Neurosurgery Flashcards

Question 1

Q

Identify the follow ing structures. The gure illustrates a right
transcallosal approach to the third ventricle.
1. Caudate nucleus

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 2

Q

identify the follow ing structures. The gure illustrates a right
transcallosal approach to the third ventricle.
2. Choroid plexus

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 3

Q

identify the follow ing structures. The gure illustrates a right
transcallosal approach to the third ventricle.
3. Foram en of Monro

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 4

Q

identify the follow ing structures. The gure illustrates a right transcallosal approach to the third ventricle.
4. Colum ns of the fornix

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 5

Q

identify the follow ing structures. The gure illustrates a right
transcallosal approach to the third ventricle.
5. Septum pellucidum

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 6

Q

identify the follow ing structures. The gure illustrates a right
transcallosal approach to the third ventricle.
6. Thalam ostriate vein

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 7

Q

identify the follow ing structures. The gure illustrates a right
transcallosal approach to the third ventricle.
7. Thalam us

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 8

Q

identify the follow ing structures. The gure illustrates a right
transcallosal approach to the third ventricle.
8. Body of the fornix

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 9

Q

identify the follow ing structures. The gure illustrates a right
transcallosal approach to the third ventricle.
9. Anterior caudate vein

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H
I. I

Question 10

Q

Surgical procedures utilized in the treatm ent of spasm odic torticollis include
I. Upper cervical ventral rhizotom ies and spinal accessory neurectomy
II. Stereotactic thalam otomy
III. Microvascular decom pression of the spinal accessory nerve
IV. Myotomy

Answer

A

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

Question 11

Q

Which surgical approach for thoracic disk herniations is associated w ith the
highest rate of neurologic injury?

A. Costotransversectomy
B. Lateral extracavitary
C. Midline laminectomy
D. Transpedicular
E. Transthoracic

Answer

A

A. Costotransversectomy
B. Lateral extracavitary
C. Midline laminectomy
D. Transpedicular
E. Transthoracic

Question 12

Q

Most patients with intrinsic brainstem gliomas initially present with

A. Cranial neuropathies
B. Headache
C. Hydrocephalus
D. Nausea and vom iting
E. Papilledema

Answer

A

A. Cranial neuropathies
B. Headache
C. Hydrocephalus
D. Nausea and vom iting
E. Papilledema

Question 13

Q

Each of the follow ing is characteristic of com plex regional pain syndrom e II
(causalgia) except

A. Atrophic changes in the lim b
B. Hypesthesia
C. Increased sweating
D. Lack of m ajor m otor de cit
E. Good relief w ith sympathetic block

Answer

A

A. Atrophic changes in the lim b
B. Hypesthesia
C. Increased sweating
D. Lack of m ajor m otor de cit
E. Good relief w ith sympathetic block

Question 14

Q

For questions 14 to 18, match the description w ith the structure
14. Bacterial m eningitis

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Answer

A

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Question 15

Q

match the description w ith the structure.
15. Aseptic m eningitis

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Answer

A

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Question 16

Q

match the description w ith the structure.
16. Associated congenital m alform ations

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Answer

A

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Question 17

Q

match the description w ith the structure.
17. Most often midline

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Answer

A

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Question 18

Q

match the description w ith the structure.
18. Responsive to radiation therapy

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Answer

A

A. Derm oid cyst
B. Epiderm oid cyst
C. Both
D. Neither

Question 19

Q

Ventricular enlargem ent from choroid plexus papillom as can be secondary to
I. Entrapm ent of cerebrospinal uid (CSF)
II. Decreased absorption of CSF from hem orrhage-induced arachnoiditis
III. Tum or grow th
IV. Excessive production of CSF

Answer

A

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

Question 20

Q

Which approach is favored for a patient w ith an 8-m m acoustic neurom a in
w hich hearing preservation is a goal?

A. Middle fossa
B. Suboccipital
C. Translabyrinthine

Answer

A

A. Middle fossa
B. Suboccipital
C. Translabyrinthine

Question 21

Q

Uncinate seizures typically produce

A. Auditory hallucinations
B. Gustatory hallucinations
C. Olfactory hallucinations
D. Vertiginous sensations
E. Visual seizures

Answer

A

A. Auditory hallucinations
B. Gustatory hallucinations
C. Olfactory hallucinations
D. Vertiginous sensations
E. Visual seizures

Question 22

Q

For questions 22 to 25, match the description w ith the structure.
22. Separates the P1 and P2A segm ents of the posterior cerebral artery

A. Calcarine sulcus
B. Lateral m esencephalic sulcus
C. Posterior communicating artery
D. Tectal plate

Answer

A

A. Calcarine sulcus
B. Lateral m esencephalic sulcus
C. Posterior com m unicating artery
D. Tectal plate

Question 23

Q

match the description w ith the structure.
23. Separates the P2A and P2P segm ents of the posterior cerebral artery

A. Calcarine sulcus
B. Lateral mesencephalic sulcus
C. Posterior com m unicating artery
D. Tectal plate

Answer

A

A. Calcarine sulcus
B. Lateral m esencephalic sulcus
C. Posterior com m unicating artery
D. Tectal plate

Question 24

Q

match the description w ith the structure
24. Separates the P2P and P3 segm ents of the posterior cerebral artery

A. Calcarine sulcus
B. Lateral m esencephalic sulcus
C. Posterior com m unicating artery
D. Tectal plate

Answer

A

A. Calcarine sulcus
B. Lateral m esencephalic sulcus
C. Posterior com m unicating artery
D. Tectal plate

Question 25

Q

match the description w ith the structure
25. Separates the P3 and P4 segm ents of the posterior cerebral artery

A. Calcarine sulcus
B. Lateral m esencephalic sulcus
C. Posterior com m unicating artery
D. Tectal plate

Answer

A

A. Calcarine sulcus
B. Lateral m esencephalic sulcus
C. Posterior com m unicating artery
D. Tectal plate

Question 26

Q

The radial nerve or one of its branches innervates each of the follow ing except the

A. Abductor pollicis longus
B. Adductor pollicis
C. Brachioradialis
D. Extensor pollicis brevis
E. Supinator

Answer

A

A. Abductor pollicis longus
B. Adductor pollicis
C. Brachioradialis
D. Extensor pollicis brevis
E. Supinator

Question 27

Q

Each of the follow ing is true of intraventricular hem orrhage (IVH) in the new born except
A. Periventricular hem orrhagic infarction is one sequela.
B. Posthem orrhagic hydrocephalus can result in persistent bradycardia and apneic spells.
C. The capillary bed of the germinal matrix is composed of large irregular vessels.
D. The germ inal matrix is the most common site of IVH in the full-term neonate.
E. The risk of IVH is greater in the preterm than in the term infant.

Answer

A

A. Periventricular hem orrhagic infarction is one sequela.
B. Posthem orrhagic hydrocephalus can result in persistent bradycardia and
apneic spells.
C. The capillary bed of the germ inal m atrix is composed of large irregular
vessels.
D. The germ inal m atrix is the m ost common site of IVH in the full-term neonate.
E. The risk of IVH is greater in the preterm than in the term infant.

Question 28

Q

The ossification centers of the odontoid consist of

A. One prim ary and two secondary centers
B. One secondary and three prim ary centers
C. Three secondary and one prim ary center
D. Two prim ary centers
E. Two prim ary and one secondary center

Answer

A

A. One prim ary and two secondary centers
B. One secondary and three prim ary centers
C. Three secondary and one prim ary center
D. Two prim ary centers
E. Two prim ary and one secondary center

Question 29

Q

The most common single-suture synostosis is
A. Coronal
B. Lam bdoid
C. Metopic
D. Sagittal
E. Sphenozygom atic

Answer

A

A. Coronal
B. Lam bdoid
C. Metopic
D. Sagittal
E. Sphenozygom atic

Question 30

Q

The most sensitive method for detecting carpal tunnel syndrome is
A. Needle examination of the abductor pollicis brevis
B. Needle examination of the rst and second lumbricals
C. Motor amplitude of the median nerve
D. Motor distal latency of the median nerve
E. Palmar sensory conduction tim e of the m edian nerve

Answer

A

A. Needle exam ination of the abductor pollicis brevis
B. Needle examination of the rst and second lumbricals
C. Motor amplitude of the median nerve
D. Motor distal latency of the median nerve
E. Palmar sensory conduction time of the median nerve

Question 31

Q

Coup contusions most commonly occur at the
A. Cerebral convexities
B. Frontal and temporal poles
C. Orbital surface of the frontal lobes
D. Posterior fossa
E. Ventral surface of the temporal lobe

Answer

A

A. Cerebral convexities
B. Frontal and temporal poles
C. Orbital surface of the frontal lobes
D. Posterior fossa
E. Ventral surface of the temporal lobe

Question 32

Q

For questions 32 to 36, match the aneurysm w ith the sign or sym ptom it is m ost likely
to produce. Each response m ay be used once, m ore than once, or not at all.
32. Pupil-involving third nerve palsy

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Answer

A

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Question 33

Q

match the aneurysm w ith the sign or sym ptom it is m ost likely
to produce. Each response m ay be used once, m ore than once, or not at all.
33. Seizures

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Answer

A

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Question 34

Q

match the aneurysm w ith the sign or sym ptom it is m ost likely
to produce. Each response m ay be used once, m ore than once, or not at all.
34. Diabetes insipidus

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Answer

A

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Question 35

Q

match the aneurysm w ith the sign or sym ptom it is m ost likely
to produce. Each response m ay be used once, m ore than once, or not at all.
35. Inferior nasal quadrantanopia

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Answer

A

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalmic artery aneurysm
E. Posterior com m unicating artery aneurysm

Question 36

Q

match the aneurysm w ith the sign or sym ptom it is m ost likely
to produce. Each response m ay be used once, m ore than once, or not at all.
36. Exophthalmos
A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Answer

A

A. Anterior com m unicating artery aneurysm
B. Intracavernous carotid artery aneurysm
C. Middle cerebral artery aneurysm
D. Ophthalm ic artery aneurysm
E. Posterior com m unicating artery aneurysm

Question 37

Q

The essential diference between a syringomyelic and a hydromyelic cavity is
that the cavity in
A. Hydromyelia is lined w ith ependym al cells, and in syringomyelia is not
B. Hydromyelia is lined w ith choroid plexus, and in syringomyelia is not
C. Syringomyelia contains CSF, and in hydromyelia contains serum
D. Syringomyelia is focal, and in hydromyelia is m ore extensive
E. Syringomyelia is an enlargem ent of the central canal, and in hydromyelia is
an enlargem ent of the anterior m edian septum

Answer

A

A. Hydromyelia is lined w ith ependym al cells, and in syringomyelia is not
B. Hydromyelia is lined w ith choroid plexus, and in syringomyelia is not
C. Syringomyelia contains CSF, and in hydromyelia contains serum
D. Syringomyelia is focal, and in hydromyelia is m ore extensive
E. Syringomyelia is an enlargem ent of the central canal, and in hydromyelia is
an enlargem ent of the anterior m edian septum

Question 38

Q

For questions 38 to 45, identify the follow ing structures. The gure illustrates the
structures exposed through the right opticocarotid triangle.
38. Basilar artery

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Question 39

Q

identify the follow ing structures. The gure illustrates the
structures exposed through the right opticocarotid triangle.
39. Pituitary stalk

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Question 40

Q

identify the follow ing structures. The gure illustrates the
structures exposed through the right opticocarotid triangle.
40. Right oculom otor nerve

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Question 41

Q

identify the follow ing structures. The gure illustrates the
structures exposed through the right opticocarotid triangle.
41. Right posterior cerebral artery

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Question 42

Q

identify the following structures. The gure illustrates the
structures exposed through the right opticocarotid triangle.
42. Internal carotid artery

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Question 43

Q

identify the follow ing structures. The gure illustrates the
structures exposed through the right opticocarotid triangle.
43. Left duplicated superior cerebellar artery

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Question 44

Q

identify the follow ing structures. The gure illustrates the
structures exposed through the right opticocarotid triangle.
44. Right superior cerebellar artery

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Question 45

Q

identify the follow ing structures. The gure illustrates the
structures exposed through the right opticocarotid triangle.
45. Right anterior cerebral artery (A1 segm ent)

Answer

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Question 46

Q

Each of the follow ing is true of basilar impression except

A. Cerebellar and vestibular com plaints typically overshadow m otor and
sensory com plaints.
B. McGregor’s line is helpful in routine screening.
C. McRae’s line is helpful in clinical assessm ent.
D. Short necks and torticollis are common.
E. Vertebral artery anom alies are common.

Answer

A

A. Cerebellar and vestibular com plaints typically overshadow m otor and
sensory com plaints.
B. McGregor’s line is helpful in routine screening.
C. McRae’s line is helpful in clinical assessm ent.
D. Short necks and torticollis are com m on.
E. Vertebral artery anom alies are com m on.

Question 47

Q

Which of the follow ing fractures has the poorest prognosis for healing w ithout
surgical intervention?

A. Hangm an’s
B. Je erson’s fracture w ith 4 m m displacem ent of lateral m asses
C. Type I odontoid
D. Type II odontoid
E. Type III odontoid

Answer

A

A. Hangm an’s
B. Je erson’s fracture w ith 4 m m displacem ent of lateral m asses
C. Type I odontoid
D. Type II odontoid
E. Type III odontoid

Question 48

Q

Sprengel’s deform ity refers to a(n)
A. Congenital elevation of the scapula
B. Congenital fusion of the upper cervical vertebrae
C. Intravertebral disk herniation
D. Postlam inectomy kyphosis
E. Scoliosis resulting from tethering of the spinal cord

Answer

A

A. Congenital elevation of the scapula
B. Congenital fusion of the upper cervical vertebrae
C. Intravertebral disk herniation
D. Postlam inectomy kyphosis
E. Scoliosis resulting from tethering of the spinal cord

Question 49

Q

For questions 49 to 55, m atch the fracture type w ith the m echanism . Each response
m ay be used once, m ore than once, or not at all.
Force Neck Posture
49. Hangm an’s fracture
A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Answer

A

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Question 50

Q

m atch the fracture type w ith the m echanism . Each response
m ay be used once, m ore than once, or not at all.
Force Neck Posture
50. Burst fracture
A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Answer

A

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Question 51

Q

m atch the fracture type w ith the m echanism . Each response
m ay be used once, m ore than once, or not at all.
Force Neck Posture
51. Unilateral facet dislocation
A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Answer

A

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Question 52

Q

m atch the fracture type w ith the m echanism . Each response
m ay be used once, m ore than once, or not at all.
Force Neck Posture
52. Teardrop fracture
A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Answer

A

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Question 53

Q

m atch the fracture type w ith the m echanism . Each response
m ay be used once, m ore than once, or not at all.
Force Neck Posture
53. Bilateral facet dislocation
A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Answer

A

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Question 54

Q

m atch the fracture type w ith the m echanism . Each response
m ay be used once, m ore than once, or not at all.
Force Neck Posture
54. Horizontal facet fracture

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Answer

A

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Question 55

Q

m atch the fracture type w ith the m echanism . Each response
m ay be used once, m ore than once, or not at all.
Force Neck Posture
55. Jefferson’s fracture

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Answer

A

A. Flexing exed
B. Com pressing exed
C. Compressing neutral
D. Distracting extended
E. Flexing axially rotated
F. Com pressing laterally bent

Question 56

Q

Lateral recess stenosis in spondylosis is most commonly caused by
A. Disk herniation
B. Hypertrophied pedicles
C. Inferior articular facet hypertrophy
D. Ligam entum avum hypertrophy
E. Superior articular facet hypertrophy

Answer

A

A. Disk herniation
B. Hypertrophied pedicles
C. Inferior articular facet hypertrophy
D. Ligam entum avum hypertrophy
E. Superior articular facet hypertrophy

Question 57

Q

In the treatm ent of chronic pain, the undesirable e ect(s) that is/are m ore
com m on in stim ulation of the periaqueductal gray than the periventricular gray
region is/are
I. Diplopia
II. Oscillopsia
III. Reduction of upgaze
IV. Sense of im pending doom

Answer

A

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

Question 58

Q

“Trilateral retinoblastom a” describes bilateral ocular retinoblastom as and a(n)
A. Astrocytom a
B. Medulloblastom a
C. Neuro brom a
D. Optic nerve sheath tum or
E. Pineoblastoma

Answer

A

A. Astrocytom a
B. Medulloblastom a
C. Neuro brom a
D. Optic nerve sheath tum or
E. Pineoblastoma

Question 59

Q

Carotid artery ligation is absolutely contraindicated in patients w ith (a)
A. Bilateral intracavernous carotid aneurysm s
B. Giant ophthalm ic artery aneurysm and evidence of vasospasm on
arteriogram
C. Giant ophthalm ic artery aneurysm and extracranial atherosclerotic
disease
D. Intracavernous carotid artery aneurysm and sudden loss of extraocular
m otility
E. Traum atic dissecting aneurysm of the petrous carotid artery

Answer

A

A. Bilateral intracavernous carotid aneurysm s
B. Giant ophthalm ic artery aneurysm and evidence of vasospasm on
arteriogram
C. Giant ophthalm ic artery aneurysm and extracranial atherosclerotic
disease
D. Intracavernous carotid artery aneurysm and sudden loss of extraocular
m otility
E. Traum atic dissecting aneurysm of the petrous carotid artery

Question 60

Q

The syndrom e of weakness in one upper extrem ity followed by lower extrem -
ity weakness on the sam e side, then contralateral lower extrem ity weakness, is
m ost characteristic of a m eningiom a involving the

A. Clivus
B. Falx
C. Foramen magnum
D. Olfactory groove
E. Tuberculum sella

Answer

A

A. Clivus
B. Falx
C. Foram en m agnum
D. Olfactory groove
E. Tuberculum sella

Question 61

Q

For questions 61 to 70, the gure illustrates a lateral view of the left cavernous sinus.
Match the follow ing triangles w ith the descriptions/structures. Each response m ay be
used once, m ore than once, or not at all.

Clinoidal segment of the internal carotid artery
A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Question 62

Q

the gure illustrates a lateral view of the left cavernous sinus.
Match the follow ing triangles w ith the descriptions/structures. Each response m ay be
used once, m ore than once, or not at all.

Intracavernous carotid artery
A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Question 63

Q

the gure illustrates a lateral view of the left cavernous sinus.
Match the follow ing triangles w ith the descriptions/structures. Each response m ay be
used once, m ore than once, or not at all.

Intrapetrous carotid artery
A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Question 64

Q

the gure illustrates a lateral view of the left cavernous sinus.
Match the follow ing triangles w ith the descriptions/structures. Each response m ay be
used once, m ore than once, or not at all.

Meningohypophyseal trunk origin
A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer 65

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer 66

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer 67

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer 68

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer 69

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer 70

A

A. Clinoidal
B. Oculom otor
C. Supratrochlear
D. Infratrochlear or Parkinson’s
E. Anterom edial
F. Anterolateral
G. Posterolateral or Glasscock’s
H. Posterom edial or Kawase’s

Answer 71

A

A. Loss of consciousness
B. Absence of third nerve palsy
C. Projection of the aneurysm m edial to the carotid on the anteroposterior
(AP) angiogram
D. Third nerve involvem ent
E. Seizures

Pat ients with posterior communication artery aneurysms who do not have
a third nerve palsy (B) or whose angiogram reveals the aneurysm project ing
laterally to the carotid are m ore likely to have aneurysm domes that are adherent
to the temporal lobe. Choices C and D are incorrect because they contradict
this statement. Neither loss of consciousness (A) nor seizures (E)
predict aneurysm adherence to the temporal lobe

Answer 72

A

A. Axillary nerve
B. Dorsal scapular nerve
C. Musculocutaneous nerve
D. Suprascapular nerve
E. Thoracodorsal nerve

Weakness of the deltoid muscle could be caused by injury to the axillary
nerve (A), which innervates the deltoid. The dorsal scapular nerve (B)
innervates the rhomboid muscles as well as the levator scapulae. The musculocutaneous
nerve (C) innervates the m uscles of the anterior compartment
of the arm including the biceps brachii and the coracobrachialis muscles. The
suprascapular nerve (D) innervates the supraspinatus and infraspinatus
muscles. An injury to the thoracodorsal nerve (E) would cause weakness of
the latissimus dorsi muscle

Answer 73

A

A.Escherichia coli
B.Haemophilus inf uenzae
C.Listeria
D.Neisseria
E.Staphylococcus

E. coli (A) is the m ost common cause of subdural empyema in the infant following
meningit is. Streptococcus pneumoniae meningitis may also lead to
subdural empyemas. Lister ia (C), Neisser ia (D), and St a phylococcu s (E) are
incorrect responses

Answer 74

A

A. Bone
B. Joints
C. Muscle
D. Nerve
E. Skin

The manifestat ions of Sudeck’s at rophy are late changes of re ex sympathetic
dystrophy (CPRS I, RSD). This condition may involve at rophic changes in the
bone (A), joints (B), m uscle (C), and skin (E), but not the nerve (D). The diagnosis
of CRPS I, or re ex sympathet ic dyst rophy, is made only in the absence
of a known nerve injury (in contrast with CRPS II, or causalgia, which requires
a known nerve injury for diagnosis).

Answer 75

A

A. 13
B. 17
C. 22
D. 24
E. 26

Answer 76

A

A. 13
B. 17
C. 22
D. 24
E. 26

Answer 77

A

A. 13
B. 17
C. 22
D. 24
E. 26

Answer 78

A

A. 13
B. 17
C. 22
D. 24
E. 26

Answer 79

A

A. 13
B. 17
C. 22
D. 24
E. 26

Answer 80

A

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

The subclavian steal syndrome is associated with symptoms of vertebrobasilar
insu ciency. It occurs when increased activity of the left arm (III) results
in shunting of blood into the left subclavian that is occluded proximal to the
origin of the left vertebral artery (I). The blood ow in the vertebral artery
is reversed, result ing in part ial brainstem ischemia exacerbated by use of the
left arm. Occlusion of the left subclavian artery distal to the origin of the
left vertebral artery (II) would not cause reversal of ow in the left vertebral
artery, and therefore would not cause subclavian steal syndrome. Occlusion
of the left vertebral artery (IV) might cause symptoms of vertebrobasilar
insu ciency, but this would not be an example of subclavian steal.

Answer 81

A

A. Axially
B. Coronally
C. Obliquely
D. Sagittally

The coronal orientation of the facets in the upper thoracic spine leads to signi
cant resistance to anterior t ranslation but lit tle resistance to rotation. In
the lower thoracic spine, the facets become more sagit tally oriented, and less
resistance to anterior t ranslation is o ered.

Answer 82

A

A. Back pain
B. Leg num bness
C. Leg weakness
D. Thoracic num bness
E. Urinary incontinence

While it is possible for a thoracic disk herniation to cause either thoracic
myelopathy, which may be characterized by leg numbness (B), leg weakness
(C), or urinary incontinence (E); or thoracic radiculopathy, which
could cause thoracic numbness (D); or thoracic pain in a dermatomal distribution,
the most common presenting symptom of a herniated thoracic
disk is back pain (A). Back pain is the presenting complaint of 57 to 88% of
patients with a thoracic herniated disk.

Answer 83

A

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

Occlusion of the thalamostriate vein during the subchoroidal transvelum
interpositum approach to the third vent ricle may result in drowsiness (I),
hemiparesis (II), or mutism (III). Seizures (IV) have not been reported after
the ligation of the thalamostriate vein during this approach.

Answer 84

A

A. A
B. B
C. C
D. D
E. E

Answer 85

A

A. A
B. B
C. C
D. D
E. E

Answer 86

A

A. A
B. B
C. C
D. D
E. E

Answer 87

A

A. A
B. B
C. C
D. D
E. E

Answer 88

A

A. A
B. B
C. C
D. D
E. E

Answer 89

A

A. Anterior, posterior, inferior
B. Anterior, superior, inferior
C. Superior, anterior, posterior
D. Posterior, superior, anterior
E. Anterior, posterior, superior

In the series of Sugita and Kobayashi, the facial nerve was anterior to the
tumor in 50%, superior in 30%, and inferior in 15% of cases

Answer 90

A

A. Axillary freckles
B. Café au lait spots
C. Lisch nodules
D. Multiple, typical skin neuro brom as
E. Skin plaques

Skin plaques (E) are the m ost common skin lesions seen in neuro bromatosis
type 2. They are well-circumscribed, raised, rough areas of skin that may
be associated with excess hair. Axillary freckles (A), café au lait spots (B),
Lisch nodules (C), and multiple typical skin neuro bromas (D) are all characteristics
of neuro bromatosis type 1.

Answer 91

A

A. Age of the patient
B. Bone invasion
C. Histologic type of benign m eningiom a
D. Postoperative tum or residual
E. Sex of the patient

Of the choices available, postoperative tumor residual (D) is the most important
factor in meningioma recurrence. Bone invasion (B) could in uence
recurrence rates as it may limit the extent of tumor resection, part icularly for
lesions at the skull base. Histologic type of benign meningioma (C) is incorrect
because this answer choice implies that the lesion is WHO grade I. Certainly
WHO grade II (atypical) and WHO grade III (anaplastic) meningiomas
have a higher recurrence rate than grade I (benign) lesions, but this is not an
answer choice. Patient age (A) and sex (E) are incorrect responses

Answer 92

A

A. Am bient cistern
B. Cerebellopontine angle cistern
C. Interpeduncular cistern
D. Lateral cerebellom edullary cistern
E. Prepontine cistern

Answer 93

A

A. Am bient cistern
B. Cerebellopontine angle cistern
C. Interpeduncular cistern
D. Lateral cerebellom edullary cistern
E. Prepontine cistern

Answer 94

A

A. Am bient cistern
B. Cerebellopontine angle cistern
C. Interpeduncular cistern
D. Lateral cerebellom edullary cistern
E. Prepontine cistern

Answer 95

A

A. Am bient cistern
B. Cerebellopontine angle cistern
C. Interpeduncular cistern
D. Lateral cerebellom edullary cistern
E. Prepontine cistern

Answer 96

A

A. Am bient cistern
B. Cerebellopontine angle cistern
C. Interpeduncular cistern
D. Lateral cerebellom edullary cistern
E. Prepontine cistern

Answer 97

A

A. Am bient cistern
B. Cerebellopontine angle cistern
C. Interpeduncular cistern
D. Lateral cerebellom edullary cistern
E. Prepontine cistern

Answer 98

A

A. Am bient cistern
B. Cerebellopontine angle cistern
C. Interpeduncular cistern
D. Lateral cerebellom edullary cistern
E. Prepontine cistern

Answer 99

A

A. Cochlear, facial, and superior vestibular nerves from the inferior vestibular
nerve
B. Cochlear and inferior vestibular nerves from the facial and superior vestibular nerves
C. Facial and cochlear nerves from the superior and inferior vestibular nerves
D. Facial, cochlear, and inferior vestibular nerves from the superior vestibular
nerve
E. Facial and inferior vestibular nerves from the cochlear and superior
vestibular nerves

This quest ion tests the examinee’s knowledge of the relationships of the
nerves in the internal acoust ic meatus. Anteriorly, the facial nerve is superior
to the cochlear nerve (“7-up, coke down”). Posteriorly, the superior and
inferior vestibular nerves are related to one another as their names imply.
The transverse crest runs horizontally separating the two superior st ructures
(facial nerve anteriorly and superior vestibular nerve posteriorly) from
the two inferior structures (cochlear nerve anteriorly and inferior vestibular
nerve posteriorly).

Answer 100

A

A. Compression of the facial nerve by the superior cerebellar artery is the
m ost com m on operative nding.
B. Deafness is m ore com m on than perm anent facial weakness as a complication of m icrovascular decom pression.
C. Men are m ore frequently a ected than wom en.
D. Symptom s typically begin in the buccal m uscles and m ove cranially.
E. The cure rate at 1 m onth after m icrovascular decom pression is 95%

Hemifacial spasm is more common in females (C is incorrect); it typically
begins in the orbicularis muscles and progresses caudally (D is incorrect).
At microvascular decompression the most common nding is compression
by the posteroinferior cerebellar artery (PICA) (A is incorrect); the cure rate
at 1 month is 86% (E is incorrect). Deafness occurs in 2.7% of patients, and
permanent facial weakness occurs in 1.5% of pat ients after microvascular
decompression (B is correct).

Answer 101

A

A. Extended extrem e lateral inferior transcondylar approach
B. Lateral suboccipital approach
C. Presigm oid transtentorial approach
D. Retrolabyrinthine transsigm oid approach
E. Subtemporal approach

Possible approaches to an aneurysm of the vertebrobasilar junction include
the extended extreme lateral inferior transcondylar approach (A), the lateral
suboccipital approach (B), the presigmoid transtentorial approach (C),
and the retrolabyrinthine transsigmoid approach (D). The subtemporal approach
(E) is best suited for aneurysms of the upper basilar trunk arising w ithin
2 cm below the tip of the posterior clinoid

Answer 102

A

A. Headache
B. Dem entia
C. Seizures
D. Sudden attacks of leg weakness
E. Sudden death

Headache (A) is the initial symptom in more than 75% of patients with colloid
cysts, and almost all patients with this lesion experience headache. “Drop
attacks,” possibly secondary to acute hydrocephalus that suddenly stretches
corticospinal leg bers (sudden leg weakness [D]), are associated with colloid
cysts. Dementia (B) m ay be prominent, and seizures (C) occur in 20% of
patients. An association with sudden death (E) has been reported.

Answer 103

A

A. A
B. B
C. C
D. D

Answer 104

A

A. A
B. B
C. C
D. D

Answer 105

A

A. A
B. B
C. C
D. D

Answer 106

A

A. A
B. B
C. C
D. D

Answer 107

A

A. Congestive heart failure
B. Hydrocephalus
C. Intracerebral hem orrhage
D. Seizures
E. Subarachnoid hem orrhage

Neonates with congestive heart failure (A) usually have multiple stulas,
and over 25% of their cardiac output is shunted. Hydrocephalus (B) and
seizures (D) are more common in infants, whereas subarachnoid hemorrhage
(E), decreased cognition, and intraparenchymal hemorrhage (C) are
more common in older children and adults.

Answer 108

A

A. Burst fracture
B. Com pression fracture
C. Fracture-dislocation
D. Seat belt injury

This t ype of fracture is generally stable because the middle column is intact ,
by de nition (ut ilizing the three-column spine model). Posterior column
failure can st ill occur, however, if the anterior body height is reduced by more
than half. The resulting kyphotic deformity can lead to neurologic deficit .

Answer 109

A

A. Burst fractures are the m ost com m on.
B. Fracture-dislocations involve all three colum ns.
C. Seat belt type injuries are generally stable.
D. Wedge com pression fractures are generally unstable.
E. Wedge com pression fractures involve the m iddle colum n

Compression fract ures are the most common thoracolumbar spine fract ure
(A is incorrect). Seat belt injuries refer to exion-dist raction t ype injuries that
are often unstable (C is incorrect). Wedge compression fractures generally
involve the anterior column and are usually stable (D and E are incorrect)

Answer 110

A

A. A result of cerebrovascular congestion
B. A result of cytotoxic edem a
C. Associated w ith a 50% m ortality rate in children w ith severe head injuries
D. Manifested on computed tom ography (CT) scan by a com pression of the
perim esencephalic cistern
E. More com m on in children than in adults

Diffuse brain swelling is a vasoactive post traumatic phenomenon occurring
within hours of head injury. It is thought to be a result of cerebrovascular
congestion (A) and can be m anifested on CT scan by a compression of the
perimesencephalic cistern (D). This pathologic process is more common in
children than adults (E), and may be associated with a 50% mortality rate
in severely head injured children (C). It is distinct from the vasogenic or
cytotoxic edema (B) that occurs later.

Answer 111

A

A. Acute and healing long bone fractures
B. Interhem ispheric subdural hem atom a
C. Parietal skull fracture
D. Retinal hem orrhages
E. Tentorial subdural hem atom a

Of the choices listed, an isolated parietal skull fracture (C) is the least suggestive
of child abuse, or nonaccidental t rauma. Acute and healing long bone
fractures (A), retinal hemorrhages (D), and the presence of subdural hematomas
(B and E) should be t reated as nonaccidental trauma until proven
otherwise. When associated with abuse, skull fractures tend to be multiple or
complex, depressed, and nonparietal.

Answer 112

A

A. Coronal suture bilaterally
B. Coronal suture unilaterally
C. Frontosphenoidal suture
D. Lam bdoid suture
E. Metopic suture

Premature closure of the metopic suture (E) results in trigonocephaly. The
incidence of trigonocephaly ranges from 10 to 16%.7

Answer 113

A

A. Cervical region
B. Lum bar region
C. Sacral region
D. Thoracic region

The cleft is located in the lumbar region (B) in 47%, thoracolumbar region
in 27%, thoracic region (D) in 23%, and sacral (C) or cervical region (A) in
1.5% of cases.3

Answer 114

A

A. 10%
B. 20%
C. 40%
D. 60%
E. 80%

Up to 80% of patients with mycotic aneurysms carry an underlying diagnosis
of subacute bacterial endocarditis

Answer 115

A

A. Infected em boli lodge in the vasa vasorum .
B. The m iddle cerebral artery is m ost com m only a ected.
C. The peripherally located branches are m ost com m only a ected.
D. Typical subarachnoid hem orrhage occurs in 18% of patients.
E. Staphylococcus aureus and b-hem olytic streptococci are m ost com m only
involved.

Bacterial (mycot ic) int racranial aneurysms are t ypically located in the peripheral
branches (C) of the middle cerebral artery territory (B). St a phylococcu s
aureus and b-hemolytic streptococci species (E) are the m ost common offending
agents. The observat ion that vasa vasorum are found only on the rst
segment of the internal carotid artery (ICA), an unusual site of the development
of bacterial aneurysms, has discredited the notion that infected emboli
lodge in the vasa vasorum (A). Although these aneurysms have a high tendency
to bleed, typical subarachnoid hemorrhage occurs in less than 20%
of patients (D).

Answer 116

A

A. Can cross suture lines
B. May be associated w ith underlying brain injury
C. Occur if the edges of the initial fracture are separated by m ore than 3 m m
D. Occur m ost com m only in the parietal bone
E. Occur m ost com m only between the ages of 2 and 5 years

Growing skull fractures may cross suture lines (A), may be associated with
an underlying brain injury (B), tend to occur if the initial fracture is separated
by more than 3 mm (C), and occur most commonly in the parietal
bone (D). Up to 75% of patients with growing skull fractures are , 1 year old
(E is false, and therefore the correct answer choice).7

Answer 117

A

A. 20%
B. 40%
C. 60%
D. 80%
E. 100%

One hundred percent (E) of infants with myelomeningocele have MRI
evidence of a Chiari II malformation, the mechanism of which is thought to
be due to CSF leaking through the myelomeningocele during development.

Answer 118

A

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

Cholesterol emboli (I) (Hollenhorst plaques) are associated with ulcerated
atheromatous plaques of the ICA. Calci c emboli (II) originate from the cardiac
valves. Platelet- brin emboli (III) are thought to arise from large-vessel
mural thrombi. Fat emboli (IV) result after trauma to marrow-containing
bones and therefore are not due to cardiovascular disease of the heart and
great vessels.4

Answer 119

A

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

The superior vermian vein (I) and precentral cerebellar vein (III) are usually
sacri ced during the infratentorial supracerebellar approach to the pineal
region. The basal vein of Rosenthal (IV) and posterior pericallosal vein (II)
are not sacri ced during this approach

Answer 120

A

A. Békésy type III or IV audiogram
B. Loudness recruitm ent
C. Low short-increm ent sensitivity index
D. Poor speech discrim ination
E. Pronounced tone decay

An absence of loudness recruitment (B is incorrect) is characterist ic of a
nerve t runk lesion, including an acoustic neuroma. Recruiting deafness
occurs with a lesion in the organ of Corti (e.g., Ménièreʼs disease). The other
responses (Békésy type III or IV audiogram [A], low short-increment
sensitivity index [C], poor speech discrimination [D], and pronounced
tone decay [E]) are all characteristic of a retrocochlear (nerve) lesion such as
an acoustic neuroma

Answer 121

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H (Not labeled)

Answer 122

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H (Not labeled)

Answer 123

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H (Not labeled)

Answer 124

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H (Not labeled)

Answer 125

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H (Not labeled)

Answer 126

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H (Not labeled)

Answer 127

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H (Not labeled)

Answer 128

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H (Not labeled)

Answer 129

A

A. Dentate ligam ent
B. Dorsal root entry zone
C. Posterior interm ediate sulcus
D. Posterior m edian sulcus
E. Zone of Lissauer

The dentate ligament (A) is a paired structure that is an extension of pia
that connects the lateral aspect of the spinal cord to the dura bilaterally—
it marks the most dorsal extent of the incision for anterolateral cordotomy,
a funct ional procedure for chronic pain. Lesioning at the dorsal root entry
zone (B) is a useful technique particularly in cases of pain related to nerve
root avulsion. The posterior intermediate sulcus (C) separates the fasciculus
gracilis from the fasciculus cuneatus. The posterior median sulcus (D) runs
in the dorsal midline separat ing the right and left dorsal columns. A erent
pain bers enter the spinal cord and may ascend or descend up to three spinal
levels in the zone of Lissauer (E) prior to terminating in the dorsal horn

Answer 130

A

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

The anterior choroidal artery is an intracranial branch of the internal carotid
artery that comes o the ICA just distal to the origin of the posterior communicating
artery. The anterior choroidal artery can be thought of as the most
medial of the lateral lenticulostriate arteries, supplying the globus pallidus
interna, the posterior limb of the internal capsule, and the optic tract. Occlusion
of the anterior choroidal artery may lead to contralateral hemiplegia (I),
hemihypesthesia (II), and a homonymous hemianopsia (III). Cognitive
function (IV) is unimpaired after occlusion of the anterior choroidal artery

Answer 131

A

E. Tremor

The symptom of Parkinson’s disease that is most likely to respond to a stereotact
ic lesion of the VIM of the thalamus is tremor (E)

Answer 132

A

A. Apert’s syndrom e
B. Crouzon’s disease
C. Both
D. Neither

Answer 133

A

A. Apert’s syndrom e
B. Crouzon’s disease
C. Both
D. Neither

Answer 134

A

A. Apert’s syndrom e
B. Crouzon’s disease
C. Both
D. Neither

Answer 135

A

A. Apert’s syndrom e
B. Crouzon’s disease
C. Both
D. Neither

Answer 136

A

A. Apert’s syndrom e
B. Crouzon’s disease
C. Both
D. Neither

Answer 137

A

A. Prim ary empt y sella syndrom e
B. Secondary empty sella syndrom e
C. Both
D. Neither

Answer 138

A

A. Prim ary empt y sella syndrom e
B. Secondary empty sella syndrom e
C. Both
D. Neither

Answer 139

A

A. Congenital
B. Iatrogenic
C. Infectious
D. Neoplastic
E. Traumatic

Os odontoideum is a segment of odontoid that is well-corticated and is not
fused with the body of the dens. The condition may be congenital (A) or
traumatic (E); trauma is the more common cause

Answer 140

A

A. Axial loading
B. Distraction
C. Extension
D. Flexion

Translat ional C1–C2 sublu xat ion is associated with exion (D) injuries, rheumatoid
arthritis, and tonsillitis (Grisel’s syndrome).

Answer 141

A

A. Bilirubin
B. Endothelin
C. Intim al proliferation
D. Lipid peroxides
E. Oxyhem oglobin

While the mechanism of cerebral vasospasm has yet to be elucidated, studies
indicate that intimal proliferation (C) is too m ild and occurs too long after
subarachnoid hemorrhage to play a signi cant role in vasospasm

Answer 142

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 143

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 144

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 145

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 146

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 147

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 148

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 149

A

A. Type I spinal AVMs
B. Type II spinal AVMs
C. Type III spinal AVMs
D. Type IV spinal AVMs
E. Types II and III spinal AVMs

Answer 150

A

A. Type I spinal AVMs
B. Type II spinal AVMs
C. Type III spinal AVMs
D. Type IV spinal AVMs
E. Types II and III spinal AVMs

Answer 151

A

A. Type I spinal AVMs
B. Type II spinal AVMs
C. Type III spinal AVMs
D. Type IV spinal AVMs
E. Types II and III spinal AVMs

Answer 152

A

A. Type I spinal AVMs
B. Type II spinal AVMs
C. Type III spinal AVMs
D. Type IV spinal AVMs
E. Types II and III spinal AVMs

Answer 153

A

A. Type I spinal AVMs
B. Type II spinal AVMs
C. Type III spinal AVMs
D. Type IV spinal AVMs
E. Types II and III spinal AVMs

Answer 154

A

A. Type I spinal AVMs
B. Type II spinal AVMs
C. Type III spinal AVMs
D. Type IV spinal AVMs
E. Types II and III spinal AVMs

Answer 155

A

A. Type I spinal AVMs
B. Type II spinal AVMs
C. Type III spinal AVMs
D. Type IV spinal AVMs
E. Types II and III spinal AVMs

Answer 156

A

C. External carotid, common carotid, internal carotid

The correct sequence of removal of clamps from the arteries following carotid
endarterectomy is the external carotid artery first, followed by the common
carotid artery, with the removal of the clamp from the internal carotid artery
last. This sequence ensures that any embolic material will be ushed into the
external carotid circulation

Answer 157

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 158

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 159

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 160

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 161

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 162

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 163

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G

Answer 164

A

A. A
B. B
C. C
D. D
E. E

Answer 165

A

A. A
B. B
C. C
D. D
E. E

Answer 166

A

A. A
B. B
C. C
D. D
E. E

Answer 167

A

A. A
B. B
C. C
D. D
E. E

Answer 168

A

A. A
B. B
C. C
D. D
E. E

Answer 169

A

A. A
B. B
C. C
D. D
E. E
F. F

Answer 170

A

A. A
B. B
C. C
D. D
E. E
F. F

Answer 171

A

A. A
B. B
C. C
D. D
E. E
F. F

Answer 172

A

A. A
B. B
C. C
D. D
E. E
F. F

Answer 173

A

A. A
B. B
C. C
D. D
E. E
F. F

Answer 174

A

A. A
B. B
C. C
D. D
E. E
F. F

Answer 175

A

A. Duration of symptom s
B. Leptom eningeal venous drainage
C. Location
D. Presentation
E. Size

The risk of hemorrhage of dural AVMs seems related to the presence of
tortuous and aneurysmal leptomeningeal arterialized veins

Answer 176

A

A. Brom ocriptine
B. Brom ocriptine, then surgery
C. Follow w ith serial MRIs
D. Radiation therapy
E. Surgery

Answer 177

A

A. Bromocriptine
B. Follow w ith serial MRIs and prolactin levels
C. Radiation therapy
D. Surgery
E. Surgery, then radiation therapy

Answer 178

A

A. Intraventricular
B. Olfactory groove
C. Posterior fossa
D. Sphenoid ridge
E. Tuberculum sella

Lateral ventricular meningiomas account for 1 to 2% of intracranial meningiomas.
Olfactory groove (B), posterior fossa (C), sphenoid ridge (D), and
tuberculum sella (E) are all m ore common locat ions.

Answer 179

A

A. Higher pressures have been m easured in the feeding arteries of sm aller as
com pared w ith larger AVMs.
B. Sm aller AVMs are m ore likely to bleed than larger AVMs.
C. The annual risk of death from a ruptured AVM is 1%.
D. The risk of bleeding from an unruptured AVM is 3 to 4% a year.
E. The risk of rebleed in the rst year after hem orrhage is highest in the rst
2 weeks.

The risk of rebleed from an AVM in the rst year after hemorrhage is as high
as 6 to 18%, but this risk is evenly dist ributed throughout the rst year.2

Answer 180

A

A. Anesthesia dolorosa
B. Decreased hearing
C. Keratitis
D. Masticatory weakness
E. Paresthesias or dysesthesias

Paresthesias (E) occur in 20% of postoperative patients; dysesthesias (E)
occur in 5.2 to 24.2%.2

Answer 181

A

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

In the technique of percutaneous radiofrequency t rigeminal gangliolysis, the
needle is inserted into the trigeminal cistern (II) via the foramen ovale (IV).
The foramen rotundum (I) does t ransmit the maxillary division of the trigeminal
nerve, but is not used in this procedure. The foramen spinosum (III)
transmits the middle meningeal artery and is not used in percutaneous trigeminal
gangliolysis

Answer 182

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Answer 183

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Answer 184

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Answer 185

A

**A. A **
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Answer 186

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Answer 187

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Answer 188

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Answer 189

A

A. A
B. B
C. C
D. D
E. E
F. F
G. G
H. H

Answer 190

A

A. Cingulotomy
B. Dorsal root entry zone (DREZ) rhizotomy
C. Morphine infusion
D. Pallidotomy
E. Sym pathectomy
F. Ventral rhizotomy

Answer 191

A

A. Cingulotomy
B. Dorsal root entry zone (DREZ) rhizotomy
C. Morphine infusion
D. Pallidotomy
E. Sym pathectomy
F. Ventral rhizotomy

Answer 192

A

A. Cingulotomy
B. Dorsal root entry zone (DREZ) rhizotomy
C. Morphine infusion
D. Pallidotomy
E. Sym pathectomy
F. Ventral rhizotomy

Answer 193

A

A. Cingulotomy
B. Dorsal root entry zone (DREZ) rhizotomy
C. Morphine infusion
D. Pallidotomy
E. Sym pathectomy
F. Ventral rhizotomy

Answer 194

A

A. Cingulotomy
B. Dorsal root entry zone (DREZ) rhizotomy
C. Morphine infusion
D. Pallidotomy
E. Sym pathectomy
F. Ventral rhizotomy

Answer 195

A

A. Cingulotomy
B. Dorsal root entry zone (DREZ) rhizotomy
C. Morphine infusion
D. Pallidotomy
E. Sym pathectomy
F. Ventral rhizotomy

Answer 196

A

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

These options (intercostal nerves, spinal accessory nerves, cervical plexus,
and phrenic nerve) have all been used with varying degrees of success. Intercostal
nerves are most commonly used for neurotizat ion procedures involving
the upper extremity

Answer 197

A

A. Frontal, greater w ing of the sphenoid, parietal, and squam ous part of the temporal
B. Frontal, lesser w ing of the sphenoid, parietal, and squam ous part of the
temporal
C. Frontal, greater w ing of the sphenoid, parietal, and zygom atic arch
D. Frontal, lesser w ing of the sphenoid, parietal, and zygom atic arch
E. Frontal, lesser w ing of the sphenoid, squam ous part of the tem poral, and
zygom atic arch

B is incorrect; the lesser wing of the sphenoid does not contribute to the
pterion. C is incorrect; the zygomat ic arch does not contribute to the pterion.
D and E are incorrect because neither the lesser w ing of the sphenoid nor the
zygomat ic arch contributes to the pterion

Answer 198

A

A. 30 Gy in 2 weeks
B. 30 Gy in 4 weeks
C. 60 Gy in 2 weeks
D. 60 Gy in 4 weeks
E. 45 Gy in 4 weeks

The most common external beam radiation therapy regimen for brain metastasis
is 30 Gy given over 2 weeks (A).

Answer 199

A

A. 8,000 cGY in 400 cGY daily fractions
B. 6,000 cGY in 200 cGy daily fractions
C. 6,000 cGy in 100 cGy daily fractions
D. 4,000 cGy in 400 cGy daily fractions
E. 4,000 cGy in 200 cGy daily fractions

The most appropriate radiat ion protocol for glioblastoma is 6,000 cGy in
200 cGy daily fractions (B).

Answer 200

A

A. Plasm a arginine vasopressin (AVP)
B. Serum osm olality
C. Serum sodium
D. Urine sodium
E. Volum e status

Pat ients with cerebral salt wasting are volume depleted, whereas those with
syndrome of inappropriate antidiuretic hormone (SIADH) are euvolemic or
volume expanded

Answer 201

A

A. ASIA A
B. ASIA B
C. ASIA C
D. ASIA D
E. ASIA E

The ASIA impairment scale is used for the grading of acute spinal cord injuries.
ASIA A (A) represents a complete spinal cord injury with no sensory or m otor
sparing in the sacral dermatomes. ASIA B (B) corresponds to a sensory incomplete
spinal cord injury, with sparing of sensat ion but not motor function distal
to the level of injury—this may include sensation in the sacral dermatomes
only (perianal sensat ion or deep anal pressure). ASIA C (C) represents m otor
incomplete injuries where . 50% of the muscles below the level of injury have
, grade 3 power—such as the patient in the vignet te. ASIA D (D) is ascribed
to patients with grade 3 power in . 50% of the m uscle groups below the
neurologic level. ASIA E (E) corresponds to pat ients who have sustained a
documented spinal cord injury, but are now neurologically intact.

Answer 202

A

A. , 3%
B. 50%
C. 75%
D. 95%
E. 100%

The ASIA impairment scale can help to predict ambulatory outcomes. The
patient in the quest ion stem has an ASIA C spinal cord injury. Please see the
table below.14
Grade % Ambulatory
A ,3
B 50
C 75
D 95
E 100

Answer 203

A

A. CAG trinucleotide repeat
B. m TOR ampli cation
C. p53 deletion
D. PTEN m utation
E. Trisomy 21

The diagnosis for the patient in the question stem is Cowden’s syndrome,
which is characterized by facial trichilemmomas, bromas of the oral mucosa,
hamartomas of the GI tract and breast , and thyroid tumors. There is
also an association with Lhermit te-Duclos disease, a hamartomatous lesion
of the cerebellum. Cowden’s disease is due to mutations of the PTEN gene
on chromosome 10q (D). CAG trinucleotide repeats (A) are associated w ith
Hunt ington’s disease. The mTOR pathway (B) has been implicated in the
pathogenesis of tuberous sclerosis. Germline mutations of p53 (C) are seen
in the Li-Fraumeni syndrome. Trisomy 21 (E) is seen in Down’s syndrome

Answer 204

A

A. Major lum bar dextroscoliosis and m inor
thoracic levoscoliosis
B. Major lum bar levoscoliosis and m ajor
thoracic dextroscoliosis
C. Major lum bar levoscoliosis and m inor
thoracic dextroscoliosis
D. Minor lum bar dextroscoliosis and m ajor
thoracic levoscoliosis
E. Minor lum bar levoscoliosis and m ajor
thoracic dextroscoliosis

The curve is named based on the direction of the convexit y of the curve. If the
convexity of the curve is to the right, it is labeled dextroscoliosis. If the convexity
of the curve is to the left, it is labeled levoscoliosis (A and D are incorrect).
The major and minor curves are determined by the Cobb angles; the curve
with the larger Cobb angle is the major curve. Conversely, the curve with the
smaller Cobb angle is the minor curve (E is incorrect). In this case, the thoracic
curve has its convexity pointed to the right with a Cobb angle of 33 degrees.
The lumbar curve has its convexit y pointed to the left and has a Cobb angle of
48 degrees. Therefore, the best description is choice C, major lumbar levosco -
liosis and minor thoracic dextroscoliosis.

Answer 205

A

A. Iliohypogastric nerve
B. Ilioinguinal nerve
C. Lateral fem oral cutaneous nerve
D. All of the above
E. None of the above

Iliac crest bone graft is harvested from a point at least 3 cm behind the anterior
superior iliac spine to avoid ilioinguinal ligament disruption. Nerves at risk
during this procedure (from lateral to medial) include the iliohypogastric (A),
ilioinguinal (B), and lateral femoral cutaneous nerves (C). The correct answer
is D, all of the above.

Answer 206

A

A. Aching along the m edial proxim al forearm
B. “Claw ” hand
C. Paresthesias in an ulnar distribution
D. Sparing of dorsal hand sensation
E. Weakness of the third and fourth lum bricals

A sensory de cit over the dorsoulnar aspect of the hand is seen in ulnar
nerve compression at the elbow. With ulnar nerve compression at the wrist in
Guyon’s canal, this dorsal sensation is spared as the dorsal sensory branch of
the ulnar nerve branches o proximal to the wrist. Therefore, D is the correct
response. The other features can be seen in ulnar nerve compression at the
elbow or the wrist

Answer 207

A

A. Acronym for “spinal cord injury without radiographic abnormality”
B. More common in children
C. MRI is always unremarkable
D. No evidence of spinal fracture is seen
E. Thought to be due to ligamentous laxity

SCIWORA refers to spinal cord injury without radiographic abnormality (A)
and is more often seen in the pediatric population (B). Pat ients will present
with signs and symptoms of spinal cord injury without radiographic (X-ray
or CT) evidence of a fracture (D). SCIWORA was rst described before MRI
was rout inely used in the evaluat ion of spine trauma, and the mechanism is
thought to be related to ligamentous laxity in children (E). MRI scans in children
with SCIWORA may reveal disruption of the discoligamentous complex
and injury to the cord itself (C is false).

Answer 208

A

A. C-collar immobilization
B. No treatment
C. Occiput to C2 posterior fusion
D. Odontoid screw placement
E. Posterior C1–C2 instrumented fusion

Type II odontoid fractures have a high rate of nonunion, and therefore, surgical intervention
is usually recommended (A and B are incorrect). Generally, odontoid
screw placement (D) and posterior C1– C2 fusion (E) either w ith transarticular
screws or a screw/rod construct are acceptable options. In this case, the transverse
ligament is disrupted, which is a contraindication to odontoid screw placement
(the patient would have ongoing atlantoaxial instability even if the odontoid was
stabilized due to ligamentous disruption between the dens and C1). Therefore, a
posterior C1– C2 fusion (E) is the most appropriate treatment for this patient.
Inclusion of the occiput would be unnecessary and introduces additional complexity
and morbidity to the procedure (C is incorrect).

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