Neuro 5 Flashcards

The largest skull-base opening is what?

During posterior fossa surgery, the surgeon identifies the cervicomedullary junction. It lies at the level of the:

A basilar skull fracture violates the anterior cranial fossa. Which lobe is most directly involved?

A mass expands within the middle cranial fossa. The adjacent cerebral lobe there is the:

A posterior fossa tumor causes truncal ataxia plus long-tract signs. Which structures are housed there?
A. Thalamus and hypothalamus
B. Basal ganglia and cortex
C. Cerebellum and brainstem
D. Limbic cortex and striatum

The anterior cranial fossa is separated from the middle cranial fossa by the:
A. Lesser sphenoid wing
B. Greater sphenoid wing
C. Crista galli
D. Clivus

A petroclival lesion abuts the boundary between middle and posterior fossae. Which bony ridge marks this division?
A. Occipital condyle
B. Petrous temporal ridge
C. Crista galli
D. Lesser sphenoid wing

A dural “roof” over the cerebellum contributes to the middle–posterior fossa separation. Which fold is it?
A. Tentorium cerebelli
B. Falx cerebri
C. Falx cerebelli
D. Diaphragma sellae

An epidural infection dissects from the inner skull surface. Which dural component is normally adherent to calvaria?
A. Pia mater
B. Arachnoid mater
C. Ependyma
D. Periosteal dura

Intracranial dural folds form where the inner dural layer reflects. Which layer forms these folds?
A. Periosteal layer
B. Arachnoid layer
C. Meningeal layer
D. Pia layer

A midline extra-axial mass compresses the dural partition separating the cerebral hemispheres. Which structure is compressed?
A. Tentorium cerebelli
B. Falx cerebelli
C. Diaphragma sellae
D. Falx cerebri

The falx cerebri runs primarily within the:
A. Interhemispheric fissure
B. Lateral sulcus
C. Calcarine fissure
D. Central sulcus

A superiorly expanding cerebellar tumor presses against the dural tent over the cerebellum. Which structure is this?
A. Falx cerebri
B. Falx cerebelli
C. Diaphragma sellae
D. Tentorium cerebelli

Uncal herniation forces tissue toward the narrow opening in the tentorium. That opening is the:
A. Foramen magnum
B. Optic canal
C. Tentorial notch
D. Jugular foramen

In transtentorial herniation, which structure normally passes through the tentorial notch?
A. Medulla
B. Pons
C. Midbrain
D. Cerebellar vermis

A neurosurgeon describes a wispy, “spidery” layer adherent to the inner dura. Which layer is this?

In normal physiology, what percolates over the brain surface within the arachnoid compartment?
A. Venous blood
B. Lymph
C. Interstitial fluid
D. Cerebrospinal fluid

A ruptured saccular aneurysm releases blood into the CSF-filled compartment between arachnoid and pia. Which space is this?
A. Epidural space
B. Subarachnoid space
C. Subdural space
D. Intraventricular space

MRI shows prominent perivascular spaces along penetrating vessels. These are called:
A. Perineural spaces
B. Dural sinuses
C. Virchow–Robin spaces
D. Subdural clefts

As arteries penetrate the brain surface, the pia initially surrounds them and then:
A. Forms arachnoid granulations
B. Fuses with vessel wall
C. Becomes periosteal dura
D. Joins ependymal lining

A temporal bone fracture causes arterial blood to accumulate between skull and tightly adherent dura. The bleed occupies the:
A. Epidural space
B. Subdural space
C. Subarachnoid space
D. Intraventricular space

A pterion fracture lacerates the middle meningeal artery. This artery entered the skull via the:
A. Foramen ovale
B. Jugular foramen
C. Foramen lacerum
D. Foramen spinosum

The middle meningeal artery normally courses between skull and dura within the:
A. Subdural space
B. Epidural space
C. Subarachnoid space
D. Venous sinus lumen

The middle meningeal artery is a branch of the:
A. Internal carotid artery
B. External carotid artery
C. Vertebral artery
D. Basilar artery

Which supplies the dura?
A. Middle cerebral artery
B. Anterior cerebral artery
C. Middle meningeal artery
D. Posterior cerebral artery

The middle cerebral artery most directly arises from the:
A. Internal carotid artery
B. External carotid artery
C. Vertebral artery
D. Basilar artery

A crescent-shaped extra-axial hemorrhage lies between inner dura and arachnoid on CT. This blood occupies the:
A. Epidural space
B. Subarachnoid space
C. Intraventricular space
D. Subdural space

After a minor fall, an elderly patient develops a subdural hematoma. Which vessels are most often torn?
A. Middle meningeal artery
B. Cortical arteries
C. Emissary veins
D. Bridging veins

The superior sagittal sinus is best described as a venous channel located:
A. In subarachnoid space
B. Between dural layers
C. Within pia mater
D. Within epidural fat

Most dural venous blood exits the cranium primarily via the:
A. Cavernous sinus
B. Straight sinus
C. Superior sagittal sinus
D. Sigmoid sinuses

The sigmoid sinuses ultimately drain into the:
A. Internal jugular veins
B. External jugular veins
C. Subclavian veins
D. Azygos veins

Bridging veins drain into large venous channels enclosed within dura called:
A. Arachnoid villi
B. Diploic veins
C. Dural venous sinuses
D. Perivascular spaces

An MRI shows inflammation of the ventricular lining. Which cells line ventricular walls?
A. Ependymal cells
B. Astrocytes
C. Oligodendrocytes
D. Pericytes

A choroid plexus papilloma arises from cuboidal cells on plexus fronds. What are these cells called?
A. Choroid epithelial cells
B. Ependymal cells
C. Arachnoid cells
D. Endothelial cells

CT reports dilation of the frontal horn of a lateral ventricle. The frontal horn is also the:
A. Inferior horn
B. Anterior horn
C. Posterior horn
D. Occipital horn

A mass expands within the frontal horn. It extends into the:
A. Parietal lobe
B. Occipital lobe
C. Temporal lobe
D. Frontal lobe

Imaging shows enlargement of the occipital horn. The occipital horn is also the:
A. Anterior horn
B. Inferior horn
C. Temporal horn
D. Posterior horn

A lesion confined to the occipital horn would localize to the:
A. Frontal lobe
B. Temporal lobe
C. Occipital lobe
D. Parietal lobe

Trapped CSF in the “inferior horn” of a lateral ventricle implies obstruction of the:
A. Temporal horn
B. Occipital horn
C. Frontal horn
D. Atrium

A hemorrhage tracking into the temporal horn most directly involves the:
A. Occipital lobe
B. Parietal lobe
C. Frontal lobe
D. Temporal lobe

A tumor at the atrium risks isolating which ventricular extensions from the body?
A. Frontal and occipital horns
B. Temporal and occipital horns
C. Frontal and temporal horns
D. Frontal and inferior horns

A colloid cyst causes acute lateral ventricle dilation by blocking the:
A. Foramen of Monro
B. Foramen of Magendie
C. Foramina of Luschka
D. Cerebral aqueduct

A pineal-region mass produces noncommunicating hydrocephalus by compressing the:
A. Foramen of Monro
B. Foramina of Luschka
C. Foramen of Magendie
D. Aqueduct of Sylvius

The Aqueduct of Sylvius is located within the:
A. Thalamus
B. Pons
C. Medulla
D. Midbrain

On coronal MRI, a C-shaped nucleus hugs the lateral ventricle. Which structure is this?
A. Putamen
B. Thalamus
C. Caudate nucleus
D. Amygdala

A major C-shaped commissural tract connects both hemispheres. Which structure is it?
A. Anterior commissure
B. Corpus callosum
C. Internal capsule
D. Fornix

A memory-circuit lesion disrupts a C-shaped tract from hippocampus. Which tract is involved?
A. Fornix
B. Optic tract
C. Mammillothalamic tract
D. Medial lemniscus

A limbic pathway arches C-shaped along the caudate tail to amygdala. Which structure is it?
A. Cingulum
B. Optic radiation
C. Stria terminalis
D. Corticospinal tract

A posterior fossa mass distorts the roof of the fourth ventricle. The roof is formed by the:
A. Thalamus
B. Cerebellum
C. Pons
D. Medulla

A lesion compresses the floor of the fourth ventricle. This floor is formed by the:
A. Midbrain and pons
B. Cerebellum and medulla
C. Pons and medulla
D. Thalamus and midbrain

Failure of CSF to exit the fourth ventricle laterally implicates the:
A. Foramen of Monro
B. Foramina of Luschka
C. Aqueduct of Sylvius
D. Foramen of Magendie

Failure of CSF to exit the fourth ventricle in the midline implicates the:
A. Aqueduct of Sylvius
B. Foramen of Magendie
C. Foramina of Luschka
D. Foramen of Monro

Subarachnoid blood pools in a cistern lateral to the midbrain. Which cistern is involved?
A. Prepontine cistern
B. Cisterna magna
C. Interpeduncular cistern
D. Ambient cistern

Hemorrhage is posterior to the midbrain beneath posterior corpus callosum. Which cistern is involved?
A. Ambient cistern
B. Prepontine cistern
C. Cisterna magna
D. Quadrigeminal cistern

A basilar tip aneurysm ruptures into the cistern between cerebral peduncles. Which cistern is involved?
A. Prepontine cistern
B. Interpeduncular cistern
C. Ambient cistern
D. Quadrigeminal cistern

A PCom aneurysm compresses CN III at its midbrain exit. CN III exits via the:
A. Cerebral aqueduct
B. Quadrigeminal cistern
C. Ambient cistern
D. Interpeduncular fossa

Blood collects just ventral to the pons. Which cistern is this?
A. Ambient cistern
B. Quadrigeminal cistern
C. Prepontine cistern
D. Interpeduncular cistern

A posterior fossa hemorrhage fills the largest cistern beneath the cerebellum. Which cistern is this?
A. Ambient cistern
B. Prepontine cistern
C. Cisterna magna
D. Quadrigeminal cistern

The cisterna magna lies adjacent to which skull-base opening?
A. Foramen spinosum
B. Jugular foramen
C. Foramen ovale
D. Foramen magnum

A lumbar puncture samples CSF from the cistern containing cauda equina. Which cistern is this?
A. Cisterna magna
B. Quadrigeminal cistern
C. Ambient cistern
D. Lumbar cistern

The blood–brain barrier’s low paracellular permeability is primarily due to endothelial:
A. Fenestrations
B. Gap junctions
C. Tight junctions
D. Desmosomes

For most nonlipid solutes, BBB passage is mainly by traversing endothelium via:
A. Paracellular diffusion
B. Bulk CSF flow
C. Passive filtration
D. Active transport processes

Which pair permeates most readily across blood–brain and blood–CSF barriers?
A. O2 and CO2
B. Glucose and lactate
C. Albumin and IgG
D. Na+ and K+

A polar solute crosses using specialized BBB systems. Which mechanism is listed?
A. Simple filtration
B. Phagocytosis
C. Facilitated diffusion
D. Exocytosis

CSF is primarily reabsorbed into venous circulation at the:
A. Arachnoid granulations
B. Choroid plexus
C. Central canal
D. Cerebral aqueduct

Arachnoid villus cells move CSF across to venous blood via:
A. One-way bulk transport
B. Two-way active pumping
C. Retrograde venous reflux
D. Bidirectional filtration

One-way CSF transfer at villi occurs through structures called:
A. Ion channels
B. Giant vacuoles
C. Tight junction pores
D. Fenestrations

Granulation vacuoles are described as large enough to engulf:
A. Red blood cells
B. Platelets
C. Neutrophils
D. Lymphocytes

In which regions is the blood–brain barrier interrupted?
A. Hippocampal formation
B. Internal capsule
C. Circumventricular organs
D. Cerebellar cortex

BBB interruption in these regions primarily allows the brain to:
A. Sense blood chemistry changes
B. Generate myelin sheaths
C. Produce cortical action potentials
D. Maintain ventricular ependyma

A lesion in the chemoreceptor trigger zone causes intractable vomiting. Which structure is involved?
A. Nucleus ambiguus
B. Locus coeruleus
C. Area postrema
D. Inferior colliculus

Which is the only paired circumventricular organ?
A. Median eminence
B. Area postremaa
C. Pineal gland
D. Neurohypophysis

The area postrema lies along the caudal wall of the:
A. Third ventricle
B. Fourth ventricle
C. Lateral ventricle
D. Cerebral aqueduct

The area postrema is located in the:
A. Medulla
B. Midbrain
C. Pons
D. Thalamus

Headache pain most directly arises from irritation of:
A. Meninges and vessels
B. Cerebral cortex
C. Ventricular ependyma
D. Basal ganglia

Pain from the supratentorial dura is carried mainly by:
A. CN VII
B. CN IX
C. CN X
D. CN V

Pain from posterior fossa dura is carried mainly by:
A. CN V
B. CN IX
C. CN X
D. CN XII

Posterior fossa dura also receives afferents from:
A. CN III and CN IV
B. CN IX and C1–C3
C. CN VII and CN VIII
D. CN I and CN II

Most headaches are broadly classified as:
A. Traumatic and metabolic
B. Central and peripheral
C. Vascular and tension
D. Infectious and neoplastic

The term “vascular headache” includes migraine and:
A. Tension headache
B. Cluster headache
C. Postdural puncture
D. Trigeminal neuralgia

About 75% of migraine patients have what feature?
A. Infectious basis
B. Genetic basis
C. Traumatic basis
D. Autoimmune basis

A patient with migraine keeps a trigger diary. Which provoker is explicitly listed as a common trigger?
A. High altitude exposure
B. Caffeine withdrawal
C. Neck extension strain
D. Sleep-pattern change

Before headache onset, a patient describes a region of vision loss bordered by zigzag lines “like a fortress wall,” preceded by shimmering distortions. What is this classic aura phenomenon called?
A. Fortification scotoma
B. Central scotoma
C. Amaurosis fugax
D. Bitemporal hemianopia

A patient reports a unilateral headache that is worse with sudden head movement and is associated with light and sound sensitivity. Which pain quality is most typical for migraine?
A. Burning pain
B. Electric shocks
C. Throbbing pain
D. Band-like pressure

During attacks, a patient avoids bright rooms and asks staff to speak quietly because both light and sound worsen the pain. Which pair best labels these sensitivities?
A. Vertigo and tinnitus
B. Diplopia and nausea
C. Syncope and palpitations
D. Photophobia and phonophobia

Which duration best fits a typical migraine?
A. 2–5 minutes
B. 30 min–24 h
C. 2–7 days
D. Seconds only

A patient presents early in a typical migraine attack and wants first-line analgesia before escalation. Which medication class is listed as commonly effective for acute attacks?
A. NSAIDs
B. Beta-blockers
C. Tricyclics
D. Calcium blockers

In the ED, a migraine patient’s main disabling symptom is vomiting, preventing oral therapy. Which medication category is specifically listed for acute attacks to target this symptom?
A. Antipsychotics
B. Antivirals
C. Antiemetics
D. Corticosteroids

A migraine patient fails NSAIDs and needs an acute agent described as a serotonin agonist. Which class fits?
A. Valproate
B. Flunarizine
C. Tricyclics
D. Triptans

A patient has recurrent migraine attacks accompanied by fully reversible focal deficits: intermittent hemiplegia, transient sensory changes, and brief visual loss. Which diagnosis best fits?
A. Complicated migraine
B. Cluster headache
C. Tension headache
D. Subarachnoid hemorrhage

A patient has migraine attacks associated with transient impaired eye movements and diplopia that resolves after the episode. Which subtype is described?
A. Basilar migraine
B. Ophthalmoplegic migraine
C. Tension headache
D. Temporal arteritis

A patient has frequent migraines and needs prevention. Which option is listed as a prophylactic agent?
A. Beta-blockers
B. Ergot derivatives
C. Triptans
D. Antiemetics

A CT shows distortion of normal brain geometry caused by an intracranial tumor. Which descriptive term applies to this distortion?
A. Hydrocephalus
B. Demyelination
C. Vasospasm
D. Mass effect

Which pattern best fits cluster headache timing?
A. Monthly single attacks only
B. Yearly continuous pain
C. Daily weeks, months remission
D. Random sporadic episodes

A patient’s cluster attacks are stereotyped and severe. Typical single-attack duration is:
A. 2–5 minutes
B. 30–90 minutes
C. 6–12 hours
D. 24–72 hours

A patient with severe unilateral headaches has ipsilateral tearing, conjunctival injection, nasal congestion, and occasional Horner syndrome during attacks. Which associated feature is characteristic of cluster headache?
A. Bilateral sensory loss
B. Generalized rash
C. Fever with rigors
D. Unilateral autonomic signs

A patient describes cluster headache pain as “an ice-pick drill” behind one eye. Which description best matches the listed quality?
A. Steady, boring, retro-orbital
B. Throbbing, bilateral, pressure
C. Electric occipital shocks
D. Diffuse scalp burning

A 41-year-old reports a sudden “explosive,” worst-ever headache peaking immediately. This presentation must prompt concern for:
A. Tension headache
B. Migraine aura
C. Subarachnoid hemorrhage
D. Cluster headache

A 76-year-old develops a new headache with scalp tenderness and transient visual symptoms. You suspect a treatable vasculitis affecting temporal arteries and vessels supplying the eye. Most likely diagnosis?
A. Basilar migraine
B. Temporal arteritis
C. Cluster headache
D. Tension headache

For suspected temporal arteritis, which diagnostic approach is specifically listed?
A. ESR and biopsy
B. MRI and EEG
C. CSF and culture
D. CT and angiography

A large mass displaces brain structures from one compartment into another across dural partitions. What is this situation called?
A. Mass effect
B. Midline shift
C. Hydrocephalus
D. Herniation

A patient has an intracranial mass raising ICP. Cerebral blood flow depends on cerebral perfusion pressure, defined as CPP = MAP − ICP. As ICP increases, CPP:
A. Increases
B. Unchanged
C. Decreases
D. Oscillates

A patient’s cerebral perfusion pressure drops modestly, but cerebral blood flow stays nearly stable because arterioles adjust caliber. What mechanism is responsible?
A. Baroreflex vasoconstriction
B. Cerebral autoregulation
C. Hypocapnic vasoconstriction
D. Collateral venous drainage

Which finding is often the most important indicator of elevated intracranial pressure?
A. Papilledema on fundoscopy
B. Sixth-nerve palsy
C. Irregular respirations
D. Altered mental status

Funduscopy in suspected elevated ICP shows engorgement and elevation of the optic disc. What is this called?
A. Papilledema
B. Optic neuritis
C. Retinal detachment
D. Vitreous hemorrhage

In papilledema from elevated ICP, which additional finding may be seen on ophthalmoscopy?
A. Macular drusen
B. Cherry-red spot
C. Retinal hemorrhages
D. Lens subluxation

A comatose patient has high blood pressure, slow pulse, and irregular breathing. What is this constellation called?
A. Horner syndrome
B. Cushing’s triad
C. Terson syndrome
D. Wallenberg syndrome

In Cushing’s triad, the hypertension most directly serves to:
A. Maintain cerebral perfusion
B. Reduce CSF production
C. Lower sympathetic outflow
D. Improve venous drainage

In Cushing’s triad, the bradycardia is best explained as:
A. Hypoxemia response
B. Hypercapnia response
C. Direct SA node injury
D. Reflex to hypertension

In Cushing’s triad, irregular respirations most directly reflect impaired:
A. Cerebellar function
B. Thalamic function
C. Brainstem function
D. Cortical association areas

The immediate management goal in elevated intracranial pressure is to:
A. Normalize CSF osmolality
B. Cure headache immediately
C. Reduce ICP to safe
D. Increase cerebral edema

Lowering ICP to safe levels primarily buys time to treat the:
A. Sleep disruption
B. Underlying disorder
C. Vascular headache pattern
D. Medication adverse effect

A lumbar puncture is avoided when severely elevated ICP is suspected because it may:
A. Precipitate herniation
B. Cause optic neuritis
C. Induce seizures
D. Produce venous thrombosis

Herniation occurs when distortion is severe enough to push structures across compartments due to:
A. CSF overproduction
B. Diffuse axonal injury
C. Venous sinus thrombosis
D. Severe mass effect

Medial temporal lobe tissue (especially the uncus) is forced inferiorly through the tentorial notch. This is:
A. Subfalcine herniation
B. Tonsillar herniation
C. Transtentorial herniation
D. Central herniation

A deteriorating patient develops a “blown” pupil, hemiplegia, and coma after a temporal mass expands. This triad most suggests:
A. Uncal herniation
B. Subfalcine herniation
C. Tonsillar herniation
D. Central herniation

In uncal herniation, the dilated pupil is usually _____ to the lesion (most cases).
A. Contralateral
B. Bilateral
C. Variable
D. Ipsilateral

In many uncal herniations, hemiplegia is contralateral to the lesion because of:
A. Contralateral cerebellar peduncle injury
B. Ipsilateral CST or motor cortex
C. Bilateral thalamic infarction
D. Reticular formation inhibition

A patient with uncal herniation develops hemiplegia on the same side as the lesion because the midbrain is compressed against the opposite tentorial notch. This is:
A. Cushing reflex
B. Subfalcine shift
C. Kernohan phenomenon
D. Basilar migraine

“Central herniation” refers to:
A. Downward brainstem displacement
B. Uncus through tentorial notch
C. Tonsils through foramen magnum
D. Cingulate under falx

Mild central herniation causes traction on CN VI over the clivus. What deficit is expected?
A. Medial rectus palsy
B. Ptosis with mydriasis
C. Facial droop
D. Lateral rectus palsy

With severe ICP elevation or a posterior fossa mass, central herniation can progress downward through the:
A. Optic canal
B. Foramen magnum
C. Foramen ovale
D. Jugular foramen

Herniation of the cerebellar tonsils downward through the foramen magnum is called:
A. Transtentorial herniation
B. Subfalcine herniation
C. Tonsillar herniation
D. Central herniation

A unilateral mass pushes the cingulate gyrus under the falx cerebri to the opposite side. This is:
A. Subfalcine herniation
B. Tonsillar herniation
C. Central herniation
D. Transtentorial herniation

After head trauma, a patient cannot form new memories and also cannot recall events just before the injury. This finding is:
A. Pure expressive aphasia
B. Anterograde and retrograde amnesia
C. Progressive spastic paraparesis
D. Persistent hemianopia only

Months after a seemingly minor concussion, a patient has headaches, lethargy, and mental dullness. This is most consistent with:
A. Wernicke encephalopathy
B. Normal pressure hydrocephalus
C. Acute epidural hematoma
D. Postconcussive syndrome

After high-speed MVC, a patient is comatose with minimal focal deficits. CT is unrevealing, but MRI later shows widespread patchy white-matter injury with cranial nerve involvement. What mechanism best fits?
A. Hypoxic-ischemic cortical injury
B. Diffuse axonal shear injury
C. Acute subarachnoid hemorrhage
D. Expanding epidural hematoma

A teenager has head trauma with a rapidly worsening headache. You suspect an epidural hematoma. Where does it accumulate?
A. Between dura and arachnoid
B. Between arachnoid and pia
C. Within brain parenchyma
D. Between skull and dura

A patient sustains a temporal bone fracture at the pterion and becomes progressively obtunded. The most typical bleeding source for an epidural hematoma is:
A. Middle meningeal artery rupture
B. Bridging vein rupture
C. Cortical vein thrombosis
D. Ruptured saccular aneurysm

CT shows a sharply marginated, lens-shaped extra-axial collection that does not cross cranial sutures. Which diagnosis best matches?
A. Acute subdural hematoma
B. Subarachnoid hemorrhage
C. Epidural hematoma
D. Intraparenchymal hemorrhage

Why does an epidural hematoma often not spread past cranial sutures?
A. Dura tightly apposed at sutures
B. Arachnoid trabeculae tether dura
C. Falx blocks lateral spread
D. Venous sinuses restrict expansion

A patient has a crescentic extra-axial collection after trauma. In which space does a subdural hematoma collect?
A. Between skull and dura
B. Between arachnoid and pia
C. Within ventricular system
D. Between dura and arachnoid

A 74-year-old on anticoagulation has progressive confusion after a minor fall. The most typical vessel injured in subdural hematoma is the:
A. Middle meningeal artery
B. Anterior choroidal artery
C. Bridging veins
D. Lenticulostriate arteries

Venous blood dissects easily along a potential space and spreads over a large surface area. Which CT shape is most characteristic?
A. Sulcal tracking pattern
B. Crescent-shaped collection
C. Biconvex lens collection
D. Intraventricular fluid level

An elderly patient with cerebral atrophy develops a slowly progressive headache and confusion with minimal trauma history. Which diagnosis is most typical?
A. Chronic subdural hematoma
B. Acute epidural hematoma
C. Hypertensive intraparenchymal bleed
D. Nontraumatic subarachnoid hemorrhage

For a significant subdural hematoma to occur immediately after injury, which factor generally must be high?
A. Brain atrophy
B. Mean arterial pressure
C. Platelet count
D. Impact velocity

Immediately after head trauma, CT shows an extra-axial hemorrhage that spreads broadly over one hemisphere. Which radiologic description best fits acute subdural hematoma?
A. Biconvex, limited by sutures
B. Hyperdensity confined to cisterns
C. Crescent, spreads widely
D. Focal bleed within basal ganglia

A noncontrast CT shows blood tracking down into the cortical sulci, following the contours of the pia. This pattern most strongly indicates:
A. Epidural hematoma
B. Acute subdural hematoma
C. Intraparenchymal hemorrhage
D. Subarachnoid hemorrhage

A previously healthy adult reports a sudden “worst headache of my life,” feeling like the head is about to explode, without trauma. The most classic concern is:
A. Nontraumatic subarachnoid hemorrhage
B. Acute bacterial meningitis
C. Acute angle-closure glaucoma
D. Temporal arteritis flare

In 75%–80% of spontaneous subarachnoid hemorrhage cases, the source is rupture of an arterial:
A. Arteriovenous malformation
B. Venous sinus aneurysm
C. Aneurysm in subarachnoid space
D. Bridging vein near falx

Which condition is a recognized risk factor for intracranial aneurysm formation?
A. Multiple sclerosis
B. Polycystic kidney disease
C. Rheumatic fever
D. Myasthenia gravis

Saccular (“berry”) aneurysms most often arise from:
A. Arterial branch points, Circle of Willis
B. Dural venous sinus junctions, Circle of Willis
C. Deep perforator arterioles, Circle of Willis
D. Capillary beds within cortex, Circle of Willis

Which is the most common berry aneurysm location (descending order list)?
A. Middle cerebral artery bifurcation
B. Basilar tip junction
C. Posterior communicating artery
D. Anterior communicating artery

After identifying a berry aneurysm at the most common site, which location is next most common?
A. Middle cerebral artery
B. Posterior communicating artery
C. Anterior inferior cerebellar artery
D. Basilar artery trunk

In the same descending list of common berry aneurysm sites, which vessel is third most common?
A. Basilar tip
B. Vertebral artery
C. Middle cerebral artery
D. Anterior cerebral artery

A patient has sudden retro-orbital pain and a painful CN III palsy. An aneurysm arising from the internal carotid artery at which site is most classically implicated?
A. Posterior communicating artery
B. Anterior communicating artery
C. Middle cerebral artery
D. Vertebral artery junction

For suspected subarachnoid hemorrhage, why is CT obtained without contrast?
A. Contrast masks edema patterns
B. Contrast falsely lowers density
C. Contrast worsens vasospasm
D. Blood and contrast both hyperdense

A patient has a thunderclap headache. Noncontrast CT is negative, but suspicion remains high. What is the next diagnostic step per the described approach?
A. Discharge with analgesics
B. Lumbar puncture
C. Start steroids immediately
D. Repeat CT with contrast

After confirming aneurysmal SAH, which study should be performed to evaluate both carotids and both vertebrals given frequent multiple aneurysms?
A. Carotid duplex ultrasound
B. Noncontrast head CT
C. Four-vessel cerebral angiogram
D. EEG with hyperventilation

A patient with aneurysmal subarachnoid hemorrhage needs definitive aneurysm treatment to prevent rebleeding. Which option pair matches the described definitive therapies?
A. Ventriculostomy or osmotic diuresis
B. Steroids or antiepileptic loading
C. Neck clip or detachable coils
D. Antiplatelet therapy or heparin

After aneurysmal SAH, a patient develops new focal deficits despite an initially stable exam. Which statement best matches the described delayed complication’s timing and frequency?
A. Half; peaks around one week
B. Rare; peaks first 24 hours
C. Half; peaks within 24 hours
D. Common; peaks after one month

A patient with delayed ischemic deficits after SAH is treated in the ICU with “triple H” therapy. Which set is correct?
A. Hypertension, hypovolemia, hemoconcentration
B. Hypotension, hypervolemia, hemodilution
C. Hypertension, hypervolemia, hemoconcentration
D. Hypertension, hypervolemia, hemodilution

Compared with spontaneous SAH, traumatic SAH is:
A. Less common overall
B. More common overall
C. Similar frequency overall
D. Limited to aneurysm rupture

A hemorrhage is described as occurring within the brain tissue itself and may involve hemispheres, brainstem, cerebellum, or even spinal cord. This best defines:
A. Epidural hematoma
B. Subdural hematoma
C. Intraparenchymal hemorrhage
D. Subarachnoid hemorrhage

A chronic hypertensive patient presents with sudden neurologic deficit and a deep hemorrhage pattern. The most common cause of intraparenchymal hemorrhage and its typical vessel type are:
A. Hypertension, small penetrating vessels
B. Aneurysm, large pial arteries
C. AVM, superficial cortical veins
D. Amyloid, dural venous sinuses

A patient with long-standing hypertension develops an intraparenchymal bleed at the most common site. Which location is most likely?
A. Cerebellum, basal ganglia
B. Thalamus, basal ganglia
C. Pons, basal ganglia
D. Putamen, basal ganglia

In the classic descending frequency list for hypertensive hemorrhage sites, after basal ganglia (putamen), the next most common location is the:
A. Cerebellum
B. Thalamus
C. Pons
D. Medulla

In the same descending frequency list for hypertensive hemorrhage sites, the third most common location is the:
A. Cerebellum
B. Pons
C. Thalamus
D. Putamen

In the classic four-site list for hypertensive hemorrhage, the least common location is the:
A. Putamen
B. Thalamus
C. Pons
D. Cerebellum

After blunt head trauma, otoscopy shows dark discoloration behind the tympanic membrane consistent with middle-ear hemorrhage. This is called:
A. Otitis media
B. CSF otorrhea
C. Mastoid ecchymosis
D. Hemotympanum

A patient with basilar skull trauma has periorbital ecchymoses described as “raccoon eyes.” This finding most directly reflects hemorrhage into:
A. Subarachnoid space
B. Ventricular system
C. Subcutaneous tissues
D. Retina

A newborn develops a scalp collection from delivery-related bleeding between the skull and external periosteum (pericranium). This is:
A. Cephalohematoma
B. Caput succedaneum
C. Subgaleal hemorrhage
D. Epidural hematoma

A child develops hydrocephalus. Which set lists the three mechanisms described for hydrocephalus development?
A. Obstruction, edema, impaired venous drainage
B. Excess CSF, obstruction, decreased reabsorption
C. Infarction, edema, decreased CSF absorption
D. Atrophy, infection, increased CSF production

A clinician asks which primary mechanism is quite rare as a cause of hydrocephalus (seen only with certain tumors). The rare mechanism is:
A. Ventricular outflow obstruction
B. Subarachnoid flow obstruction
C. Impaired arachnoid reabsorption
D. Excess CSF production

Ventriculomegaly occurs because CSF reabsorption at arachnoid granulations is impaired or flow is obstructed in the subarachnoid space (or rarely production is excessive). This is:
A. Noncommunicating hydrocephalus
B. Ex vacuo ventriculomegaly
C. Communicating hydrocephalus
D. Idiopathic intracranial hypertension

A patient has hydrocephalus caused by obstruction of CSF flow within the ventricular system itself. This is:
A. Noncommunicating hydrocephalus
B. Communicating hydrocephalus
C. Normal pressure hydrocephalus
D. Idiopathic intracranial hypertension

Progressive ventricular dilation compresses descending white matter pathways from the frontal lobes. Which clinical pair best fits the resulting frontal-lobe–like abnormalities?
A. Ataxia and dysarthria
B. Seizures and aphasia
C. Diplopia and vertigo
D. Magnetic gait and incontinence

A neurosurgeon plans endoscopic access to the third ventricle by passing through the right frontal lobe into the right lateral ventricle. Which structure must then be traversed to enter the third ventricle?
A. Foramen of Magendie
B. Foramen of Monro
C. Foramen of Luschka
D. Aqueduct of Sylvius

An elderly patient has chronically dilated ventricles with gait difficulty, urinary incontinence, and cognitive decline. The most likely diagnosis is:
A. Communicating hydrocephalus
B. Noncommunicating hydrocephalus
C. Normal pressure hydrocephalus
D. Idiopathic intracranial hypertension

Which statement correctly distinguishes tumor origin categories?
A. Primary CNS origin; metastatic elsewhere
B. Primary elsewhere; metastatic CNS origin
C. Primary always benign; metastatic malignant
D. Primary infratentorial; metastatic supratentorial

In children, the most common brain tumors are astrocytoma and medulloblastoma, followed by:
A. Meningioma
B. Glioblastoma
C. Schwannoma
D. Ependymoma

Which age-based distribution best matches typical brain tumor location frequency?
A. Adults infratentorial; children supratentorial
B. Adults supratentorial; children infratentorial
C. Adults equal; children supratentorial
D. Adults infratentorial; children equal

A 34-year-old develops focal seizures and MRI shows a slow-growing cortical mass. Which tumor type is most commonly associated with seizures?
A. Primary CNS lymphoma
B. Medulloblastoma
C. Low-grade glioma
D. Pineal germinoma

A 58-year-old has new-onset focal seizures. MRI shows a dural-based extra-axial mass with a broad attachment. Which tumor is also commonly associated with seizures?
A. Meningioma
B. Ependymoma
C. Pineocytoma
D. Schwannoma

Which tumor typically leads to death within 1–2 years?
A. Oligodendroglioma
B. Ependymoma
C. Medulloblastoma
D. Glioblastoma

Pathology shows a dural tumor arising from arachnoid villus cells. Which diagnosis fits best?
A. Schwannoma
B. Meningioma
C. Metastatic carcinoma
D. Glioblastoma

A meningioma is found at its most common site. Which location is most likely?
A. Lateral convexities
B. Cerebellar vermis
C. Pineal recess
D. Brainstem tegmentum

A meningioma is found at the second most common site. Which location is most likely?
A. Basal cranial regions
B. Parasellar region
C. Tentorial notch
D. Falx

A meningioma is found at the third most common site. Which location is most likely?
A. Cerebellopontine angle
B. Ventricular lining
C. Basal cranial regions
D. Lateral fissure

A patient has progressive unilateral hearing loss and tinnitus. A schwannoma is suspected on the most common cranial nerve. Which nerve is it?

A brain mass in an immunocompromised patient raises concern for a tumor that has increased in incidence in recent years, only partly explained by HIV trends. Which tumor fits?
A. Meningioma
B. Low-grade glioma
C. Pinealoma
D. Primary CNS lymphoma

A 21-year-old has a pineal region mass. Which statement best matches pineal region tumors overall?
A. Uncommon, under 1% cases
B. Always metastatic in origin
C. Usually dural-based lesions
D. Most present after age 60

A pineal region tumor is labeled a “pinealoma.” Which pair is listed under pinealomas?
A. Germinoma and teratoma
B. Pineocytoma and pineoblastoma
C. Glioblastoma and ependymoma
D. Meningioma and schwannoma

A pineal region tumor list includes rare entities. Which option is specifically listed as a rare pineal region tumor type?
A. Hemangioblastoma
B. Craniopharyngioma
C. Teratoma
D. Medulloblastoma

A patient has multiple brain metastases. Which set lists the three most common primary cancers?
A. Colon kidney thyroid
B. Lung breast melanoma
C. Prostate pancreas bladder
D. Ovary cervix uterus

A patient presents with hemorrhage into a brain metastasis. Which primary tumor most commonly causes brain hemorrhage mainly due to high incidence and frequent brain spread?
A. Melanoma
B. Breast carcinoma
C. Renal carcinoma
D. Lung carcinoma

A 6-year-old has a midline posterior fossa tumor. Which age association is most accurate?
A. Astrocytoma mostly >40 years
B. Medulloblastoma usually <10 years
C. Lymphoma usually <10 years
D. Meningioma mostly 2–20 years

A 14-year-old has a cerebellar astrocytoma. Which age range is most typical?
A. Birth to 2 years
B. 10 to 40 years
C. 2 to 20 years
D. Over 60 years

A cancer patient develops neurologic dysfunction from a remote autoimmune response rather than direct invasion or metastasis. What is this called?
A. Paraneoplastic syndrome
B. Tumor lysis syndrome
C. Mass effect syndrome
D. Central herniation

Infectious meningitis is defined as infection of CSF in which space?
A. Epidural space
B. Subdural space
C. Ventricular space
D. Subarachnoid space

On exam, the patient resists passive neck flexion due to involuntary neck muscle contraction with pain. What sign is this?
A. Babinski sign
B. Nuchal rigidity
C. Lhermitte sign
D. Romberg sign

In suspected acute bacterial meningitis, which management principle is emphasized?
A. Delay therapy until MRI
B. Wait for CSF culture
C. Do not delay antibacterials
D. Treat only after biopsy

A patient’s CSF suggests acute bacterial meningitis. Which CSF pattern best fits?
A. Low WBC, high glucose
B. Normal protein, high glucose
C. High lymphocytes, low protein
D. PMN-predominant WBC elevation

The same CSF sample is further characterized by which paired chemistry pattern is typical of acute bacterial meningitis?
A. High protein, low glucose
B. Low protein, high glucose
C. High protein, high glucose
D. Low protein, low glucose

A 3-year-old recovers from bacterial meningitis. Which complication must be screened for because early cochlear implantation can improve long-term outcomes?
A. Vision loss
B. Seizure disorder
C. Hearing loss
D. Spastic paresis

A patient has fever and focal deficits; imaging shows a ring-enhancing expanding mass lesion that behaves like a tumor but progresses faster. What diagnosis fits best?
A. Metastatic tumor
B. Brain abscess
C. Chronic subdural
D. Glioblastoma

Aspiration of a brain abscess grows common bacterial pathogens. Which organism is listed among common causes?
A. Mycoplasma pneumoniae
B. Vibrio vulnificus
C. Chlamydia trachomatis
D. Streptococci species

Another abscess case involves an organism described as a rare bacterial cause. Which organism matches that description?
A. Nocardia
B. Bacteroides
C. Enterobacteriaceae
D. Staphylococcus aureus

Beyond bacteria, which parasite is an important cause of brain abscess?
A. Taenia solium
B. Toxoplasma gondii
C. Schistosoma mansoni
D. Trichinella spiralis

A patient has severe back pain, fever, and neurologic deficits; MRI shows a collection requiring urgent treatment, often in the spinal canal. What is it?
A. Subdural empyema
B. Brain abscess
C. Epidural abscess
D. Epidural hematoma

A patient develops pus in the space between dura and arachnoid after spread from sinusitis or otitis. What is this called?
A. Subdural empyema
B. Epidural abscess
C. Subarachnoid hemorrhage
D. Intraparenchymal abscess

Tuberculous involvement of the epidural space and vertebral bones is termed:
A. Paget disease
B. Buerger disease
C. Lyme disease
D. Pott disease

The two most important spirochetal nervous system infections are:
A. TB and toxoplasmosis
B. Neurosyphilis and Lyme disease
C. HSV and VZV
D. West Nile and rabies

In meningovascular syphilis, chronic meningeal arteritis of medium-sized vessels most characteristically causes:
A. Basal ganglia calcifications
B. Demyelinating plaques
C. Diffuse white matter infarcts
D. Epidural pus collection

A 57-year-old with untreated syphilis has loss of vibration/proprioception in both legs and a wide-based sensory ataxia. His feet “slap” down because he overflexes at the hip and knee. Which gait is described?
A. Spastic scissoring gait
B. Festinating gait
C. High-stepping tabetic gait
D. Waddling Trendelenburg gait

A patient with suspected tabes dorsalis has pupils that accommodate but do not constrict to light. Which finding is this?
A. Argyll Robertson pupils
B. Relative afferent pupillary defect
C. Adie tonic pupil
D. Marcus Gunn pupil

Which clinical bundle best matches tabes dorsalis?
A. Hyperreflexia, clonus, spasticity
B. Fever, photophobia, neutrophils
C. Aphasia, facial droop, neglect
D. Incontinence, optic atrophy, ataxia

A patient is diagnosed with neurosyphilis after CSF abnormalities and neurologic deficits. What therapy is indicated?
A. Oral doxycycline
B. IV penicillin G
C. Oral acyclovir
D. IM benzathine penicillin

After neurosyphilis treatment is started, which follow-up strategy is specifically recommended to monitor response?
A. Serial MRI scans
B. Serial EEG recordings
C. Serial lumbar punctures
D. Serial carotid ultrasounds

A hiker develops erythema migrans and later neurologic symptoms after a deer tick bite. Which pairing is correct?
A. Treponema pallidum—Aedes mosquito
B. JC virus—Ixodes deer tick
C. Borrelia burgdorferi—Ixodes tick
D. Taenia solium—sandfly vector

A clinician asks where Ixodes-associated Lyme disease is described as endemic. Which set matches?
A. United States, Europe, Australia
B. Central Asia, Antarctica, Greenland
C. Japan, Korea, Iceland
D. South America only

Viral infection of brain parenchyma is called:
A. Viral meningitis
B. Viral encephalitis
C. Subdural empyema
D. Brain abscess

A previously healthy adult develops acute encephalitis. Which pathogen is the most common cause?
A. Varicella-zoster virus
B. HSV-1
C. Cytomegalovirus
D. JC virus

A patient with advanced HIV develops progressive attention and memory impairment, more common late in illness. This syndrome is:
A. Progressive multifocal leukoencephalopathy
B. Cerebral toxoplasmosis
C. Cryptococcal meningitis
D. HIV neurocognitive disorder

In patients with HIV, encephalitis can also be caused by HSV, VZV, or which additional virus?
A. Epstein–Barr virus
B. Measles virus
C. Influenza A virus
D. Cytomegalovirus

A patient with AIDS has retinitis that improves with ganciclovir and later develops a polyradiculitis involving the cauda equina. Which diagnosis best fits?
A. HSV-1 infection
B. VZV infection
C. JC virus infection
D. Cytomegalovirus infection

A patient with AIDS develops progressive neurologic deficits; MRI suggests demyelination. Which agent is the cause of Progressive multifocal leukoencephalopathy (PML)?
A. CMV herpesvirus
B. JC papovavirus
C. Borrelia spirochete
D. HSV-1 herpesvirus

A patient with PML is counseled on prognosis. Typical survival is:
A. Hours to days
B. 1–2 years
C. 3–6 months
D. 10–20 years

An HIV-positive patient has chronic headaches; you suspect a fungal meningitis that is common in HIV. Which diagnosis fits best?
A. Candida meningitis
B. Aspergillus meningitis
C. Histoplasma meningitis
D. Cryptococcal meningitis

A patient with HIV has focal deficits and ring-enhancing intracranial lesions. Which cause is described as the most common intracranial mass lesion in HIV?
A. Primary CNS lymphoma
B. CMV encephalitis
C. PML
D. Toxoplasmosis

Which feature best matches aspergillosis/candidiasis?
A. CSF-only infection, mild inflammation
B. Dura-only infection, mild inflammation
C. Ventricles-only infection, no inflammation
D. Parenchyma infection, intense inflammation

A patient develops rapidly progressive dementia with exaggerated startle, myoclonus, visual distortions, and ataxia. Which diagnosis fits best?
A. Creutzfeldt–Jakob disease
B. HAND
C. HSV-1 encephalitis
D. Cryptococcal meningitis

Before performing a lumbar puncture, the safest routine practice to reduce herniation risk is to first obtain:
A. EEG
B. Head CT scan
C. Carotid ultrasound
D. PET scan

CSF contains red blood cells. Which explanation is specifically needle-induced rather than pathologic bleeding?
A. Traumatic tap
B. Subarachnoid hemorrhage
C. Hemorrhagic HSV encephalitis
D. Ruptured epidural vessel

Centrifuged CSF shows a yellow supernatant several hours after symptom onset, and RBC counts do not fall across tubes. This pattern most supports:
A. Traumatic tap
B. Epidural hematoma
C. Ventriculitis
D. Subarachnoid hemorrhage

Which pair lists two specific diagnostic uses of lumbar puncture described here?
A. Diagnose migraine; monitor ICP
B. Cytology cancer meningitis; MS bands
C. Detect aneurysm; measure lactate
D. Treat hydrocephalus; drain hematoma

During craniotomy, burr holes are drilled without entering a layer, then connected to remove a bone flap. After removing the flap, which structure is exposed before opening it?
A. Pia mater
B. Arachnoid mater
C. Cerebral cortex
D. Dura mater

A surgeon removes the skull at the pterion to access inferior frontotemporal lobes for anterior circulation/basilar tip aneurysms, cavernous sinus, or suprasellar tumors. Which approach is this?
A. Temporal craniotomy
B. Suboccipital craniotomy
C. Frontal craniotomy
D. Pterional craniotomy

A lateral skull approach is used to resect temporal lobe seizure foci and decompress most traumatic intracranial hematomas. Which approach is this?
A. Temporal craniotomy
B. Frontal craniotomy
C. Pterional craniotomy
D. Suboccipital craniotomy

A posterior skull approach provides access to cerebellopontine angle, vertebral artery, brainstem, and lower cranial nerves. Which approach is this?
A. Pterional craniotomy
B. Temporal craniotomy
C. Suboccipital craniotomy
D. Frontal craniotomy