Neurosurgery Practice 3

The precuneus (area 7) can be found
A. on the lateral aspect of the frontal lobe.
B. on the medial aspect of the frontal lobe.
C. on the lateral aspect of the occipital lobe.
D. on the medial aspect of the occipital lobe.
E. on the medial aspect of the parietal lobe.

The most common vascular malformation is
A. capillary telangiectasia.
B. venous malformation.
C. arteriovenous malformation.
D. cavernous malformation.
E. dural arteriovenous fistula

The anterior meningeal artery typically arises
A. from the ophthalmic artery.
B. from the maxillary artery.
C. from the middle meningeal artery.
D. from the occipital artery.
E. from the facial artery.

The caudal anterior limb of the internal capsule is supplied
A. by the middle cerebral artery.
B. by the internal cerebral artery.
C. by the recurrent artery of Heubner.
D. by the posterior communicating artery.
E. none of the above

The external urethral sphincter is composed mainly of _______fibers arranged in a _______ fashion.
A. type I, longitudinal
B. type II, longitudinal
C. type I, circular
D. type II, circular
E. none of the above

Regarding atlanto-occipital dislocation all of the following are true EXCEPT:
A. It should be suspected in a multitrauma victim with mandibular fractures and submental lacerations.
B. Prevertebral soft tissue swelling may be the only clue to its diagnosis.
C. The gap between the occipital condyles and condylar surface of the atlas is greater than 5 mm.
D. The distance between the tip of the dens and basion is less than 12 mm.
E. The clivus line is not tangential to the odontoid.

The action potential in the neuron is initiated
A. at the dendrite.
B. at the soma.
C. at the hillock.
D. at the node of Ranvier.
E. at the axon terminal.

Which of the following conditions is most often associated with chronic temporal lobe epilepsy?
A. pilocytic astrocytoma
B. ganglioglioma
C. DNET
D. astrocytoma
E. pleomorphic xanthoastrocytoma

Which of the following is NOT a functional indication for stereotactic radiosurgery?
A. trigeminal neuralgia refractory to medication
B. glossopharyngeal neuralgia in a patient with carbamazepine hypersensitivity.
C. unilateral essential tremors refractory to medication
D. Parkinson’s tremor in the left upper extremity with levodopa-induced
dyskinesias
E. Huntington’s chorea

Regarding the venous drainage of the insula, which of the following statements is true?
A. The entire insula drains to the deep venous system.
B. The entire insula drains to the superficial venous system.
C. The anterior portion of the insula drains to the deep system.
D. The posterior portion of the insula drains to the superficial system.
E. none of the above

Which of the following separates the anterior cerebellar lobe from the poste-
rior cerebellar lobe?
A. posterolateral fissure
B. horizontal fissure
C. dorsolateral fissure
D. primary fissure
E. postlunate fissure

Regarding spinal vascular malformations, which of the following is FALSE?
A. Dural arteriovenous fistulas are believed to be acquired.
B. Normal neural parenchyma is seen within juvenile AVMs.
C. Glomus AVMs may have associated aneurysms.
D. Acute progression is most likely due to venous congestion.
E. Dural AV fistulas have a female predilection.

The ischemic penumbra has a cerebral blood flow
A. of 1 to 8 mL/100 g/min.
B. of 8 to 23 mL/100 g/min.
C. of 23 to 30 mL/100 g/min.
D. of 30 to 40 mL/100 g/min.
E. of 40 to 50 mL/100 g/min.

What is the area interposed between the lenticular fasciculus and the thalamic fasciculus?
A. substantia nigra
B. pedunculopontine nucleus
C. zona incerta
D. subthalamic nucleus
E. none of the above

Which of the following areas modulate control of micturition?
A. medial parts of the frontal lobes
B. preoptic region of the hypothalamus
C. basal ganglia
D. all of the above
E. none of the above

The juxtarestiform body is _______ to the ______cerebellar peduncle.
A. lateral, inferior
B. lateral, superior
C. medial, inferior
D. medial, superior
E. none of the above

The flower spray ending is associated with which nerve type?
A. IA
B. IB
C. II
D. III
E. IV

When performing a caudalis rhizotomy, which tract is penetrated to access the
target?
A. ventral spinocerebellar tract
B. dorsal spinocerebellar tract
C. gracile fasciculus
D. cuneate fasciculus
E. none of the above

The arterial dicrotic notch
A. has no corresponding area in the intracranial pressure (ICP) waveform.
B. corresponds to the area between P1 and P2 of the ICP waveform.
C. corresponds to the area between P2 and P3 of the ICP waveform.
D. corresponds to the area after P3 of the ICP waveform.
E. none of the above

The basal vein of Rosenthal begins at this area on the base of the brain.
A. anterior perforated substance
B. posterior perforated substance
C. tuber cinereum
D. medial geniculate body
E. lateral geniculate body

The calcified glomus of the choroid plexus seen on CT is most often found
A. in the frontal horn.
B. in the third ventricle.
C. in the trigone.
D. in the occipital horn.
E. in the foramen of Monro.

Decussation of the superior cerebellar peduncles occurs in which area of the
brain?
A. cerebellum
B. rostral midbrain
C. rostral pons
D. caudal midbrain
E. caudal pons

Cranial nerves IX, X, and XI are supplied
A. by the superior thyroid artery.
B. by the ascending pharyngeal artery.
C. by the lingual artery.
D. by the facial artery.
E. by the occipital artery.

Attempted lateral gaze where there is destruction of the abducens nucleus
results
A. in ipsilateral lateral and medial rectus palsies.
B. in ipsilateral lateral and contralateral medial rectus palsies.
C. in contralateral lateral and ipsilateral medial rectus palsies.
D. in contralateral lateral and medial rectus palsies.
E. none of the above

Brainstem auditory evoked response ( BAER) is most useful to monitor the
function
A. of the medial lemniscus.
B. of the lateral lemniscus.
C. of the corticospinal tracts.
D. all of the above
E. none of the above

The lateral subnucleus of cranial nerve III innervates
A. the inferior rectus.
B. the inferior oblique.
C. the medial rectus.
D. all of the above
E. none of the above

Deep pressure and joint position is localized to Brodmann’s area
A. 3a.
B. 3b.
C. 2.
D. 1.
E. none of the above

Which of the following is the least consistent feature of conus syndrome?
A. symmetric involvement
B. pain
C. saddle anesthesia
D. bladder and bowel symptoms
E. sudden onset

Malignant peripheral nerve sheath tumors most commonly affect cranial
nerve
A. III.
B. IV.
C. V.
D. VI.
E. VII.

The superior ophthalmic vein courses most closely with which cranial nerves?
A. IV (trochlear) and V (trigeminal)
B. III (oculomotor) and IV
C. III and II (optic)
D. V and VI (abducens)
E. II and IV

The caudate nucleus forms
A. the medial wall of the frontal horn.
B. the floor of the temporal horn.
C. the lateral wall of the occipital horn.
D. the roof of the lateral ventricle.
E. none of the above

Which of the following is true regarding the dorsal trigeminothalamic tract?
A. It arises from the principal sensory nucleus of V.
B. It terminates on the VPM thalamus.
C. It conveys touch and pressure information from the face.
D. It is an uncrossed tract.
E. All of the above

Valveless emissary veins are found in which layer of the scalp?
A. skin
B. subcutaneous tissue
C. galea
D. loose areolar tissue
E. periosteum

Apocrine sweat glands in the axilla are innervated by what type of fibers?
A. adrenergic fibers
B. cholinergic fibers
C. nitric oxide
D. VIP
E. none of the above

The greatest decline in water content of the nucleus pulposus occurs
A. just after birth.
B. in childhood.
C. in adolescence.
D. in young adulthood.
E. in late adulthood.

The tapeta are fibers
A. from the claustrum.
B. from the globus pallidus.
C. from the corpus callosum.
D. from the thalamus.
E. none of the above

Dressing apraxia is most often described with lesions
A. of the dominant frontal lobe.
B. of the nondominant frontal lobe.
C. of the dominant parietal lobe.
D. of the nondominant parietal lobe.
E. none of the above

Cerebrospinal fluid is reabsorbed into the bloodstream
A. through the valveless arachnoid villi.
B. through the pressure insensitive valves of the arachnoid villi.
C. through the pressure sensitive one-way valves of the arachnoid villi.
D. through the pressure insensitive valveless arachnoid villi.
E. none of the above

The precursor of ACTH is
A. CLIP.
B. Beta-lipotropin.
C. Alpha-MSH.
D. POMC.
E. none of the above

Regarding myasthenia gravis (MG), which of the following statements is FALSE?
A. It involves autoantibodies directed against acetylcholine receptors at the
neuromuscular junction.
B. The prevalence is between 1 in 10,000 and in 15,000.
C. Juvenile MG is more common in Asians.
D. There is an increased incidence of an underlying thymoma in late-onset MG.
E. Late-onset MG is more common in females.

The internal carotid artery (ICA) enters the cranium via a canal formed
A. by the sphenoid bone.
B. by the occipital bone.
C. by the sphenoid and temporal bones.
D. by the temporal bone.
E. by the temporal and occipital bones.

All of the following are true of the trochlear nerve EXCEPT:
A. It has a nucleus located in the midbrain tegmentum at the level of the
inferior colliculus.
B. It decussates in the superior medullary velum.
C. It exits the brainstem from the dorsal surface.
D. It courses lateral to the frenulum of the superior medullary velum.
E. Damage to the nucleus results in dysfunction of the superior oblique mus-
cle on that side.

The asterion is located at the intersection
A. of the lambdoid, occipitomastoid, and parietomastoid sutures.
B. of the lamboid, sagittal, and occipitomastoid sutures.
C. of the lambdoid, sagittal and parietomastoid sutures.
D. of the sagittal and occipitomastoid sutures.
E. none of the above

Which nucleus of the hypothalamus is involved with the dissipation of heat?
A. posterior nucleus
B. ventromedial nucleus
C. lateral nucleus
D. anterior nucleus
E. none of the above

Which of the following joints lack an intervertebral disc?
A. occipitoatlantal joint
B. atlantoaxial joint
C. sacrum
D. all of the above
E. none of the above

The diagnosis of syndrome of inappropriate secretion of antidiuretic hormone
(SIADH) is made by the following observations EXCEPT:
A. serum sodium <135 mEq/L
B. serum osmolarity <280 mOsm/L
C. hypervolemia
D. urine sodium >20 mmol/24 h
E. urine osmolarity > serum osmolarity

Which of the following congenital conditions results in a deficit in abduction of the eye resulting from failure of development of motoneurons in the sixth nerve nucleus?
A. Marcus Gunn syndrome
B. Joubert’s syndrome
C. De Morsier’s syndrome
D. Duane’s syndrome
E. none of the above

Dilantin levels are increased by all of the following EXCEPT:
A. cimetidine
B. coumadin
C. carbamazepine
D. isoniazid
E. sulfa drugs

Which of the following fiber tracts end as climbing fibers?
A. olivocerebellar
B. reticulocerebellar
C. pontocerebellar
D. all of the above
E. none of the above

The most relevant factor in assessing prognosis of paraganglioma patients is
A. tumor location.
B. tumor size.
C. time to surgery.
D. response to chemotherapy and radiation.
E. none of the above

The anteromedial middle fossa triangle is defined by cranial nerves
A. IV and V 1 .
B. V 1 and V 2 .
C. V 2 and V 3 .
D. V 3 and VI.
E. none of the above

Hyperperfusion encephalopathy most commonly involves which part of the
brain?
A. subcortical white matter of the occipital lobes bilaterally with little to no
edema
B. subcortical white matter of the occipital lobes bilaterally with edema
C. the cortical ribbon of the parietal lobes bilaterally
D. the cortical ribbon and subcortical white matter bilaterally
E. the cortical ribbon with sparing of the subcortical U-fibers

Glasscock’s triangle is defined by the posterior border of V 3 and which foramina?
A. foramen ovale and spinosum
B. foramen ovale and rotundum
C. foramen rotundum and spinosum
D. foramen spinosum and lacerum
E. foramen lacerum and ovale

Which of the following is FALSE regarding hyperperfusion encephalopathy?
A. The vast majority of patients recover completely.
B. The edema tends to resorb completely.
C. The vertebrobasilar system is vulnerable due to extensive sympathetic
innervation.
D. A similar condition may occur after a carotid endarterectomy.
E. Patients with hyperperfusion encephalopathies often have labile blood
pressures.

All of the following are correct statements about the central sulcus EXCEPT:
A. It separates the frontal lobe from the parietal lobe.
B. It separates the motor cortex from the sensory cortex.
C. It extends into the paracentral lobule.
D. It is usually continuous with the lateral sulcus.
E. It is located on the lateral convex surface of the hemisphere.

Which of the following is NOT a feature of migraine headaches?
A. normal intraocular pressure
B. ipsilateral flushing
C. decreased local skin temperature
D. female predominance
E. no aura is seen with common migraines.

Cortical paralysis of visual fixation, optic ataxia, and disturbance of visual
attention, with preservation of spontaneous and reflex eye movements may be seen after bilateral parietooccipital lesions. The syndrome described is
A. Anton’s syndrome.
B. Adie’s syndrome.
C. Cogan’s syndrome.
D. Vernet’s syndrome.
E. Balint’s syndrome.

During a selective amygdalohippocampectomy for intractable seizures, the surgeon must be aware that the most medial part of the amygdala is in close
proximity
A. to the basal ganglia.
B. to the anterior commissure.
C. to the caudate nucleus.
D. all of the above
E. none of the above

The anterior choroidal artery usually runs ______ to the posterior communicat-
ing artery, and ______ to the optic tract.
A. lateral, parallel
B. medial, parallel
C. lateral, perpendicular
D. medial, perpendicular
E. none of the above

Which of the following muscles is a medial rotator of the thigh?
A. piriformis
B. obturator internus
C. quadratus femoris
D. gluteus minimus
E. gluteus maximus

Lewy bodies may be seen in all the following EXCEPT:
A. Parkinson’s disease
B. Shy-Drager syndrome
C. multiple system atrophy (MSA)
D. diffuse Lewy body dementia
E. paralysis agitans

The largest contributor to the internal cerebral vein is
A. the septal vein.
B. the thalamostriate vein.
C. the caudate vein.
D. the basal vein of Rosenthal.
E. the vein of Galen.

During a thalamotomy for parkinsonian tremor, the patient reports that he has
paresthesias of the fingertips and the mouth. This would most likely be due to
the electrode being too
A. anterior to the target.
B. posterior to the target.
C. medial to the target.
D. lateral to the target.
E. close to the target.

Deficiencies of complement components C5 and C6-C9 predispose
A. to Streptococcus pneumoniae.
B. to Haemophilus influenzae.
C. to Neisseria meningitidis.
D. to Proteus.
E. none of the above

Meningiomas of the ventricular system are most frequently located
A. at the body.
B. at the trigone.
C. at the temporal horn.
D. at the occipital horn.
E. at the frontal horn.

In patients with multiple cerebral metastases, the most important determi-
nant of survival is
A. the size of the largest metastasis.
B. the extent of systemic disease.
C. the number of visible metastases on MRI.
D. the neurologic condition preoperatively.
E. the proximity to eloquent cortex.

Sensory axons that transmit information from the Golgi tendon organs are
A. Ia (A-α).
B. Ib (A-α).
C. II (A-β).
D. III (A-δ).
E. IV (C).

The vast majority of spinal epidural abscesses can be best described as
A. caused by staphylococci, and occur in the cervical cord.
B. caused by streptococci, and occur in the cervical cord.
C. caused by staphylococci, and occur in the thoracic cord.
D. caused by streptococci, and occur in the thoracic cord.
E. caused by staphylococci, and occur in the lumbar cord.

With regard to shunt infections, which of the following is FALSE?
A. Staphylococcus is the organism implicated in a majority of cases.
B. Symptoms include shunt failure, headache, nausea, and vomiting.
C. Elevated temperature is a more reliable sign of infection in VA as opposed to VP shunts.
D. There is a greater risk of shunt infection with distal revision than proximal revision.
E. Staphylococcus infections may cause obstruction without fever.

Which of the following is the most common type of tumor arising in the sella following irradiation for pituitary adenoma?
A. liposarcoma
B. fibrosarcoma
C. angiosarcoma
D. chondrosarcoma
E. osteosarcoma

Dopamine loss in Parkinson’s disease is believed to lead
A. to disinhibition of the subthalamic nucleus.
B. to high activity of Gpi/SNr.
C. to inhibition of the motor thalamus.
D. all of the above
E. none of the above

Which of the following is true regarding the etiology of postoperative diabetes
insipidus?
A. It is due to disruption of the pituitary stalk.
B. There is degeneration of distal axons in the region of dissection.
C. Stored ADH is depleted.
D. All of the above
E. None of the above

Which of the following parasites present with cord compression in infected
patients?
A. strongyloides
B. schistosomiasis
C. paragonimiasis
D. neurocysticercosis
E. echinococcus

The mediodorsal nucleus of the thalamus is reciprocally connected
A. to the cingulated gyrus.
B. to the prefrontal cortex.
C. to the substantia nigra.
D. to the lateral lemniscus.
E. to the inferior parietal lobule.

Lymphoma metastatic to the brain tends to localize
A. to the subependymal.
B. to the gray-white junction.
C. to the meninges.
D. to the frontal lobe.
E. to the corpus callosum.

In developing an interforniceal plane for resection of an anterior third ven-
tricular tumor, the surgeon must be most cognizant of what structure in the
posterior component of the forniceal structure?
A. anterior commissure
B. posterior commissure
C. hippocampal commissure
D. all of the above
E. none of the above

All the following are true of the centromedian nucleus of the thalamus
EXCEPT:
A. It is the largest of the intralaminar nuclei.
B. It receives input from the globus pallidus.
C. It projects to the striatum.
D. It projects diffusely to the entire neocortex.
E. It is reciprocally connected to areas 41 and 42.

The stylomastoid foramen is located _____ to the insertion of the _______ belly
of the digastric muscle.
A. medial, anterior
B. medial, posterior
C. lateral, anterior
D. lateral, posterior
E. none of the above

Mutism following transcallosal surgery may be the result
A. of division of the anterior corpus callosum.
B. of retraction on the fornix.
C. of circulatory disturbance in the SMA.
D. all of the above
E. none of the above

Which of the following are sources of input to the red nucleus?
A. dentate nucleus
B. globose nucleus
C. emboliform nucleus
D. all of the above
E. none of the above

Which of the following is a noncompetitive alpha-blocker?
A. phentolamine
B. atropine
C. phenylephrine
D. amphetamine
E. phenoxybenzamine

All of the following are true statements regarding the cerebral metabolic rate
(CMRO 2 ) EXCEPT:
A. Forty percent of the energy consumed is for maintenance of ionic
gradients.
B. Once EEG silence is induced, barbiturates will not produce further reductions in (CMRO 2 ).
C. Once EEG silence is induced, temperature reduction does produce further reductions in (CMRO 2 ).
D. Normal rate is ~5.5 mL/100 g/min.
E. Ketamine anesthesia decreases CMRO 2 .

The globus pallidus projects to which thalamic nuclei?
A. centromedian
B. ventral anterior
C. ventral lateral
D. all of the above
E. none of the above

The most medial fibers in the crus cerebri are
A. frontopontine.
B. corticobulbar.
C. corticospinal.
D. parietopontine.
E. none of the above

Relative contraindications for surgery for spinal metastasis include all of the
following EXCEPT:
A. multiple myeloma
B. recurrence after maximal radiation
C. multiple lesions at multiple levels
D. total paralysis for greater than 24 hours
E. expected survival less than 4 months

The usual radiation dose for spinal epidural metastasis is:
A. 20 Gy in 2-Gy fractions over 10 days.
B. 30 Gy in 3-Gy fractions over 10 days.
C. 60 Gy in 6-Gy fractions over 10 days.
D. 100 Gy in 10-Gy fractions over 10 days.
E. 200 Gy in 50-Gy fractions over 30 days.

Which statement is true about the presentation of multiple myeloma in the spine?
A. Hypocalcemia occurs in 25% of patients.
B. Bone pain is characteristic at rest and with movement.
C. Occurrence of amyloidosis.
D. Invasion of the spinal canal occurs in over 50% of patients.
E. Definitive diagnosis can be made by plain x-ray.

Criteria for the diagnosis ofmultiple myeloma include all ofthe following EXCEPT:
A. biopsy-proven plasmacytoma.
B. myeloma cells in a single peripheral blood smear.
C. plasma cells greater than 10 of 1000 cells on marrow morphology.
D. radiographic survey demonstrating lytic lesions.
E. monoclonal immunoglobulins in the urine or blood.

The Batson’s plexus route of spinal metastases represents which type of
spread?
A. perinervous
B. arterial
C. venous
D. direct extension
E. none of the above

A 56-year-old woman just had a large frontal tumor resected. The tumor was
positive for reticulin on immunostaining. The tumor histology contained mitotic figures as well as necrosis and pseudopalisading. The most likely diagnosis is
A. ganglioglioma.
B. gliosarcoma.
C. glioblastoma multiforme.
D. gliomatosis cerebri.
E. germinoma.

Out of the following choices, which represents the most common source of
arterial embolus?
A. left atrium
B. left ventricle
C. pulmonary veins
D. aorta
E. ventricular aneurysms

Potassium depletion would MOST likely result from which of the following
diseases?
A. diabetic ketoacidosis
B. Cushing’s syndrome
C. high intestinal obstruction
D. diarrhea
E. uremia

Which of the following is the first sign of hypomagnesemia?
A. seizures
B. tetany
C. hypotension
D. loss of deep tendon reflexes
E. stupor

All the following are appropriate concentrations of ions in Ringer’s lactate
solution EXCEPT:
A. Na + 130 mEq/L
B. Cl· 109 mEq/L
C. Lactate 28 mEq/L
D. Ca 2+ 16 mEq/L
E. K + 4 mEq/L

The nucleus secreting hormones that stimulate release of luteinizing hormone
(LH) and follicle-stimulating hormone (FSH) and project to the medial emi-
nence is
A. the tuberoinfundibular nucleus.
B. the preoptic nucleus.
C. the paraventricular nucleus.
D. the mamillary bodies.
E. none of the above

Efferent pupillary defects are seen in the following disorders EXCEPT:
A. Adie’s pupil
B. posterior communicating artery aneurysm
C. Foster Kennedy syndrome
D. Horner’s syndrome
E. third nerve lesion

Relative afferent pupillary defects are seen in the following disorders EXCEPT:
A. macular degeneration
B. optic neuritis
C. papilledema
D. metabolic optic neuropathy
E. retinal lesion

Hypoxemia due to a 50% shunt is most likely to be improved by which of the
following measures?
A. decreasing the positive end expiratory pressure to 0 cm H 2 O
B. hyperventilation
C. improving mixed venous oxygen content
D. oxygen supplementation
E. none of the above

The half-life of platelets used for transfusion is
A. 96 hours.
B. 72 hours.
C. 48 hours.
D. 24 hours.
E. 12 hours.

Which phase of blood coagulation is the most time consuming?
A. conversion of prothrombin to thrombin
B. activation of contact factors
C. generation of thromboplastin
D. release of phospholipids from platelets
E. conversion of fibrinogen to fibrin

Which of the following is an early sign of cyanide poisoning?
A. blurred vision
B. diaphoresis
C. apnea
D. hallucinations
E. all of the above

Which of the following minerals is important in wound healing?
A. manganese
B. zinc
C. iron
D. copper
E. all of the above

The mechanism of action of aminoglycosides is best described by
A. inhibition of DNA synthesis.
B. cell membrane destruction.
C. cell wall damage.
D. inhibition of protein synthesis.
E. none of the above

Antimicrobial agents causing neuromuscular blockade include all the follow-
ing EXCEPT:
A. streptomycin
B. kanamycin
C. neomycin
D. polymyxin
E. gentamicin

Accumulations seen in metachromatic leukodystrophy are
A. sulfatides.
B. galactocerebroside.
C. ganglioside.
D. long chain fatty acids.
E. none of the above

The T-reflex represents
A. flexor response as seen in decerebrate rigidity.
B. crossed extensor reflex.
C. monosynaptic stretch reflex.
D. supramaximal stimulation of a mixed motor-sensory nerve.
E. all of the above

The trochlear nerve arises from the brainstem at the level
A. of the lower pons.
B. of the upper pons.
C. of the lower midbrain.
D. of the upper midbrain.
E. none of the above

A 57-year-old man with a known history of lung cancer presents with generalized muscle weakness. The most likely associated finding is
A. opsoclonus.
B. increased glutamic acid decarboxylase.
C. anti–Purkinje cell antibodies.
D. presynaptic acetylcholine receptor disorder.
E. multiple sclerosis.

To produce a 1 mEq/L rise in serum potassium, the total body potassium stores need to increase by which quantity?
A. 50 mEq
B. 150 mEq
C. 350 mEq
D. 500 mEq
E. 1000 mEq

If the C6 nerve root is severed, all the following may be affected EXCEPT:
A. lateral cord
B. ulnar nerve
C. musculocutaneous nerve
D. median nerve
E. lower subscapular nerve

Which of the following is a characteristic of narcolepsy?
A. hallucinations while sleeping
B. convulsions while sleeping
C. daytime hyperalertness
D. NREM onset of sleep
E. gelastic seizures

All the following are associated with torsade de pointes EXCEPT:
A. phasic changes of amplitude and polarity of ventricular complexes
B. hypokalemia
C. hypomagnesemia
D. narrowed QT intervals
E. may be predisposed by erythromycin

After a motorcycle accident, a patient is able to dorsiflex and invert his foot but
is unable to evert his foot. The most likely nerve lesioned is
A. the deep peroneal nerve.
B. the superficial peroneal nerve.
C. the common peroneal nerve.
D. the sciatic nerve.
E. the tibial nerve.

The brachial plexus structure just distal to the division is
A. the trunk.
B. the branch.
C. the cord.
D. the root.
E. none of the above

middle cerebral artery bifurcation aneurysm. What is the proper order of steps to ensure safe clipping of this
aneurysm?
A. definitive clipping, temporary clipping, fissure splitting, dissection of M2
branch from dome
B. dissection of M2 branch from dome, fissure splitting, temporary clipping,
definitive clipping
C. fissure splitting, temporary clipping, dissection of M2 branch from dome,
definitive clipping
D. temporary clipping, fissure splitting, dissection of M2 branch from dome,
definitive clipping
E. fissure splitting, dissection of M2 branch from dome, temporary clipping,
definitive clipping

Molecular genetic alterations in glioma, not part of a specific syndrome,
include all the following EXCEPT:
A. overexpression of CDK4
B. deletion of p53
C. mutation of retinoblastoma
D. amplification of K-ras
E. overexpression of CDK6

Oligodendrogliomas exhibit loss of chromosomal regions on all the following
EXCEPT:
A. 1p
B. 7q
C. 9p
D. 19q
E. 22

All the following statements are true about the sympathetic nervous system
EXCEPT:
A. Stellate ganglionectomy is used in the treatment of long QT syndrome.
B. Anhydrosis occurs with ganglionectomy.
C. Each intercostal nerve is connected to the sympathetic trunk by at least
one white ramus and two gray rami.
D. The inferior hypogastric plexus lies in front of the promontory of the
sacrum between the two common iliac arteries and is sometimes called
the presacral nerve.
E. Sympathetically conveyed stimulus to the sweat glands is transmitted by
acetylcholine.

Which of the following has the highest incidence of associated platelet
disorders?
A. ALS
B. Huntington’s disease
C. acute respiratory distress syndrome
D. AIDS
E. multiple sclerosis

regarding epidural abscess all are true EXCEPT:
A. most common location is cervicothoracic.
B. presence of a malignancy is a predisposing condition.
C. increased incidence with epidural anesthesia
D. incidence is 1:10,000 in the U.S.
E. increased incidence with drug abuse

The leading cause of magnesium deficiency is
A. antibiotic therapy.
B. diuretics.
C. secretory diarrhea.
D. diabetes mellitus.
E. Dilantin therapy.

All of the following may be used to differentiate between a lesion of the glos-
sopharyngeal nerve and a lesion of the facial nerve EXCEPT:
A. loss of sensation to the outer ear
B. loss of taste on the tongue surface
C. loss of salivatory secretion from a gland
D. weakness of the pharynx
E. strength of facial muscles

Neuromelanin has the following characteristics EXCEPT:
A. accumulates in neurons of the substantia nigra
B. found in the locus ceruleus
C. made by tyrosinase
D. is a catecholamine waste product
E. chelates metal ions such as aluminum and iron

Amygdala afferents include all the following EXCEPT:
A. nucleus accumbens
B. pyriform cortex
C. solitary tract nucleus
D. locus ceruleus
E. prefrontal cortex

Etiologies of distal renal tubular acidosis include all of the following EXCEPT:
A. amphotericin B
B. lithium
C. toluene
D. carbonic anhydrase inhibitors
E. cyclamate

Which of the following is NOT a valid therapeutic measure in patients with
addisonian crisis?
A. hydrocortisone sodium succinate (Solu-Cortef) for glucocorticoid emer-
gencies
B. fludrocortisone (Florinef) for mineralocorticoid emergencies
C. methylprednisolone (Solu-Medrol) for glucocorticoid emergencies
D. cortisone acetate for glucocorticoid emergencies
E. intravenous fluids

Therapeutic measures for syndrome of inappropriate secretion of antidiuretic
hormone (SIADH) include
A. furosemide.
B. phenytoin.
C. lithium.
D. all of the above
E. none of the above

Which of the following medications is safe to use in a patient with history of
malignant hyperthermia?
A. epinephrine
B. isoflurane
C. halothane
D. thiopental
E. all of the above

Which of the following neoplasms is LEAST likely to metastasize to the spine?
A. lung carcinoma
B. breast carcinoma
C. colon carcinoma
D. renal cell carcinoma
E. prostate carcinoma

In relation to what vessel are the cords of the brachial plexus named?
A. brachiocephalic artery
B. axillary artery
C. subclavian artery
D. brachial artery
E. internal carotid artery

Which type of spondylolisthesis is most common in gymnasts and football
players?
A. traumatic
B. degenerative
C. isthmic
D. pathologic
E. dysplastic

Of the following signs and symptoms, which is the most common in the pres-
entation of an osteoid osteoma?
A. radicular pain
B. scoliosis
C. weakness
D. atrophy
E. none of the above

Of the following signs and symptoms, which is the most common in the pres-
entation of an osteoblastoma?
A. radicular pain
B. scoliosis
C. weakness
D. atrophy
E. none of the above

DeQuervain’s syndrome is characterized by all the following EXCEPT:
A. caused by frequent repetitive motion at the wrist
B. pain and tenderness occurs in the wrist, near the thumb
C. Finkelstein test is positive
D. nerve conduction velocities are decreased
E. difficulty gripping

The dorsal horn of the spinal cord is derived from
A. the basal plate.
B. the notochord.
C. the neural crest cells.
D. the somites.
E. the endoderm.

All the following are features of malignant hyperthermia (MH) EXCEPT:
A. autosomal-recessive inheritance pattern
B. in 20% of cases there is no hyperthermia accompanying the muscle rigidity
C. may be associated with autonomic instability
D. may be caused by muscle relaxants
E. a mutation in the ryanodine receptor is related to MH

Which anesthetic agent is LEAST likely to cause further decrease in blood pres-
sure in the face of hypovolemic shock?
A. ketamine
B. thiopental
C. halothane
D. enflurane
E. isoflurane

The inferior frontal gyrus is bordered by which structure caudally?
A. operculum
B. sylvian fissure
C. precentral sulcus
D. rolandic fissure
E. none of the above

The actions of nitroglycerine are mediated by the following mechanisms
EXCEPT:
A. Nitroglycerine binds the surface of endothelial cells.
B. Nitroglycerine undergoes two chemical reductions to form nitric oxide.
C. Nitric oxide promotes the formation of cyclic guanosine triphosphate.
D. Nitric oxide moves out of the endothelial cell into adjacent smooth muscle cells.
E. Nitric oxide has also been referred to as endothelium-derived relaxing
factor.

Which of the following causes hypokalemia?
A. amphotericin
B. angiotensin-converting enzyme inhibitors
C. aspirin
D. cyclosporine
E. heparin

A patient with von Willebrand’s disease sustained a motorcycle crash and is
losing blood from an open fracture. The blood product best suited for man-
agement is
A. whole blood.
B. fibrinogen.
C. platelets.
D. packed red blood cells.
E. cryoprecipitate.

Typical presentation of patients with conus medullaris lesions include all the
following EXCEPT:
A. Bilateral sensory deficit
B. Symmetric motor loss
C. Loss of ankle jerk but preserved knee jerk
D. Autonomic symptoms occur late
E. Urinary retention and atonic anal sphincter cause overflow urinary incon-
tinence and fecal incontinence.

Typical presentation of patients with cauda equina lesions include all the fol-
lowing EXCEPT:
A. Sensory dissociation
B. Asymmetric motor loss
C. Late autonomic symptoms
D. Absence of ankle jerk and knee jerk
E. Numbness tends to be more localized to saddle area.

Which of the following structures is the second branch of the proximal aorta
as it exits the left ventricle?
A. brachiocephalic artery
B. right subclavian artery
C. left subclavian artery
D. right carotid artery
E. left carotid artery

Bilateral internuclear ophthalmoplegia results in which abnormality on physical exam?
A. convergence deficit
B. adduction deficit
C. downward gaze palsy
D. vertical gaze palsy
E. Parinaud’s syndrome

Watershed infarcts are seen in all the following EXCEPT:
A. regional hypotension
B. CBF below critical level
C. atrial fibrillation
D. cardiac arrest
E. anaphylaxis

Which of the following arteries arises directly from the intracavernous carotid?
A. artery of Bernasconi-Cassinari
B. persistent stapedial artery
C. Heubner’s artery
D. McConnell’s capsula arteries
E. vidian artery

What is the significance of an elevated N-acetylaspartate (NAA) peak on an MR
spectroscopy scan?
A. increased neuronal density
B. increased metabolism
C. increased excitatory neurotransmission
D. necrosis
E. none of the above

Which of the following muscles is innervated by the glossopharyngeal nerve?
A. stapedius
B. tensor veli palatini
C. stylopharyngeus
D. posterior belly of digastric
E. none of the above

Which of the following is represented by “X” in this formula? X = (Cardiac output) (Arterial O 2 content – venous O 2 content)
A. oxygen delivery
B. oxygen uptake
C. oxygen extraction ratio
D. oxygen content
E. none of the above