Neurosurgery
Text test tasks
1
A.
B.
C.
D.
E.
Epidural hematomas are frequently followed by
*Skull fractures
Nasal liquorrhoea
Auricular liquorrhoea
Ventricular hematomas
Pneumocephalus
2
A.
B.
C.
D.
E.
Epidural hematomas are mostly limited by
Cerebral cortex
Choroid plexuses
Falciform processus
Tentorium cerebelli
*Skull sutures
3
A.
B.
C.
D.
E.
Acute traumatic intracranial hematomas are characterized by
Foster-Kennedy syndrome
Pulsatile exophthalmus
*Symptom "lucid period"
Bruns' syndrome
Complete block of subarachnoid space during Queckenstedt test
4
A.
B.
C.
D.
E.
Acute traumatic intracranial hematomas are characterized by
*Anisocoria
Anisocytosis
Hemibalismus
Hemihyperaesthesia
Hemiathetosis
5
A.
B.
C.
D.
E.
Acute traumatic intracranial hematomas are characterized by
Hemiparesis or hemiplegia on the side of hematoma
*Hemiparesis or hemiplegia on the contralateral side
Hemianaesthesia or hemiplegia on the side of hematoma
Choreoathetosis on the contralateral side
Hemibalismus on the contralateral sided
6
A.
B.
C.
D.
E.
Acute traumatic intracranial hematomas are manifest with
Hypersalivation
Hyperhydrosis
*Seizures
Acute adrenal failure
Toxic shock
7 Bradycardia, hemiparesis and midriasis are classic presentation of
A. Carotid-cavernous fistula
B. Arnold-Chiari anomaly
C. Pituitary tumor
D. Compression vascular neuropathy
E. *Traumatic intracranial hematoma
8
A.
B.
C.
D.
E.
Sources for formation of epidural hematomas are
Cerebral arteries and veins
Choroid plexus of the 4th ventricle
Galen's vein
Diploic vessels of cranial bones
*Meningeal arteries
9
A.
B.
C.
D.
E.
Sources for formation of subdural hematomas are
Anterior choroid artery
*Pial veins
Choroid plexuses of the lateral ventricles
Choroid plexus of the 4th ventricle
Arteries of the circle of Willis
10
A.
B.
C.
D.
E.
There exist the following types of intracranial hematomas
Epidural
*Intradural
Subdural
Intracerebral
Intraventricular
11
A.
B.
C.
D.
E.
Major type of memory disorders in head injury are
Congrade amnesia
Anterograde amnesia
*Retrograde amnesia
Anteroretrograde amnesia
Cognitive amnesia
12
A.
B.
C.
D.
E.
Anisocoria in right-side subdural hematoma presents with
Left-side myosis
Right-side ptosis
Right-side myosis
*Left-side mydriasis
Right-side mydriasis
13
A.
B.
C.
D.
E.
The following types of pressed skull fractures are distinguished
Impressive
*Expressive
Depressive
Linear
Perforated
14 Causes of early prolapse of the brain are
A. *Brain edema and swelling
B. Bevelopment of encephalitis
C. Development of brain abscess
D. Acute hydrocephalus
E. Formation of intracranial hematomas
15
A.
B.
C.
D.
E.
Acute intracranial hematomas are those which form
During the first 5 days
During the first 14 days
*During the first 3 days
During the first 6 days
During the first 10 days
16
A.
B.
C.
D.
E.
Subacute intracranial hematomas are those which form
During the first 3 days
*During the first 3-14 days
During the first 6 days
During the first 7-20 days
During the first 1-30 days
17
A.
B.
C.
D.
E.
Chronic intracranial hematomas are those which form
In 3 days
*In 14 days
In 10 days
In 7 days
In 12 days
18
A.
B.
C.
D.
E.
Cause of brain compression in head injury are
*Intracranial hematomas
Impressed skull fractures
Fractures of the cranial basis
Pneumocephalus
Subdural hydromas
19
A.
B.
C.
D.
E.
Causes of brain compression in head injury are
Perforated skull fractures
Brain edema and swelling
Foreign bodies
Subarachnoid bleeding
Epidural hematomas
20
A.
B.
C.
D.
E.
As brain decompression measures in head injury the following are performed
Decompression trepanations
Defect cranioplasty
Dehydratation
Liquidation of the impressed fracture
*Removal of the intracranial hematomas
21 During decompressive skull trepanation
A. *Dura mater is dissected
B. Dura mater is never cut open
C. All right
D. All wrong
E. It’s not important
22
A.
B.
C.
D.
E.
Primary cranioplasty for the skull defect si performed
*In the first 2 days
Up to 14 days
To 2 months
After 2 months
After 2 years
23
A.
B.
C.
D.
E.
Primarily-postponed cranioplasty of the skull defects is performed
In the first 2 days
*Up to 14 days
Up to 2 months
After 2 months
After 2 years
24 In diffuse axonal injury clinical presentations determined by morphological changes
occurring at the level
A. In the cortical regions of the frontal lobes
B. *In the deep regions of the brain with impairment of the white matter, corpus callosum
and subcortical structures
C. In the medulla with lesions of the nuclei of the cranial nerves
D. In the upper cervical region of the spinal cord and in the medulla
E. All right
25
A.
B.
C.
D.
E.
Diffuse axonal injury most often presents with
Prolonged comatose status
*Vegetative status
Practically always with meningeal syndrome
Pyramid-extrapyramid tetrasyndrome
Mild transient and focal symptoms
26 In the syndrome of prolonged compression of the head primary surgical debridement of
the head wounds
A. *Is early and is performed during the first hours in the injury admission ward
B. Is postponed and is performed in the specialized facilities
C. Surgical debridement is not performed
D. Is late and is performed in the general surgical inpatient departments
E. Is early and is performed in the general surgical inpatient departments
27
A.
B.
C.
D.
E.
Fatty embolization of the cerebral vessels in head injury is observed
In fracture of the cranial basis
In multiple fractures of the calvarium
*In joint cranioskeletal trauma
In gunshot skull fractures
In isolated intracranial hematomas
28
A.
B.
C.
D.
E.
During emergency medical care in head injury foreign bodies off the brain
Should be necessarily removed
Are removed through active aspiration and dissection of the brain substance
It’s not important
*Are not removed
The foreign bodies with even edges made of hard material are predominantly removed
29 Combined head injury is
A. *Constellation of various injuries including head injury which develop as the result of
simultaneous impact of various damaging factors
B. Constellation of various injuries including head injury which develop as the result of
simultaneous impact of mechanical factor on several regions of the body
C. Constellation of various injuries including head injury which develop as the result of
simultaneous impact of chemical factor on several regions of the body
D. Fractures of the bones of the calvarium which combine with intracranial hematomas d
intracranial hematomas which combine with trauma of the facial skeleton
E. Constellation of various injuries including head injury which develop as the result of
simultaneous impact of mechanical factor on several regions of the body
30 Joint head injury is
A. *Constellation of various injuries including head injury which develop as the result of
simultaneous impact of mechanical factor on several regions of the body
B. Constellation of various injuries including head injury which develop as the result of
simultaneous impact of various damaging factors
C. Combination of fractures of the bones of calvarium with intracranial hematomas or
liquorrhoea
D. Combination of fractures of the bones of calvarium with trauma of the facial skeleton
E. Constellation of various injuries including head injury which develop as the result of
simultaneous impact of various damaging factors
31
A.
B.
C.
D.
E.
According to Glasgow coma scale a severe head injury would score
1-2 points
*3-7 points
8-10 points
8 points
10-12 points
32
A.
B.
C.
D.
E.
According to Glasgow coma scale a moderately severe head injury would score
1-2 points
3-7 points
12-15 points
5-7 points
*8-12 points
33
A.
B.
C.
D.
According to Glasgow coma scale a mild head injury would score
3-5 points
7-10 points
13-15 points
*10-12 points
E. 8 points
34
A.
B.
C.
D.
E.
Nasal liquorrhoea most often occurs in fractures in the region of
Frontal sinus
Petrosus part of the temporal bone pyramid
Cribriform plate
Ethmoidal bone
Occipital bone
35
A.
B.
C.
D.
E.
Auricular liquorrhoea most often occurs in fractures in the region of
Petrosus part of the temporal bone pyramid
Frontal sinus
Cribriform plate
Sphenoidal sinus
Ethmoidal bone
36
A.
B.
C.
D.
E.
Supplemental methods in diagnostics of liquorrhoea are
Glucotest
Endoscopic examination
Echo-encephalography
Radioisotope gamma-cisternography
*CT-cisternography
37
A.
B.
C.
D.
E.
Meningeal syndrome is most often in the clinical presentation of
Brain concussion
Brain contusion
Chronic subdural hematoma
Chronic subdural hydroma
*Subarachnoid hemorrhage
38 According to the type of wound canal there are no the following type of gunshot
craniocerebral injury
A. Perforating
B. Blind
C. Open
D. Yangent
E. *Subaponeurotic
39
A.
B.
C.
D.
E.
Inflammatory craniocerebral complications of the head injury NOT include
Ventriculitis
Liquorrhoea
Abscess
Meningitis
Encephalitis
40
A.
B.
C.
None-inflammatory craniocerebral complications of the head injury include
Posttraumatic granulomas
*Dislocation syndromes
Thromboembolism of cerebral vessels, brain infarction
D. Late prolapse of the brain
E. Collapse of the brain
41
A.
B.
C.
D.
E.
Extracranial complications NOT INCLUDE
Shock
DIC syndrome
Pneumonia
Liquorrhoea
Acute cardiovascular failure, cardiac rhythm disorders
42 In which cases should head injury be considered an open one
A. Injury of the skull and brain with contusions and wounds of the soft tissues without
lesion of the aponeurosis
B. Injury of the skull and brain with contusions and wounds of the soft tissues with the
lesion of aponeurosis
C. All cases of CCT with liquorrhoea
D. Head injury with any types of calvarium fractures
E. All right
43
A.
B.
C.
D.
E.
Penetrating head injury is considered to be
Open head injury with rupture of the arachnoid
Open head injury with injury of the dura mater
Open head injury with pneumocephalus
Open head injury with hydrocephalus
Open head injury with rupture of the aponeurosis
44 The following changes occurs in brain concussion
A. Solitary ruptures of axons in the diencephalic regions of the brain
B. *Ultra structural changes such as injury of the synaptic membranes, cellular organelles,
redistribution of the cellular fluid
C. Small focal changes in the cortical regions of frontal and temporal lobes as well as
microscopic hemorrhages in the paraventricular zones
D. Cerebral hemorrhage
E. Subarachnoid hemorrhage
45
A.
B.
C.
D.
E.
The course of head injury has the following periods
Acute
Final
Remote
A and B right
All right
46
A.
B.
C.
D.
E.
Cephalohematoma is
Subcutaneous hematoma
Subaponeurotic hematoma
*Subperiostal hematoma
Subdural hematoma
Multi-storey hematoma
47
A.
B.
C.
D.
E.
The optimal treatment method in cephalohematomas is
Dissection with further drainage
*Puncture removal
Total removal with its capsule
Total removal with bone resection
Decompressive cranial trepanation
48
A.
B.
C.
D.
E.
Type of consciousness disorders in severe head injury are
Torpor
Sopor
*Coma
Shock
Amnesia
49
A.
B.
C.
D.
E.
For brain concussion typical consciousness disorder is
*Short-term unconsciousness
Multiple vomiting
One-time vomiting
Headache
Presence of mild dislocation syndromes
50
A.
B.
C.
D.
E.
Among the trasient focal symptoms in brain concussion the most frequent is
Spontaneous horizontal nystagmus
Brudzinskiy symptom
*Marinesku-Radovici symptom
Lasseg's symptom
Weakness of convergence
51 The method of choice in therapeutic tactics in traumatic subarachnoid hemorrhages is
A. Urgent surgical intervention aimed at arresting of the bleeding and decompression of the
brain
B. *Unloading lumbar punctures
C. Selective neurosurgical intervention aimed at decompression of the brain in 7-10 days
after injury
D. Stereotactic clipping of the pia mater vessels in 7-10 days after injury
E. All right
52
A.
B.
C.
D.
E.
Subdural hematomas are located
Between the aponeurosis and the periosteum
*Between the dura and the arachnoid mater
Between the dura and the periosteum
In the great occipital cistern
All are wrong
53
A.
B.
C.
D.
In case of subdural hematoma and dislocation of the brain is indicated
*Urgent neurosurgical intervention
Dynamic follow-up in the intensive care unit
Hemostatic therapy and dynamic follow-up in the neurologic department
Urgent lumbar puncture, especially in hematomas of the posterior cranial fossa
E. All are wrong
54
A.
B.
C.
D.
E.
Method of surgical treatment of acute subdural hematomas is
Removal through the drilled openings
*Removal during skull trepanation
Endovascular removal
Stereotactic removal
Puncture removal of the hematoma
55
A.
B.
C.
D.
E.
Subdural hydromas are
Subarachnoid accumulation of CSF
Accumulation of exudate under the dura
*Accumulation of CSF under the dura
Accumulation of liquid blood under the dura
Accumulation of transsudate under the dura
56
A.
B.
C.
D.
E.
Methods of surgical threatment of subdural hydromas
*Puncture emptying through the drilled opening
Stereotactic removal
Prolonged endolumbar drainage
Endovascular removal
All are wrong
57
A.
B.
C.
D.
E.
Peculiarities of head injury in the eldery and senile age
*Hypertensive syndrome is mildly prominent
Hypertensive syndrome is almost always present
Severe consciousness disorders develop frequently
Relatively severe lesions of the brain
Brain lesions are relatively milder than those in young and middle-aged patients
58
A.
B.
C.
D.
E.
Peculiarities of head injury in alcoholic intoxication are
Relatively mild course
Consciousness disorders are often more prominent and prolonged
Quick progression of intracranial hypertension
Hypertensive syndrome is mildly prominent
Prominent vestibular and vegetative disorders
59
A.
B.
C.
D.
E.
Growing cranial bone fractures are most typical for
Children younger than 3 years old
*Elderly and senior people
For patients with skull base fractures
For patients with injuries of the calvarium
All right
60
A.
B.
C.
D.
Peculiarity of epidural hematomas in children is
Limitation to a single bone (along the suture line)
*Frequently spreads beyond the limits of cranial sutures
A and B right
Don’t spreads beyond the limits of cranial sutures
E. All right
61
A.
B.
C.
D.
E.
Shock in isolated head injury
*Is rather frequent (in 10-15% of cases)
Is practically never observed (1-2% cases)
In 50% of cases
In 100% of cases
All wrong
62
A.
B.
C.
D.
E.
In case of epidural hematoma the following is indicated
*Urgent neurosurgical intervention
Urgent lumbar puncture to determine the size of hematoma
Dynamic follow-up (control CT or MRI) in the settings of intensive care unit
Stereotactic removal
Endovascular removal
63
A.
B.
C.
D.
E.
The method of choice for surgical treatment of acute epidural hematomas is
*Removal by means of trepanation
Endovascular removal
Puncture removal through the drilled openings
Stereotactic removal
Urgent lumbar puncture
64
A.
B.
C.
D.
E.
Major indirect mechanism of spine injury are
*Hyperflexion
Traction
Hyperextension
Rotation
Axial compression
65 Clinical signs of dislocation in the cervical spine are
A. *Forced position of the head, severe pain, especially during head movements, neck
muscle
tension
B. Free course of the disease, mild crackle during maximal rotations of the head
C. Continuous vomiting, generalized epileptic seizures, presence of alternating syndromes
D. A and B right
E. B and C right
66
A.
B.
C.
D.
E.
Hematomyelia is
Hemorrhage under the spinal meninges
Hemorrhage into the white matter of the spinal cord
Hemorrhage into the grey matter of the spinal cord
Hemorrhage into the peripheral nerves
All wrong
67 Major method for treatment of hematomyelia is
A. Urgent neurosurgical intervention with resection of obviously non-viable regions
B. *Conservative (medical) treatment (hemostatic therapy, hypothermia etc.)
C. Combmation of a neurosurgical intervention aimed at resection of non-viable regions of
the spinal cord and intensive conservative treatment
D. A and B right
E. B and C right
68
A.
B.
C.
D.
E.
Most common cause of spinal cord compression in trauma are
Spinal meningeal hematomas
*Bones or their fragments
Ligaments
Foreign bodies
Intervertebral disks
69
A.
B.
C.
D.
E.
Most typical signs of injury of the thoracic spine at the level of Th4-Th5 are
Spastic tetraplegia, central-type disorders of urinary bladder function
Superior flaccid paralysis and inferior spastic paralysis
*Inferior spastic paralysis, central-type disorders of urinary bladder function
Inferior flaccid paralysis, peripheral- type disorders of urinary bladder function
All wrong
70 Most typical signs of the cervical spine at the level of C3- C4 are
A. *Spastic tetraplegia, central-type disorders of urinary bladder function
B. Superior flaccid paralysis and inferior spastic paralysis, central-type disorders of urinary
bladder function
C. Superior spastic paralysis, central-type disorders of urinary bladder function d spastic
tetraplegia, peripheral-type disorders of urinary bladder function
D. A and B right
E. All right
71
A.
B.
C.
D.
E.
Which spinal cord injury should undergo surgical treatment
Concussion
Contusion
Compression
Complete anatomic rupture
Hematomyelia
72
A.
B.
C.
D.
E.
To prevent urosepsis in patients with spinal injury the following are necessary
*Constant catheterization of the urinary bladder with periodical irrigation with antiseptics
Application of the inflow-outflow Monroe system
Urethral plastics
Subarachnoid space dranage
All right
73
A.
B.
C.
D.
E.
Short–term inflammatory complications of the spinal injury include
*Purulent epiduritis
Purulent meningomyelitis
Spinal cord abscess
Posttraumatic aseptic arachnoiditis
All right
74
A.
B.
C.
D.
E.
Which is the major absolute contraindication for spinal puncture
High blood pressure
Soporous consciousness disorders
Pregnancy
Acute urinary retention
*Hypertensive syndrome
75
A.
B.
C.
D.
E.
Which radiographic signs are not the evidence of increased cranial pressure
Enlarged digital impressions
Emphasized sutures of the calvarium
Osteoporosis of the dorsum of sella turcica
*Hyperostosis of the temporal bone
All right
76
A.
B.
C.
D.
E.
Indicate the reasons of increased cranial pressure
Brain abscess
Brain tumor
Edema-swelling of the brain, trauma
*All of the mentioned above
None of the mentioned above
77
A.
B.
C.
D.
E.
Select indications for carotid cerebral angiography
Meningitis
Suspicion of the cerebellar tumor
Suspicion of the craniospinal tumor
*Spontaneous subarachnoid hemorrhage
None of the abovementioned
78
A.
B.
C.
D.
E.
Which are the major clinical signs of traumatic subarachnoid hemorrhage
Blood in the CSF
Severe headache
Meningeal signs
Fever
*All of the above mentioned
79
A.
B.
C.
D.
E.
In what nosologic forms of brain injury disease is symptom “lucid period”
Brain contusion
Brain concussion
*Subdural hematoma
Subarachnoid hemorrhage
None of the listed
80
A.
B.
C.
D.
E.
Transition from prolonged coma to stable or transient vegetative status is taking place in
Brain concussion
*Diffuse axonal lesion of the brain
Subdural hematoma
Brain tumor
Epidural hematoma
81 Which of the listed methods of investigation should the patient with head injury undergo
first of all:
A. Chest X-ray
B. General blood analysis
C. Ultrasonography of chest organs
D. *Skull X-ray in two projections
E. ECG
82
A.
B.
C.
D.
E.
Which of the listed symptoms is not informative in fracture of the cranial basis:
*Auricular liquorrhoea
"eyeglasses" symptom
Eosinophilia
Subarachnoid hemorrhage
Anemia
83
A.
B.
C.
D.
E.
Detection of blood in the CSF is typical in:
Brain concussion
Epidural hematoma
Spinal cord concussion
*Subarachnoid hemorrhage
Tuberculous meningitis
84
A.
B.
C.
D.
E.
Persistent anisocoria with stagnant disks of the optic nerves can be observed in case of:
*Chronic subdural hematoma
Contusion of the cervical spinal cord
Subarachnoid hemorrhage
Linear fracture of the temporal bone
Brain concussion
85
A.
B.
C.
D.
E.
Indicate major clinical signs of the cerebellar tumor
Insomnia
Unsteady gait
Position headaches
*Impaired movement coordination
None of the above mentioned
86
A.
B.
C.
D.
E.
Indicate major clinical signs of the tumor of ponto-cerebellar angle
Tinnitus in one ear with decreased hearing in the same ear
Vestibular disorders
*Spontaneous nystagmus
Polydipsia
None of the above mentioned
87
A.
B.
C.
D.
E.
Which of the listed symptoms indicate eosinophilic adenoma:
*Acromegaly, gigantism
Amenorrhoea, decreased libido
Bitemporal hemianopsia
Fever
None of the abovementioned
88 In basophilic pituitary adenoma (Itsenko-Cushing`s syndrome) the following clinical
signs are observed
A. Cachexia
B. Arterial hypotension
C. Callergy
D. Fever
E. *None of the abovementioned
89
A.
B.
C.
D.
E.
Indicate direct radiologic signs of the brain tumor
Disconnection of sutures, their emphasis
Dislocation of pineal body
*Hyperostosis or osteoporosis of the adjacent to the tumor bone section
Bone destruction
None of the abovementioned
90
A.
B.
C.
D.
E.
Meningeal tumors of the brain do not include:
Meningioma
*Sarcoma
Glioblastoma
Meningosarcoma
None of the abovementioned
91
A.
B.
C.
D.
E.
Focal neurologic symptoms in brain tumors are devided into
*Primary and secondary focal
Dislocation symptoms
Neighboring symptoms
None of the abovementioned
All of above mentioned
92
A.
B.
C.
D.
E.
Foster-Kennedy symptom is observed in:
Tumors of the pole of the frontal lobe
Tumors of the occipital lobes
Tumors of the temporal lobe
Tumors of the parietal lobes
Cerebellar tumors
93
A.
B.
C.
D.
E.
For tumors of the pineal gland most typical is:
Endocrine and metabolic disorders
Epileptic seizures
Homonymic hemianopsia
Central paralysis
Movement coordination disorders
94
A.
B.
C.
D.
E.
Which of the listed factors is not typical for spinal osteochondrosis
Degenerative changes of the intervertebral disks
Reactive changes in the vertebrae
Reactive changes m the ligaments
Impaired congruence of the intervertebral joints
*Osteoporosis of bodies and arches of the vertebrae
95
A.
B.
C.
D.
E.
Direct causes for initial manifestations of osteochondrosis are:
*Mechanical factor (weight lifting, abrupt movement)
Weakening of the abdominal press after surgeries and deliveries
Consequences of previous infections and hypothermia
All of the above mentioned
None of above mentioned
96 Which of the symptoms is not typical for subarachnoid hemorrhage in rupture of arterial
aneyrism of cerebral vessels:
A. Kernig's symptom
B. Brudzinskiy's symptom
C. Occipital stiffness
D. Paresis of the oculomotor nerve
E. *Horner's symptom
97 Which of the listed clinical manifestations is not typical for arteriovenous malformations
of the brain:
A. Epileptic seizure
B. Syndrome of the intracranial hypotension
C. Recurrent ischemic disorders of the cerebral circulation
D. *Intracranial hemorrhage
E. None of about mentioned
98
A.
B.
C.
D.
E.
Intracranial surgeries in prosopalgis include
Transection of the 1 branch of trigeminal nerve
Janet's surgery
*Transection of the 2 branch of trigeminal nerve
Transection of the 3 branch of trigeminal nerve
Transection of glossopharyngeal nerve
99
A.
B.
C.
D.
E.
In what type of prosopalgia “status neuralgicus” developes most frequently
*Trigeminal neuralgia
Neuralgia of occipital nerves
Glossopharyngeal neuralgia,
Periodic facial neuralgia
Migrame
100Which of the listed factors is etiologic for pevelopment of pain paroxysm in the zone of
V pair of cranial nerves?
A. Foci of chronic infection in the oral cavity
B. Narrowing of bone canals
C. Malocclusion
D. Compression of the nerve root by the superior cerebellar artery
E. *All of the abovementioned
101Symptomatic trigeminal neuralgia can develop in:
A. Spinal cord tumors
B. Arterial aneurism
C. Narrowing of the bone canals
D. Compression of the nerve root by superior cerebellar artery
E. All of the mentioned above
102Jannet's surgery is performed in case of:
A. *Trigeminal neuralgia due to vaso-neural conflict
B. Trigeminal neuralgia due to narrowing of bone canals
C. Neuralgias of occipital nerves
D. Neuralgias of glossopharyngeal nerve
E. Neuralgias of cilliary ganglion
103Informative symptom in detection of hydrocephalus in newborn and infants is:
A. Increased motor activity
B. Impaired statics
C. Flaccidity, adynamia
D. *Increasing of the size of the head
E. Increased excitability
104What method of treatment of hydrocephalus do you know
A. Perforation of the septum pellucidum
B. Dissection of the cerebellar vermis
C. Puncture of corpus callosum
D. *Ventriculoperitneostomy
E. Brain tumor removal
105Tremor in the hands that is most obvious when the patient is awake and trying to perform
an action is most likely due to disease in which of the following structures?
A. Thalamus
B. *Cerebellum
C. Substantia nigra
D. Spinal cord
E. Internal capsule
106In the person with Parkinson's disease, the tremor that is evident when a limb is at rest
changes in what way when the patient falls asleep?
A. It becomes more rapid
B. Its amplitude increases
C. It generalizes to limbs that were uninvolved when the patient was awake
D. *It disappears
E. It transforms into choreiform movements
107Dysdiadochokinesia is an impairment of
A. Successive finger movements
B. Heel-to-toe walking
C. *Rapid alternating movements
D. Tremor suppression
E. Conjugate eye movements
108The most common cause of stroke is
A. *Atherosclerosis
B.
C.
D.
E.
Fibromuscular dysplasia
Mitral valve prolapse
Arterial dissection
Meningovascular inflammation
109A pure motor stroke is most likely with damage to the
A. *Internal capsule
B. Cerebellum
C. Putamen
D. Caudate
E. Amygdala
110A pure sensory stroke is most likely with damage to the
A. Internal capsule
B. *Thalamus
C. Hippocampus
D. Globus pallidus
E. Pons
111The focal weakness lasting for 24 h was most likely attributable to
A. Intracerebral hemorrhage
B. Subarachnoid hemorrhage
C. Encephalitis
D. *Todd's paralysis
E. Hyponatremia
112The episodes of visual loss are most likely related to
A. Retinal vein thrombosis
B. *Central retinal artery ischemia
C. Posterior cerebral artery ischemia
D. Middle cerebral artery ischemia
E. Posterior ciliary artery ischemia
113Basilar migraine differs from classic migraine in the
A. Sex of the persons most often affected
B. Resistance of the visual system to involvement
C. *Severity of symptoms
D. Duration of the aura
E. Sequence of neurologic deficits and headache
114Both trigeminal neuralgia and atypical facial pain involve pain that may be
A. Lancinating
B. Paroxysmal
C. Associated with anesthetic patches
D. Abolished with resection of the gasserian ganglion
E. *Unilateral
115Magnetic resonance imaging (MRI) of the patient's first few hours of injury should reveal
A. A normal brain
B.
C.
D.
E.
Intracerebral hematoma
Temporal lobe contusion
Subarachnoid hemorrhage
*Epidural hematoma
116Computed tomography scanning of the patient's head within 2 h of the injury should
reveal
A. A normal brain
B. *A lens-shaped density over the frontal lobe
C. Increased CSF density with a fluid-fluid level
D. Multifocal attenuation of cortical tissue
E. Bilateral sickle-shaped densities over the hemispheres
117The next day the patient's spinal fluid cultures begin growing Listeria monocytogenes.
The drug of choice in this case now is
A. Penicillin G
B. *Ampicillin plus gentamicin
C. Tetracycline
D. Ceftriaxone
E. Rifampin
118A CT scan reveals several rim-enhancing lesions with minimal mass effect. An
appropriate investigation at this point would be to
A. Get a cerebral angiogram
B. Order a ventricular cerebrospinal fluid (CSF) aspiration
C. *Perform a lumbar puncture and include cerebrospinal fluid for Epstein-Barr virus
(EBV) PGR in tests ordered
D. Stop all antiretroviral therapy
E. Treat with intravenous acyclovir
119The patient turns out to have CNS Toxoplasma gondii. Which of the following is the best
treatment?
A. Intravenous acyclovir
B. Neurosurgical removal of the lesions
C. Oral fluconazole
D. *Sulfadiazine and pyrimethamine
E. Thiabendazole
120Localization of an encephalitis to the medial temporal or orbital frontal regions of the
brain is most consistent with
A. Treponema pallidum
B. Varicella zoster virus
C. *Herpes simplex virus
D. Cryptococcus neoformans
E. Toxoplasma gondii
121Neuroimaging of the brain before attempting a lumbar puncture is advisable in cases of
acute encephalitis because
A. The diagnosis may be evident on the basis of magnetic resonance imaging (MRI) alone
B. *Massive edema in the temporal lobe may make herniation imminent
C. The computed tomography (CT) picture may determine whether a brain biopsy should be
obtained
D. Shunting of the ventricles is usually indicated, and the imaging studies are needed to
direct the placement of the shunt
E. It may establish what pathology is responsible
122The cranial neuropathy most commonly found with Lyme disease is that associated with
damage to cranial nerve
A. Ill
B. V
C. *VII
D. IX
E. XII
123The medication most appropriate in patients with CNS involvement by B. burgdorferi is
A. Streptomycin
B. *Ceftriaxone
C. Gentamicin
D. Isoniazid
E. Rifampin
124Abscesses in the brain most often develop from
A. *Hematogenous spread of infection
B. Penetrating head wounds
C. Superinfection of neoplastic foci
D. Dental trauma
E. Neurosurgical intervention
125The most common site for abscess formation in the brain is the
A. Put amen
B. Thalamus
C. Head of the caudate
D. *Gray-white junction
E. Subthalamus
126Most of the organisms found in brain abscesses are
A. *Streptococcal
B. Staphylococcal
C. Bacteroides spp.
D. Proteus spp.
E. Pseudomonas spp.
127The most common cause of brain abscess in patients with AIDS is
A. Cryptococcus neoformans
B. *Toxoplasma gondii
C. Tuberculosis
D. Cytomegalovirus
E. Herpes zoster
128The most common complaint in patients with brain abscess is
A. Nausea and vomiting
B. Ataxia
C. *Headache
D. Neck stiffness
E. Seizures
129The most common sources of primary brain tumors are
A. *Glial cells
B. Neurons
C. Meningeal cells
D. Lymphocytes
E. Endothelial cells
130The most common type of primary brain tumor is
A. Meningioma
B. *Astrocytoma
C. Lymphosarcoma
D. Oligodendroglioma
E. Medulloblastoma
131Most brain tumors in children are
A. Metastatic lesions from outside the central nervous system (CNS)
B. Oligodendrogliomas
C. Glioblastomas multiforme
D. Meningiomas
E. *Infratentorial
132The incidence of primary brain tumors in children—about 1 to 5 per 100,000 per year—
is mainly accounted for by
A. Meningiomas and neurofibromas
B. *Astrocytomas and medulloblastomas
C. Melanomas and choriocarcinomas
D. Gliomas and adenomas
E. Colloid cysts of the third ventricle
133Further evaluation reveals multiple brain masses. The most common source of metastatic
tumors to the brain is the
A. Breast
B. *Lung
C. Kidney
D. Skin
E. Uterus
134Metastatic lesions to the brain most often appear
A. *At the gray-white junction
B. In the thalamus
C. In the posterior fossa
D. In the caudate
E. In the sella turcica
135The shortest life expectancy with metastatic disease to the brain will be found in the
patient with metastatic
A. *Malignant melanoma
B. Breast cancer
C. Lung cancer
D. Renal cancer
E. Prostate cancer
136A patient has a MRI performed and a colloid cyst of the third ventricle is identified. The
most common complication of this lesion is
A. Bitemporal hemianopsia
B. *Hydrocephalus
C. Gait ataxia
D. Optic atrophy
E. Oscillopsia
137The tumor type that is common in the brain of patients with AIDS, but otherwise
extremely rare, is
A. Lymphocytic leukemia
B. Metastatic lymphoma
C. *Primary lymphoma
D. Kaposi s sarcoma
E. Lymphosarcoma
138With an ependymoma of the posterior fossa, the patient is at risk of dying because of
A. *Transforaminal herniation
B. Emboli from the tumor
C. Vascular occlusion by the tumor
D. Hemorrhagic necrosis of the tumor
E. Status epilepticus
139The most common cause of dementia in the general population is
A. Epilepsy
B. Vascular disease
C. *Alzheimer's disease
D. Parkinsons disease
E. Head trauma
140In the dementia associated with Alzheimer's disease, the EEG will usually show
A. Spike-and-wave discharges
B. Periodic frontal lobe discharges
C. Focal slowing
D. *Generalized background slowing
E. An isoelectric record
141The brain of the adult with trisomy 21 (Down syndrome) exhibits many of the
histopathologic features of which of the following?
A. Tay-Sachs disease
B. Friedreich s disease
C. Picks disease
D. Parkinsons disease
E. *Alzheimer's disease
142A patient gives a history of chorea gravidarum. This condition only occurs in
A. Newborns
B. Depressed men
C. *Pregnant women
D. Pubescent girls
E. Pubescent boys
143Atrophy in the head of the caudate nucleus in patients with Huntington's disease affects
the shape of the
A. Cerebellum
B. *Lateral ventricle
C. Third ventricle
D. Lenticular nuclei
E. Temporal lobe
144Which brain structures are currently targets for deep brain stimulation in patients with
Parkinson`s disease?
A. Globus pallidus, medulla, and parietal lobe
B. *Globus pallidus, subthalamic nucleus, and thalamus
C. Hippocampus, medulla, and thalamus
D. Medulla, occipital lobe, and subthalamic nucleus
E. Parietal lobe, temporal lobe, and thalamus
145Which of the following would you use to treat person with Parkinson`s disease ?
A. Alteplase
B. *Carbidopa-levodopa
C. Glatiramer
D. Interferon p-lA
E. Sertraline
146Neurons remaining in the substantia nigra of the patient with Parkinson`s disease may
exhibit
A. Intranuclear inclusion bodies
B. Intranuclear and intracytoplasmic inclusion bodies
C. *Intracytoplasmic inclusion bodies
D. Neurofibrillary tangles
E. Amyloid plaques
147The CSF in persons with multiple sclerosis will typically exhibit
A. Glucose content of less than 20% of the serum content
B. Persistently elevated total protein content
C. *Persistently elevated immunoglobulin G (IgG) content
D. Mononuclear cell counts of greater than 100 cells per L
E. Erythrocyte counts of greater than 10 cells per L
148The most appropriate pharmacological treatment for multiple sclerosis is
A. Interferon (5-IB
B. *Corticosteroids
C. Gabapentin
D. Glatiramer
E. Pramipexole
149 Multiple sclerosis is the most common demyelinating disease in the United States,
affecting approximately 1 person in
A. 100
B. 500
C. *1,000
D. 5,000
E. 10,000
150The evoked response pattern that is most often abnormal in patients with early multiple
sclerosis is the
A. Brainstem auditory evoked response (BAER)
B. Far-field somatosensory evoked response (SSER)
C. *Visual evoked response (VER)
D. Jolly test
E. Sensory nerve conduction test
151Cystometrographic analysis of bladder function in the patient with multiple sclerosis is
likely to show which of the following abnormalities?
A. Bladder hypotonia
B. Large residual volume of urine
C. *Premature bladder emptying
D. Good voluntary control of bladder emptying
E. Urinary tract infection
152Which of the following factors might be expected to worsen the condition of patient with
multiple sclerosis?
A. Bright lights
B. Red wine
C. Tyramine-containing compounds
D. *Hot weather
E. Amantadine
153The second cervical vertebra extends above the level of the foramen magnum and places
the patient at high risk of having
A. Meningoencephalocele
B. Myelomeningocele
C. Syringobulbia
D. Syringomyelia
E. *Brainstem compression
154With agenesis of the corpus callosum, magnetic resonance imaging (MRI) will reveal
A. Atrophy of the frontal lobes
B. *Abnormally shaped lateral and third ventricles
C. Cerebellar aplasia
D. Schizencephaly
E. Encephaloclastic porencephaly
155Congenital hydrocephalus may develop as a consequence of which first-trimester
maternal disorder?
A. Complicated migraine
B. *Viral infection
C. Pseudotumor cerebri
D. Chorea gravidarum
E. Intervertebral disk herniation
156Uncorrected congenital hydrocephalus will usually produce which of the following?
A. Dolichocephaly
B. Brachycephaly
C. Holoprosencephaly
D. *Macrocephaly
E. Microcephaly
157Adenoma sebaceum of the face is especially common with which of the following
diseases?
A. Neurofibromatosis
B. Sturge-Weber syndrome
C. *Tuberous sclerosis
D. Ataxia telangiectasia
E. Fragile X syndrome
158Calcifications evident on the skull x-ray or CT scan of a patient with tuberous sclerosis
usually represent
A. *Calcified subependymal glial nodules
B. Calcified meningeal adhesions
C. Meningeal psammoma bodies
D. Calcified astrocytomas
E. Calcified granulomas
159The treatment of choice for children with infantile spasms is
A. Carbamazepine (Tegretol)
B. Phenobarbital
C. Phenytoin (Dilantin)
D. Divalproex sodium (Depakote)
E. *Adrenocorticotropic hormone (ACTH)
160The newborn infant with motor neuron disease is likely to exhibit
A. Seizures
B. *Hypotonia
C. Hypsarrhythmia
D. Mora reflexes
E. Spina bifida
161Many children with Tay-Sachs disease develop blindness before they die, with retinal
accumulation of gangliosides that produces
A. Optic neuritis
B. *Cherry red spots
C. Chorioretinitis
D. Retinal detachments
E. Waxy exudates
162Porencephaly usually develops as a consequence of
A. Fetal alcohol syndrome
B. *Vascular or other destructive injuries to the fetal brain
C. Trisomy 13
D. Trisomy 21
E. Dandy-Walker syndrome
163What percentage of patients with tuberous sclerosis have mental retardation?
A. 1
B. 10
C. 25
D. *65
E. 99
164The most obvious site of disease in myasthenia gravis is the
A. Anterior horn cell
B. *Neuromuscular junction
C. Sensory ganglion
D. Parasympathetic ganglia
E. Sympathetic chain
165The most common manifestation of muscle weakness with myasthenia gravis is
A. Diaphragmatic weakness
B. Wristdrop
C. Footdrop
D. *Ocular muscle weakness
E. Dysphagia
166Duchenne muscular dystrophy is a sex-linked disorder involving the gene responsible for
the synthesis of
A. Glucose-6-phosphatase
B. Hexosaminidase B
C. Myosin
D. *Dystrophin
E. Act in
167Duchenne dystrophy affects approximate
A. 1 in 3,000 infants
B.
C.
D.
E.
*1 in 3,000 male infants
1 in 30,000 infants
1 in 30,000 male infants
1 in 50.000 infants
168For a female child to have Duchenne dystrophy she must have
A. *Turner syndrome (XO)
B. Klinefelter syndrome (XXY)
C. Two affected parents
D. An affected father
E. An affected brother
169The spontaneous mutation rate for the dystrophin gene is presumed to be high because
A. *Men with Duchenne dystrophy do not reproduce
B. The incidence of Duchenne dystrophy is increasing
C. Numerous birth defects occur in families with Duchenne dystrophy
D. Men may become symptomatic after adolescence
E. Genetic studies of eggs in human ovaries reveal an excess of abnormal dystrophin genes
170Intellectual function in children with Duchenne dystrophy is usually
A. Markedly impaired
B. *Slightly impaired
C. Normal
D. Slightly better than that of the general population
E. Markedly superior to that of the general population
171With Duchenne dystrophy pseudohypertrophy routinely
A. Does not occur
B. Is limited to the shoulder girdle
C. Is limited to the hip girdle
D. *Is limited to the calf muscles
E. Is limited to the thigh muscles
172The shortest life expectancy is associated with which clinical sign in amyotrophic lateral
sclerosis?
A. Atrophy of the interossei
B. Atrophy of the gastrocnemius
C. Fasciculations in the lumbrical muscles
D. Atrophy of the pectoralis muscles
E. *Fasciculations in the tongue
173Triorthocresyl phosphate (TOCP) is an organophosphate that may cause lethal neurologic
complications by
A. Eliciting massive intracerebral edema
B. *Causing a severe motor polyneuropathy
C. Producing widespread CNS demyelination
D. Allowing CNS infections secondary to generalized immunosuppression
E. Inducing status epilepticus
174Early in the evolution of Meniere's disease, hearing is lost
A. Over all frequencies
B. Primarily over high frequencies
C. Primarily over middle frequencies
D. *Primarily over low frequencies
E. In virtually no patients
175The olfactory cortex in humans is located in the
A. Anterior perforated substance
B. *Lateral olfactory gyrus (prepiriform area)
C. Posterior third of the first temporal gyrus
D. Angular gyrus
E. Calcarine cortex
176The hypogonadism and anosmia of Kallman syndrome usually attract medical attention
during
A. The newborn period
B. Infancy
C. Childhood
D. *Adolescence
E. Adult life
177The posterior column neurons decussate at what level?
A. *At the medulla
B. At the midbrain
C. At the pons
D. At the thalamus
E. Within one or two levels after entering the spinal cord
178The lateral corticospinal tract decussates at what level?
A. *At the junction of the medulla and the spinal cord
B. At the junction of the midbrain and the medulla
C. At the junction of the pons and the medulla
D. At the thalamus
E. Within one or two levels after entering the spinal cord
179The arteria radicularis magna approximately what level?
A. C2-C5
B. C5-C8
C. T2-T8
D. *T10-L1
E. L4-S4
180The periumbilical area is innervated by which sensory dermatome?
A. C6
B. T2
C. T5
D. *T10
E. S3
181The patient has a greatly dilated abdominal aorta with a normal thoracic aorta. The most
likely cause of this damage is
A. Syphilis
B. Trauma
C. Chronic hypertension
D. Diabetes mellitus
E. *Atherosclerosis
182Physical examination just after transurethral resection of the prostate (TURP) reveals
preservation of some sensation in the feet. The most intact modality would be
A. *Vibration
B. Pain
C. Temperature
D. Two-point discrimination
E. Graphesthesia
183The most common cause of mononeuropathy multiplex is
A. *Diabetes mellitus
B. Temporal arteritis
C. Sarcoidosis
D. Systemic lupus erythematosus
E. Periarteritis nodosa
184Injuries limited to the upper brachial plexus are most likely with
A. Node dissections in the axilla
B. Pancoast tumor
C. *Birth trauma
D. Dislocation of the head of the humerus
E. Aneurysm of the subclavian artery
185The most prominent areas of degeneration with Friedreich's disease are in the
A. Cerebellar cortex
B. Inferior olivary nuclei
C. Anterior horns of the spinal cord
D. *Spinocerebellar tracts
E. Spinothalamic tracts
186Acute herniation of an intervertebral disk will require emergency surgery if
A. The disk is laterally herniated at C7
B. The disk is causing radicular pain
C. *The cauda equina is being crushed
D. Thoracic disk is involved
E. The filum terminale is displaced
187The presence of periorbital ecchymosis in patient should be considered a symptom of
A.
B.
C.
D.
Subdural hemorrhage
Parenchymal hematoma
Ocular injury
Retinal detachment
E. *Basilar skull fracture
188A positive Romberg test, performed standing with eyes closed, indicates a lesion in the:
A. *Cerebellum
B. Peripheral nerve
C. Proprioceptive system
D. Spinothalamic tract
E. Visual system
189With regard to the Glasgow Coma Scale:
A. The review of the head CT is essential.
B. The minimum value is zero.
C. *A score of 8 or less indicates a severe head injury.
D. Is not correlated with outcome.
E. All of above mentioned
190Management options in the treatment of intracranial hypertension secondary to trauma
include all of the following except:
A. *High dose corticosteroids.
B. Mild sedation.
C. External ventricular drainage.
D. Use of osmotic diuretics.
E. All of above mentioned
191Indications for hospital observation of a patient who has suffered a cerebral concussion
include:
A. Alcohol intoxication.
B. Abnormal CT scan.
C. Decreased level of consciousness.
D. *All of the above
E. None of the above
192With regard to diffuse axonal injury:
A. Treatment is usually surgical.
B. Neurologic outcome is usually excellent.
C. Decorticate or decerebrate posturing is frequently seen.
D. *All of the above.
E. None of the above
193With regard to acute traumatic subdural hematoma:
A. Blood products collect between the inner surface of the calvarium and the dura.
B. *Bleeding usually results from tearing of bridging veins.
C. Cerebral contusions are infrequently seen.
D. Burr hole drainage is the surgical treatment of choice.
E. None of the above
194The size of the cavity produced in the wake of a high velocity bullet is related to:
A. Mass of the bullet.
B. Velocity of the bullet.
C. Shape of the bullet.
D. None of the above.
E. *All of the above
195The most common location for spontaneous intracerebral hemorrhage secondary to
hypertension is:
A. Cerebellum
B. Cerebral white matter
C. *Basal ganglia
D. Cortex
E. Brainstem
196Venous angiomas are frequently associated with:
A. *Cavernous angiomas
B. Capillary telangiectasias
C. Arteriovenous malformations
D. None of the above.
E. All of the above
197Which of the follow findings on lumbar puncture is not suggestive of subarachnoid
hemorrhage:
A. Nonclotting blood
B. Xanthochromia
C. Red blood cell count greater than 100,000
D. *Low opening pressure
E. None of the above
198Indications for treatment of unruptured intracerebral aneurysm include all of the
following but:
A. Symptomatic lesion
B. Size greater than 10 mm
C. Size less than 10 mm
D. *History of subarachnoid hemorrhage secondary to another treated aneurysm
E. None of the above
199Indications for carotid endarterectomy include (select all that apply):
A. 50% carotid stenosis in an asymptomatic patient
B. *80% carotid stenosis in an asymptomatic patient
C. 30% carotid stenosis in a patient having frequent TIAs
D. 60% carotid stenosis in a patient who has only had a single episode of AF
E. All of the above
200The Frankel grade of a patient with sensation below the level of the injury but no motor
function below the level of the injury is:
A. A
B. *B
C. C
D. D
E. E
Situational tasks
1 A patient has been hospitalized due to closed craniocerebral trauma, fracture of the left
temporal bone. 6 hours after trauma patient's status has abruptly deteriorated, patient is
unconscious, respiration disorders have developed, tonic seizures occur periodically, pupils
are wide, reaction to light is weak, left pupil is somewhat wider than the right one. What
caused deterioration of patient's status?
A. Meningoencephalitis;
B. Stroke;
C. *Development of epidural hematoma;
D. Development of brain abscess;
E. Peculiarities of clinical course of brain contusion.
2 A 9-year old boy has fallen from the tree and has hit his occipital region; a short loss of
consciousness has taken place. Child's status is satisfactory, patient reports headaches and
dizziness. Cranial radiograms have demonstrated an impressed comminuted fracture of the
occipital bone. What treatment is indicated to this patient?
A. Anti-inflammatory therapy;
B. *Surgical intervention;
C. Hemostatic therapy;
D. Unloading lumbar punctures;
E. Complex conservative treatment.
3 Patient has a cut wound of the inferior 1/3 of the left shoulder. After the injury left hand
has hung down. Patient can not extend his wrist, abduct his thumb and extend his fingers.
Which nerve has been injured?
A. Median nerve;
B. Ulnar nerve;
C. *Radial nerve;
D. Brachial plexus;
E. Axillary nerve.
4 Patient has been transported to the specialized traumatological department in the status of
alcoholic intoxication. Psychomotor agitation was noted. A subcutaneous hemorrhage has
been detected in the left temporal region; hemorrhagic fluid is continuously flowing out of
the external acustic meatus. Patient has been diagnosed with alcohol intoxication and therapy
has been prescribed. 6 hours after admission patient has developed tonic seizures, anisocoria
(left pupil is wider than the right one) and a status of deep spoor. What is the diagnosis?
A. Alcohol delirium;
B. Brain concussion;
C. *Epidural hematoma;
D. Acute disorder of cerebral circulation;
E. Meningoencephalitis.
5 Patient became a victim of traffic accident and has hit his head against pavement. Patient's
status is severe, unconscious state, respiration is intermittent and noisy. A large wound of soft
tissues is detected in the frontal region, bone fragments are visualized as well as brain
detritus, wound is bleeding.
Indicate management tactics at the pre-hospital stage.
A. Removal of bone fragments;
B. Wound suturing;
C. *Hemostasis, aseptic dressing;
D. Removal of brain detritus;
E. Anti-edema therapy.
6 A 42-year old patient was admitted to the clinic with complaints on headache which is
worsening in the morning hours and is followed by vomiting, unsteady gait and absent
hearing in the right ear. Patient reports "darkening" in her eyes when changing her body
position. She has been ill for about 5 years. First, tinnitus in her right ear developed; she has
been examined and treated by otorhinolaryngologists with no improvement. Than her hearing
in the right ear started to deteriorate. Two years ago deafness of the right ear has occurred.
During the last year patient reports headaches in the pre-morning hours. Currently her
headache is constant and the above mentioned symptoms have developed. Determine the type
of brain lesion.
A. Otosclerosis;
B. Neuritis of the auditory nerve;
C. *Neurinoma of the auditory nerve;
D. Meningoencephalitis;
E. Insufficient circulation in the vertebra-basilar system.
7 Mother of a 9-month old infant has consulted her physician due to recurrent vomiting
which has developed a month ago. In the age of 6 months child has fallen off the 60-cm high
sofa hitting his head; there was swelling of parietal region and repeated vomiting which
lasted one day. One month after the injury cranial part of the head has started to enlarge and
the great fontanel has enlarged. Upon examination child is hypotrophic, cranial part of the
head is enlarged, skin is thin, transparent, veins on the skin of the head are dilated, the great
fontanel is tense. Establish the preliminary diagnosis.
A. Meningoencephalitis;
B. Rickets;
C. *Post-traumatic hydrocephalus;
D. Gastroenterocolitis;
E. Brain abscess.
8 Child was born at term. Parturition was uncomplicated. In the frontal region along the
midline there is a tumor-like swelling 4x4x5 cm. Over the
swelling skin is unchanged, and the swelling increasing when child is straining. No changes
were detected in the neurologic status. Determine the type of pathology.
A. Cephalhematoma;
B. *Craniocerebral hernia;
C. Hydrocephalus;
D. Osteoma;
E. Labor tumor.
9 Patient has fallen down and hit his head; there was a short loss of
consciousness. In two hours pulsating noise has developed in his right side of the head,
hyperemia of the right eye conjunctiva , right-side exophthalmus which is increasing and
weakness in the left extremities. What caused this clinical presentation?
A. Brain contusion;
B. Intracranial hematoma;
C. *Carotid-cavernous fistula;
D. Hydro ma;
E. Brain concussion.
10 A 34-year old patient is complaining of constant pain in the interscapular region,
predominantly on the left side, which increases in the recumbent position and during abrupt
movements. During coughing pain becomes darting and spreads to the left subscapular
region. Pain increases during percussion of the spinal process of Th5. A month ago patient
developed weakness in his lower extremities, numbness of his feet and shins. Sensitivity
disorders have an ascending pattern. Which is the most possible diagnosis?
A. Multiple sclerosis;
B. Intercostal neuralgia;
C. *Spinal cord tumor;
D. Spondyloarthrosis;
E. Syringomyelia.
11 A 32-year old patient has fainted when lifting heavy loads and fell down. Upon admission
his status is severe. According to his relatives' words until this event he has been practically healthy and had no complaints. No traumatic lesions
are detected on the cranium. Focal neurologic symptoms are absent. During lumbar puncture
CSF is intensely colored with blood, CSF pressure is 200 mm FkO. What is the most likely
cause of the disease;
A. Meningoencephalitis;
B. *Rupture of the aneurism;
C. Brain abscess with communication to the ventricle;
D. Brain tumor;
E. Thrombosis of the middle cerebral artery.
12 A 28-year old patient has been hospitalized in a severe status and unconscious. Patient is
pale, her pulse is threadlike and frequent, blood pressure 60/0 mm Hg. Focal neurologic
symptoms and meningeal signs are absent. In the frontal region there is an abrasion and a
small hemorrhage. Emergency team physician has said that patient had been found
unconscious.
The most likely cause of the disorder is:
A. Acute disorder of cerebral circulation;
B. Brain contusion;
C. *Intraabdominal bleeding;
D. Brain abscess;
E. Viral meningitis.
13 A 62-year old patient is in severe status. Patient reports severe headaches which increase
in the morning, vomiting, and limited movements in the left extremities. Patient has been sick
for 2 weeks and his status is progressively deteriorating. Patient has been smoking since he
was 20 years old. For the last year patient has been reporting constant coughing. Patient is
skinny, skin is grayish and dry; signs of intoxication. There are focal symptoms of right
hemispheric lesion; on the fundus - edema of the optic nerve disks. What is the preliminary
diagnosis?
A. Atherosclerotic encephalopathy
B. *Metastatic tumor of the brain
C. Pneumonia
D. Arachnoencephalitis
E. Ischemic stroke
14 Patient is reporting headache which is more prominent on the right side, fever up to 38°C,
and weakness in the left extremities. From the history it is known that 2 months ago patient
has been discharged from the hospital where he has undergone a surgery due to open
impressed comminuted of the right parietal bone. During examination there is a 4x4 cm
defect of the right parietal bone. Skin over the defect is moderately painful and hyperemic.
Anisocoria; tendon reflexes are predominant on the left side, muscle strength is somewhat
decreased in the left extremities, hemihypaesthesia on the left side. An 8 mm leftward
dislocation of midline echo has been detected. What preliminary diagnosis is most likely?
A. Chronic subdural hematoma;
B. Meningitis;
C. Meningoencephalitis;
D. *Brain abscess;
E. Osteomyelitis.
15 A 30-year old patient has been admitted to the neurosurgical department in a severe status.
Profound torporous disorder of consciousness, moderate anisocoria (D>S), hemiparesis and
hemihypaesthesia on the left side. From the history it is clear that patient has chronic otitis .
Two weeks ago he has undergone a surgery due to right-side otitis media. One week after the
surgery patient's status has deteriorated, he has developed headache and fever up to 38°.
During Echo-EG - an 8 mm leftward dislocation of midline echo is detected.
What is the preliminary diagnosis?
A. Brain tumor;
B. Chronic subdural hematoma;
C. *Brain abscess;
D. Acute disorder of cerebral circulation;
E. Arachnoencephalitis.
16 A 38-year old patient has developed lumbar pain with irradiation along the posterior
surface of his left leg during lifting heavy weights. Pain increases when body position is
changed and in the upright position. Positive stretch symptoms were detected during
examination. What is the preliminary diagnosis?
A. *Pathology of the intervertebral disks (osteochondrosis);
B. Spinal cord tumor;
C. Arachnomyelitis;
D. Polyneuritis
E. Myelopathy.
17 An 8-year old child has been reporting vomiting for 3 weeks predominantly in the premorning hours and during abrupt changes of head position. During examination child has a
forced position of his head tilted rightwards, bilateral horizontal positional nystagmus is
detected as well as unsteadiness in Romberg's position. On the ocular fundus - edema of the
optic nerve disks.
The most likely diagnosis in this child is:
A. Gastritis
B. Helminthic invasion;
C. Meningoencephalitis;
D. *Tumor of the IV ventricle;
E. Chronic cholecystitis.
18 A 40-year old patient is reporting worsening of her eyesight in the right eye, protrusion of
her right eye, periodical headache predominantly in the morning, decreased memory.
Objectively: right-side exophthalmus, right-side vision acuity 0.05, left-side - 1.0. On the
ocular fundus - primary atrophy of the right optic nerve, edema of the left optic nerve disk.
What pathology caused these clinical manifestations:
A. Carotid-cavernous fistula;
B. Aneurism of the cerebral vessels;
C. Orbital tumor;
D. *Tumor of the anterior cranial fossa;
E. Thyrotoxicosis;
19 A 36-year old patient has lower spastic paraparesis, conduction hypalgesia from the level
of Th4. During lumbar puncture CSF pressure is 80 mm H20, during liquorodynamic tests complete liquorodynamic block, CSF hyperalbuminosis. Which disease is most likely?
A. Syringomyelia;
B. Myelitis;
C. Vascular process (myelopathy);
D. *Spinal cord tumor;
E. Multiple sclerosis;
20 A 20-year old patient has undergone an otorhinolaryngologic a 1 surgery due to left-side
purulent otitis. Three days after the procedure patient developed general cerebral symptoms
as well as focal symptoms of the left hemispheric lesion. During Echo-EG - a 6 mm
rightward dislocation of the midline echo has been detected. On the ocular fundus - veins are
dilated, plethoric, increased pulsation of the arteries. What caused deterioration of patient's
status?
A. Meningitis;
B. Exacerbation of otitis;
C. Encephalitis;
D. *Brain abscess;
E. Ischemic stroke.
21 A child aged 1 year and 10 months has been admitted to the clinic. The dressing on child's
head is overwhelmingly soaked with ichorous liquid. Father has said that the child has fallen
on the playground and has hit her head against the board; she did not faint. The dressing has
been put which is continuously soaking. During examination child is somnolent, no focal
neurologic symptoms are detected, and meningeal signs are absent. In the right parietal
region there is a linear skin injury 1 cm long which is constantly excreting ichorous fluid.
What is the preliminary diagnosis?
A. Brain concussion;
B. Meningitis;
C. *Open CCT with liquorrhoea;
D. Brain contusion;
E. Closed CCT.
22 A 20-year old patient was admitted to the intensive care unit in a severe status,
unconscious, with seizures more prominent in the left extremities, pricking causes
intensification of seizures, prominent meningeal syndrome.
Parents have said that 7 years ago patient developed seizures in the left extremities which
occurred once in 6 months. Three years ago generalized seizures developed with loss of
consciousness which repeated every 2 months. Today in the morning patient has developed
severe headache, vomiting, weakness in the left extremities, clonic seizures with loss of
consciousness. During lumbar puncture patient's CSF is intensely colored with blood, CSF
pressure is 240 mm H20.
What is the preliminary diagnosis?
A. Brain abscess;
B. Brain tumor;
C. *Arteriovenous malformation;
D. Arachnoencephalitis;
E. Craniocerebral trauma.
23 A 36-year old patient two months ago has undergone a radical surgery due to chronic
right-side otitis. Patient's status after the surgery was satisfactory. Three weeks ago patient
developed headache, nausea and vomiting t - 39° -38.5° as well as focal symptoms of the
right hemispheric lesion, meningeal syndrome. Patient is hospitalized due to otogenic
meningitis. Today patient's status has worsened, patient is in sopor; anisocoria is detected
D>S. Midline M-echo is dislocate leftwards by 8 mm. What pathology caused deterioration
of patient's status?
A. Arteriovenous malformation;
B. Brain tumor;
C. Hemorrhagic stroke;
D. *Brain abscess;
E. Meningitis.
24 A 32-year old patient has reported severe headache and fainted, falling down. Emergency
physician has noted patient's severe status, sopor, and meningeal syndrome. In the inpatient
department - during lumbar puncture - CSF is hemorrhagic, CSF pressure is 260 mm. What is
the preliminary diagnosis?
A. Brain tumor;
B. Meningoencephalitis;
C. *Aneurism, hemorrhagic stroke;
D. Ischemic stroke;
E. Craniocerebral trauma.
25 A 36-year old patient reports abrupt back pain which irradiates along the posterior surface
of lower limbs. Pain syndrome is exacerbated in the recumbent position which is the reason
why patient can't be laying down. Patient has been ill for about 2 years and has undergone
inpatient and outpatient treatment of osteochondrosis. Patient has undergone a course of
balneotherapy in the sanatorium settings. His status is progressively worsening and the
intensity of pain syndrome has increased. What is the preliminary diagnosis?
A. *Tumor of the cauda equina
B. Myelopathy
C. Arachnomyelitis
D. Consequences of spinal trauma
E. Multiple sclerosis
26 An 85-year-old man is being evaluated for gait difficulties. On examination it is found that
joint proprioception is absent in his toes. People with impaired position sense will usually fall
if they stand with their feet together and do which of the following?
A. Flex the neck
B. Extend their arms in front of them
C. Flex the knees
D. Turn the head
E. *Close their eyes
27 A 21-year-old woman presents with right arm loss of sensation that has been progressive
over a few days. Her physician is concerned that this might be some type of demylinating
disorder. A relatively small plaque of demyelination, should be evident on which of the
following?
A. Tl-weighted MR1
B. *T2-weighted MR1
C. Precontrast CT
D. Diffusion-weighted MRI
E. PET
28 A 67-year-old woman says that she is having problems with dizziness. A more careful
history reveals that she has an abnormal sensation of movement intermittently Which of the
following tests would be most helpful in determining the cause of episodic vertigo?
A. CSF
B. C-spine MRI
C. Visual evoked response (VER)
D. *Electronystagmography (ENG)
E. Electroencephalography (EEG)
29 A 42-year-old woman is being evaluated for gait difficulties. On examination, it is found
that her ability to walk along a straight line touching the heel of one foot to the toe of the
other is impaired. This finding is most common with which of the following?
A. * Cerebellar dysfunction
B. Parietal lobe damage
C. Temporal lobe damage
D. Ocular motor disturbances
E. Dysesthesias in the feet
30 A 55-year-old woman is being examined. The clinician notices the presence of fine
twitching movements beneath the surface of the tongue and wasting of one side of the tongue.
This finding suggests damage to cranial nerve
A. V
B. VII
C. IX
D. X
E. *XII
31 A 46-year-old longshoreman complains of lower back pain radiating down the posterior
aspect of his left leg, and paresthesias in the lateral aspect of his left foot. This has been
present for 6 months. Strength and bowel and bladder function have been normal.
Examination would be most likely to show which of the following?
A. Left Babinski sign
B. Loss of pinprick sensation over the webspace between the first and second digits of the left
foot
C. Hyperreflexia at the left knee jerk
D. *Hyporeflexia in the left Achilles tendon reflex
E. Decreased rectal tone
32 A 75-year-old man with a history of recent memory impairment is admitted with
headache, confusion, and a left homonymous hemianopsia. He has recently had two episodes
of brief unresponsiveness. There is no history of hypertension. Computed tomography (CT)
scan shows a right occipital lobe hemorrhage with some subarachnoid extension of the blood.
An MRI scan with gradient echo sequences reveals foci of hemosiderin in the right temporal
and left frontal cortex. The likely cause of this patient's symptoms and signs is
A. Gliomatosis cerebri
B. Multi-infarct dementia
C. Mycotic aneurysm
D. *Amyloid angiopathy
E. Undiagnosed hypertension
33 Within 1 clay of admission, the patient's right-sided weakness began to abate, and within 1
week it completely resolved. On the fourth day of hospitalization, the patient abruptly lost
consciousness and exhibited clonic movements starting in his right side and generalizing to
his left side. The movements stopped within 3 min, but he had residual right-sided weakness
for 24 h. CT scan was unchanged from that obtained on admission. The most appropriate
treatment to institute involves
A. Heparin
B. Recombinant tissue plasminogen activator (r-TPA)
C. Lamotrigine
D. *Phenytoin
E. Warfarin
34 A 16-year-old girl with complex partial seizures and mild mental retardation has an area of
deep red discoloration (port-wine nevus) extending over her forehead and left upper eyelid. A
CT scan of her brain would be likely to reveal
A. Hemangioblastoma
B. Charcot-Bouchard aneurysm
C. An arteriovenous malformation
D. *A leptomeningeal angioma
E. A fusiform aneurysm
35 A 72-year-old woman has the abrupt onset of right face and hand weakness, disturbed
speech production, and a right homonymous hemianopsia. This is most likely attributable to
occlusion of the
A. *Left middle cerebral artery
B. Left anterior cerebral artery
C. Left vertebrobasilar artery
D. Right anterior choroidal artery
E. Left posterior inferior cerebellar artery (PICA)
36 A 35-year-old woman works as a keyboard operator and must type for 6 h per day She is
especially susceptible to injury of the
A. Axillary nerve
B. *Median nerve
C. Ulnar nerve
D. Radial nerve
E. Long thoracic nerve
37 A 28-year-old police officer sustains a gunshot wound to the upper arm. This type of
trauma may cause partial damage to the median nerve that may leave the patient with
A. *Easily provoked pain in the hand
B. Weakness on wrist extension
C. Atrophy in the first dorsal interosseous muscle
D. Numbness over the fifth digit
E. Radial deviation of the hand
38 A 19-year-old man is involved in a street fight in which he is viciously attacked with a
lead pipe. A particularly forceful blow hits his left elbow. Blunt trauma to the elbow may lead
to the development of
A. Wristdrop
B. Weakness of the abductor pollicis brevis
C. *Clawhand or benediction sign
D. Ulnar deviation of the hand
E. Poor pronation of the forearm
39 A 21-year-old right-handed woman works at an airport as a luggage handler. She is
usually on the tarmac working in an environment in which loud noises are routine. Ear
protection must be worn to protect against loss of hearing and the development of
A. Vertigo
B. *Tinnitus
C. Ataxia
D. Diplopia
E. Oscillopsia
40 A young man fractures his humerus in an automobile accident. As the pain from the injury
subsides, he notices weakness on attempted flexion at the elbow. He develops paresthesias
over the radial and volar aspects of the forearm. During the accident, he probably injured his
A. Suprascapular nerve
B. Long thoracic nerve
C. *Musculocutaneous nerve
D. Radial nerve
E. Median nerve
41 A 37-year-old alcoholic man awakes with clumsiness of his right hand. Neurologic
examination reveals poor extension of the hand at the wrist. He most likely has injured his
A. Median nerve
B. Brachioradialis nerve
C. Musculocutaneous nerve
D. *Radial nerve
E. Ulnar nerve
42 A 72-year-old man slipped and fell in the bathroom 1 week ago. He hit the right side of his
head, but did not think it was necessary to seek medical attention. He finally goes to his
doctor because his son thinks his balance was off. Computed tomography (CT) of the brain
may fail to reveal a small subdural hematoma in this patient because
A. *The lesion is subacute
B. The hematoma extends into the brain from the subdural space
C. The resolution of the CT machine is greater than 2 mm
D. The subdural hematoma is less than 4 h old
E. The patient has extensive cerebral atrophy
43 Computed tomography scanning of the patient's head within 2 h of the injury should reveal
A. A normal brain
B. *A lens-shaped density over the frontal lobe
C. Increased CSF density with a fluid-fluid level
D. Multifocal attenuation of cortical tissue
E. Bilateral sickle-shaped densities over the hemispheres
44 The elderly person who suffers relatively mild head trauma, but subsequently develops a
progressive dementia over the course of several weeks, is most likely to have sustained which
of the following?
A. An acute subdural hematoma
B. An acute epidural hematoma
C. *A chronic subdural hematoma
D. An intracerebral hematoma
E. An intracerebellar hematoma
45 A 42-year-old woman is involved in a head-on collision with a lamppost at 50 mph. Her
head hits the windshield. She is highly likely to have an intracranial hemorrhage in which one
of the following structures?
A. Occipital lobe
B. Thalamus
C. Putamen
D. Parietal lobe
E. *Temporal lobe
46 A 57-year-old woman is involved in a motor vehicle accident in which she strikes the
windshield and is briefly unconscious. She makes a full recovery, except that 3 months later
she complains she cannot taste the food she is eating. Her complaint is most likely due to
A. Medullary infarction
B. Temporal lobe contusion
C. Sphenoid sinus hemorrhage
D. Phenytoin use to prevent seizures
E. *Avulsion of olfactory rootlets
47 An 18-year-old boy is brought into the emergency room after a diving accident. He is
awake and alert, has intact cranial nerves, and is able to move his shoulders, but he cannot
move his arms or legs. He is flaccid and has a sensory level at C5. Appropriate management
includes
A. Naloxone hydrochloride
B. *Intravenous methylprednisolone
C. Oral dexamethasone
D. Phenytoin 100 mg tid
E. Hyperbaric oxygen therapy
48 A 17-year-old right-handed boy has had infectious meningitis 8 times over the past 3
years. He has otherwise been generally healthy and developed normally. Recurrent
meningitis often develops in persons with
A. Otitis media
B. Epilepsy
C. Multiple sclerosis
D. Whipple's disease
E. *Cerebrospinal fluid (CSF) leaks
49 An 82-year-old man with a history of pulmonary tuberculosis in 1947 presents with left
body weakness and neglect. Imaging and subsequent biopsy reveal that recurrent tuberculosis
was the cause. Mass lesions in the brain of the patient with tuberculosis may develop as a
reaction to the tubercle bacillus and consist of
A. Dysplastic central nervous system (CNS) tissue
B. *Caseating granulomas
C. Heterotopias
D. Colobomas
E. Mesial sclerosis
50 A 13-year-old boy is brought into the emergency room lethargic with a stiff neck and
fever. Despite aggressive therapy the child dies. Postmortem evaluation reveals that the child
had primary amebic meningoencephalitis. This condition is usually acquired through
A. *Freshwater swimming
B. Eating contaminated meat
C. Eating calves1 brains
D. Anal intercourse
E. Animal bites
51 A 72-year-old woman has a head CT performed because of headaches. It is significant for
a left hemisphere mass with an overlying hyperostosis of the skull. She most likely has which
of the following?
A. *Meningioma
B. Pituitary adenoma
C. Astrocytoma
D. Schwannoma
E. Hemangioblastoma
52 A 9-year-old girl with papiledema and precocious is most likely to have
A. *A pineal region tumor
B. An oligodendroglioma
C. A Kernohan class II astrocytoma
D. A brainstem glioma
E. An ependymoma
53 A 15-year-old boy has multiple angiomatoses of the retina and cysts of the kidney and
pancreas. The brain tumor that is most likely to develop in this child is which of the
following?
A. Glioblastoma multiforme
B. Meningioma
C. *Hemangioblastoma
D. Ependymoma
E. Pinealoma
54 A 56-year-old right-handed woman who had breast cancer 1 year ago began having
neurological problems about 1 week ago. She began experiencing nausea, vomiting, and
numbness in the right hand and foot. Today she is experiencing crescendo pain in the left
retroorbital area. Her headache is throbbing and positional, particularly when she tries to
bend forward. The headache was intense in the morning, and at times it woke her up last
night. On examination, the only deficits are loss of double simultaneous tactile stimulation
and right lower facial droop when smiling. The most appropriate next action would be to
A. Administer intravenous prochlorperazine
B. Give the patient a prescription for zolmitriptan
C. Make a follow-up appointment for next month
D. Order an electroencephalogram to rule out seizures
E. *Get a brain MRI
55 A patient has a MRI performed and a colloid cyst of the third ventricle is identified. The
most common complication of this lesion is
A. Bitemporal hemianopsia
B. *Hydrocephalus
C. Gait ataxia
D. Optic atrophy
E. Oscillopsia
56 A 37-year-old man presents with visual impairment. Examination reveals a bitemporal
hemianopsia. Which of the following tumors is most likely responsible for this finding?
A. Optic glioma
B. Occipital astrocytoma
C. Brainstem glioma
D. *Pituitary adenoma
E. Sphenoid wing meningioma
57 A 9-year-old girl presents with precocious puberty and episodes of uncontrollable
laughter. Which of the following mass lesions might explain her symptoms?
A. Craniopharyngioma
B. Choroid plexus papilloma
C. Giant aneurysm
D. Metastatic carcinoma
E. *Hypothalamic hamartoma
58 A 57-year-old woman began having weakness and trouble walking 1 year ago. Current
exam findings include weak, wasted muscles with spasticity, fasciculations, extensor plantar
responses, and hyperreflexia. This case is most suggestive of
A. Dorsal spinal root disease
B. Ventral spinal root disease
C. Arcuate fasciculus damage
D. *Motor neuron disease
E. Purkinje cell damage
59 A 36-year-old man is being evaluated for left hand weakness. On examination, it is readily
apparent the he has atrophy of the first dorsal interosseous muscle. This may indicate damage
to spinal roots
A. C5 and C6
B. C6 and C7
C. C7andC8
D. *C8andTl
E. Tl and T2
60 A 35-year-old woman falls 12 ft off of a ladder and fractures her c-spine, causing damage
at the C4 level. She is initially a flaccid quadriplegic with areflexia. This areflexia and
flaccidity usually evolve into hyper-reflexia and spasticity within
A. 2 to 4 months
B. 1 to 2 months
C. *3 days to 3 weeks
D. 1 to 3 h
E. 5 to 25 min
61 After biopsy resection of a lymph node in her neck, a 23-year-old woman notices
instability of her shoulder. Neurologic examination reveals winging of the scapula on the side
of the surgery. During surgery she probably suffered damage to the
A. Deltoid muscle
B. *Long thoracic nerve
C. Serratus anterior muscle
D. Suprascapular nerve
E. Axillary nerve
62 A 25-year-old woman is involved in a motor vehicle accident. Among her injuries is a
lumbar vertebral body fracture. Which of the following most likely contributed to this injury?
A. *Flexion
B. Extension
C. Torsion
D. Spondylolisthesis
E. Subluxation
63 A myelogram is performed and the cerebrospinal fluid (CSF) is checked. Both are
unremarkable except for a slight increase in the CSF protein content. A computed
tomography (CT) scan of the lumbar spinal cord is unrevealing. Plain films of the spine are
completely normal. An MRI of the lumbar cord with gadolinium reveals patchy enhancement
at about the L4-L5 spinal cord level. These findings suggest
A. An intraspinal hemorrhage
B. An extraparenchymal meningioma
C. An intraparenchymal ependymoma
D. *A transverse myelitis
E. A syringomyelia
64 A biopsy of the spinal cord is performed, and widespread granulomas are found at the
level of the patchy irregularity seen on MRI. In the midst of one granuloma is an ovoid mass
with a spine extending from one side. The pathologist interprets this as a parasitic ovum. If
the pathologist is correct, the most likely cause of the lesion is
A. Taenia solium
B. Entamoeba histolytica
C. *Schistosoma mansoni
D. Schistosoma japonicum
E. Treponema pallidum
65 Because of the obvious aortic aneurysm discovered on aortography, the vascular surgeon
consulting on the case recommends a bypass procedure. Preoperatively the patient showed
substantial recovery of leg strength and sensation, despite the persistence of bilateral
Babinski (plantar extensor) signs. The patient submits to the surgery and is paraplegic
postoperatively with dense loss of sensation of pain and temperature below the level of T10.
A follow-up aortogram should reveal
A. Complete occlusion of the bypass graft
B. Complete occlusion of the hypogastric artery
C. Complete occlusion of the aorta below the tenth thoracic vertebra
D. *No flow through the artery of Adamkiewicz
E. No flow through the external iliac artery
66 Because the facial weakness persists despite antituberculous treatment, the physician
decides to administer high-dose steroids. Within 1 week of the introduction of prednisone, the
patient develops pain radiating down the back of his right leg and difficulty dorsiflexing the
right foot. This new complaint probably represents which of the following disorders?
A. *Borrelia radiculopathy
B. Diabetic mononeuritis multiplex
C. Isoniazid neuropathy
D. Rifampin toxicity
E. Tuberculous radiculopathy
67 A 25-year-old woman is being examined by her physician. The knee jerk is being tested.
The patellar tendon reflex involves sensory fibers of the femoral nerve that originate in spinal
segments
A. S3-S4
B. S2-S3
C. S1-S2
D. L4-L5
E. *L2-L3
68 A 51-year-old factory worker has noticed progressive weakness over the past year.
Examination and testing reveal a painless largely motor peripheral neuropathy. Of the
following agents, the one most likely to be etiologic in this case is
A. *Lead
B. Manganese
C. Thallium
D. Cyanide
E. Mercury
69 A very thin elderly woman complains of left-sided neck pain. Her family attempted to give
her a deep intramuscular injection of steroids. She complains acutely of pain radiating down
her arm and develops a wristdrop. The probable site of injection is the
A. *Posterior cord of the brachial plexus
B. Medial cord of the brachial plexus
C. Lateral cord of the brachial plexus
D. Thl spinal root
E. C5 spinal root
70 A 27-year-old man undergoes general anesthesia for a hernia repair-As the anesthesia
begins, his jaw muscles tense and he becomes generally rigid. He becomes febrile,
tachycardic, and tachypneic. Intravenous administration of which agent may be lifesaving?
A. Suxamethonium
B. Nitrous oxide
C. Succinylcholine
D. *Dantrolene
E. Phenobarbital
71 A 66-year-old woman presents with fever and a generalized convulsion. Neuroimaging
and lumbar puncture are most consistent with a diagnosis of herpes encephalitis. The most
appropriate treatment for this patient is which of the following?
A. Cyclophosphamide
B. Amphotericin B
C. Gamma globulin
D. Methotrexate
E. *Acyclovir
72 A 6-month-old child who develops a febrile seizure should be investigated with a spinal
tap because
A. All febrile seizures justify spinal taps
B. Most febrile seizures are due to bacterial infections
C. Febrile seizures cause increased intracranial pressure that must be relieved by withdrawing
cerebrospinal fluid (CSF)
D. Intrathecal antiepileptics must be given
E. *Children this age may have meningitis with no manifestations other than fever and
seizures
73 A 17-year-old girl presents with subacute mental status change and left arm weakness. She
had a viral illness 1 week ago and now a diagnosis of acute disseminated encephalomyelitis
(ADEM) is made. ADEM is a white matter disease that is distinguishable from multiple
sclerosis (MS) by its being
A. *Monophasic
B. Rapidly lethal
C. Associated with brainstem and spinal cord disease
D. Associated with magnetic resonance imaging (MRI) lesions, which may resolve
E. Associated with inflammatory changes in the brain
74 A 57-year-old man has been diagnosed with cluster headache. Ergotamine prophylaxis has
been partially successful. The most effective means of aborting a cluster headache is
A. *Inhaled 100% oxygen
B. Sublingual nitroglycerin
C. Oral methysergide
D. Oral propranolol
E. Dihydroergotamine suppository
75 A 33-year-old operating room nurse accidentally has blood splashed in her eyes during a
procedure. The surgical resident who examines her immediately afterward notices that she
has 2-mm anisocoria and sends her to the emergency room. She feels well, is alert and
talkative, and has no motor dysfunction. On examination, the emergency room physician
recognizes that the iris of the eye with the smaller pupil is pale blue, while that of the other
eye is brown. The etiology of the woman's anisocoria is probably
A. Conjunctivitis
B. Traumatic third-nerve palsy
C. Carotid artery dissection
D. Pupillary sphincter injury
E. *Congenital
76 Six months later, the woman again presents to the emergency room complaining of brief,
sharp pain radiating into the left side of her face. The vision in her right eye has largely
recovered, and there is no evidence of sensory loss on the right side of her face. She describes
the pain as ice pick-like and grimaces with each attack. She is most likely to have symptomatic relief from her facial pain if she is managed with
A. Aspirin
B. Acetaminophen
C. Ibuprofen
D. Carbamazepine
E. Codeine
77 On further questioning, the patient reveals that she has had recurrent episodes of bed
wetting (enuresis) over the preceding month. This should decrease with the administration of
A. *Imipramine
B. Phenytoin
C. Carbamazepine
D. Baclofen
E. Methacholine
78 Over the course of the next few months, she develops painful spasticity in her left leg that
interferes with flexion of her leg. The spasticity progresses to the point of interfering with her
sleep. She should now be treated with
A. Imipramine
B. Phenytoin
C. Carbamazepine
D. *Baclofen
E. Methacholine
79 A newborn infant has a cystic swelling at the base of the spine that is covered with
hyperpigmented skin and some coarse hair. Which of the following is the most likely
explanation?
A. *Mongolian spot
B. Spina bifida occulta
C. Nevus flammeus
D. Meningocele
E. Encephalocele
80 A 34-year old patient has reported cessation of her menstrual periods and then her eyesight
began to worsen. Primary atrophy of optic nerves has been detected as well as bitemporal
hemianopsia.
For 3 years patient has been treated by ophthalmologists in outpatient and inpatient settings
but her eyesight was progressively decreasing. At visual acuity of 0.02, 0.03 and prominent
primary atrophy of the optic nerves select the supplemental investigation which will make it
possible to set the diagnosis.
A. Ventriculography;
B. CSF analysis;
C. *Cranial X-ray;
D. EEG (electroencephalography of the brain);
E. EchoEG (echo-encephalography)
Questions to figures
1 What sign is represented on a picture? (Рис.Fig._1)
A. Brudzinsksy`s sign
B. *Kernig`s sign
C. Oppengeym`s sign
D. Rossolimo`s sign
E. Pussep`s sign
2 What clinical form of head injury is represented by this tomogram?
(Рис.Fig._2)
A. *Cerebral contusion
B. Brain concussion
C. Cerebral haemorrhage
D. Ischemic stroke
E. Subarachnoid hemorrhage
3 That you can see at this CT? (Рис.Fig._3)
A. Subdural haematoma
B. Cerebral contusion
C. Brain abscess
D. Cerebral haemorrhage
E. *Extradural haematoma
4 The name of the method of investigation is: (Рис.Fig._4)
A. MRI
B. *CT-scan
C. Positron-emission tomography
D. 3D-CT
E. Single photon emission computerized tomography
5 What is mark of herniation of the cerebellar tonsils into the foramen
magnum? (Рис.Fig._5)
A. a
B. b
C. c
D. d
E. *e
6 What kind of pathology is represented on a picture? (Рис.Fig._6)
A. Extradural haematoma
B. *Subdural haematoma
C. Intracerebral haemorrhage
D. Subarachnoid hemorrhage
E. Severe head injury
7 The name of the method of investigation is: (Рис.Fig._7)
A. *Skull x-ray
B. Myelography
C. Skull x-ray in a lateral projection
D. MRI
E. CT
8 That do you see intraoperative? (Рис.Fig._8)
A. Linear skull fracture
B. *Depressed skull fracture
C. Scalp laceration
D. Fracture of the base of the skull
E. Bone stitches divergence
9 What do you see at this CТ? (Рис.Fig._9)
A. Brain swelling
B. Shearing forces
C. Hydrocephalus
D. Brain concussion
E. *It is normal CT
10 The name of the method of investigation is: (Рис.Fig._10)
A. *MRI
B. CT
C. Positron-emission tomography
D. 3D-CТ
E. Skull x-ray
11 The name of the method of investigation is: (Рис.Fig._11)
A. *Cerebral angiography
B. CT-angiography
C. CT
D. MRI
E. Skull x-ray
12 That kind of pathology is represented on a picture? (Рис.Fig._12)
A. *Saccular aneurysm
B. Fusiform aneurysm
C. Arterio-venous malformation
D. Cavernoma
E. Carotid-cavernosus fistula
13 What type of violation of cerebral circulation of blood is represented on a
picture? (Рис.Fig._13)
A. Intracerebral haemorrhage
B.
C.
D.
E.
* Ischemic stroke
Subdural haematoma
Cavernosus hemangioma
Extradural haematoma
14 That kind of pathology is represented on a picture? (Рис.Fig._14)
A. Saccular aneurysm
B. Fusiform aneurysm
C. *Arterio-venous malformation
D. Carotid-cavernosus fistula
E. Cavernoma
15 What number is aneurysm under? (Рис.Fig._15)
A. 1
B. 2
C. 3*
D. 4
E. Aneurysm is not present
16 That is represented on a picture? (Рис.Fig._16)
A. Saccular aneurysm
B. Fusiform aneurysm
C. Arterio-venous malformation
D. Carotid-cavernosus fistula
E. *Normal microcirculation
17 That is represented on a picture? (Рис.Fig._17)
A. Saccular aneurysm
B. Fusiform aneurysm
C. *Arterio-venous malformation
D. Carotid-cavernosus fistula
E. Normal microcirculation
18 What do you see at the cerebral angiogram? (Рис.Fig._18)
A. *Saccular aneurysm
B. Fusiform aneurysm
C. Arterio-venous malformation
D. Carotid-cavernosus fistula
E. Normal microcirculation
19 What do you see at the MRI? (Рис.Fig._19)
A. *Pituitary tumor
B. Osteoma
C. Intracerebral haemorrhage
D. Acoustic neurinoma
E. Olfactory groove meningioma
20 What do you see at the MRI? (Рис.Fig._20)
A. *Disc prolaps
B. Intradural tumour
C. Extradural tumour
D. Syrinx
E. Meningioma
21 That is this? (Рис.Fig._21)
A. *Disc prolaps
B. Intradural tumour
C. Extradural tumour
D. Syrinx
E. Meningioma
22 That do you see pathomorphologicaly? (Рис.Fig._22)
A. *Cerebellum tumor
B. Brain abscess
C. Brain cyst
D. Brain gigroma
E. Giant aneurysm
23 That is this? (Рис.Fig._23)
A. Disc prolaps
B. Syrinx
C. Nevrinoma
D. *Spinal tumor
E. Spinal AVM
24 What type of spinal injury is shown? (Рис.Fig._24)
A. Flexion injury
B. *Compressive injury
C. Flexion-extension injury
D. Hyperextension injury
E. Flexion-rotation injury
25 What is this? (Рис.Fig._25)
A. Disc prolaps
B. Syrinx
C. Nevrinoma
D. *Spinal tumor
E. Spinal AVM
26 What do you see at this MRI? (Рис.Fig._26)
A. *Contussion of left frontal lobe
B. Contussion of right frontal lobe
C. Intracerebral haemorrhage
D. Brain tumor
E. Giant aneurysm
27 What do you see at this MRI? (Рис.Fig._27)
A. Ischemic stroke
B. Brain contusion
C. Temporal lobe tumor
D. Brain abscess
E. * Intracerebral haemorrhage
28 What do you see at this CT? (Рис.Fig._28)
A. Ischemic stroke
B. Cavernoma
C. Brain cyst
D. * Intracerebral haemorrhage
E. Brain abscess
29 What do you see at this CT? (Рис.Fig._29)
A. *Basal ganglia haemorrhage
B. Cerebellum hemorrhage
C. Ischemic stroke
D. Ependimoma
E. Brain cyst
30 What do you see at the CT? (Рис.Fig._30)
A. *Linear skull fracture
B. Depressed skull fracture
C. Scalp laceration
D. Fracture of the base of the skull
E. Bone sutures divergence
31 What do you see at this cerebral angiogram? (Рис.Fig._31)
A. Saccular aneurysm
B. Fusiform aneurysm
C. *Arterio-venous malformation
D. It is normal angiogram
E. Carotid-cavernosus fistula
32 What do you see at this CT? (Рис.Fig._32)
A. Cerebral contusion
B. Brain concussion
C. Cerebral haemorrhage
D. *Ischemic stroke
E. Subarachnoid hemorrhage
33 What do you see at this CT? (Рис.Fig._33)
A. Brain swelling
B. *Shearing forces
C. Hydrocephalus
D. Brain concussion
E. It is normal CT
34 What do you see at this CT? (Рис.Fig._34)
A. Brain swelling
B. *Shearing forces
C. Hydrocephalus
D. Brain concussion
E. It is normal CT
35 Specify localization of brain injury on a picture. (Рис.Fig._35)
A. Frontal lobe
B. *Temporal lobe
C. Parietal lobe
D. Occipital lobe
E. Cerebellum
36 What number is mark the frontal brain lobe? (Рис.Fig._36)
A. *1
B. 2
C. 3
D. 4
E. 5
37 What is this? (Рис.Fig._37)
A. Ischemic stroke
B. Cavernoma
C. Brain cyst
D. *Intracerebral haemorrhage
E. Subarachnoid hemorrhage
38 What number is mark an medulla? (Рис.Fig._38)
A. 1
B. 2
C. *3
D. 4
E. 5
39 How is the represented mechanism of head injury named? (Рис.Fig._39)
A. Accelerations-decelerations
B. *Impact
C. Direct
D. Accelerations
E. Rotatory
40 The number of a.vertebralis is. (Рис.Fig._40)
A. 10
B. 11
C. 12
D. *13
E. 14
41 The number of a.communicans posterior is. (Рис.Fig._41)
A. 1
B. 2
C. 3
D. *4
E. 5
42 The number of a.communicans anterior is. (Рис.Fig._42)
A. 1
B. 2
C. *3
D. 4
E. 5
43 What number of cerebellum is.(Рис.Fig._43)
A. 1
B. 2
C. 3
D. 4
E. *5
44 What do you see at the MRI? (Рис.Fig._44)
A. *Temporal lobe tumor
B. Occipital lobe tumor
C. Ischemic stroke
D. Intracerebral haemorrhage
E. Severe head injury
45 There is the tumor localize? (Рис.Fig._45)
A. Left frontal lobe
B. *Right frontal lobe
C. Right occipital lobe
D. Left occipital lobe
E. Basal ganglia
46 That device is it? (Рис.Fig._46)
A. *Cyber-knife
B. Neuronavigation system
C. Cyclotron
D. MRI
E. Nothing of the above mentioned
47 What method of treatment is it? (Рис.Fig._47)
A. *Stenting
B. Balloon angioplasty
C. Endarterectomy
D. Ateromectomy
E. Direct trombectomy
48 What do you see at this MRI? (Рис.Fig._48)
A. Cavernoma
B. Fusiform aneurysm
C. *Arterio-venous malformation
D. It is normal angiogram
E. Carotid-cavernosus fistula
49 The name of approach for craniotomy at the picture is. (Рис.Fig._49)
A. *Pterional
B. Temporal
C. Frontal
D. Fronto-temporo-occipital
E. Bifrontal
50 Which pathology manifestate by symptom represented on a picture?
(Рис.Fig._50)
A. Anterior cranial fossa fracture
B. *Middle cranial fossa fracture
C. Posterior cranial fossa fracture
D. Orbital fracture
E. Temporal bone fracture
51 What is this? (Рис.Fig._60)
A. Subdural haematoma
B. Cavernosus hemangioma
C. *Extradural haematoma
D. Intraventricular haematoma
E. Intracerebral haemorrhage
52 Name the author of this conception (3th supporting collumn). (Рис.Fig._52)
A. *Dennis
B. Dandy
C. Chushing
D. Moniz
E. Spiegel
53 What is this? (Рис.Fig._53)
A. *Subdural haematoma
B. Cavernosus hemangioma
C. Extradural haematoma
D. Intraventricular haematoma
E. Intracerebral haemorrhage
54 What is this? (Рис.Fig._54)
A. * Subarachnoid hemorrhage
B. Intracerebral haemorrhage
C. Intraventricular hemorrhage
D. Subdural haematoma
E. Extradural haematoma
55 What number is mark disk herniation? (Рис.Fig._55)
A. *1
B. 2
C. 3
D. 4
E. 5
56 What number is mark a dura mater? (Рис.Fig._56)
A. 1
B. 2
C. 3
D. *4
E. 5
57 What number is mark a procesus spinosus? (Рис.Fig._57)
A. 1
B. 2
C. 3
D. 4
E. *5
58 What number is mark the annulus fibrosus? (Рис.Fig._58)
A. 1
B. *2
C. 3
D. 4
E. 5
59 What number is mark a nerve root? (Рис.Fig._59)
A. 1
B. 2
C. *3
D. 4
E. 5
60 What is this? (Рис.Fig._60)
A. Spondilolysis
B. *Spondylolisthesis
C. Spondylosis
D. Spondylodesis
E. Subluxation of faset joints
61 The name of the method of investigation is: (Рис.Fig._61)
A. CT
B. MRI
C. *3D-CT angiography
D. Spectroscopy
E. Positron-emission tomography
62 The name of device is: (Рис.Fig._62)
A. *CT
B. MRI
C. Cyclotron
D. Gamma-knife
E. Angiograph
63 Name the type of fracture: (Рис.Fig._63)
A. Hyperextension fracture-dislocation
B. Rotatory
C. *Compressive
D. Hyperflection fracture-dislocation
E. Burst
64 What do you see at this MRI? (Рис.Fig._64)
A. *Meningioma
B. Subdural haematoma
C. Cavernosus hemangioma
D. Extradural haematoma
E. Intraventricular haematoma
65 What do you see at this CT? (Рис.Fig._65)
A. Shearing force
B. Brain death
C. Diffuse cortical atrophy
D. *Hydrocephalus
E. Brain swelling
66 What is this? (Рис.Fig._66)
A. Cavernoma
B. Fusiform aneurysm
C. *Arterio-venous malformation
D. Saccular aneurism
E. Carotid-cavernosus fistula
67 This is the operation of. (Рис.Fig._67)
A. Ventriculoperitoneostomy
B. *Ventriculocisternostomy
C. Ventriculokardiostomy
D. Lumboperitoneostomy
E. Third ventriculostomy
68 This is the operation of. (Рис.Fig._68)
A. *Ventriculoperitoneostomy
B. Ventriculocisternostomy
C. Ventriculokardiostomy
D. Lumboperitoneostomy
E. Third ventriculostomy
69 Name the type of fracture: (Рис.Fig._69)
A. *Burst
B. Rotatory
C. Compression
D. Hyperflection fracture-dislocation
E. Hyperextension fracture-dislocation
70 The number of foramen spinosum is: (Рис.Fig._70)
A. 1
B. 2
C. 3
D. *4
E. 5
71 The number of foramen ovale is: (Рис.Fig._71)
A. 1
B. *2
C. 3
D. 4
E. 5
72 The number of foramen rotundum is: (Рис.Fig._72)
A. 1
B. 2
C. *3
D. 4
E. 5
73 How is the point B named? (Рис.Fig._73)
A. Asterion
B. *Pterion
C. Bregma
D. Inion
E. Obelion
74 How is the point E named? (Рис.Fig._74)
A. *Asterion
B. Pterion
C. Bregma
D. Inion
E. Obelion
75 The number of middle cranial fossa is: (Рис.Fig._75)
A. 1
B. *2
C. 3
D. 4
E. 5
76 The number of dura mater is: (Рис.Fig._76)
A. 1
B. *2
C. 3
D. 4
E. 5
77 The number of pia mater is: (Рис.Fig._77)
A. 1
B. 2
C. 3
D. *4
E. 5
78 Named the devise for head fixation at the picture. (Рис.Fig._78)
A. *Mayfield frame
B. CITO frame
C. Hallo-west devise
D. Kruchfield frame
E. All answers is wrong
79 The number of foramen spinosum is: (Рис.Fig._79)
A. 1
B. 2
C. *3
D. 4
E. 5
80 At what level of spinal injury there will be tetraplegia. (Рис.Fig._80)
A. *1 and 2
B. 2 and 3
C. 1
D. 3
E. 4