NEUROSURGERY

Question 1

10. Surgical procedures utilized in the treatment of spasmodic torticollis include

I. upper cervical ventral rhizotomies and spinal accessory neurectomy
11. stereotactic thalamotomy
111. microvascular decompression of the spinal accessory nerve
IV. myotomy

A. I, 11,111
B. I, 111
C. 11, IV
D. IV
E. all of the above

Answer 1

E. all of the above

Question 2

Which surgical approach for thoracic disk herniations is associated with the
highest rate of neurologic injury?

A. costotransversectomy
B. lateral extracavitary
C. midline laminectomy
D. transpedicular
E. transthoracic

Answer 2

C. Midline Laminectomy

Question 3

12. Most patients with intrinsic brainstem gliomas initially present with

A. cranial neuropathies
B. headache
C. hydrocephalus
D. nausea and vomiting
E. papilledema

Answer 3

A. cranial neuropathies

Question 4

Each of the following is characteristic of complex regional pain syndrome I1
(causalgia) except

A. atrophic changes in the limb
B. hypesthesia
C. increased sweating
D. lack of major motor deficit
E. good relief with sympathetic block

Answer 4

B. hypesthesia

Question 5

19. Ventricular enlargement from choroid plexus papillomas can be secondary to

I. entrapment of cerebrospinal fluid (CSF)
11. decreased absorption of CSF from hemorrhage-induced arachnoiditis
111. tumor growth
IV. excessive production of CSF

A. I, 11, 111
B. I, 111
C. 11, IV
D. IV
E. all of the above

Answer 5

E. all of the above

Question 6

20. Which approach is favored for a patient with an 8 mm acoustic neuroma in
    which hearing preservation is a goal?

A. middle fossa
B. suboccipital
C. translabyrinthine

Answer 6

A. middle fossa

Question 7

21. Uncinate seizures typically produce

A. auditory hallucinations
B. gustatory hallucinations
C. olfactory hallucinations
D. vertiginous sensations
E. visual seizures

Answer 7

C. olfactory hallucinations

Question 8

26. The radial nerve or one of its branches innervates each of the following except the

A. abductor pollicis longus
B. adductor pollicis
C. brachioradialis
D. extensor pollicis brevis
E. supinator

Answer 8

B. adductor pollicis

Question 9

27. Each of the following is true of intraventricular hemorrhage (IVH) in the newborn except

A. Periventricular hemorrhagic infarction is one sequela.
B. Posthemorrhagic hydrocephalus can result in persistent bradycardia and apneic spells.
C The capillary bed of the germinal matrix is composed of large irregular vessels.
D. The germinal matrix is the most common site of IVH in the full-term neonate.
E. The risk of IVH is greater in the preterm than in the term infant.

Answer 9

D. The germinal matrix is the most common site of IVH in the full-term neonate.

Question 10

28. The ossification centers of the odontoid consist of

A. one primary and two secondary centers
B. one secondary and three primary centers
C. three secondary and one primary center
D. two primary Centers
E. two primary and one secondary center

Answer 10

E. two primary and one secondary center

Question 11

29. The most common single-suture synostosis is

A. coronal
B. lambdoid
C. metopic
D. sagittal
E. sphenozygomatic

Answer 11

D. sagittal

Question 12

30. The most sensitive method for detecting carpal tunnel syndrome is

A. needle examination of the abductor pollicis brevis
B. needle examination of the first and second lumbricals
C motor amplitude of the median nerve
D. motor distal latency of the median nerve
E. palmar sensory conduction time of the median nerve

Answer 12

E. palmar sensory conduction time of the median nerve

Question 14

31. Coup contusions most commonly occur at the

A. cerebral convexities

B. frontal and temporal poles
C. orbital surface of the frontal lobes
D. posterior fossa
E. ventral surface of the temporal lobe

Answer 14

A. cerebral convexities

Question 15

For questions 32 to 36, match the aneurysm with the sign or symptom it is most
likely to produce. Each response may be used once, more than once, or not at all.

A. anterior communicating artery aneurysm
B. intracavernous carotid aneurysm
C. middle cerebral artery aneurysm
D. ophthalmic artery aneurysm
E. posterior communicating artery aneurysm

Answer 15

32. pupil-involving third nerve palsy
33. seizures
34. diabetes insipidus
35. inferior nasal quadrantanopia
36. exophthalmos

Question 16

37. The essential difference between a syringomyelic and a hydromyelic cavity is that the cavity in

A. hydromyelia is lined with ependymal cells, and in syringomyelia is not
B. hydromyelia is lined with choroid plexus, and in syringomyelia is not
C. syringomyelia contains CSF, and in hydromyelia contains serum
D. syringomyelia is focal, and in hydromyelia is more extensive
E. syringomyelia is an enlargement of the central canal, and in hydromyelia is an enlargement of the anterior median septum
For questions 38 to 45, identify the following structures. The figure illustrates the

Answer 16

A. hydromyelia is lined with ependymal cells, and in syringomyelia is not

Question 17

46. Each of the following is true of basilar impression except

A. Cerebellar and vestibular complaints typically overshadow motor and sensory complaints.
B. McGregor’s line is helpful in routine screening.
C. McRae’s line is helpful in clinical assessment.
D. Short necks and torticollis are common.
E. Vertebral artery anomalies are common.

Answer 17

A. Cerebellar and vestibular complaints typically overshadow motor and sensory complaints.

Question 18

47. Which of the following fractures has the poorest prognosis for healing without surgical intervention?

A. hangman’s
B. Jefferson’s fracture with 4 mm displacement of lateral masses
C. type l odontoid
D. type 11 odontoid
E. type I11 odontoid

Answer 18

D. type 11 odontoid

Question 19

48. Sprengel’s deformity refers to a(n)

A. congenital elevation of the scapula
B. congenital fusion of the upper cervical vertebrae
C. intravertebral disk herniation
D. postlaminectomy kyphosis
E. scoliosis resulting from tethering of the spinal cord

Answer 19

A. congenital elevation of the scapula

Question 20

For questions 49 to 55, match the fracture type with the mechanism. Each response may be used once, more than once, or not at all.
Force Neck Posture!

A. flexing . flexed
B. compressing flexed
C. compressing neutral
D. distracting extended
E. flexing axially rotated
F. compressing laterally bent

Answer 20

49. hangman’s fracture
50. burst fracture
51. unilateral facet dislocation
52. teardrop fracture
53. bilateral facet dislocation
54. horizontal facet fracture
55. Jefferson’s fracture

Question 21

56. Lateral recess stenosis in spondylosis is most commonly caused by

A. disk herniation
B. hypertrophied pedicles
C. inferior articular facet hypertrophy
D. ligamentum flavum hypertrophy
E. superior articular facet hypertrophy

Answer 21

E. superior articular facet hypertrophy

Question 22

57. In the treatment of chronic pain, the undesirable effect(s) that islare more common in stimulation of the periaqueductal gray than the periventricular gray region is lare

I. diplopia
11. oscillopsia
111. reduction of upgaze *
IV. sense of impending doom

A. I, 11, Ill
B. I, I11
C. 11, IV
D. IV
E. all of the above

Answer 22

E. all of the above

Question 23

58. '’Trilateral retinoblastoma” describes bilateral ocular retinoblastomas and a(n)

A. astrocytoma
B. medulloblastoma
C. neurofibroma
D. optic nerve sheath tumor
E. pineoblastoma

Answer 23

E. pineoblastoma

Question 24

59. Carotid artery ligation is absolutely contraindicated in patients with (a)

A. bilateral intracavernous carotid aneurysms
B. giant ophthalmic artery aneurym and evidence of vasospasm on arteriogram
C. giant ophthalmic artery aneurysm and extracranial atherosclerotic disease
D. intracavernous carotid artery aneurysm and sudden loss of extraocular
motility
E. traumatic dissecting aneurysm of the petrous carotid artery

Answer 24

B. giant ophthalmic artery aneurym and evidence of vasospasm on arteriogram

Question 25

60. The syndrome of weakness in one upper extremity followed by lower extremity weakness on the same side, then contralateral lower extremity weakness, is most characteristic of a meningioma involving the A. clivus B. falx C. foramen magnum D. olfactory groove E. tuberculum sella

Answer 25

C. foramen magnum

Question 26

For questions 61 to 70, the figure illustrates a lateral view of the left cavernous sinus. Match the following triangles with the descriptions/structures. Each response may be used once, more than once, or not at all. A. clinoidal B. oculomotor C. supratrochlear D. infratrochlear or Parkinson's E. anteromedial F. anterolateral G. posterolateral or Glasscock's H. posteromedial or Kawase's

Answer 26

61. clinoidal segment of the internal carotid artery 62. intracavernous carotid artery 63. intrapetrous carotid artery 64. meningohypophyseal trunk origin 65. optic strut 66. sphenoid sinus and lower margin of Vl 67. Two margins of this triangle are formed by the anterior and posterior petroclinoidal dural folds. 68. located between V2 and V3 69. contains the foramen spinosum 70. contains the cochlea

Question 27

71. Adherence of a posterior communicating artery aneurysm to the temporal lobe is most likely in a patient presenting with A. loss of consciousness B. no third nerve palsy . . C. projection of the aneurysm medial to the carotid on the anteroposterior (AP) angiogram D. third nerve involvement E. seizures

Answer 27

B. no third nerve palsy . .

Question 28

72. Weakness of the deltoid muscle is caused by injury to the A. axillary nerve B. dorsal scapular nerve C. musculocutaneous nerve D. suprascapular nerve E. thoracodorsal nerve

Answer 28

A. axillary nerve

Question 29

73. Subdural empyema resulting after meningitis in an infant most commonly develops with A. Escherichia coli B. Haemophilus influenme C. Listeria D. Neisseria E. Staphylococcus

Answer 29

A. Escherichia coli

Question 30

74. Sudeck's atrophy, associated with causalgia, refers to atrophic changes occur. ring in each of the following structures except A. bone B. joints C. muscle D. nerve E. skin

Answer 30

D. nerve

Question 31

For questions 75 to 79, match the embryological event with the postovulatory day. Each response may be used once, more than once, or not at all. Postovulatory Day Number A. 13 B. 17 C. 22 D. 24 E. 26

Answer 31

75. closure of the caudal neuropore 76. closure of the cranial neuropore 77. formation of the notochord 78. formation of the primitive streak 79. fusion of the neural folds to form the neural tube

Question 32

80. Factors that predispose to the subclavian steal syndrome include I. occlusion of the left subclavian artery before the origin of the left vertebral artery 11. occlusion of the left subclavian artery after the origin of the left vertebra artery Ill. active use of the left arm IV. occlusion of the left vertebral artery A. I, 11, 111 B. I, 111 C. 11, IV D. IV E. all of the above

Answer 32

B. I, 111

Question 33

81. The articular facet joint in the upper thoracic region is oriented A. axially B. coronally C. obliquely D. sagittally

Answer 33

B. coronally

Question 34

82. The most common presenting symptom of a thoracic herniated disk is A. back pain B. leg numbness C. leg weakness D. thoracic numbness E. urinary incontinence

Answer 34

A. back pain

Question 35

83. Neurologic deficits thought to result from occlusion of the thalamostriate vein during the subchoroidal transvelum interpositum approach to the third ventricle include 1. drowsiness 11. hemiparesis Ill. mutism IV. seizures A. I, 11, 111 B. I, Ill C. 11, IV D. IV E. all of the above

Answer 35

A. I, 11, 111

Question 36

89. In the suboccipital transmeatal approach to an acoustic neuroma, the location of the facial nerve in relation to the tumor, in decreasing frequency of occurrence, is A anterior. posterior, inferior B. anterior, superior, inferior C. superior, anterior, posterior D. posterior, superior, anterior E. anterior, posterior, superior

Answer 36

B. anterior, superior, inferior

Question 37

90. Each of the following features is usually minimal or absent in patients with type 2 neurofibromatosis except A. axillary freckles B. cafe au lait spots C. Lisch nodules D. multiple. typical skin neurofibromas E. skin plaques

Answer 37

E. skin plaques

Question 38

91. The single most important factor in the recurrence of meningiomas is A age of the patient B. bone invasion C. histologic type of benign meningioma D. postoperatiye tumor residual E. sex of the patient

Answer 38

D. postoperatiye tumor residual

Question 39

For questions 92 to 98, match the cistern with the structure it contains. Each response may be used once, more than once, or not at all. A ambient cistern B. cerebellopontine angle cistern C. interpeduncular cistern D. lateral cerebellomedullary cistern E. prepontine cistern

Answer 39

92. contains the anteroinferior cerebellar artery (AICA) 93. contains the origin of the posteroinferior cerebellar artery (PICA) 94. contains the superior cerebellar artery 95. contains cranial nerve (CN) IV 96. contains CN V 97. contains the basal vein of Rosenthal 98. contains the choroid plexus at the foramen of Luschka

Question 40

99. The transverse crest separates the A cochlear, facial, and superior vestibular nerves from the inferior vestibular nerve B. cochlear and inferior vestibular nerve from the facial and superior vestibular nerve C. facial and cochlear nerves from the superior and inferior vestibular nerves D. facial, cochlear, and inferior vestibular nerves from the superior vestibular nerve E. facial and inferior vestibular nerves from the cochlear and superior vestibular nerves

Answer 40

B. cochlear and inferior vestibular nerve from the facial and superior vestibular nerve

Question 41

100. Which of the following is true of hemifacial spasm? A. Compression of the facial nerve by the superior cerebellar artery is the most common operative finding. B. Deafness is more common than permanent facial weakness as a complication of microvascular decompression. C. Men are more frequently affected than women. D. Symptoms typically begin in the buccal muscles and move cranially. E. The cure rate at 1 month after microvascular decompression is 95%.

Answer 41

B. Deafness is more common than permanent facial weakness as a complication of microvascular decompression.

Question 42

101. Each of the following surgical approaches may be considered for an aneurysm of the vertebrobasilar junction except the A. extended extreme lateral inferior transcondylar approach B. lateral suboccipital approach C. presigmoid transtentorial approach D. retrolabyrinthine transigmoid approach E. subtemporal approach

Answer 42

E. subtemporal approach

Question 43

102. The most common presenting symptom in patients with colloid cysts is A. headache B. dementia C. seizures D. sudden attacks of leg weakness E. sudden death

Answer 43

A. headache

Question 44

For questions 103 to 106, the figure illustrates the nerves occupying the right internal auditory canal through a middle fossa approach. Identify their relative positions.

Answer 44

103. inferior and anterior 104. inferior and posterior 105. superior and anterior 106. superior and posterior

Question 45

107. The most common presenting symptom of neonates with vein of Galen aneurysms is A. congestive heart failure B. hydrocephalus C. intracerebral hemorrhage D. seizures E. subarachnoid hemorrhage

Answer 45

A. congestive heart failure

Question 46

The most common upper thoracic spine injury is a A. burst fracture B. compression fracture C. fracture-dislocation D. seat-belt injury

Answer 46

B. compression fracture

Question 47

Which is true of thoracolumbar spine fractures? A. Burst fractures are the most common. B. Fracture-dislocations involve all three columns. C. Seat-belt type injuries are generally stable. D. Wedge compression fractures are generally unstable. E. Wedge compression fractures involve the middle column.

Answer 47

B. Fracture-dislocations involve all three columns.

Question 48

110. Each of the following is true of diffuse brain swelling except that it is A. a result of cerebrovascular congestion B. a result of cytotoxic edema C. associated with a 50% mortality rate in severely head-injured children D. manifested on computed tomography (CT) scan by a compression of the perimesencephalic cistern E. more common in children than in adults

Answer 48

B. a result of cytotoxic edema

Question 49

111. Which of the following is least suggestive of child abuse? A. acute and healing long bone fractures B. interhemispheric subdural hematorna C. parietal skull fracture D. retinal hemorrhages E. tentorial subdural hematoma

Answer 49

C. parietal skull fracture

Question 50

112. Trigonocephaly results from premature closure of the A. coronal suture bilaterally B. coronal suture unilaterally C. frontosphenoidal suture D. lambdoid suture E. metopic suture

Answer 50

E. metopic suture

Question 51

113. The cleft in the spinal cord associated with diastematomyelia is most commonly located in the A. cervical region B. lumbar region C. sacral region D. thoracic region

Answer 51

B. lumbar region

Question 52

114. Up to what percentage of patients with bacterial arterial (mycotic) aneurysms carry an underlying diagnosis of subacute bacterial endocarditis? A. 10% B. 20% C. 40% D. 60% E. 80%

Answer 52

E. 80%

Question 53

115. Each is true of bacterial intracranial aneurysms except A. Infected emboli lodge in the vasa vasorum. B. The middle cerebral artery is most commonly affected. C. The peripherally located branches are most commonly affected D. Typical subarachnoid hemorrhage occurs in 18% of patients. E. Staphylococcus aureus and beta hemolytic streptococci are most commonly involved.

Answer 53

A. Infected emboli lodge in the vasa vasorum.

Question 54

Each of the following is true of growing skull fractures except that they A. can cross suture lines B. may be associated with underlying brain injury C. occur if the edges of the initial fracture are separated by more than 3 mm D. occur most commonly in the parietal bone E. occur most commonly between the ages of 2 and 5

Answer 54

E. occur most commonly between the ages of 2 and 5

Question 55

Approximately what percentage of infants with myelomeningocoele have magnetic resonance imaging (MRI) evidence of a Chiari I1 malformation? A. 20% B. 40% C. 60% D. 80% E. 100%

Answer 55

E. 100%

Question 56

Cardiovascular disease involving the heart and great vessels gives rise to which of the following types of emboli in the retina? I. cholesterol 11. calcific 111. platelet-fibrin IV. fat A. I, 11, Ill B. I, 111 , C. 11, IV D. IV E. all of the above

Answer 56

A. I, 11, Ill

Question 57

In the infratentorial supracerebellar approach to the pineal region, which of the following veins are usually sacrificed? I. superior vermian vein 11. posterior pericallosal vein Ill. precentral cerebellar vein IV. basal vein of Rosenthal A. I, 11,111 B. I, 111 C. 11, IV D. IV E. all of the above

Answer 57

B. I, 111

Question 58

Each of the following is characteristic of an acoustic neuroma except a. Bekesy type 111 or IV audiogram b. loudness recruitment c. low short-increment sensitivity index (SiSi) d. poor speech discrimination e. pronounced tone decay

Answer 58

b. loudness recruitment

Question 59

For questions 121 to 128, the figure illustrates the left retrosigmoid approach. Identify the following structures ![]() 121. subarcuate artery 122. anteroinferior cerebellar artery 123. cochlear nerve 124. facial nerve 125. glossopharyngeal nerve 126. spinal accessory nerve 127. posteroinferior cerebellar artery 128. vagus nerve

Question 60

Which of the following structures provides a marker for the most dorsal extent of the incision for anterolateral cordotomy for pain control? a. dentata ligament b. dorsal root entry zone c. posterior intermediate sulcus d. posterior median sulcus e. zone of Lissauer

Answer 60

a. dentata ligament

Question 61

130. Occlusion of the anterior choroidal artery results in I. contralateral hemiplegia 11. hemihypesthesia 111. homonymous hemianopia IV. impaired cognition A. I, 11,111 B. I, 111 C. 11, IV D. IV E. all of the above

Answer 61

A. I, 11,111

Question 62

131. Which of the following symptoms of Parkinson's disease is most likely to respond to a stereotactic lesion in the posterior ventral oval (VOP)/ventral intermediate (VIM) (ventrolateral) thalamus? A. bradykinesia B. gait disturbance C. rigidity D. speech disturbance E. tremor

Answer 62

E. tremor

Question 63

For questions 132 to 136, match the description with the syndrome or disease. A. Apert's syndrome B. Crouzon'sdisease C. Both D. Neither

Answer 63

132. autosomal recessive inheritance 133. exorbitism 134. syndactyly 135. The majority of patients have preoperative 136. intelligence quotients (IQs) greater than 90. 137. Anterior open bite is common.