NEUROSURGERY Multiple Choice Questions and Answers pdf :-
1. Which of the following are true about the history of neurosurgery?
A. The history of trepanation dates back to the Neolithic period.
B. The earliest known writing dealing with surgical topics is the Ebers papyrus.
C. The writings of Hippocrates contain the first recorded descriptions of trepanation.
D. The three key developments that were necessary to permit successful intracranial and intraspinal surgery were anesthesia, asepsis, and the concept of localization of different functions in different areas of the nervous system.
E. Victor Horsely of London was the first surgeon to specialize in neurosurgery.
2. The neurosurgeon who has had the most profound influence on the development of neurosurgery is:
A. Fedor Krause of Germany.
B. William Macewen of Scotland.
C. Harvey Cushing of the United States.
D. Egas Moniz of Portugal.
E. Goeffrey Jefferson of England.
3. Which of the following conditions can be evaluated by magnetic resonance imaging (MRI)?
A. Stroke is suspected in a patient with a cardiac pacemaker.
B. Computed tomography (CT) shows a skull base tumor.
C. A coma patient with CT-demonstrated subarachnoid hemorrhage and an aneurysmal clip.
D. A patient with intractable complex partial seizure.
E. A lung cancer patient whose plain film of the lumbar spine shows a compression fracture of the L2 vertebral body.
4. Which of the following statements about neuroradiologic imaging modalities is/are correct?
A. Diffusion-weighted MRI can differentiate tumor from edema and identify the nonenhancing part of the tumor.
B. For evaluating the stenosis of the carotid bifurcation, MR angiography (MRA) is the most accurate imaging modality.
C. Myelography is still useful in detecting some diffuse spinal disease such as cerebrospinal fluid (CSF) seeding.
D. For evaluating the bony detail of patients with facial trauma, CT is a better imaging modality than MRI.
E. Decreased amount of N-acetyl aspartate (NAA) and increased amount of lactate can be shown in the MR spectroscopy (MRS) of a patient with acute stroke.
5. Which of the following are true about intracranial tumors?
A. The most common location of brain tumors of childhood is the posterior cranial fossa.
B. With few exceptions, examination of the CSF is of no value in the diagnosis of an intracranial tumor.
C. Even the most malignant of primary brain tumors seldom spread outside the confines of the central nervous system (CNS).
D. The majority of astrocytomas can be cured surgically.
E. Primary neoplasms of astrocytic, oligodendroglial, or ependymal origin represent gradations of a spectrum from slowly growing to rapidly growing neoplasms.
6. The intracranial tumor most likely to be encountered in a middle-aged man with the acquired immunodeficiency syndrome (AIDS) is:
A. Glioblastoma multiforme.
DISCUSSION: Primary intracranial lymphomas occur with increased frequency in patients who are immunocompromised, such as recipients of organ transplants and patients with AIDS.
7. Patients who have survived a subarachnoid hemorrhage from a ruptured intracranial aneurysm are at risk for:
B. Cerebral artery vasospasm.
C. Ischemic stroke.
8. Intracranial hemorrhages resulting from chronic arterial hypertension:
A. Most often originate in the basal ganglia.
B. Most often originate in the subarachnoid space.
C. Can present as an enlarging cerebellar mass.
D. Should not be treated surgically when they occur in the cerebellum.
9. The physician is most effective in treating:
A. Cerebral contusions.
B. Epidural hematomas.
C. Cerebral lacerations.
10. The evaluation of a comatose patient with a head injury begins with:
A. The cardiovascular system.
B. Pupillary reflexes.
C. Establishment of an airway.
D. Computed tomography (CT) of the brain.
11. An epidural hematoma:
A. Is usually arterial in origin.
B. Is usually accompanied by a skull fracture.
C. Should be suspected only in comatose patients.
D. Can be diagnosed from a brain CT scan.
12. Which of the following statements is/are true?
A. Cranial osteomyelitis most frequently arises from the spread of bacteria through the bloodstream from an infection elsewhere in the body.
B. Subdural empyema is ordinarily treated by administration of antibiotics without the need for surgical drainage.
C. Bacterial meningitis may lead to the development of hydrocephalus.
D. A bacterial brain abscess commonly presents as a mass lesion of the brain, without systemic signs of infection such as fever or leukocytosis.
E. Bacterial brain abscesses are difficult to visualize by CT.
13. Complete excision of a brain abscess used to be the preferred method of treatment, and it is still performed occasionally today. Most commonly, now, a brain abscess is treated by:
A. Systemic antibiotic administration.
B. Aspiration and drainage of the abscess through a small opening in the skull.
C. Injection of antibiotics into the abscess.
D. Aspiration and drainage of the abscess plus systemic antibiotic administration.
E. Marsupialization of the abscess.
14. Which of the following statements are true?
A. Extradural neoplasms are usually benign.
B. A typical type of intramedullary tumor is a meningioma.
C. An intradural extramedullary neoplasm is ordinarily treated by a combination of surgical resection and radiotherapy.
D. Extradural neoplasms are usually malignant.
E. A hemangioblastoma is a benign intramedullary tumor that has the potential for surgical cure.
15. Which of the following statements about intraspinal dermoid and epidermoid tumors and lipomas are true?
A. They are benign lesions.
B. They can be found within the spinal subarachnoid space.
C. They can be found within the spinal cord.
D. They are most common in the lumbosacral area.
E. They are at times associated with spinal dysraphism.
16. Which of the following statements are true?
A. The usual symptomatic lumbar disc herniation occurs in a posterolateral direction.
B. Approximately 95% of lumbar disc herniations occur at the L5–S1 or L4–L5 level.
C. Sciatica is a term used to denote pain felt along the distribution of the sciatic nerve.
D. Weakness of dorsiflexion of the foot is a mechanical sign of a lumbar disc herniation.
E. X-ray films of the lumbosacral spine are obtained to demonstrate the presence and location of a lumbar disc herniation.
17. A right-sided disc herniation at the L5–S1 level typically may cause:
A. Low back pain and right sciatica.
B. Weakness of dorsiflexion of the right foot.
C. A diminished or absent right ankle jerk.
D. Diminution of sensation over the medial aspect of the right foot, including the great toe.
E. Weakness of dorsiflexion of the left foot.
18. Which of the following statements are true?
A. A symptomatic cervical disc herniation usually occurs in an anterolateral or anterior direction and can be removed by a surgical approach through the front of the neck.
B. Cervical spondylosis represents a combination of degenerative disc disease and osteoarthritis in the cervical spine.
C. The joints of Luschka are the main spinal facet joints.
D. The term cervical myelopathy refers to pain and/or neurologic dysfunction in the distribution of one or more cervical nerve roots.
E. Full neck extension frequently accentuates the neck and arm pain of a patient with a cervical disc herniation.
19. A 36-year-old man developed neck and left arm pain. He noted paresthesias in the left index and long fingers. He was found to have weakness of the left triceps muscle and a diminished left triceps jerk. His left-sided disc herniation is most likely to be at:
20. Which of the following statements are true?
A. The fascicles in a peripheral nerve divide and recombine along their course.
B. Neurapraxia is a type of nerve injury in which the nerve is still in continuity but individual axons are disrupted.
C. Recovery from neurotmesis requires surgical repair.
D. Axonal sprouting begins 1 to 2 months after transection of a peripheral nerve.
E. The patient’s age influences the rate and success of nerve regeneration.
21. Which of the following statements are true?
A. The Hoffmann-Tinel sign localizes the level of a nerve injury.
B. Causalgia is a term used to denote the etiology of pain.
C. Secondary repair of a lacerated nerve 3 to 8 weeks after injury has several advantages.
D. A surgeon who finds at delayed (3 to 8 weeks) exploration that a clinically nonfunctioning nerve is in continuity should resect the injured portion of the nerve and suture together the ends.
E. If a nerve is found to be disrupted at delayed (3 to 8 weeks) exploration, the surgeon should find the two ends of the nerve and suture them together.
22. Which of the following lesions is not one of the cutaneous stigmata of occult spinal dysraphism?
A. Midline lumbar capillary hemangioma.
B. Focal hairy patch over the thoracolumbar spine.
C. Dermal sinus located above the midsacrum.
D. Midline subcutaneous lipoma.
E. Café-au-lait spot over the thoracolumbar spine.
23. Myelomeningoceles are congenital malformations of the spinal cord. Which of the following findings are not commonly associated?
B. Chiari II malformation.
C. A midline dorsal spinal mass easily noted at birth.
D. Skin, bone, and dural defects superficial to the neural placode.
E. Mandatory urinary incontinence.
24. Which of the following signs does Horner’s syndrome include?
B. Facial hyperhidrosis.
25. Cordotomy results in which of the following?
A. Contralateral loss of pin appreciation.
B. Vagal instability.
C. Contralateral loss of temperature appreciation.
D. Ipsilateral loss of pin and temperature appreciation.
E. Contralateral loss of two-point discrimination.
NEUROSURGERY Interview Questions and Answers ::
26. Surgical therapy for epilepsy should be considered in patients with:
A. Seizures poorly controlled with antiepileptic medications.
B. A single epileptic focus.
C. Seizures arising from multiple areas of cerebral cortex.
D. Seizures arising within the cortical motor strip.
27. The epileptogenic area of cerebral cortex is localized by:
A. Direct identification.
B. Observing the patient’s seizures.
D. Visualizing cortical abnormalities on cerebral imaging studies.
28. Which of the following stereotactic procedures would be performed primarily to alter the function of the brain?
A. Stereotactic biopsy of a brain tumor in the right posterior thalamus.
B. Stereotactic radiotherapy of an arteriovenous malformation in the right ventrolateral thalamus.
C. Stereotactic radiofrequency lesion of the right ventrolateral thalamus for Parkinson’s disease.
D. Stereotactic craniotomy for excision of arteriovenous malformation in the right posterior thalamus.
29. What is the critical difference between frame-based and frameless stereotactic procedures?
A. The use of digitized imaging studies such as CT and MRI.
B. The use of rendered three-dimensional images and a three-dimensional digitizer.
C. Rigid fixation of the patient’s head to the operating room table.
D. The presence of a lesion in the brain on digitized imaging studies.
E. The absence of a lesion in the brain on digitized imaging studies.
30. A 54-year-old patient with a history of successful renal transplantation is hospitalized with a diverticular abscess. Surgical exploration and drainage of the abscess with a Hartmann’s procedure is eventually required. Although the patient’s septic appearance resolves, the patient complains of severe headache and altered mental status is observed. A grand mal seizure follows. Which of the following statement(s) is/are true concerning this patient’s management?
a. An intracranial epidural abscess is the likely diagnosis
b. A bacterial brain abscess secondary to hematogenous spread from the pericolonic infection is the likely diagnosis
c. The abscess expected in this case is usually solitary
d. Appropriate parenteral antibiotic treatment should be sufficient in this high risk patient.
e. Despite aggressive surgical and medical management, mortality rates associated in this patient may exceed 30%
Answer: b, d, e
31. All intracranial nervous system tumors can be malignant in behavior due to their location. Which of the following tumor(s) is/are usually considered to be histologically benign?
Answer: b, c, e
32. A 54-year-old physician with a history of lung cancer presents after a grand mal seizure with a several month history of increasing headaches. Which of the following statement(s) is/are true concerning this patient?
a. Lung cancer as well as breast, kidney, testicular and colon cancer are the most common primary sites to metastasize to the brain
b. A symptomatic, solitary metastatic brain lesion should be removed if surgically accessible
c. If excision is complete, no further chemo-or radiation therapy is indicated
d. Symptoms of cranial nerve palsies, radiculopathies and nuchal rigidity are suggestive of meningeal carcinomatosis
e. Cytologic examination of CSF is almost always positive with meningeal metastasis
Answer: a, b, d
33. The management of a skull fracture is highly dependent on the type and location of the fracture. Which of the following statement(s) is/are true concerning skull fractures?
a. A simple nondepressed linear skull fracture is of no significant consequence
b. Most depressed skull fractures require surgery to elevate the depressed bone fragment regardless of neurologic status
c. Basal skull fractures involve the base of the calvarium and may be suggested by bruising about the eye or behind the ear
d. CSF rhinorrhea associated with a basal skull fracture requires prompt surgical exploration and repair of the defect
e. Prophylactic antibiotics are indicated in all basal skull fractures associated with CSF rhinorrhea or otorrhea
Answer: b, c
34. Which one or more of the following statement(s) is/are true concerning spinal cord injuries?
a. Incomplete spinal cord lesions may result in the Brown-Sequard syndrome which is manifest by contralateral loss of motor function and position-vibratory sensation with ipsilateral loss of pain and temperature sensation below the level of the injury
b. The presence of hypotension associated with a cervical spine injury following blunt trauma would suggest invariably the presence of blood loss in association with the neurologic injury
c. Cervical spine malalignment can almost always be reduced by skeletal traction
d. An indication for early operation following spinal cord injury is neurologic deterioration in a patient with initially incomplete cord lesion
e. The natural history of a cord injury in which some function is preserved immediately after the injury is progressive loss of function despite appropriate treatment
Answer: c, d, e
35. A 48-year-old man presents with chronic back pain with radiation into the buttock, posterior thigh, and calf. Which of the following statement(s) is/are true?
a. In the lumbar spine, more than half of clinical problems arise from L-2 to L-3 and L-3 to L-4 intervertebral discs
b. Imaging studies with CT or MRI followed by myelography is necessary for the diagnosis in most patients
c. Initially, medical management is indicated in all patients who do not have neurologic deterioration
d. Surgical treatment is reserved for the patient with acute or progressive neurologic deficit, chronic disabling back pain, or both
e. Anal sphincter muscle disturbances can be expected in most patients and are of no clinical significance
Answer: c, d
36. Which of the following statement(s) is/are true concerning intracranial aneurysms?
a. Over 85% of cerebral aneurysms occur in the carotid or anterior circulation
b. Most intracranial aneurysms are congenital
c. Up to 20% of patients with cerebral aneurysms have multiple aneurysms
d. Most patients with intracranial aneurysms present with signs and symptoms of subarachnoid hemorrhage with severe headache followed by neck stiffness and photophobia
e. Once the diagnosis of aneurysmal rupture is confirmed, surgery should be performed immediately
Answer: a, b, c, d
37. The severity of a brain injury reflects the result of both the primary injury and resulting complications constituting the secondary injury. Which of the following statement(s) concerning brain injury is/are true?
a. Increased intracranial pressure (ICP) contributes to secondary brain injury by reducing cerebral perfusion pressure producing cerebral ischemia
b. Intracranial hypertension is one of the most important factors affecting outcome for brain injury
c. In using the Glasgow Coma Scale (GCS), the higher the score, the poorer the neurologic status
d. Comatose patients who require emergent surgery for other injuries should have their ICP monitored
e. Corticosteroids are the first line treatment for elevation of ICP
Answer: a, b, d
38. A 15-year-old boy is struck by a baseball in the side of the head. He briefly looses consciousness but quickly returns to a lucid state. Which of the following statement(s) is/are true concerning his subsequent course.
a. The initial neurologic finding may be dilatation of the ipsilateral pupil
b. If the patient has a normal neurologic examination at the time of emergency room assessment, he can be discharged safely to home
c. A head computed tomography (CT) scan should be performed regardless of the current neurologic examination
d. The likely mechanism of injury arises from a tear of a branch of the middle meningeal artery as it courses through a grove in the skull at the area of impact
e. If, after an initial lucid interval, a rapid progression to coma with fixed and dilated pupils and decerebration occurs, the most likely CT finding would be a subdural hematoma
Answer: a, c, d
39. Which of the following statement(s) is/are true regarding peripheral nerve injuries?
a. Neuropraxia is temporary loss of function without axonal injury; structure damage does not occur
b. Axonotmesis is disruption of the axon and axon sheath associated with traumatic injury
c. Neurotmesis is disruption of the axon with preservation of the axon sheath which usually preserves sensory and motor function
d. Electromyography (EMG) is useful in the early assessment of nerve injuries
e. Regeneration in a peripheral nerve occurs at a rate of 1 mm/day, so improvement may not be obvious for many months
Answer: a, e