SANS Mei 2013 Flashcards
Sebuah pandangan dari atas menuju bagian anterior dari ventricle tertius ditunjukkan dalam Gambar 1. Lokasi terbaik untuk melakukan third ventriculostomy adalah pada nomor :
A. 8
B. 5
C. 6
D. 9
E. 7
A. 8
This view into the anterior part of the third ventricle exposes the columns of the fornix (1), inferior to the foramen of Monro, and the anterior commissure (2), crossing the anterior wall of the third ventricle in front of the columns of the fornix (1) and just above the lamina terminalis (3). The chiasmatic recess (5) is located between the upper margin of the posterior edge of the optic chiasm (6) and the lamina terminalis (3). The posterior edge of the optic chiasm (6) is located below the chiasmatic recess. The infundibular recess (7) extends into the base of the pituitary stalk, and the mamillary bodies (9) are located above the apex of the basilar artery. An endoscopic third ventriculostomy would be completed at (8), where the floor of the third ventricle is thinnest.
Agen asuransi kesehatan federal termasuk Medicaid dan Medicare telah menentukan standar spesifik untuk pengkodean, penagihan, dan pengembalian medis. di bawah sistem tersebut, tanggung jawab primer untuk penagihan dan pengkodean akurat tergantung kepada :
A. The Surgical Practice Manager
B. The Surgical Coding Specialist
C. The Hospital Billing Department
D. The Operative Surgeon
E. The Hospital Compliance Officer
D. The Operativen Surgeon
The operative surgeon is vested with primary responsible, including legal liability under medicare fraud regulations, for accurate coding and billing. Although some institutions may issue a combined bill for hospital and professional services, adequate procedural documentation, coding and billing are the responsibility of the surgeon for whom services are billed. Similarly, although institutionally-based compliance programs are designed for improvement and oversight of billing accuracy, the existence of such programs does not limit the personal liability of the operating surgeon. The degree to which surgical coding specialists are liable for inaccuracies or fraud is not completely clear. However, surgeons may be held accountable for errors promulgated by coders or other practice personnel engaged in service billing under their supervision.
Pembuluh darah manakah yang paling mungkin untuk menimbulkan kontak patologis dengan nervus trigeminal pada trigeminal neuralgia :
A. Vertebral Artery
B. Anterior Inferior Cerebellar Artery
C. Superior Cerebellar Artery
D. Posterior Inferior Cerebellar Artery
E. Basilar Artery
C. Superior Cerebellar Artery
The superior cerebellar artery lies in close vicinity to the normal trigeminal nerve. In most cases, this is the arterial structure most likely to compress the trigeminal nerve in trigeminal neuralgia. Even in cases where significant ectasia of the vertebral artery or basilar artery can be appreciated on MRI, the superior cerebellar artery continues to be the most likely culprit on exploration.
Seorang laki-laki berusia 16 tahun dengan gejala klinis nyeri kepala, mual, dan penglihatan kabur. Dari pemeriksaan neurologis ditemukan impaired upgaze dan nistagmus konvergen yang signifikan. Contrast-enhanced computed tomography dari otak menunjukkan sebuah lesi pada ventricle tertius bagian posterior, seperti yang ditunjukkan dalam Gambar 1. Serum beta-HCG dan kadar alpha-fetoprotein dalam batas normal. Diagnosis yang paling mungkin adalah :
A. Choriocarcinoma
B. Germinoma
C. Meningioma
D. Endodermal Sinus Tumor
E. Embryonal Carcinoma
B. Germinoma
Pineal region tumors are rare. They may present with hydrocephalus, raised intracranial pressure, and Parinaud syndrome (upward gaze palsy, pupillary dilation with spared convergence constriction, and convergence-retraction nystagmus). The most frequent pineal region tumor which does not alter serum or CSF levels of beta-HCG and alpha-fetoprotein is a germinoma.
Untuk specimen tumor ini, hasil positif pada immunohistochemical stains pada vimentin dalam Gambar 1 dan epithelial membrane antigen (EMA) dalam Gambar 2 merupakan diagnosis untuk :
A. Meningioma
B. Meduloblastoma
C. Metastatic Adenocarcinoma
D. Malignant Melanoma
E. Glioblastoma Multiforme
A. Meningioma
Meningiomas exhibit immunohistochemical features that are consistent with the dual mesenchymal and epithelial nature of their progenitor cells, the arachnoidal cap cells. The principal intermediate filament, present in almost 100% of cases, is vimentin confirming their mesenchymal nature. However, epithelial markers including epithelial membrane antigen (EMA) and cytokeratin are also demonstrated in meningiomas. EMA is seen in the majority of cases but may be focal or less conspicuous in atypical and malignant meningiomas. Cytokeratin epitopes are demonstrated in about 20% of the cases, mainly in the epithelial variants of meningiomas. The combination of vimentin and EMA positivity would not typically be seen in any of the potential diagnoses listed except meningioma.
Pendekatan bedah untuk lesi yang ditunjukkan dalam Gambar 1, yang memiliki resiko paling rendah untuk terjadinya kerusakan saraf adalah :
A. Pterional
B. Far Lateral Suboccipital
C. Orbitozygomatic
D. Midline Suboccipital
E. Presigmoid
B. Far Lateral Suboccipital
This lateral vertebral angiogram demonstrates a small posterior inferior cerebellar artery aneurysm. This lesion can be approached using either a lateral suboccipital craniotomy/craniectomy or a far lateral suboccipital craniotomy/craniectomy, but the latter has been shown to be associated with a reduced incidence of lower cranial nerve palsies. The other approaches listed are inapproapriate. A midline suboccipital craniotomy would give one access to the distal PICA but not the proximal PICA where this aneurysm originates. The orbital zygomatic and pterional craniotomies are useful for aneurysms of the upper basilar artery and anterior circulation aneurysms. The presigmoid craniotomy is useful in gaining access to the mid-basilar artery and while one might see the dome of this aneurysm from a presigmoid approach one would not have proximal vertebral control.
Faktor tunggal apakah yang paling meningkatkan resiko terjadinya ruptur kista arachnoid ?
A. Tempat tinggal yang memiliki altitude tinggi
B. Obesitas
C. Ukuran kista lebih besar dari 5 cm dalam diameter
D. Trauma kepala minor dalam kurun waktu 30 hari
E. Usia lebih dari 18 tahun
D. Trauma kepala minor dalam kurun waktu 30 hari
A history of minor head trauma is the factor that most significantly influences the risk of arachnoid cysts rupture. Enduring a minor head trauma within the past 30 days increases the odds of rupture 25.1 times. An arachnoid cyst with a maximal diameter greater than 5 cm is also more likely to rupture than smaller cysts, with an odds ratio of 16.5. Having a high altitude home residence is not significantly associated with arachnoid cyst rupture nor is obesity. Therefore, the scenario with the greatest overall risk is having a cyst greater than 5 cm in diameter as well as having sustained a minor head trauma within the past 30 days.
Selain untuk memfleksi siku lengan, apakah fungsi lain dari otot biceps ?
A. Abduksi lengan
B. Pronasi
C. Supinasi
D. Extensi lengan
C. Supinasi
The correct answer is supination. The biceps muscle performs both elbow flexion and forearm supination. Based on tendon transfer and nerve reanimation studies, the contribution of the biceps muscle to both these functions is variable. According to several authors, forearm supination is the main function of the biceps musclewhich acts as a secondary muscle in elbow flexion, while the brachialis muscle is the strongest flexor of the elbow. The pronator teres muscle performs forearm pronation. Arm abduction is mainly a deltoid muscle function while arm extension is a triceps function.
Berapakah persentase yang dilaporkan atas kejadian kekambuhan stenosis carotid yang mengikuti carotid endarterectomy (CEA) pada study terkini ?
A. 20-30 %
B. 10-20 %
C. 0-10 %
D. 30-40 %
C. 0-10 %
The rate of recurrent carotid stenosis following carotid endarterectomy is < 10%. In the Carotid Revascularization Endarterectomy vs. Stenting Trial, the rate of restenosis in patients receiving CEA was 6.3% within 2 years of treatment. In modern studies with long term follow up, the rate of restenosis greater than 70% by NASCET criteria has been 0-5%. A recent study by Babu et al. of 1,335 patients undergoing CEA in which 60% were symptomatic, the rate of recurrent stenosis greater than 70% over a mean follow-up of 15.8 years was 0.9%. The improvements in medical care including increased use of antiplatelet agents may be a significant factor in decreased rates of restenosis. In CREST the rate of stenosis in patients receiving CAS was 6.0% at 2 years follow up on duplex ultrasound. A review of the literature indicates that the recurrent stenosis rate post-stenting ranges from 7.5-12.5%. CEA has been found to be a durable long-term treatment of patients with carotid stenosis and further studies to assess the long-term outcomes of patients treated with endovascular stenting are warranted.
