chapter 6 neurosurgery Flashcards
(35 cards)
QUESTIONS 62-69
Directions: Match each of the following questions with the most likely fracture pattern (letterhead) depicted in Figure 6.62-6.69Q, using each answer once, more than once, or not at all.
- Median nerve damage, paralysis of hypothenar muscles, some thenar muscles, and most of the deep muscles of the hand; flexion and adduction of wrist spared
C
QUESTIONS 62-69
Directions: Match each of the following questions with the most likely fracture pattern (letterhead) depicted in Figure 6.62-6.69Q, using each answer once, more than once, or not at all.
- Can be associated with brachial plexus injuries
A
QUESTIONS 62-69
Directions: Match each of the following questions with the most likely fracture pattern (letterhead) depicted in Figure 6.62-6.69Q, using each answer once, more than once, or not at all.
- Most likely to cause combined radial, medial, and ulnar nerve injuries
C
- A 9-year-old girl presented to her pediatrician with headaches and a bitemporal field cut. Her MRI is depicted below (Figure 6.70Q). Which of the following would be true regarding the endocrine outcome after surgical resection of this tumor?
A. There is a 30% chance that she will develop diabetes insipidus
B. The most serious and disabling problem is the development of obesity, which occurs in about 50% of these patients after surgery
C. Approximately 90% of patients will not require maintenance corticosteroid and thyroid replacement
therapy
D. Approximately 10% of patients will require growth
hormone replacement therapy
E. The endocrine outcome after surgery is very
unpredictable
- A 42-year-old female was recently diagnosed with spontaneous intracranial hypotension. All of the following are frequently associated with this problem EXCEPT?
A. The headaches often resemble a post-lumbar puncture headache
B. MRI scans with contrast may reveal enhancement of
the dura over the cerebral and cerebellar convexities
C. Spontaneous improvement is rarely seen, since CSF
leaks are often identified adjacent to nerve roots
D. Spinal fluid may reveal elevated protein and pleocytosis
E. Analgesics containing caffeine may be helpful
A. The headaches often resemble a post-lumbar puncture headache
- All of the following lesions are appropriate for stereotactic radiosurgery EXCEPT?
A. A 3-cm3 arteriovenous malformation in the brainstem
B. A 1-cm right frontal and 2-cm left parietal metastatic
carcinoma from the lung
C. Recurrent glioblastoma of the left temporal lobe (2 cm3)
D. A 1-cm cavernoma of the right caudate nucleus that
previously hemorrhaged
E. Bilateral thalamic arteriovenous malformations (3 cm3)
D. A 1-cm cavernoma of the right caudate nucleus that
previously hemorrhaged
- All of the following would reduce pain conduction or a
patient’s reaction to pain EXCEPT?
A. Stimulation of the periaqueductal gray
B. Prefrontal lobotomy
C. Cingulotomy
D. Hippocampectomy
E. Ventrolateral cordotomy
B. Prefrontal lobotomy
- A 34-year-old female is involved in a motor vehicle collision, suffers a severe closed head injury (Figure 6.74QJ, and develops a significant posttraumatic tremor in the right arm. Although posttraumatic tremors are generally difficult to manage, which surgical procedure may help control tremors, which are otherwise refractory to medical therapy?
A. Thalamic stimulation
B. Subthalamic nucleus stimulation
C. Motor cortex stimulation
D. Capsulotomy
E. Multiple subpial transections
C. Motor cortex stimulation
- A 36-year-old female has a complex aneurysm that
requires the use of cardiac arrest and profound hypothermia during surgery. All of the following are potential physiologic effects of profound hypothermia EXCEPT?
A. Increased blood viscosity
B. Hyperglycemia
C. Decreased corticosteroid release
D. Complement-mediated pneumonitis
E. Hypercoagulable state
D. Complement-mediated pneumonitis
- What is the most common physical manifestation of the abnormality depicted by the angiogram below (Figure 6.76QJ?
A. Neck pain
B. Cervical bruit
C. Contralateral arm weakness or numbness
D. Dysesthesia
E. Transient vision loss
D. Dysesthesia
- Refer to Figure 6.77-6.79Q, What is the most likely diagnosis?
A. Echinococcus infection
B. Neurocysticercosis
C. Cryptococcus infection
D. Cytomegalovirus infection
E. Trichinosis
A. Echinococcus infection
- This patient is most likely to present with?
A. Headaches
B. Obtundation
C. Cranial nerve palsies
D. Fevers
E. Seizure
E. Seizure
- This disorder is caused by
A. Borrelia burgdorferi
B. Echinococcus granulosa
C. Toxoplasma gondii
D. Treponema pallidum
E. Taenia solium
B. Echinococcus granulosa
- What is the most likely diagnosis depicted by the angiogram below (Figure 6.80Q)?
A. Blue rubber bleb nevus syndrome
B. Vein of Galen aneurysm
C. Carotid-cavernous fistula
D. Intracranial hemangioblastoma of infancy
E. Sinus pericranii
B. Vein of Galen aneurysm
- The posterior interosseous nerve supplies all of the
following muscles EXCEPT?
A. Supinator
B. Extensor carpi ulnaris
C. Abductor pollicis longus
D. Extensor digitorum
E. Pronator quadratus
E. Pronator quadratus
- The ability to create irregularly shaped radiosurgical
volumes is important to achieve conformal irradiation of
target tissue. Which of the following techniques can be
employed to create such plans?
A. Combine multiple isocenters of irradiation in different
planes
B. Individual isocenters can be weighted variably to
change their relative shape
C. Individual radiation beams can be blocked to restrict
dose away from critical structures, such as the optic
chiasm
D. A and B only
E. All of the above
E. All of the above
- A 45-year-old female undergoes a C5-6 and C6-7 anterior cervical discectomy and fusion. Postoperatively, she awakens with a Horner’s syndrome. The most likely etiology of this finding was related to damage of what structure(s)?
A. Sympathetic nerves running along the carotid artery
during neck dissection
B. Injury of the Tl nerve root during the discectomy
C. Interruption of the sympathetic chain located on the
anterior surface of the longus colli muscles
D. Spinal cord injury during surgery
E. A small hypothalamic infarct during surgery
B. Injury of the Tl nerve root during the discectomy
- A left-sided approach decreases the risk of recurrent
laryngeal nerve palsy during anterior cervical procedures,
but at lower levels in the neck a left-sided approach runs therisk of injuring what structure?
A. Inferior laryngeal nerve
B. Thyrocervical artery
C. Thoracic duct
D. C5 nerve root
E. Dominant cardiac accelerator nerves
- Degenerative spondylolisthesis is most common at what level in the lumbar spine?
A. Ll-2
B. L2-3
C. L3-4
D. L4-5
E. L5-S1
E. L5-S1
- A 72-year-old female with rheumatoid arthritis is found to have a reducible atlantoaxial dislocation after 36 hours of cervical traction. There is minimal ventral compression from pannus formation, no cranial settling, and no foramen magnum stenosis noted on MR scan. What is the best treatment strategy for this patient?
A. Transarticular screw fixation and fusion if the lateral
atlantal masses are intact with good-quality bone
B. Transoral odontectomy followed by posterior occipital-
cervical decompression and fusion
C. Laminectomy
D. Transoral odontectomy followed by observation
E. Halo placement
E. Halo placement
- The ideal bone graft provides all of the following ele-
ments for successful healing EXCEPT?
A. Osteoconductive matrix
B. Osteoinductive factors
C. To support viable osteogenic cells
D. Structural support
C. To support viable osteogenic cells
- Interfering with uptake of which ion into cells during
severe closed head injury has resulted in a significant clinical benefit?
A. Ga2*
B. Na*
c. cr
D. K*
E. None of the above
c. cr
- Surgical therapies used for dystonia have traditionally
included all of the following EXCEPT?
A. Peripheral denervation
B. Pallidotomy
C. Thalamotomy
D. Dorsal column stimulation
E. Motor cortex stimulation
D. Dorsal column stimulation
- All of the following surgical procedures have been
employed to treat neuropsychiatric illness and behavioral
disorders EXCEPT?
A. Arcuate fasciculotomy
B. Subcaudate tractotomy
C. Limbic leukotomy
D. Anterior capsulotomy
E. Anterior cingulotomy
A. Arcuate fasciculotomy
