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NEUROSURGERY practice questions
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practice questions- systems based approach(NEUROSURGERY)
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Neurosurgery1. In taking a history from a patient with a 4. Which of the following is not true
ring-enhancing lesion seen on CT, all of concerning Brown-Sequard syndrome?
the following should be considered in a) Contralateral spinothalamic deficits
your differential diagnosis EXCEPT: b) Ipsilateral spinothalamic deficits
a) Breast cancer metastasis c) Ipsilateral dorsal column deficits
b) Meningioma d) Ipsilateral pyramidal tract deficits
c) Glioblastoma
d) Infarct 5. A 52-year-old man presented to the
e) Cerebral abscess urgent care centre 2 weeks ago with
severe left shoulder pain. He was
2. A 75 year old man is brought to your diagnosed with bursitis and treated with
office by his daughter, who is his primary NSAIDs. The pain has gradually
caregiver. She describes a gradual improved, but the patient has scheduled
decline in her father's gait over the last an office visit because he is concerned
two months. She now describes his feet about weakness of the left arm. On
as being ‘glued' or 'magnetized' to the examination, the patient has full passive
floor. He also has a worsening dementia range of motion of the arm and shoulder
and has recently become incontinent of without pain. Marked atrophy and
urine. Assuming this patient has had no weakness are noted in the left deltoid and
prior investigations, which of the following shoulder girdle muscles. Biceps and
is the most appropriate next step in his triceps reflexes are absent. The
management: remainder of the examination is
a) Lumbar puncture unremarkable. Which of the following is
b) Routine bloodworm (CBC, lytes, the most likely diagnosis for this patient?
BUN, Cr) a) Thoracic outlet syndrome
c) Urinalysis b) Brachial plexitis (Parsonage-Turner
d) CT or MRI of the head syndrome)
e) Carotid dopplers c) Rotator cuff tear
d) Spinal cord tumour
3. A 40 year old lady is hospitalized for e) Lacunar infarction
treatment of a severe, bilateral
pneumonia with parapneumonic pleural
effusions. Two days into her stay, she
develops a severe headache, then has a
seizure overnight. She has no prior
history of epilepsy. What is your most
likely diagnosis:
a) Stroke
b) Cerebral abscess
c) Bacterial endocarditis
d) Migraine
e) Toxoplasmosis secondary to HIV/
AIDS
, 6) A 24-year-old man is brought to the 7) A 46-year-old woman is brought to the
emergency department by the emergency emergency department by EMS after being
medical service (EMS). He suffered head involved in a car accident.She was a
trauma 20 minutes ago while playing passenger in the back seat of the car. The
football. Immediately after the event, he lost accident involved frontal impact, with the car
consciousness for 3 minutes and then woke moving at 50 mph. The patient was not
up mildly confused. He complains of a wearing a seatbelt. The driver says she has
moderate frontal headache. On physical not been awake since the accident, which
examination, the patient's vital signs are occurred 30 minutes ago. On admission, the
stable, his Glasgow Coma Scale (GCS) patient's vital signs are as follows: blood
score is 15, and he has no focal signs on pressure, 100/60 mm Hg; heart rate, 78
neurologic examination. What interventions beats/min; respiratory rate, 8 breaths/min;
would be appropriate in the treatment of this GCS score,7. CT scan shows a frontal
patient? epidural hematoma with mass effect. How
a) Continue with observation and repeat would you treat this patient?
neurologic examinations; repeat a) Intubate the patient, administer
assessment with the GCS periodically; hyperventilation to a carbon dioxide
and consider imaging with a CT scan to tension (PCO2) of 25 to 35 mm Hg,
rule out contusions induce a barbiturate coma, and admit the
b) Continue with observation and repeated patient to the ICU for further evaluation
neurologic examinations; repeat b) Intubate the patient, administer
assessment with the GCS periodically; hyperventilation to a PCO2 of 25 to 35
and obtain an MRI mm Hg, and ask for emergent
c) Admit the patient for prolonged neurosurgery consult for evacuation of
observation; obtain a CT scan to rule out the hematoma
contusions; and start I.V. mannitol for c) Intubate the patient, administer
brain edema hyperventilation to a PCO2 of 25 to 35
d) Admit the patient to the ICU; obtain an mm Hg, admit to ICU for close
MRI; and consider intraventricular observation, and consult neurosurgery
monitoring of intracranial pressure (ICP) for intraventricular ICP monitoring
d) Admit to ICU for further evaluation and
start mannitol and steroids
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