Neurosurgery Practice Questions and Answers (701-805)

701. Neurogenic shock is characterized by which of the following? A. Increased arteriolar tone B. Increased in peripheral vascular resistance C. Cool molten skin D. Hypertension E. Bradycardia 702. Gram-negative se ...

701. Neurogenic shock is characterized by which of the following? A. Increased arteriolar tone B. Increased in peripheral vascular resistance C. Cool molten skin D. Hypertension E. Bradycardia 702. Gram-negative septicemia in hospitalized patients is MOST likely to originate from A. urinary tract infection. B. pneumonia. C. wound infection. D. gastrointestinal infection. E. pressure ulcers. 703. Which of the following tests has the highest sensitivity in diagnosing Clostridium difficile colitis? A. Latex agglutination test B. Tissue culture assay for cytotoxin C. Stool culture D. Stool microscopy E. Polymerase chain reaction (PCR) analysis Match the anesthetic with the corresponding property: A. Isoflurane B. Enflurane C. Thiopental D. Halothane 704. Increases cerebral blood flow the most 705. Decreases intracranial pressure 706. Causes transient tachycardia in children 707. Increases systemic vascular resistance Match the finding with appropriate syndromes: A. Neurofibromatosis type 1 (NF1) B. Neurofibromatosis type 2 (NF2) C. Both A and B D. None of the above 708. Autosomal dominant inheritance 709. Retinal hemangioma 710. Iris hamartoma 711. Segmental and confined to one part of the body 712. This is an intraoperative picture showing clipping of an ophthalmic artery aneurysm. With regard to the neck of the aneurysm, which statement is true? A. The neck of the aneurysm is unobstructed. B. The neck of the aneurysm is obstructed by the dome. C. The neck of the aneurysm is obstructed by the optic nerve. D. The neck of the aneurysm is obstructed by the carotid artery. E. The neck of the aneurysm is obstructed by the anterior clinoid process. 713. During microvascular decompression for trigeminal neuralgia, this intraoperative picture is taken and the offending artery is seen. What is the artery and what structure does it come close to more proximally in this picture? A. Superior cerebellar artery, abducens nerve B. Anterior inferior cerebellar artery, trochlear nerve C. Superior cerebellar artery, trochlear nerve D. Anterior inferior cerebellar artery, abducens nerve E. Superior cerebellar artery, oculomotor nerve 714. Which of the following is the LEAST favorable therapeutic approach for the lesion depicted on the MRI scans? A. Supracerebellar infratentorial approach for cyst resection B. Midline frontal approach for cyst resection C. Third ventriculostomy D. Midline frontal approach for cyst decompression E. Endoscopic cyst resection Match the correct medication with its effect: A. Meperidine B. Thyroid hormones C. Fluconazole D. Papaverine 715. Inhibits antiparkinsonism effect of levodopa 716. Increases serum phenytoin levels 717. Enhances clotting factor catabolism 718. Decreases warfarin metabolism 719. May cause hypertension, rigidity, and excitation when used with monoamine oxidase inhibitors 720. Which of the following medications is safe to use in a patient with history of malignant hyperthermia? A. Epinephrine B. Isoflurane C. Halothane D. Thiopental E. All of the above 721. Which of the following neoplasms is LEAST likely to metastasize to the spine? A. Lung carcinoma B. Breast carcinoma C. Colon carcinoma D. Renal cell carcinoma E. Prostate carcinoma 722. In relation to what vessel are the cords of the brachial plexus named? A. Brachiocephalic artery B. Axillary artery C. Subcalvian artery D. Brachial artery E. Internal carotid artery 723. Which type of spondylolisthesis is most common in gymnasts and football players? A. Traumatic B. Degenerative C. Isthmic D. Pathological E. Dysplastic Match the following visual disturbances with the choices that follow: A. Homonymous hemianopia B. Upper homonymous quadrantanopia C. Bilateral central scotomas D. Monocular loss of vision with contralateral upper outer quadrantanopia E. Lower homonymous quadrantanopia 724. Lesion of the optic nerve just distal to the chiasm 725. Occipital lobe infarction 726. PICA interruption 727. Cushing’s disease 728. Temporal lobe lesion 729. Parietal lobe lesion Match the following anatomical structures with their related condition: A. Struthers ligament B. Arcade of Struthers C. Arcade of Frohse D. Guyon’s canal 730. Ulnar nerve entrapment 731. Extensor carpi ulnaris palsy 732. Brachial artery passes under this structure 733. Which of the following is the LEAST likely presenting sign in a patient with rhinorrhea and this metrizamide CT scan finding? A. Reservoir sign B. Early morning headache C. Meningitis D. Visual deficits E. Sinus congestion 734. Of the following signs and symptoms, which is the most common in the presentation of an osteoid osteoma of the spine? A. Radicular pain B. Scoliosis C. Weakness D. Atrophy E. None of the above 735. Of the following signs and symptoms, which is the most common in the presentation of an osteoblastoma? A. Radicular pain B. Scoliosis C. Weakness D. Atrophy E. Cardiac ischemia 736. What mechanisms lead to neurological deficits in patients with vertebral hemangiomas? 1. Epidural growth of the tumor 2. Expansion of bone with widening of the pedicle and lamina 3. Compression fracture of the involved vertebrae 4. Spinal cord ischemia due to steal phenomenon A. 1, 2, and 3 B. 1 and 3 C. 2 and 4 D. 1, 2, 3, and 4 E. 2 and 3 737. DeQuervain’s syndrome is characterized by all of the following EXCEPT: A. It is caused by frequent repetitive motion at the wrist. B. Pain and tenderness occurs in the wrist near the thumb. C. The Finkelstein test is positive. D. Nerve conduction velocities are decreased. E. There is difficulty with gripping. Match the anatomical structure with its location: A. Fourth ventricle roof B. Fourth ventricle floor C. Both of the above D. None of the above 738. Inferior medullary velum 739. Facial colliculus 740. Hypoglossal trigone 741. Rhomboid fossa 742. What is the best therapeutic option in this 1-year-old with the lesion appearing on this MRI? A. Surgical evacuation B. Systemic antibiotics C. Head wrapping D. Radiation therapy E. VP shunt 743. The dorsal horns of the spinal cord are derived from which of the following? A. Basal plate B. Notochord C. Neural crest cells D. Somites E. Endoderm Match the breathing pattern with the location of the lesion: A. Cheyne–Stokes respiration B. Apneustic respiration C. Ataxic respiration D. Central neurogenic hyperventilation 744. Medulla 745. Midbrain 746. Pons 747. Diencephalon Match the cerebellar elements with their descriptions: A. Middle cerebellar peduncle B. Inferior cerebellar peduncle C. Nodulus D. Flocculus E. None of the above 748. Devoid of pontine inputs 749. Contains only afferent fibers 750. All the following are associated with this angiogram finding EXCEPT: A. It connects the basilar artery between the superior cerebellar and the anterior inferior cerebellar arteries by passing through the petrous bone. B. It connects the basilar artery by passing through the internal auditory meatus. C. It is present in 0.1% of the population. D. There is increased frequency of arteriovenous malformations. E. It is the second most common persistent fetal circulation. Match the following risk rates with needlestick injury infections: A. 75% B. 50% C. 25% D. 2% E. 0.3% 751. The risk of acquiring HIV from a hollow needlestick injury from an affected individual 752. The risk of acquiring hepatitis C from a hollow needlestick injury from an affected individual 753. The risk of acquiring hepatitis B from a hollow needlestick injury from an affected individual with an extremely low viral load 754. This scan of a 35-year-old woman on hormonal contraceptives is most consistent with the diagnosis of A. tentorial subdural hemorrhage. B. subarachnoid hemorrhage. C. normal CT scan. D. dural sinus thrombosis. E. arteriovenous fistula. 755. All of the following are features of malignant hyperthermia EXCEPT: A. There is an autosomal recessive inheritance pattern. B. In 20% of cases there is no hyperthermia accompanying the muscle rigidity. C. It may be associated with autonomic instability. D. It may be caused by muscle relaxants. E. A mutation in the ryanodine receptor is related to malignant hyperthermia (MH). 756. Which of the following is the lesion on this MRI scan associated with? A. Cerebral aneurysm B. Arteriovenous malformation C. Endocrinopathy D. Venous angioma E. Progressive supranuclear palsy 757. Which of the following changes are represented at the end plates of L4–L5 levels on this T2-weighted MRI scan? A. Type 1 Modic changes B. Type 2 Modic changes C. Yellow marrow replacement D. Hypovascularization of the end plates E. None of the above 758. All of the following neurological deficits may be present with the lesion seen on this MRI scan EXCEPT: A. Ataxia B. Ipsilateral hearing deficits C. Contralateral temperature sensation loss D. Lateral rectus palsy E. Balance problems 759. Which anesthetic agent is least likely to cause further decrease in blood pressure in the face of hypovolemic shock? A. Ketamine B. Thiopental C. Halothane D. Enflurane E. Isoflurane 760. Which of the following statements is not associated with the images shown here? A. Froin’s syndrome B. Positive Queckenstedt’s sign C. Male predominance with peak age in mid-40s D. Cellular type E. Neoplastic disease 761. Which of the following is associated with this set of MRI scans in a patient with a functional ventriculoperitoneal shunt placed in the right ventricle? A. Syringobulbia B. Elevated serum angiotensin-converting enzyme C. Aqueductal stenosis D. Hallervorden–Spatz disease E. Subdural hematoma Match the following choices with their appropriate functions: A. Proximal renal tubular function B. Distal renal tubular function C. Kidney glomerular function D. None of the above 762. Secretion of H+ and reabsorption of Cl. 763. Secretion of organic acids and reabsorption of amino acids 764. Secretion of K+ and reabsorption of Na+ 765. Function is maximal in young adulthood and decreases thereafter. 766. Which of the following prognostic factors is true in the case of a 16-year-old boy with failure to thrive and the following findings on MRI scan? A. The most significant factor associated with recurrence is extent of resection. B. A factor associated with recurrence is histology. C. MIB-1 LI >7% is associated with a low likelihood of recurrence. D. Malignant transformation to carcinoma frequently occurs. E. Recurrence is dependent on the presence of intracytoplasmic inclusions. 767. This tumor shows on histopathology uniform round cells with perinuclear halos. Its immunohistochemistry is positive for synaptophysin. What is the most likely diagnosis? A. Central neurocytoma B. Oligodendroglioma C. Ependymoma D. Endodermal sinus tumor E. Yolk sac tumor 768. The inferior frontal gyrus is bordered by which structure caudally? A. Operculum B. Sylvian fissure C. Precentral sulcus D. Rolandic fissure E. None of the above 769. The actions of nitroglycerine are mediated by the following mechanisms EXCEPT: A. Nitroglycerine binds the surface of endothelial cells. B. Nitroglycerine undergoes two chemical reductions to form nitric oxide. C. Nitric oxide promotes the formation of cyclic guanosine triphosphate. D. Nitric oxide moves out of the endothelial cell into adjacent smooth muscle cell. E. Nitric oxide increases cAMP in smooth muscle cells. Match the closest relative risk of stroke with the appropriate patient presentation: A. 1% per year B. 2% per year C. 4% per year D. 13% per year E. 26% per year 770. Symptomatic 70–90% stenosis of the carotid on angiogram 771. Asymptomatic 70–90% stenosis of the carotid on angiogram 772. Postcarotid endarterectomy in a preoperative symptomatic 70–90% stenosis of the carotid on angiogram 773. Which of the following causes hypokalemia? A. Amphotericin B. Angiotensin-converting enzyme inhibitors C. Aspirin D. Cyclosporin E. Heparin 774. What is the most likely age of the hemorrhage shown here? A. 2 hours B. 2 days C. 12 days D. 22 days E. 32 days Match the following substances with the choices: A. Ethanol B. Acetone C. Methanol D. Ethylene glycol (antifreeze) E. Acethaldehyde 775. Lowest molecular weight 776. Most lethal 777. A patient with von Willebrand’s disease sustained a motorcycle crash and is losing blood from an open fracture. The blood product best suited for management is A. whole blood. B. fibrinogen. C. platelets. D. packed red blood cells. E. cryoprecipitate. 778. Which of the following is least likely to be associated with the finding on this MRI scan? A. Ipsilateral Horner’s syndrome B. Downbeat nystagmus C. Loss of abdominal cutaneous reflex D. Neurogenic bladder E. Extremity weakness 779. Typical presentation of patients with conus medullares lesions includes all of the following EXCEPT: A. Saddle bilateral sensory deficit B. Symmetric motor loss C. Loss of ankle jerk D. Autonomic symptoms that occur late E. Urinary retention and atonic anal sphincter that cause overflow urinary incontinence and fecal incontinence 780. Typical presentation of patients with cauda equina lesions includes all of the following EXCEPT: A. Sensory dissociation B. Asymmetric motor loss C. Late autonomic symptoms D. Absence of ankle jerk and knee jerk E. Numbness that tends to be more localized to saddle area 781. Which of the following structures is the second branch of the proximal aorta as it exits the left ventricle? A. Brachiocephalic artery B. Right subclavian artery C. Left subclavian artery D. Right carotid artery E. Left carotid artery 782. Bilateral internuclear ophthalmoplegia results in which abnormality on physical exam? A. Convergence deficit B. Adduction deficit C. Horizontal gaze palsy D. Vertical gaze palsy E. Parinaud’s syndrome Match the appropriate neurotransmitter with the area of the brain: A. Acetylcholine B. Noradrenaline C. Dopamine D. GABA E. Glutamate 783. Inferior cervical ganglion 784. Locus ceruleus 785. Periaqueductal gray 786. In which disorder of speech are both repetition and comprehension affected? 1. Transcortical sensory aphasia 2. Wernicke’s aphasia 3. Conductive aphasia 4. Global aphasia A. 1, 2, and 3 are true. B. 1 and 3 are true. C. 2 and 4 are true. D. Only 4 is true. E. All of the above are true. 787. Watershed infarcts are seen in all of the following EXCEPT: A. Regional hypotension B. CBF below critical level C. Atrial fibrillation D. Cardiac arrest E. Anaphylaxis 788. Which of the following arteries arises directly from the intracavernous carotid? A. Bernasconi’s artery B. Persistent stapedial artery C. Heubner’s artery D. McConnell’s artery E. Vidian artery 789. All the following statements are true regarding the findings of this scan EXCEPT: A. Thirty to fifty percent of patients are febrile. B. Spontaneous fusion of vertebral bodies may occur. C.Haemophilus influenzae may be a causative organism in juvenile cases. D. Radionuclide scans have a relatively low sensitivity. E. There is increased incidence with intravenous drug abuse. 790. What is the significance of an elevated N-acetylaspartate peak on an MR spectroscopy scan? A. Increased neuronal density B. Increased metabolism C. Increased excitatory neurotransmission D. Necrosis E. None of the above Questions 791 and 792 are based on this radiograph: 791. Choose the best answer based on the following MRI finding in a 20-year-old woman with Hodgkin’s lymphoma and an opportunistic infection. Which of the following is the most likely infection? A.Mucor B.Aspergillus C.Coccidioides D.E. histolytica E. Virus 792. Characteristic features of the organism referred to in the preceding question include all of the following EXCEPT: A. Perivascular invasion B. Hemorrhagic infarcts C. Paranasal sinus mycetoma D. Caseating granulomas E. Increased prevalence with the use of chemotherapy and corticosteroids 793. What is the best treatment option in a 63-year-old woman with mental status changes and the following imaging study? A. Intravenous antibiotics B. Surgical resection C. Systemic chemotherapy and whole-brain radiation D. Ommaya reservoir placement and intrathecal chemotherapy E. Ventriculoperitoneal shunt 794. Which of the following muscles is innervated by the glossopharyngeal nerve? A. Stapedius B. Tensor veli palatini C. Stylopharyngeus D. Posterior belly of digastric E. None of the above Match the following choices with the appropriate measurements on the lung volume spirogram: 795. Equals 2.4 L at rest and 2.4 L during exercise 796. Represents vital capacity minus expiratory reserve volume 797. Measured at ~4.4 to 5 L in healthy adults 798. Calculated after having the patient inspire a mixture containing 10% helium from a spirometer at 21°C Questions 799 and 800 are based on this MR spectroscopy study: 799. Point 1 being closest to normal and point 3 showing the most abnormality, which of the following statements with regard to spectroscopy is correct regarding point 3? A. Elevated N-acetylaspartate (NAA) peak and normal choline (Chol) and creatine (Cr) peaks B. Elevated Cr peak and decreased Chol and NAA peaks C. Increased Chol:Cr ratio and decreased NAA peak D. Increased Cr:Chol ratio and decreased NAA peak E. All of the above 800. What do the preceding MR spectroscopy findings most likely represent? A. Increased astrocytic density at point 3 as compared with point 1 B. Presence of tumor cells at point 3 C. Presence of necrosis at point 3 D. Increased metabolism at point 3 E. All of the above 801. Which of the following is represented by X in this formula? X = (Cardiac output) (Arterial O2 content – venous O2 content) A. Oxygen delivery B. Oxygen uptake C. Oxygen extraction ratio D. Oxygen content E. None of the above 802. Which of the following formulas describes shunt fraction? Note: Pulmonary capillary O2 content = Cc O2 Venous O2 content = Cv O2 Arterial O2 content = Ca O2 A.Cc O2 − Ca O2 / Cv O2 − Ca O2 B. (Cc O2 − Cv O2)/(Cc O2 − Ca O2) C.Cc O2 − Ca O2/Cc O2 − Cv O2 D. (Cc O2 − Ca O2)/(Cc O2 − Cv O2) E. (Cc O2 − Ca O2)/(Cv O2 − Ca O2) 803. Which of the following is the formula for flow (Q) of nonpulsatile fluids? Note: P = pressure R = radius L = length V = viscosity A.Q = Pπr4/8VL B.Q = 8PL/Vπr4 C.Q = Vπr4/8PL D.Q = 8Vπr4/PL E. None of the above 804. A prisoner with suicidal tendencies is brought to the emergency room after stabbing himself in the eye with a pencil. The patient is started on broad-spectrum antibiotics, antiseizure medication, and taken immediately for open surgical debridement. The CT scan shown here is taken. The foreign object should be removed A. immediately in the ER. B. before a CT scan. C. in the operating room. D. before antibiotics are given. E. after the patient has been stabilized. 805. A 48-year-old woman presents with progressive myelopathy and difficulty walking for several months. Her MRI and CT scans are shown here. What would be the best management of the offending lesion? A. Single-level anterior cervical diskectomy and fusion (ACDF) B. Two-level ACDF C. Posterior decompression D. Cervical corpectomy and fusion E. Three-level ACDF