Neurosurgery Practice Questions and Answers (101-200)

Neurosurgery Practice Questions and Answers (101-200) 101. In contrast to primary glioblastomas, the most common genetic mutation seen in secondary glioblastomas is A. loss of heterozygosity 10q. B. TP53 mutation. C. ...

Neurosurgery Practice Questions and Answers (101-200) 101. In contrast to primary glioblastomas, the most common genetic mutation seen in secondary glioblastomas is A. loss of heterozygosity 10q. B. TP53 mutation. C. EGFR amplification. D. p16INK4a deletion. E. PTEN mutations (25%). 102. The straight sinus is formed from the union of the A. internal cerebral vein and basal vein. B. inferior sagittal sinus and vein of Galen. C. basal vein and great cerebral vein. D. inferior sagittal vein and basal vein. E. precentral cerebellar vein and internal cerebral vein. 103. A lesion of the vestibular labyrinth that causes images in the visual fields to move back and forth is best described as A. ocular flutter. B. ocular dysmetria. C. ocular bobbing. D. oscillopsia. E. opsoclonus. 104. Atropine mainly affects which type of synapses? A. Parasympathetic preganglionic B. Parasympathetic postganglionic C. Sympathetic postganglionic D. All of the above E. None of the above 105. Wernicke’s encephalopathy is due to deficiency of A. vitamin B1. B. vitamin B2. C. vitamin B6. D. vitamin B12. E. None of the above 106. The solitary pathways are concerned with A. taste. B. thoracic viscera. C. sudden changes in blood pressure. D. All of the above E. None of the above 107. The greatest difference between diffuse astrocytomas (WHO grade II) and anaplastic astrocytomas (WHO grade III) is A. MIB-1 fraction. B. the presence of mitotic activity. C. the presence of necrosis. D. angiogenesis. E. the presence of gemistocytes. 108. The most common intraconal orbital mass is the A. neurilemmoma. B. fibrous histiocytoma. C. hemangiopericytoma. D. cavernous hemangioma. E. None of the above 109. HIV-infected individuals have an increased risk of cerebrovascular events, such as stroke, when the following risk factors are present EXCEPT: A. Intravenous drug abuse B. Low CD4 cell count C. Exposure to abacavir D. Exposure to highly active antiretroviral therapy (HAART) E. CD4 cell count ≤ 200 cells/μL before the start of HAART 110. The location of the apex in most arteriovenous malformations is A. cortical. B. insular. C. parietal. D. occipital. E. periventricular. 111. In catecholamine biosynthesis, the rate-limiting step during conditions of neuronal activation is A. dopamine β-hydroxylase. B. tyrosine hydroxylase. C. aromatic amino acid decarboxylase. D. monoamine oxidase. E. phenylethanolamine N-methyltransferase. 112. The venous angle is seen angiographically by the junction of which two veins? A. Septal and caudate B. Septal and terminal C. Terminal and caudate D. Internal cerebral and terminal E. Basal and internal cerebral 113. Ocular bobbing may be seen in which of the following? A. Hydrocephalus B. Pontine infarct C. Hepatic encephalopathy D. Trauma E. All of the above 114. The most likely diagnosis for this lesion seen on CT is A. aneurysmal bone cyst. B. epidermoid granuloma. C. osteosarcoma. D. hemangioma. E. osteoid osteoma. 115. The striae medullares (rhombencephali) arise from A. the septal nuclei. B. the habenular trigone. C. the arcuate nuclei. D. the amygdala. E. None of the above 116. The delivery of nutrients and removal of wastes from the vertebral disk is dependent on A. arterioles and venules. B. capillaries penetrating the disk. C. diffusion. D. All of the above E. None of the above 117. Which of the following statements is true of the olivocochlear bundle? A. It is part of the ascending auditory pathway to the dorsal cochlear nucleus. B. It can be seen readily in brainstem sections of the upper pons. C. It communicates directly with the medial lemniscus. D. Stimulation of it inhibits acoustic fiber responses to auditory stimuli. E. It arises from the inferior olivary nucleus and projects to the cochlea. 118. Which of the following orbital tumors is at highest risk of tumor seeding and recurrence during removal? A. Cavernous hemangioma B. Pleomorphic adenoma of the lacrimal gland C. Neurilemmoma D. Hemangiopericytoma E. Fibrous histiocytoma 119. The pterygoid plates are made up of which bones? A. Sphenoid and temporal B. Sphenoid and vomer C. Palatine and sphenoid D. Palatine E. None of the above 120. Brodmann area 44 is a part of A. Wernicke’s area. B. Visual cortex. C. Broca’s area. D. Prefrontal area. E. Frontal eye field. 121. Which one of the following is NOT a characteristic of hydromyelia? A. The fluid collection may communicate with the fourth ventricle. B. The fluid collection may be noncommunicating with the fourth ventricle. C. The fluid collection is typically not lined by ependymal cells. D. It may be associated with hydrocephalus. E. It may be associated with Chiari malformation. 122. Which of the following arteries supplies the deep cerebellar nuclei? A. Posterior inferior cerebellar artery B. Superior cerebellar artery C. Thalamogeniculate branches D. Posterior choroidal artery E. None of the above 123. In the comatose patient, extensor movements of the arms and weak flexor movements of the legs are most likely to occur with a lesion A. above the red nucleus. B. at the red nucleus. C. between the red nucleus and above the vestibular nuclei. D. at the vestibular nuclei. E. below the vestibular nuclei. 124. “Crocodile tears” or lacrimation from gustatory stimulation is classically described as the result of aberrant regeneration of fibers from A. cranial nerve III reaching the ciliary ganglion. B. cranial nerve V reaching the ciliary ganglion. C. cranial nerve VII reaching the ciliary ganglion. D. cranial nerve III reaching the sphenopalatine ganglion. E. cranial nerve VII reaching the sphenopalatine ganglion. 125. Syringomyelia affecting the lower cervical area may result in attenuation or abolition of which of the following somatosensory evoked potentials? A. N13 B. N20 C. P40 D. N22 E. None of the above 126. If an instrumentation system is too stiff, disuse osteoporosis can occur around the instrumentation. This statement is related to A. Sherrington’s law. B. Flourens’ law. C. Wolff’s law. D. Delpech’s principle. E. Jackson’s law. 127. In comparison to chordomas, chondrosarcomas A. arise more laterally. B. result in more neurological deficits at presentation. C. are nearly always S-100 positive. D. display all of the above features. E. display none of the above features. 128. Which of the following conditions would benefit most from thalamotomy? A. Medically refractory essential tremor B. Rigidity associated with Parkinson’s disease C. Intention tremor from cerebellar stroke D. Bradykinesia associated with progressive supranuclear palsy (PSP) E. Dyskinesia associated with striatonigral degeneration 129. Which of the following is the best measure of the “equator” of the spinal cord when performing a cordotomy for pain management? A. Just ventral to the dentate ligament B. Just dorsal to the dentate ligament C. At the attachment of the dentate ligament D. The midway point between the exit of the dorsal and ventral rootlets E. Approximately 5 mm from the anterior spinal artery 130. When is the earliest time after radiation therapy that one would expect to observe the changes appearing on this T2-weighted MRI taken in a patient who underwent a tumor resection? A. 1 month B. 3 months C. 14 months D. 48 months E. 72 months 131. Levels of L-dopa are virtually unmeasurable in the central nervous system under basal conditions because A. the activity of tyrosine hydroxylase is low. B. L-dopa is localized in vesicles. C. the activity of aromatic amino acid decarboxylase is high. D. dopamine β hydroxylase is localized in the vesicles. E. the activity of tyrosine hydroxylase is high. 132. The facial nucleus and the spinal trigeminal nucleus and tract are supplied by which artery? A. Posterior inferior cerebellar artery (PICA) B. Anterior inferior cerebellar artery (AICA) C. Superior cerebellar artery (SCA) D. Basilar E. Anterior choroidal 133. Which of the following statements regarding the length constant of a nerve fiber is true? A. The length constant is directly proportional to the membrane resistance. B. It is the distance along a fiber where a change in the membrane potential by a given current decays to half its original value. C. The length constant is directly proportional to the axial resistance. D. The length constant is greater in unmyelinated than myelinated fibers. E. None of the above 134. Dysfunction of which cell is the main problem in Raynaud’s phenomenon? A. Red blood cell B. Sympathetic neuron C. Platelet D. Mast cell E. Fibroblast 135. Epidural hematomas in children are the result of A. arterial injury. B. bone oozing. C. bleeding from the periosteal surface. D. All of the above E. None of the above 136. Spondylolysis most often occurs at A. L1. B. L2. C. L3. D. L4. E. L5. 137. The finding seen in the photograph is caused by damage to A. a nerve arising from the upper trunk of the brachial plexus. B. a nerve arising from the roots of the brachial plexus. C. the dorsal scapular nerve. D. the thoracodorsal nerve. E. None of the above 138. The typical target for thalamotomy for reduction of tremor is A. Vim. B. Vop. C. Voa. D. VC. E. None of the above 139. Which of the following structures are derived from the telencephalon? A. Caudate B. Putamen C. Amygdala D. All of the above E. None of the above 140. The precuneus (Brodmann areas 7 and 31) is located A. on the medial surface of the frontal lobe. B. in the secondary visual cortex. C. within the occipital lobe. D. on the medial surface of the parietal lobe. E. on the medial surface of the occipital lobe. 141. Given the imaging provided, the indications for surgery include all of the following EXCEPT: A. Failure of medical treatment B. Open biopsy C. Significant bony or paraspinal abscess with sepsis D. Significant bony destruction on CT scan due to limited penetration of medical treatment E. Sensory deficit along the rib cage 142. Neural crest derivatives include all of the following EXCEPT: A. Schwann cells B. Bipolar cells C. Leptomeninges D. Chromaffin cells of the suprarenal medulla E. Parafollicular cells 143. Which of the following is located in the bony modiolus of the cochlea? A. Scala vestibuli B. Cochlear duct C. Organ of corti D. Spiral ganglion E. Basilar membrane 144. Damage to this area leaves the patient transiently mute, with complete recovery in a few weeks. A. Broca’s area B. Wernicke’s area C. Arcuate fasciculus D. Uncinate fasciculus E. Supplementary motor area 145. The foramen spinosum is located in A. the sphenoid bone anterior to the greater and lesser superficial petrosal nerves. B. the sphenoid bone between to the greater and lesser superficial petrosal nerves. C. the temporal bone posterior to the greater and lesser superficial petrosal nerves. D. the temporal bone between the greater and lesser superficial petrosal nerves. E. None of the above 146. Spondyloptosis corresponds to Meyerding grade A. I. B. II. C. III. D. IV. E. V. 147. Golgi tendon organs are A. sensitive to stretch. B. in series with extrafusal fibers. C. encapsulated. D. All of the above E. None of the above 148. During a thalamotomy procedure, which of the following indicates that the electrode is in the correct location? A. Low frequency (2 Hz) stimulation causes driving of the tremor. B. The patient reports contralateral paresthesias. C. High-frequency (50 Hz) stimulation results in tremor suppression. D. All of the above E. None of the above 149. Olfactory glomeruli are made up of A. granule and tufted cells. B. granule and mitral cells. C. tufted and mitral cells. D. granule cells only. E. None of the above 150. The sylvian triangle is defined by points along which artery/arteries? A. MCA only B. MCA and ACA C. ACA, MCA, and PCA D. MCA and PCA E. ACA only 151. Select the FALSE statement regarding monoamine oxidase (MAO). A. MAOA has a high affinity for norepinephrine and serotonin. B. MAOA is selectively inhibited by clorgyline. C. MAOB has a high affinity for o-phenylethylamines. D. MAOA and MAOB are associated with the inner mitochondrial membrane. E. MAOB is selectively inhibited by deprenyl. 152. The superior part of the fourth ventricle is derived from which of the following vesicles? A. Metencephalon B. Myelencephalon C. Mesencephalon D. Prosencephalon E. None of the above 153. This structure is a projection of the spiral limbus that overlies the hair cells of the organ of Corti. A. Tectorial membrane B. Basilar membrane C. Vestibular membrane D. Reissner’s membrane E. None of the above 154. Which fibers are associated with the gag reflex? A. Spinal trigeminal nucleus projections to the nucleus ambiguus B. Solitary projections to the nucleus ambiguus C. Solitary projections to the salivatory nucleus D. Salivatory nucleus projections to the dorsal motor nucleus of the vagus E. None of the above 155. A 64-year-old man presents to the clinic with severe back pain going down the left lateral leg (see X-ray). He states that the pain is worst when he reaches and bends to the right. He is most comfortable when he is lying still. He has attempted and failed conservative therapy of medication and physical therapy. If surgery is offered, what would be the best choice from the following options? A. Lumbar laminectomy of L4–S1 B. Lumbar hemilaminectomy at L4 on left side C. Pedicle screw fusion of L4–L5 D. Pedicle screw fusion of L3–S1 E. Pedicle screw fusion of L3–L4 156. Which of the following receptors is activated by baclofen and is insensitive to bicuculline? A. GABA-A B. GABA-B C. GABA-C D. All of the above E. None of the above 157. All of the following structures pass through the annulus of Zinn (tendinous ring) EXCEPT: A. Cranial nerve III, superior division B. Nasociliary nerve C. Cranial nerve IV D. Cranial nerve III, inferior division E. Cranial nerve VI Match the organisms associated with the lesion shown here, given the patient presentation: A.Proteus B.Streptococcus C.Staphylococcus D.Pseudomonas 158. Sixteen year-old boy who sustained a parietal skull fracture after a motorcycle accident 159. Sixty-year-old woman with chronic ear infection 160. Three-month-old baby with irritability and decreased oral intake 161. Tranylcypromine is A. an inhibitor of MAOA. B. an inhibitor of MAOB. C. an inhibitor of COMT. D. a reuptake inhibitor of serotonin. E. an inhibitor of acetylcholinesterase. 162. Which is the embryological structure that becomes the ventral white commissure in the adult? A. Basal plate B. Floor plate C. Alar plate D. Basal plate E. Sulcus limitans 163. Which of the following is FALSE regarding the syndrome that has a prominent feature illustrated in this CT scan? A. There is involvement of the upper eyelid. B. Radiotherapy is not effective. C. Hemiparesis is contralateral to the facial lesion. D. The triad classically consists of nevus flammeus, venous malformation, and glaucoma. E. Abnormalities of chromosome 9 are seen. 164. CSF is produced by A. choroid plexus. B. ependymal surface. C. brain parenchyma. D. bulk flow from the brain. E. All of the above 165. In patients with known systemic cancer, what percentage of single brain lesions are cerebral abscesses or primary brain tumors? A. Less than 0.1% B. 1% C. 15% D. 30% E. 50% 166. Vigabatrin has anticonvulsant properties related to its interference of A. GABA breakdown. B. GABA synthesis. C. GABA reuptake. D. All of the above E. None of the above 167. The indusium griseum is a remnant of A. the habenula. B. the hippocampus. C. the hypothalamus. D. the gyrus of Heschl. E. None of the above 168. A patient who had a thalamotomy for Parkinsonian tremor earlier in the month has noticed weakness of the arm. The most likely explanation for this is that the lesion placed during the thalamotomy was too A. medial. B. lateral. C. anterior. D. posterior. E. mild. 169. Which immunosuppressive agent works at the level of the T cells by inhibiting expression of interleukin (IL)-2? A. Azathioprine B. Cyclosporine C. Methotrexate D. All of the above E. None of the above 170. Posterior thalamo-perforating arteries are the perforators that arise from which artery? A. Pcom B. Pcom and P1 C. P1 and P2 D. P2 E. P1 171. Which nucleus of the hypothalamus gives rise to dopamine innervation of the median eminence? A. Supraoptic B. Dorsomedial C. Lateral D. Arcuate E. Ventromedial 172. The alar plate gives rise to all of the following EXCEPT: A. Gracile and cuneate nuclei B. Inferior olivary nuclei C. Solitary nucleus D. Spinal trigeminal nucleus E. Nucleus ambiguus 173. Normal thoracic kyphosis is generally accepted to vary from A. 10–35°. B. 20–45°. C. 30–55°. D. 40–65°. E. 50–70°. 174. In preparation for placement of a ventriculostomy catheter, a resident measures a point 2.5 cm from the midline and 1 cm anterior to the coronal suture. The point that is being measured is A. Keen’s point. B. Kocher’s point. C. McEwen’s point. D. Barker’s point. E. Sylvian point. 175. A 60-year-old man with this MRI finding is most likely to present with the following signs on examination: A. Bilateral limb ataxia B. Ipsilateral Horner’s syndrome C. Contralateral abducens palsy D. Ipsilateral tongue paralysis E. None of the above 176. All of the following epilepsy drugs have hepatic enzyme-inducing properties EXCEPT: A. Carbamazepine B. Phenytoin C. Clonazepam D. Primidone E. Phenobarbitone 177. The interposed nuclei project to A. the contralateral red nucleus. B. the ipsilateral red nucleus. C. the contralateral thalamus. D. the ipsilateral thalamus. E. None of the above 178. All of the following symptoms may improve after pallidotomy EXCEPT: A. Drug-induced dyskinesias B. Painful dystonias C. On/off fluctuations D. Bradykinesia E. Postural instability 179. With regard to neurological manifestations of HIV disease, which of the following is true? A. Neurological involvement in HIV infection is more frequent in adults than in children. B. Neurological complications occur in less than 20% of patients with HIV infection. C. Neurological complications are the presenting feature of AIDS in 20% of cases. D. At autopsy, the prevalence of neuropathological abnormalities is ~20%. E. An ongoing increase in HIV-associated CNS disease has been observed in very recent years 180. AICA originates from the A. vertebral artery. B. distal one-third of the vertebral artery. C. proximal two-thirds of the basilar artery. D. posterior cerebral artery. E. distal two-thirds of the basilar artery. 181. Which is FALSE regarding serotonin? A. It is metabolized to melatonin in the pineal gland. B. The majority of body stores of serotonin are found in the central nervous system. C. Two critical enzymes take part in its synthesis. D. Tryptophan is the precursor amino acid. E. It has an indole structure. 182. The basal plate gives rise to all of the following EXCEPT: A. Oculomotor nucleus B. Trochlear nucleus C. Substantia nigra D. Red nucleus E. Superior colliculus 183. Which of the following are more expressed in painful degenerative disk disease as compared with disk herniation? A. Tumor necrosis factor-α and interleukin (IL)-8 B. IL-1β and IL-6 C. IL-6 and IL-12 D. IL-3 and IL-4 E. None of the above 184. During the abdominal portion of the operation for a ventroperitoneal (VP) shunt, if the surgeon is below the arcuate line, which structures would lie behind the rectus abdominis? A. External oblique aponeurosis B. Internal oblique aponeurosis C. Transversus abdominis aponeurosis D. Transversalis fascia E. None of the above 185. Which of the following posterior fossa tumors has the tendency to arise from the floor of the fourth ventricle? A. Medulloblastoma B. Ependymoma C. Astrocytoma D. Hemangioblastoma E. None of the above 186. Which of the following is true of Lissauer’s tract? A. Its fibers are derived from the lateral division of the dorsal roots. B. It contains Aδ fibers. C. It contains C fibers. D. All of the above E. None of the above 187. The limen insula can be found A. in the occipital lobe. B. at the junction of the insula and the frontal lobe. C. within the third ventricle. D. in cross sections through the pons. E. in none of the above. 188. During pallidotomy when the surgeon believes the electrode is near the target, a high-frequency stimulation is performed to insure that the electrode is not too close to the A. thalamus. B. internal capsule. C. optic tract. D. amygdala. E. putamen. 189. The apex of the thoracic curvature typically lies at A. T3. B. T5. C. T7. D. T9. E. T11. 190. An important landmark for identifying the junction of the tegmentum and the cerebral peduncle is the A. anterior pontomesencephalic vein. B. lateral mesencephalic vein. C. precentral cerebellar vein. D. vein of Galen. E. superior vermian vein. 191. This amino acid is not only a precursor to GABA but is also a neurotransmitter. A. Glycine B. Glutamate C. Arginine D. Tyrosine E. Tryptophan 192. Which of the following is FALSE regarding stiff person syndrome? A. It is transmitted in an autosomal recessive pattern. B. The stiffness primarily affects the truncal muscles. C. Chronic pain and impaired mobility are common symptoms. D. Lumbar hyperlordosis is often seen. E. Patients have high glutamic acid decarboxylase antibody titers. 193. All of the following inflammatory factors are expressed at high levels in degenerative disk disease EXCEPT: A. Interleukin (IL)-1β B. IL-3 C. IL-6 D. IL-8 E. Tumor necrosis factor-α 194. In phenylketonuria, the deficiency of phenylalanine hydroxylase results in decreased levels of A. dopamine. B. norepinephrine. C. serotonin. D. None of the above E. All of the above 195. Classic phenylketonuria is characterized by all EXCEPT: A. Low levels of prolactin B. Increased gray matter volume in the ventral part of the striatum C. A diet low in phenylalanine as a major part of disease management D. Neurological symptoms such as intellectual disability, tremors, seizures, and jerky movements E. Occurs in 1 in 10,000 to 15,000 newborns 196. Which of the following findings is LEAST likely to be associated with this MRI scan? A. Elevated serum angiotensin-converting enzyme B. Eosinophilic granuloma C. Meningitis D. Elevated adrenocorticotrophic hormone E. Sarcoidosis 197. A central facial palsy would involve A. only the ipsilateral upper face. B. only the ipsilateral lower face. C. only the contralateral upper face. D. only the contralateral lower face. E. None of the above 198. Palatal nystagmus is most likely due to a lesion of A. the dorsal spinocerebellar tract. B. the corticospinal tract. C. the middle cerebellar peduncle. D. the central tegmental tract. E. None of the above 199. The single best predictor for patients with esthesioneuroblastoma is A. completeness of primary tumor excision and extent of involvement at presentation. B. TP53 overexpression. C. the presence of Homer–Wright rosettes on pathology. D. neuron-specific enolase expression. E. destruction of the cribriform plate. 200. During a lateral suboccipital approach for tumor resection, cerebellar retraction may be excessive if the BSAEP indicates A. increased latency in wave 3. B. decreased latency in wave 4. C. decreased latency in wave 5. D. increased latency in wave 4. E. increased latency in wave 5.