Neurosurgery

·      Anatomy 

1.    Anatomy.

???) The following arteries contribute to the formation of the circle of Willis, except:

A.    Internal carotid artery

B.     Posterior commnicating artery

C.     Posterior cerebral artery

D.    Anterior cerebral artery

E.     Posterior inferior cerebellar artery

Answer: E* Posterior inferior cerebellar artery

·      Intracranial Pressure (ICP) 

1.    Cerebral Blood Flow (CBF).

???) Regarding the cerebral blood flow (CBF) which of the following statements is

true:

Average flow is 54 ml / 100 g / min

Inferior colliculus and sensorimotor cortex have the highest rate of CBF

Grey matter has higher CBF than white matter

Venous pressure, mean arterial pressure, and intracranial pressure are factors that affect the CBF

All of the above.

Answer: 5* All of the above

2.    ICP Measurement.

???) General measures that are used to lower intracranial pressure include all of the following except:

Head up 30 degrees

Avoid Hypotension

Avoid jugular venous outflow constriction

Induce hyperventilation

Intubate patients with GCS < 8 or with respiratory distress

Answer: 4* Induce hyperventilation

·      Hydrocephalus 

1.    Hydrocephalus.

???) Which is acceptable procedures for the treatment of hydrocephalus:

Endoscopic third ventriculostomy

Ventriculo peritoneal shunt

Ventricular access device with frequent tapping

External ventricular drain

All of the above

Answer: 5* All of the above

???) One of the following is the most common cause of hydrocephalus in children:

Spina bifida with meningornyelocele

Post-inflammatory and post-traumatic obstruction

Neoplasma (glyoma in the third ventricle)

Arnold Chiari malformation

Epilepsy

Answer: 4* Arnold Chiari malformation

???) Shunt infection is one of the common problems in neurosurgery, which statement is false:

Infection occurs in nearly 5% of shunt cases

Gram -ve micro organisms are the commonest micro organism to cause infection

Young age, poor skin condition, and surgeon's experience are all risk factors

CSF (obtained from shunt reservoir) culture and analysis is diagnostic in 95% of cases

A child with shunt infection may present with only irritability and intermittent fever

Answer: 2* Gram -ve micro organisms are the commonest micro organism to cause infection

·      Idiopathic Intracranial Hypertension 

1.    Pseudotumor Cerebri.

***) Benign intracranial hypertension (pseudotumor cerebri) is usually associated with which of the following:

Hemiparesis

Papilloedema

Increased CSF protein and sugar

Convulsions

Severe mental retardation

Answer: 2* Papilloedema

·      Blood 

1.    Extradural Hematoma.

???) In extradural hematoma all are true, except:

A.    History of head injury

B.     Lucid interval

C.     Convulsions or hemiplegia of the contralateral side

D.    Dilatation of the ipsilateral pupil

E.     The source of bleeding is one of the scalp vessels

Answer: 5* The source of bleeding is one of the scalp vessels

2.    Subdural Hematoma.

???) The scalp hematoma that takes the shape of the underlying skull bone and with time it may give a false impression of a depressed fracture is:

A.    Subcutaneous hematoma

B.     Subgaleal hematoma

C.     Intramuscular hematoma

D.    Sub-epicranial hematoma

E.     Extradural hematoma

Answer: 4* Sub-epicranial hematoma

·      Cerebrovascular Disease 

1.    Subarachnoid Hemorrhage (SAH).

???) Regarding aneurysmal subarachnoid hemorrhage (SAH) all is true except:

Rebleeding is the major concern and killer in the initial stabilization period

Vasospasm may occur several days after the bleeding

Hyponatremia & vasospasm are two causes of sudden deterioration in the patient's sensorium

Any type of arrhythmia may occur in SAH cases

Nimodipine a drug that facilitate calcium channels passage is used to prevent vasospasm in SAH

Answer: 5* Nimodipine a drug that facilitate calcium channels passage is used to prevent vasospasm in SAH

***) Subarachnoid hemorrhage occurs most commonly as a result of:

Rupture of an arteriovenous anomaly

Rupture of a berry aneurysm

Rupture of a mycotic aneurysm

Trauma

Rupture of a fusiform aneurysm

Answer: 2* Rupture of a berry aneurysm

·      Vascular Malformations 

1.    Arteriovenous Malformations (AVM).

???) Regarding AVM of the brain which statement is false:

AVM are dysplastic arteries and vessels with no capillaries or intervening neural parenchyma

Risk of hemorrhage is life long as they are congenital

Small AVM's tend to present more often with bleeding than larger ones

The angiogram is diagnostic radiological exam as AVM's cannot be diagnosed or visualized on MRI

The younger patient at the time of diagnosis the higher risk of developing

Answer: 4* The angiogram is diagnostic radiological exam as AVM's cannot be diagnosed or visualized on MRI

·      Dermatome  

1.    Myotome.

???) Ankle jerk is controlled by:

A.    L1 - L2

B.     L2 - L3

C.     L3 - L4

D.    L5 - S1

E.     L4 - L5

Answer: 4* L5 - S1

·      Extradural Lesions  

1.    Cervical Disc Syndrome.

???) Which statement regarding cervical prolapsed disc (PID) it false:

C6 C7 is the commonest site of occurrence

In a CS C6 PID the radiculopathy involves C6 root, and the biceps reflex is diminished

C4 C5 PID results in forearm flexion weakness

CD- C7 Tl PID results in weakness of hand intrinsic muscles

Left C6 radiculopathy may present with pain simulating a myocardial infarction

Answer: 3* C4 C5 PID results in forearm flexion weakness

2.    Cauda Equina Syndrome.

???) The spinal cord ends in adults at:

A.    The lower end of the 1st lumbar vertebra

B.     The lower end of the 12th dorsal vertebra

C.     The lower end of the 3rd lumbar vertebra

D.    The lower end of the 5th lumbar vertebra

E.     The lower end of the 3rd sacral vertebra

Answer: 1* The lower end of the 1st lumbar vertebra

???) The following associations are true, except:

A.    Biceps reflex C5-C6

B.     Knee jerk L3-L4

C.     Ankle jerk S3-S4

D.    Cremasteric reflex L1-L2

E.     Triceps reflex C7-C8

Answer: C* Ankle jerk S3-S4

·      Pediatric Neurosurgery 

1.    Spinal Dysraphism.

***) A sacral meningomyelocele commonly associated with all of the following, except:

Spasticity of the lower limbs

Hydrocephalus

A neurogenic bladder

A lax anal sphincter

Meningitis

Answer: 2* Hydrocephalus

2.    Intraventricular Hemorrhage (IVH).

***) All of the following are risk factors of intraventricular hemorrhage, except:

Prematurity

Respiratory syndrome

Pneumothorax

Hypercapnia and acidosis

Portal hypertension

Answer: 5* Portal hypertension

3.    Craniosynostosis.

???) Large anterior fontanel is due to all of the following, except:

Hydrocephalus

Achondroplasia

Craniosynostosis

Down syndrome

Prematurity

Answer: C* Craniosynostosis