Soal 121------ Flashcards by anugrahonie widhiatmo

Following severe closed head injury, cerebral blood (CBF) is:
a. typically abnormally low during the first few hours after injury, and increases over the next 2-3 days
b. uniformly reduced by 3% to 4% per torr decrease in arterial pCO2 with little regional variation
c. usually the major contributor to brain swelling by the third day after injury
d. not affected by barbiturates

a. typically abnormally low during the first few hours after injury, and increases over the next 2-3 days
c. usually the major contributor to brain swelling by the third day after injury

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121. While cooking dinner a healthy 42-year-old woman felt a sudden "snap" in her neck and had the onset of severe posterior cervical and left shoulder pain. With the onset pain, she reported "seeing stars." When examined 5 days later she still complained of left neck and shouider pain made worse when turning in any direction. Neurologic examination was normal. The cervical magnetic resonance image is shown in Figure 121. The origin of this patient's pain involves which of the following structures:
A. bone
B. disc
C. blood vessel
D. spinal cord
E. facet joint

C. blood vessel

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A 47-year-old woman with neuralgia is treated with carbamazepine. After 3 months of treatment with good relief of pain, her white blood count is 2300 and Her platelet count is 10.000. Liver enzymes are mildly elevated, The neurosurgeon MOST APPROPRIATE response would be to;
A. stop carbamazepine therapy and switch Dilantin
B. stop Carbamazepine and advise operation
C. continue carbamazepine with repeat lab studies every 2-4 weeks
D. continue carbamazepine in decreased doses
E. continue carbamazepine after discussing the situation in detail with the patient, with lab studies every 3-6 months, or sooner if alarming symptoms develop

E. continue carbamazepine after discussing the situation in detail with the patient, with lab studies every 3-6 months, or sooner if alarming symptoms develop

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A 24-year-old man undergoes a cervical lymph node biopsy by a general surgeon. Postoperatively he is have an injury to the spinal accessory nerve. Which one of the following statement is true
A. The resulting impairment will be mild.
B. The prognosis for spontaneous recovery is good.
C. The nerve is most vulnerable to injury along the upper one third of the anterior border of the sternomastoid muscle.
D. Exploration and possible grafting should be considered if there is no sign of recovery of function in 3 months.
E. Athletic trauma is the most common cause of spinal accessory nerve injury.

D. Exploration and possible grafting should be considered if there is no sign of recovery of function in 3 months.

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A 50-year-old undergoes Iiver transplantation for cirrhosis. On the fourth postoperative day he becomes lethargic, tremulous, and experiences visual hallucinations. Several days later all of his extremities are weak and he appears to be in a state of akinetic mutism. His pupils are equal and reactive. A T2-weighted magnetic resonance image shows diffuse areas of increased intensity in the white matter of the cerebral hemisfer and brain stem. The most appropriate therapy for this patient would be to:
A. stop phenothiazine antiemetics and give intravenous anticholinergics
B. stop cyclosporine
C. start anticoagulants for cardiac emboli if verified on transesophageal echocardiography
D. lower serum ammonia
E. treat hyponatremia slowly

B. stop cyclosporine

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125. A 32-year-old woman has bad headaches 2 to 4 times per months, lasting several hours to several days. Her pain is bilateral and has a pressing, nonthrobbing quality. She has no nausea or vomiting with the headache, but sometimes experiences mild photophobia. Routine movement, such as walking stairs, does not aggravate her pain. She will usually cancel her appointments when the headaches occur. According to the International Headache Society Classification(1998)the most appropriate diagnosis of
her headache would be:
A. cluster headache
B. episodic tension type headache
C. Classic migraine
D. common migraine
E. tumor type headache

B. episodic tension type headache

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For which of the following primary brain tumors of childhood is the extent of resection believed to be an important prognostic factor?
a. ependymoma of the fourth ventricle
b. fibrillary astrocytoma of the hemisphere
c. medulloblaastoma
d. chiasmatic glioma

a. ependymoma of the fourth ventricle

c. medulloblaastoma

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Which of the following signs are associated with a poor prognosis in newborns with
birth injuries of the brachial plexus?
a. Horner’s syndrome
b. obliteration of cortical somatosensory evoked potentials with preservation of sensory nerve conduction
c. pseudomeningocele formation
d. failure of recovery of palpable muscle contractions in the biceps and deltoid within three months

a. Horner’s syndrome
b. obliteration of cortical somatosensory evoked potentials with preservation of sensory nerve conduction
c. pseudomeningocele formation
d. failure of recovery of palpable muscle contractions in the biceps and deltoid within three months

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Which of the following statements concerning birth injuries of the brachial plexus are TRUE?
a. Nerve root avulsion at C5 and C6 levels are common lesions in severe cases.
b. Despite paralysis of limb musculature, osseous development proceeds normally.
c. Injuries of the upper plexus are associated with selective weakness of the suscapularis leading eventually to limited active and passive internal rotation of glenohumeral joint
d. rupture of the upper trunk is a common lesion in severe cases

d. rupture of the upper trunk is a common lesion in severe cases

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A full term infant with a vertex presentation underwent a precipitous delivery by means of a vacuum extractor. The patient had been stable for 18 hours when she began to exhibit intermittent bradycardia and apneic spells. The fontanelle was tense and a T1W MRI was obtained ( figure 129). Which of the following statements is true?
a. the patients has a cephalohematoma.
b. .the patients has acute hydrocephalus
c. the patients has a posterior fossa subdural hematoma
d. . the patients has a caput succedaneum

a. the patients has a cephalohematoma.
b. the patients has acute hcp
c. the patients has a posterior fossa subdural hematoma

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Which of the following are NOT relevant in the pathogenesis of meningioma ?
A. deletion of chromosome 22
B. expression of the cis oncogene
C. smoking excessively
D. neurofibromatosis
E. previous low-level radiation to the head

C. smoking excessively

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The following statements about Cushing’s disease are true EXCEPT:
A. Cushing’s disease is caused by an adrenocorticotrophic hormone (ACTH) secreting pituitary adenoma
B. It may be difficult to differentiate from alcoholism or depression.
C. It may present with vertebral body fracture.
D. It can be excluded with a normal gadolinium-enhanced magnetic resonance image.
E. Surgical treatment can result in approximately an 80% cure rate.

D. It can be excluded with a normal gadolinium-enhanced magnetic resonance image.

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Which of the following statements regarding moyamoya disease is FALSE?
A. It is characterized by stenosis of the internal carotid artery.
B. It usually presents with hemorrhage in children.
C. It is associated with Factor VIII deficiency.
D. Intimal thickening of the pancreatic arteries is occasionally seen.
E. Women are more commonly affected than men.

B. It usually presents with hemorrhage in children.

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133. Which of the following is NOT a feature of  Friedreich’s ataxia?
A. familial
B. Scoliosis
C. Pes cavus
D. onset in early mid 30's
E. mental status changes

D. onset in early mid 30’s

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134. Important factors in the secondary injury after spinal cord damage include all of the following EXCEPT:
A. arachidonic acis cascade
B. calcium influx
C. lipid peroxidation
D. hypertension
E. bradykinin

D. hypertension

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Which of the following statements regarding ophthalmic segment aneurysms is FALSE?
A. They comprise approximately 5% of all aneurysms.
B. There is a female predominance.
C. There is a greater incidence of multiplicity and bilaterally than with other aneurysms.
D. They may present with hemorrhage or visual symptoms.
E. They are usually small ( <1 cm)

E. They are usually small ( <1 cm)

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136. A 67-year-old normotensive right-handed woman presents with headache, then evolving over 10 hours. On examination, she is lethargic, purposefully moving her right side more than her left side. Brain stem reflexes are intact. Computed tomographic scan shows a multilobulated 4x4 cm hemorrhage in the right parietal lobe, with a small amount of overlying subdural blood. There is no enhancement with the addition of contrast material. In the emergency room she develops an anisocoria and increased left-sided weakness. The MOST likely cause of this hemorrhage is:
A. hypertension
B. ruptured arteriovenous malformation
C. ruptured aneurysm
D. amyloid angiopathy
E. trauma

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D. amyloid angiopathy

The BEST management of the patient in question 136 would be:
A. intubation, hyperventilation, diuresis and pressure monitoring
B. angiography followed by craniotomy
C. urgent craniotomy
D. no therapy, if the family agrees, because her prognosis is so poor
E. acute medical management with later definitive radiosurgery

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C. urgent craniotomy

Which of the following statements regarding amyloid angiopathy is FALSE?
A. The cardinal clinical manifestation of arnyloid angiopathy is dementia.
B. Hematomas from arnyloid angiopathy tend to be “lobar,” especially near the cortical surfaces of the occipital and parietal areas.
C. The amyloid is a proteinaceous compound deposited in the walls of cerebral and leptomeningeal vessels.
D. Familial forms of the disease have not been described,
E. A green yellow birefringence can be noted when affected vessel stained with Congo red is visualized under polarized light

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D. Familial forms of the disease have not been described,

Which statement regarding craniosynostosis is TRUE’!
A. Increased radioisotope activity along a suture is diagnostic of craniosynostosis
B. There is a female preponderance in sagittal synostosis.
C. Increased bone growth parallel to the fused suture is the rule.
D. Lambdoisd synostosis is the most common cause of posterior plagiocephaly
E. Sagittal synostosis is frequently part of a recognizable syndrome.

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C. Increased bone growth parallel to the fused suture is the rule.

Middle cerebral artery (MCA)aneurysms accounts for 20% of all intracranial aneurysms. With regard to these aneurysms, which of the following is TRUE?
A. Giant aneurysms are rare in this location,
B. Ischemic symptoms such as transient ischemic attacks (TIA)are sometimes associated.
C. Vasospasme is very common, compared to other aneurysms.
D. These aneurysms areless likely than others to be associated with seizures.
E. A superior temporal gyrus approach is particularly for proximally located MCA aneurysms.

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B. Ischemic symptoms such as transient ischemic attacks (TIA)are sometimes associated.

A 28-year-old right-handed white male is admitted to the neurosurgical service after a rollover motor vehicle accident. He is neurologically normal. Further examination reveals drainage of clear fluid the right ear. Which of the following statements is ‘TRUE?
A. Fracture lines transverse to the long axis of the petrous pyramids commonly result in otorrhea
B. Meningitis in this patient would be unexpected, as it only occurs in 1% to 2% of patients with traumatic CSF leaks.
C.Leakage will most likely spontaneously stop within a week
D. Immediate surgery for repair of the CSF leak should be undertaken
E. A glucose level in the fluid of 10mg% would be highly suggestive of CSF

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C.Leakage will most likely spontaneously stop within a week

With regard to cerebrospinal fluid leaks, which of the following is TRUE?
A.Nontraumatic CSF leakage is rarely due to a tumor
B.CSF flow is greater in traumatic leaks than in nontraumatic leaks.
C. Risks of infection are greater in spontaneous leaks than in traumatic leaks.
D. Spontaneous cessation of leakage may occur in as many as onethird of nontraumatic cases
E. In spontaneous rhinorrhea, leakage through the cribriform plate itself is seen rarely

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D. Spontaneous cessation of leakage may occur in as many as onethird of nontraumatic cases

A 59-year-old patient presents with back pain radiating to the left flank and abdomen. A plain lumbar film reveals enlargement of the T12-L1 foramen on the left. Which of the following statements is TRUE?
A. Pathology results will likely show Antoni A and Antoni B tissue.
B. The patient probably is a female.
C. The patient probably is a male.
D. A search of primary tumor is indicated
E. This lesion is found more in the cervical region

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A. Pathology results will likely show Antoni A and Antoni B tissue.

144. Which of the following findings suggest shunting will improve a patient with idiopathic adult communicating hydrocephalus? A. evidence of cerebrovascular disease on radiographic studies B. a history of gait disturbance preceding disturbance in mentation C. slowing on EEG D. absence of B waves or high pressure peaks during intracranial pressure monitoring E. none of the above

B. a history of gait disturbance preceding disturbance in mentation

145. Which of the following statements regarding medulloblastoma are TRUE? a. There is a 2: 1 male predominance. b. The peak age of occurrence is 8 years. c. True rosettes are seen on pathologic examination. d. Hydrocephalus is a late finding.

a. There is a 2: 1 male predominance. b. The peak age of occurrence is 8 years. c. True rosettes are seen on pathologic examination.

``` 146. Angiographis vasospasm is present in up to what percent of patients subarachnoid hemorrhage? A. 10% B. 25% C. 50% D. 75% E. 100 % ```

D. 75%

``` 147. Signs of vasospasm include all of the following EXCEPT: A. fever B. meningitis C. lethargy D. seizures E. Hypernatremia ```

E. Hypernatremia

``` 148. Which transcranial Doppler velocity in the middle cerebral artery correlates best with the presence of severe angiographic vasospasm? A. 20 cm/sec B. 50 cm/sec C. 100 cm/sec D. 150 cm/sec E. 200 cm/sec ```

E. 200 cm/sec

149. In clinical trials nimodipine has been demonstrated to: A. decrease the incidence of angiographic vasospasm when compared to placebo controls B. decrease the incidence of delayed ischemic neurologic deficits when compared with placebo controls C. increase cerebral blood flow in patients having vasospasm D. have high incidence of induced hypotension with usage E. eliminate the need of hypervolemic hypertensive therapy

B. decrease the incidence of delayed ischemic neurologic deficits when compared with placebo controls

150. Current management of clinically active cerebral vasospasm should include: A. nimodipine, 60 mg PO q4h , B. hypervolemic hemodilution to improve the rheologic characteristics of the cerebral circulation C. reduction of intracranial pressure to promote cerebral blood flow D. Angioplasty in medically refractory cases E. All of the above

E. All of the above

151. The major disadvantage of radiosurgery in the treatment of artericrvennus malformations( AVMs) is : A. lack of study with long term follow up B. the rarity of total obliteration of the AVM C. the high rate of neurologis complications D. the lack of efficacy in smalI lesion E. the long latency between traetment and subsequent obliteration of the AVM

E. the long latency between traetment and subsequent obliteration of the AVM

152. The MOST common cause of neurologic symptoms in AIDS is: A. viral encephalitis B. toxoplasmosis C. central nervous system lymphoma D. herpes encephalitis E. progressive multifocal leukoencepahalopaty

A. viral encephalitis

153. Factors affecting biopsy decisions in HIV-positive patients with cerebral lesions include: A.lesions enhancement B. state of systemic disease C . responsive to an antibiotics therapy for toxoplasmosis D. Karnofsky score E. all of the above

E. all of the above

154. HIV positive patients with cerebral lesions LATE in their illness should: A. he treated with an empiric toxoplasmosis antimicrobial therapy if the lesion enhance B. undergo stereotactic biopsy if the lesion enhances C. undergo biopsy if the lesion does not enhance D. receive supportive care E. be treated for progressive multifocal leukoencepalopathy

B. undergo stereotactic biopsy if the lesion enhances

``` 155. A 21-year-old female patient with a 6 months history of galactorrhea and amenorrhea is referred for evaluation. Other than a 30 lb weight gain she has no other symptoms. A serum prolactin is 359. Possible explanations for this elevation include: A. pituitary stalk compression B. stress C. pituitary adenoma D. hypothyroidism E. all of the above ```

C. pituitary adenoma

156. The patient in question 155 undergoes magnetic resonance (Figure 156). Treatment options: A. differ from those for microadenoma B. are affected by the possibility of pregnancy C. may not be likely to result in cure D. include transphenoidal surgery E. include all of the above

E. include all of the above

A. H-reflex B. F Wave C. nerve conduction velocity (NCV) D. electromyogram E. Somatosensory evoked potentials(SSEPs) 157. will reveal fibrillations or fasciculatians if denervation is present

D. electromyogram

A. H-reflex B. F Wave C. nerve conduction velocity (NCV) D. electromyogram E. Somatosensory evoked potentials(SSEPs) 158. abnormalities reflected by increased "latencies"

C. nerve conduction velocity (NCV)

A. H-reflex B. F Wave C. nerve conduction velocity (NCV) D. electromyogram E. Somatosensory evoked potentials(SSEPs) 159. generated by antidromic stimulation of the motoneuron pool

B. F Wave

A. H-reflex B. F Wave C. nerve conduction velocity (NCV) D. electromyogram E. Somatosensory evoked potentials(SSEPs) 160. can be recorded from peripheral nerve, spinal cord, or brain

E. Somatosensory evoked potentials(SSEPs)

Soal 121------ Flashcards

(41 cards)