Soal Ujian Flashcards
(99 cards)
1
Q
Each of the following is true regarding cerebrospinal fluid (CSF), EXCEPT :
A. 70% of CSF is secreted by the choroids plexus
B. Net production of CSF (in man) is 0,35/min
C. Volatile anesthetic agents and CO2 decrease CSF formation
D. The exit of the CSF via the arachnoid villi is pressure dependent
E. The choroid plexus regulates the production and composition of the CSF
A
C. volatile decrease CSF
2
Q
Cholesterol granulomas have WHICH of the following features on T1-weighted MRI studies? A. T1 : Hyperintense, T2 : Hyperintense B. T1 : Hypointense, T2 : Hyperintense C. T1 : Hyperintense, T2 : Hypointense D. T1 : Hypointense, T2 : Hypointense E. T1 : Hypointense, T2 : Isointense
A
A. T1 : Hyperintense, T2 : Hyperintense
3
Q
Increased signal within hemorrhage on a T1-weighted MRI is MOST LIKELY due to : A. oxyhemoglobin within the hemorrhage B. deoxyhemoglobin within the hemorrhage C. methemoglobin D. hemosiderin and ferritin E. hemosiderin only
A
C. methemoglobin
4
Q
6 month years old baby boy with congenital hydrocephalus already been shunting (VP shunt), 6 days ago, got fver and leukocytosis. If thi is caused by shunt infection, what is the most possibility causes A. Coagulase-positive staphylocci B. H. Influenza C. Coagulase-negative staphylococci D. Strep Pneumoniae E. Klebsiella pneumoniae
A
C. Coagulase-negative staphylococci
5
Q
A 63 year old right-handed male present with a three-year history of clumpsy gait. He was diagnosed one year ago with cervical spondylitic myelopathy and underwent a C5-7 posterior cervical decompressive laminectomy. He did well initially, but in the past view month his gait has worsened and he now complains of clumsiness of his hands. He denies any sensory deficits or incontinence. On examination, he has marked lower-extremity spasticity and weakness of hand graps billaterally with early atrophy of interossei. A lateral cervical spine x-ray demonstrates the laminectomy defect with no evidence of subluxatio. Which of the following would be least helpful in determining a diagnosis A. detailed sensory examination B. Oblique view of the cervical spine to assess foraminal narowing C. Electromyography/nerve conduction velocity studies of the upper and lower extremities D. Urodynamic studies and assesment of sphincter tone E. Examination f the tongue
A
B. Oblique view of the cervical spine to assess foraminal narowing
6
Q
A 75 year old epileptic male with bitemporal hemianopsia is referred for transsphenoidalresectionof a nonfunctioning pituitary macroadenoma. His only medication is Dilantin for seizure control in neurosurgical departement Hasan Sadikin Hospital. He has mild cirrhosis secondary to chronic alcoholism. Endocrine tests reveal that he is hypothyroid with corticotropin deficiency. MRI showed that the tumor already grow into the anterior recess of 3rd ventricle and already down and localized perforation of sellar floor. Accoring to MODIFIED HARDY SYSTEM CLASSIFICATIN, how about the tumor condition? A. Extension grade A, Invasion grade II B. Extension grade D, Invasion grade IV C. Extension grade C, Invasion grade III D. Extension grade C, Invasiongrade IV E. Extension grade B, Invasion grade III
A
E. Extension grade B, Invasion grade III
7
Q
Neurotransmitter mana yang paling banyak ditemukan di thalamus?
A. Glutamate
B. Aspartate
C. GABA
D. Acetylcholine
E. Substance P
A
C. GABA
8
Q
Halothane effect in neuroanesthesia, except A. Increases CBF B. Decreases CBV C. Decreases CSF absorption D. Affects EEG E. Produces isoelectric EEG at 4,5% concentration
A
B. Decreases CBV
9
Q
Enflurane effect, EXCEPT A. Poor agent for neuroanesthesia B. Lowers seizure treshold C. CSF production decreases D. Increase ICP E.Can cause acute renal failur
A
C. CSF production decreases
10
Q
Fentanyl effect in neurosurgery, except A. Crosses BBB B. Reduces CMR 2 C. Reduces CBV D. Increases ICP E. less potent than sufentanil
A
D. Increases ICP
11
Q
Neurogenic pulmonary oedema, except A. Rare condition B. Seizures can presents C. Sudden increase of ICP D. Sympathetic discharge causing redistribution of blood E.Decrease permeability of endotellium lead to oedema
A
E.Decrease permeability of endotellium lead to oedema
12
Q
Under normal condition, adrenal cortex secretes …. Mg/day hydrocortisone and …. Mg/day corticosterone A. 15-25 and 1-5 B. 12-30 and 2-6 C. 15-25 and 1,5-4 D. 14-23 and 2-4 E. 13-27 and 2-5
A
C. 15-25 and 1,5-4
13
Q
Clinical correlates of serum osmolarity can make risk of renal failre if, value is more than …. And produces stupor if value more than … A. 295 and 321 B. 321 and 400 C. 320 and 360 D. 320 and 384 E. 321 and 400
A
D. 320 and 384
14
Q
Central pontine myelinolisis, except : A. Caused by excessively very slow correction of hyponatremia B. Producing insidious spastic quadriplegia C. Can causemental status change D. Can cause cranial nerve abnormalities E. Can cause hepatic enchephalopaty
A
B. Producing insidious spastic quadriplegia
15
Q
SIADH,except : A. Release of ADH in the absent of physiologic stimuli B. related with Schwartz-Bartter syndrome C. Can related with bronchogenic cancer D. Can occur in euvolemia E. Sometimes occur secondary to anemia
A
d. can occur in euvolemia
16
Q
CSW, except : A. Renal loss of sodium B. Always also hypovolemia in CSW C. Fluid restriction many exacerbate vasospasm D. Haematocrytes increases E. Seizures sometimes present
A
B. Always also hypovolemia in CSW
17
Q
Diabetes insipidus, EXCEPT A. due to low level of ADH B. high output of dilute urine C. often accompanied by craving for water D. if caused by nephrophaty called Sjorgen syndrome E. Can cause hypocalcemia
A
E. Can cause hypocalcemia
18
Q
Recommended transfusion of platelets in spontaneous intracranialhaemorhages, EXCEPT A. thrombocytopenia less than
A
B. PC less than 20 K even if no bleeding
19
Q
For headache therapy, this true about acetaminophen,except A. infant 10-15 mg/kg PO q 4-6 hours B. adult dose don’t exceed 4000 mg/day C. hepatic toxicity can present D. cytochrome p-450 increase toxicity E. ceiling effect sometimes appear
A
E. ceiling effect sometimes appear
20
Q
Analgesics for mild-moderate pain, except A. codeine B. propoxyphene C. pentazocine D. hydrocodone E. tramadol
A
D. hydrocodone
21
Q
Antispasmodics effect for neurosurgery patient, except : A. cyclobenzaprine B. methocarbamol C. diazepam D. carisoprodol E. oxazepam
A
E. oxazepam
22
Q
True about midazolam, Except A. 4x potent than diazepam B. dissolve in aqueous solution C. amnestic effect not as stong as valium D. do not exceed 2,5 mg with initial dose E. Lipid soluble
A
C. amnestic effect not as strong as valium
23
Q
Dementia, Except A. loss of memory B. loss of judgement C. affect 5-15% of community dwelling adults D. risk factor apolipoprotein E-4 alele E. memory eficit is the cardinal feature
A
C. affect 5-15% of community dwelling adults
24
Q
About migrane is true, EXCEPT A. classic type may have headache B. classic type resolve completely inless than 24 hour C. cluster type happened more in male with 7:1 ratio D. basilar artery type can present with scotomata E. Hemiplegic type : hemiplegic may persist even after headache resolve
A
C. cluster type more in male with 7:1 ratio
25
This statement correct about Multiple sclerosis, Except : A. demyelinating disease B. affect white matter only C. Corticospinal tracts and posterior columns involved D. usual age of onset 16-59 years old E. deficits present \> 6 months usually persist
D. age of onset 16-59 years old
26
Amyotrophic lateral sclerosis, Except A. also known as Lou Gehrigs disease B. etiology is still not known C. true upper motor neuron disease D. onset usually after 40 years of age E. tongue atrophy may occur
C. true upper motor neuron disease
27
You are asked to evaluate a patient in the neurology clinic. Your neurological examination reveals the following symptoms: (1) loss of pain and temperature sensation over the left side of the face (2) loss of pain and temperature sensation in the right arm and leg (3) normal tactile and vibratory sensations on the face, body and extremities. Where is the lesion? A. mesencephalon at the level of the inferior colliculus B. spinal cord at the cervical enlargement C. dorsolateral medulla D. posterior limb of the internal capsule E. diencephalons at the level of the massa intermedia
C. dorsolateral medulla
28
All of the following muscles are innervated by the mandibular division of the trigeminal nerve EXCEPT the A. lateral pterygoid B. masseter C. buccinator D. anterior belly of the diagnostic E. temporalis
C. buccinator
29
The facial nerve provides the parasympathetic innervation for all of the following glands EXCEPT the A. Lacrimal B. Submandibular C. Parotid D. Nasal E. Palatine
C. Parotid
30
symptoms of cerebellar disease EXCEPT A. resting tremor B. wide-based stance or staggering gait C. hypometria D. kinetic tremor E. dysdiadochokinesia
A. resting tremor
31
Charasteritic signs and symptoms that indicate damage to the corticospinal system include all of the following EXCEPT A. spasticity b. the Babinski sign c. loss of deep tendon reflexes d. immediate muscle degeneration and atrophy e. hypertonia
b. Babinski sign
32
Axon that originate from neurons in the globus pallidus pars interna A. lateral spinothalamic tract B. ansa lenticularis C. spinal trigeminal tract D. dorsal spinocerebellar tract E. anencephaly F. meningomyelocele
B. ansa lenticularis
33
Carries pain sensation from the teeth A. lateral spinothalamic tract B. ansa lenticularis C. spinal trigeminal tract D. dorsal spinocerebellar tract E. anencephaly F. meningomyelocele
C. spinal trigeminal tract
34
Failure of the anterior neuropore to close A. lateral spinothalamic tract B. ansa lenticularis C. spinal trigeminal tract D. dorsal spinocerebellar tract E. anencephaly F. meningomyelocele
E. anencephaly
35
Axon that originate from cells in the nucleus dorsalis of clarke A. lateral spinothalamic tract B. ansa lenticularis C. spinal trigeminal tract D. dorsal spinocerebellar tract E. anencephaly F. meningomyelocele
D. dorsal spinocerebellar tract
36
Tremor by a cerebellar lesion is differentiated from that caused by loss of the dopaminergic nigrostriatal tracts in that A. it it present at rest B. it is decreased during activity C. it only occurs during voluntary movements D. its frequency is very regular E. its amplitude remains constant during voluntary movements
C. it only occurs during voluntary movements
37
You see a patient with damage to the left cervical sympathetic chain ganglia as results of a neck tumor. Which of the following physical signs would be expected? A. ptosis (hanging of the upper eye lid) on the left B. pupil dilatation of the left eye C. lateral deviation of the left eye D. pale skin on the left side of the face E. increased sweat secretion on the left side of the face
D. pale skin on the left side of the face
38
All of the following are specific functions of the parasympathetic nerves EXCEPT A. increased gastrointestinal motility B. decreased gastrointestinal sphincter tone C. penile erection D. semen ejaculation E. emptying uf urinary bladder and rectum
D. semen ejaculation
39
A chronic demyelinating neurologic disorder of young adults that is characterized by plaques within the central nervous system and cerebrospinal fluid oligoclonal immunoglobulin is A. multiple sclerosis B. Huntington disease C. pemphigus vulgaris D. amyotrophic lateral sclerosis E. spinocerebellar degeneration
A. multiple sclerosis
40
The neurotoxic actions of botulinum toxin are associated with A. nicotinic receptor depolarization blockade B. blockade of somatic nerve transmitter exocytosis C. inhibition of smooth muscle myosin light-chain kinase D. irreversible inhibition of cholinesterase E. reversal by infusion of heroic doses of choline
B. blockade of somatic nerve transmitter exocytosis
41
A patient has started taking a medication and now complains about dizziness to the point of almost fainting upon standing up rapidly. This complaint is frequently encountered with therapy using A. diazepam B. chlorpromazine C. meprobamate D. fluoxetine E. chlordiazepoxide
B. chlorpromazine
42
An early sign of phenytoin intoxication following oral dosing is A. nystagmus B. hyperexcitability C. loss of seizure control D. gastrointestinal complaints E. tremor
A. nystagmus
43
All of the following are true about phenytoin EXCEPT that it
A. is highly bound to plasma proteins
B. is mainly excreted unchanged in the urine
C. has dose-dependent elimination kinetics
D. is effective in grand mal seizures
E. induces the metabolism of certain drugs
B. is mainly excreted unchanged in the urine
44
Aqueductal stenosis A. excessive cerebrospinal fluid secretion B. syringomyelia C. non-communicating hydrocephaly D. Dandy-Walker malformation E. communicating hydrocephaly
C. non-communicating hydrocephaly
45
Bacterial meningitis A. excessive cerebrospinal fluid secretion B. syringomyelia C. non-communicating hydrocephaly D. Dandy-Walker malformation E. communicating hydrocephaly
E. communicating hydrocephaly
46
Choroid plexus papilloma
A. excessive cerebrospinal fluid secretion
B. syringomyelia
C. non-communicating hydrocephaly
D. Dandy-Walker malformation
E. communicating hydrocephaly
A. excessive cerebrospinal fluid secretion
47
Spinal cord trauma A. excessive cerebrospinal fluid secretion B. syringomyelia C. non-communicating hydrocephaly D. Dandy-Walker malformation E. communicating hydrocephaly
B. syringomyelia
48
Large posterior fossa cyst with partial or complete absence of the cerebellar vermis A. excessive cerebrospinal fluid secretion B. syringomyelia C. non-communicating hydrocephaly D. Dandy-Walker malformation E. communicating hydrocephaly
D. Dandy-Walker malformation
49
Increased intracranial pressure is correctly described as all of the following EXCEPT A. resulting from head injury B. resulting from intracranial pressure C. relieved by solute diuresis D. an indication for spinal tap E. treatable with ventriculostomy
D. an indication for spinal tap
50
All of the following statements concerning carotid endarterectomy are true EXCEPT A. the procedure may be performed under local or general anesthesia B. the procedure may be performed with or without a shunt C. the arteriotomy site may be closed with or without a vein patch graft D. it is indicated for patients with hemispheric transient ischemic attacks E. it is the treatment of choice in asymptomatic oatients with 50% occlusion of carotid bifurcation
E. it is the treatment of choice in asymptomatic oatients with 50% occlusion of carotid bifurcation
51
all of the following are true of neurofibromatosis (NF) EXCEPT: A. chromosome 17 is abnormal in NF1 B. Lisch bodies usually do not cause visual problems C. acoustic neuromas are mostly found in NF2 D. meningiomas and gliomas are a common finding in NF E. patients with NF1 often loss their vision
E. patients with NF1 often loss their vision
52
A 17-year-old male involved in a motorcycle accident arrives at the emergency room with a Glasgow Coma Scale score of 4, a dilated and nonreactive left pupil, and a mean arterial blood pressure of 90 torr. After airway management and fluid resuscitation, his Glasgow Coma Scale improves to 6, but his right upper extremity remains sluggish to pain and the left pupil remains dilated and nonreactive. Your initial emergency room management of this patient is : A. Begin hyperventilation because of clinical evidence of elevated intracranial pressure (ICP) from asymmetric exam B. Administer mannitol once volume resuscitation and bladder drainage are secure because of clinical evidence of elevated intracranial pressure from asymmetric exam C. Move directly to CT scan once cervical spine film, chest X-ray, and initial physical examination are expeditiously completed D. All of the above
D. All of the above
53
A 67-year-old male presents with classical manifestations of acromegaly, including sleep apnea. An MRI reveals a 2,5 cm pituitary macroadenoma with questionable involvement of the cavernous sinus. The patient has no visual symptoms, but visual field testing reveals a very minimal chiasmal syndrome. Serum growth hormone levels after induced hyperglycemia are in the range of 120 mg/dl. The most appropriate initial management of this patient's acromegaly would be :A. Transsphenoidal surgery B. Conventional radiation C. Gamma knife radiosurgery D. Bromocriptine
D. Bromocriptine
54
Guillain Barre Syndrome, EXCEPT : a. acute onset of peripheral neuropathy b. progressive muscle weakness c. elevated CSF protein without pleocytosis d. can occure 6 days after diarrhea e. motor weakness peaks at 2 weeks in 50%
d. can occure 6 days after diarrhea
handbook hal 53
55
Laboratory findings in neurosarcoidosis, EXCEPT : a. mild leukocytosis b. neutrophilia c. elevation of serum angiotensin-converting enzymes (ACE) d. no organism are recovered on culture or gram stain e. mostly lymphocytes in CSF findings
b. neutrophilia
56
All are correct about periarteritis nodosa, EXCEPT : a. palpated nodules among muscular arteries b. inflammatory necrosis c. hemorrhage d. CNS manifestations are common e. thrombosis
d. CNS manifestations are common
57
These are correct about clinical presentation of fibromuscular dysplasia, EXCEPT: a. headache b. cerebral ischemia c. horner’s syndrome d. vomit e. epilepsy
d. vomit
58
Gerstmann’s syndrome is one of additional effects of dominant parietal lobe lesion that show clinical symptoms below, EXCEPT : a. agraphia b. acalculia c. alexia d. left-right confusion e. digit agnosia
c. alexia
59
Central pathways for coordinating bladder function : a. voluntary cortical control primarily excitation of the pontine reflex b. voluntary cortical control originates in the anteromedial portion of parietal lobes c. efferents to the bladder travel in ventral portion of lateral columns of spinal cords d. voluntary cortical control originates in the genu corpus callosum e. cortical lesion caused an urinary retention
a. voluntary cortical control primarily excitation of the pontine reflex
60
Craniosynostosis can be diagnosed through clinical and imaging findings, EXCEPT : a. gentle firm pressure with the thumbs fails to cause relative movement of the bones on either side of the suture b. beaten copper calvaria on plain skull x-rays c. excess of normal lucency in center of suture d. will demonstrate hydrocephalus if present e. may show expansion of the frontal subarachnoid space
c. excess of normal lucency in center of suture
61
These are correct about comparison Chiari type 1 and Chiari type 2, EXCEPT : a. caudal dislocation of medulla in Chiari type 2 b. medullary kink absent in Chiari type 2 c. Chairi type 2 usually present in infant d. hydrocephalus may be absent in Chiari type 1 e. progressive hydrocephalus can present in Chiari type 2
e. progressive hydrocephalus can present in Chiari type 2
62
Characteristic of iniencephaly, EXCEPT : a. defect around foramen magnum b. cleft lip c.rachishisis d. most are stillborn e. some survive up to age 17
b. cleft lip
63
Tethered cord syndrome can happened in adult or childhood. Those facts are right about it, EXCEPT : a. pain in uncommon in adult tethered cord b. foot deformities common early in childhood tethered cord c. motor deficits are common in childhood tethered cord d. trophic ulcerations are rare in adult tethered cord e. progressive spinal deformity is uncommon in adult tethered cord
a. pain in uncommon in adult tethered cord
64
Absence of septum pellucidum may occur in, EXCEPT : a. Chiari type 2 malformation b. schizencephaly c. occipital encephalocele d. holoprosencephaly e. hydrancephaly
c. occipital encephalocele
65
MR spectroscopy findings that suggest to tumor, EXCEPT : a. reduced NAA b. increased lactate c. increased choline d. decreased lipid e. lactate is always not present in normal brain
d. decreased lipid
66
Facts about basilar impression, EXCEPT : a. upward displacement of foramen magnum margins and cervical spine into posterior fossa b. can be congenital or acquired c. Mc Rae’s line should be more than 19 mm d. Odontoid part can be above that line maximum 2 mm e. can be seen in rheumatoid arthritis
d. Odontoid part can be above that line maximum 2 mm
67
About cervical spine plain film, EXCEPT : a. there are 4 contour lines b. spinolaminar line is the posterior margin of spinal canal c. atlanto-dental interval is the distance betweeen anterior margin of the dens and anterior arch C1 d. 18 mm is normal canal diameter e. In the presence of osteophytic spurs, measure from the ventral of the spur to spinolaminar line
e. In the presence of osteophytic spurs, measure from the ventral of the spur to spinolaminar line
68
Which of the following statements concerning caloric induced nystagmus is false? a. Cold water irrigation of the left ear results in nystagmus to the right (fast phase) b. Cold water irrigation of the left ear results in fast pointing to the left c. Caloric testing permits the evaluation of the individual semicircular ducts d. Caloric testing is the only way to find brain stem death e. Hot water irrigation results in the reverse reactions
d. Caloric testing is the only way to find brain stem death
69
. A patient in the emergency room has been stabbed in the back of the neck and complains that he is unable to lift his shoulder. Which of the following nerve has likely been damaged?
a. supra scapular nerve
b. dorsal scapular nerve
c. accesory nerve
d. thoraco dorsal nerve
e. lateral thoracic nerve
c. accesory nerve
70
The cutaneous innervation to the palmar surface of the middle finger is usually from the... a. axillary nerve b. musculocutaneous nerve c. radial nerve d. median nerve e. ulnar nerve
d. median nerve
71
The cell bodies of general visceral (GVA) neurons are located in the a. ventral horn b. intermediolateral cell column (IMLCC) c. dorsal root ganglion d. paravertebral ganglion e. prevertebral ganglion
b. intermediolateral cell column (IMLCC)
72
Your patient is unable to dorsiflex and evert his right foot. The nerve most likely damaged is the... a. common peroneal b. superficial peroneal c. deep peronal d. tibial e. obturator
a. common peroneal
73
Lesions of which of the following nerves may produce a “wristdrop”? a. axillary b. musculocutaneous c. radial d. median e. ulnar
c. radial
74
Intervertebral disks may protude or rupture in anya direction, but most commonly occur a. anteriorly b. posteriorly c. anterolaterally d. posteriorlaterally e. laterally
d. posteriorlaterally
75
The neurotransmitter released from cerebellar corticonuclear and corticovestibular fibers is a. glutamate b. gamma aminobutyric acid c. acetylcholine d. serotonin e. gylcine
b. gamma aminobutyric acid
76
Which layer of the cerebral cortex contains most of the neurons that give reise to subcortical projections such as thecorticospinal fibers? a. external granular b. external pyramidal c. internal granular d. interal pyramidal e. molecular
d. interal pyramidal
77
Which of the following statements concerning Parkinson’s disease is correct? a. it involves neuronal degeneration of the substantia nigra pars reticulate b. there is a reduction in the release of norepinephrine by nigrostriatal axon terminals c. tachykinesia (an increase in the spread of movement) is a characteristic of the disease d. carbidopa, an inhibitor of aromatic amino acid decarboxylase, is given because it can cross the blood-brain barrier e. it is characterized by a resting or pill rolling type of tremor involving the fingers and bands
e. it is characterized by a resting or pill rolling type of tremor involving the fingers and bands
78
You observe the following during a neurological examination of your patient: Both eye can look to the left without difficulty; on attempted horizontal gaze to the right, the right eye abducts (look laterally), but the left eye does not adduct (does not move mush beyond the vertical meridian of the eye). Based on this information, which of the following is the likely location of the lesion? a. trochlear nerve on the left b. abducens nerve on the left c. medial longitudinal fasiculus on the left d. abducens nerve on the right e. medial longitudinal fasciculus on the right
a. trochlear nerve on the left
79
A 40 year old female suffered a cerebellar hemorrhage, but made a complete without surgical intervention. A follow up CT scan demonstrates a linear vascual structure whick is felt to represent a venous angioma. Which on of the following statements is true ? A. Cerebellar venous angiomas have a greater tendency to bleed than those occuring in the cerebral hemispheres B. Theres is a 6% chance of reccurent homorrhage from this lesion during the first year C. Angiographic appearance of the angioma is key in deciding the approach to treatment D. This cerebellar venous angioma does not need surgical treatment E. If this lesion extended into the brainstem, Gamma knife radiosurgery might be the best option
D. This cerebellar venous angioma does not need surgical treatment
80
A 27-year-old right-handed man presents with headache and confusion. A CT scan shows a ring-enhancing lesion in the frontal lobe adjacent to the frontal horn of the lateral ventricle. The patient is HIV (human immunodeficiency virus) positive. Which of the following statements is FALSE ? A. The differential diagnosis includes toxoplasmosis, lymphoma, cryptococcal abscess, and metastatic carcinoma B. Stereotactic biopsy is not indicated because a definitive diagnosis will not alter the patient's outcome C. A diagnosis of toxoplasmosis can be made on a biopsy even if tachyzoites are not identified D. The risk of transmission of human immunodeficiency virus (HIV) from the patient to the surgeon and surgical team can be reduced by the use of universal precautions and double gloving
B. Stereotactic biopsy is not indicated because a definitive diagnosis will not alter the patient's outcome
81
What characteristic of the sympathetic nervous system is CORRECT ? A. Sympathetic output originates in the anterior hypothalamus B. The sympathetic system has diffuse widespread innervation in the peripher C. The preganglionic neurotransmiiter is always norepinephrine D. The postganglionic neurotransmitter is always norepinephrine
B. The sympathetic system has diffuse widespread innervation in the peripher
82
Which of the following neuronal responses does NOT occur in the calcarine cortex ? A. Respones formed by the side-by-side arrangement of excitatory and inhibitory fields B. Responses to slits of light, edges, or dark bars with specific orientation C. Respon to onset of light and onset of dark in circular fields D. Respones to the length and direction of stimulus
C. Respon to onset of light and onset of dark in circular fields
83
Which of the following lesions is not appropriate for treatment with stereotactic radiosurgery ? A. An arteriovenous malformation (volume 3 cm3) which previously hemorrhaged into the left thalamus B. Metastatic carcinoma from the lung to the left frontal lobe (2 cm diameter) and right temporal lobe (1 cm diameter) C. Reccurent glioblastoma multiforme in the parietal lobe with a tumor volume of 8 cm3 D. A cavernous angioma (2 cm diameter) in the right parietal frontal lobe which had previously hemorrhaged)
D. A cavernous angioma (2 cm diameter) in the right parietal frontal lobe which had previously hemorrhaged)
84
Which of the following statements regarding treatment for vestibular schawannomas is INCORRECT ? A. Stereotactic radiosurgery has a much better likehood of preserving hearing than direct surgical intervention B.The facial nerve is found superiorly and anteriorly in the porous acoustics C. If the patient does not have functional hearing, a translabyrinthine approach is appropriate D. A common complication of the translabyrinthine approach is a CSF leak
A. Stereotactic radiosurgery has a much better likehood of preserving hearing than direct surgical intervention
85
A 46-year-old female presents with a one-year history of nausea and a three month history of progressive ataxia and morning headaches. She is found on MRI to have a large tentorial mass causing obstructive hydrocephalus and compression of the medulla. A gross total resection is accomplished. The pathologic diagnosis is atypical meningioma with aggressive features. The patient's next therapeutic intervention MOST LIKELY will be : A. Observation with serial MRIs every six months B. Course intravenous cisplatin, dacarbazine, and doxorubicin C. Hormone therapy D. Radiation therapy (52 Gy) E. Combine radiation therapy and chemotherapy
A. Observation with serial MRIs every six months
SANS VI
86
Recent basic science studies have found that meningiomas are associated with the expression of progesterone receptors. Where are these receptors located in the meningioma cell and are they considered functional ? A. Intranuclear progesterone receptors, considered nonfunctional B. Intranuclear progesterone receptors, considered functional C. Cytoplasmic progesterone receptors, considered nonfunctional progesterone receptors found on the cell membrane, considered nonfunctional D. Progesterone receptors found on the cell membrane, considered functional
B. Intranuclear progesterone receptors, considered functional
87
A 38 year-old-male underwent anterior cervical discectomy and fusion for cervical radiculopathy using autologous iliac crest bone graft. Three months later he presented with burning lateral thigh pain on the side of the bone graft. The best treatment option at this point is : A. Conservative management; the pain should resolve within six additional months B. Antidepressant therapy C. Neurolysis of the lateral femoral cutaneous nerve D. Decompression and transposition on the lateral cutaneous nerve E. Transaction of the lateral femoral cutaneous nerve
E. Transaction of the lateral femoral cutaneous nerve
SANS VI
88
A 57-year-old female presents with a history of adenocarcinoma of the lung diagnosed three years ago. She is referred to you after suffering a seizure. On MRI there is a 3 cm mass in right premotor area that enhances with gadolinium. She is restaged and found not to have evidence of systemic disease other than the brain mass. The BEST recommendation for therapy for the cerebral mass is : A. Surgical resection B. Whole brain radiaton C. Chemotherapy D. Surgical resection followed by whole brain radiation E. Surgical resection followed by chemotherapy
D. Surgical resection followed by whole brain radiation
SANS VI
89
Your patient undegoes succesful surgical excision followed by whole beam radiation. She had no evidence of intracranial disease until one year later, when she was presented with left upper extremity paresis. She was found on follow-up later to have additional metastases in the cerebellum (2cm), the right frontal lobe (4cm), and the left occipital lobe (1 cm). She has no other systemic disease and is otherwise healthy. The BEST recommendation for treatment now is : A. Intravenous chemotherapy B. Radiation therapy C. Surgical resection of all three lesions D. Surgical resection of the posterior fossa lesion E. Surgical resection of the symptomatic lesion followed by chemo therapy
C. Surgical resection of all three lesions
90
In patients with intractable epilepsy from mass lesions in the temporal lobe, the following is true, EXCEPT :
A] lesionectomy is just as effective as anterior lobectomy
B] Location of mass lesion in temporal lobe influences the amount of hipocampal neuron loss
C] Theres good chance that anterior temporal lobectomy will be associated with specific reduction of memory
D] A history of seizure over many years is associated with larger reduction of hipocampal neurons
A] lesionectomy is just as effective as anterior lobectomy
91
A 57-year-old male underwent an arteriogram for evaluation of a carotid bruit. In addition to a significant stenosis of 80 %, the radiologist comments about a vessel that arises from the intracavernous internal carotid artery (ICA) and connects with the basilar artery between the superior cerebellar and anterior inferion cerebellar arteries. This vessel may represent all of the following, EXCEPT :
A. A primitive hypoglossal artery
B. A possible cause of trigeminal neuralgia
C. An important source of blood flow to the hindbrain in the developing fetus
D. An angiographic variant with an incidence of approximately 0,1 to 0,6 %
E. A rare association with aneurysms and carotid cavernous sinus fistulas.
A. A primitive hypoglossal artery
92
A 57-year-old male underwent an arteriogram for evaluation of a carotid bruit. In addition to a significant stenosis of 80 %, the radiologist comments about a vessel that arises from the intracavernous internal carotid artery (ICA) and connects with the basilar artery between the superior cerebellar and anterior inferion cerebellar arteries. Regarding the anatomy of the intravavernous ICA, all of the following vessels can be found arising from the intracavernous ICA or its branches EXCEPT : A. Inferior hypophyseal artery B. Ophthalmic artery C. Artery of Bernasconi and Cassinari D. McConnell's capsular arteries E. Superior hypophyseal artery
E. Superior hypophyseal artery
93
A 43-year-old woman is referred to your emergency room for evaluation of stroke. She is accompanied by an MR angiogram that shows absence of filling of the right posterior inferior cerebellar artery. All of the following symptoms are commonly seen as part of a syndrome in a patient with occlusion of the posterior inferior cerebellar artery, EXCEPT : A. Speech and swallowing difficulties B. Nystagmus and tendency to fall to the ipsilateral side C. Weakness of the contralateral arm and leg D. Loss of pain sensation of the contralateral arm and leg E. Analgesia of the ipsilateral face
C. Weakness of the contralateral arm and leg
94
A 67-year-old hypertensive male presents to the emergency room with left-sided hemiplegia and right-sided facial weakness involving both his upper and lower face. He also has diplopia which is worsened while looking to the right. His lesion is MOST LIKELY located in which of the following regions ? A. Right ventrocaudal pons B. Right dorsal midbrain C. Right tegmentum of midbrain D. Right ventrocaudal midbrain E. Left ventrocaudal midbrain
A. Right ventrocaudal pons
95
All of the following syndromes have been associated with either unilateral or bilateral occulsion of the posterior cerebral arteries, EXCEPT : A. Alexia with or without agraphia B. Dysartria-clumsy hand syndrome C. Dejerine-Roussy syndrome D. Anton's syndrome E. Transient global amnesia
B. Dysartria-clumsy hand syndrome
96
You are called to the emergency room to see a 17-year-old male driver who lost control of his car and struck a telephone pole. He experienced a brief loss of consciousness and awoke to find he was unable to move his right upper extremity and was densely paretic with his left hand. He is mildly confused but otherwise appropriate. He notes near normal strength in both his legs. The MOST LIKELY cause for his condtion is : A. Bilateral subdural hematomas B. Bilateral brachial plexus injuries C. Bilateral frontal contusions D. Craniocervical junction injury E. Caudal cervical spine injury
D. Craniocervical junction injury
97
You are called to the emergency room to see a 17-year-old male driver who lost control of his car and struck a telephone pole. He experienced a brief loss of consciousness and awoke to find he was unable to move his right upper extremity and was densely paretic with his left hand. He is mildly confused but otherwise appropriate. He notes near normal strength in both his legs. True statements regarding this condition include all of the following EXCEPT :
A. The prognosis for a significant recovery is good
B. There is a high incidence of C1 and C2 fractures with this injury
C. Facial hypalgesia may be associated with this injury
D. A horner's syndrome may be associated wiith this injury
E. The injury is due to the somatotopic arrangement of fibers supplying the upper extremities in the corticospinal tracts at the pyramidal decussation
E. The injury is due to the somatotopic arrangement of fibers supplying the upper extremities in the corticospinal tracts at the pyramidal decussation
98
All of the following statements are true regarding the Guillain-Barre syndrome, EXCEPT :
A. There is usually very little or no sensory involvement
B. Sphincter function is usually not affected
C. History of viral upper respiratory infection, immunization, or surgery frequently precedes the onset of symptoms by a few weeks.
D. Albuminocytologic dissociation (elevated CSF protein without pleocytosis) is a typical CSF finding in Guillain-Barre syndrome
E. Steroids are proven to be effective in hastening the recovery and reducing the neurological deficits
E. Steroids are proven to be effective in hastening the recovery and reducing the neurological deficits
99
Increased signal within hemoorhage on a T1-weighted MRI is MOST LIKELY due to : A. Oxyhemoglobin within the hemorrhage B. Deoxyhemoglobin within the hemorrhage C. Methemoglobin D. Hemosiderin and ferritin
C. methemoglobin
