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14. Neurosurgery Primary Examination Review > Section 9 > Flashcards

Section 9 Flashcards

Comprehensive

1
Q

A 52-year-old female. non-smoker, presents with
double vision, bitemporal hemianopsia, and the
following imaging findings. What is the most likely
diagnosis?
A. Lymphocytic hypophysitis
B. Metastatic lung cancer
C. Sarcoidosis
D. Pituitary macroadenoma
E. Pituitary carcinoma

A

C. Sarcoidosis

The finding of basilar leptomeningeal enhancement (left frontal) and hilar lymphadenopathy with a sellar/suprasellar mass is highly suggestive of sarcoidosis. ACE (angiotensin-converting enzyme) level should be checked in the serum and/
or CSF. Lymph node biopsy via video-assisted cervical mediastinoscopy revealed sarcoidosis.

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2
Q

The substantia gelatinosa of Rolando is continuous with which trigeminal nucleus?
A. Spinal nucleus
B. Main sensory nucleus
C. Motor nucleus
D. Mesencephalic nucleus
E. None of the above

A

A. Spinal nucleus

The spinal nucleus of the trigeminal nerve (cranial nerve V), pars caudalis is continuous with the substantia gelatinosa of Rolando in the spinal cord and transmits pain, temperature, and crude touch sensations.

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3
Q

A 70-year-old diabetic male, with a history of
myelodysplastic syndrome for which he underwent chemotherapy, presents with headaches and mental status changes. What diagnosis is supported by the following MRI findings (a, T1 with contrast; b, diffusion; and c. ADC)?
A. Multifixal glioblastoma (GBM)
B. Brain metastases
C. Tumefactive multiple sclerosis (MS)
D. Brain abscesses
E. Epidermoid cysts

A

D. Brain abscesses

The imaging is typical of multiple brain abscesses with a small focus of subdural empyema at the frontal pole. Note the maxillary sinus disease. There is ring-enhancement (a), restricted diffusion (brightness) (b), and darkness on ADC (c).
The patient had mucormycosis orbitorhinosinusitis complicated by brain abscesses. He died a week later. Things that are bright on both diffusion and ADC are just T2 shine-through and not diffusion restriction. In tumefactive MS, the ring enhancement is usually incomplete. In GBM and metastases the enhancing wall is usually thicker with
irregularities of the inner aspect. Epidermoid cysts have restricted diffusion but are typically located in the cerebellopontine angle and do not enhance.

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3
Q

Arsenic poisoning is associated with all of the following, except
A. Mees’ white lines in the nails
B. Basophilic stippling of RBCs
C. Peripheral neuropathy
D. Encephalopathy
E. Hyperkeratosis of palms and soles

A

B. Basophilic stippling of RBCs

Basophilic stippling of RBCs is characteristic of lead poisoning. Arsenic poisoning is treated with BAL (British anti-lewisite).

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3
Q

The following is true about Merkel’s discs, except
A. Present in dermal papillae of hairy and non-hairy skin
B. Transmit touch and pressure sensation
C. Slowly adapting receptors
D. Small receptive field
E. Signals travel through type DI and IV fibers

A

E. Signals travel through type DI and IV fibers

Merkel’s discs transmit signals through type II fibers.

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3
Q

All of the following is true aboutpropofol (diprivan), except
A. Can cause severe respiratory depression
B. Hypertension is a known side effect
C. Rapid acting sedative
D. Lipid-soluble
E. No analgesic effects

A

B. Hypertension is a known side effect

Main side effects of propofol are respiratory depression and hypotension.

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4
Q

Orbitofrontal syndrome is characterized by all of
the following, except
A. Bilateral lesions of the orbitofrontal cortex
B. Severe cognitive decline
C. Hypersexuallty
D. Hyperphagia
E. Urinary behavioral disorder

A

B. Severe cognitive decline

Cognition is typically spared in orbitofrontal syndrome.

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5
Q

Following anterior cervical discectomy and fusion
(ACDF) with iliac crest bone graft, a patient complains of anterolateral thigh pain; this is most
likely associated with injury to the
A. Lateral femoral cutaneous n
B. llioinguinal n
C. Genitofemoral n
D. Intermediate cutaneous n of the thigh
E. Posterior cutaneous n of the thigh

A

A. Lateral femoral cutaneous n

Meralgia paresthetica can complicate iliac crest bone graft harvest from injury to the lateral femoral cutaneous n.

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5
Q

The presence of macrocephaly, mental retardation, seizures, and Rosenthal fibers are characteristics of which metabolic disorder?
A. Alexander’s disease
B. Krabbe’s disease
C. Metachromatic leukodystrophy
D. Adrenoleukodystrophy
E. Pilocytic astrocytoma

A

A. Alexander’s disease

These are all features of Alexander’s disease. Macrocephaly is associated with Tay-Sachs disease, Alexander’s disease, and Canavan’s disease. Rosenthal fibers also occur in pilocytic astrocytoma, but this is a neoplasm not a metabolic disorder.

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6
Q

Which of the following is true about the nucleus of tractus solitarius?
A. Fibers travel through cranial nerves IX, X, and
XI
B. Provides general visceral efferents
C. Provides special visceral afferents
D. Provides general somatic efferents
E. Provides general somatic atferents

A

C. Provides special visceral afferents

The nudeus of tractus solitarius relays taste sensation (special visceral afferents) through cranial nerves VII, IX, and X. General visceral efferents consist of cranial parasympathetic outflow (e.g., salivary nuclei and dorsal vagal nudeus ). General
somatic efferents include supply to skeletal muscles (e.g., the hypoglossal nucleus), while general somatic afferents include the sensory nuclei of the trigeminal nerve.

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7
Q

A 48-year-old female on oral contraceptive pills
presents with severe headache, nausea, and vomiting. CT head axial without(a) and coronal with contrast (b) are depicted below. The most important next step in this patient’s management is
A. Aspirin (Acetylsalicylic acid)
B. Prophylactic dose of heparin subcutaneously
C. IV heparin
D. Nimodipine
B. Craniotomy

A

C. IV heparin

Females on contraceptive pills are at high risk of sinus thrombosis, especially if dehydrated. CT reveals a spontaneously hyperdense left transverse sinus (a) with filling defect with contrast (b) sometimes called delta sign. The most important step in treatment is IV heparin, in addition to rehydration. Nimodipine is more appropriate for subarachnoid hemorrhage.

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7
Q

Regarding Tolosa-Hunt syndrome, the following Is
the least likely to occur
A. Periorbital headache
B. Loss of sensation over the forehead
C. Blindness
D. Third nerve palsy
E. Fourth nerve palsy

A

C. Blindness

Tolosa-Hunt syndrome is caused by granulomatous inflammation of the lateral wall of the cavernous sinus or superior orbital fissure. It presents typically with painful ophthalmoplegia. It rarely involves the optic n. It is self-limited but can recur. Treatment is with steroids.

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8
Q

After a lymph node biopsy of the neck, a patient
experiences inability to raise the arm above the
head and pain. His wife noticed a winged scapula.
What is the most likely injured nerve?
A. Long thoracic n
B. Spinal accessory n
C. Axillary n
D. Suprascapular n
E. Upper trunk of the brachial plexus

A

B. Spinal accessory n

Injury to the spinal accessory n (cranial nerve XI) is typically seen with lymph node biopsies in the posterior triangle of the neck. The nerve is very superficial in this location. This results in inability to abduct the shoulder beyond 90°, scapular winging, and pain. Suprascapular and axillary nerves do
not cause scapular winging. Long thoracic n can give scapular winging and loss of shoulder abduction but the nerve is too deep within the middle scalene muscle and is unlikely to be injured with a lymph node biopsy.

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9
Q

A 62-year-old male presents with back pain. T2 (a)
and T1-contrasted (b) MR images reveal
A. Metastatic spine disease
B. Degenerative disc disease
C. Myxopapillary ependymoma
D. Discitis with epidural abscess
E. Cystic schwannoma

A

D. Discitis with epidural abscess

Imaging reveals L5-S1 disdtis with epidural abscess. If blood cultures are negative, needle biopsy of the disc should be performed. WBC count, ESR, and CRP should also be checked. If no neurological deficits, treatment is largely conservative with antibiotics and bracing for comfort.

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10
Q

To diagnose Creutzfeldt-Jakob disease (CJD~ the
presence of which of the following in CSF is helpful?
A. 14-3-3 protein
B. ACE (angiotensin-converting enzyme)
C. Oligoclonal bands
D. Placental alkaline phosphatase (PI.AP)
E. Alpha-fetoprotein (AFP)

A

A. 14-3-3 protein

The presence of CSF 14-3-3 protein can help establish the diagnosis of sporadic CJD. ACE level is helpful for sarcoidosis, oligodonal bands for the diagnosis of multiple sclerosis (MS), PLAP for germinomas, and AFP for endodermal sinus tumor
and embryonal carcinoma.

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11
Q

Stiff-man syndrome is associated with
A. Phytanic acid oxidase deficiency
B. Decreased dystrophin
C. Myophosphorylase deficiency
D. Anti-Hu antibodies
E. Anti-GAD (glutamic acid decarbaxylase) antibodies

A

E. Anti-GAD (glutamic acid decarbaxylase) antibodies

Stiff-man (stiff person, Moersch-Woltman) syndrome is associated with the following antibodies: anti-gephyrin, anti-amphiphysin (paraneoplastic), and anti-GAD (non-paraneoplastic). Phytanic acid oxidase deficiency causes Refsum’s disease. Decreased dystrophin is associated with Duchenne’s muscular dystrophy. Myophosphorylase deficiency causes McArdle’s disease. Anti-Hu antibody is associated with small cell lung cancer and lymphoma: it causes sensory neuropathy involving the dorsal root ganglion (DRG).

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12
Q

Which of the following nuclei are involved in parasympathetic control?
A. Anterior hypothalamus
B. Posterior hypothalamus
C. Lateral hypothalamus
D. Supraoptic nuclei
E. Paraventricular nuclei

A

A. Anterior hypothalamus

Parasympathetic control involves anterior and medial hypothalamus. Sympathetic control: posterior and lateral hypothalamus. Supraoptic and paraventricular nuclei control the release of vasopressin ( antidiuretic hormone) and oxytocin, respectively.

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13
Q

A 22-year-old male presents with left-sided proptosis. The most likely diagnosis is
A. Metastasis
B. Meningioma
C. Eosinophilic granuloma
D. Fibrous dysplasia
E. Paget’s disease

A

D. Fibrous dysplasia

The ground glass expansion of the skull between 10 and 30 years of age is typical for fibrous dysplasia.

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14
Q

All of the following is true about cerebral salt wasting syndrome (CSWS), except
A. Hyponatremia
B. Hypervolemia
C. Increased serum atrial natriuretic peptide
(ANP)
D. Increased fractional excretion of sodium
(FeNa)
E. Observed in traumatic brain injury and subarachnoid hemorrhage

A

B. Hypervolemia

CSWS is associated with hypovolemia.

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15
Q

The following findings in a clival lesion are characteristic of
A. Chondrosarcoma
B. Chordoma
C. Metastatic lung cancer
D. Meningioma
E. Osteosarcoma

A

B. Chordoma

The presence ofphysaliphorous cells on a mucinous background is a characteristic of chordoma.

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16
Q

Sacral sparing in the setting of a spinal cord injury
A. Is a good prognostic sign
B. Should be retested after return of the bulbocavernosus reflex
C. Is evidenced by plantar Hexion of the big toe
D. Is positive if there is preserved anal sphincter
function
E. All of the above

A

E. All of the above

Sacral sparing is a sign of incomplete spinal cord injury. Return of the bulbocavemosus reflex means that the patient is not in spinal shock (transient loss of function below the level of the injury) anymore, which makes clinical evaluation more
accurate. Testing for sacral sparing includes perianal sensation to pin prick, rectal tone, and plantar flexion of the big toe. It is a good prognostic sign due to the proximity of the spinothalamic tract to the lateral corticospinal tract. In both tracts, the sacral fibers are lateral.

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17
Q

The resting membrane potential is maintained
by the
A. Sodium-potassium pump
B. Rapid influx of sodium
C. Calcium influx
D. Potassium efflux

A

A. Sodium-potassium pump

The resting membrane potential is maintained
by the sodium-potassium pump; using 1 ATP
(adenosine triphosphate), 3 sodium ions go out and 2 potassium ions go in. Rapid sodium influx causes depolarization, potassium efflux causes repolarization, while calcium influx causes neurotransmitter release from presynaptic terminal.

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17
Q

The following specimen was remowd from the
temporal lobe of a child with seizures. What is the
diagnosis?
A. Gangliogtloma
B. DNET (dysembryoplastic neuroepithelial
tumor)
c. Oligodendroglioma
D. Central neurocytoma
E. PNET (primitive neuroectodennal tumor)

A

B. DNET (dysembryoplastic neuroepithelial
tumor)

The presence of large cells (neurons) in mucin, small rounded cells, and chicken-wire vascular pattern are characteristic of DNET. The tumor is common in children, in the temporal lobe, and usually manifests with seizures.

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17
Q

The highest Cho:NAA ratio ( choline:N-acetylaspartate) on MR spectroscopy is found in
A. Normal brain
B. Ependymoma
C. Benign astrocytoma
D. Medulloblastoma
E. Radiation necrosis

A

D. Medulloblastoma

The highest Cho (cell membrane turnover): NAA (neuronal viability) ratio is found in malignant brain tumors (glioblastoma, medulloblastoma). This is followed by ependymoma, then benign astrocytoma. In normal brain and radiation necrosis, the Cho is almost = NAA.

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18
Q

Dementia, diarrhea, and dermatitis may occur in
which vitamin deficiency?
A. B1 (Thiamine)
B. B3 (Niacin)
C. B6 (Pyridoxine)
D. B12 (Cobalamin)
E. A

A

B. B3 (Niacin)

Dementia, diarrhea, and dermatitis (DDD) are symptoms of pellagra, which is associated with vitamin B3 (niacin) deficiency. It is found in predominantly corn eaters. B1 deficiency is associated with beriberi, Wernicke’s, and Korsakoff’s syndromes. B6 is associated with peripheral neuropathy, B12 with pernicious anemia, and vitamin A with nocturnal blindness.

19
Q

Wave IV of the brain auditory evoked responses
(BAER) originates from
A. Cochlear nuclei
B. Superior olivary nucleus
C. Lateral lemniscus
D. Medial geniculate body
E. Auditory radiation

A

C. Lateral lemniscus

BAER waves: I: cochlear nerve, II: cochlear nuclei, III: superior olivary nucleus, IV: lateral lemniscus, V: inferior colliculus, VI: medial geniculate body, VII: auditory radiation (sublentiform fasciculus)

19
Q

Which of the following structures pass through the foramen ovale?
A. Trochlear n (IV)
B. Ophthalmic division oftrigeminal n (V1)
C. Maxillary division oftrigeminal n (V2)
D. Mandibular division oftrigeminal n (V2)
E. Middle meningeal a

A

D. Mandibular division oftrigeminal n (V2)

Structures passing through the foramen ovate are V3, lesser petrosal n, and accessory meningeal a. Cranial n IV passes through the superior orbital fissure outside the annulus of Zinn. V1 passes through the superior orbital fissure with the lacrimal and frontal branches passing outside the annulus of
Zinn while the nasociliary is inside it (remember outside the annulus of Zinn LFT: lacrimal, frontal, and trochlear). V2 passes through foramen rotundum with the artery of foramen rotundum (from maxillary artery). Middle meningeal a passes
through foramen spinosum with the meningeal branch of V3.

20
Q

Which brain tumor is commonly encountered in
Li-Fraumeni syndrome?
A. Astrocytic glioma
B. Medulloblastoma
C. Ependymoma
D. Hemangioblastoma
E. Pituitary adenoma

A

A. Astrocytic glioma

Li-Fraumeni syndrome is a rare autosomal dominant cancer predisposition syndrome. There is usually p53 mutation on chromosome 17. It is characterized by astrocytic gliomas, soft tissue sarcomas, and breast cancer. Medulloblastoma characterizes the syndromes ofTurcot and Gorlin but is rare in Li-Fraumeni. Ependymomas are seen in NF2, but they are rare in Li-Fraumeni. Hemangioblastomas are seen in von Hippel-Lindau disease, while pituitary adenomas are a feature ofMEN1 (multiple endocrine neoplasia 1 ) syndrome.

21
Q

All of the following is true about Huntington’s disease, except
A. CAG trinucleotide repeats
B. Autosomal recessive
C. Age 30-50 years at presentation
D. Choreiform movements and dementia
E. Striatal atrophy causing box car ventricles

A

B. Autosomal recessive

Huntington’s disease inheritance is autosomal dominant, characterized by CAG trinudeotide repeats in IT15 (huntingtin) gene on chromosome 4.

22
Q

Suprascapular n entrapment is associated with
loss of which shoulder movement?
A. Flexion
B. Extension
C. Protraction
D. Internal rotation
E. External rotation

A

E. External rotation

Suprascapular n entrapment is associated with weakness of supraspinatus (shoulder abduction) and infraspinatus (external rotation).

23
Q

The lateral spinothalamic tract has all of the following features, except
A. It conveys pain and temperature sensation
B. It arises from the contralateral side of the
body
C. Fibers originate in Rexed layers I, IV, and V
D. It is somatotopically organized with the leg
medial
E. Efferents relay in the VPL (ventral posterolateral) nucleus of thalamus

A

D. It is somatotopically organized with the leg medial

The lateral spinothalamic tract conveys pain and temperature from the contralateral dorsal horn (layers I, IV, and V) to the VPL of thalamus then the sensory cortex (postcentral gyrus). Somatotopic organization with the leg lateral and the arm medial.

24
Q

All of the following is true about abrupt intrathecal baclofen withdrawal, except
A. A life-threatening condition
B. Flaccidity
C. Seizures
D. Fever
E. Altered level of conciousness

A

B. Flaccidity

Abrupt intrathecal baclofen withdrawal is an emergency. It is characterized by increased rigidity, fever, seizures, loss of consciousness, labile blood pressure, and hallucination. Untreated, it may lead to rhabdomyolysis, hepatic failure, renal failure, DIC (disseminated intravascular coagulopathy), and death. The patient should be admitted to the ICU (intensive care unit), oral badofen started, intravenous (IV) diazepam (Valium) or midazolam (Versed).

25
Q

The first web space on the dorsum of the foot is
supplied by
A. Saphenous n
B. Superficial peroneal n
C. Deep peroneal n
D. Sural n
E. Tibial n

A

C. Deep peroneal n

The dorsum of the foot is supplied by the superficial peroneal n except the first web space which is supplied by the deep peroneal n. The sural n supplies the lateral aspect of the foot and the little toe. The saphenous n (from the femoral n) supplies the area of the medial malleolus. The tibial nerve supplies the sole of the foot through the medial and lateral plantar nerves and the medial calcaneal branches.

26
Q

Huntington’s disease is characterized by deficiency of the enzyme
A. Choline acetyltransferase
B. Acetylcholine estBase
C. Arylsulfatase B
D. Sphingomyelinase
E. lduronate-2-sulfatase

A

A. Choline acetyltransferase

Huntington’s disease is associated with choline
acetyltransferase deficiency. Acetylcholinesterase inhibition occurs in organophosphate poisoning. Arylsulfatase B deficiency occurs in Maroteaux-Lamy syndrome, sphingomyelinase in Niemann-Pick disease, and iduronate-2-sulfatase in Hunter’s disease.

27
Q

The following specimen is from an intraventricular
tumor. What is the diagnosis?
A. Ependymoma
B. Plasmacytoma
C. Meningioma
D. Medulloblastoma
E. SEGA (subependymal giant cell astrocytoma)

A

E. SEGA (subependymal giant cell astrocytoma)

Note the large astrocytes with large eccentric nuclei. SEGA can be sporadic or occur in tuberous sclerosis. Inheritance of the latter is autosomal dominant on chromosomes 9 or 16.

28
Q

An 18-year-old athletic female presents with low
back pain. The most likely cause is
A. Spondylolysis
B. Discitis
C. Spondyloptosis
D. Spondylosis
E. Ankylosing spondylitis

A

A. Spondylolysis

There is bilateral L5 pars defect: spondylolysis. X-ray also reveals grade I spondylolisthesis (slipped vertebra). Spondyloptosis is a grade V spondylolisthesis where the body of one vertebra drops in front of the body of the vertebra below. Spondylosis means degenerative arthritis of the spine, with development of osteophytes, typically above 40 years old. Ankylosing spondylitis causes bamboo spine and fusion of the facet joints. It is more common in males with HLA-827 and starts in adolescents and young adults.

28
Q

All of the following is true about internuclear ophthalmoplegia (INO), exapt
A. It is caused by a lesion in the ipsilateral medial
longitudinal fasdculus (MLF)
B. It results in inability to adduct the eye
C. Anterior INO typically preserves convergence
D. Posterior INO is caused by a pontine lesion
E. One-and-a-half syndrome is caused by bilateral MLF lesion and unilateral VI nerve palsy

A

C. Anterior INO typically preserves convergence

Convergence is affected in anterior INO (midbrain). Posterior INO is caused by a lesion in the pons and preserves convergence (remember PPP: Posterior, Pons, Preserves convergence).

29
Q

The following er was obtained after a car accident.
After stabilizing the vital signs, what should be the
initial management of the patient?
A. Halo immobilization
B. Anterior C2-C3 fusion
C. Posterior C2-C3 fusion
D. Posterior Cl-C3 fusion
E. Posterior Occiput-C3 fusion

A

A. Halo immobilization

The initial management of Hangman’s fracture should be external immobilization and reduction. Surgery can be considered for Effendi type III fractures (severe angulation with C2-C3 facet dislocation) or failed external immobilization.

30
Q

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by all of the following, except
A. Hyponatremia
B. Decreased serum osmolarity
C. Decreased serum uric acid
D. Hypovolemia

A

A. Hyponatremia

SIADH is characterized by normo- or hypervolemia.

31
Q

During a retroperitoneal approach, the nerve that
is antimor to the psoas muscle is
A. Obturator n
B. Genitofemoral n
C. Lateral femoral cutaneous n
D. Ilioinguinal n
E. Lumbosacral trunk

A

B. Genitofemoral n

The lumbar plexus forms inside the psoas major muscle. The genitofemoral n exits anterior to the psoas. Medial to the psoas passes the obturator n, the accessory obturator n, and the lumbosacral trunk. Lateral to the psoas are the iliohypogastric, ilioinguinal, lateral femoral cutaneous, and femoral nn.

32
Q

Which of the following statements is true about
the Hoffmann reflex (H-reflex)?
A. It results from stimulation of the muscle
spindle.
B. Afferents travel in la fibers.
C. It is produced by supramaximal stimulation.
D. It is a polysynaptic reflex.
E. The latency does not depend on the distance
between the muscle and the spinal cord.

A

B. Afferents travel in la fibers.

Despite it mimicking the stretch reflex, the H-reflex bypasses the muscle spindle and is obtained by submaximally stimulating the nerve afferents in the Ia fibers. It is a monosynaptic reflex and efferents originate in the alpha motomeuron. The latency increases, the further the muscle is
from the spinal cord. The F response is obtained by supramaximal stimulation.

33
Q

The following intraparenchymal brain tumor was
positive for GFAP (glial fibrillary acid protein) and
reticulin. What is the diagnosis?
A. Pleomorphic xanthoastrocytnma (PXA)
B. Grade II astrocytoma
C. Grade III astrocytoma
D. Glioblastoma
E. Gliosarcoma

A

B. Grade II astrocytoma

Gliosarcoma has two components: glial (a) with necrosis, positive for GFAP and sarcoma (b) with spindle cells, positive for reticulin.

34
Q

The following is true about Botulinum toxin:
A. Inhibits SNARE (soluble N-ethylmaleimide-sensitive factor-attachment protein-receptor)
proteins
B. Competitive muscle blocker
C. Depolarizing muscle blocker
D. Muscarinic receptor blocker
E. Nicotinic receptor ganglion blocker

A

A. Inhibits SNARE (soluble N-ethylmaleimide-sensitive factor-attachment protein-receptor)
proteins

Botulinum toxin inhibits SNARE proteins, thus preventing release of acetylcholine from presynaptic terminals. Curare is a competitive muscle blocker, succinylcholine a depolarizing blocker, atropine a muscarinic blocker, and hexamethonium a ganglion blocker.

35
Q

The following is a radiological sign of occcipitocervical dislocation:
A. Powers ratio 1
B. Basion-dens interval (BDI) 13 mm
C. Basion-axis interval (BAI) 11 mm
D. Atlantodental interval (ADI) 6 mm
E. Sun ratio of 2

A

B. Basion-dens interval (BDI) 13 mm

Radiological signs of occipitocervical dislocation include: Powers ratio >1, BDI (basion to tip of dens) >12 mm (Wholey), BAI (basion to posterior axis line) >12 mm (Harris), and Sun ratio (C1-C2/ C2-C3 interspinous distance) >2 5. ADI (back of
anterior arch of atlas to front of dens) > 3 mm in adults and >5 mm in children is a sign of C1-C2 dislocation.

36
Q

All of the following is true about neurogenic shock, except
A. Hypotension
B. Tachycardia
C. Occurs after spinal cord injury (SC)
D. Results from autonomic dysfunction
E. Decreased systemic vascular resistance {SVR)

A

B. Tachycardia

Neurogenic shock occurs after stroke or SCI. It is characterized by loss of sympathetic tone, decreased SVR, hypotension, and bradycardia. Treatment should start with fluid resuscitation.
Vasopressors can then be used. Hemorrhagic shock is associated with tachycardia.

37
Q

The nucleus responsible for parotid salivary secretion is
A. Nucleus solitarius
B. Nucleus ambiguus
C. Dorsal vagal nucleus
D. Superior salivary nucleus
E. Inferior salivary nucleus

A

E. Inferior salivary nucleus

The parasympathetic fibers for parotid secretion originate in the inferior salivary nucleus, travel with the glossopharyngeal n (IX), relay in the otic ganglion then join the auriculotemporal n. The superior salivary nucleus supplies the lacrimal,
submandibular, and sublingual glands through cranial nerve VII. The dorsal vagal nucleus supplies parasympathetic to the cardiac, respiratory, and digestive systems. The nucleus solitarius provides taste sensation (VII, IX, and X), while the nucleus ambiguus is special visceral efferent (IX, X, and XI) to palate, pharynx, and larynx.

38
Q

Which of the following projections correspond
with Mediodorsal (MD)?
A. Areas 18 and 19
B. Area 4
C. Premotor cortex
D. Cingulate gyrus
E. Amygdala

A

E. Amygdala

MD receives afferents from the amygdala, SN, prefrontal cortex, temporal cortex, and GP. It projects to the prefrontal area.

38
Q

All of the following is true about smooth muscles,
except
A. They are supplied by autonomic nerves.
B. They have 15 more times actin than myosin.
C. They contain troponin.
D. Contraction is initiated by 4 calcium ions
binding calmodulin.
E. Myosin kinase is involved In musde contraction, while myosin phosphatase in relaxation.

A

C. They contain troponin.

Smooth muscles have no troponin.

38
Q

The most common organism recovered from neurosurgical postoperative infection is
A. Staphylococcus aureus
B. Group B streptococcus
C. Streptococcus pneumaniae
D. Escherichia coli (E. coli)
E. Neissma meningitides

A

A. Staphylococcus aureus

The most common organism recovered from neurosurgical postoperative infections is Staphylococcus aureus, S. epidermidis, and gram-negative bacilli. E. coli, group B streptococci, and listeria monocytogenes are seen in neonates and up to 3 months old. Hemophilus influenza between 3
months and 18 years old, now less common since Hib vaccine. Neisseria meningitidis is common in children and young adults (school age). Streptococcus pneumoniae is common >50 years old and <3 months old, or after skull base fractures.

39
Q

Ramsay Hunt’s syndrome is characterized by herpes zoster infection to the
A. Geniculate ganglion
B. Gasserian ganglion
C. Inferior petrosal ganglion
D. Nodose ganglion
E. External auditory canal

A

A. Geniculate ganglion

Ramsay Hunt’s syndrome is caused by reactivation of herpes zoster infection to the geniculate ganglion. It causes ear pain, loss of hearing, vertigo, tinnitus, facial weakness, and vesicles in the external ear.

40
Q

A 56-year-old female presented with headaches,
seizures, and the following MRI. What is the most
likely diagnosis?
A. GlioblaslDma
B. Brain metastasis
C. Multiple sclerosis (MS)
D. Brain abscess

A

D. Brain abscess

Although the four options can cause ring enhancement (a), in a brain abscess the wall is thin and the inner wall is sharply demarcated. On T2 the hypointense abscess wall contrasts with the hyperintense pus inside and the hyperintense
edema outside (b). It also shows restricted diffusion (c:). In MS, the ring is typically incomplete.

41
Q

Which of the following projections correspond
with Anterior nuclear group (ANG)?
A. Areas 18 and 19
B. Area 4
C. Premotor cortex
D. Cingulate gyrus
E. Amygdala

A

D. Cingulate gyrus

ANG receives afferents from the fornix and projects to the cingulate cortex.

41
Q

Which of the following projections correspond
with Pulvinar?
A. Areas 18 and 19
B. Area 4
C. Premotor cortex
D. Cingulate gyrus
E. Amygdala

A

A. Areas 18 and 19

The pulvinar receives afferents from the superior colliculus and projects to areas 18, 19.

41
Q

Which of the following projections correspond
with ventral posterolateral, pars oralis (VPLo )?
A. Areas 18 and 19
B. Area 4
C. Premotor cortex
D. Cingulate gyrus
E. Amygdala

A

B. Area 4

VPLo and VLc (Vim and Vop) receive afferents from the dentate nudeus and project to motor area 4.

42
Q

Which of the following projections correspond
with Ventral lateral, pars oralis (Vlo)?
A. Areas 18 and 19
B. Area 4
C. Premotor cortex
D. Cingulate gyrus
E. Amygdala

A

D. Cingulate gyrus

VLo (Voa) receive afferents from GP and red nuceus and project to the premotor area.

43
Q

Which of the following diseases correspond with
Bunina bodies?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Rabies
D. Amyotrophic lateral sclerosis (ALS)
E. Multiple myeloma

A

D. Amyotrophic lateral sclerosis (ALS)

Bunina bodies are found in anterior horn cells in patients with ALS.

44
Q

Which of the following diseases correspond with
Negri bodies?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Rabies
D. Amyotrophic lateral sclerosis (ALS)
E. Multiple myeloma

A

C. Rabies

Negri bodies are found in rabies especially in hippocampus.

45
Q

Which of the following diseases correspond with
Lewy bodies?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Rabies
D. Amyotrophic lateral sclerosis (ALS)
E. Multiple myeloma

A

A. Parkinson’s disease

Lewy bodies are found in Parkinson’s disease.

46
Q

Which of the following diseases correspond with
Russel bodies?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Rabies
D. Amyotrophic lateral sclerosis (ALS)
E. Multiple myeloma

A

A. Parkinson’s disease

Russel bodies are found in plasma cells in patients with multiple myeloma.

47
Q

Which of the following diseases correspond with
Hirano bodies?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Rabies
D. Amyotrophic lateral sclerosis (ALS)
E. Multiple myeloma

A

B. Alzheimer’s disease

Hirano bodies, neurofibrillary tangles, and neuritic plaques are characteristic of Alzheimer’s disease.

14. Neurosurgery Primary Examination Review (10 decks)

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