‫البشري‬

‫ِّ‬ ‫الطب‬
‫ِّ‬ ‫لجن ُة‬
‫ُرؤية تُنير ُدروب تميّزكم‬

‫‪Neurosurgery‬‬

‫‪-‬‬
 Yaqeen Batch

1. ALL sign of basel skull fracture except

A. complete central cord syndrome
B. paraplagia
C. hemiplagia

Answer:

2. 55 teacher arrested for stealing and hasn’t showerd for 1 month Lesion is in
A. Occipital
B. Temporal
C. Frontal
D. Cerebellar

Answer:

3. Tongue deviation to the right what nerve a ected

A. 12 right
B. 12 left
C. 10 right
D. 10 left

Answer:

4. Middle meningeal artery is

A. SAH
B. SDH
C. EXTRA DURAL

Answer:

5. Risk factors for spina bi ida include all except:

A. hypoglycaemia*
B. maternal intake for anticonvulsants
C. previous delivery or sibling with spina bi ida
D. family history of spina bi ida

Answer:

6. Common symptoms of basal skull fracture

A. Ottorhea
B. Subconjuntival bleeding
C. Brittle sign
D. Raccoon -

Answer:
f
f
f
ff
7. Quida equina syndrome in adults
A. L1 l2
B. L3 l4
C. S2

Answer:

8. pt with tonuge portuded to the left which nerve is injured

A. left hypoglossial
B. right hypoglossial
C. left vegal
D. right vegal

Answer:

9. eye movement examition, pt with weak addiction and elevation right eye slightly
downward both puplie reactive to light , injury in
A. right 3rd crinal nerve
B. left 3rd crinal nerve
C. left 6th crinal nerve
D. right 4th crinal nerve

Answer:

10. which nerves control eye movement

A. 1,2,3
B. 4,5,6
C. 3,4, 6
D. 5,6, 7

Answer: C

11. pt with right epidural hemtoma what you suspect

A. right pupil diation and left limbs weakness
B. left pupil diation with right limb weakness
C. left pupil diation with left limb weakness
D. right pupil constriction with left side weakness

Answer:

12. All are causes of spina bi ida except :

A. Hypoglycemia *
B. Anticonvulsant
C. Family history
D. Folic acid -

Answer:
f
13. Bilateral schwannoma mostly associated with :
A. Turner syndrome
B. NF type 1
C. NF type 2
D. Addison’s disease

Answer: C

14. Not indication for surgery in SDH:

A. thickness >10 mm
B. neurological di icits
C. volume > 30 mm*
D. seizure (Volume >30 cc not mm)

Answer:

15. Pain in parts of the shoulder, forearm, hand, and/or little inger.Numbness in the
forearm and/or hand. Due to disc prolapse at which level ?

Answer : C7 t1

16. Most common modalities for brain tumor

Answer : T2 MRI without contrast

17. Pt with meninigoma and treated with medication and after 3 days she improved her
improvements due to :

Answer: vasogenic edema regression

18. 4 y/o with dilated ventricular system due to tumor on CT, where do you expect to see
the tumor:

Answer: 4th ventricle (?)

19. Case of dilated right lateral ventricle on imaging, obstruction of which of the following
structures causes the hydrocephalus:

Answer: Rt. Foramen of Monroe

20.Most common site for AEDH:

Answer: Temporoparietal region

21. Indications for surgical intervention

- on EDH include of the the following except:

Answer: Seizures (?)

22. If a patient presents with symptoms of increased ICP you should do all of the following
except:

Answer: head elevation with the head tilted to the left

f
f
23.3 y/o with acute hydrocephalus due to tumor, after stabilization & maintaining ABC,
what is the most appropriate intervention:

Answer: CSF diversion procedure

24.Patient presents with an enhancing ring lesion of imaging, the least likely di erential
is:

Answer: Meningoma

25. All of the following are intra-dural cell origins except:

Answer: Arachnoid cap

26.Which of the following causes communicating hydrocephalus :

Answer: Either Meningitis or Hemorrhage

27. Patient presents with loss of sensation right lower limb weakness and hyperre lexia
and loss of the pain and temperature below the left dermetome of T8, where is the
lesion:

Answer: Right level of T8

-
ff
f
Neurosurgery Final
 1. Most common presentation of normal pressure hydrocephalus
A. abnormal gait
B. Headache

Answer : A

2. Most common syntosis

A. Sagittal

Answer: A

3. L4-L5 prolapse causes which nerve compression ?

Answer : L5

4. False correlation:
A. Arachnoid cap with meningioma
B. Medullocyte with medulloblastoma
C. Astrocyte with astrocytoma
D. oligodendroglioma – oligodendrocyte

5. False about subdural hematoma:

Answer: from arterial source

6. Comparison between neurofibroma and schwannoma False:

Answer: histologically Neurofibroma has more Antoni a

7. False:

Answer: fever decreases metabolic demand of the brain.

8. Most common tumor in spine :

Answer: Mets

9. Most common tumor in brain :

Answer: Meningioma
 10. True about edema
a. Caused by cell damage and swelling
b. Treat peirtumor edema by dextromethasone
c. Brain tumor cytotixic edema

Answer: B

11. Rt handed patient with expressive dysphasia, where is the lesion?

a. right front-temporal
b. left front-tempora

Answer: B

12. Fracture that don't cause damage to 8 craneal nerve

a. Longitudinal
b. Oblique
c. Transverse
d. TIP
e. All

Answer: D

12 Surgical fot hydrocephalus except

a. Ventricular peritoneal
b. Ventricular atrial
c. Venricular pleural
d. Acetazolomide

13. Patient with suspected tumor cause hydrocephalus:

a. EEG
b. MRI without contrast
c. MRI with contrast
d. CT without contrast
e. CT with contrast

14. Acute axonal injury present in all the following sites except
a. Temporal lobe
b. Grey matter junction
c. Corpus callosum
d. cerebellar peduncles
 15. False about cauda equina and conus medullaris
a. Cauda equina -- asymmetfical areflexia
b. Cauda equina -- radicular pain
c. Conus medullaris -- back pain
d. Conus medullaris present with late urinary retention

16. Headach not caused by

Answer: Brain irritation

17. Lateral forearm pain + paratheasia in thumb and index

Answer: C5-C6

18. All of the following are sings of basal skull fracture except:
a. Rhinorira
b. Hemptympanum
c. battle sign
d. loss of consciousness

Answer: D

19. The first sign for normal pressure intracranial HTN

Answer: Gait disturbances

20. True about neurogenic claudication

Answer: improve when bending forward

21. All are signs of UmL except.

Answer: Hoffman

22. All signs of hydrocephalus except :

Answer: facial pulsy

 23. Correct about Brown Sequard?
a) 3 options with "Contralateral something"
b) Contralateral loss of pain & temperature
c) all of the above
d) none of the above

Answer: B

24. brain edema related to tumour:

-cytotoxic is the most common type of edema

-cytotoxic edema is caused by dead cells accumulating fluid

-immediate mannitol solves the edema

-dexamethasone/prednisolone is useful (i forgot which drug they said but it was one of those 2)

(1 other option i forgot)

Answer: idk what was correct D

28. which one IS a feature of malignancy:

-no atypia

-high cell mitotic index (correct)

-calcified
1.56-year-old, female underwent resection of grade three meningioma in the frontal convexity, all are
true except: Single choice.

a) Female gender is a risk factor for meningioma.

b) Grade three total resection needs to be followed by radiotherapy.
c) Stereotactic radiosurgery is an option for treatment.
d) In the spine, these are classified as intradural intramedullary tumors.
e) Observation is an option for small lesions.
Answer: d

2.All the following are options in treating hydrocephalus: Single choice.

a) Ventriculoperitoneal shunt.
b) External ventricular drain
c) Tumor excision in obstructive hydrocephalus.
d) Intracranial pressure monitoring.
e) Endoscopic third ventriculostomy.
Answer: d

3. In regards to the ventricular system anatomy, the correct answer is: Single choice.

a) The Trigone is the area connecting the body of 3rd ventricle to occipital and temporal horns.
b) Choroid plexus is absent in the inferior temporal horn.
c) Foramen of Monro is passageway for CSF from lateral to 3rd ventricles.
d) There are 2 foramens of Magendi and one foramen of Luschka.
Answer: c

4.45 years old female with a history of progressive lower limb weakness associated with numbness
and paresthesia at the level of the umbilicus. All true except: Single choice.

a) It is more likely that this patient has a spastic paraparesis.

b) The lesion level is likely to be at T10 level.
c) Intradural tumor is a possible cause.
d) She may have signs of cauda equina syndrome.
e) Babinski sign can be positive.
Answer: d

5.A 48-year-old woman presents with acute low central lumbar pain of five days duration. This pain
radiates down the back of her right leg to the outer aspect of her foot. Her symptoms are exacerbated
by raising an extended leg beyond 30 degrees and by bending forward. The first step in management
is: Single choice.
 a)
b) Order an urgent MRI scan.
c) Conservative management is likely to include simple analgesics and physiotherapy.
d) The symptoms are unlikely to resolve without surgery.
e) Order a DEXA scan to check for osteoporosis.
Answer: a

6.Glioblastoma multiforme, all true except: Single choice.

a) Are of glial origin.

b) Are intra axial tumors.
c) Are curable by surgery.
d) Are primary brain tumors.
e) Associated with high mortality at 2 years.
Answer: c

7.Blood leak from a linear skull fracture may lead to: Single choice.

a) Formation of acute subdural hematoma.

b) Sub arachnoid hemorrhage.
c) Formation of Acute extradural hematoma.
d) Formation of acute intracerebral hemorrhage.
e) Intraventricular hemorrhage.
Answer: c

8.Regarding basal skull fracture, one of the following is FALSE: Single choice.

a) All patients with basal skull fractures should be admitted for observation.
b) The use of prophylactic antibiotics for meningitis is a must.
c) Most post-traumatic CSF leaks heal without surgical intervention.
d)
e) Racoon eyes indicates anterior cranial fossa fracture.
Answer: b

9.Regarding cauda equina syndrome (CES), choose the INCORRECT statement Single choice.

a) The involvement of sacral nerve roots is the hall mark of CES.

b) Perianal numbness and paresthesia are one of the main symptoms.
c) Can be caused by disc prolapse, infection or trauma.
d) It can involve any group of nerve roots from L1 to S4.
e) Urine and/or stool incontinence are constant features.
Answer: d
 a) It indicates upper motor neuron lesion.
b) It can be positive in cervical myelopathy.
c) It indicates lesion above C5 cord level.
d) It can be found bilaterally in normal individuals.
e) It can be associated with hyper-reflexia
Answer: c

11. In Spina bifida Aperta, the correct answer is:

a) Meningocele is covered with skin and has no neural tissue.

b) Myelomeningocele always has exposure to neural tissue.
c) Myelomeningocele is less common than meningocele.
d) Should be treated after 1 week of birth.
e) All the above.
Answer: b

12.The Monro-Kellie doctrine states that the sum volumes of the brain, cerebrospinal fluid (CSF), and
intracerebral blood is constant. An increase in one can cause a reciprocal decrease in either one or
both remaining. A brain tumor can cause disequilibrium by all the following except

a) Edema surrounding the tumor.

b) Hemorrhage within the tumor
c) Hydrocephalus
d) Increased pathological brain tissue.
e) Seizure
Answer: e

13.Regarding brain metastasis all false except:

a) Are found incidentally during staging.

b) The outcome depends on the primary prognosis alone.
c) The outcome depends on the premorbid status alone.
d) They need surgery always.
e) Outcome depends on both primary histology and premorbid status.
Answer: e

14.All of the following can cause myelopathy except:

a) Thoracic Spondylarthritis.
b) Cervical epidural abscess
 c) Metastatic spinal cord compression
d) Midbrain infarction
e) Spinal astrocytoma
Answer: d

15.Which of the following appear hyperintense of T1 WI (weighted images) MRI of the brain:

a) CSF.
b) Calcified tumor.
c) Bone
d) White matter.
e) Fat.
Answer: e

16.In upper motor neuron lesions, all are correct EXCEPT:

a) Hyperactive muscles stretch reflex.

b) Clonus
c) Clasp-knife spasticity
d) Babinski sign
e) Atrophy of denervation
Answer: e

17.When doing a lumbar puncture, which of the following indicates traumatic tap

a) High opening pressure.

b) Xanthochromia.
c) Low protein.
d) RBC to WBC ratio is like peripheral blood sample.
e) Low glucose.
Answer: d

18.In head injury patients, the most important sign is:

a) Pupil dilatation
b) Level of consciousness
c) CT brain findings.
d) Hemiplegia
e) CSF leak
Answer: b
19.A 42-year-old man presents to A & E after a grand-mal seizure. He fails to recover. A CT scan shows
a subdural hematoma with a 1 cm midline shift. Unfortunately, his consciousness level deteriorates.
Which blood test would you need prior to surgery?

a) Blood alcohol level

b) Coagulation screen
c) Liver function tests
d) Plasma sodium level
e) Option 2
Answer: b

20.One of the following emergency situations is weakly demonstrated on non-contrasted CT scan:

a) Depressed skull fracture.

b) Acute epidural hematoma.
c) Acute stroke.
d) Acute subdural hematoma.
e) Pneumocephalus.
Answer: c

21.The most common symptom in patients with post-concussion syndrome is:

a) Fatigue.
b) Photophobia.
c) Depression.
d) Headache.
e) Word finding difficulty
Answer: d

22.which of the following statements is/are CORRECT about EMG?

a) It stands for Electromyogram.

b) A normal motor exam will usually be associated with a normal EMG.
c) EMG is best reserved for cases with weakness, where additional prognostic information is
needed.
d) EMG is
e) All the above are true.
Answer: e

23.One of the following statements is false regarding cephalhematoma:

a) Appears within few days after birth.

 b) Well defined by suture.
c) Usually, soft.
d) No skin change,
e) In contrast to caput succedaneum, it requires surgical treatment.
Answer: e

24.A 3-year-old boy with a history of headaches and morning vomiting for 10 days presents to the ER
after a bad episode of vomiting. He is afebrile. The diagnostic studies might include all the following
except:

a) Fundoscopic examination
b) CSF by lumbar puncture for viral PCR
c) Brain CT scan
d) Brain MR scan
e) Blood tests
Answer: b

25.The differential diagnosis of numbness and paresthesia in the distribution of index and ring fingers
is all except:

a) Cervical rib.
b) Guyon's canal syndrome.
c) Carpal tunnel syndrome.
d) Cubital fossa syndrome.
e) C8 radiculopathy.
Answer: c

26.Regarding Hypocarbia (decrease level of arterial Pco2 tension) can cause:

a) .
b) Increase intracranial pressure.
c) Vasoconstriction and Ischemia.
d) Increase in cerebral blood flow (CBF).
e) Peripheral vasodilatation.
Answer: c

27.In Chronic subdural hematoma, choose the incorrect answer:

a) Commonly seen in elderly men after trivial head trauma.

b) Associated with a mortality of about 15 %
c) Develops from an increase in osmotic activity of hematoma from hemolysis of red blood cells.
d) Should be evacuated in all cases.
 e) It is hypodense on CT scan
Answer: d

28.All the following are options for treatment of meningioma, except:

a) Observation
b) Surgery
c) Radiosurgery
d) Gamma Knife
e) Chemotherapy
Answer: e

29.All the following are a contraindication to MRI, EXCEPT:

a) Some cardiac pacemakers.

b) Ventriculoperitoneal shunt
c) Swann-Ganz catheter
d) cochlear implants
e) ferromagnetic aneurysm clips
Answer: b

30.The most common extra-axial primary brain tumor is:

a) Glioblastoma multiforme
b) Meningioma
c) Astrocytoma
d) Skull metastasis
e) Hemangiomas
Answer: b

31.Glioblastoma Multiforme is a grade four primary brain tumor, Regarding grade 4 primary brain
tumors, choose the incorrect answer:.

a) cytologically malignant of glial origin.

b) mitotically inactive.
c) necrosis-prone neoplasms
d) Rapidly fatal despite aggressive treatment.
e) Can present with seizures.
Answer: b
32.An old gentleman presented to your clinic with claudication symptoms all the following are in favor
of neurogenic claudication over vascular claudication except:.

a) Symptoms improve on bending forward.

b) Symptoms improve on cycling.
c) It happens at fixed distance.
d) Walking uphill is painless.
e) Standing aggravates the symptoms.
Answer: c

33.A 32-year-old male patient complaining of neck pain that radiates along the C6 nerve distribution
of 3 days duration. Choose the most correct answer:

a) Prescribe adequate analgesia and follow him up.

b) Request an MR scan and follow him up.
c) Offer surgery to relieve nerve root compression.
d) Reassure him and discharge from clinic.
e) Request a CT to exclude fracture
Answer: a

34.Most of the CSF is produced by:

a) Arachnoid villi.
b) Interstitial space.
c) Frontal horns of the lateral ventricles.
d) Choroid plexuses of lateral and 4th ventricles.
e) Ependymal cells.
Answer: d

35.The dural sinuses are folds of the dura, which drains the brain venous blood. select the correct
sequence of blood flow in the venous sinuses:

a) Superior Sagittal sinus to sigmoid sinus then, internal jugular.

b) Cavernous sinus, transverse sinus then internal Jugular
c) Inferior sagittal sinus to the torcula, then internal jugular vein.
d) Superior Sagittal sinus to transverse sinus then, sigmoid sinus.
e) None of the above.
Answer: d

36.You were called to assess a patient with an ongoing seizure, your priority is:

a) Securing airways
 b) Breathing
c) Safe environment
d) Starting 5% dextrose water
e) Giving 5mg of IV lorazepam
Answer: c

37.Carpal Tunnel syndrome is associated with all the following, EXCEPT:

a) Often bilateral in amyloidosis.

b) Weakness of abductor pollicis brevis.
c) Findings of delayed ulnar nerve conduction by NCS
d) A possible cause of pain in forearm.
e) Can be associated with pregnancy.
Answer: c

38.According to ASIA score, a patient with incomplete spinal cord injury with only sensory function
preserved, is considered:

a) A score.
b) B score.
c) C score
d) D score
e) E score.
Answer: b

39. In Hydrocephalus (HCP) classification, the correct answer is:.

a) CSF overproduction is commonly considered as a major cause of hydrocephalus.

b) In non-communicating HCP, the obstruction is distal to the arachnoid granulations.
c) In communicating HCP, the obstruction is proximal to the arachnoid granulations.
d) Impaired CSF reabsorption is found in all types of HCP.
e) None of the above.
Answer: d

40.24 years old patient was involved in RTA and sustained a severe head injury, he has a right-sided
dilated pupil and left-sided hemiparesis, He has uncal herniation secondary to right temporal
extradural hematoma. The uncus can compress all the following except:

a) The posterior cerebral artery

b) The Oculomotor nerves
c) The ipsilateral corticospinal tract
 d) The contralateral corticospinal tract
e) Midbrain
Answer: d

41.19 years old male patient had a fall from three meters height, his GCS is 8 and a brain CT scan
showed extradural hematoma, while waiting for surgery his ICP monitor showed sustained readings
above 25mmhg, which of the following statements is correct:

a) Hypertonic saline is contraindicated, it may increase his blood pressure.

b) His blood pressure needs to be brought down quickly to avoid expansion of hematoma.
c) The neck should be free, in midline position to facilitate venous drainage.
d) Administration of mannitol now can cause immediate rebound high ICP.
e) Hypocarbia <27 mmgh is effective in treating his elevated ICP.
Answer: c

42.In Signs & symptoms of neonatal hydrocephalus all are true except:

a) CN VI palsy
b) Increase of Head circumference.
c) Early closure of cranial sutures.
d) Sunset eyes.
e) Prominent scalp veins.
Answer: c

43.The hallmark of central cord syndrome is:

a) Complete loss of sensation below level.

b) Ipsilateral loss of motor and proprioception.
c) Contralateral loss of motor and proprioception.
d) Upper extremity motor weakness greater than the lower extremity.
e) Proprioception spared.
Answer: d

44.75 years old male, with a history of prostate cancer on hormonal therapy presented to A&E with
insidious onset low back pain, fever, and bilateral lower limb weakness. He is hypotensive and febrile,
mostly likely he has discitis; the most urgent step is:

a) Resuscitation for septic shock

b) Blood culture to identify causative micro-organism.
c) Order an urgent MRI scan.
d) Vertebral biopsy to identify micro-organism.
e) Urgent decompression to treat lower limb weakness.
Answer: a
45. In Spina Bifida occulta, the correct answer is:

a) It has no visible exposure to meninges or any neural tissue.

b) Found in 30 % of the population.
c) Rarely to be associated with skin manifestation.
d) Much less common than Spina bifida Aperta.
e) All the above.
Answer: a