawabannya : D CNBR Fig. 3-298C Type I11 odontoid fractures usually heal well with an external orthosis (e.g., halo, Somi. Minerva). Type I1 fractures will more often require surgical stabilization, especially if there is more than 6 mm of displacement.

Question 80

108. A. Abcess B. Lyphoma C. Multiple sclerosis D. Periventrikuler leukomalacia E. Tuberus Sclerosis

Answer 80

Jawabannya : B Yock case 434, p. 271. Periventricular involvement by primary central nervous system lymphomas is common.

Question 81

109. A. acute infarction B. chronic subdural hematoma C. epidermoid cyst D. intracranial hypotension E. Sturge-Weber syndrome

Answer 81

Jawabannya : E CNBR Fig. 180C. The layer of enhancement covering the hypoplastic right hemisphere represents the meningeal angioma.