Board Questions and Answers - PowerPoint Presentation

1. Board Questions and Answers

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5. Question 4Surgical procedures utilized in the treatment of spasmodic torticollis include:Upper cervical ventral rhizotomies and spinal accessory neurectomyStereotactic thalamotomyMicrovascular decompression of the spinal accessory nervemyotomyI, II, IIII, IIIII, IVIVAll of the above

6. Answer 4Torticollis that is refractory to medical therapies and relaxation techniques can be treated with selective rhizotomy of the spinal accessory nerve-81-97% improveMyotomy was the earliest surgical procedure used to treat torticollis70% patients improve after MVD of spinal accessory nerveRoughly 2/3 patients have good result after stereotactic thalamotomy

7. Question 5Which surgical approach for thoracic disk herniations is associated with the highest rate of neurologic injuryCostotransversectomyLateral extracavitaryMidline LaminectomyTranspedicularThransthoracic

8. Answer 5There are reports that thoracic laminectomy performed for thoracic diskectomy is associated with unacceptably high rates of morbidity and mortality. It is estimated that there is at least a 45% chance of experiencing neurological deterioration or no benefit with this approach.

9. Answer 5

10. Question 6Most patients with intrinsic brainstem gliomas initially present with:Cranial neuropathiesHeadacheHydrocephalusNausea and vomitingPapilledema

11. Answer 6Cranial nerve palsies and weakness/ataxia (in that order) are the initial symptomsHeadache, N/V, Papilledema are late findings.These are symptoms related to hydrocephalus

12. Question 7Each of the following is characteristic of complex regional pain syndrome II (causalgia) except:Atrophic changes in the limbHypesthesiaIncreased sweatingLack of major motor deficitGood relief with sympathetic block

13. Answer 7

14. Question 8For the following questions, match the description with the structure.A. Dermoid cystB. Epidermoid cystC. bothD. Neither 1. Bacterial meningitis2. Aseptic meningitis3. Associated congenital malformations4. Most often midline5. Responsive to radiation therapy

15. Answer 8Dermoid Cyst:Occur in midline (lumbosacral spine, parasellar, post. Fossa)Capsular calcification sometimes bright on T10.3% brain tumorsOccur when cell rests with dermal and epidermal componenets are included in neural ectodermCommunication with exterior predisposes to bacterial meningitisSeen mostly in peds-congenital malformationsEpidermoid Cyst:Found off midline (CPA, parasellar, middle fossa)Signal characteristics of csf-increased signal on dwiComprise 0.5-1.8% brain tumorsResult from epidermal cell restsSpillage casuses aseptic meningitisSeen mostly in adults

16. Question 9Ventricular enlargement from choroid plexus papillomas can be secondary to :I. Entrapment of CSFII. Decreased absorption of CSF from hemorrhage-indruced arachnoiditisIII. Tumor GrowthIV. Excessive production of CSFA. I, II, IIIB. I, IIIC. II, IVD. IVE. all of the above

17. Answer 9Cause hydrocephalus by obstruction of CSF pathways and overproduction of CSFMost common in lateral ventricles in children/ fourth ventricle in adultsVascular tumor that occasionally cause intraventricular hemorrhageProminent enhancement with contrast-usually show feeding vessels from choroidal vessels on angiography.Surgical removal is the treatment of choice.

18. Question 10 Which approach is favored for a patient with an 8 mm acoustic neuroma in which hearing preservation is a goal

19. Answer 10Good results of hearing preservation have been reported with both the suboccipital approach and middle fossa approach to acoustic neuromas. The middle fossa approach is best used for small laterally placed tumors in the IAC.Hearing preservation results ranging from 52% to 100% have been described in the literature.The hearing preservation rates for the middle fossa approach and suboccipital approach were 57% and 47%, respectivelytumors between 1 and 2 cm, hearing preservation rates for the middle fossa approach and retrosigmoid approach were 0% and 47%,

20. Question 11Uncinate seizures typically produce:A. Auditory hallucinationsB. Gustatory hallucinationsC. Olfactory hallucinationsD. Vertiginous sensationsE. Visual seizures

21. Answer 11C. Olfactory hallucinations.olfactory auras are more commonly associated with temporal lobe tumors (hamartomas and gliomas) than with other causes of temporal lobe epilepsypathway may be from the amygdala which receives input from the olfactory tract to the corticomedial nucleus under the pyriform cortexpyriform cortex is the primary olfactory cortex

22. Question 12Match the description with the structureA. Calcarine sulcusB. Lateral mesencephalic sulcusC. Posterior communicating arteryD. Tectal plateSeparates the P1 and P2A segments of the PCASeparates the P2A and P2P segments of the PCASeparates the P2P and P3 segments of the PCASeparates the P3 and P4 segments of the PCA

23. Answer 12The PCA was divided into four segments: P1 was the segment proximal to the posterior communicating artery (PCoA); P2 extended from the PCoA to the posterior margin of the midbrain and was subdivided into an equal anterior (P2A) and posterior (P2P) half; P3 began at the posterior midbrain, ran within the quadrigeminal cistern, and ended at the anterior limit of the calcarine fissure

24. Question 13The radial nerve or one of its branches innervates each of the following except the:A. Abductor pollicis longusB. Adductor pollicisC. BrachioradialisD. Extensor pollicis brevisE. Supinator

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26. Answer 13Musculocutaneous:Coracobrachialis, biceps brachii, brachialisAxillary:Teres minor and deltoidRadial:Triceps, anconeus, brachioradialis, extesnor carpi radialis (brevis/longus), supinatorPIN: abductor pollicis longus, extensor pollicis longus/brevis, extensor indices, extensor carpi ulnaris, extensor digitorum, extensor digiti minimi

27. Answer 13Median:Flexor carpi radialis, palmaris longus, flexor pollicis brevis (sup head), flexor digitorum superficialis, flexor digitorum profundus, abductor pollicis brevis, opponens pollicis, lumbricals (2,3)AIN: flexor pollicis longus, pronator quadratus, flexor digitorum profundusUlnar:Flexor carpi ulnaris, flexor digitorum profundus, adductor pollicis, palmaris brevis, flexor pollicis brevis (deep head), lumbricals (4,5), hypothenar muscles, palmar and dorsal interossei

28. Question 14Each of the following is true of intraventricular hemorrhage in the newbown except:A. Periventricular hemorrhagic infarction is one sequelaB. Posthemorrhagic hydrocephalus can result in peristent bradycarida and apneic spells.C. The capillary bed of the germinal matrix is composed of large irregular vessels.D. The germinal matrix is the most common site of IVH in the full-term neonateE. The risk of IVH is greater in the preterm than in the term infant

29. Answer 14The most common site of IVH in a full term neonate is the choroid plexusThe most common site of IVH in a pre-term neonate is the germinal matrixPathogenesis of hemorrhage involves hypoxic injury to the fragile microcirculation of the germinal matrix, which leads to loss of autoregulation, overperfusion, and hemorrhage

30. Question 15The ossification centers of the odontoid consist of:A. One primary and two secondary centersB. One secondary and three primary centersC. Three secondary and one primary centerD. Two primary centersE. Two primary and one secondary center

31. Answer 15E. Two primary and one secondary centersThe secondary center is apicalThe primary centers lie inferiorly on either side of midline

32. Question 16The most common single-suture synostosis is:A. CoronalB. LambdoidC. MetopicD. SagittalE. Sphenozygomatic

33. Answer 16Sagittal (scaphocephaly)Accounts for up to 50% in some studiesIncreased AO skull diameter and narrowed biparietal diameter.Coronal synostosisBrachycephaly-increased bitemporal diameter and bulging foreheadOxycephaly-slightly retroverted foreheadTurricephaly-high/vertical foreheadMetopic (Trigonocephaly)Wedge-shaped head