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Board Questions and Answers. Question 4 Surgical procedures utilized in the treatment of spasmodic torticollis include: – Upper cervical ventral.

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Presentation on theme: "Board Questions and Answers. Question 4 Surgical procedures utilized in the treatment of spasmodic torticollis include: – Upper cervical ventral."— Presentation transcript:

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- indruced arachnoiditis – 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. Calcarine sulcus – B. Lateral mesencephalic sulcus – 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 pollicis longus – B. Adductor pollicis – C. Brachioradialis – D. Extensor pollicis brevis – E. Supinator


26 Answer 13 Musculocutaneous: – Coracobrachialis, biceps brachii, brachialis Axillary: – Teres minor and deltoid Radial: – Triceps, anconeus, brachioradialis, extesnor carpi radialis (brevis/longus), supinator – PIN: abductor pollicis longus, extensor pollicis longus/brevis, extensor indices, extensor carpi ulnaris, extensor digitorum, extensor digiti minimi

27 Answer 13 Median: – Flexor carpi radialis, palmaris longus, flexor pollicis brevis (sup head), flexor digitorum superficialis, flexor digitorum profundus, abductor pollicis brevis, opponens pollicis, lumbricals (2,3) – AIN: flexor pollicis longus, pronator quadratus, flexor digitorum profundus Ulnar: – Flexor carpi ulnaris, flexor digitorum profundus, adductor pollicis, palmaris brevis, flexor pollicis brevis (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 peristent bradycarida 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

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