Board Questions and Answers

1. Board Questions and Answers

5. Question 4 • Surgical procedures utilized in the treatment of spasmodic torticollis include: • Upper cervical ventral rhizotomies and spinal accessory neurectomy • Stereotactic thalamotomy • Microvascular decompression of the spinal accessory nerve • myotomy • I, II, III • I, III • II, IV • IV • All of the above

6. Answer 4 • Torticollis that is refractory to medical therapies and relaxation techniques can be treated with selective rhizotomy of the spinal accessory nerve-81-97% improve • Myotomy was the earliest surgical procedure used to treat torticollis • 70% patients improve after MVD of spinal accessory nerve • Roughly 2/3 patients have good result after stereotactic thalamotomy

7. Question 5 • Which surgical approach for thoracic disk herniations is associated with the highest rate of neurologic injury • Costotransversectomy • Lateral extracavitary • Midline Laminectomy • Transpedicular • Thransthoracic

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

9. Answer 5

10. Question 6 • Most patients with intrinsic brainstem gliomas initially present with: • Cranial neuropathies • Headache • Hydrocephalus • Nausea and vomiting • Papilledema

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

12. Question 7 • Each of the following is characteristic of complex regional pain syndrome II (causalgia) except: • Atrophic changes in the limb • Hypesthesia • Increased sweating • Lack of major motor deficit • Good relief with sympathetic block

13. Answer 7

14. Question 8 • For the following questions, match the description with the structure. • A. Dermoid cyst • B. Epidermoid cyst • C. both • D. Neither • 1. Bacterial meningitis • 2. Aseptic meningitis • 3. Associated congenital malformations • 4. Most often midline • 5. Responsive to radiation therapy

15. Answer 8 • Dermoid Cyst: • Occur in midline (lumbosacral spine, parasellar, post. Fossa) • Capsular calcification sometimes bright on T1 • 0.3% brain tumors • Occur when cell rests with dermal and epidermal componenets are included in neural ectoderm • Communication with exterior predisposes to bacterial meningitis • Seen mostly in peds-congenital malformations • Epidermoid Cyst: • Found off midline (CPA, parasellar, middle fossa) • Signal characteristics of csf-increased signal on dwi • Comprise 0.5-1.8% brain tumors • Result from epidermal cell rests • Spillage casuses aseptic meningitis • Seen mostly in adults

16. Question 9 • Ventricular enlargement from choroid plexus papillomas can be secondary to : • I. Entrapment of CSF • II. Decreased absorption of CSF from hemorrhage-indrucedarachnoiditis • III. Tumor Growth • IV. Excessive production of CSF • A. I, II, III • B. I, III • C. II, IV • D. IV • E. all of the above

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

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

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

20. Question 11 • Uncinate seizures typically produce: • A. Auditory hallucinations • B. Gustatory hallucinations • C. Olfactory hallucinations • D. Vertiginous sensations • E. Visual seizures

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

22. Question 12 • Match the description with the structure • A. Calcarinesulcus • B. Lateral mesencephalicsulcus • C. Posterior communicating artery • D. Tectal plate • Separates the P1 and P2A segments of the PCA • Separates the P2A and P2P segments of the PCA • Separates the P2P and P3 segments of the PCA • Separates the P3 and P4 segments of the PCA

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

24. Question 13 • The radial nerve or one of its branches innervates each of the following except the: • A. Abductor pollicislongus • B. Adductor pollicis • C. Brachioradialis • D. Extensor pollicisbrevis • E. Supinator

26. Answer 13 • Musculocutaneous: • Coracobrachialis, biceps brachii, brachialis • Axillary: • Teres minor and deltoid • Radial: • Triceps, anconeus, brachioradialis, extesnorcarpiradialis (brevis/longus), supinator • PIN: abductor pollicislongus, extensor pollicislongus/brevis, extensor indices, extensor carpiulnaris, extensor digitorum, extensor digitiminimi

27. Answer 13 • Median: • Flexor carpiradialis, palmarislongus, flexor pollicisbrevis (sup head), flexor digitorumsuperficialis, flexor digitorumprofundus, abductor pollicisbrevis, opponenspollicis, lumbricals (2,3) • AIN: flexor pollicislongus, pronatorquadratus, flexor digitorumprofundus • Ulnar: • Flexor carpiulnaris, flexor digitorumprofundus, adductor pollicis, palmarisbrevis, flexor pollicisbrevis (deep head), lumbricals (4,5), hypothenar muscles, palmar and dorsal interossei

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

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

30. Question 15 • The ossification centers of the odontoid consist of: • A. One primary and two secondary centers • B. One secondary and three primary centers • C. Three secondary and one primary center • D. Two primary centers • E. Two primary and one secondary center

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

32. Question 16 • The most common single-suture synostosis is: • A. Coronal • B. Lambdoid • C. Metopic • D. Sagittal • E. Sphenozygomatic

33. Answer 16 • Sagittal (scaphocephaly) • Accounts for up to 50% in some studies • Increased AO skull diameter and narrowed biparietal diameter. • Coronal synostosis • Brachycephaly-increased bitemporal diameter and bulging forehead • Oxycephaly-slightly retroverted forehead • Turricephaly-high/vertical forehead • Metopic (Trigonocephaly) • Wedge-shaped head