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26.  The  most common site  of  origin  of  the  recurrent  artery  of  Heubner is the


A.  A1 segment,
B.  A2 segment
C.  internal  carotid artery
D.  Ml segment
E.  M2 segment

B

Osb  p.  120.  The  recurrent  artery  of  Heubner  (one of the  medial  striate arteries)  takes  origin from  the  A2 segment  34 to 50% of  the  time,  from the A1 segment  17 to 45% of  the  time, and  from the  anterior communicating artery  5  to 20% of the  time.

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27.  lntracranial  hypotension  related  to  leakage or removal  of  cerebrospinal  fluid (CSF)  is  most closely associated with which  magnetic resonance finding?


A.  diffuse dural enhancement
B.  ependymal  enhancement
C  pneumocephalus
D.  slitlike  ventricles
E.  ventriculomegaly

A

Yock p.  333.  This enhancement  is  thought  to represent an increase in  blood volume  in the  dura.  Inferior  displacement  of  the  structures in the  posterior
fossa may accompany  this  finding in such cases  of  intracranial hypotension.

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28.  Which  of  the  following imaging characteristics  is  least  likely  for pleomorphic xanthoastrocytoma?


A.  calcification
B.  cyst formation
C.  multiple lesions
D.  superficial location
E.  temporal  lobe location

C

Yock  p.  72. This  variant of  astrocytoma usually presents as a  large single  mass in a young  patient  with a  long history  of  seizures.  The  other options listed are typical.

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29.  Choroid plexus papillomas in children are  most common in the


A.  fourth  ventricle
B.  left  lateral  ventricle
C.  right lateral ventricle
D.  third ventricle

B. left  lateral  ventricle

Yock p.  204. This  propensity  to lateralize has  not  been explained. These large bulky tumors usually arise in the  trigone.

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30.  Choroid plexus papillomas in  adults  occur most commonly in  the

A.  fourth  ventricle
B.  left lateral ventricle
C.  right lateral ventricle
D.  third ventricle

A

Yock pp.  204-205.  These  tumors in the  adult population  are  often found  at the  caudal  aspect  of  the  fourth  ventricle  and  frequently  calcify.

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31.  Which  one  of the  following white matter lesions usually initially  involves  the parieto-occipital regions?


A.  adrenoleukodystrophy
B.  Canavan's disease
C.  metachromatic leukodystrophy
D.  multiple sclerosis
E.  Schilder's disease

A. adrenoleukodystrophy

Yock p.  252.  The  lesions of  adrenoleukodystrophy are  usually symmetrical, begin in the  parieto-occipital region, and  spread  anteriorly.

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32. caudal  displacement  of  cerebellar tonsils

A.  Chiari l  malformation
B.  Chiari 11  malformation
C.  both
D.  neitherC

C. both

For  questions 32-37  see  Yock pp.  520-521. Chiari  I  malformations  consist of inferior displacement  of  the  cerebellar tonsils through  the  foramen magnum.
They usually occur in early adulthood. In  Chiari  I1  malformations, the  caudal displacement  of the  hindbrain is more severe, with beaking of the  tectum and medullary kinking  often  seen.  Myelomeningoceles are  virtually  always present. Chiari  I1  malformations usually present in infancy. Chiari I11  malfor-mations display the  most severe  displacement  of posterior  fossa  structures and  are  often associated  with a high cervical or occipital meningocele.

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33.  Beaking of  the  midbrain  tectum is characteristic.

A.  Chiari l  malformation
B.  Chiari 11  malformation
C.  both
D.  neither

B. Chiari 11  malformation

For  questions 32-37  see  Yock pp.  520-521. Chiari  I  malformations  consist of inferior displacement  of  the  cerebellar tonsils through  the  foramen magnum.
They usually occur in early adulthood. In  Chiari  I1  malformations, the  caudal displacement  of the  hindbrain is more severe, with beaking of the  tectum and medullary kinking  often  seen.  Myelomeningoceles are  virtually  always present. Chiari  I1  malformations usually present in infancy. Chiari I11  malfor-mations display the  most severe  displacement  of posterior  fossa  structures and  are  often associated  with a high cervical or occipital meningocele.

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34.  A meningomyelocoele is virtually always present.

A.  Chiari l  malformation
B.  Chiari 11  malformation
C.  both
D.  neither

B. Chiari 11  malformation

For  questions 32-37  see  Yock pp.  520-521. Chiari  I  malformations  consist of inferior displacement  of  the  cerebellar tonsils through  the  foramen magnum.
They usually occur in early adulthood. In  Chiari  I1  malformations, the  caudal displacement  of the  hindbrain is more severe, with beaking of the  tectum and medullary kinking  often  seen.  Myelomeningoceles are  virtually  always present. Chiari  I1  malformations usually present in infancy. Chiari I11  malfor-mations display the  most severe  displacement  of posterior  fossa  structures and  are  often associated  with a high cervical or occipital meningocele.

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35.  Medullary kinking is  seen.

A.  Chiari l  malformation
B.  Chiari 11  malformation
C.  both
D.  neitherB

B. Chiari 11  malformation

For  questions 32-37  see  Yock pp.  520-521. Chiari  I  malformations  consist of inferior displacement  of  the  cerebellar tonsils through  the  foramen magnum.
They usually occur in early adulthood. In  Chiari  I1  malformations, the  caudal displacement  of the  hindbrain is more severe, with beaking of the  tectum and medullary kinking  often  seen.  Myelomeningoceles are  virtually  always present. Chiari  I1  malformations usually present in infancy. Chiari I11  malfor-mations display the  most severe  displacement  of posterior  fossa  structures and  are  often associated  with a high cervical or occipital meningocele.

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36.  Occipital  or high cervical encephalocele is present.

A.  Chiari l  malformation
B.  Chiari 11  malformation
C.  both
D.  neither

D.  neither

For  questions 32-37  see  Yock pp.  520-521. Chiari  I  malformations  consist of inferior displacement  of  the  cerebellar tonsils through  the  foramen magnum.
They usually occur in early adulthood. In  Chiari  I1  malformations, the  caudal displacement  of the  hindbrain is more severe, with beaking of the  tectum and medullary kinking  often  seen.  Myelomeningoceles are  virtually  always present. Chiari  I1  malformations usually present in infancy. Chiari I11  malfor-mations display the  most severe  displacement  of posterior  fossa  structures and  are  often associated  with a high cervical or occipital meningocele.

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37.  usually presents in  young  adulthood

A.  Chiari l  malformation
B.  Chiari 11  malformation
C.  both
D.  neitherA

A. Chiari l  malformation

For  questions 32-37  see  Yock pp.  520-521. Chiari  I  malformations  consist of inferior displacement  of  the  cerebellar tonsils through  the  foramen magnum.
They usually occur in early adulthood. In  Chiari  I1  malformations, the  caudal displacement  of the  hindbrain is more severe, with beaking of the  tectum and medullary kinking  often  seen.  Myelomeningoceles are  virtually  always present. Chiari  I1  malformations usually present in infancy. Chiari I11  malfor-mations display the  most severe  displacement  of posterior  fossa  structures and  are  often associated  with a high cervical or occipital meningocele.

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38.  The  term bovine  arch  refers  to


A.  bi-innominate  arteries
B.  left  common  carotid artery  origin from  the  aortic arch
C.  left  common  carotid artery  origin from  the  right brachiocephalic  trunk
D.  right aortic  arch
E.  right subclavian  artery  distal to the  left subclavian artery

C. left  common  carotid artery  origin from  the  right brachiocephalic  trunk

Morris  pp.  99-101. The  left  common  carotid  artery  usually arises  from the aortic  arch distal to the  right brachiocephalic artery. In  the  bovine arch variant,
the  left common carotid  artery  arises from  the  proximal right brachiocephalic artery.  Variant A is rare. A right  aortic arch  may be  incidental or associated with congenital heart disease. Variant E  is associated with Down syndrome.

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39.  The  differential diagnosis  of  colpocephaly,  or dilatation of  the  posterior  portion of  the  lateral ventricles, includes
I.  agenesis  of  the  corpus callosum
II.  Leigh's  disease
III.  periventricular leukomalacia
IV.  Hallervorden-Spatz disease
A.  I,  II. Ill
B.  I,  III
C.  II,  IV
D.  IV
E.  all of  the  above

B. I.  agenesis  of  the  corpus callosum, 

III.  periventricular leukomalacia

Yock pp. 367.525.  Agenesis  of  the  corpus  callosum and periventricular  leuko- malacia can  both  result  in  colpocephaly.  Leigh's  disease and  Hallervorden-
Spatz disease can both cause symmetric  lesions of the  globus  pallidus but are not  associated with colpocephaly.

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40.  Schizencephaly is essentially a


A.  demyelinating illness
B.  disease that  first develops in  the  elderly
C.  disorder  of  neuronal migration
D.  neurodegenerative  disorder
E.  psychiatric  disorder

C. disorder  of  neuronal migration

Yock pp.  540-522.  The cleft  of  schizoencephaly can  be unilateral or bilateral, but  it  usually involves  the  region  near the  central sulcus. Patients can  present with seizures or focal deficits.

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41.  The  differential diagnosis  of  optic nerve thickening includes
I.  optic nerve sheath  meningioma
II.  orbit4 pseudotumor
III.  optic nerve glioma
IV.  Graves' disease
A.  I,  II,III
B.  I,  III
C.  II. IV
D.  IV
E.  all of the  above

E.

I.  optic nerve sheath  meningioma

II.  orbit4 pseudotumor

III.  optic nerve glioma

IV.  Graves' disease

Yock  p.  305. Optic nerve thickening  may  be caused by nonneoplastic processes like Graves'  disease, orbital pseudotumor,  optic neuritis, papilledema, and vas-cular  malformations,  or by tumors like gliomas, meningiomas,  lymphomas, leukemia, and  metastases.

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42.  The  most common primary benign tumor  of the  adult orbit is


A.  cavernous hemangioma
B.  dermoid  cyst
C.  lymphangioma
D.  optic nerve glioma
E.  sarcoidosis

A. cavernous hemangioma

Y  p.  1373. Cavernous hemangiomas of  the  orbit are  usually well  demarcated, vascular, intraconal lesions with smooth or lobulated borders.

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43.  Which of the  following is a branch  of the  ophthalmic  artery?

A.  anterior ethmoidal  artery
B.  posterior ethmoidal artery
C.  both
D.  neither

C.  both

Morris pp. 135-137.  The  ethmoidal arteries  are  branches  of  the  ophthalmic artery.  They supply  a  portion  of  the  anterior  cranial  fossa and  the  mucosa
of the  nasal septum.  During embolization  of  the  internal  maxillary  artery, dangerous  potential anastomoses  from the  sphenopalatine  branches  of  the internal  maxillary to branches  of  the  ophthalmic  artery.

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44.  Which  of  the  following set  of  findings  on  a  lumbar  MRI  scan  performed immediately  after contrast  injection  is  most characteristic  of  a  recurrent  disk herniation and epidural fibrosis, respectively?


A.  a rim of enhancement  in the  recurrent  disk, diffuse enhancement  in the  fibrosis
B.  a rim of  enhancement  in the  fibrosis,  diffuse enhancement  in the  recurrent disk
C a rim of enhancement  in the  recurrent  disk, no enhancement  in the  fibrosis
D.  diffuse enhancement  in the  recurrent  disk, no enhancement  in the  fibrosis
E.  no enhancement  of  either  the  recurrent  disk  or fibrosis

A. a rim of enhancement  in the  recurrent  disk, diffuse enhancement  in the  fibrosis

Yock pp.  582-583.  Scar  tissue  contains  vascular  granulation  tissue  that enhances more diffusely  than a residual or recurrent  disk.

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45.  Lesions in diffuse axonal  injury  are commonly found in the
I.  corpus callosum
II.  gray-white junction
III.  rostra1  brainstem
IV.  temporal lobe
A.  I,  II,III
B.  I.  III
C.  II,  IV
D.  IV
E.  all of  the  above

A.

I.  corpus callosum
II.  gray-white junction
III.  rostra1  brainstem

GIT p.  1426.

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46.  Acute subarachnoid  hemorrhage is  more difficult to diagnose  on MRI  than on computed tomography (m)  because


A.  Extracellular methemoglobin  is  isointense  on TI and  R.
B.  Hemosiderin is isointense  on TI and  T2.
C.  Most radiologists  are  not  familiar with the  appearance  of  acute subarachnoid  hemorrhage on MRI.
D.  The  high oxygen tension in the  subarachnoid  space prevents conversion  of oxyhemoglobin to deoxyhemoglobin.
E.  The  low  oxygen tension in  the  subarachnoid  space prevents conversion  of deoxyhemoglobin to oxyhemoglobin.

D.  The  high oxygen tension in the  subarachnoid  space prevents conversion  of oxyhemoglobin to deoxyhemoglobin.

GlT pp.  1437-1438.

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47.  Which of  the  following is  true  of the  choroidal blush?


A.  It  is  an indicator  of  the  choroidal plexus in  the  lateral ventricle.
B.  It  is  best seen  on the  anteroposterior projection.
C.  It  is  from the  posterior  ethmoidal branches  of  the  ophthalmic  artery.
D.  Its configuration is usually a thin, dense  crescent.
E.  Its presence usually indicates  an elevated intraocular  pressure.

D.  Its configuration is usually a thin, dense  crescent.

Morris  p.  137.  The choroidal blush  signifies the  choroidal  plexus of the  eye and is supplied by the  ciliary branches  of  the  ophthalmic  artery.  It  is charac-
teristically  seen as a  thin  crescent  on the  lateral  projection  of  the  internal carotid angiogram.  Its absence can be an indirect sign of  elevated intraorbital
or intraocular  pressure.

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48.  The  most likely  etiology  of this neonate's pathology is

A.  astrocytoma
B.  metastatic tumor
C.  Staphylococcus aureus
D.  Citrobacter

D. Citrobacter

CNBR Fig.  3-24A,  p.  177.  Large neonatal  brain abscesses are  usually caused by Citrobacter, Bacteroides, hoteus, and  various gram-negative bacilli.

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49.  identify the  lesions.

A  eosinophilic granuloma
B.  epidermoid cyst
C.  fibrous dysplasia
D.  hemangioma
E.  multiple myeloma
F.  osteoma

C.  fibrous dysplasia

Burg 3  Fig.  1.1, p.  2.  (Courtesy of  Dr. John A.  Goree, Durham, NC.)  Note involve-
ment of  the  left  facial  bones.

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50. identify the  lesions.

A  eosinophilic granuloma
B.  epidermoid cyst
C.  fibrous dysplasia
D.  hemangioma
E.  multiple myeloma
F.  osteoma

A  eosinophilic granuloma

Burg Fig.  1.12,  p.  5.  (Courtesy of  Dr. John A.  Goree,  Durham,  NC.)  A discrete radiolucent area is seen.