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Which of the following is the most likely diagnosis in a demented 70 y/o man
with high intensity on T2-weighted images and focal lesions in the periventricular
and subcortical white matter?
a. Multiinfarct dementia
b. Picks disease
c. Multiple sclerosis
d. Alzheimers
Type- Neuro
Answers- a
Notes-
by KW
Verified Osborn p774
1994 Single Best Answer Question
Changes described above likely represent changes of small vessel ischemic disease
and therefore multi infact dementia.
2. Which of the following is the most likely diagnosis in a head trauma patient
who loses consciousness, recovers to have a lucid interval, and again loses
consciousness?
a. contusion
b. subdural hematoma
c. subarachnoid hemorrhage
d. epidural hematoma
Type- Neuro
Answers- d
Notes-
a. CNS lymphoma
b. medulloblastoma
c. schwannoma
d. prolactinoma
Type- Neuro
Answers- a,b
Notes-
by KH
1995 Question
not verified
4. At what age do you first see the adult pattern of myelination on a 1.5 tesla
magnet?
a. 1 week
b. 8 months
c. 1 month
d. 2 years
e. 4 years
Type- Neuro
Answers- d
Notes-
by AE
1997 Question
Type- Neuro
Answers- d
Notes-
a. vein of Galen
b. internal cerebral vein
c. inferior sagittal sinus
d. basal vein of rosenthal
Type- Neuro
Answers-
Notes-
by KH
1995 Question
not verified
Type- Neuro
Answers- a
Notes-
D332
Thyroglossal duct cysts on CECT appear as a low density mass with a uniformly thin
peripheral rim of enhancement. Septations occasionally are seen. located at or
below the level of the hyoid bone are embedded in the strap muscles adjacent to
the outer margin of the thyroid cartilage. Unlike, the thyroglossal duct cyst,
other lesions found in this area are superficial to the strap muscles. Papillary
carcinoma is the most common tumor to arise from these cysts(Head & Neck Imaging-
Som p532-3).
Thyroglossal duct cysts are midline masses lined by squamous cell mucosa;
suprahyoid 20%, hyoid 15%, infrahyoid 65%. Usually a midline / paramediancystic
mass 2-4cm with infrahyoid strap muscles beaking over the edge of the cyst.
Complications include infection, and duct carcinoma (<1%). (D254)
They appear on MR scan as well-circumscribed fluid-density structures in the
midline. (TF)
Thickening and enhancement of the wall indicates infection.
AJNR Am J Neuroradiol 2000 Apr;21(4):770-4
Thyroglossal duct carcinoma should be suspected in an adult patient in the
presence of a solid nodule or invasive features in association with a thyroglossal
duct lesion visible on CT scans or MR images. The presence of calcification, which
is seen best on CT scans, may be a specific marker for carcinoma.
Arch Pathol Lab Med 2000 Jan;124(1):139-42
The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst
is rare and occurs in about 1 % of thyroglossal duct cysts. Only 17 such cases
diagnosed with fine-needle aspiration biopsy have been previously reported in the
English-language literature, with a diagnostic rate of 53%.
Radiographics 1999 Jan-Feb;19(1):121-46; quiz 152-3
Cervical congenital cystic masses constitute an uncommon group of lesions usually
diagnosed in infancy and childhood. The most common congenital neck mass is the
thyroglossal duct cyst. The diagnosis is easily established from the presence of a
cystic lesion in the anterior midline portion of the neck. The vast majority of
branchial cleft cysts arise from the second branchial cleft. They can occur
anywhere from the oropharyngeal tonsillar fossa to the supraclavicular region of
the neck. Cystic hygroma is the most common form of lymphangioma. In the neck,
cystic hygromas are most commonly found in the posterior cervical space. They
typically extend into adjacent structures without respecting the fascial planes.
Dermoid and epidermoid cysts result from sequestration of ectodermal tissue. The
floor of the mouth is the most common location in the neck. Cervical thymic cysts
are very uncommon lesions and are found anywhere from the angle of the mandible
down to the sternum. Laryngoceles are classified into internal, external, and
mixed types and have a frequent association with laryngeal carcinoma.
1998 Board Question
by CM
8. Metachromatic leukodystrophy:
Type- Neuro
Answers- a
Notes-
by KW
Dahnert p252, Osborne 722
Most common hereditary leukodystrophy (demyelinating disease)
Autosomal recessive lysosomal disorder
Bilateral symmetric demyelination with sparing of the sub-cortical U fibers
1997 Old Board Question
a. contrast-enhanced CT
b. mass effect on CT
c. gadolinium-enhanced MR
d. 18F-deoxyglucose PET scan
Type- Neuro
Answers- d
Notes-
by KW
Verified Osborn p550
1993 Single Best Answer Question
10. Which of the following represent the OMU complex sinus pattern?
a. Sphenoid only
b. Frontal only
c. Ethmoid only
d. Maxillary only
e. Frontal, anterior ethmoid, and maxillary
Type- Neuro
Answers- e
Notes-
The osteomeatal complex is the control point for drainage of all 3 sinuses:
frontal, anterior ethmoid, maxillary (P572).
1999 Board Question
by MH
11. Which of the following structures is the most medial structure in the
cavernous sinus?
a. optic nerve
b. trigeminal nerve
c. cranial nerve VI
d. cranial nerve IV
Type- Neuro
Answers- c
Notes-
Dahnert p.203
Som p880,Osborne p463
1995 Single Best Answer Question
In the cavernous sinus lie the CNIII- which is in the superolat portion, CNIV-
which lies just below III, V-1, V-2, VI- which lies just lateral to the carotid. p
51 Requisites
The optic nerve is not in the cavernous sinus.
The most medial according to the fig 641 in Clemente is III, the oculomotor nerve,
then abducens-VI.
ref: Requisites p 51, Clemente fig 641
by AE
a. Pheochromocytoma
b. Meningioma
c. Carcinoid
d. Renal Cell CA
e. Medullary carcinoma of the thyroid
Type- Neuro
Answers- b,d
Notes-
13. Which of the following would be seen by MR in a patient who is 1 day S/P CVA?
a. vascular enhancement
b. mass effect
c. meningeal enhancement
d. parenchymal enhancement
e. hemosiderin deposition
Type- Neuro
Answers- a,b
Notes-
Dahnert p244
Meningeal and parenchymal enhancement at 1-7 days
Arterial enhancement has proven useful as an early marker of infarction.
Enhancement in arteries appears to be more sensitive that T2WI in the first few
hours of acute infarction, and thus enhancement is clearly useful for the workup
of acute ischemic syndromes. because normal rapid arterial flow produces a flow
void, arterial enhancement represents slow flow, and this can be detected in
approximately 50% of ischemic lesions. neuro requisties 112
1995 True/False Question
Findings on MR may be seen within a few hours. Swelling is observed on T1 and
proton density w/o changes of signal. 8hrs, high signal develops on T1 and PDWI.
16hr, low signal on T1. Arterial enhancement which is slow flow is detected in
approximately 50% of ischemic lesions. Arterial enhancement is more sensitive than
T2 in the first few hr of stroke. Reappearance of flow void occurs around 7-
11days. this suggests establishment of collateral flow of lysis of embolus.
Noncortical infarctions have parenchymal enhancement between 4-7 days whereas
cortical infarctions enhance after 6 days. Enhancement of the infarct may last 6-
8weeks. On CT, 6hr-faint loss of gray-white border, 12-24hr, indistinct low
density, feeble mass effect, >24hr, more mass effect, 3-5days, peak mass effect.
Parenchymal enhancement is rarely
seen before 3 days. If see earlier enhancement, either because of excellent
collaterals, or embolus has moved distally. Mass effect resolves at around 2-4
weeks. ref: Requisites p 112
by KH
14. Which one of the following infections of the brain is most commonly seen in a
patient with AIDS?
a. CMV encephalitis
b. HIV encephalitis
c. toxoplasmosis
d. cryptococcus
Type- Neuro
Answers- b
Notes-
Primer p514
Toxoplasma is the most common opportunistic CNS infection in AIDS patients.
Toxo is the most common focal CNS infection in AIDS.
1995 Single Best Answer Question
by KH
15. Which one of the following vessels is affected in the Wallenberg (lateral
medullary) stroke syndrome?
Type- Neuro
Answers- d
Notes-
Osborne p.368
1992, 1988 Single Best Answer Question
by AE
a. Medulloblastoma
b. Ependymoma
Type- Neuro
Answers- a
Notes-
by KW
Dahnert p172
Up to 33% of Medulloblastomas have drop mets
Check Osborne
2000 Board Question
a. Sarcoidosis - uveitis
b. None of the above
c. Sjogrens - keratoconjunctivitis
Type- Neuro
Answers- a,c
Notes-
Not Verified
1993 Board Question
a. Ghosting
b. Chemical shift
c. Phase misregistration
Type- Neuro
Answers- a
Notes-
Not Verified
1993 Board Question
19. A patient presents with pectoralis weakness and numbness of the skin over the
lateral shoulder. Which nerve is damaged?
a. Radial
b. Musculocutaneous
c. Axillary
Type- Neuro
Answers- c
Notes-
20. Wormian bones can be seen with all of the following except:
a. Chiari II malformation
b. Cleidocranial dysostosis
c. Osteogenesis imperfecta
d. Normal variant
Type- Neuro
Answers- a
Notes-
Type- Neuro
Answers- b
Notes-
22. 29 year old female with acute vision loss and headache. MR shows a
sellar/super sellar lesion with fluid levels. The most common cause is likely:
a. Ependymoma
b. Pinealoma
c. Pituitary apoplexy
d. Craniopharyngioma
Type- Neuro
Answers- c
Notes-
by KW
Dahnert p266
Pituitary apoplexy = massave hemorrhage into pituitary adenoma with sudden
infarction of pituitary gland
Patients present with headache, nausea, vomiting, acute visual defects
Sheehan syndrome = pituitary infarct of anterior pituitary gland post-partum
1997 Old Board Question
23. A 20 y/o was weight lifting and suddenly developed confusion. He has
diminished right visual field response. The left pupil is smaller than the right.
He is speaking gibberish. His brother has been nursing a cold sore for 10 days.
Which of the following is the most likely diagnosis?
Type- Neuro
Answers- a
Notes-
24. A 23-year-old patient presents with headache for 6 weeks and occasional
vomiting without nausea. Physical examination reveals bilateral papilledema and
mild truncal ataxia. Which of the following imaging findings would be most
consistent with this history?
a. Obstructive hydrocephalus
b. Multiple infarcts
c. Massive subarachnoid hemorrhage
d. Low CT attenuation within the periventricular white matter
Type- Neuro
Answers- a
Notes-
Colloid cysts are smooth spheric cysts ranging in size from 0.3 cm to 4 cm. They
comprise approximately 2% of all intracranial tumors, and are most common in the
third to fifth decade with no sex predilection. Their location is nearly constant
in the anterior portion of the third ventricle with rare cases reported in the
lateral ventricles. Their characteristic location explains the clinical
presentation of episodic headache secondary to transient obstruction of the
foramen of Monro related to head position. More commonly, however, affected
patients present with gradual onset of symptoms related to obstructive
hydrocephalus. Such symptoms include insidious onset of headache, gait apraxia,
mental status changes, and papilledema. (Although d may be seen with interstitial
edema secondary to hydrocephalus, the best answer is c).
1999 Board Question
by CM
Type- Neuro
Answers- a
Notes-
26. A 30 y/o female had a severe headache 6 days ago. She has a known Berry
aneurysm and now presents with an acute headache and one episode of nausea without
vomiting. What is the most likely diagnosis?
a. communicating hydrocephalus
b. recurrent subarachnoid hemorrhage
Type- Neuro
Answers- b
Notes-
Berry aneurysm- due to congenital weakness in the media and elastica of arterial
wall, occurs at branching points
Aneurysm location: 1) Ant comm artery/ ant cerebral artery
2) ICA
3) Middle cerebral artery
4) Vertebrobasilar
1991 Single Best Answer Question
Intracranial aneurysms are the most common atraumatic cause of subarachnoid
hemorrhage. Only about 10% occur in the posterior fossa, the majority of these
arising in the
basilar tip. At least 20% are multiple. By definition, aneurysms larger than 2.5
cm are termed
giant. Although the vast majority of berry aneurysms occur in isolation, certain
diseases
predispose to their formation. These include autosomal dominant polycystic kidney
disease
(???6% incidence of aneurysm), AVM, fibromuscular dysplasia, coarctation of the
aorta, and
collagen vascular disease (Ehlers-Danlos and Marfans).
by AE
27. A 35 y/o male sustained blunt trauma to the neck two weeks prior to
development of amaurosis fugax and Horners syndrome. Which of the following is
the most likely diagnosis?
Type- Neuro
Answers- b
Notes-
by KW
Verified Osborn p234, Dahnert p314
Carotid dissection is a frequent cause of ipsilateral Horners syndrome and
amaurosis fugax
1993 Single Best Answer Question
aneurysm = focal dilatation of an artery
pseudoaneurysm = organized hematoma from a vessel that has bled.
28. A 37 year old female who had been painting for two weeks develops loss of pain
and temperature sensation within the left face and on the contralateral side of
her body. She also has right truncal ataxia and left tongue weakness. This is
most consistent with?
Type- Neuro
Answers- a
Notes-
a. Low-grade glioma
b. Herpes encephalitis
c. Mesial temporal sclerosis
Type- Neuro
Answers- b
Notes-
by KW
Herpes usally associated with mass effect, classic location for herpes however.
Mesial temp sclerosis usually unilateral, after long standing epilepsy
2000 Board Question
30. A 40 year old female presents with fullness of the cheeks and history of
progressive dry mouth. Imaging reveals bilateral enlarged parotid glands with
multiple cysts. The most likely etiology for this condition is?
a. Parotid adenomatosis
b. HIV
c. Warthin tumor
d. Sjogrens syndrome
e. Bilateral pleomorphic adenomas
Type- Neuro
Answers- d
Notes-
Type- Neuro
Answers- a
Notes-
thought if this was not single best answer format that vertebral artery dissection
might also cause these symptoms. Dissection of the cervicocerebral arteries cause
stroke in kids and young adults. Trauma
is the most frequent cause. Horners syndrome occurs in over half the cases. p
1981-2 Harrisons
Dissection can involve the carotid or vert. Sx include neck and face pain, HA,
Horners, CN involvement, ischemic sx that can occur days to weeks from
dissection. Ptosis, miosis, HA with preservation of ipsilateral facial sweating
(Raeders syndrome) can occur with cervical ICA dissection. Sympathetic fibers for
sweat go with ECA and those controling the dilator pupillae and superior palpebral
muscles follow the ICA . p133-4 Requisites
1994 Single Best Answer Question
by KH
32. A 45 y/o woman has unilateral papilledema and calcification of the junction of
the opticnerve and posterior globe. What is the most likely diagnosis?
a. Drusen
b. retinoblastoma
c. melanoma
d. choroidal osteoma
Type- Neuro
Answers- a
Notes-
33. A 45 year old female presents with midfacial trauma and signs of acute central
cord syndrome. Cervical spine films reveal normal alignment of the spine and pre-
vertebral soft tissue swelling. This most likely represents?
a. Hyperextension injury
b. Pillar fracture
c. Atlanto-axial dissociation
d. Hangmans fracture
e. Non-displaced odontoid fracture
Type- Neuro
Answers- a
Notes-
34. A 52 y/o interior decorator has just finished 2 weeks of painting a house.
She presents with loss of pain and temperature sensation on the right side of the
body with loss of pain and temperature sensation on the left side of the face.
She also has ataxia and her tongue deviates to the right. What is the most likely
diagnosis?
a. glioma
b. central pontine infarct
c. Horners syndrome
d. Webers syndrome
e. Wallenberg syndrome secondary to left vertebral artery dissection
Type- Neuro
Answers- e
Notes-
by KW
Verified Osborn p368
Wallenberg = Lateral Medullary Syndrome
1995 Single Best Answer Question
vertebral artery distribution, the lateral medulla is most often affected +/ the
posterior inferior
cerebellum. Lateral medullary infarction can result from occlusion of vert, PICA,
sup, middle,
inf lateral medullary arteries. In 70-80% of cases, get after ipsilateral
vertebral artery occlusion.
Get pain, numbness, inpaired sensation over ipsilateral face, arm, trunk, leg AND
contralateral
impaired pain, thermal sense over half of body. Get ataxia of limbs, falling to
side of lesion,
nystagmus, horners, dysphagia, hoarsenes, paralysis of palate, vocal cords, and
diminished gag.
Deviation of the tongue to the right is from 12th nerve palsy on the right which
can result
from medial medullary syndrome -- occlusion of the vert or branch of the vert or
lower basilar
artery.
Webers syndrome is a result of PCA infarct Webers is a third nerve palsy with
contralateral hemiplegia. Involves infarction of the third nerve and cerbellar
peduncle. fig 351-6
p 1984
ref: Harrisons 12th ed p 1988-9, 1984, 1987
dissection b/c ipsilateral face sx and tongue deviation.
35. A 55 year old male undergoes brain MR. A temporal lobe lesion is identified
which is very dark centrally and bright peripherally on T2 weighted images. The
entire lesion is isointense on T1 weighted images. This most likely represents?
a. Lymphoma
b. Aggressive glioma
c. Hemorrhagic contusion
d. Abscess
e. Cavernous hemangioma
Type- Neuro
Answers- c
Notes-
a.This sounds like the single best answer to me although, Im not certain. The
temporal lobe is a common location for contusion(D p225-6). b.Cavernous
hemangioma (=cavernous angioma) has mixed signal intensity centrally surrounded by
a hypointense rim (hemosiderin) on T2W (Dahnert p221, Osborn p313). c.GBM may
show central necrosis and hemorrhage of varying age (dark on T2W) with peripheral
edema (bright)(Osborn p543). c.F (Osborn p620-3). e.F(Osborn p691).
1999 Board Question
by CM
36. A 7 year old patient with scoliosis and bilateral lower extremity weakness and
leg length discrepancy (left greater than right). The patient also has a sacral
dimple with a hairy patch. This is most consistent with?
a. Tethered cord
b. Ependymoma of the conus medullaris
c. Meningocele
d. Chiari II with lipomeningocele
e. Astrocytoma
Type- Neuro
Answers- a,c
Notes-
Dahnert p173,179
A tethered spinal cord is one that is held down in an abnormally low position by a
fibrous band, bone spur, or mass, which presumably has prevented it from ascending
to the normal level during embryogenesis. Tethering has significance when the cord
becomes stretched between (1) the tethering band, bone spur, or mass and (2) fixed
attachments along the dentate ligaments and at the foramen magnum. Stretching the
spinal cord constricts its blood supply, so the cord blanches and becomes
ischemic. The typical symptoms of tethered cord - paraparesis and paraplegia,
sensory loss, and reduced bladder and bowel function - are believed to result from
chronic repetitive cord ischemia. Spinal flexion and gain in height exacerbate the
stretching, so patients frequently have greater symptoms and present to medical
attention following unusual exercise or during growth spurts. Perhaps the most
straightforward example of tethered spinal cord is the tight filum terminale
syndrome. Tight filum terminale syndrome denotes traction on the conus medullaris
as a result of an abnormally short, abnormally thickened ilium terminale. This
term specifically excludes cases with concurrent diastematomyelia, fibrous
adhesions, or other cause for tethering of the cord. Females (57%) are affected
slightly more commonly than males. Patients typically present at ages 5 to 10
years or 10 to 15 years during periods of rapid gain in height. The presenting
symptoms include motor weakness (76%), pain (42%), bladder dysfunction (35%),
sensory loss (21%), and scoliosis (17 .5%). Fifty percent of patients exhibit
cutaneous stigmata, usually a midline skin dimple, less commonly a capillary
hemangioma or patch of hypertrichosis. Kyphoscoliosis is present in 17% to 25% of
cases. In one third of cases, the scoliosis improves after surgical section of the
ilium releases the spinal cord. Plain spine radiographs (nearly) always
demonstrate malformation(s) of the neural arches at one or more lumbar,
lumbosacral, or sacral levels. Most commonly these are incomplete fusion (spina
bifida occulta) of L-4, L-5, and/or S-1. Since every one of their 86 patients with
this syndrome had such malformed neural arches, Hendrick and co-workers suggest
that normal spine radiographs nearly exclude this diagnosis. Myelography, computed
tomography (CT), and magnetic resonance imaging (MRI) show that the tip of the
conus medullaris lies below L-2 in 86% of cases. In 10% to 15% of cases, the
spinal cord continues inferiorly without distinct termination and attaches to the
distal most thecal sac by a small lipoma. By definition, the filum is thicker than
2 mm in 100% of cases. It contains a filar fibrolipoma in 29% of cases.
1999 Board Question
by MH
37. A cerebral angiogram reveals an enlarged tentorial branch arising from the
meningohypophyseal trunk. This most likely represents?
a. Cerebellar metastasis
b. Dural AVM
c. Glomus jugulare
d. Hemangioblastoma
e. Vestibullar schwannoma
Type- Neuro
Answers- b
Notes-
by KW
Osborne p124 - enlarges to supply dural AVMs or neoplasms that involve the
tentorium, cavernous sinus, or clivus
Not Glomus tumor, Som p1074
The meningohypophyseal artery arises from the precavernous or intracavernous
segment of the internal carotid artery and has three major branches: tentorial,
inferior hypophyseal, and dorsal meningeal branches. The inferior hypophyseal
branch courses superiorly and medially and reaches the lateral surface of the
hypophysis. It divides into superior and inferior branches, which run in the
sulcus between the anterior and posterior pituitary. The tentorial branch
supplies the free margin of the tentorium. The dorsal meningeal artery courses
medially and posteriorly and supplies the dura over the clivus and the dorsum
sellae. Rich anastomoses are noted among the distal branches of the right and left
meningohypophyseal arteries.
1999 Board Question
38. A cervical spine myelogram is performed and the cord appears enlarged in the
AP projection but is small to normal in the lateral projection:
a. Hematomyelia
b. cervical spondylosis
c. ependymoma
d. Arnold-Chiari malformation with hydromyelia
e. epidural hematoma
Type- Neuro
Answers- b
Notes-
a.Epidural hematoma of the spine may cause cord compression (Osborn p870,872).
b.60% of intracranial ependymomas are located in the posterior fossa and 40% are
found above the tentorium. 90% of infratentorial ependymomas occur in the 4th
ventricle. Ependymomas are known for there tendency to ooze or extrude down
through the foramen magnum into the upper cervical spine behind the
cervicomedullary junction (Osborn p567,p569 fig13-53).
c.Spondylosis with osteophytosis can cause spinal stenosis. (you would think
osteophytes would be seen during a myelogram)?T/F (Osborn p845).
d.Arnold-Chiari = Chiari II malformation. Hydromyelia causes an enlarged cord (I
would assume in AP & Lat. dimensions).
e. Hematomyelia = hemorrhage within the spinal cord.
by CM
1996 Question
39. A child is found to have a cystic cerebellar lesion with an enhancing mural
nodule. This most likely represents?
Type- Neuro
Answers- c
Notes-
Verifed Osborne554
Pilocytic astrocytomas represent only 5% to 10% of all cerebral gliomas but
account for nearly one third of pediatric glial neoplasms. Opticochiasmatic-
hypothalamic PAs are one of the most common supratentorial neoplasms in children,
and cerebellar astrocytomas are the most common posterior fossa tumor in this age
group (in some series medulloblastoma is the most common pediatric infratentorial
tumor). Brainstem gliomas are the third most common pediatric infratentorial
tumor. osborn555
Cerebellar astrocytoma is the second most common tumor of the posterior fossa in
children 10-20%. Classically a cystic lesion with a tumor nodule (mural nodule)
in the cyst wall (50%), solid mass with cystic center 40-45%. Calcifications 20%.
(D168)
Ependymoma is 15% of pediatric posterior fossa tumors. Majority are benign, slow-
growing tumors of mature well-differentiated ependymal cells. Location: floor of
fourth ventricle (70%) of all intracranial ependymomas. CT: sharply marginated
multilobulated iso-slightly hyperdense 4th ventricular mass with heterogeneous to
moderately uniform enhancement of the solid portions (80%). (D176)
Medulloblastoma is the most common neoplasm of the posterior fossa in children 30-
40%. Classic features in 53%: 70% hyperdense, rapid intense homogeneous
enhancement 97%. Atypical features: cystic/necrotic areas 10-16%, calcifications
13%. May metastasize to subarachnoid with drop mets. (D190)
Brainstem glioma is 20-30% of all infratentorial brain tumors, 12-15% of all
pediatric brain tumors. Usually an anaplastic astrocytoma / GBM. Location: pons
> midbrain > medulla. CT: iso / hyopdense mass with indistinct margins, absent /
minimal / patchy contrast enhancement (50%), ring enhancement in necrotic /
aggressive tumor, engulfment of basilar artery. (D179)
Choroid plexus papilloma 2-5% of all brain tumors in children. Location: glomus
of choroids plexus in trigone of lateral ventricles L > R (in children). Large
mass with smooth lobulated border and small foci of calcifications. Distinctive
feature: engulfment of the glomus of the choroids plexus. Ventricular dilatation
secondary to overproduction / decreased resorption of CSf. CT: iso- to mildly
hyperdense with intense homogeneous enhancement with contrast. (D172)
1999 Board Question
by KH
40. A child is found to have a homogeneously enhancing mass lesion arising from
the cerebellar vermis and bulging into the 4th ventricle. This most likely
represents?
a. Ependymoma
b. Hemangioblastoma
c. Brainstem glioma
d. Astrocytoma
e. Medulloblastoma
Type- Neuro
Answers- e
Notes-
Req p.83-86, Medulloblastoma- usually arise in the midline from the cerebellar
vermis, usually compress the fourth
vent causing hydrocephalus, moderate enhancement.
-Ependymoma- enlarge the fourth vent, 40-50% calcify, mild enhancement
-Hemangioblastoma- most common primary infratentorial tumor in adults, assoc. with
polycythemia
PRIMITIVE NEUROECTODERMAL TUMOR [PNET, MEDULLOBLASTOMA]: Histologically, a PNET is
a malignant, embryonal childhood tumor arising in the cerebellum that is composed
of densely packed cells with round to oval, or carrot-shaped nuclei and scanty
cytoplasm. The cells have variable mitotic activity. The PNET usually arises in
the cerebellum and is centered in the midline. The mass is homogeneous and
spherical in shape, growing as if a solid expanding ball. Hemorrhage, cysts, and
calcifications occur in approximately 10% of cases. The residual lumen of the 4th
ventricle may be seen as a crescent of CSF density or intensity along the anterior
surface of the mass. On CT, the tumor frequently appears of homogeneous
hyperattenuation relative to gray matter. The increased attenuation is thought to
be due to the dense cellular nature and high nuclear to cytoplasm ratio of its
cells. On MR, the mass is homogeneously hypointense on T1- and usually hypo- or
isointense on T2-weighted images relative to gray matter. By either CT or MR, the
PNET homogeneously enhances following intravenous contrast injection. Treatment
of PNET is complete surgical resection followed by aggressive chemotherapy and/or
radiation therapy. A complete metastatic work-up is needed as up to 30% of
patients with PNETs have leptomeningeal spread of tumor at the time of diagnosis.
Currently, the 5-year survival rate is approximately 45% in children younger than
8 years old at diagnosis and 74% in children older than 11 years old at diagnosis
(TF).
1999 Board Question
by AE
Type- Neuro
Answers- a
Notes-
42. A CT of the neck is performed to evaluate a patient with left vocal cord
paralysis. Inferior images should extend to?
a. Cricoid cartilage
b. AP window
c. Costo-phrenic angle
d. Thyroid gland
e. Thoracic inlet
Type- Neuro
Answers- b
Notes-
The left recurrent laryngeal nerve branches from the vagus (X) at the level of the
aortic arch and courses medially to the esophagus and superiorly back to the
larynx. The right recurrent laryngeal nerve branches from the vagus (X) at the
level of the subclavian artery and courses lateral to the esophagus superiorly
back to the larynx. netter68
1999 Board Question
by KH
43. A diabetic patient has a CT which shows enhancement in the inferior frontal
lobes. Which of the following is the most likely diagnosis?
a. infarct
b. herpes
c. lymphoma
d. fungal encephalitis
e. PML
Type- Neuro
Answers- b
Notes-
Type- Neuro
Answers- b
Notes-
a. S1 level
b. L4 level
c. L3 level
d. L5 level.
Type- Neuro
Answers- d
Notes-
Req p.448
1989 Board Question
by AE
46. A hyperdense mass with attenuation of 30-50 with surrounding well defined thin
enhancement:
a. Lymphoma
b. aging hematoma
c. abcess
d. high-grade glioma
Type- Neuro
Answers- b
Notes-
by KW
Dahnert p238,248
Lymphoma could have this appearance... can have little edema.... check Osborne
2000 Board Question
47. A lucent lesion in the calvarium with a sclerotic margin is most likely?
a. Hemangioma
b. Venous lake
c. EG
d. Epidermoid inclusion cyst
e. Metastatic disease
Type- Neuro
Answers- d
Notes-
by KW
Osborn 516
Dahnert p87,146
EG does not have sclerotic margin, Epidermoid does
Normal osteolytic lesion of the skull: emissary vein connecting inner and outer
skull; venous lake; pacchionian granulations (usually within 3cm of the SSS); and
parietal foraminae (embryonal rests).
Epidermoid inclusion cyst
1998 Board Question
48. A one year old is found to have strabismus and an enhancing mass of the sella:
a. Paraphyseal cyst
b. Craniopharyngioma
c. Optic glioma
d. Infundibuloma
e. Ectopic pinealoma
Type- Neuro
Answers- b
Notes-
by KW
Verified Dahnert p263,199,226
Pinealoma = Pineal Germinoma - Age 10-25 years, ectopic in sella, enhances
Craniophayngioma - most common suprasellar mass - Age from birth to seventh
decade, enhances, 2nd most common intrasellar mass
Optic glioma - Age 1st decade, peak ~ 5 years, slight enhancement
Infundibuloma and Paraphyseal cyst????
1996 Question
49. A patient has palsies involving cranial nerves III, IV, V1, V2, and VI. What
is the location of the lesion?
a. brainstem
b. superior orbital fissure
c. optic canal
d. cavernous sinus
e. inferior orbital fissure
Type- Neuro
Answers- d
Notes-
50. A patient presents with a conductive hearing loss and ipsilateral facial nerve
palsy. This is most likely secondary to?
Type- Neuro
Answers- d
Notes-
The glomus tympanicum tumor is the most common tumor in the middle ear, followed
by the facial neuroma. Patients present with hearing loss, pulsatile tinnitus,
bruit, and reddish purple mass behind the tympanic membrane (D p322-3). CT will
demonstrate a characteristic nondestructive small soft-tissue mass protruding from
the cochlear promontory. Usually there are no other findings, except for
occasional fluid opacification. Contrast enhancement is difficult to define due to
CT beam hardening. MR may demonstrate enhancement with Gadolinium. Angiography
shows a small densely blushing middle ear mass. (TF)
Glomus jugulare tumors are usually larger and more destructive than tympanicum
tumors. They cause tinitus and hearing loss (D p323). Most follow a
characteristic pattern of growth. Pervasive destruction is a feature that
characterizes the invasiveness of the glomus jugulare tumor. The tumors commonly
expand the jugular fossa with irregular erosive changes. There may be involvement
of the occipital condyle, mastoid facial nerve canal, and hypoglossal canal.
Paragangliomas commonly extend through the jugular fossa into the inferior middle
ear cavity. They may spread along the dural sinuses toward the torcula or
inferiorly toward the chest. These tumors can erode the otic capsule, most
commonly near the cochlea. They may envelope the petrous carotid artery and extend
beyond the dura to occlude the jugular vein. Destruction of the caroticojugular
spine, best appreciated on axial CT is another characteristic finding with glomus
jugulare tumors. Although there may be mastoid and middle ear opacification, the
ossicles are rarely eroded or displaced. (TF)
Cerebellopontine angle tumor may cause cranial neuropathy including high frequency
hearing loss(VIII), tinnitus, facial motor(VII) and sensory dysfunction(V). (D
p193).
Temporal bone fractures have been divided into longitudinal and transverse types,
depending on the course of the fracture line. This classification tends to be
artificial in that fractures frequently extend in a serpiginous fashion. To some
extent, fractures more frequently extend along the plane of the temporal bone than
across it. Transverse fractures are perpendicular to the axis of the petrous
pyramid and run from the superior petrous ridge across the labyrinth usually to
the jugular fossa. These may cause facial nerve palsy and neurosensory hearing
loss. Longitudinal fractures are parallel to the axis of the petrous pyramid and
tend to involve the temporal squama with extension into the mastoid, reaching the
external auditory canal. Medially, the extent is usually anterior to the labyrinth
and is extralabyrinthian (TF). Longitudinal fractures cause conductive hearing
loss (no neurosensory loss) and may cause facial nerve palsy.
Peripheral facial nerve palsy may result from trauma. Facial nerve involvement
has been reported with both longitudinal and transverse fractures. The incidence
and morbidity is greater with the transverse variety. Mechanisms of injury
include displaced bone fragment, nerve transsection, and intraneural hematoma or
edema. The most severe damage to the nerve is at the meatal foramen (entrance of
the distal intracanalicular segment into the labyrinthine segment). (R-HN844).
(Dahnert p322).
1999 Board Question
by CM
Type- Neuro
Answers- a
Notes-
52. A patient with spinal cord trauma has headache, diaphoresis, and blood
pressure fluctuations after intravesical instillation of 150 cc of contrast. All
symptoms are relieved by insertion of a Foley catheter. What is the level of
injury?
a. T8-9
b. cervical spine
c. S1-2
d. S3-4
e. T12-L4
Type- Neuro
Answers- b
Notes-
53. A patient with unilateral field cut and medial rectus paralysis has a lesion
in:
a. cavernous sinus
b. optic chiasm
c. medulla oblongata and the pons
d. occipital lobe
e. cerebellopontine angle
Type- Neuro
Answers- a
Notes-
by KW
Dahnert 217
Not exactly sure what a unilateral field cut is, asssuming it is hemianopsia
involving one eye only.
This lesion is affecting the second and third cranial nerves. It must be along
the distal course.
A Cavernous sinus lesion (such as a aneurysm) can cause visual loss, oculomotor
loss, and trigeminal distribution pain.
1993 Single Best Answer Question
The lesion has to be before the optic chiasm. CNIII supplies extraocular muscles
except
lateral rectus and superior oblique. The nucleus is in the midbrain just
posterior to the red
nucleus and anterior and superior to the aqueduct. It goes thru the
interpeduncular cistern to
between the PCA and superior cerebellar arteries lateral to the PCOM. Thru the
caverous sinus
thru the superior orbital fissure. The optic nerve goes back to the lateral
geniculate in the
pulvinar of the thalamus and back thru the geniculocalcarine tract.
ref; Req p 45, see figure 2-14 p 44
54. A right paracentral L4/L5 disc herniation causes most likely causes which
nerve impingement:
a. S-1
b. right l5
c. none
d. right l4 and l5
e. right l4
Type- Neuro
Answers- b
Notes-
by KW
Multiple repeats...
2000 Board Question
55. A trauma patient has bilateral C6-7 facet dislocation and C6-7 cord level
findings with no sensory or motor function below that level. On the following day
he regains the bulbocavernous reflex. Which of the following is the best
explanation?
Type- Neuro
Answers- c
Notes-
56. A vertebral hemangioma most commonly will have which pattern of signal
intensity?
Type- Neuro
Answers- a
Notes-
The vertebral bodies and skull are most commonly involved and show dense vertical
striations. High signal intensity on both T1 and T2 (H67).
1999 Board Question
by AE
57. A young woman comes in with sudden onset of blurred vision. CT shows a
pituitary mass with suprasellar extension. This mass has area of high attenuation
and fluid level. Cause:
a. pituitary apoplexy
b. germinoma
c. sarcoidosis
d. metastatic disease
e. craniophyrangioma
Type- Neuro
Answers- a
Notes-
by KW
Dahnert p266
Pituitary apoplexy = massavie hemorrhage into pituitary adenoma with sudden
infarction of pituitary gland
Patients present with headache, nausea, vomiting, acute visual defects
Sheehan syndrome = pituitary infarct of anterior pituitary gland post-partum
2000 Board Question
Type- Neuro
Answers- a
Notes-
by KW
2000 Board Question
59. All of the following are important in the evaluation of spinal stenosis
except?
Type- Neuro
Answers- c
Notes-
by KW
Osborn 845-848 does not mention dentate ligament....
Netter p155 lists the denticulate ligament as a small ligament connecting the cord
to the dura
Multiple sources do not list this ligament as a cause of spinal stenosis
All contribute to spinal stenosis except denticulate ligament hypertrophy. The
denticulate ligaments attach the cord to the dura mater at the nerve root exits.
(Netter)
1998 Board Question
60. An elderly male patient presents with slowly progressive cervical myelopathy.
Imaging reveals 5mm thick calcification/ossification within the anterior aspect of
the thecal sac immediately posterior to the C3-C5 vertebral bodies. This is most
consistent with?
a. Ankylosing spondylitis
b. Arachnoiditis
c. Ossification of the posterior longitudinal ligament
d. DISH
e. Calcification of a previous epidural hemorrhage
Type- Neuro
Answers- c
Notes-
by KW
Osborne p848
Ossification of the PLL is more common in Japenese, and found in mid-cervical and
mid-thoracic spine.
Ossification of the posterior longitudinal ligament is uncommon, occurring mostly
in the Japanese. Most common in the midcervical and midthoracic spine causing
neurologic symptoms (Osborn 1st ed. 848). AS causes ossification of the annulus
fibrosis (not the ALL (D27)) and a bamboo spine with biconvex intervertebral
disks, erosion of the anterior margins of the vertebral bodies and ossification of
the paraspinal ligaments (D113). Arachnoiditis causes blunting of nerve root
sleeves without cord displacement (D123). DISH (diffuse idiopathic skeletal
hyperostosis) occurs lower thoracic > lower cervical, occurring on the anterior
and right syndesmophytes of at least 4 contiguous bodies (D39).
1999 Board Question
Type- Neuro
Answers- a,b,e
Notes-
D p323
Som 1074
by CM
1996 Question
62. Brain MR reveals multiple bright areas of T2 signal intensity within the
cortical and subcortical white matter of the occipital lobes bilaterally in a
young woman. There is no evidence of hemorrhage or significant mass effect.
Repeat MR imaging in 2 weeks is normal. This is most consistent with which of the
following?
a. Superior sagittal sinus thrombosis
b. Progressive multifocal leukomalacia
c. Herpetic encephalopathy
d. Eclampsia/Pre-eclampsia
e. Tip of the basilar artery syndrome
Type- Neuro
Answers- d
Notes-
a. Commonly multilocular
b. Commonest at the angle of mandible
c. 1st Branchial arch more common
d. Commonly presents in adolescent
Type- Neuro
Answers- b
Notes-
by KW
Dahnert p301
Commonly in young to middle-aged adults
Second branchial cleft cyst is most common, 95%
They are commonly in the parotid space at the angle of the mandible and
paraphyrangeal space
2000 Board Question
a. True
b. False
Type- Neuro
Answers- a
Notes-
by KW
1997 Old Board Question
65. Child with dehydration and mental status changes. CT showing bilateral
thalamic hemorrhage with mass effect. Cause:
Type- Neuro
Answers- a
Notes-
by KW
Dahnert p274
Dehydration in children is a risk for Sinus Thrombosis
Hemmorhage in gray and white matter unilateral in 2/3, bilateral in 1/3 of cases
Check Osborne for more specific findings
2000 Board Question
Straight sinus/Vein of galen thrombosis with bilateral thalamic infarction
Type- Neuro
Answers- a,b,c,e
Notes-
by KW
Osborn 507,
Jugular foramen - CN IX,X,XI - depressed gag reflex CN IX?
1998 Board Question
The lateral posterior choroidal artery can originate either from P2 or proximal
cortical branches. The lateral posterior choroidal artery courses over the
pulvinar of the thalamus and supplies the posterior thalamus and lateral
ventricular choroid plexus. Osborn140. The anterior choroidal artery usually
arises from the distal internal carotid artery above the posterior communicating
artery origin. The medial and lateral posterior choroidal arteries arise from the
PCA. The three choroidal arteries are in hemodynamic balance with each other and
their vascular territories are complementary. The anterior choroidal artery
typically supplies part of the posterior limb and genu of the internal camsule,
medial globus pallidus, optic tract, temporal lobe uncus, and amygdaloid nucleus
and choroid plexus of the lateral ventricle. osborn363.
The AICA runs toward the cerebellopontine angle and may loop into the internal
auditory canal, where it gives off labyrinthine branches to the inner ear before
supplying the anteroinferior part of the cerebellum. neuro requisites 60.
The superior cerebellar artery is the last infratentorial branch off of the
basilar artery. The lateral marginal and hemispheric branches supply the upper
part of the cerebellum before the vessel terminates in the superior vermian
artery. Other fine branches help supply the pons, the superior cerebellar
peduncle, and the inferior colliculus. The superior vermian vessel anastomoses
with the inferior vermian artery of the PICA. requisites 60.
The anterior choroidal artery supplies (and follows) portions of the optic tract,
medial temporal lobe, uncus, amygdala, hippocampus, anterior limb of the internal
capsule, choroid plexus of the lateral ventricle, inferior globus pallidus,
caudate nucleus, cerebral peduncles, and midbrain. neuro requisites56-57.
1989 Board Question
by KH
a. Intracranial calcification
b. Angioma of the retina
c. Intrarenal tumors
d. Rhabdomyoma of the heart
e. Skull thickening
Type- Neuro
Answers- a,e
Notes-
Type- Neuro
Answers- c
Notes-
Type- Neuro
Answers- a,b,c
Notes-
Cavum septi pellucidi= 5th ventricle; thin triangular membrane consisting of two
glial layers covered laterally with ependyma separating the frontal horns of
lateral ventricles. 80% in term infants/15% in adults; Cavum vergae=6th
ventricle;cavity posterior to columns of fornix; contracts after about 6th
gestational month.; Cavum veli interpositi=extension of quadrigeminal plate
cistern above 3rd ventricle to foramen of Monro, laterally bounded by columns of
fornix + thalums. D188.
1989 Board Question
by KH
Type- Neuro
Answers- b,d
Notes-
a. cerebellar astrocytoma
b. facial nerve neuroma
c. PNET
d. epidermoid
Type- Neuro
Answers- a,b,d
Notes-
by KW
Osborn p441, 617
Nonacoustic neuromas cause CPA masses, usually trigeminal neuroma, ? facial nerve
neuroma
Medulloblastomas are usually in the vermis, may be in the lateral cerebellar
hemispheres
Much less than 1% can be from exophytic brainstem/cerebellar astrocytoma
1993, 1988 True/False Question
a. skull defect
b. microcephaly
c. syndactyly
d. pyelectasis
e. echogenic kidneys
Type- Neuro
Answers- a,b,e
Notes-
a. myelolipoma
b. sacralization of L5
c. Dandy-Walker cyst
d. diastomatomyelia
e. syringobulbia
Type- Neuro
Answers- d
Notes-
p528
1992 True/False Question
For b. lipoma is associated with a tethered conus which is associated with mild
dysraphism.
The mechanism for development of spinal dyraphism is lack of folding of primodial
neural tissue into a tube. No bone is induced directly over the neural tissue.
Get meningocele,
myelocele, myelomeningocele are tissue that go through a boney spinal defect.
when fat,
meninges, cord roots protrude through the defect its called a
lipomyelomeningocele.
Lipomyelomening is associated with tethered cord and Chiari II and
syringohydromyelia. p
273Req
Dandy Walker is partial or complete absence of the vermis with dilatation of the
fourth
ventricle. p 259
myelolipoma is a benign tumor of the adrenals. p 273 Dunnick
ref: Requisites p 259, 273, Dunnick p 273
by MH
a. hydrocephalus
b. predilection for temporal lobe
c. normal radionuclide brain scan
d. due to herpes zoster
e. usually fatal
Type- Neuro
Answers- b,e
Notes-
Caused by Herpes simplex I (in adults) and II (in neonates). Mortality 70%.
Brain scintigraphy demonstrates characteristic focal increase in activity in the
temporal lobes. No hydrocephalus (D p230).
by CM
1996 Question
76. Homonymous hemianopsia is most likely to occur from a lesion in which brain
territory?
a. Optic nerve
b. Anterior optic chiasm
c. Posterior optic chiasm
d. Lateral geniculate body
e. Occipital lobe
Type- Neuro
Answers- c,d,e
Notes-
a. craniopharyngioma
b. optic chiasm glioma
c. germinoma
d. Rathke cleft cyst
e. dermoid
Type- Neuro
Answers- a,b,c,d,e
Notes-
78. In a patient with acquired hepatocellular degeneration, the basal ganglia are
most likely to demonstrate which of the following signal intensity patterns with
MR?
a. Increased signal on T2
b. Increased signal on T1 and T2
c. Decreased signal on T1
d. Decreased signal on T2
e. Increased signal on T1
Type- Neuro
Answers- e
Notes-
Type- Neuro
Answers- a
Notes-
by KW
Verified Osborn p143
1991 Single Best Answer Question
The intracranial extracavernous internal carotid artery gives rise to several
important
branches:
a- superior hypophyseal artery
b- ophthalmic artery (anterior falx artery and, occasionally, the middle meningeal
artery arise from it)
c- posterior communicating artery (one or both are hypoplastic in 20% of cases)
d- anterior choroidal artery (divides into proximal (cisternal) and distal
(plexal) segments) - it is an important supply to the choroid plexus of the
temporal horn of the lateral ventricle.
e- small unnamed branches to the hypothalamus, optic tract, and optic chiasm
The ophthalmic artery is an important source of collateral flow in cases of
cervical ICA occlusion.
80. In a patient with multiple cerebral aneurysms, the most reliable finding which
will accurately localize the site of bleeding is:
a. largest aneurysm
b. irregularity of anerysm
c. vasospasm
d. location of the hematoma
Type- Neuro
Answers- a
Notes-
a. True
b. False
Type- Neuro
Answers- a
Notes-
1996 Question
a. renal agenesis
b. meningomyelocele
c. caudal regression syndrome
Type- Neuro
Answers- a,c
Notes-
by KW
Dahnert p161,791
Caudal regression associated with diabetic mothers in ~20% of cases
2000 Board Question
Type- Neuro
Answers- a,b,c
Notes-
84. Lesions in which of the following areas can result in homonymous hemianopsia?
Type- Neuro
Answers- a,b,d
Notes-
neuroanatomy atlas207
1988 True/False Question
Neuroradiology Section
by KH
a. Hydrocephalus
b. Small foramen magnum
c. Dandy Walker
d. Craniosynostosis
e. Myelomenigocele
Type- Neuro
Answers- e
Notes-
by KW
Verified Dahnert p172, Kirks p94
Nearly all patients with Chiari II malformation manifest a dysplasia of the
membranous bones of calvarium called Lckenschdel. This appears as clusters of
thinnings, pits, and fenestrae that are most prominent near the vertex or the
torcula. Lckenschdel may be observed in a fetus in utero as early as at 8 months
of gestation. It typically persists until 1 to 3 months of age and then disappears
after approximately age 6 months, whether or not there is progressive
hydrocephalus. (TF)
1999 Board Question
Type- Neuro
Answers- e
Notes-
Beaking of the tectum is seen with Chiari II, Luckenschadel skull also with Chiari
II
Chiari described four unrelated malformations of the posterior fossa, now called
Chiari I, II, III, and IV. In simplified form, the Chiari I malformation
consists of protrusion of the cerebellar tonsils downward through the foramen
magnum; obliteration of the cisterna magna; and variable, usually very mild,
elongation and caudal displacement of the fourth ventricle, brain stem, and
cerebellum. Chiari I malformation is associated with hydrosyringomyelia (60%-70%
of patients), hydrocephalus (20%-25%), and segmentation anomalies of the
craniovertebral junction including basilar impression (25%), assimilation of C1 to
the occiput (10%), Klippel-Feil (10%), and incomplete ossification of the C1 ring
(5%). It is not associated with myelomeningocele.
Many patients with Dandy-Walker malformation show persistent fetal position of
tentorium and sinuses, so the tentorium lies in a nearly vertical position along
the parietal bones and the torcular lies far above the lambda ( torcular-lambdoid
inversion). The posterior tentorium may be dehiscent with terminal duplication of
the straight sinus. The incisura in the tentorium is inclined nearly vertically
with the tentorial leaves and is often wider than normal. In axial CT sections,
the tentorial leaves and the incisura usually form an inverted-V
The Chiari II malformation is the most common serious malformation of the
posterior fossa. It is a complex deformity of the calvarium, dura, and hindbrain,
which nearly always is associated with spina bifida and (meningo) myelocele. In
aggregate, the changes create a bony and dural posterior fossa that is too small
for the brain stem and cerebellum. Then, as the brain grows, it erodes the walls
of the posterior fossa and extrudes into the spinal canal below and the
supratentorial space above. In this process, the posterior fossa contents mold and
become molded by the structures upon which they impinge. The changes induced in
the very fluid immature brain become set by the process of myelination and appear
to persist relatively unchanged despite later alterations in the bone. The
midbrain is abnormal in nearly every case. Characteristically, the four colliculi
are at least partially fused into a conical mass designated the beak. Since the
beaking affects the inferior colliculi more than the superior colliculi, beaking
is seen best on low CT sections caudal to the expected position of midbrain. The
upper midbrain may, in fact, appear deceptively normal.
1999 Board Question
by AE
Type- Neuro
Answers- b,c,d
Notes-
per MH
1998 Board Question
by MH
a. Microcrania - Trisomy 13
b. Macrocrania - Chiari 1
c. Sagittal suture synostosis - Scaphocephaly
d. Brachycephaly - Aperts syndrome
Type- Neuro
Answers- a,c,d
Notes-
by KW
1997 Old Board Question
Brachycephaly - closure of the coronal and lamboid sutures
Type- Neuro
Answers- a,b,c
Notes-
by KW
Osborne p704,724
Acute Disseminated Encephalomyelitis = Immune mediated post viral demyelination
Mostly in children and young adults
Subcortical hyperintensity foci on T2
Adrenoleukodystrophy = X linked deficiency of single peroxisome enzyme involved in
oxidation of fatty acids
1997 Old Board Question
Type- Neuro
Answers- b,c,d
Notes-
by KW
Dahnert p223
Chiari I = Adult, Chiari II = Childhood
Chiari I and II are associated with syringohydromyelia (20-30%)
Chiari II - also associated with syringhydromyelia
Bat wing configuration of frontal horn - horns point inferiorly
There is elevation of the tentorium with Chiari II
There is colpocephaly, or enlargement of occipital horns
1997 Old Board Question
Type- Neuro
Answers- a,b,c
Notes-
by KW
Dahnert p268, 272, 275
1997 Old Board Question
92. MR findings in a 12 year old reveal a prominent optic chiasm and a focus of
increased T2 signal within the basal ganglia and cerebellum. This most likely
represents?
a. Neurofibromatosis 2
b. Von Hippel Lindau
c. Sturge Weber
d. Tuberous Sclerosis
e. Neurofibromatosis 1
Type- Neuro
Answers- e
Notes-
93. On an injection of contrast into the left vertebral artery, there is non-
visualization of the ipsilateral posterior cerebral artery. Which of the
following are possible causes?
Type- Neuro
Answers- a,b,d,e
Notes-
Type- Neuro
Answers- c
Notes-
by KW
Dahnert p283 lists Patulous subarachnoid space as a cause of optic nerve
enlargement
Per Dr. Acker
1992 Single Best Answer Question
95. On SPECT imaging (ECD), which pattern does patient with Alzheimer have:
Type- Neuro
Answers- b
Notes-
by KW
Per Tim Baker
Decreased uptake in the temporoparietal region
Check source
2000 Board Question
a. Meningioma
b. Enlargement of the optic foramina
c. Sphenoid wing dysplasia
d. CC fistula
Type- Neuro
Answers- c
Notes-
by KW
Dahnert p261
Pulsitile exopthalmos due to herniation of subarachnoid space and temporal lobe
into orbit...
Could be enlargement of the optic foramina or Sphenoid wing dysplasia...
But p260 states that defect in sphenoid bone leads to extension of middle cranial
fossa into orbit
Also states that there is concentric enlargement of optic foramen due to optic
glioma
2000 Board Question
Patients with neurofibromatosis may be pulsatile exophthalmos due to absence of
the greater wing of sphenoid bone. The pulsation results from transmitted cranial
pulsation
97. Patient with small subcortical shear injury. Which is the best MR sequence for
evaluating it:
a. Flair sequence
b. T1, T2 spin echo
c. Gradient echo T2
Type- Neuro
Answers- c
Notes-
by KW
2000 Board Question
98. Patient with wernicks encephalopathy would have atrophy of which cranial
structure:
a. caudate lobe
b. hippocampus
c. mamillary body
d. substantia niagra
Type- Neuro
Answers- c
Notes-
Osborn p764
by KW
2000 Board Question
a. neurofibromatosis
b. Sturge-Weber
c. TORCH
d. tuberous sclerosis
Type- Neuro
Answers- c,d
Notes-
Type- Neuro
Answers- a,b,c
Notes-
Type- Neuro
Answers- b,c,d,e
Notes-
102. Punctate hemorrhages near the vertex are most likely due to:
Type- Neuro
Answers- b
Notes-
by KW
1997 Old Board Question
103. Regarding anatomy of the orbit:
a. annulus of zinn divides the globe into anterior and posterior compartment
b. the inferior oblique is supplied by the trochlear nerve
c. the trochlea is situated on the lateral side of the orbit
d. the ophthalmic artery is situated inferior to the superior opthalmic vein
Type- Neuro
Answers- d
Notes-
by KW
See figure on Dahnert p285
Lateral Rectus - Abducens nerve
Superior Rectus Oblique - Trochlear nerve
2000 Board Question
Type- Neuro
Answers- c
Notes-
a. Tentorial artery
b. Recurrent artery of Huebner
c. Otic artery
d. Occipital artery
Type- Neuro
Answers- c,d
Notes-
Req p.55, ECA anastomose to vertebral via occipital, ascending pharyngeal, and
posterior auricular arteries.
Several fetal anastomotic channels may persist rarely--> trigeminal a., otic a.,
hypoglossal a., proatlantal a.
Recurrent artery of Huebner is a lenticulostriate branch of the ant. cerebral
artery, supplies the anterioinferior
portion of the caudate head, putamen, anterior limb of the internal capsule.
1998 Board Question
The authors describe the case of a 67-year-old man with acquired obstruction of
the common carotid artery and a large, direct occipital-vertebral artery
anastomosis bridging the vertebral and carotid artery systems. They discuss the
hemodynamics within this type of anastomosis in the context of cerebrovascular
occlusive disease and outline their classification of the hemodynamic patterns
that have been observed. Surgical procedures for occlusive disease in the presence
of such anastomoses are also addressed. Surg Neurol 1989 Nov;32(5):350-5
by AE
a. indicates hydrocephalus
b. pathologic
c. none of the above
d. rare in newborns
Type- Neuro
Answers- c
Notes-
Type- Neuro
Answers- a,b,c,d
Notes-
by KW
Verified Osborn 757,761
1989 Board Question
Type- Neuro
Answers- b,c
Notes-
Type- Neuro
Answers- b
Notes-
Type- Neuro
Answers- a,c,d
Notes-
by KW
Osborn 587,900
1993 True/False Question
Meningiomas are hypo to iso on T1 to gray matter and iso to hyperintense on T2 to
gray
matter. Intraventricular meningiomas typically occur around the choroid in the
trigone of the
lateral venticle esp the left lat vent. p 68-73 Requisites
a. macrocrania
b. sphenoid wing dysplasia
c. optic nerve glioma
d. acoustic neuroma
Type- Neuro
Answers- a,b,c
Notes-
by KW
Verified Osborn 73,82
1995 True/False Question
NF-1 is von Recklinghausens disease. To dx must have two or more of the following
findings-- >6 cafe au lait spots, >2 lisch nodules of the iris, >one plexiform
meurofibroma,
axillary freckling, >one bony dysplasia, pseudarthrosis of long bone, optic
glioma, 1st degree
relative with NF. Acoutic neuroma is associated with NF-2.
ref: Requisites p 266
The orbit frequently displays a characteristic unilateral defect fo the greater
and lesser
wings of the sphenoid attributed to underlying mesodermal dysplasia. Other cranial
abnomalities
include bone defect along left side of the lambdoid suture, hypoplastic maxillary
and ethmoid
sinuses. Themandible and maxilla may be affected by overlying soft tissue
abnormalities. p
1220 Resnick.
Macrocranium is seen in 75%. Manaster p 326
a. The annulus of Zinn divides the globe into anterior and posterior
chambers
b. The trochlea for the superior oblique is on the lateral wall of the orbit
c. The superior ophthalmic artery is superior to the vein
d. The trochlear nerve innervates the superior oblique muscle
Type- Neuro
Answers- d
Notes-
The extraocular muscles along with the intermuscular membrane divide the
retrobulbar space into the intraconal and extraconal compartments. Six extrinsic
muscles coordinate the movement of the globe: the superior, inferior, medial, and
lateral recti and the superior and inferior oblique. The four rectus muscles arise
at the orbital apex from the anulus of Zinn, a tendinous band encircling the
orbital end of the optic canal and the medial portion of the superior orbital
fissure. (TF) The iris divides the anterior and posterior chambers.
a.(Head & Neck Imaging by Som p751) b.(Som p754) c.(Netter Plate 80) d.(Netter
Plate 79)
1998 Board Question
by CM
Type- Neuro
Answers- a
Notes-
Dahnert p292
1993 Single Best Answer Question
Grave disease may result in thyroid ophthalmopathy, which is the most common cause
of
bilateral exophthalmos in an adult. Pathologically, there is deposition of
mucopolysaccharides
and infiltration by lymphocytes in the muscle bodies and retroorbital fat.
Imaging reveals
bilateral enlargement of the muscle bodies, with sparing of their tendinous muscle
insertions on
the globe. This is in contrast to orbital pseudotumor (myositis), wherein the
tendinous insertions
are involved
Also see a True/False question in this section on the same topic
Orbital pseudotumor is a common cause of unilateral exophtalomos. Clinical
features
include restriction of ocular motility, chemosis, lid swelling, pain. They
usually have rapid onset
and repond to steroids. There is a chronic progressive from which responds poorly
to steroids.
and is treated with chemo and XRT. In the acute case, it is a inflammatory
condition that may be
an autoimmune condition involving the lacrimal gland, extraocular m, connective
tissue
surrounding the dura of the optic nerve, the orbital fat, epibulbar connective
tissue, and sclera.
May present as a lacrimal mass.
Tolosa-Hunt syndrome is a inflammatory condition similar to orbital pweudotumor
that
involves the cavernous sinus and orbital apex. This presents with painful
opthalmoplegia. p
297
ref: Requisites
by MH
Type- Neuro
Answers- a,b,c,d
Notes-
Serum prolactin levels of more than 200ng/ml are highly specific for prolactin-
secreting adenomas whereas markedly elevated prolatin levels(>1000 ng/ml) imply
cavernous sinus invasion. neurorequisties313.
1994 True/False Question
From Osborne, page 467
By definition all microadenomas are less than 1 cm
There are many microadenomas discovered as incidental findings at autopsy
therefore most are not prolactin-secreting.
Pituitary adenomas are the most common intrasellar tumor, representing 10-15% of
all intracranial neoplasms. Prolactinomas account for 40-50% of hormonally active
adenomas; less commonly, adenomas may produce growth hormone (20%) or ACTH (20%).
T1-weighted images are best for visualizing the pituitary because the bright
signal of the surrounding CSF on T2-weighted images obscures the gland.
Hemorrhage into macroadenomas is not uncommon. Reference: Atlas, pp. 632-640
Treatment with bromocriptine increases the likelihood of hemorrhage which has been
reported in more than half of the bromocriptine treated adenomas. ? Hemmorrhage
into the gland not into the fossa. p 315 Requisites
by KH
116. Regarding spinal meningiomas:
a. intradural extramedullary
b. more common in cervicothoracic region
c. more common in women
d. hyperintense on T2
Type- Neuro
Answers- a,c
Notes-
Most intracranial lesions can be bright on T2, but spinal meningiomas are usually
isointense
Most are typical benign meningiomas; second most common cause of spinal tumor;
classic patient is a middle-aged woman; most common location; thoracic spine; 90%
are intradural extramedullary; Imaging findings-Bone erosion, CA++ rare; most are
isointense with cord on T1 and T2WI; moderate contrast enhancement; +/- dural tail
Osborn899
1991 True/False Question
by KH
a. intracranial calcification
b. intrarenal tumors
c. skull thickening
d. rhabdomyoma of the heart
e. angioma of the retina
Type- Neuro
Answers- a,c
Notes-
118. Regarding the appearance of the basal ganglia in chronic liver disease on
MRI?
a. Low signal on T2
b. High signal on T1
c. High signal on T2
d. Paramagnetic effects on T2
e. Low signal on T1
Type- Neuro
Answers- b
Notes-
Requisites p236
B.Acquired hepatocerebral degeneration is an irreversible neurodegenerative
syndrome that occurs with many types of chronic liver disease. It is most
frequently associated with alcoholic cirrhosis, subacute or chronic hepatitis, and
portal-systemic shunts. Pathologically, the brain has laminar or pseudolaminar
necrosis with microcavitary changes at the gray-white matter junction, in the
corpus striatum, and in the cerebellar white matter. Imaging changes correlate
with plasma ammonia levels. The typical finding is bilateral basal ganglia
hyperintensities on T1, seen in 50-75% of patients with advanced chronic liver
disease. Other areaas of increased signal include the pituitary, caudate,
subthalamic region, and the mesencephalon around the red nucleus. Long-term TPN
may also cause increased T1 in the BG, probably caused by mangenese toxicity.
(O775)
1998 Board Question
by MH
Type- Neuro
Answers- c
Notes-
Dahnert p286
Evaluation of carotid-cavernous sinus fistula should be assessed by bilateral
selective arteriography of the internal and external carotid arteries. Traumatic
carotid-cavernous sinus fistula is usually caused by a fracture through the
cavernous sinus; few cases are caused by surgical trauma. The spontaneous type is
usually caused by a dural malformation about the cavernous sinus. They are often
found in elderly women who suddenly develop proptosis, blurred vision, and dilated
conjunctival vessels. All these cases have a greatly dilated superior ophthalmic
vein on the side of proptosis. (TF)
For the investigation of a carotid cavernous fistula, contrast CT, MRI, and
conventional angiography are utilized for determination of the size of the
fistula, along with demonstration of associated dilated venous channels,
especially the superior ophthalmic vein. CT, following bolus injection of
iodinated contrast material, demonstrates a dilated cavernous sinus and enlarged
and tortuous superior ophthalmic vein. (TF)
Route of drainage from a carotid-cavernous fistula is through the superior
ophthalmic vein (common), the contralateral cavernous sinus, the petrosal sinus,
and rarely the cortical veins. Patients present with pulsating exopthalmos,
chemosis, conjunctival edema, and a persistant bruit. There is a decrease in
extraocular movement and in vision due to increased intraocular pressure (50%)
which is an indication for immediate treatment. (P219)
1998 Board Question
by MH
a. In-utero infection
b. Migrational abnormality
c. Neural tube closure defect
d. Induction defect
Type- Neuro
Answers- b
Notes-
by KW
Verified Dahnert p267
Occurs 30-60 days gestation
Schizencephaly is a segmental developmental failure of cell migration to form
cerebral cortex, or destruction of a portion of the germinal matrix, occurring
before the formation of the hemispheres. Associated with polymicregyria,
microcephaly, and gray matter heterotopia. Types: clefts with fused lips (walls
oppose one another obliterating the CSF space), clefts with separated lips (CSF
fills cleft from lateral ventricle to subarachnoid space). Located mostly near
the pre- and post-central gyri; uni- or bilateral. Pathognomonic: gray matter
lining cleft extending through entire hemisphere.
1999 Board Question
Type- Neuro
Answers- a,d,e
Notes-
Dahnert p232
1992 True/False Question
10% of epidurals are venous
An epidural hematoma is collection of blood along the subperiosteal inner table.
Itis
associated with skull fracture in 90%. It is biconvex, and since it is
subperiosteal, it is limited by
the sutures (exception is when a fracture crosses a suture). Sources of blood are
the meningeal
vessels (arteries (60%) or veins), dural sinuses, diploic veins, and marrow
sinusoids. The
meningeal vessels are displaced from the inner table. ref: Req p 151
Collection of blood along the subperiosteal outer table is called a
cephalohematoma. An
epidural hematoma can decompress through a fracture to cause a cephalohematoma or
subgaleal
hematoma.
Subdural hemorrhages are due to tears of bridging veins. There is dissection of
the
subdural space with dural vessels remaining close to the inner table. SDH may be
due to minor
trauma or no trauma with such things such as bleeding diatheses. A SDH is usually
crescentic
and, since it is not subperiosteal, crosses regions of sutures.
by MH
122. Structures within the superior orbital fissure include:
a. ophthalmic artery
b. optic nerve
c. maxillary portion of the trigeminal nerve
d. superior ophthalmic vein
e. oculomotor nerve
Type- Neuro
Answers- d,e
Notes-
a. 1
b. 3
c. 2
Type- Neuro
Answers- a
Notes-
by KW
Som p564
I - submental and submandibular
II - Suprahyoid IJ chain
III - Infrahyoid IJ chain to level of omohyoid
IV - Infraomohyoid IJ chain
V - Posterior triangle
VI - Thyroid nodes
VII - Tracheoesophageal nodes
2000 Board Question
Type- Neuro
Answers- a
Notes-
a. pillar fracture
b. hyperextension strain
c. hyperextension dislocation
Type- Neuro
Answers- c
Notes-
by KW
Dahnert p169
Hyperextension teardrop fracture = avulsion of anteroinferior corner by anterior
ligament (longitudinal?)
2000 Board Question
Whiplash or Hyperextension Strain
Whiplash or hyperextension strain is manifested on the x-ray by kyphotic angle of
greater than 10 degrees and a fanning of interspinous process of 12 mm or more. On
MRI examination whiplash injuries may show separation of the disc from the
vertebral end-plate, anterior longitudinal ligament injuries, anterior annular
tear, occult anterior vertebral end-plate fracture.
Hyperextension Dislocation
Hyperextension injuries have two mechanisms, direct anterior craniofacial trauma
and rear-end motor vehicle collision resulting in forceful extension of the head
(whiplash). It may be associated with disruption of the anterior longitudinal
ligament and rupture of the adjacent disc. This injury is associated with
significant morbidity and mortality due to the spinal cord damage. Older patients
with spondylosis are more likely to have this injury because of the limited
elasticity of the soft tissues. The majority of this injury appears in the neck
and lower cervical spine. Radiographically, the changes are subtle, wide disc
space, small avulsion fracture of the anterior-inferior end-plate, prevertebral
soft tissue swelling is seen. MRI shows disruption of the anterior longitudinal
ligament, disc disruption, prevertebral fluid and cord injury. This is an unstable
and significant trauma.
a. scoliosis
b. widened pedicles
c. bone spicule
d. associated lymphoma
e. occult spinal dysraphism
Type- Neuro
Answers- a,b,c,e
Notes-
Type- Neuro
Answers- d
Notes-
a. ataxia telangiectasia
b. tuberous sclerosis
c. neurofibromatosis
d. Gardners syndrome
e. Peutz-Jeghers
Type- Neuro
Answers- a,b,c
Notes-
a. Hemangioma
b. Meningioma
c. Glioma
Type- Neuro
Answers- c
Notes-
by KW
Dahnert p191
Gliomas are 50% of intracranial tumors
Medulloblastoma is 15% of intracranial tumors
Hemangioma - not a cerbral brain tumor
1997 Old Board Question
Type- Neuro
Answers- b
Notes-
by KW
Osborn p588
1992 Single Best Answer Question
Intraventricular meningiomas occur around chorid plexus in the trigone of the
lateral
ventricle (left > right). 15% are in the 3rd ventricle and 5% are in the 4th
ventricle. While
associated with neurofibromatosis (type II), most patients with intraventricular
meningiomas
dont have neurofibromatosis. (Grossman and Yousem 1994, p. 70)
a. Glioma
b. Choroid plexus papilloma
c. Hemangioblastoma
d. PNET
e. Ependymoma
Type- Neuro
Answers- a
Notes-
by KW
Dahnert p249 - We think that Dahnert is wrong.... Probably Glioma/Cerebellar
Astrocytoma
Also most malignant infratentorial neoplasm
But only 15% of pediatric brain tumors... Glioma most common overall
1997 Old Board Question
a. hemangioblastoma
b. medulloblastoma
c. ependymoma
d. cerebellar astrocytoma
Type- Neuro
Answers- d
Notes-
Cerebellar astrocytomas are the most common posterior fossa tumor in this age
group (in some series medulloblastoma is the most common pediatric infratentorial
tumor:). Brainstem gliomas are the third most common pediatric infratentorial
tumor. osborn555. Medulloblastoma the most malignant infratentorial neoplasm in
children, they are second in incidence to cerebellar astrocytoma. kirks125.
1993 Single Best Answer Question
Medulloblastomas (one of the PNET tumors) are one of the most common posterior
fossa masses in the pediatric population, accounting for more than one third of
posterior fossa neoplasms and 50% of cerebellar tumors in children (Grossman &
Yousem, 1994, p. 85) These tumors are usually seen in the midline arising from
the superior velum of the fourth ventricle. Patients usually have hydrocephalus.
On nonenhanced CT the lesions are hyperdense well-circumscribed masses.
Subarachnoid seeding may be present. Borkovich claims that there are slightly
more cerebellar astrocytomas in most series. ???Quoting Lee, Rao, & Zimmerman
1992, p. 389, Depending on the series, medulloblastoma or cerebellar astrocytoma
is the most common primary neoplasm of the
pediatric posterior fossa. According to Grossman and Yousem (1994), pilocytic
astrocytomas are the most common infratentorial neoplasm in children - 20% are in
the brainstem and 40% are cerebellar. Ependymoma is usually associated with the
4th ventricle. They have a greater incidence of calcification (40-50%) than other
posterior fossa pediatric neoplasms. Answer : probably b. medulloblastoma
by KH
a. hemangioma
b. astrocytoma
c. ependymoma
d. hemangioblastoma
Type- Neuro
Answers- b
Notes-
a. aqueduct of sylvius
b. third ventricle
c. atria of the lateral ventricle
Type- Neuro
Answers- c
Notes-
by KW
Osborn 587,900
Intraventricular meningiomas typically occur around the choroid in the trigone of
the
lateral venticle esp the left lat ventricle, p 68-73 Requisites
2000 Board Question
135. The patient with a dry mouth and bilateral swollen parotid glands most likely
has:
a. AIDS
b. Sjogren syndrome
c. Kaposi sarcoma
d. Lymphoma
e. Lupus
Type- Neuro
Answers- b
Notes-
by KW
Dahnert p437
1997 Old Board Question
Type- Neuro
Answers- b
Notes-
Dahnert p261
In NF-1, pulsitile exopthalmos or unilateral proptosis is caused by herniation of
the subaachnoid space and temporal lobe into the orbit . Harlequin appearance to
the orbit from partial absence of the greater and lesser wing of the sphenoid, and
orbital plate of the frontal bone. (D198)
1998 Board Question
by MH
Type- Neuro
Answers- a
Notes-
138. There is a single ventricle and midline fusion of the thalami. What is the
most likely diagnosis?
a. holoprosencephaly
b. infarct
c. encephalocele
d. hydrocephalus
Type- Neuro
Answers- a
Notes-
Dahnert p240
1989, 1990 Single Best Answer Question
Meningoencephalocele is a disorder of midline closure commonly seen in the
occipital
region. It represents herniation of the meninges-containing CSF through a
congenital defect in
the skull vault. In an encephalocele, contents include brain tissue. The most
common site is the
occipital region.
by MH
139. There was a simple question regarding the location of the facial nerve in the
IAC:
Type- Neuro
Answers- a
Notes-
by KW
2000 Board Question
Dahnert p311
The facial nerve is superior and anterior in the IAC. So the facial nerve is
superior to crista falciformis and anterior to Bills Bar.
140. Thirty-five year old male with back pain. MRI shows a lesion in the
vertebral body that is high signal on T1 and T2. The most likely diagnosis is?
a. Bone island
b. Metastasis
c. Hemangioma
d. Schmorls node
Type- Neuro
Answers- c
Notes-
c. The vertebral bodies and skull are most commonly involved and show dense
vertical striations. High signal intensity on both T1 and T2 (H67).
1996 Question
a. Responds to steroids
b. Have positive findings on imaging studies
c. Can be painful
d. Is associated with pseudo tumor cerebri
e. Requires radiation treatment
Type- Neuro
Answers- a,b,c
Notes-
by KW
Dahnert p292
Pseudotumor cerebri is bilateral congenital papilladema
If fails steroid therapy, XRT and chemo can be used...
1997 Old Board Question
Type- Neuro
Answers- b,c
Notes-
by KW
Dahnert p325
Almost exclusively in males
Usually adolescents
Most common benign nasopharyngeal tumor
Spreads via the pterygopalatine fossa
1997 Old Board Question
Type- Neuro
Answers- a,b,c,d,e
Notes-
by KW
Dahnert p314
Adenoid cystic carcinoma = cylindroma, propensity to spread along the facial nerve
4-15% of all salivary tumors
1997 Old Board Question
Type- Neuro
Answers- a,c,d
Notes-
Dahnert p250
by KW
1997 Old Board Question
145. True/False, A patient with an intracerebral bleed gets acutely worse one week
later. This may be caused by:
a. Re-bleed
b. Communicating hydrocephalus
c. Vasospasm
d. Venous thrombosis
Type- Neuro
Answers- a,c
Notes-
by KW
Dahnert p269
1997 Old Board Question
a. True
b. False
Type- Neuro
Answers- a
Notes-
by KW
Dahnert p169, Resnick p802
The rate of non-union is high in Type II fractures
1997 Old Board Question
a. cystic
b. presents with hemorrhage
c. presents with Parinaud syndrome
d. calcification
e. avascular
Type- Neuro
Answers- a
Notes-
Dahnert p237
1992 True/False Question
Hemangioblastoma is the most common primary neoplasm of the adult posterior fossa
and arise most frequently in the cerebellum. It is associated with von Hippel-
Lindau disease. It
does not typically present with hemorrhage although there may occasionally be
hemorrhage in
the nodular component. They are very vascular with very intense staining on
angiography, and
prominent flow voids on MR. It is solid in one third but commonly appears cystic
+/- mural
nodule. It almost never calcifies. A spinal hemangioblastoma can present with
subarachnoid
hemmorrhage. Common sx include HA, ataxia, N/V, vertigo. 40% can have P vera from
erythropoietin produation. p 81 Requisites
Perinauds syndrome is loss of upward gaze which is seen with pineal tumors.
Reference: Dahnert 1993, pp. 180-181
by MH
Type- Neuro
Answers- c,d,e
Notes-
Not Verified
1994 Question
Type- Neuro
Answers- a,b
Notes-
netter133.
Dahnert p208
1989 Board Question
by KH
150. What is the most likely cause of conductive hearing loss and facial nerve
palsy in a trauma patient?
Type- Neuro
Answers- b
Notes-
151. What is the most likely diagnosis if a 50-60 HU density is seen in the brain
and it has peripheral enhancement?
Type- Neuro
Answers- b
Notes-
Dahnert p234
1991 Single Best Answer Question
by AE
a. T10
b. T12
c. L4
d. S1
e. L2
Type- Neuro
Answers- e
Notes-
In early embryogenesis, the spinal cord passes all the way to the end of the
spinal canal. Each spinal cord segment lies exactly opposite the corresponding
vertebral segment and each segmental nerve root passes laterally to its exit
foramen. As the embryo matures, the vertebral bodies grow faster than the neural
elements, so the spinal cord appears to ascend within the spinal canal. As a
general rule, the tip of the conus medullaris lies at approximately L2-3 at birth
and nearly at the adult level of L1-2 by age three months. The tip of the conus
medullaris lies at or above the L2-3 intervertebral disc space in 97.8% of cases.
It lies over the L-3 vertebra in 1.8% of cases. Therefore, a spinal cord that
lies at or below L-3 is best regarded as abnormal until detailed evaluation proves
it is not held in abnormally low position by a tethering mass, a fibrous band, or
a bone spur. (D p160)
1999 Board Question
by CM
Type- Neuro
Answers- c
Notes-
by KW
Verified Dahnert p335, Som 321-325
Pleomorphic adenoma is most common benign tumor, more common in women greater than
40, is lateral to the facial nerve in greater than 80% of cases
Warthins more common in men
2000 Board Question
154. Where is low density seen by CT with occlusion of the posterior cerebral
artery?
Type- Neuro
Answers- a,b,c
Notes-
Req p.60-62
1989 Board Question
by AE
Type- Neuro
Answers- b,d
Notes-
by KW
Verified Osborn p24
Type III = Type II + encephalocele
Type IV = cerebellar hypoplasia
1989 Board Question
156. Which is false regarding Dyke Davidoff Mason syndrome or unilateral atrophy:
Type- Neuro
Answers- e
Notes-
by KW
Dahnert p229
This syndrome is an insult to immature brain resulting in neuronal loss and
impaired brain growth
May be prenatal - congenital malformation, infection, or vascular insult
May be perinatal - birth trauma, anoxia and hypoxia, intracranial hemmorhage
May be postnatal - trauma, tumor, infection, prolonged febrile seizures
The above entail most of the findings, with contraction of a hemisphere or lobe
2000 Board Question
Type- Neuro
Answers- a
Notes-
by KW
Verified Baby Resnick 800, 805, Dahnert p168
Check .... which has worse and more acute neurological sequela....
Both Hyperextension injury and AtlantoOccipital Dislocation share these findings
However, Atlantooccipital dislocation is rarely due to trauma (rheumatoid, downs,
CPPD, etc)
Hyperextension injury is much more common, accounting for 25% of all cervical
trauma cases
Could they have forgot the choice of hyperflexion tear drop, the most sever and
unstable C-Spine injury...
2000 Board Question
a. Hangmans fracture
b. Type II dens fracture
c. Atlanto-occipital disassociation
d. C-1 arch fracture
e. Jefferson fracture
Type- Neuro
Answers- c
Notes-
by KW
Osborne p867
Atlanto-occipital disassociation may have normal xray findings, but is commonly
fatal.
1998 Board Question
a. Punctate calcification
b. Multinodularity
c. Peripheral eggshell calcification
Type- Neuro
Answers- b
Notes-
by KW
Ultrasound Requisites p450, Dahnert p304
Peripheral calcification more likely benign, small punctate calcification more
likely malignant
I dont know how periphral calcification compares with multiplicity
A cold nodule in a multinodular thyroid carries a 1-6% risk of carcinoma, compared
to 15-25% for solitary cold nodule
2000 Board Question
160. Which is the most likely cause of a lesion in the cerebellum with a sharp
medial border at the midline?
a. astrocytoma/glioma
b. subacute infarction
c. medulloblastoma
d. metastasis
e. hemangioblastoma
Type- Neuro
Answers- b
Notes-
Dahnert p249
1992 Single Best Answer Question
by MH
Type- Neuro
Answers- b
Notes-
by KW
Verified Dahnert p335, Som 321-325
Pleomorphic adenoma is most common benign tumor, more common in women greater than
40, is lateral to the facial nerve in greater than 80% of cases
Warthins more common in men
1995 True/False Question
80% of tumors are benign, 80% are pleiomorphic adenomas, 80% are in the
superficial
lobe of the parotid, 80% of pleiomorphics are in the parotic, 80% of pleiomorphics
if left unRx
ed stay benign.
The portion of the parotid that extends deep to the plane of the facial nerve is
the deep
lobe. The superficial lobe extends from just under the skin. Thes lobes dont
really exist but are
arbitrary distinction for surgical purpose. If the tumor is in the superficial
lobe, the facial nerve
is dissected out deep to the mass and the tumor is resected superfical to the
facial nerve. Are
most commonly seen in middle aged women. p 414, 420
Warthins tumor are nearly exclusive to the parotid and are the most common
multiple
and bilateral tumors in the gland. These lesions are entirely benign. Warthins
are most
commonly seen in elderly men. p 420 They are the second most common benign tumor
of the
parotic-- 10% as stated in Danhertp 256. These lesions are usually round to oval
encapsulated
masses. p 824 Robbins
ref: Requisites p 420, 414, Danhert p 256, Robbins, p 824
Type- Neuro
Answers- b
Notes-
Early subacute hematomas have high signal on T1WI. The high signal typically
begins at teh hematoma periphery and progresses inward. Thus the center of early
subacute clots remains relatively isointense on T1WI and the rim becomes
hyperintense. Early subacute clots are profoundly hypointense on T2WI and
gradient-refocussed sequences. Osborn167.
Anaplastic glioma appears on MR as a poorly delinated lesion that has
heterogeneous signal intensities on both T1 and T2WI. Mixed iso- to hypodense
areas are seen on the T1-weighted sequences. Some hemorrhagic foci may be
present. A common appearance on T2W1 is a central core of hyperintensity
surrounded by an isointense rim with peripheral fingerlike high intensity
projections secondary to vasogenic edema. osborn538
1989 Board Question
by KH
163. Which of the following are associated with increased incidence of primary
brain tumor?
a. Gardners
b. sickle cell disease
c. von Hipple-Lindau
d. Turcots
e. tuberous sclerosis
Type- Neuro
Answers- c,d,e
Notes-
by KW
Osborn 94,104, Dahnert p685,717
Turcots - Glioblastoma (esp. Supratentorials) + Medulloblastoma
von-Hippel - hemangioblastomas
Tuberous Sclerosis - Giant Cell Astrocytomas
1993 True/False Question
Von Hipple-Lindau syndrome is autosomal dominant and consists of cerebellar
hemangioblastomas and retinal angiomatosis (67%), pheochromocytoma, cysts of
kidneys,
pancreas, liver, and epididymis, and a high incidence of renal cell carcinoma.
Turcots is associated with CNS tumors, especially supratentorial glioblastomas.
Gardners consists primarily of colonic polyps, osteomas, and soft tissue tumors.
The intracranial manifestations of tuberus sclerosis include periventricular
subependymal
nodules, cortical and subcortical peripheral tubers, white matter lesions, and
subependymal giant
cell astrocytomas.
In sickle cell disease the incidence of cerebrovascular occlusive disease is 5-
17%.
Infarction is most likely related to stasis and ischemia in the vasa vasorum which
leads to intimal
and medial hyperplasia and subsequent narrowing and occlusion of internal carotid
or proximal
anterior and middle cerebral arteries.
a. hypoparathyroidism
b. tuberous sclerosis
c. progeria
d. Cornelia De Lange
e. Sturge-Weber syndrome
Type- Neuro
Answers- a,b,c,e
Notes-
165. Which of the following are causes of third cranial nerve palsy?
a. migraine
b. diabetes
c. multiple sclerosis
d. posterior inferior cerebellar artery aneurysm
e. lymphomatous meningitis
Type- Neuro
Answers- a,b,c,e
Notes-
166. Which of the following are frequently calcified lesions in the posterior
fossa?
a. hemangioblastoma
b. dermoid
c. acoustic schwanomma
d. astrocytoma
e. medulloblastoma
Type- Neuro
Answers- b
Notes-
a. medulloblastoma
b. ependymoma
c. cerebellar astrocytoma
d. hemangioblastoma
Type- Neuro
Answers- a,b
Notes-
a. alobar holoprosencephaly
b. schizencephaly
c. Chiari II malformation
d. unilateral megaencephaly
e. heterotopic bands
Type- Neuro
Answers- b,d,e
Notes-
Proliferation - Megalencephaly
Migration - Schiz, Heterotopic bands, pachygyria, polymicrogyria
other migational disorders- pachgyria, polymicrogyria
Megalencephaly is migrational disorder - Neuro requisites. - KW
Kirks 98-106
1995 True/False Question
Schizencephaly is a abnormality of neuronal migration is the 5-7th week. It is a
cleft seen
coursing from the ependyma to the pial surface. The disorder is secondary to
failure of the
germinal matrix to form. p 253
Heterotopia is usually in the gray matter which is located in the wrong place due
to arrest
in neuronal migration. This usually occurs in the 7th to 16th week when migration
of the neuroblasts
form the perivent to the pia is thwarted. Ectopic gray matter is usually in the
subependymal or
subcortical location. p 256
Holoprosencephaly is a congenital abnormality where separation of the right and
left
cerebral hemispheres is incomplete. Alobar type is the most severe and
demonstrates almost no
separation of the cerebral hemispheres and ventricles. There is one large
horseshoe shaped vent
with no interhemispheric fissure. The BG and thalamus are fused. p 252
Etiologies of unilateral cranial enlargement-- Dyke-davidoff-masson syndrom,
hemimegalencephaly(neruonal migrational anomaly), NF, Klippel-Trenaunay Synd,
Proteus
Sydrome. Can get polygyria associated with hemispheric size, or agyria associated
with less sever
hemispheric enlargment. MR demonstrates distorted thickened cortex with
ipsilateral ventricular
dilatation. p 258
Chiari malformation is dx when cerebellar tonsils are below the foramen magnum. ?
no
etiology stated. p 261
ref: Requisites
by AE
169. Which of the following are potential causes of enhancing posterior third
ventricular mass?
a. pinealcytoma
b. pineal cyst
c. vein of Galen aneurysm
d. dysgerminoma
e. PNET
Type- Neuro
Answers- a,b,c,d,e
Notes-
Dahnert p263
1994 True/False Question
Pineal cysts typically ring enhance on MRI. Supratentorial PNETs are distinctly
uncommon and in her tenure at CHOP Jill has not seen one involving the pineal. We
are
therefore not including this. If you include pineoblastomas as a PNET( table 3-6
p 83), the
answer is easy with PNET being true as well.
Pineal region masses include germinoma aka dysgerminona or seminoma which have
marked enhancement and are almost exclusively male, pinealblastoma and
pineocytoma.
Pineocytoma enhance vividly.
Other lesions in this area include pineal and tectal gliomas, cavernous
hemangioma,
meningioma, and benign cyst. Pineal cyst can be large. Pineocytoma can be hard
to differentiate
froma cyst because it can also have cystic components. Key is long-term f/u.
Because pineal
cyst are surrounded by limbs of inernal cerebral veins, have to be careful not to
misread vascular
enhancement as solid mass enhancement.
ref: Requisites p 96-7
by MH
Type- Neuro
Answers- e
Notes-
Type- Neuro
Answers- c,d
Notes-
172. Which of the following are true regarding the position of the facial nerve in
the internal auditory canal?
Type- Neuro
Answers- b,c
Notes-
by KW
Dahnert p311
1988 True/False Question
The facial nerve is superior and anterior in the IAC. So the facial nerve is
superior to crista falciformis.
173. Which of the following are true with regards to amyloid angiopathy?
Type- Neuro
Answers- a,e
Notes-
174. Which of the following best describes the appearance of the pituitary gland
on MR imaging?
Type- Neuro
Answers- b,c
Notes-
Dahnert p202
Isointense on T1/T2 to white matter
1999 Board Question
by AE
175. Which of the following can most closely resemble MS on MRI of the brain?
a. Lymphoma
b. Alzheimers disease
c. Acute infarct
d. Lyme disease
e. Herpes encephalitis
Type- Neuro
Answers- d
Notes-
176. Which of the following cause a cystic midline mass that can mimic an enlarged
third or fourth ventricle?
a. dermoid cyst
b. suprasellar arachnoid cyst
c. intraventricular cysticercosis
d. cerebellar astrocytoma
e. hypothalamic polycystic astrocytoma
Type- Neuro
Answers- b,c,d
Notes-
1993 True/False Question
Im guessing on the correct answers here.
A dermoid cyst is a midline mass which may occur in the 4th ventricle(Osborn p67,
D p228-9). Its capsule is thick, commonly with peripheral calcification (p 320
Requisites). The presence of fat or calcium in it can distinguish it from a large
ventricle.
Cysticercosis is one of the most common parasitic diseases that affect the brain.
A large cyst or cluster of cysts within the 4th ventricle may simulate dilatation
of that ventricle, Lee, Rao, and Zimmerman 1992, pp. 572-573. (Dahnert p227)
Cysticercosis is acquired by ingestion of a parasite which is in insufficiently
cooked pork. The cysticerci are located in brain parenchyma, subarachnoid space,
and the ventricles (rarely intraspinal). The parenchymal cysts have a propensity
for cortical and deep gray matter; whereas subarachnoid cysts can produce
hydrocephalus and mass lesions, particularly in the suprasellar cistern,
cerebellopontine angle cistern, and the Sylvian cistern. There are four stages of
the cyst. In stage I, the larvae are alive and the cyst has clear fluid. Edema
is minimal and the cyst is surrounded by a thin capsule. On MR, the fluid of the
cyst is isointense on all pulse sequences and the eccentric scolex (which appears
as a mural nodule) can be identified. CT shows a circumscribed cyst with density
similar to CSF (the scolex is more dense). Visualization of the scolex is
pathognomonic of cysticercosis. When the larvae die, the cysts incite an
inflammatory response.
The hypothalamic polycystic astrocytoma has incomplete necrosis which sometimes
leads to a polycystic appearance. Supratentorial astrocytomas in children
frequently involve the thalamus. (D p235)
If a suprasellar arachnoid cyst invaginates into the 3rd ventricle, it can be
mistaken for an enlarged 3rd ventricle on the basis of acqueductal stenosis.
Most cerebellar astrocytomas arise in the midline and can be cystic. Cystic
astrocytomas with a mural nodule account for 50% of cerebellar astrocytomas in
children(Dahnert p222).
d.(Osborn p481)
by CM
a. Sturge-Weber syndrome
b. One day old infarct
c. Ten day old infarct
d. Twenty day old infarct
e. Immediately post seizure
Type- Neuro
Answers- a,c
Notes-
by KW
Verified Osborn 100, 347, Dahnert p193
1989 Board Question
178. Which of the following commonly cause hemorrhagic metastases in the brain?
a. choriocarcinoma
b. melanoma
c. colon
d. lymphoma
e. renal cell carcinoma
Type- Neuro
Answers- a,b,e
Notes-
Dahnert p253
Also oat cell carcinoma
1991 True/False Question
Mets which have a propensity for hemmorrhage include melanoma, renal cell,
choriocarcinoma, and thyroid ca. While bronchogenic ca doesnt have a propensity
for
hemorrhage, hemorrhagic lesions may be seen b/c lung ca is so common.
ref: p 423 Lee, Rao, Zimmerman- Cranial MR and CT
by MH
a. herpes encephalitis
b. multiple sclerosis
c. cytotoxic edema secondary to infarct
d. CNS lymphoma
e. vasogenic edema secondary to tumor
Type- Neuro
Answers- b,d,e
Notes-
Dahnert p255
1994 True/False Question
Vasogenic edema results from breakdown of the blood brain varrier. Cytotoxic
edema begins as intracellular swelling secondry to any type of insult to the cell
membrane usually due to ischemia p 295 Lee, Rao
In stroke, treatment of edema is done with water restriction and agents that raise
serum osmolality such as mannitol. p 1996 With edema secondary to tumor,
treatment is based on lowering intracranial pressure. Treatment with daily doses
of dexamethasone or methylprednisone reduces cerebral edema and improves surgical
prognosis. This may not control sx of obstructed ventricular system, so a
ventriculostomy may need to be placed. p 2014 HSV encephalities is Rx with IV
antiviral therapy- acyclovir which has been noted to shorten the course of
infection. p 684 CNS lymphoma is Rxed with high dose methotrexate,
glucocorticoids alone or in combo with cyclophosphamide, doxorubicin, vincristine
followed by XRT. p 2019 No effective treatment for MS is known. Therapy is
directed towards reducing the acute episode, prevent relapses or progression, and
relief of Sx. In acute flare, glucocorticoid treatment may lessen the severity,
but recoverty is not improved or the extent of disability is not altered. Can give
ACTH. Immunosupressive agents like azathioprine, and cyclophosphamide have
claimed to reduce the # of relapses but there is no consensus. All tried is total
lymphoid radiation, alpha and beta interferon, diet alteration. p 2042-3 ref:
Harrisions 12th ed
by MH
180. Which of the following injuries to the cervical spine is most likely to cause
neurologic symptoms?
a. hip prostheses
b. Stuart Edwards valve
c. metallic foreign body within the eye
d. Greenfield filter
Type- Neuro
Answers- c
Notes-
by KW
2000 Board Question
Consensus...
Absolute contraindication means that the patient absolutely should not be scanned.
This includes cardiac pacemakers, automatic internal defribrillators, implanted
infusion pumps, implanted insulin pumps, bone growth stimulators, non-removable
neurological stimulators, cochlear implants, metal in the eyes, shrapnel in vital
locations, and tattooed eyeliners or lipsticks.
Relative contraindication means that some of these devices may and some may not be
scanned. This includes aneurysm clips, penile prostheses, cardiac valve
prostheses, middle ear prostheses, and shrapnel or foreign bodies in non-vital
locations. Safe means that the device may be scanned without any problems. This
typically includes orthopedic prostheses, pins, rods, plates, surgical clips (2-3
months post surgery), dental fillings, orthodontics, braces, root canal work,
intrauterine devices, and contraceptive diaphragms. Controversial means that there
is no general consensus on the safety of the device. This includes such things as
Gianturco embolization coils, inferior vena cava filters, and endovascular stents.
Dr. Frank Shellock, who has done a great deal of research regarding the MR
compatability of various implants, cautions that his list cannot be taken as the
final word. It is prudent to assume that no list of supposedly MR compatible
devices is absolutely correct. Paraphrasing Dr. Shellock from his latest pocket
guide on MR procedures, ... a manufacturer may change the composition of the
implant, material, device or object without going back to the FDA for new approval
as long as the function of the device remains the same ... Of course the final
decision, when there is a question of safety, is the responsibility of the
physician.
Contraindicacions of MRI exam:
-Pacemakers, defibrillators or neurostimulators
-CNS surgical clips
-Ocular implants or foreign bodies
-Metallic fragments near a vital structure
-Othologic implants or hearing aids
-Starr-Edwards mitral prosthetic heart valve pre-6000 series
-Claustrophobia
-Thermodilution catheters, pulse oximeters, standard ECG wires and leads
-Pregnancy (controversial)
182. Which of the following is associated with the shaken baby syndrome?
a. retinal hemorrhage
b. white matter shear injury
c. cortical hematoma
d. subdural hematoma
e. Schizencephaly
Type- Neuro
Answers- a,b,c,d
Notes-
In others we did not include white matter shear injury.... true or false?
by KW
Verified Dahnert p41, Osborn 244-5
1993 True/False Question
In shaken baby syndrome retinal hemorrhages are observed with subdural
(particularly interhemispheric) hematomas and/or subarachnoid hemorrhage.
Contusions and diffuse cerebral swelling are also noted. The abused child can
have epidural, subdural, subarachnoid, and intraventricular hemorrhages as well as
DAI. Traumatic subdural hematomas in the child (from any traumatic cause) are
bilateral in 80%.
a. Extracellular methemoglobin
b. Intracellular methemoglobin
c. Deoxyhemoglobin
d. Oxyhemoglobin
e. Hemosiderin
Type- Neuro
Answers- b
Notes-
D239
1999 Board Question
by KH
a. cochlea
b. stapedius
c. vestible
d. malleolus
Type- Neuro
Answers- a,b
Notes-
a. astrocytoma
b. choroid plexus papilloma
c. PNET
d. ependymoma
e. brainstem glioma
Type- Neuro
Answers- b
Notes-
186. Which of the following is most highly associated with peripheral aneurysms of
the MCA?
a. Berry aneurysm
b. mycotic aneurysm
c. Takayasus arteritis
d. polyarteritis nodosa
Type- Neuro
Answers- b
Notes-
by KW
Dahnert p217,533, Osborn 272
Polyarteritis nodosa can have similiar picture, but is rare, and is more
associated with renal aneurysms
1993, 1988 Single Best Answer Question
A mycotic aneurysm is often secondary to endocarditis with septic emboli to the
vasa vasorum and secondary destruction of the vessel wall - all that is left is
the intima. The aneurysms may be saccular or fusiform. The aneurysms tend to be
peripheral in the MCA
distribution.
Polyarteritis nodosa is a multisystem disease with necrotizing inflammation of
muscular arteries. There is CNS involvement in 45% (usually late). There are no
specific findings.
Berry anuerysms, or saccular aneurysms, are congenital weaknesses in the media and
elastica of the arterial wall. The occur at branching point where the parent
vessel is curving.
Takayasus arteritis tends to involve large vessels coming off the arch. Aneurysms
are not a typical feature. Generalized vasculitis may lead to infarcts.
187. Which of the following is not associated with tethered cord and spinal
dysraphism?
Type- Neuro
Answers- e
Notes-
by KW
Osborn p807-808, Dahnert p179
Trick question i think
Dorlands Dictionary, p1089 and 1093:
Myelolipoma = A rare benign tumor of the adrenal gland, composed of adipose
tissue, lymphocytes, and myeloid cells
Myolipoma = A benign mesenchymoma containing fatty or lipomatouis elements
Note that the text below is wrong concerning myelolipoma.
1993, 1990, 1989 Single Best Answer Question
Spinal dysraphism basically means a group of spinal anomalies with the common
feature of imperfect union of midline structures. Tethered cord is a spinal cord
that is held in an abnormally low position by a fibrous band, bone spur, or mass.
Diastematomyelia is a longitudinal split in the spinal cord, conus medullaris, or
filum terminale associated with bony abnormalities including spina bifida. It
also is associated with tethering of the conus medullaris (below L2 in 76%).
Hydrosyringomyelia is a cavity in the spinal cord. Most are associated with
congenital spinal and hindbrain abnormalities. Thickening of the filum terminale
(= tethered spinal cord syndrome) is associated with
midline bony defects. Myelolipoma is lipoma(s) of the filum terminale. This is
another form of spinal dysraphism and tethering of the spinal cord. These lesions
have fat on CT or MR. Spinal lipomas are masses of fat and connective tissue that
are at least partially encapsulated and have definite connection to the spinal
cord and meninges. They are considered in three major groups: intradural lipomas,
lipomyelomeninigoceles, and lipomas of the filum terminale. In patients with
lipomyelocele there is no substantial meningocele component and the lipoma usually
extends into the canal through an occult spina bifida. The lipoma is attached to
the dorsal surface of the neural tissue and is covered by intact skin. The spinal
cord may assume different shapes and associated tethering may be present.
Fibrolipomas frequently occur in the filum terminale, and may be considered a
normal variant if not associated with tethering of the spinal cord or neurologic
dysfunction. These developmental lesions arise secondary to the persistence of
caudally located pleuripotential cells that differentiate into fat. Fibrolipomas
of the filum may be intradural or extradural, or both; extradural lesions tend to
be diffuse.
188. Which of the following is the most common cause of a peripheral MCA
microaneurysm?
a. intravenous amphetamine
b. berry aneurysm
c. atherosclerosis
d. septic emboli
e. polyarteritis nodosa
Type- Neuro
Answers- d
Notes-
Dahnert p217
1993 Single Best Answer Question
Mycotic aneurysms are peripheral to the 1st bifurcation of a major vessel in 64%
and are often located near the surface of the brain, especially over the
convexities. (e.g., often just distal
to MCA trifurcation in the inferolateral Sylvian fissure.)
Polyarteritis nodosa may involve all organs, but mainly the kidney (85%), heart
(65%), and liver (50%).
Intravenous amphetamine can yield a CNS vasculitis and subsequent microaneurysms,
but this is rare.
by MH
189. Which of the following is the most common CNS infection in AIDS?
a. TB
b. Cryptococcus
c. HIV encephalitis
d. Toxoplasmosis
e. Histoplasmosis
Type- Neuro
Answers- c
Notes-
Osborne p.698
A.HIV is a neurotrophic virus that can directly involve both the peripheral and
central nervous systems. The HIV virus itself is the most common CNS pathogen in
AIDS patients, followed by Toxoplasma gondi, and Cryptococcus neoformans. (O696)
1998 Board Question
by AE
190. Which of the following is the most common posterior fossa tumor in an adult?
a. hemangioblastoma
b. metastasis
c. medulloblastoma
d. glioma
e. ependymoma
Type- Neuro
Answers- b
Notes-
191. Which of the following is the most common supratentorial neoplasm in a child?
a. meningioma
b. ependymoma
c. glioma
d. PNET
e. hemangioblastoma
Type- Neuro
Answers- c
Notes-
192. Which of the following is the most convincing evidence against multiple
sclerosis in a patient?
Type- Neuro
Answers- a
Notes-
by KW
Dahnert p254
The following suggest a process other than MS-
No eye findings
No bladder findings
No sensory findings
No clinical remission
Totally local disease
1991 Single Best Answer Question
Multiple sclerosis is a demyelinating disease of unknown etiology which most
frequently
affects young adults. The classic lesions seen on MR are plaques, which occur
commonly in the
periventricular white matter, internal capsule, corpus callosum, pons, and
brachium pontis. They
are best seen on long TR sequences.
193. Which of the following is the most likely cause of an enhancing suprasellar
mass in a 1-year-old?
a. pituitary adenoma
b. glioma
c. neuroblastoma metastasis
d. dysgerminoma
e. craniopharyngioma
Type- Neuro
Answers- e
Notes-
194. Which of the following is the most likely cause of conductive hearing loss
and facial nerve palsy in a patient with acute trauma?
Type- Neuro
Answers- d
Notes-