Surgery_Neurosurgery

Question 1

Which clinical picture associates with the following symptoms? Sudden occipital headache, photophobia, fever, neck stiffness.
A) Acute subdural hemorrhage
B) Intracerebral hemorrhage
C) Posterior fossa tumor
D) Subarachnoid hemorrhage
E) Migraine

Answer 1

D) Subarachnoid hemorrhage

Question 2

What should be done with a patient with subarachnoidal bleeding?
A) Observation
B) Sending to inpatient provider institute
C) Sending to neurosurgery department
D) Asking MRI
E) Asking angiography

Answer 2

C) Sending to neurosurgery department

Question 3

The main pathologies causing trigeminal pain:
A) Intracranial tumors
B) Sclerotic plaque
C) Vascular compression of the nerve
D) Idiopathic

Answer 3

C) Vascular compression of the nerve

Question 4

In case of traumatic spine fracture the main purposes of the operation are the following, except for:
A) Decompression of neural elements
B) Restoration of spine statics
C) Stabilization
D) Spine stimulation

Answer 4

D) Spine stimulation

Question 5

We need to think of a stenotic spinal canal when the patient’s walking is facilitated by bending, when there is neurogenic claudication, so occurring low back pain which can radiate to the legs during walking.
A) true
B) false

Answer 5

A) true

Question 6

It is necessary to prepare brain MRI when cerebellar symptoms are noticed during or after upper respiratory tract infection in childhood because of the suspicion of scala posterior tumor:
A) true
B) false

Answer 6

A) true

Question 7

The specific symptoms in case of elderly normal pressure hydrocephalus are the following, except for:
A) gait disturbance
B) blurred vision
C) incontinence
D) memory loss

Answer 7

B) blurred vision

Question 8

In case of inactive pituitary tumor, without compressive symptoms and progressive growing, the chosen treatment is the following:
A) early tumor resection by using transsphenoidal approach
B) periodic ophthalmological examination and MRI control within the confines of endocrinology care
C) radiotherapy
D) hormone substitution

Answer 8

B) periodic ophthalmological examination and MRI control within the confines of endocrinology care

Question 9

A patient with isolated head injury is transferred to the hospital with the following parameters: GCS 7, BP 130/85 mmHg, HR 75/min, oxygen saturation 97%; no space-occupying lesion is detectable in the cranial CT scan. What is to be done?
A) only observation
B) intubation, placement of ventricular drain, measurement of intracranial pressure
C) decompressive craniectomy (DC)
D) induction of barbiturate coma

Answer 9

B) intubation, placement of ventricular drain, measurement of intracranial pressure

Question 10

Spinal dysraphia (neural tube defect) can frequently present with hydrocephalus.
A) true
B) false

Answer 10

A) true

Question 11

Chronic subdural hematoma can be diagnosed based on the following symptoms: banal head injury, lack of serious headache, memory impairment and altered level of consciousness fluctuating from hour to hour:
A) true
B) false

Answer 11

A) true

Question 12

Spinal dysraphias (neural tube defects) are always associated with neurological signs.
A) true
B) false

Answer 12

B) false

Question 13

If the pain radiates to the medial part of the arm and the elevation or abduction of the arm leads to the disappearance of the radial pulse, we should think of the following pathology:
A) syringomyelia
B) coarctation of the aorta
C) cervical disc hernia
D) thoracic outlet syndrome
E) poliomyelitis

Answer 13

D) thoracic outlet syndrome

Question 14

Acute epidural hematoma is half as dangerous as subdural hematoma considering mortality:
A) true
B) false

Answer 14

A) true

Question 15

Arteriovenous malformations are congenital lesions, which have lifelong bleeding risk without treatment.
A) true
B) false

Answer 15

A) true

Question 16

All the unconscious patient who have suffered head injury should be potentially considered to have spine injury (thus immobilized) till detailed medical examination rules it out.
A) true
B) false

Answer 16

A) true

Question 17

One of the following locations considered as the most frequent level of herniated disc disease:
A) LIII–IV
B) LIV–V
C) CIV–V
D) CVI–VII
E) ThXI–XII

Answer 17

B) LIV–V

Question 18

Acupuncture or physiotherapy may expressly worsen radiating pain of herniated disc disease initially:
A) true
B) false

Answer 18

A) true

Question 19

In case of so-called silent carotid stenosis, no surgical solution is recommended because the results of medication treatment are better than the surgical solution:
A) true
B) false

Answer 19

B) false

Question 20

Which is the most common central nervous system tumor?
A) pituitary adenoma
B) glioblastoma multiforme
C) metastasis
D) meningioma

Answer 20

C) metastasis

Question 21

If the patient is in deep coma, their pupils are dilated and they do not respond to light, there isn’t spontaneous breathing and any response to painful stimuli, brain death can be stated.
A) true
B) false

Answer 21

B) false

Question 22

What is your treatment recommendation if your patient suddenly experiences a lumbar pain that radiates into the lower limb on its outer surface towards the old finger?
A) pain relief and bed rest
B) pain relief and acupuncture treatment
C) pain relief and neurosurgical consultation
D) Medication and orthopedic examination
E) Pain relief and physiotherapy

Answer 22

A) pain relief and bed rest

Question 23

Surgical treatment is more often than endovascular treatment among ruptured or unruptured aneurysms.
A) true
B) false

Answer 23

B) false

Question 24

Cerebral vasopasm is a condition that takes after subarachnoid hemorrhage:
A) 12-24 hours
B) 1-3 days
C) 3-14 days
D) 0-48 hours

Answer 24

C) 3-14 days

Question 25

Mortality of acute subdural haemorrhage is at least two-times higher than diffuse axonal injury: A) true B) false

Answer 25

A) true

Question 26

Which anatomical location has been injured, if patient has psychomotoric attacks and temporarily sensory aphasia? A) left fronto-parietal region B) right limbic lobe C) left temporal lobe D) right central region E) left thalamus

Answer 26

C) left temporal lobe

Question 27

How long bleeding ruptured aneurysms in subarachonoidal room? A) approx. 1–2 minutes B) approx. half hour C) approx. a week D) while artery systolic pressure higher than intracranial pressure E) while perfusion pressure higher than 40 Hgmm

Answer 27

D) while artery systolic pressure higher than intracranial pressure

Question 28

Most common signs of arteriovenous malformations are: A) headache, epilepsy B) dementia, neurological focal symptom C) subarachnoid haemorrhage, intracerebral haemorrhage bruit, cardiac failure

Answer 28

A) headache, epilepsy

Question 29

A 50-year-old, regularly smoking male patient complains about weakness of his right limbs and has a problem with verbal self expressing, though he understands verbal communication. There is a contrast-enhancing tumorous lesion with a diameter of 2 cm with perifocal oedema in the superficial area of the left frontal lobe on the skull CT scans. There is no midline shift. What should you do? A) Neurosurgical concilium, acute operation, irradiation B) Neurosurgical concilium, skull MRI, further investigation for other tumors (staging), operation and acute oncological therapy by the decision of the neuro-oncology team C) Irradiation of the whole skull and decreasing of the oedema D) Chemotherapy

Answer 29

B) Neurosurgical concilium, skull MRI, further investigation for other tumors (staging), operation and acute oncological therapy by the decision of the neuro-oncology team

Question 30

The patient has regular events like TIA and the ultrasound and angiography certified an ulcerous and sclerotic plaque causing a stenosis of 50%. In this case is it preferred to do endarterectomy? A) yes B) no

Answer 30

B) no

Question 31

There is no need for hospitalization for every patient with traumatic skull injury, you can let a patient under the influence of alcohol with traumatic skull injury to go home after examination and wound treatment in case he does not have neurological symptoms. A) true B) false

Answer 31

B) false

Question 32

The most obvious cause of a gradually forming hemiparesis: A) rupture on an aneurysm B) hemispheric tumor C) obstruction of the internal carotid artery D) problem with the circulation of cerebrospinal fluid E) tumor of the posterior fossa

Answer 32

B) hemispheric tumor

Question 33

These are the next compensating mechanisms in case of an intracranial space occupying lesion: 1) decrease of the intracranial blood volume 2) decrease of the subdural liquid volume 3) decrease of the cerebrospinal fluid volume 4) decrease of the brain’s water content 5) thinning of the skull bones A) all of the answers are correct B) 1st and 3rd answers are correct C) 2nd and 5th answers are correct D) none of the answers are correct

Answer 33

B) 1st and 3rd answers are correct 1) decrease of the intracranial blood volume 3) decrease of the cerebrospinal fluid volume

Question 34

The most common symptomes of the suprasellar tumors: 1) ophtalmoplegia 2) endocrine disorders 3) facial palsy 4) visual field defect 5) dementia A) all of the answers are correct B) 1st, 3rd and 5th answers are correct C) 2nd and 4th answers are correct D) none of the answers are correct

Answer 34

C) 2nd and 4th answers are correct 2) endocrine disorders 4) visual field defect

Question 35

Elements of the Glagow Coma Scale: 1) consciousness 2) verbal response 3) size of the pupil 4) motor response 5) eye opening response 6) Babinski-sign A) all of the answers are correct B) 1st and 3rd answers are correct C) 3rd and 6th answers are correct D) 2nd, 4th and 5th answers are correct E) 1st, 3th and 6th answers are correct

Answer 35

D) 2nd, 4th and 5th answers are correct 2) verbal response 4) motor response 5) eye opening response

Question 36

Choose the correct statements. 1) Each and every head trauma patient has to be transported to a trauma surgery department. 2) In the case of a posttraumatic pupillary inequality(/anisocosia/ unequal pupils) an immidiate transport to neurosurgery is required. 3) By a suspected impression fracture of the skull, the patient has to be transported to the nearest trauma clinic. 4) A polytraumtic patient with skull injury needs an immidiate transport to neurosurgery. 5) A prompt transport to neurosurgery in a case of a severe (traumatic) skull injury is mandatory A) only 1st and 2nd answers are correct B) only 3rd answer is correct C) only 4th and 5th answers are correct D) all of the answers are correct

Answer 36

C) only 4th and 5th answers are correct 4) A polytraumtic patient with skull injury needs an immidiate transport to neurosurgery. 5) A prompt transport to neurosurgery in a case of a severe (traumatic) skull injury is mandatory

Question 37

Which are the characteristics of the hangman’s fracture 1) the peculiar fracture of the C2 2) A complete spinal cord injury occurs instantly in most cases 3) Typical injury of motorcyclists 4) the point is: traumatic spondylolisthesis A) All of the answers are correct B) 1st, 2nd and 4th answers are correct C) only 3rd answer is correct D) None of the answers are correct

Answer 37

B) 1st, 2nd and 4th answers are correct 1) the peculiar fracture of the C2 2) A complete spinal cord injury occurs instantly in most cases 4) the point is: traumatic spondylolisthesis

Question 38

Clinical sings of the basilar skull fracture: 1) blood or liquor discharge from the ear 2) nose-bleeding 3) bilateral periorbital ecchymoses (raccoon’seyes) 4) presence of air within the cranial cavity 5) trauma related anosmia 6) hemotympnaum 7) trauma related vertigo A) only 1st answer is correct B) 2nd and 5th answers are correct C) 5th and 7th answers are correct D) 1st, 3rd, 4th and 6th answers are correct E) All of the answers are correct

Answer 38

D) 1st, 3rd, 4th and 6th answers are correct 1) blood or liquor discharge from the ear 3) bilateral periorbital ecchymoses (raccoon’seyes) 4) presence of air within the cranial cavity 6) hemotympnaum

Question 39

The possible complications of a subarachnoid hemorrhage: 1) hydrocephalus 2) vasospasm 3) memory impairment 4) epidural hemorrhage 5) cerebral abscess 6) cerebral edema A) all of the answers are correct B) only 1st answer is correct C) 1st, 2nd, 3rd and 6th answers are correct D) 4th and 5th answers are correct

Answer 39

C) 1st, 2nd, 3rd and 6th answers are correct 1) hydrocephalus 2) vasospasm 3) memory impairment 6) cerebral edema

Question 40

The main principles of the management of the spine injuries: 1) Principally the primary spinal cord injury is to be treated. 2) The most important is to prevent the secondary injury of the spinal cord. 3) By a suspected spinal cord injury immobilization is required. 4) In a case of a spinal cord injury above the C4 segment an acute respiratory failure is expected, therefore the patient has to be intubated. A) all of the answers are correct B) only 1st answer is correct C) 2nd, 3rd and 4th answers are correct

Answer 40

C) 2nd, 3rd and 4th answers are correct 2) The most important is to prevent the secondary injury of the spinal cord. 3) By a suspected spinal cord injury immobilization is required. 4) In a case of a spinal cord injury above the C4 segment an acute respiratory failure is expected, therefore the patient has to be intubated.