Neurosurgery

Question 1

Visual defect with lesion at the retina

Answer 1

Central scotoma

Question 2

Visual defect of the right optic nerve

Answer 2

(Right) monocular vision loss

Question 3

Visual defect of the optic chiasm

Answer 3

Bitemporal hemianopia

Question 4

Visual defect of the right optic tract

Answer 4

Contralateral (left) homonymous hemianopia

Question 5

Visual defect at brainstem with PCA occulusion

Answer 5

Contralateral homonymous heminanopia

Question 6

Management of ventriculitis

Answer 6

IV Ceftazidime

IV Vancomycin

Question 7

Classification of brain tumours

Answer 7

Supratentorial
Infratentorial
Relates to whether tumour is above or below the tentorium cerebelli

Question 8

Parietal lobe tumours

Gerstmann Syndrome

Answer 8

May see dyspraxia
Agraphia 
Acalculia 
Finger agnosia 
Left-right disorientation

Question 9

Contrast and MRI

Answer 9

Only give contrast in T1 MRI scans

Ventricles appear dark

Question 10

Chemotherapy used 1st line in GBM

Answer 10

Temozolamide

Question 11

2nd line chemotherapy in GBM

Answer 11

PCV - procarbazine, CCNU, vincristine

Question 12

Important investigation in acoustic neuromas

Answer 12

Audiometry/audiology

If hearing is good and tumour small, may not intervene surgically as risk damage and hearing loss

Question 13

Investigations used in germ cell tumours

Answer 13

Alpha fetoprotein
B-HCG
LDH

Question 14

Modern management of hydrocephalus

Answer 14

ETV - endoscopic third ventriculostomy

Question 15

Traditional management of hydrocephalus

Answer 15

VP shunts

Question 16

TACI

Answer 16

Higher cerebral dysfunction
Homonymous visual field defect
Ipsilateral motor and/or sensory deficit to at least 2 areas (face, arms, legs)

Question 17

PACI

Answer 17

Only 2 of the 3 components of TACI

Question 18

Presentation of posterior circulation infarct (4)

Answer 18

Any of the following:
Bilateral motor/sensory deficit 
Isolated homonymous visual field defect 
Ipsilateral cranial nerve palsy with contralateral motor and/or sensory deficit 
Disorder of conjugate eye movement

Question 19

Presentation of a Lacunar Infarct (5)

Answer 19

One of 4 main clinical lacunar syndromes
Pure motor/hemiparesis 
Ataxis hemiparesis 
Dysartria/clumsy hand 
Pure sensory stroke 
Mixed sensorimotor stroke

Question 20

Thrombolysis protocol for stroke

Answer 20

Need to be initiated within 3 hours of symptom onset
Must be within 4.5 hours at most
Dose is 0.9mg/kg up to 90mg: 10% as bolus, rest as infusion

Question 21

Glabellar reflex =

Answer 21

Primitive blink reflex
Tapped on forehead, should stop blinking within 5 times
Associated with frontal lobe pathology

Question 22

Presentation of cervical myelopathy (6)

Answer 22

Hoffmans Sign +VE 
Pain in neck, shoulders and arms 
Weakness in arms
Unable to pick up objects 
Wide based gait 
Positive Babinski/UMN signs

Question 23

Hoffman’s Sign =

Answer 23

Involuntary flexion movement of the thumb and index finger on tapping middle finger nail

Question 24

Management of Subarachnoid Haemorrhage

Answer 24

CT angiogram

Endovascular Coiling

Question 25

Risks with ACDF (4)

Answer 25

Hoarseness
Horner’s Syndrome
Swallowing Difficulties
Failure to Fuse