Neurosurgery Practice Questions and Answers (1-100)

Answers listed at the end 1. Regarding the pathophysiology of myasthenia gravis, what is/are the possible mechanisms by which acetylcholine receptor antibodies interfere with neuromuscular transmission? A. Binding to t ...

Answers listed at the end 1. Regarding the pathophysiology of myasthenia gravis, what is/are the possible mechanisms by which acetylcholine receptor antibodies interfere with neuromuscular transmission? A. Binding to the acetylcholine receptor and blocking the binding of acetylcholine B. Cross-linking acetylcholine receptors, thereby increasing their rate of internalization C. Binding of complement resulting in destruction of the muscle end plate D. All of the above E. None of the above 2. All of the following statements are correct regarding the medial lemniscus EXCEPT: A. Near the sensory decussation, its blood supply comes from the anterior spinal artery. B. The medial lemniscus can be found in close proximity to the anterolateral tract in the medulla. Its somatotopy in the pons is such that leg fibers are lateral to arm fibers. C. The fibers of the medial lemniscus arise from the cuneate and gracile nuclei. D. Brainstem lesions involving medial lemniscus fibers usually include adjacent structures, resulting in motor and sensory losses. E. None of the above statements are correct. 3. All the following findings are associated with the abnormality seen on the scan shown here EXCEPT: A. Ankylosing spondylitis B. Positive FABER test C. Positive thigh thrust D. Pain upon internal rotation of the hip E. Positive thigh compression text 4. Which of the following lines at the craniocervical junction extends from the basion to the opisthion? A. McRae’s line B. McGregor’s line C. Chamberlain’s line D. Wackenheim’s line E. Anterior marginal line 5. The somatotopic arrangement in the ventral horn is such that the A. flexors are dorsal to extensors and limbs are medial to trunk. B. extensors are dorsal to flexors and limbs are medial to trunk. C. flexors are dorsal to extensors and limbs are lateral to trunk. D. extensors are dorsal to flexors and limbs are lateral to trunk. E. None of the above 6. All of the following techniques may be used to aid in identifying the level of interest in a thoracic diskectomy procedure EXCEPT: A. Intraoperative lateral fluoroscopy with counting levels starting from the sacrum and moving rostral with midline needle localizers B. Intraoperative anteroposterior (AP) fluoroscopy with counting levels starting from the 12th rib and moving rostral with midline needle localizers C. Intraoperative AP fluoroscopy with counting levels starting from the first rib and moving caudal with midline needle localizers D. Neuronavigation with skin surface fiducial registration E. Neuronavigation with spinal bony landmark registration within the proximity of the level of interest 7. The MRI scan shown here represents an opportunistic infection in a 25-year-old man with acute myelogenous leukemia. All the following statements are true EXCEPT: A. Pathology reveals pleomorphic short and wide septate hyphae. B. It can be treated with Cancidas, voriconazole, and AmBisome. C. It causes hemorrhagic necrosis and ischemic strokes. D. The organism originates in the soil. E. It may be seen with an immunocompromised patient. 8. Somatic motor efferents to the urethral sphincter are located in A. intermediolateral cell columns of the sacral cord. B. Onuf’s nucleus. C. Barrington’s nucleus. D. All of the above E. None of the above 9. Cerebral ischemia begins when cerebral perfusion pressure (CPP) falls below A. 100 mm Hg. B. 75 mm Hg. C. 50 mm Hg. D. 23 mm Hg. E. 8 mm Hg. 10. Regarding the anatomy near the cavernous sinus, the borders of the clinoidal triangle are cranial nerves A. I and II. B. II and III. C. III and IV. D. IV and V. E. None of the above 11. Which of the following is FALSE regarding myasthenia gravis? A. The first presentation is usually weakness of the extraocular muscles. B. Weakness fluctuates and fatigues over the course of the day. C. Speech may be hypernasal or hoarse in some patients. D. It may present with a head drop. E. Dysphagia is worst at breakfast and improves during the course of the day. 12. All of the following are true of polymyositis EXCEPT: A. It involves a symmetric weakness of proximal limb and trunk muscles. B. Its onset is insidious. C. Ocular muscles are usually spared. D. Muscles are not tender to palpation. E. Skin changes typically occur before muscle abnormalities. 13. Protein 14-3-3 is elevated in the CSF in which of the following conditions? A. Creutzfeldt-Jakob disease B. Demyelinating disease C. Head trauma D. Meningoencephalitis E. All of the above 14. Which of the following statements is most accurate regarding the nerve supplying the teres minor muscle? A. It has a contribution from the lateral cord. B. It is an extension of the posterior cord. C. Ventral rami C8 and T1 are major contributors to this nerve. D. It is derived from the same cord as the musculocutaneous nerve. E. None of the above 15. The pterion is formed by the junction of the all of the following EXCEPT: A. Frontal bone B. Sphenoid bone C. Zygomatic bone D. Temporal bone E. Parietal bone 16. Which of the following is FALSE regarding the sonic hedgehog (SHH) gene? A. SHH has been found to have the critical roles in development of the limb and midline structures in the brain and spinal cord. B. Mutations in the human SHH gene, cause holoprosencephaly type 3 as a result of the loss of the ventral midline. C. The SHH transcription pathway has been linked to the formation of embryonic cerebellar tumors such as medulloblastoma. D. SHH has been shown to act as an axonal guidance cue: SHH attracts retinal ganglion cell axons at high concentrations and repels them at lower concentrations. E. SHH plays a critical role in the induction of the floor plate and diverse ventral cell types within the neural tube. 17. Regarding infection in a trauma patient with the X-ray shown here, the most common pathogen is A.Staphylococcus aureus. B.Pseudomonas. C.Proteus. D.Streptococcus pneumoniae. E.Escherichia coli. 18. Which of the following is incorrect regarding the zona incerta? A. It is a zone of gray matter between the thalamic and lenticular fasciculi. B. It is composed of cells that are continuous laterally with the thalamic reticular nucleus. C. Unlike the thalamic reticular nucleus, the neurons of this zone do not display immunoreactivity for the calcium binding protein calbindin D-28k. D. It receives corticofugal fibers from the precentral cortex. E. All of the above statements are correct. 19. All the following are potential contraindications for vagal nerve stimulation placement EXCEPT: A. Upper cranial nerve deficits B. Presence of a single vagus nerve only C. Cardiac arrhythmias D. Lung disease E. Ulcers 20. The anterior loop of the internal carotid artery lies in the floor of this triangle. A. Lateral triangle B. Anterior lateral triangle C. Parkinson’s triangle D. Anterior medial triangle E. None of the above 21. Jitter is best described as A. synchronous muscle fiber activation between fibers of different motor units. B. a difference in timing of muscle fiber activation between two fibers in a single motor unit. C. a difference in timing of muscle fiber activation between two fibers of different motor units. D. the complete failure of neuromuscular transmission at one muscle fiber in a pair. E. None of the above 22. Ataxia may be seen in all of the following syndromes EXCEPT: A. Claude’s syndrome B. Benedikt’s syndrome C. Nothnagel’s syndrome D. Basilar artery syndrome E. Weber’s syndrome 23. Which of the following is the least common complication of vagal nerve stimulation placement in the pediatric population? A. Hoarseness B. Coughing C. Shortness of breath D. Nausea E. Increased drooling 24. A lesion of which of the following structures would most significantly impair memory? A. Amygdala B. Fornix C. Dorsomedial nucleus of the thalamus D. Mammillary body E. Area 44 25. Which of the following is NOT associated with the findings on this X-ray? A. Weakness of hand intrinsic flexors B. Horner’s syndrome C. Raynaud’s syndrome D. Traction meningocele E. Ulnar paresthesias 26. Bannayan–Riley–Ruvalcaba syndrome is associated with all the following EXCEPT: A. Multiple subcutaneous lipomas B. Macrocephaly C. Hemangiomas D. Intracranial arteriovenous malformations E. Capillary malformation or “port-wine stain” 27. Where is the extreme capsule located? A. Between the claustrum and the putamen B. Between the claustrum and the insular cortex C. Between the putamen and the globus pallidus externus D. Between the globus pallidus externus and the globus pallidus internus E. Above the caudate nucleus 28. Which of the following neurotransmitters promotes penile erection? A. Serotonin B. Dopamine C. Noradrenaline D. All of the above E. None of the above 29. The peak reduction in intracranial pressure (ICP) after administration of mannitol occurs in about A. 4 hours. B. 2 hours. C. 1 hour. D. 30 minutes. E. 15 minutes. 30. The borders of the paramedial triangle are cranial nerves A. I and II. B. II and III. C. III and IV. D. IV and V. E. None of the above 31. The Tensilon test A. is not sensitive but very specific for myasthenia gravis (MG). B. is not particularly useful in ocular MG. C. when negative, rules out the diagnosis of MG. D. shows no correlation with subsequent response to pyridostigmine. E. is not affected by the quantity of acetylcholine receptors. 32. In posterior interosseous syndrome, there is a fingerdrop but no wristdrop because of sparing of the A. extensor carpi radialis longus. B. extensor carpi radialis brevis. C. extensor digitorum. D. extensor carpi ulnaris. E. brachioradialis. 33. What is the Spetzler–Martin grade of this arteriovenous malformation (AVM) found in a 30-year-old asymptomatic healthy patient? A. 1 B. 2 C. 3 D. 4 E. 5 34. Interruption of the inferior geniculocalcarine fibers results in which of the following? A. Ipsilateral superior quadrantanopia B. Contralateral superior quadrantanopia C. Ipsilateral inferior quadrantanopia D. Contralateral inferior quadrantanopia E. None of the above 35. Which of the following may be seen with ocular myoclonus? A. Vertical oscillation of the eyes occurring with movements of the palate B. Hypertrophy of the inferior olivary nucleus C. Prior lesions of the central tegmental tract D. All of the above E. None of the above 36. All of the following characterize Acute respiratory distress syndrome (ARDS) EXCEPT: A. Late hypoxemia B. Diffuse infiltrate C. Leaky capillaries D. Association with sepsis and trauma E. Protein content of fluid greater than with pulmonary edema 37. In a healing wound, maximum collagen deposition occurs at A. 2 weeks. B. 4 weeks. C. 6 weeks. D. 8 weeks. E. 10 weeks. 38. All of the following are true regarding the condition depicted by this histopathology EXCEPT: A. It is histologically characterized by a biphasic pattern. B. Rosenthal fibers are a prerequisite for this diagnosis. C. It may mimic oligodendroglioma. D. It is a CNS neoplasm seen with neurofibromatosis type 1. E. Recurrence is usually a reformation of the cyst rather than the solid tumor. 39. Barbiturates presumably act by which of the following mechanisms? A. Inverse steal phenomenon B. Decrease CMR C. Decrease oxygen consumption D. Scavenge free radicals E. All of the above 40. Parkinson’s (infratrochlear) triangle is defined by cranial nerves A. II and III. B. III and IV. C. IV and V1. D. V1 and V2. E. V2 and V3. 41. Which of the following is true of myasthenia gravis? A. The majority of acetylcholine receptor antibodies are of the M subtype. B. Cyclosporine is used as a first-line treatment. C. Corticosteroids may reduce the risk of secondary generalization in the ocular form. D. Pathological abnormalities of the thymus are found in less than 5% of patients. E. Weakness confined to the ocular muscles beyond 3 years is associated with poor prognosis. 42. The border of the foramen lacerum is formed by the A. sphenoid bone. B. temporal bone. C. sphenoid and temporal bones. D. sphenoid, temporal, and occipital bones. E. occipital bone. 43. Absence of inflammation is typical of the following diseases EXCEPT: A. Neuropathy from diphtheria B. Creutzfeldt–Jakob disease C. Paraneoplastic necrotizing myelopathy D. Central pontine myelinolysis E. Tolosa–Hunt syndrome 44. Wernicke’s area is BEST described as including A. area 39. B. supramarginal, area 40, and posterior one-third of the superior temporal gyri. C. angular and posterior one-third of the superior temporal gyri. D. areas 39 and 40. E. supramarginal and posterior one-third of the superior temporal gyri. 45. Anti-pause cell antibody may be seen with childhood infections or paraneoplastic syndrome in adults. Immune-mediated defects in pause cell function most likely result in A. opsoclonus. B. square wave jerks. C. downbeat nystagmus. D. upbeat nystagmus. E. None of the above 46. The origin of axons that mediate the swallowing reflex is the A. solitary nucleus. B. dorsal motor nucleus of X. C. nucleus ambiguus. D. All of the above E. None of the above Match these MRI scan findings with the following comments: A. Scan 1 B. Scan 2 C. Both scans 1 and 2 D. Neither scan 1 nor scan 2 47. Hypertension 48. Early facial nerve involvement 49. Hypotension and bronchoconstriction during resection 50. Explosive diarrhea 51. Early hearing loss and tinnitus 52. Laboratory manifestations of disseminated intravascular coagulation (DIC) include all of the following EXCEPT: A. Increased fibrinogen level B. Prolonged PT C. Prolonged PTT D. Thrombocytopenia E. Fragmented RBCs 53. The mastoid air cells are innervated by A. V1. B. V2. C. V3. D. IX. E. X. 54. Which of the following statements is most accurate regarding the band of Gennari? A. It divides the third layer of the cortex of areas 17 and 18. B. It divides the third layer of the cortex of area 17. C. It divides the fourth layer of the cortex of areas 17 and 18. D. It divides the fourth layer of the cortex of area 17. E. It divides the fourth layer of the cortex of areas 17, 18, and 19. 55. The following are prenuclear structures for vertical gaze EXCEPT: A. Nucleus of Darkshevich B. Posterior commissure C. Interstitial nucleus of Cajal D. Rostral interstitial nucleus of the medial longitudinal fasciculus (MLF) E. Nucleus prepositus hypoglossi 56. Which of the following neurons or nerve cell processes is/are particularly involved with new, novel movements? A. Mossy fibers B. Betz cell C. Climbing fibers D. All of the above E. None of the above 57. Which of the following disease states is characterized by high trophic hormone and low target hormone? A. Cushing’s disease B. Graves’s disease C. Adrenal tumors D. Addison’s disease E. None of the above 58. Which of the following intrinsic muscles of the thumb does NOT insert on the proximal phalanx? A. Adductor pollicis B. Abductor pollicis brevis C. Flexor pollicis brevis D. Opponens pollicis E. Extensor pollicis brevis 59. Which of the following statements is FALSE with regard to the scan shown here? A. The first symptom in 90% of patients is unilateral hearing loss. B. Headaches, clumsy gait, and mental confusion may occur. C. The seventh cranial nerve is frequently involved preoperatively. D. Essentially everyone who has been treated for an acoustic neuroma experiences difficulty with balance and/or dizziness to some degree. E. Sporadic defects in tumor suppressor genes may give rise to these tumors. Match these brachial plexus structures with the appropriate letter in the diagram: 60. Medial brachial cutaneous nerve 61. Long thoracic nerve 62. Medial antebrachial cutaneous nerve 63. Suprascapular nerve 64. Median pectoral nerve 65. The medial longitudinal fasciculus (MLF) is responsible for the binocular coordination of the following eye movements EXCEPT: A. Lateral B. Vertical C. Vergence D. Oblique E. Horizontal 66. Which of the following is a distinguishing factor between Apert’s and Crouzon’s syndrome? A. Pattern of inheritance B. Association with bilateral coronal synostosis C. Severity of mental retardation D. All of the above E. None of the above 67. TRH is a secretagogue for A. prolactin. B. ACTH. C. GH. D. TSH. E. All of the above 68. Which of the following nerves is responsible for movement of the ring finger? A. Radial only B. Radial and median C. Radial, median, and ulnar D. Radial, median, and axillary E. Musculocutaneous, median, and ulnar 69. Which of the following immunohistochemical profiles has been shown to be expressed in 100% of primary glioblastoma? A. Survivin B. MMP-9 C. EGFR D. MDM2 E. Fas (APO-1/CD95) 70. This triangle is defined laterally by the greater superficial petrosal nerve and medially by the petrosal sinus. A. Lateral triangle B. Paramedial triangle C. Glasscock’s triangle D. Kawase’s triangle E. Parkinson’s triangle 71. Which is FALSE regarding the hormone prolactin (PRL)? A. Its releasing hormone is located in the arcuate nucleus. B. Normal levels are 5–25 ng per mL. C. Levels may be increased after syncope. D. Levels are increased after tonic clonic seizure activity. E. Levels are increased after nonepileptic seizures. 72. Which of the following circumventricular organs is a central receptor site for angiotensin II? A. Organum vasculosum of the lamina terminalis B. Median eminence of the tuber cinereum C. Subcommissural organ D. Subfornical organ E. Area postrema 73. All of the following are true of the sinuvertebral nerve EXCEPT: A. It is a branch from the posterior division of the spinal nerve proximal to the dorsal root ganglion. B. It may enter the intervertebral foramen. C. It supplies most of the innervation to the posterior aspect of the disk. D. It may have a proprioceptive and/or nociceptive function. E. It has been shown to consist of two roots at cervical levels. 74. All of the following are true of conduction aphasia EXCEPT: A. It is caused by a lesion of the arcuate fasciculus. B. There is fluent paraphasic speech with intact repetition. C. It may be caused by occlusion of a middle cerebral artery(MCA) posterior temporal branch. D. Patients may mimic Wernicke’s disease, but are able to understand. E. Patients are aware of the problem. 75. Which statement is true about the aneurysm shown here? A. It arises from the cavernous internal carotid artery. B. It measures ~6–8 mm. C. It usually presents pituitary dysfunction. D. All of the above statements are true. E. None of the above statements are true. 76. What does the Torg-Pavlov ratio measure? A. Vertebral blood flow B. Carotid blood flow C. Cervical stenosis D. Thoracic stenosis E. Lumbar stenosis 77. Which of the following is FALSE when comparing primary and secondary glioblastoma? A. Primary glioblastoma has an incidence that is about 10 times higher than secondary glioblastoma. B. The mean age at presentation in primary glioblastoma is much younger (45 years) than in secondary glioblastoma (62 years). C. Primary glioblastoma is more common in males when compared with secondary glioblastoma. D. The median survival at presentation is longer in secondary glioblastoma as compared with primary glioblastoma. E. Loss of heterozygosity on 10p or 10q is one of the most common genetic mutations in primary glioblastoma. 78. Cell bodies of nerve fibers in the medial brachial cutaneous nerve are found in the A. dorsal root ganglia only. B. anterior horn only. C. sympathetic chain ganglia and dorsal root ganglia. D. lateral horn and sympathetic chain ganglia. E. None of the above 79. The perforant path is the main A. inhibitory pathway of the hippocampus. B. excitatory pathway of the hippocampus. C. inhibitory pathway of the hypothalamus. D. excitatory pathway of the hypothalamus. E. None of the above 80. Which triangle has its base at the petrous apex? A. Parkinson’s triangle B. Kawase’s triangle C. Glasscock’s triangle D. Inferior medial triangle E. Paramedial triangle 81. The most common type of headache is A. cluster. B. tension. C. migraine. D. postconcussive. E. due to temporal arteritis. 82. The trochlear nerve can be found in which cistern? A. Cerebellomedullary B. Interpeduncular C. Ambient D. Chiasmatic E. Pontine 83. Which scalene muscle(s) insert on the first rib? A. Anterior scalene B. Anterior and medial C. Medial and posterior D. Anterior and posterior E. Anterior, medial, and posterior 84. A lesion of the left geniculocalcarine tract and the corpus callosum is most likely to cause A. pure word blindness. B. pure word deafness. C. mutism. D. anomic aphasia. E. global aphasia. 85. All of the following are true regarding hemispherectomy EXCEPT: A. Improvement in IQ is often seen postoperatively. B. Behavior is improved after surgery. C. It is not necessary to preserve the septum pellucidum. D. The foramen of Monro is often plugged with a piece of temporalis muscle. E. Patients are usually uncommunicative for about a week after surgery. 86. The principle behind multiple subpial transection for epilepsy is that A. horizontal fibers have a limited functional role. B. vertical fibers have a limited functional role. C. the pia has a limited functional role. D. All of the above E. None of the above 87. The presenting symptom of a hypothalamic hamartoma is most commonly A. headache. B. vomiting. C. visual field disturbance. D. sexual precocity. E. seizures. 88. All of the following are true of the tumor in this pathology slide EXCEPT: A. It is found in superficial brain regions. B. It shows intracellular accumulation of lipids. C. It corresponds to WHO grade II. D. It carries a dismal prognosis. E. It presents in patients with a long history of seizures. 89. Schaffer collaterals carry A. excitatory input from CA1. B. excitatory input from CA3. C. inhibitory input from CA1. D. inhibitory input from CA3. E. None of the above 90. Which of the following muscles would you expect to find weak given the finding on this scan? A. Gastrocnemius B. Tibialis anterior C. Extensor hallucis longus D. Iliopsoas E. None of the above 91. Which is the optimal approach for resection of the lesion in the scan shown previously for Question 90? A. Midline laminectomy approach B. Paramedian partial facetectomy approach C. Transforaminal lumbar interbody fusion D. Posterior lumbar interbody fusion E. A and C 92. All of the following structures are supplied by the anterior spinal artery EXCEPT: A. Pyramids B. Medial lemniscus C. Fibers of cranial nerve XII D. Gracile and cuneate nuclei E. Anterior two-thirds of the spinal cord 93. During a clinic appointment, the patient is asked to sit with the arms dependent, hold her breath, and tilt her head back and turn it to the side. Meanwhile the doctor is checking for presence or absence of a radial pulse. What is being described? A. Allen’s test B. Ayer’s test C. Adson’s test D. Addis test E. Dix–Hallpike maneuver 94. The corticobulbar tract is located in which area of the internal capsule? A. Anterior limb B. Posterior limb C. Retrolenticular limb D. Sublenticular limb E. Genu 95. The medial forebrain bundle interconnects the following areas EXCEPT: A. Septal nuclei B. Raphe nuclei C. Locus ceruleus D. Medulla E. Hypothalamus 96. Cerebellar tonsillar displacement is seen in A. Chiari I. B. Chiari II. C. Crouzon’s syndrome. D. All of the above E. None of the above 97. The most severe forms of hypothalamic cachexia are seen in lesions of the A. lateral hypothalamus. B. anterior hypothalamus. C. posterior hypothalamus. D. ventromedial hypothalamus. E. suprachiasmatic hypothalamus. 98. The region of the cortex most closely associated with the conscious perception of smell is the A. temporal cortex. B. cingulate cortex. C. prefrontal cortex. D. posterior parietal cortex. E. anterior parietal cortex. 99. Which amino acids are precursors for catecholamines? A. Phenylalanine and tyrosine B. Phenylalanine and tryptophan C. Tyrosine and tryptophan D. Arginine and tyrosine E. Phenylalanine and arginine 100. Which of the following pathological diagnoses is most likely associated with this hemorrhagic lesion? A. Melanoma B. Choriocarcinoma C. Breast carcinoma D. Renal cell carcinoma E. Choroid plexus papilloma