soal gambar 3

Question 1

102. What is depicted in the photomicrograph below (Figure 8.102OJ?

A. Hemangiopericytoma
B. Medulloblastoma
C. Melanoma
D. Rhabdoid tumor
E. Germinoma

Answer 1

102. A.

Note the “staghorn” vascular channel in this grade II
hemangiopericytoma. These tumors are vimentin-positive,
EMA-negative, have a dense arrangement of sheet-like cells,
and have a high nuclear-cytoplasmic ratio. Other characteristics
include focal lobularity, paucicellular areas, and dense
pericellular reticulin (Ellison, pp. 736-738).

Question 2

105. The lesion depicted below (Figure 8.105Q.) most likely originates from what blood vessel?
     FIGURE 8.105Q
     A. Accessory middle cerebral artery
     B. Frontopolar artery
     C. Anterior temporal artery
     D. Posterior temporal artery
     E. Lenticulostriate

Answer 2

105. C.

The middle cerebral artery (MCA) is divided
anatomically into four major segments: Ml (horizontal) segment,
M2 (insular segment), M3 (opercular segment), and
M4 (cortical) segment. The anterior temporal artery typically
arises from the Ml segment of the MCA before the
bifurcation. It passes directly anteriorly and inferiorly over
the temporal tip and usually does not course toward the
sylvian fissure. Although relatively uncommon, aneurysms
can form at the origin or further distally along this vessel (as
depicted here). An accessory middle cerebral artery is an
MCA branch that arises from either the ACA (more common)
or the ICA and parallels the Ml segment toward the sylvian
fissure. The lenticulostriate arteries are divided into a
smaller medial group and a larger lateral group that originate
from the distal half of the Ml segment and project superiorly
to enter the anterior perforated substance to supply parts of
the lentiform nuclei, caudate nucleus, and internal capsule.
The posterior temporal artery usually originates from the
M4 segment of the MCA and supplies the posterior temporal
lobe. The frontopolar artery is a branch of the anterior cerebral
artery (A2 portion), which originates below the rostrum
or genu of the corpus callosum and extends anteriorly to
supply the frontal pole (Osborn DCA, pp. 135-137).

Question 3

QUESTIONS 108-116
Directions: Figure S.108-8.116Q, depicts an endoscopic
approach to the third ventricle. Match the following anatomic
structures to the corresponding letterhead, using each
answer either once, more than once, or not at all.
FIGURE 8.108-116Q

108. Thalamostriat e vein
109. Septal vein
110. Thalamus
111. Choroid plexus
112. Anterior caudate vein
113. Superior choroidal vein
114. Fornix
115. Superior superficial thalamic veins
116. Caudate nucleus

Answer 3

108-A; 109-D; 110-G; 111-B; 112-F; 113-C; 114-E; 115-H; 116- I.

Question 4

QUESTIONS 120-122

120. The etiology of the abnormality depicted on the MPJ
     scan below (Figure 8.120-8.122Q.) is most likely
     FIGURE 8.120-122Q
     A. Iatrogenic
     B. Infectious
     C. Traumatic
     D. Developmental
     E. Neoplastic

Answer 4

120-D

Question 5

121. What is the diagnosis?
     A. Diffuse axonal injury
     B. Obstruction of the aqueduct of Sylvius
     C. Meningitis
     D. Agenesis of the corpus callosum
     E. Obstruction of the foramen of Monro

Answer 5

121-D

Question 6

122. Associated conditions may include all of the following
     EXCEPT?
     A. Schizencephaly
     B. Chiari I malformation
     C. Dandy-Walker malformation
     D. Cephaloceles
     E. Azygos anterior cerebral artery

Answer 6

122-B

Question 7

QUESTIONS 124-125
Scenario: A 45-year-old telemarketing agent has noticed
a gradual decline in his hearing over the course of a few
months and, only recently, some right arm weakness. Physical
exam discloses full extraocular motion, symmetric facial
movements, a Weber test that lateralizes to the right, a Rinne
test revealing bone conduction better than air conduction on
the left side, a uvula that deviates slightly to the right, and a
tongue that deviates to the left. His MRI is depicted below
(Figure 8.124-8.125QJ.

124. What is the most likely diagnosis?
     A. Foramen magnum meningioma
     B. Acoustic neuroma
     C. Glomus jugulare tumor
     D. Hemangiopericytoma
     E. Chordoma
125. The best treatment strategy for this patient wound entail
     A. Radiosurgery
     B. Proton-beam radiation
     C. Observation with serial MRI scans
     D. Attempted gross total resection
     E. Conventional external-beam radiation

Answer 7

124-C; 125-D. This patient harbors a glomus jugulare tumor,
which often presents with unilateral hearing loss or pulsatile
tinnitus. Intracranial extension usually affects multiple
cranial nerves, which may result in a number of clinical
problems including dysphagia. Angiography is essential
because it helps with surgical planning. It helps delineate the
blood supply to the tumor as well as collateral blood flow
to the brain. Often preoperative embolization is a useful
adjunct for these highly vascular and locally invasive tumors.
Although observation with serial imaging studies to determine
tumor progression may be an appropriate option for
medically frail patients, gross total resection is considered
the treatment of choice for symptomatic lesions (Youmans,
pp. 1295-1308).

Question 8

QUESTIONS 126-127

126. What is the most likely mechanism accounting for the
     fracture pattern depicted in Figure 8.126-8.127QJ?
     FIGURE 8.126-127Q
     A. Direct axial load on a neutral neck
     B. Direct axial load on a flexed neck
     C. Distraction
     D. Direct axial load on a laterally bent neck
     E. Hyperextension
127. What amount of CI lateral mass excursion beyond the axis indicates transverse ligament disruption?

A. 4 mm
B. 5 mm
C. 6 mm
D. 7 mm
E. 9 mm

Answer 8

126-A; 127-D. The fracture-pattern (Jefferson fracture)
depicted on this axial CT scan most often results from an
axial load on a neutral neck. These patients are usually neurologically
intact due to the large diameter of the spinal canal
at this level. If the sum of overhang of both lateral masses on
C2 is > 7 mm, the transverse ligament is probably disrupted,
which requires rigid immobilization (usually with a halo
vest) or surgical fixation if additional fractures are present
(Greenberg, pp. 702-703).

Question 9

QUESTIONS 133-134
133. What is the most likely mechanism of injury of the
abnormality depicted below (Figure 8.133-8.1340J?
FIGURE 8.133-134Q
A. Hyperextension and axial loading
B. Axial load on a neutral neck
C. Axial loading on a laterally bent neck
D. Severe hyperflexion and axial loading
E. Hyperextension and distraction

134. Therapeutic options may include all of the following
     EXCEPT?
     A. Cervical collar
     B. Halo vest immobilization
     C. Open reduction with internal fixation (C2 to C3)
     D. Odontoid screw
     E. SOMI brace
     End of set

Answer 9

133-A; 134-D. The mechanism of most modern hangman’s
fractures results from hyperextension and axial loading
(diving and motor vehicle accidents), while judicial hangings
often resulted in hyperextension and distractive forces from
submeatal knot placement. Patients rarely require surgical
intervention for this type of fracture, which is typically
reserved for irreducible fractures, failure of external immobilization,
traumatic G2-3 disc herniation (with canal compromise
and progressive neurologic deficit), and established
nonunion. All fusion techniques typically involve fusing C2
to G3, although the majority of patients can be successfully
treated with a cervical collar, SOMI brace, or halo vest (most
common) (Greenberg, pp. 704-706).