INBR 7 - Multidicipline Self Assesment Examination Flashcards Preview

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1

1.Ciri klinis penyakit BROWN-SEQUARD meliputi hal di bawah ini, KECUALI

A. Hilangnya rasa nyeri kontralateral dan sensasi suhu mulai satu atau dua segmen tulang di bawah lesi

B. Hilangnya propriosepsi secara ipsilateral dan sensasi getar di bawah level benjolan

C. Sindroma HORNER secara ipsilateral jika lesi di servical

D. Hilangnya sensasi peraba kasar secara ipsilateral di bawah level lesi

E. Hilangnya keringat secara ipsilateral di bawah level lesi

D. (DeMyer, p. 137; Greenberg, p. 700; Youmans, pp. 272, 439 7 , 4872) .

2

2. Apa yang ditunjukkan pada fotomikrograf di bawah ini ?

A. Sel tegak (palisading) di sekeliling daerah nekrosis pada pasien dengan glioblastoma.

B. Perubahan spongiform pada pasien dengan penyakit prion

C. Homer-Wright Rossete pada laki-laki usia 3 tahun dengan Meduloblastoma

D. Infark akut pada pasien dengan epilepsi mioklonik dengan serat-serat merah yang rusak (MERRF)

E. Nekrosis fibrinoid pada pasien dengan Leukoensepalopati hemoragik akut.

A.

Note the "picket fence" arrangement (pseudopalisading) of the nuclei surrounding a region of necrosis in this photomicrograph, which depicts a glioblastoma (Ellison, pp. 628-63 1).

3

3. Uji laboratorium manakah yang paling peka bagi deteksi neuro-sistiserkosis (NCC)?

A. Hitung eosinopil periferal

B. hitung sel darah putih serum lengkap

C. Stool untuk ova dan parasit

D. Enzyme-linked immunosorbent assay (ELISA)

E. Electroimmunotrasfer blot (EITB)

E.

Complete white blood cell count, peripheral eosinophil level, and serum anticysticercal antibody levels should be obtained in all patients suspected of having NCC. Patients requiring ventriculostomy placement should have cerebrospinal fluid (CSF) analyzed for eosinophil and anticysticercal antibody levels. Stool testing for ova and parasites is helpful in patients with simultaneous intestinal tapeworm infection but is insensitive and nonspecific for T. solium species and is found in less than 33% of cases. Several laboratory methods have been developed to detect host antibodies against circulating cysticercal antigens. From the many tests performed, current data indicate that enzyme-linked immunosorbent assay (ELISA) and electroimmunotransfer blot (EITB) tests are the most effective. Studies comparing these diagnostic modalities have shown that the EITB assay is more sensitive overall than ELISA, especially when serum is being tested. Both techniques are more sensitive in cases with multiple cysts than in cases with solitary or confined lesions. Additionally, no global difference among cases was found with parasites located in different compartments (ventricles, subarachnoid space, parenchyma) of the central nervous system (Greenberg, pp. 236-238; Proano-Narvaez et a l . , p. 2 118).

4

4. Degenerasi gabungan subakut dini

E (DeMyer, p. 135; Brazis, pp. 85-95; Merritt, pp. 136-137 , 186, 7 10- 7 13 , 7 15-717) .

5

5. Sringomielia

F

(DeMyer, p. 135; Brazis, pp. 85-95; Merritt, pp. 136-137 , 186, 7 10- 7 13 , 7 15-717) .

6

6. Tabes Dorsalis

D

(DeMyer, p. 135; Brazis, pp. 85-95; Merritt, pp. 136-137 , 186, 7 10- 7 13 , 7 15-717) .

7

7. Poliomielitis     

A (DeMyer, p. 135; Brazis, pp. 85-95; Merritt, pp. 136-137 , 186, 7 10- 7 13 , 7 15-717) .

8

8. Amiotropik lateral sklerosis

C

(DeMyer, p. 135; Brazis, pp. 85-95; Merritt, pp. 136-137 , 186, 7 10- 7 13 , 7 15-717) .

9

9. Paraplegia spastis familial

B

(DeMyer, p. 135; Brazis, pp. 85-95; Merritt, pp. 136-137 , 186, 7 10- 7 13 , 7 15-717) .

10

10. Tumor berikut manakah yang memiliki gambaran histopatologi sebagaimana lesi di bawah ini ?

1. Ependimoma sel bening

2. Neurositoma Central

3. Tumor Neuroepitelial disembrioplastis

4. Meningioma fibrous

A.

The differential diagnosis of oligodendroglia! tumors includes clear cell ependymoma, central neurocytoma, and dysembryoplastic neuroepithelial tumor. All of these entities exhibit the presence of neoplastic cells with a uniform round nucleus and clear cytoplasm. A rare differential diagnosis of oligodendroglioma is clear cell meningioma (not fibrous meningioma), which can be differentiated from oligodendroglioma by abundant diastase-sensitive PAS positivity and immunoreactivity for El\1A. Note the prominent calcification, "chicken wire" capillaries (prominent branching) , "fried egg" cells with round monomorphic nuclei, and perinuclear halos arranged in a back-to-back fashion i n this photomicrograph depicting an oligodendroglioma (Ell ison, pp. 641-644; WHO, p . 59) .

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11. Lapisan dinding abdominal manakah yang paling baik dijahit (daya regang paling kuat) selama penempatan pirau ventrikuloperitoneal?

A. Colles fascia

B. Cruveilhier’s fascia

C. Buck’s fascia

D. Scarpa’s fascia

E. Camper’s fascia

D.

The anterior abdominal wall consists of the epidermis, superficial layer of superficial fascia (of Camper), the deep layer of superficial fascia (of Scarpa) , the deep fascia (investing fascia of musculature ) , the external and internal oblique muscles, the transverse abdominis muscle, transversalis fascia, loose extraperitoneal connective tissue, and peritoneum. Camper's fascia is predominately an adiposelayer that contains most of the fat of the subdermis. It continues over the pubis as the superficial layer (of Cruveilhier) of the superficial perineal fascia, crosses the inguinal ligament to merge with the superficial fascia of the thigh, and continues over the chest as the superficial layer of superficial thoracic fascia. Scarpa's fascia is a fibrous layer that will best hold sutures (highesttensile strength) . It continues over the • pubis as the deep layer of superficial perineal fascia (of Calles) and passes into the upper thigh, where it attaches to - the fascia lata. The deep fascia is the investing fascia of the musculature, aponeuroses, and large neurovascular struc- . tures and is not easily separated from the underlying epimysium of muscle. It extends into the penis as Buck's fascia, continues over the spermatic cord as the external spermatic fascia, and passes over the pubis and perineal musculature as the deep perineal fascia of Gallaudet (April , p. 173).

12

12. Simaklah gambar berikut, apa Diagnosisnya

A. Filum lemak dengan tethered cord

B. Ependimoma Miksopapilaris

C. Saluran sinus dermal

D. Hematoma epidural

E. Tumor dermoid

A.

Note the cord tethering and fatty filum on this sagittal MRI (Ramsey, pp. 104-106) .

13

13. Manakah pernyataan yang benar mengenai lesi yang ditunjukkan pada angiogram di bawah ini ?

A. Risiko tahunan pendarahan adalah sekitar 3%

B. Berasosiasi dengan bruit kranial dan gagal jantung kongestif selama periode neonatal

C. Hilangnya gen penekan tumor pada kromosom 22

D. Lesi ini biasanya ditemukan pada parensima otak normal

E. Mencerminkan adanya varian anatomis ekstrim dari pasokan darah arteri kortikal

D.

This angiogram depicts the classic "caput medusae" pattern of a venous angioma, which is an extreme anatomic variant of medullary (white matter) venous drainage. The precise etiology of this lesion remains unclear, although some authors have proposed that it results from arrested development of parts of the venous vasculature at a time when normal arterial development is nearly complete. This results in the retention of primitive venous channels that typically empty into a single large draining vein (Osborn, pp. 294-295) .

14

14. Struktur manakah di bawah ini yang terhubung dengan stria medularis talamus ?

A. Nucleus basal dan nuklei septal

B. Nuklei septal dan nuklei habenular

C. Nuklei habenular dan korteks okipital

D. Nuklei septal dan nuklei talamik depan

E. Kelenjar pineal dan anterior commissure

B.

The stria medullaris thalami contains projections that originate in the septal nuclei, anterior thalamic nuclei, and hypothalamus (preoptic region) and terminate in the habenular nuclei. The habenular nuclei then project to the raphe nuclei of the midbrain via the fasciculus retroflexus. In this manner, the stria medullaris thalami act as a relay point for limbic system information that is transmitted to the midbrain (Carpenter, p. 252; Martin , p. 4 73).

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15. Sel retina manakah yang berperan mekanisme untuk mediator respons berlawanan dalam kelompok selsel fotoreseptor di sekitarnya, yang telah digunakan untuk menguatkan kontras antar obyek?

A. Sel Fleksiform

B. Amakrin

C. Sel-sel horisontal

D. Ganglion

E. Sel-sel bipolar

C.

Visual information flows vertically from photoreceptor cells (outer nuclear layer) to bipolar cells (inner nuclear layer) to ganglion cells (ganglion cell layer) as well as laterally via horizontal cells (outer plexiform layer) and amacrine cells (inner plexiform layer) . Light produces opposite effects on the rate of bipolar cell firing depending on whether it stimulates the center or surrounding part of the cell's receptive field . Additionally, a lateral network of horizontal cells that directly interconnect neighboring groups of photoreceptor cells helps mediate this antagonist property. Hence, horizontal cells pro,•ide a mechanism for mediating opposite responses in adjacent photoreceptor cells, which is used to enhance luminance contrast. The precise role of amacrine cells remains unclear, although some amacrine cells function like horizontal cells. They mediate antagonistic inputs between bipolar cells and ganglion cells in the inner plexiform layer. Other amacrine cells have been implicated in shaping the complex receptive field properties of various types of ganglion cells, such as M-type cells that process orientation information ( Pritchard , pp. 292-302; Kande l , p . 5 15).

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16. Defisit neurologi manakah yang disebabkan oleh rusaknya daerah EXNER?

A. Alexia

B. Aphasia

C. Agraphia

D. Anosmia

E. Apatis

C.

Exner's area lies superior to Broca's area, in Brodmann's area 8, and if damaged may result in pure agraphia without aphasia (Brazis, pp. 515- 516) .

17

Jodohkanlah struktur-struktur di bawah ini dengan huruf jawaban yang tepat pada CT scan aksial di bawah ini dari tulang Temporal Petrosus kanan

17. Vestibula

F

These three axial CT scans (Figures 8 . 1 7-8.24 Q a, b, c) illustrate critical portions of the petrous temporal bone and progress sequentially in a superior-inferior direction. In these figures, A represents the lateral semicircular canal, B the superior semicircular canal, C the internal auditory canal, D the vestibular aqueduct, E the posterior semicircular canal, F the vestibule, G the facial nerve, H the cochlea, and I the endolymphatic sac. Notice the labyrinthine and anterior tympanic portions of the facial nerve, separated by the geniculate ganglion, in figure B . Figure C depicts the horizontal segment of the facial nerve and the vestibular aqueduct joining the endolymphatic sac at the posterior aspect of the petrous temporal bone (Som, pp. 1319 - 1325) .

18

Jodohkanlah struktur-struktur di bawah ini dengan huruf jawaban yang tepat pada CT scan aksial di bawah ini dari tulang Temporal Petrosus kanan

18. Koklea

H

These three axial CT scans (Figures 8 . 1 7-8.24 Q a, b, c) illustrate critical portions of the petrous temporal bone and progress sequentially in a superior-inferior direction. In these figures, A represents the lateral semicircular canal, B the superior semicircular canal, C the internal auditory canal, D the vestibular aqueduct, E the posterior semicircular canal, F the vestibule, G the facial nerve, H the cochlea, and I the endolymphatic sac. Notice the labyrinthine and anterior tympanic portions of the facial nerve, separated by the geniculate ganglion, in figure B . Figure C depicts the horizontal segment of the facial nerve and the vestibular aqueduct joining the endolymphatic sac at the posterior aspect of the petrous temporal bone (Som, pp. 1319 - 1325) .

19

Jodohkanlah struktur-struktur di bawah ini dengan huruf jawaban yang tepat pada CT scan aksial di bawah ini dari tulang Temporal Petrosus kanan

19. Kanalis semisirkularis posterior

E

These three axial CT scans (Figures 8 . 1 7-8.24 Q a, b, c) illustrate critical portions of the petrous temporal bone and progress sequentially in a superior-inferior direction. In these figures, A represents the lateral semicircular canal, B the superior semicircular canal, C the internal auditory canal, D the vestibular aqueduct, E the posterior semicircular canal, F the vestibule, G the facial nerve, H the cochlea, and I the endolymphatic sac. Notice the labyrinthine and anterior tympanic portions of the facial nerve, separated by the geniculate ganglion, in figure B . Figure C depicts the horizontal segment of the facial nerve and the vestibular aqueduct joining the endolymphatic sac at the posterior aspect of the petrous temporal bone (Som, pp. 1319 - 1325) .

20

Jodohkanlah struktur-struktur di bawah ini dengan huruf jawaban yang tepat pada CT scan aksial di bawah ini dari tulang Temporal Petrosus kanan

20. Kanalis semisirkularis lateral

A

These three axial CT scans (Figures 8 . 1 7-8.24 Q a, b, c) illustrate critical portions of the petrous temporal bone and progress sequentially in a superior-inferior direction. In these figures, A represents the lateral semicircular canal, B the superior semicircular canal, C the internal auditory canal, D the vestibular aqueduct, E the posterior semicircular canal, F the vestibule, G the facial nerve, H the cochlea, and I the endolymphatic sac. Notice the labyrinthine and anterior tympanic portions of the facial nerve, separated by the geniculate ganglion, in figure B . Figure C depicts the horizontal segment of the facial nerve and the vestibular aqueduct joining the endolymphatic sac at the posterior aspect of the petrous temporal bone (Som, pp. 1319 - 1325) .

21

Jodohkanlah struktur-struktur di bawah ini dengan huruf jawaban yang tepat pada CT scan aksial di bawah ini dari tulang Temporal Petrosus kanan

21. Akuaduk vestibular

D

hese three axial CT scans (Figures 8 . 1 7-8.24 Q a, b, c) illustrate critical portions of the petrous temporal bone and progress sequentially in a superior-inferior direction. In these figures, A represents the lateral semicircular canal, B the superior semicircular canal, C the internal auditory canal, D the vestibular aqueduct, E the posterior semicircular canal, F the vestibule, G the facial nerve, H the cochlea, and I the endolymphatic sac. Notice the labyrinthine and anterior tympanic portions of the facial nerve, separated by the geniculate ganglion, in figure B . Figure C depicts the horizontal segment of the facial nerve and the vestibular aqueduct joining the endolymphatic sac at the posterior aspect of the petrous temporal bone (Som, pp. 1319 - 1325) .

22

Jodohkanlah struktur-struktur di bawah ini dengan huruf jawaban yang tepat pada CT scan aksial di bawah ini dari tulang Temporal Petrosus kanan

22. Saraf Fasial

G

These three axial CT scans (Figures 8 . 1 7-8.24 Q a, b, c) illustrate critical portions of the petrous temporal bone and progress sequentially in a superior-inferior direction. In these figures, A represents the lateral semicircular canal, B the superior semicircular canal, C the internal auditory canal, D the vestibular aqueduct, E the posterior semicircular canal, F the vestibule, G the facial nerve, H the cochlea, and I the endolymphatic sac. Notice the labyrinthine and anterior tympanic portions of the facial nerve, separated by the geniculate ganglion, in figure B . Figure C depicts the horizontal segment of the facial nerve and the vestibular aqueduct joining the endolymphatic sac at the posterior aspect of the petrous temporal bone (Som, pp. 1319 - 1325) .

23

Jodohkanlah struktur-struktur di bawah ini dengan huruf jawaban yang tepat pada CT scan aksial di bawah ini dari tulang Temporal Petrosus kanan

23. Kanalis semisirkularis superior

B

These three axial CT scans (Figures 8 . 1 7-8.24 Q a, b, c) illustrate critical portions of the petrous temporal bone and progress sequentially in a superior-inferior direction. In these figures, A represents the lateral semicircular canal, B the superior semicircular canal, C the internal auditory canal, D the vestibular aqueduct, E the posterior semicircular canal, F the vestibule, G the facial nerve, H the cochlea, and I the endolymphatic sac. Notice the labyrinthine and anterior tympanic portions of the facial nerve, separated by the geniculate ganglion, in figure B . Figure C depicts the horizontal segment of the facial nerve and the vestibular aqueduct joining the endolymphatic sac at the posterior aspect of the petrous temporal bone (Som, pp. 1319 - 1325) .

24

Jodohkanlah struktur-struktur di bawah ini dengan huruf jawaban yang tepat pada CT scan aksial di bawah ini dari tulang Temporal Petrosus kanan

24. Duktus endolimpatis

I

These three axial CT scans (Figures 8 . 1 7-8.24 Q a, b, c) illustrate critical portions of the petrous temporal bone and progress sequentially in a superior-inferior direction. In these figures, A represents the lateral semicircular canal, B the superior semicircular canal, C the internal auditory canal, D the vestibular aqueduct, E the posterior semicircular canal, F the vestibule, G the facial nerve, H the cochlea, and I the endolymphatic sac. Notice the labyrinthine and anterior tympanic portions of the facial nerve, separated by the geniculate ganglion, in figure B . Figure C depicts the horizontal segment of the facial nerve and the vestibular aqueduct joining the endolymphatic sac at the posterior aspect of the petrous temporal bone (Som, pp. 1319 - 1325) .

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25. Katup manakah diantara di bawah ini yang merupakan katup pengatur aliran?

A. Katup Orbis-Sigma

B. Katup delta medical PS

C. Katup horisontal-vertikal kordis

D. Katup terprogram Goldman Hakim

E. Katup Holter-Haussner

A.

Some of the valves currently used in clinical practice include the static (Holter-Hausner valve, Denver shunt, Codman Uni-Shunt) and programmable (Codman Medos, Sophy valve) differential pressure valves, flow-regulated valves (Orbis Sigma), and gravity-actuated valves (Cordis horizontal-vertical valve). The PS Medical Delta valve consists of an antisiphoning device just distal to a differential pressure valve. More recently Codman has introduced the Hakim programmable valve with a Siphon-Guard valve, while Medtronic has introduced the Strata valve, a programmable valve with variable pressure settings that can be coupled with their Delta valve antisiphoning device. The valves described above all use different approaches to control flow through the valve system and limit overshunting. Differential pressure valves open when the pressure at the inlet is higher than that the outlet by a preselected amount. Programmable differential pressure valves act in a similar fashion except that the surgeon can change the opening pressure with an external device, which often obviates the need for surgical shunt revision. Flow-regulated valves use a three-stage resistance mechanism to keep the flow rate through the valve constant. Gravity-actuated valves attempt to decrease siphoning by increasing opening pressure with the assistance of gravity when a patient sits or stands. Cordis horizontal-vertical valves are gravity-actuated valves that have traditionally been used with lumboperitoneal shunts (Youmans, pp. 33 76-3379; Albright, pp. 79-80; Wi lkins, pp. 3647-3651; American Society of Pediatric Neu rosurgeons, p p . 506-508; Committee on Education i n Neurological Surgery, pp. 137-138) .

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26. Simaklah di bawah ini. Apa Diagnosisnya?

A. Porensepali

B. Displasia kortikal

C. Skizensepali bibir terbuka (open lip)

D. Kiste araknoid

E. Skizensepali bibir terbuka

C

The process of celltilar migration typically occurs between the second and fifth gestational months . Faulty cellular migration can result in heterotopias, callosal agenesis, lissencephaly, pachygyria/polymicrog\Tia, and openor closed-lip schizencephaly. Note the prominent cleft (open-lip) that is lined entirely by gray matter on this sagittal MRI. Porencephalic clefts are predominately lined by gliotic white matter (Osborne DN, pp. 5 2 - 55 ) .

27

27. Kelainan ini diyakini disebabkan oleh gangguan tahap embriologis yang mana?

A. Neurulasi primer

B. Neurulasi sekunder

C. Disjungsi

D. Migrasi sel

E. Mielinasi

D

The process of celltilar migration typically occurs between the second and fifth gestational months . Faulty cellular migration can result in heterotopias, callosal agenesis, lissencephaly, pachygyria/polymicrog\Tia, and openor closed-lip schizencephaly. Note the prominent cleft (open-lip) that is lined entirely by gray matter on this sagittal MRI. Porencephalic clefts are predominately lined by gliotic white matter (Osborne DN, pp. 5 2 - 55 ) .

28

28. Semua hal di bawah ini berasal dari sebuah prekursor yang sama, KECUALI

A. ACTH

B. Hormon perangsang melanosit

C. Lipotropin Beta

D. Endorpin Beta

E. Leusin-enkepalin

E.

Proopiomelanocortin (PO.MC) gives rise to betalipotropin and ACTH. The sequences of beta-endorphin and melanocyte-stimulating hormone are contained in beta-lipotropin ( Kandel, p. 487).

29

29. Ny. X, 62 tahun menjalani reseksi transpenoidal tanpa komplikasi atas makroadronema pituitaris dan sedang mengalami pemulihan di UPI. Pasca-bedah, dia merasa semakin merasa haus, mual, output urine naik (>300 ml/3 jam), hipernatremia (149 mEq/L) dan osmolaritas serum sebesar 323 mEq/L. Pada titik ini, perawatan optimal untuk pasien ini seharusnya mencakup…

A. Fludrokortison asetat

B. Urea

C. Desmopressin astetat (DDAVP) oral

D. Vasopresin arginin (aqueous Pitressin) secara intravena

E. Pitressin pada minyak tonik dari suspensi secara intramuscular

D.

This patient has developed diabetes insipidus (DI). Criteria frequently used to make the diagnosis include: urine osmolarity 50 to 150 mOsm/L, specific gravity 1.001 to 1 .005, urine output :2 250 to 300 cc/hr for 3 consecutive hours, and progressively increasing Na• levels on serial lab draws. This patient should receive aqueous vasopressin (Pitressin) (IVP/IM/SQ), as the lipid-soluble form is poorly absorbed compared to the aqueous form. This patient would likely not tolerate oral DDA VP due to her nausea, and a n asogastric tube is generally contraindicated after a transsphenoidal operation. Fludrocortisone acetate acts directly on the renal tubules to increase sodium absorption. This medication, along with urea, would be more applicable for patients with cerebral salt wasting or SIADH. Complications with fludrocortisone acetate include pulmonary edema, hypokalemia, and hypertension (Greenberg, p p . 20-23; Committee on Education i n Neurological Surgery, p . 99) .

30

30. Apa yang ditunjukan pada EEG di bawah ini

A. Kejang-kejang absen

B. Left temporal lobe spike-and-wave discharge

C. Irama alpha

D. Irama tetap

E. K kompleks

C.

This EEG depicts normal posterior dominant rhythm ("alpha rhythm") in a healthy adult man, maximal in the posterior head regions when the eyes are closed ( Rowa n , pp. 2 5 - 26).