Section 1 Flashcards
According to Brodmann’s map of the cytoarchitectonic fields of the human brain, which of the following is Broca’s area (motor speech area)?
A. 41
B. 42
C. 43
D. 44
E. 45
D. 44
According to Brodmann’s map of the cytoarchitectonic fields of the human brain, which of the following is Wernicke’s area?
A. 40
B. 41
C. 42
D. 43
E. 44
A. 40
Which of the following Brodmann’s area is the precentral gyrus, the primary motor cortex consisting of a large concentration of giant pyramidal cells of Betz?
A. 4
B. 6
C. 8
D. 10
E. 12
A. 4
The junction of lambdoid, occipitomastoid, and parietomastoid sutures is:
A. Nasion
B. Glabella
C. Stephanion
D. Asterion
E. Lambda
D. Asterion
The junction of coronal suture and superior temporal line is also labeled as:
A. Nasion
B. Glabella
C. Stephanion
D. Asterion
E. Lambda
C. Stephanion
Taylor-Haughton (T-H) lines can be constructed on an angiogram, CT/MRI scout film, or skull X-ray. They can be constructed on the patient in the OR based on visible external landmarks. A line from inferior margin of orbit through the upper margin of the external auditory meatus (EAM) is:
A. Frankfurt plane
B. Reid’s baseline
C. Condylar line
D. Sylvian fissure line
E. Central sulcal line
A. Frankfurt plane
Numerous methods utilize external landmarks to locate the motor strip (pre-central gyrus) or the central sulcus (Rolandic
fissure) which separates motor strip anteriorly from primary sensory cortex posteriorly. About how far the motor strip usually lies behind the coronal suture?
A. 3 cm
B. 5 cm
C. 8 cm
D. 10 cm
E. Lies anterior to coronal suture
B. 5 cm
For non-hydrocephalic ventricles, what is the average length
of third ventricles?
A. 0.6 cm
B. 1.2 cm
C. 2.8 cm
D. 4 cm
E. 5 cm
C. 2.8 cm
To access the potential recipient vessels in the angular gyrus for EC/IC bypass surgery, a 4 cm craniotomy should be performed, and it should be centered around:
A. Reid’s line
B. Condylar line
C. Chater’s point
D. Mastoid notch
E. Zygomatic arch
C. Chater’s point
Regarding estimates of spinal levels for spine surgery, at
what level is the inferior scapular pole posteriorly?
A. C6
B. T2
C. T4
D. T6
E. T10
D. T6
Regarding cranial foramina and their contents, middle meningeal artery and vein pass through which of the following?
● A. Cribriform plate
● B. Optic canal
● C. Foramen rotundum
● D. Foramen ovale
● E. Foramen spinosum
E. Foramen spinosum
Regarding estimates of spinal levels for spine surgery, at what level is the carotid tubercle anteriorly?
A. C6
B. T2
C. T4
D. T6
E. T10
A. C6
Which of the following is not a content of porus acusticus?
● A. Facial nerve
● B. Nervus intermedius
● C. Acoustic portion of vestibulocochlear nerve
● D. Superior branch of vestibular nerve
● E. Glossopharyngeal nerve
E. Glossopharyngeal nerve
What is the average length of frontal horn anterior to foramen of Monro?
● A. 1 cm
● B. 1.5 cm
● C. 2.5 cm
● D. 4 cm
● E. 5 cm
C. 2.5 cm
What is the average length of the fourth ventricle at the level of fastigium?
● A. 0.8 cm
● B. 1.4 cm
● C. 2.2 cm
● D. 2.5 cm
● E. 3 cm
B. 1.4 cm
Regarding the vascular supply of internal capsule, all of the retrolenticular part including optic radiation and ventral part
of posterior limb of internal capsule are supplied by which of the following?
● A. Anterior choroidal artery
● B. Lateral striate branches
● C. Direct distal branches of internal carotid artery
● D. Terminal branches of middle meningeal artery
● E. Paramedian artery
A. Anterior choroidal artery
What are the most important structures in maintaining atlantooccipital stability, without which the remaining cruciate ligament and apical dentate ligament are insufficient?
● A. Tectorial membrane and alar ligament
● B. Descending bands of cruciate ligament
● C. Ascending bands of cruciate ligaments
● D. Anterior and posterior atlantal ligaments
● E. Anterior and posterior atlantooccipital membranes
A. Tectorial membrane and alar ligament
Flexor muscle tone is a function of which descending motor tracts of spinal cord?
● A. Anterior corticospinal tracts
● B. Lateral corticospinal tracts
● C. Rubrospinal tract
● D. Vestibulospinal tracts
● E. Medullary reticulospinal tracts
C. Rubrospinal tract
Sensory pain and temperature are the function of which ascending tract?
● A. Fasciculus gracilis
● B. Posterior spinocerebellar tract
● C. Anterior spinocerebellar tract
● D. Anterior spinothalamic tract
● E. Lateral spinothalamic tract
E. Lateral spinothalamic tract
The receptors for pain and temperature are probably free nerve endings. The 1st order neurons enter the cord at dorsolateral tract (zone of Lissauer) and synapse in substantia gelatinosa that is equivalent to which Rexed lamina?
● A. I
● B. II
● C. III
● D. IV
● E. V
B. II
Brodmann’s area 44 in dominant hemisphere (motor speech area) is known as what?
● A. Wernicke’s area
● B. Angular gyrus area
● C. Supramarginal area
● D. Broca’s area
● E. Frontal eye field area
D. Broca’s area
The most prominent paired grooves on CT or MRI of brain which is posterior to the widest biparietal diameter in midline is known as what?
● A. Pars opercularis
● B. Pars triangularis
● C. Pars orbitalis
● D. Pars marginalis
● E. Pars terminalis
D. Pars marginalis
What is the significance of Wernicke’s area in dominant hemisphere which comprises Brodmann’s area 40 and 39?
● A. Motor speech
● B. Voluntary eye movements
● C. Speech and language
● D. Auditory function
● E. Visual function
C. Speech and language
The line connecting anterior commissure and posterior commissure (AC–PC line) has following characteristics except?
● A. It is used as baseline for axial MRI of brain
● B. It is used in functional neurosurgery
● C. Orbitomeatal line is 9 degrees steeper than the AC–PC line
● D. AC and PC are white matter tracts that help identify this line
● E. It is also called as Frankfurt’s plane
E. It is also called as Frankfurt’s plane
Homunculus is somatotopic organization of sensory and motor cortex on the brain representing which of the following?
● A. Arm and face are represented on upper medial surface
● B. Foot and leg are represented on convexity of brain
● C. Arm and face are represented by the convexity of brain
● D. Foot and leg are represented on upper medial surface
● E. Both C and D
E. Both C and D
Where is the central sulcus located at interhemispheric fissure?
● A. Anterior to pars marginalis
● B. Lateral to pars marginalis
● C. Posterior to pars marginalis
● D. Medial to pars marginalis
● E. Above pars marginalis
A. Anterior to pars marginalis
All of the following landmarks do not match the level of spine except?
● A. Scapular spine—T2, T3
● B. Inferior scapular pole—T6
● C. Intercristal line—L4–L5 disk space
● D. Thyroid cartilage—C4, C5
● E. Hyoid bone—C6, C7
E. Hyoid bone—C6, C7
Pterion, which is located two finger breaths above zygomatic arch, is meeting point of what?
● A. Lambdoid, occipitomastoid, and parietomastoid sutures
● B. Coronal suture and superior temporal line
● C. Frontal, temporal, parietal, and sphenoid bones
● D. Frontal, temporal, zygomatic, and sphenoid bones
● E. Coronal suture and sagittal suture
C. Frontal, temporal, parietal, and sphe-
noid bones
The point over skull which is used for external and internal carotid bypass craniotomy is called as what?
● A. Keen’s point
● B. Taylor Huhgton point
● C. Stephanion
● D. Chater’s point
● E. None of the above
D. Chater’s point
Which is the strongest ligament in the spine which attaches to medial tubercles of C1 and traps dens against C1?
● A. Transverse atlantal ligament (TAL)
● B. Ascending band of cruciate ligament
● C. Alar ligament
● D. Tectorial membrane
● E. Descending band of cruciate ligament
A. Transverse atlantal ligament (TAL)
Vertical crest (Bill’s bar) separates the internal auditory meatus into which of the following?
● A. Cochlear area anteriorly and vestibular area posteriorly
● B. Facial canal anteriorly and vestibular area posteriorly
● C. Facial canal posteriorly and vestibular area anteriorly
● D. Superior vestibular area, facial canal superiorly and inferior vestibular area, cochlear area inferiorly
● E. Both B and D
B. Facial canal anteriorly and vestibular
area posteriorly
Fine touch, deep pressure, and proprioception sensations are carried from the body to the brain through which spinal cord tract?
● A. Lateral spinothalamic tract
● B. Posterior spinothalamic tract
● C. Fasciculus gracilis
● D. Fasciculus cuneatus
● E. B, C, and D
E. B, C, and D
Regarding anatomical segments of intracranial cerebral arteries, the segment of anterior cerebral artery from the branch point of callosomarginal curving around the genu of the corpus callosum to superior surface of corpus callosum 3 cm posterior to the genu is what?
● A. Pre-communicating
● B. Post-communicating
● C. Pre-callosal
● D. Supracallosal
● E. Post-callosal
C. Pre-callosal
Regarding anatomical segments of intracranial cerebral arteries, the segment of middle cerebral artery from bifurcation to emergence from Sylvian fissure is what?
● A. M1
● B. M2
● C. M3
● D. M4
● E. M5
B. M2
The segment of posterior cerebral artery that traverses the quadrigeminal plate is what?
● A. P1
● B. P2
● C. P3
● D. P4
● E. P5
C. P3
Which of the following is the primary feeder for jugular foramen tumors?
● A. Ascending pharyngeal
● B. Lingual
● C. Facial
● D. Occipital
● E. Ophthalmic
A. Ascending pharyngeal
Which of the following is the first anterior branch of external carotid artery?
● A. Superior thyroid
● B. Facial
● C. Superficial temporal
● D. Infra-alveolar
● E. Infraorbital
A. Superior thyroid
Petroclival meningiomas are mainly supplied by branches of which segment of internal carotid artery?
● A. Lacerum
● B. Clinoidal
● C. Ophthalmic
● D. Communicating
● E. Cavernous
E. Cavernous
In case of internal cerebral artery occlusion, an important collateral flow is via anastomosis between branches of facial artery and what?
● A. Ascending pharyngeal
● B. Lingual
● C. Facial
● D. Occipital
● E. Ophthalmic
E. Ophthalmic
Which segment of internal carotid artery begins just proximal to origin of posterior communicating artery?
● A. Lacerum
● B. Clinoidal
● C. Ophthalmic
● D. Communicating
● E. Cavernous
D. Communicating
Postpartum occlusion of inferior hypophysial artery causes pituitary infarcts (Sheehan’s necrosis); however, diabetes insipidus is rare because the stalk is spared as it is supplied by what?
● A. Superior hypophysial artery
● B. Anterior choroidal artery
● C. Posterior choroidal artery
● D. Artery of McConnell
● E. Branches from plexal point
A. Superior hypophysial artery
Fetal circulation is present in 15 to 35% of patients where posterior cerebral artery is supplied on one or both sides primarily by the carotid artery instead of via the vertebrobasilar system. The carotid artery provides this supply via what?
● A. Ascending pharyngeal
● B. Anterior communicating
● C. Posterior communicating
● D. Artery of Hubner
● E. Italian artery
C. Posterior communicating
Which of the following is the first branch of subclavian artery?
● A. Basilar artery
● B. Vertebral artery
● C. ICA
● D. ACA
● E. ECA
B. Vertebral artery
V1 prevertebral segment of vertebral artery courses superiorly and posteriorly to usually enter the foramen transversarium of which vertebral body?
● A. C7
● B. C6
● C. C5
● D. C4
● E. C3
B. C6
Which of the following is the largest branch of vertebral artery?
● A. Mandibular
● B. Anterior meningeal
● C. Posterior meningeal
● D. Posterior inferior cerebellar
● E. Anterior inferior cerebellar
D. Posterior inferior cerebellar
Regarding carotid–vertebrobasilar anastomosis, which is the most common of the persistent fetal anastomosis?
● A. Persistent primitive trigeminal artery (PPTA)
● B. Otic
● C. Hypoglossal
● D. Proatlantal intersegmental
● E. Optic
A. Persistent primitive trigeminal artery
(PPTA)
Which branch of the peduncular segment P1 of posterior cerebral artery supplies the tectum and cerebral peduncles and also Edinger-Westphal, oculomotor, and trochlear nuclei?
● A. Artery of Percheron
● B. Medial posterior choroidal
● C. Lateral posterior choroidal
● D. Interpeduncular thalamoperforators
● E. Mesencephalic perforating
E. Mesencephalic perforating
Vein of Labbe is the inferior anastomotic vein and is prominent on the dominant side while the superficial superior anastomotic vein which is prominent on the non-dominant side is what?
● A. Vein of Percheron
● B. Vein of Trolard
● C. Vein of Labbe
● D. Basal vein of Rosenthal
● E. Vein of Galen
B. Vein of Trolard
Which of the following is not a content of cavernous sinus?
● A. Oculomotor nerve (III)
● B. Trochlear nerve (IV)
● C. Ophthalmic division of trigeminal (V1)
● D. Maxillary division of trigeminal (V2)
● E. Mandibular division of trigeminal (V3)
E. Mandibular division of trigeminal (V3)
Triangular space (of Parkinson) is a landmark for surgical entrance to the cavernous sinus. Its superior border is formed by cranial nerves III and IV, and the lower margin is formed by cranial nerve VI and what?
● A. Optic nerve
● B. Ophthalmic division of trigeminal (V1)
● C. Maxillary division of trigeminal (V2)
● D. Mandibular division of trigeminal (V3)
● E. Facial nerve
B. Ophthalmic division of trigeminal
Artery of Adamkiewicz also called arteria radicularis anterior magna is the main arterial supply for which levels of the spinal cord?
● A. C3
● B. C6–C8
● C. T4 or T5
● D. T3–T8
● E. T8 to the conus
E. T8 to the conus
Regarding spinal cord vasculature, a normal variant where the anterior spinal artery joins with the paired posterior spinal arteries at the conus medullaris is called as arcade of what?
● A. Parkinson
● B. Willis
● C. Lazorthes
● D. Adamkiewicz
● E. Sulcal
C. Lazorthes
Recurrent artery of Heubner (AKA medial striate artery) which supplies the head of caudate, putamen, and anterior internal capsule originates most commonly from what?
● A. Pre-communicating segment of anterior cerebral artery (A1)
● B. Post-communicating segment of anterior cerebral artery (A2)
● C. Junction of anterior cerebral artery and anterior communicating artery
● D. From anterior communicating artery
● E. A, B, and C
C. Junction of anterior cerebral artery
and anterior communicating artery
All of the following are segments of middle cerebral artery except?
● A. M1—from origin to bifurcation
● B. M2—from bifurcation to emergence from Sylvian fissure
● C. M3, M4—distal branches
● D. M5—terminal branch
● E. M6—cortical branch
E. M6—cortical branch
Which of the following are branches of internal carotid artery in the neck?
● A. Ascending pharyngeal, superior thyroid, lingual, facial
● B. Recurrent laryngeal, thyroid, cricoid branches
● C. Mandibular, maxillary, zygomatic branches
● D. Anterior temporal, frontal, orbitofrontal
● E. None of the above
E. None of the above
A patient presented in OPD with MRI of the brain showing petroclival meningioma. Which of the following arteries becomes prominent in this condition?
● A. Anterior choroidal artery
● B. Medial lenticulostriate artery
● C. Posterior cerebral artery
● D. Meningohypophyseal trunk
● E. Anterior clival artery
D. Meningohypophyseal trunk
In 15 to 30% of the patients the posterior cerebral artery on one or both sides is primarily supplied by the carotids instead of via the vertebrobasilar system. This phenomenon is known as what?
● A. Carotid vertebrobasilar bypass
● B. Persistent primitive circulation
● C. Fetal circulation
● D. Embryonal circulation
● E. Persistent anterior circulation
C. Fetal circulation
Vertebral artery is the first and the largest branch of subclavian artery which has all of the following segments except?
● A. V1 prevertebral
● B. V2 traversing through transverse foramina from C6 to C2
● C. V3 from axis vertebrae to the foramen magnum
● D. V4 pierces the dura and enters the subarachnoid space
● E. V5 vertebral artery of both sides join to form basilar artery
E. V5 vertebral artery of both sides join
to form basilar artery
Posterior inferior cerebellar artery (PICA) is the largest branch of vertebral artery which originates 10 mm distal to the point where vertebral artery becomes intradural. Which of the following segments of PICA must be preserved during surgery?
● A. Anterior medullary
● B. Lateral medullary
● C. Tonsillomedullary
● D. Cortical segments
● E. A, B, and C
E. A, B, and C
Basilar artery is formed by junction of two vertebral arteries.
Which of the following are its branches?
● A. Anterior inferior cerebellar artery (AICA)
● B. Internal auditory (labyrinthine)
● C. Pontine branches
● D. Superior cerebellar artery (SCA)
● E. All of the above
E. All of the above
A patient presents with acute stroke in emergency. On DWI there is infarction on medial side of left frontal lobe of the brain. Which artery is involved in this ischemic stroke?
● A. Anterior cerebral
● B. Middle cerebral
● C. Posterior cerebral
● D. Vertebral arteries
● E. Basilar artery
A. Anterior cerebral
All of the following are contents of cavernous sinus except?
● A. Oculomotor and trochlear nerve
● B. V1 and V2 nerves
● C. V3 nerve
● D. Abducens nerve
● E. Carotid artery
C. V3 nerve
Great cerebral vein of Galen is formed by confluences of which of the following veins?
● A. Vein of Trolard and vein of Labbe
● B. Cortical veins
● C. Precentral cerebellar vein, basal vein of Rosenthal, and internal cerebral vein
● D. Precentral cerebellar vein, internal cerebral vein, and anterior septal vein
● E. Precentral cerebellar vein, basal vein of Rosenthal, and thalamostriate vein
C. Precentral cerebellar vein, basal vein
of Rosenthal, and internal cerebral vein
The blood–brain barrier is present in which of the following areas?
● A. Choroid plexus
● B. Hypophysis
● C. Tuber cinereum
● D. Area postrema
● E. Brain stem
E. Brain stem
According to classical model of language and speech function, conduction aphasia is caused by a damage to which of the following?
● A. Brodmann’s area 39
● B. Brodmann’s area 40
● C. Broca’s area
● D. Wernicke’s area
● E. Arcuate fasciculus
E. Arcuate fasciculus
In head injury, the blood–brain barrier is closed; therefore, there is no protein extravasation and no enhancement on CT or MRI. The cells swell and then shrink. What kind of cerebral edema is this?
● A. Cytotoxic
● B. Vasogenic
● C. Vasospastic
● D. Ischemic
● E. Mixed
A. Cytotoxic
The afferent limb of the plantar reflex originates in cutaneous receptors restricted to which dermatome?
● A. L1
● B. L4
● C. L5
● D. S1
● E. S2
D. S1
In a patient with suspected stroke, the plantar reflex could not be elicited by stimulation of the lateral plantar surface and transverse arch in a single movement, so the examiner pinched the Achilles tendon to elicit the plantar response. What is this
maneuver called?
● A. Chaddok
● B. Schaeffer
● C. Oppenheim
● D. Gordon
● E. Bing
B. Schaeffer
Where does the primary coordinating center for bladder function reside within the pons?
● A. Nucleus locus coeruleus
● B. Nucleus V
● C. Area postrema
● D. Lateral medullary nucleus
● E. Medial medullary nucleus
A. Nucleus locus coeruleus
Hoffman’s sign is elicited by flicking downward on the nail of the middle or ring finger: a positive (pathologic) response consists of involuntary flexion of the adjacent fingers and/or thumb. It is monosynaptic (synapse in Rexed lamina IX) and indicates a lesion above what?
● A. C3
● B. C5
● C. C8
● D. T1
● E. T3
C. C8
The detrusor muscle of the bladder contracts and the internal sphincter relaxes under parasympathetic stimulation; the
preganglionic cell bodies reside in the intermediolateral gray of which spinal cord segments?
● A. T2–T10
● B. T10–T12
● C. L1–L3
● D. L2–L4
● E. S2–S4
E. S2–S4
Regarding bladder physiology, sympathetic cell bodies lie within the intermediolateral gray column of lumbar spinal cord segments T12–L2. Preganglionic axons pass through the sympathetic chain (without synapsing) to the inferior mesenteric ganglion. Detrusor smooth muscle relaxation during bladder filling and storage is carried out by stimulation of which of the following?
● A. Alpha 1
● B. Alpha 2
● C. Beta 1
● D. Beta 2
● E. Beta 3
E. Beta 3
A patient presented with urinary frequency, urgency, incontinence, and nocturia. Urodynamic findings showed detrusor overactivity (DO) without detrusor sphincter dyssynergia (DSD). What is the level of lesion?
● A. Supraspinal
● B. Suprasacral during spinal shock
● C. Suprasacral after resolution of spinal shock
● D. Infrasacral
● E. Systemic, e.g., diabetes
A. Supraspinal
What is the cut off value of bladder pressure for safe storage?
● A. < 40 cm H2O
● B. < 60 cm H2O
● C. < 80 cm H2O
● D. < 100 cm H2O
● E. < 120 cm H2O
A. < 40 cm H2O
Tamsulosin is a prostate alpha1A adrenoreceptor antagonist. What is the initial usual adult daily dose?
● A. 0.1 mg
● B. 0.4 mg
● C. 1 mg
● D. 2 mg
● E. 4 mg
B. 0.4 mg
Which of the following is a parietal lobe syndrome with a unilateral asomatognosia, anosognosia, apathy, allocheiria, dressing apraxia, and extinction and inattention to an entire visual field?
● A. Anton Babinski syndrome
● B. Foster Kennedy syndrome
● C. Parinaud’s syndrome
● D. Weber syndrome
● E. Gertsmann’s syndrome
A. Anton Babinski syndrome
A patient presented with agraphia without alexia, left–right
confusion, digit agnosia and acalculia. This is typical for which
syndrome?
● A. Anton Babinski syndrome
● B. Foster Kennedy syndrome
● C. Parinaud’s syndrome
● D. Weber syndrome
● E. Gertsmann’s syndrome
E. Gertsmann’s syndrome
Which of the following is cranial nerve III palsy with contralateral hemiparesis?
● A. Anton Babinski syndrome
● B. Foster Kennedy syndrome
● C. Parinaud’s syndrome
● D. Weber syndrome
● E. Gertsmann’s syndrome
D. Weber syndrome
Which syndrome is usually associated with olfactory groove or medial third sphenoid wing tumor and presents with the classic triad of ipsilateral anosmia, ipsilateral central scotoma, and contralateral papilledema?
● A. Anton Babinski syndrome
● B. Foster Kennedy syndrome
● C. Parinaud’s syndrome
● D. Weber syndrome
● E. Benedikt’s syndrome
B. Foster Kennedy syndrome
Pars vascularis is the larger posterolateral compartment of jugular foramen and it contains which of the following?
● A. Vagus nerve
● B. Glossopharyngeal nerve
● C. Branching Jacobson’s nerve
● D. Inferior petrosal sinus
● E. Meningeal branch of the ascending pharyngeal artery
A. Vagus nerve
After resection of a posterior fossa brain tumor, a child presented with speechlessness, ataxia, hypotonia, and irritability along with cranial nerve deficits, neurobehavioral changes, and urinary incontinence. What syndrome is this?
● A. Cerebellar mutism syndrome
● B. Posterior fossa syndrome
● C. Jugular foramen syndrome
● D. Cerebellar syndrome
● E. Fourth ventricle syndrome
B. Posterior fossa syndrome
Which of the following is a jugular foramen syndrome with palsies of cranial nerves IX, X, XI, and XII without sympathetic involvement?
● A. Collet-Sicard syndrome
● B. Villaret’s syndrome
● C. Tapia syndrome
● D. (Hughlings) Jackson’s syndrome
● E. Schmidt’s syndrome
A. Collet-Sicard syndrome
Which of the following is a jugular foramen syndrome with palsies of cranial nerves IX, X, XI, and XII with sympathetic involvement?
● A. Collet-Sicard syndrome
● B. Villaret’s syndrome
● C. Tapia syndrome
● D. (Hughlings) Jackson’s syndrome
● E. Schmidt’s syndrome
B. Villaret’s syndrome
Blood–brain barrier (BBB) which is formed by the tight junctions (zona occludens) between cerebral capillary endothelial cells is absent in following areas of brain except?
● A. Area postrema and posterior eminence of hypothalamus
● B. Pineal gland and choroid plexus
● C. Tuber cinereum and preoptic recess
● D. Anterior pituitary (adenohypophysis)
● E. Posterior pituitary (neurohypophysis)
D. Anterior pituitary (adenohypophysis)
A patient presented in OPD with tumor on brain MRI which showed marked perilesional edema. This edema is due to extravasation of protein because of blood–brain barrier disruption. What is this type of edema in this case of brain tumor called?
● A. Cytotoxic edema
● B. Vascular edema
● C. Vasogenic edema
● D. Ischemic edema
● E. Both B and C
C. Vasogenic edema
A patient presents in neurosurgical OPD with complaint of fluent speech, and he/she is unable to understand speech of other people. This phenomenon is known as receptive aphasia. In which brain area this patient most likely has a lesion?
● A. Broca’s area
● B. Wernicke’s area
● C. At arcuate fasciculus
● D. Primary auditory area
● E. Areas of ventral and dorsal stream flow
B. Wernicke’s area
Planter reflex also known as Babinski sign is a primitive reflex present in infancy usually up to 10 months. This reflex consists of extension of great toe in response to noxious stimulus applied to the planter aspect of foot. It is not present in adults in which one of the following conditions?
● A. Tumor in left frontal brain region
● B. Cervical spinal cord compression by prolapsed disk
● C. Tumor at L4–L5 spinal cord level
● D. Compression of thoracic spinal cord due to traumatic vertebral fracture
● E. L4–L5 spinal vertebral level disk
E. L4–L5 spinal vertebral level disk
Hoffmann’s sign consists of involuntary flexion of adjacent finger and/or thumb on flicking downward on the nail of middle or ring finger. This sign is positive if lesion is found at which cord level?
● A. Above C5
● B. At or above C3
● C. Only at C8
● D. Only at C5 level
● E. Above C8 level
E. Above C8 level
Primary coordinating center for bladder function resides within nucleus locus coeruleus. This area is supplied by inhibitory signals for voluntary cortical control of micturition from where?
● A. Anteromedial portion of frontal lobe
● B. Genu of corpus callosum
● C. Gyrus rectus
● D. Frontal lobe of brain
● E. Both A and B
E. Both A and B
Gerstmann’s syndrome is because of lesion in the dominant parietal lobe. It consists of which of the following?
● A. Agraphia without alexia
● B. Left–right confusion
● C. Digit agnosia
● D. Acalculia
● E. All of the above
E. All of the above
A patient presented in emergency with traumatic large herniated lumbar disk at L4–L5 vertebral level. This lesion can result in which of the following conditions?
● A. Detrusor overactivity (DO) without detrusor sphincter dysnergy (DSD)
● B. DO with DSD
● C. Only detrusor overactivity
● D. Detrusor areflexia with overflow incontinence
● E. None of the above
D. Detrusor areflexia with overflow incontinence
Frontal eye field is located in the posterior frontal lobe and is Brodmann’s area 8. Destructive lesion in this area causes which of the following conditions?
● A. Impaired gaze to the contralateral side
● B. Causing gaze toward contralateral side
● C. Patient looks toward the side of lesion
● D. Patient looks away from the side of lesion
● E. Both A and C
● F. Both C and D
E. Both A and C
Olfactory groove meningioma or medial sphenoid wing meningioma can cause “Foster Kennedy syndrome.” All of the following are the features of this syndrome except?
● A. Contralateral optic atrophy
● B. Ipsilateral anosmia
● C. Ipsilateral central scotoma
● D. Contralateral papilledema
● E. All of the above
A. Contralateral optic atrophy
Speechlessness that develops following cerebellar injury is called as mutism with subsequent dysarthria. It is also known as what?
● A. Cerebellar mutism
● B. Cerebellar mutism syndrome
● C. Posterior fossa syndrome
● D. Cerebellar dysfunction
● E. Both A and B
A. Cerebellar mutism
According to the American Society of Anesthesiologists (ASA)
grading system to estimate anesthetic risk for various condi-
tions, a patient with severe systemic disease that is a constant threat to life will be assigned which ASA class?
● A. I
● B. II
● C. III
● D. IV
● E. V
D. IV
Regarding the importance of temperature control in neuroanesthesia, for each 1°C drop in patient’s temperature, the cerebral metabolic rate of oxygen (CMRO2) decreases by about what amount?
● A. 1%
● B. 7%
● C. 11%
● D. 15%
● E. 20%
B. 7%
CO2 is the most potent cerebral vasodilator; hyperventilation reduces PaCO2 (hypocapnea). The goal for safe neurological surgery is generally end tidal CO2 (ETCO2) of what?
● A. 20–25 mmHg
● B. 25–30 mmHg
● C. 30–35 mmHg
● D. 35–40 mmHg
● E. > 45 mmHg
B. 25–30 mmHg
Regarding drugs used in neuroanesthesia, which of the following is associated with development of tension pneumocephalus?
● A. Nitrous oxide
● B. Propofol
● C. Etomidate
● D. Barbiturates
● E. Ketamine
A. Nitrous oxide
Most barbiturates are anticonvulsants except which of the following?
● A. Phenobarbital
● B. Pentobarbital
● C. Sodium thiopental
● D. Primidone
● E. Methohexital
E. Methohexital
Regarding remifentanil, which statement is false?
● A. Reduces intracranial pressure
● B. Reduces cerebral blood volume
● C. Increases CMRO2
● D. Large doses can be neurotoxic to limbic system
● E. Can be used in awake craniotomy
C. Increases CMRO2
Dexmedetomidine (Precedex®) is used for control of hypertension postoperatively, as well as for its sedating qualities during awake craniotomy either alone or in conjunction with propofol. It is an agonist for which of the following?
● A. Alpha 1 receptors
● B. Alpha 2 receptors
● C. Beta receptors
● D. Beta 2 receptors
● E. Beta 3 receptors
B. Alpha 2 receptors
Regarding paralytics for intubation, which of the following is an intermediate-acting, aminosteroid, nondepolarizing muscle relaxant agent approved for rapid sequence intubation?
● A. Succinylcholine
● B. Lidocaine
● C. Rocuronium
● D. Cisatracurium
● E. Etomidate
C. Rocuronium
Which of the following is the ideal modality regarding anesthesia issues related to intraoperative evoked potential (EPs) monitoring?
● A. Total intravenous anesthesia
● B. Intermittent boluses are preferred over continuous infusion
● C. Nitrous/narcotic is the first choice
● D. Monitoring of temperature and blood pressure changes is not mandatory as these do not affect the potentials
● E. Halothane is the ideal inhalational drug
A. Total intravenous anesthesia
Malignant hyperthermia is a hypermetabolic state of skeletal muscle due to idiopathic block of calcium re-entry into sarcoplasmic reticulum. Which of the following is the earliest possible sign?
● A. Increased end tidal pCO2
● B. Bradycardia
● C. Metabolic alkalosis on arterial blood gas analysis
● D. Decreased myoglobin levels
● E. Decreased CPK levels
A. Increased end tidal pCO2
Parameters of primary relevance to neurosurgical surgery that can be modulated by anesthesiologist which play a primary role in control of intracranial pressure (ICP) and cerebral metabolic requirements of nutrients include all of the following except?
● A. Blood pressure which affects cerebral perfusion pressure (CPP)
● B. Jugular venous pressure
● C. Arterial CO2 tension
● D. Body temperature
● E. Elevating hematocrit
E. Elevating hematocrit
Nitrous oxide (N2O) is an inhalational anesthetic agent which is 34 times more soluble in blood as compared to nitrogen. When N2O comes out of blood into the airtight cranial cavity it can produce tension pneumocephalus. Which of the following are steps that can be used to reduce chances of tension pneumocephalus while using N2O in patients?
● A. Filling the cranial cavity with fluid while doing closure
● B. Doing the operation in more supine position
● C. Turning off N2O 10 minutes prior to completion of dural closure
● D. All of the above
● E. Aspirating air with needle while doing closure
D. All of the above
Etomidate is an intravenous anesthetic agent which should be avoided in patients with what?
● A. Liver disease
● B. Renal disease
● C. High blood pressure
● D. Respiratory difficulty
● E. All of the above
B. Renal disease
Ketamine is usually not used in neurosurgical patients because of its which side effect?
● A. Respiratory depression
● B. Bradycardia
● C. Low blood pressure
● D. Increase in intracranial pressure
● E. All of the above
D. Increase in intracranial pressure
Which of the following are disadvantages of using narcotics in neurosurgical patients?
● A. May cause hypotension by histamine release
● B. May cause cerebrovascular vasodilation which can cause increased ICP
● C. Can cause confusion in renal insufficient patient
● D. Can cause confusion in hepatic insufficient patient
● E. All of the above
E. All of the above
Following are the useful characteristics of propofol which make it more suitable for use in neurosurgical patients except?
● A. Reduces cerebral metabolism, cerebral blood flow, and intracranial pressure
● B. It is a cerebral protectant
● C. Short half-life makes it useful for use in awake craniotomy
● D. Produces isoelectric EEG
● E. All of the above
D. Produces isoelectric EEG
Which of following is an alpha 2 adrenergic receptor agonist which is used for control of hypertension in postoperative patients and for sedation during awake craniotomy?
● A. Dexmedetomidine (Precede)
● B. Esmolol
● C. Lidocaine
● D. Propofol
● E. None of the above
A. Dexmedetomidine (Precede)
Paralytics should not be given until it has been determined that the patient can be ventilated manually unless what?
● A. The patient has cervical spine injury
● B. The patient has brain tumor
● C. Treating the patient with laryngospasm
● D. When treating the patient with botulism
● E. None of the above
C. Treating the patient with laryngospasm
For inhalational anesthetic agent, maximum alveolar concentration (MAC) of drug should ideally be what?
● A. More than 1
● B. Less than 0.5
● C. More than 1.5
● D. Less than 2
● E. Exactly 1
B. Less than 0.5
A patient developed elevated body temperature (> 44 degrees Celsius or 113 degrees Fahrenheit) after giving succinylcholine during induction of anesthesia. It is a malignant hypertension due to idiopathic block of calcium re-entry into the sarcoplasmic reticulum. Which of the following is treatment for this condition?
● A. Eliminating offending agent and hyperventilation
● B. Giving dantrolene sodium with surface and cavity cooling
● C. Giving bicarbonate with IV insulin and glucose
● D. Giving procainamide and diuretics
● E. All of the above
E. All of the above
According to the classification of severity of hyponatremia, severe hyponatremia is sodium level (mEq/L) less than what?
● A. 160
● B. 155
● C. 145
● D. 135
● E. 125
E. 125
Which of the following is an etiology for hypotonic hyponatremia?
● A. Mannitol therapy
● B. Renal failure
● C. TURP syndrome
● D. Paraproteinemia
● E. Hypertriglyceridemia
B. Renal failure
Hyponatremia is acute if duration documented is less than what?
● A. 48 hours
● B. 56 hours
● C. 72 hours
● D. 5 days
● E. 7 days
A. 48 hours
The most important differentiating criterion for differentiation between syndrome of inappropriate ADH (SIAD) and cerebral salt wasting (CSW) is what?
● A. Serum sodium level
● B. Urinary sodium level
● C. Glycemic level
● D. Volume status
● E. Potassium level
D. Volume status
Which of the following is not included in the diagnostic criteria for SIAD?
● A. Decreased effective serum osmolality (< 275 mOsm/kg of water)
● B. Urine osmolality > 100 mOsm/kg of water
● C. Clinical euvolemia
● D. Increased thyroid stimulating hormone (TSH) level
● E. No recent diuretic use
D. Increased thyroid stimulating
hormone (TSH) level
Solute ratio is defined as (Urinary [Na] + Urinary [K])/Plasma [Na]. For a ratio of 1, what is the recommended fluid intake (mL/d) in SIAD?
● A. < 500
● B. 600
● C. 100
● D. 1500
● E. 2000
B. 600
During treatment of SIAD, what is the limit of correction that
should not be exceeded?
● A. 2–4 mEq/L in 24 hours
● B. 6–8 mEq/L in 24 hours
● C. 8–10 mEq/L in 24 hours
● D. 12–14 mEq/L in 48 hours
● E. 14–15 mEq/L in 48 hours
C. 8–10 mEq/L in 24 hours
During treatment of SIAD, a patient developed insidious flaccid quadriplegia, mental status changes, and cranial nerve abnormalities with a pseudobulbar palsy appearance. What is the most probable diagnosis?
● A. The diagnosis of SIAD was wrong
● B. Central pontine myelinolysis
● C. Weber syndrome
● D. Transverse myelitis
● E. Hydrocephalus
B. Central pontine myelinolysis
Which of the following is avoided during treatment of cerebral salt wasting?
● A. Normal saline
● B. 3% saline
● C. Packed red blood cells
● D. Steroids
● E. Furosemide
E. Furosemide
Which of the following drugs is effective in treatment of cerebral salt wasting?
● A. Demeclocycline
● B. Conivaptan
● C. Vasopressin receptor antagonists
● D. Lithium
● E. Fludrocortisone acetate
E. Fludrocortisone acetate
Within what time frame should the initial half be replaced?
● A. 10–15 minutes
● B. 30 minutes
● C. 1 hour
● D. 2 hours
● E. 24 hours
E. 24 hours
For indeterminate cases, polyuria due to diabetes insipidus can be differentiated from psychogenic polydipsia by the water deprivation test. What is the highest urinary osmolality after Pitressin in water deprivation test that is interpreted as normal?
● A. < 5% increase
● B. 10% increase
● C. 20% increase
● D. 45% increase
● E. > 50% increase
A. < 5% increase
Which of the following is not a diagnostic criterion for diabetes insipidus?
● A. Urine osmolality < 300 mOsm/kg
● B. Inability to concentrate urine to > 300 mOsm/kg in the presence of clinical dehydration
● C. Urine output > 50 mL/kg/24 h
● D. Hyponatremia
● E. Normal adrenal function
D. Hyponatremia
Intravenous fluid management for diabetes insipidus includes base intravenous fluid: D5 1/2 NS + 20 mEqKCl/L at 75–100 mL/h. In addition to that, the urine output above base intravenous rate should be replaced mL for mL with which of the
following?
● A. Normal saline
● B. ½ Normal saline
● C. Hypertonic saline
● D. Red cell concentrates
● E. No need for this replacement
B. ½ Normal saline
Regarding desmopressin in DDAVP® Nasal Spray 100 μg/mL, about how much each spray delivers?
● A. 1 μg
● B. 10 μg
● C. 30 μg
● D. 50 μg
● E. 100 μg
B. 10 μg
A patient is presented to emergency with anorexia, headache, difficulty concentrating, and irritability. On investigations, he/she has serum sodium level of 131 mEq/L, serum osmolality of 265 mOsm/kg, and urine osmolality more than 100 mOsm/kg with euvolemia. What is the most probable diagnosis in this patient?
● A. Diabetes insipidus
● B. Cerebral salt wasting
● C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
● D. Hyponatremia
● E. Renal failure
C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
A patient presented with aneurysmal subarachnoid hemorrhage with only symptom of severe headache. After some time he/she developed irritability, difficulty concentrating, and muscle weakness. Her/his plain brain CT showed no new finding. On labs serum osmolality was less than 275 mOsm/kg, urine osmolality was more than 100 mOsm/kg with volume depletion, and urinary sodium more than 20 mEq/L. What is the most probable diagnosis?
● A. Diabetes insipidus
● B. Cerebral salt wasting
● C. SIADH
● D. Hyponatremia
● E. Renal failure
B. Cerebral salt wasting
Which of the following is the cause of syndrome of inappropriate antidiuretic hormone secretion?
● A. CNS infection
● B. Head trauma
● C. Brain tumors
● D. Aneurysmal subarachnoid hemorrhage
● E. All of the above
E. All of the above
A patient presents with hyponatremia in hospital. On lab investigation urine osmolality is less than 500 mOsm/kg. She/he was given normal saline infusion test with 2 liters of normal saline over 24 to 48 hours. What does correction of hyponatremia suggest?
● A. SIADH
● B. CSW
● C. Extracellular fluid volume depletion
● D. DI
● E. None of the above
C. Extracellular fluid volume depletion
A patient being treated for hyponatremia suddenly develops flaccid quadriplegia, mental status changes, and some cranial nerve abnormalities. What is the most probable diagnosis in this case?
● A. Osmotic demyelination syndrome
● B. Severe hyponatremia
● C. Severe hypernatremia
● D. Wernicke’s encephalopathy
● E. All of the above
A. Osmotic demyelination syndrome
A patient presents in emergency with severe hyponatremia with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following are treatment options for
this condition?
● A. Admission in ICU
● B. 3% normal saline at 1 to 2 mL/kg
● C. Furosemide 20 mg
● D. Restriction of water intake
● E. A, B, and C
E. A, B, and C
A patient being treated for hyponatremia with normal saline develops decreased renal cortical blood flow, metabolic acidosis, reduced gastric mucosal perfusion, tachypnea, hypocapnia, and increased risk of vasoconstriction in brain. Which of the following is the cause of these symptoms?
● A. Severe hypernatremia
● B. Fluid overload
● C. Hyperchloremic acidosis
● D. Severe hyponatremia
● E. None of the above
C. Hyperchloremic acidosis
A patient underwent pituitary surgery. After surgery he developed high urine output. Labs showed urine osmolality less than 300 mOsm/kg and urine specific gravity less than 1.003, with normal or high serum osmolality and high serum sodium.
What is the most probable diagnosis in this case?
● A. SIADH
● B. Cerebral salt wasting
● C. Diabetes insipidus
● D. Dehydration
● E. Hypernatremia
C. Diabetes insipidus
Treatment of diabetes insipidus consists of which of the following?
● A. Desmopressin 0.1 mg per oral bd
● B. Nasal spray 2.5 μg by nasal insufflation bd
● C. Clofibrate
● D. Chlorpropamide
● E. All of the above
E. All of the above
In nonambulatory comatose patient, treatment of diabetes insipidus consists of what?
● A. Admission in ICU with input–output monitoring every 1 hour, urine specific gravity every 4 hours
● B. Measure serum electrolytes with osmolality every 6 hours
● C. Baseline fluid D5 ½ NS plus 20 mEq/L at 75 to 100 mL/h
● D. Arginine vasopressin
● E. All of the above
E. All of the above
Labetalol is α1 selective and β nonselective blocker. Its effects include ICP reduction or no change, pulse rate decrease or no change, and it does not change cardiac output. What is the dose adjustment for renal failure?
● A. Same dose
● B. < 15%
● C. < 25%
● D. < 50%
● E. Absolutely contraindicated
A. Same dose
Dopamine has α, β, and dopaminergic effects at what dose
(μg/kg/min)?
● A. 0.5
● B. 1
● C. 2
● D. > 5
● E. > 10
E. > 10
Which of the following is a pure alpha sympathomimetic and useful in hypotension associated with tachycardia?
● A. Dopamine
● B. Dobutamine
● C. Phenylephrine
● D. Norepinephrine
● E. Isoproterenol
C. Phenylephrine
What is the mainstay of treatment of rhabdomyolysis?
● A. Antiallergics
● B. Steroids
● C. Mannitol
● D. Sodium carbonate
● E. Expansion of extracellular volume
E. Expansion of extracellular volume
Dialysis may be required in patients with rhabdomyolysis in all of the following except?
● A. Oliguric renal failure
● B. Persistent hyperkalemia
● C. Pulmonary edema
● D. Congestive heart failure
● E. Persistent metabolic alkalosis
E. Persistent metabolic alkalosis
Labetalol (Normodyne or Trandate) is an alpha one selective and beta nonselective blocker drug. It is used intravenously as an antihypertensive drug in dosage sequence of 20, 40, 80, 80, and then 80 (total 300 mg) every 10 minutes until the desired blood pressure (BP) is achieved. It is widely used in neurosurgical patients because of which of the following characteristics?
● A. It has no effect on ICP or may reduce ICP
● B. It does not exacerbate coronary ischemia
● C. It does not change cardiac output
● D. It does not affect pulse rate much
● E. All of the above
E. All of the above
Neurogenic shock, which occurs because of paralysis due to spinal cord injury, is caused by which of the following mechanisms?
● A. Dysrhythmias and myocardial infarction
● B. Pooling of blood in the venous capacitance vessels
● C. Because of hemorrhage due to spinal cord injury
● D. Disruption of neuronal signals below the level of injury
● E. All of the above
B. Pooling of blood in the venous capacitance vessels
Positive inotropic (causing heart to contract with more force) effect of dopamine occurs at what dosage (μg/kg/min)?
● A. 0.5 to 2
● B. 2 to 10
● C. More than 10
● D. 10 to 20
● E. Less than 0.5
B. 2 to 10
Which of the following drugs is avoided in neurogenic shock due to spinal cord injury?
● A. Dopamine
● B. Dobutamine
● C. Phenylephrine
● D. Norepinephrine
● E. All of the above
C. Phenylephrine
Stress ulcers AKA Cushing’s ulcer can occur because of which of the following CNS pathologies?
● A. Brain injury (especially GCS less than 9)
● B. Brain tumor
● C. Intracerebral hemorrhage
● D. CNS infection
● E. All of the above
E. All of the above
Acute kidney injury in rhabdomyolysis patient (a syndrome caused by injury to skeletal muscles) is because of which of the following mechanisms?
● A. Excessive ferrihemate which is formed from myoglobin released due to muscle injury at pH < 5.6
● B. Allergic reaction caused due to release of excessive myoglobin at the time of injury
● C. Renal vasoconstriction
● D. Decreased extracellular volume
● E. A, C, and D
E. A, C, and D
Management of patient with rhabdomyolysis involves the following steps except?
● A. Admission in ICU, input–output monitoring, electrolytes correction
● B. Expansion of extracellular fluid volume by giving IV fluid
● C. Use of mannitol and sodium bicarbonate
● D. Minimizing other nephrotoxic agents like nephrotoxic antibiotic or iodinated IV contrast
● E. Surgical removal of the whole muscle causing rhabdomyolysis
E. Surgical removal of the whole muscle
causing rhabdomyolysis
Followings are the side effects of using omeprazole (Prilosec) for prolonged period of time except?
● A. Nausea, vomiting, and headache
● B. Vertigo
● C. Diarrhea
● D. Abdominal pain
● E. Rash
B. Vertigo
Which of the following crystalloids has less tendency to promote cerebral edema?
● A. Normal saline
● B. Ringer lactate
● C. 5% dextrose water
● D. 3% NaCl
● E. None of the above
A. Normal saline
Dobutamine acts as vasodilator by acting on beta one receptors and as positive inotrope by acting on beta 2 receptors. Use of dobutamine at doses greater than 20 μg/kg/min can exacerbate what?
● A. Hypertension
● B. Myocardial ischemia
● C. Renal damage
● D. Hyperglycemia
● E. Hepatic failure
B. Myocardial ischemia
Regarding Richmond agitation–sedation scale, an alert and calm patient will be given a score of what?
● A. 0
● B. 1
● C. 3
● D. 5
● E. 7
A. 0
Propofol is a sedative hypnotic and a neuroprotectant. What is the maximum dose (μg/kg/min) for sedation?
● A. 1
● B. 5
● C. 10
● D. 25
● E. 50
E. 50
Succinylcholine is an ultra-short muscle relaxant. Its onset is within 1 minute and duration of action is 5 to 10 minutes and spontaneous recovery occurs after long?
● A. 5 minutes
● B. 10 minutes
● C. 20 minutes
● D. 45 minutes
● E. 1 hour
C. 20 minutes
Regarding analgesic properties of Aspirin, what is the maximum daily dose?
● A. 25 mg
● B. 50 mg
● C. 100 mg
● D. 1 g
● E. 4 g
E. 4 g
For reduction of gastrointestinal side effects of NSAIDs, which of the following is most important?
● A. Taking before meals
● B. Taking with meals
● C. Taking after meals
● D. Antacids
● E. Misoprostol
E. Misoprostol
A patient is admitted in neurosurgical ICU after sustaining head injury in a road traffic accident. The patient has to be mechanically ventilated but he/she is aggressive, trying to pull and remove tubes and catheters. The on-call doctor has to give sedation to this patient. After 20 minutes of giving sedation the
patient is not responding to voice but shows movement or eye opening on physical stimulation. According to Richmond agitation-sedation scale (RASS), what are the agitation and sedation
scores, respectively, in this patient?
● A. + 4,−4
● B. + 3,−3
● C. + 4,−3
● D. + 3,−4
● E. + 2,−3
D. + 3,−4
Thiopental (Pentothal) is a short-acting barbiturate which is used for sedating patients. Following are the side effects of thiopental except?
● A. Dose-related respiratory depression
● B. Myocardial depression
● C. Damage to basal ganglia in brain
● D. Hypotension in hypovolemic patients
● E. Intra-arterial injection can cause necrosis
C. Damage to basal ganglia in brain
Propofol is a sedative hypnotic. It is used for sedation during general anesthesia and acts as neuroprotectant in aneurysm surgery at high doses. If a patient develops hyperkalemia, hepatomegaly, myocardial failure, renal failure, or death after propofol infusion then what is this condition called?
● A. Anaphylaxis reaction due to propofol infusion
● B. Multiorgan failure
● C. Propofol infusion reaction
● D. Propofol infusion syndrome
● E. All of the above
D. Propofol infusion syndrome
Following are the characteristics of nonsteroidal anti-inflammatory drugs (NSAIDs) except?
● A. No dependence develops with NSAIDs
● B. NSAIDs do not demonstrate a ceiling effect
● C. Risk of GI upset is common
● D. Most reversibly inhibit platelet function and prolong bleeding time
● E. All of them cause sodium and water retention and carry the risk of NSAID-induced nephrotoxicity
B. NSAIDs do not demonstrate a ceiling effect
A patient presented in neurosurgical emergency with severe headache. He is given pain killer after which he develops respiratory depression. Which analgesic overdosage can cause this side effect?
● A. Ketorolac tromethamine (Toradol)
● B. Indomethacin
● C. Tramadol (Ultram)
● D. Naproxen sodium
● E. All of the above
C. Tramadol (Ultram)
For percutaneous rhizotomy in which the patient needs to be sedated and awakened repeatedly, which of the following sedative drugs is most suitable?
● A. Methohexital (Brevital)
● B. Thiopental (Pentothal)
● C. Remifentanil (Ultiva)
● D. Propofol
● E. Precede (Dexmedetomidine)
A. Methohexital (Brevital)
Precedex (Dexmetomidine), an alpha-2 adrenoceptor agonist, has both sedative and analgesic properties and dramatically reduces the risk of respiratory depression as well. It has to
be with caution in the following patients except?
● A. In advanced heart block
● B. In basal bradycardia
● C. Using with other drug that lowers heart rate
● D. Hypovolemic patients
● E. Hypertensive patients
E. Hypertensive patients
During intubation of a head injury patient in the emergency department, which of the following muscle relaxants can be used?
● A. Rocuronium (Zemuron)
● B. Cisatracurium (Nimbex)
● C. Succinylcholine (Anectin)
● D. Vecuronium (Norcuron)
● E. All of the above
E. All of the above
Reversal of competitive muscle blockade is achieved by using neostigmine. What is its maximum dosage?
● A. 2.5 mg
● B. 5 mg
● C. 7.5 mg
● D. 10 mg
● E. 15 mg
B. 5 mg
For visceral or deafferentation pain, which of the following analgesics is used?
● A. Tricyclic antidepressants
● B. Tryptophan
● C. Carbamazepine
● D. Tegretol
● E. All of the above
E. All of the above
Regarding routine thyroid hormone replacement, what does levothyroxine contain?
● A. T3
● B. T4
● C. TSH
● D. TSH and T3
● E. TSH, T3, and T4
B. T4
What is the mineralocorticoid potency of dexamethasone?
● A. 0
● B. 1 +
● C. 2 +
● D. 3 +
● E. 5 +
A. 0
Posterior pituitary hormones—ADH and oxytocin—are synthesized in supraoptic and paraventricular nuclei of the hypothalamus in?
● A. Neuroendocrine neurons
● B. Neuroendocrine glands
● C. Median eminence of pituitary stalk
● D. Tuber cinereum
● E. Parvocellular system
B. Neuroendocrine glands
Corticotropin also called adrenocorticotrophic hormone (ACTH) is a 39 amino acid trophic hormone synthesized from POMC. It has an active half-life of 10 minutes. It produces a diurnal peak in cortisol. When does the highest peak occur?
● A. Early morning
● B. Noon
● C. Afternoon
● D. 11 p.m.
● E. Midnight
A. Early morning
What is the most powerful physiologic stimulus for ADH release?
● A. Increase in serum osmolality
● B. Hypokalemia
● C. Hyponatremia
● D. Hypoglycemia
● E. Pain
A. Increase in serum osmolality
The posterior pituitary (neurohypophysis AKA pars nervosa) derives from downward evagination of neural crest cells (brain neuroectoderm) while the anterior pituitary (adenohypophysis) develops from an upward evagination of epithelial ectoderm of oropharynx. This upward evagination of ectoderm of oropharynx is known as?
● A. Median eminence
● B. Craniopharyngeal duct
● C. Rathke’s pouch
● D. Remnants of Rathke’s pouch
● E. Pars intermedius
C. Rathke’s pouch
The six hormones that are released from anterior pituitary are primarily formed in tuber cinereum nucleus while two hormones (ADH and oxytocin) that are released from posterior pituitary are primarily formed in magnocellular neuroendocrine
neurons in the supraoptic and paraventricular nuclei. Where does these three nuclei reside?
● A. Thalamus
● B. Hypothalamus
● C. Basal ganglia
● D. Median eminence
● E. Both A and B
E. Both A and B
Growth hormone (GH) is under dual hypothalamic control via the hypophyseal portal system. GH releasing hormone from the arcuate nucleus stimulates synthesis and secretion of GH while GH release is suppressed by which of the following?
● A. Ghrelin, a peptide secreted by GI tract
● B. Somatostatin from the periventricular nucleus
● C. Insulin-like growth factor-1 synthesized by liver
● D. Somatomedin-C
● E. A and B
B. Somatostatin from the periventricular nucleus
Antidiuretic hormone (ADH) AKA arginine vasopressin (AVP) is released from posterior pituitary gland into the systemic circulation. It causes increased reabsorption of water in kidneys
and produces concentrated urine. What is the most powerful physiologic stimulus for ADH release?
● A. Reduction of intravascular volume
● B. Activation of thirst center in brain
● C. Increase in serum osmolality
● D. Reduction of water in interstitial spaces
● E. Both A and C
C. Increase in serum osmolality
Physiologic replacement therapy (in the absence of stress) for secondary adrenal insufficiency due to deficient corticotrophin (ACTH) release by pituitary is as follows:
● A. Hydrocortisone 10 mg PO a.m. and 20 mg PO p.m.
● B. Hydrocortisone 20 mg PO a.m. and 10 mg PO p.m.
● C. Hydrocortisone 25 mg PO a.m. and 10 mg PO p.m.
● D. Prednisone 5 mg PO every a.m. and 2.5 mg PO every p.m.
● E. Both B and D
E. Both B and D
A patient presented with fatigue, anorexia, nausea, hypotension, and hypoglycemia in emergency. This patient was previously taking hydrocortisone for a long period for brain edema due to brain tumor, which was stopped abruptly. What is most
likely cause of the symptoms in this patient?
● A. Exacerbation of brain edema
● B. Sudden increase in tumor size
● C. Steroid withdrawal
● D. Thyroid deficiency
● E. All of the above
C. Steroid withdrawal
A patient on prolonged steroid use started developing side effects due to prolonged steroid usage. Following are the side effects of steroid except?
● A. Hypertension
● B. Hypokalemic acidosis
● C. Sodium and water retention
● D. Pseudotumor cerebri
● E. Progressive multifocal leukoencephalopathy
B. Hypokalemic acidosis
