front 1 The largest skull-base opening is what? | back 1 Foramen magnum |
front 2 During posterior fossa surgery, the surgeon identifies the cervicomedullary junction. It lies at the level of the: | back 2 Foramen magnum |
front 3 A basilar skull fracture violates the anterior cranial fossa. Which lobe is most directly involved? | back 3 Frontal lobe |
front 4 A mass expands within the middle cranial fossa. The adjacent cerebral lobe there is the: | back 4 Temporal lobe |
front 5 A posterior fossa tumor causes truncal ataxia plus long-tract signs.
Which structures are housed there? | back 5 C. Cerebellum and brainstem |
front 6 The anterior cranial fossa is separated from the middle cranial fossa
by the: | back 6 A. Lesser sphenoid wing |
front 7 A petroclival lesion abuts the boundary between middle and posterior
fossae. Which bony ridge marks this division? | back 7 B. Petrous temporal ridge |
front 8 A dural “roof” over the cerebellum contributes to the
middle–posterior fossa separation. Which fold is it? | back 8 A. Tentorium cerebelli |
front 9 An epidural infection dissects from the inner skull surface. Which
dural component is normally adherent to calvaria? | back 9 D. Periosteal dura |
front 10 Intracranial dural folds form where the inner dural layer reflects.
Which layer forms these folds? | back 10 v |
front 11 A midline extra-axial mass compresses the dural partition separating
the cerebral hemispheres. Which structure is compressed? | back 11 D. Falx cerebri |
front 12 The falx cerebri runs primarily within the: | back 12 A. Interhemispheric fissure |
front 13 A superiorly expanding cerebellar tumor presses against the dural
tent over the cerebellum. Which structure is this? | back 13 D. Tentorium cerebelli |
front 14 Uncal herniation forces tissue toward the narrow opening in the
tentorium. That opening is the: | back 14 C. Tentorial notch |
front 15 In transtentorial herniation, which structure normally passes through
the tentorial notch? | back 15 C. Midbrain |
front 16 A neurosurgeon describes a wispy, “spidery” layer adherent to the inner dura. Which layer is this? | back 16 Arachnoid mater |
front 17 In normal physiology, what percolates over the brain surface within
the arachnoid compartment? | back 17 D. Cerebrospinal fluid |
front 18 A ruptured saccular aneurysm releases blood into the CSF-filled
compartment between arachnoid and pia. Which space is this? | back 18 B. Subarachnoid space |
front 19 MRI shows prominent perivascular spaces along penetrating vessels.
These are called: | back 19 C. Virchow–Robin spaces |
front 20 As arteries penetrate the brain surface, the pia initially surrounds
them and then: | back 20 B. Fuses with vessel wall |
front 21 A temporal bone fracture causes arterial blood to accumulate between
skull and tightly adherent dura. The bleed occupies the: | back 21 A. Epidural space |
front 22 A pterion fracture lacerates the middle meningeal artery. This artery
entered the skull via the: | back 22 D. Foramen spinosum |
front 23 The middle meningeal artery normally courses between skull and dura
within the: | back 23 B. Epidural space |
front 24 The middle meningeal artery is a branch of the: | back 24 B. External carotid artery |
front 25 Which supplies the dura? | back 25 C. Middle meningeal artery |
front 26 The middle cerebral artery most directly arises from the: | back 26 A. Internal carotid artery |
front 27 A crescent-shaped extra-axial hemorrhage lies between inner dura and
arachnoid on CT. This blood occupies the: | back 27 D. Subdural space |
front 28 After a minor fall, an elderly patient develops a subdural hematoma.
Which vessels are most often torn? | back 28 D. Bridging veins |
front 29 The superior sagittal sinus is best described as a venous channel
located: | back 29 B. Between dural layers |
front 30 Most dural venous blood exits the cranium primarily via the: | back 30 D. Sigmoid sinuses |
front 31 The sigmoid sinuses ultimately drain into the: | back 31 A. Internal jugular veins |
front 32 Bridging veins drain into large venous channels enclosed within dura
called: | back 32 C. Dural venous sinuses |
front 33 An MRI shows inflammation of the ventricular lining. Which cells line
ventricular walls? | back 33 A. Ependymal cells |
front 34 A choroid plexus papilloma arises from cuboidal cells on plexus
fronds. What are these cells called? | back 34 A. Choroid epithelial cells |
front 35 CT reports dilation of the frontal horn of a lateral ventricle. The
frontal horn is also the: | back 35 B. Anterior horn |
front 36 A mass expands within the frontal horn. It extends into the: | back 36 D. Frontal lobe |
front 37 Imaging shows enlargement of the occipital horn. The occipital horn
is also the: | back 37 D. Posterior horn |
front 38 A lesion confined to the occipital horn would localize to
the: | back 38 C. Occipital lobe |
front 39 Trapped CSF in the “inferior horn” of a lateral ventricle implies
obstruction of the: | back 39 A. Temporal horn |
front 40 A hemorrhage tracking into the temporal horn most directly involves
the: | back 40 D. Temporal lobe |
front 41 A tumor at the atrium risks isolating which ventricular extensions
from the body? | back 41 B. Temporal and occipital horns |
front 42 A colloid cyst causes acute lateral ventricle dilation by blocking
the: | back 42 A. Foramen of Monro |
front 43 A pineal-region mass produces noncommunicating hydrocephalus by
compressing the: | back 43 D. Aqueduct of Sylvius |
front 44 The Aqueduct of Sylvius is located within the: | back 44 D. Midbrain |
front 45 On coronal MRI, a C-shaped nucleus hugs the lateral ventricle. Which
structure is this? | back 45 C. Caudate nucleus |
front 46 A major C-shaped commissural tract connects both hemispheres. Which
structure is it? | back 46 B. Corpus callosum |
front 47 A memory-circuit lesion disrupts a C-shaped tract from hippocampus.
Which tract is involved? | back 47 A. Fornix |
front 48 A limbic pathway arches C-shaped along the caudate tail to amygdala.
Which structure is it? | back 48 C. Stria terminalis |
front 49 A posterior fossa mass distorts the roof of the fourth ventricle. The
roof is formed by the: | back 49 B. Cerebellum |
front 50 A lesion compresses the floor of the fourth ventricle. This floor is
formed by the: | back 50 C. Pons and medulla |
front 51 Failure of CSF to exit the fourth ventricle laterally implicates
the: | back 51 B. Foramina of Luschka |
front 52 Failure of CSF to exit the fourth ventricle in the midline implicates
the: | back 52 B. Foramen of Magendie |
front 53 Subarachnoid blood pools in a cistern lateral to the midbrain. Which
cistern is involved? | back 53 D. Ambient cistern |
front 54 Hemorrhage is posterior to the midbrain beneath posterior corpus
callosum. Which cistern is involved? | back 54 D. Quadrigeminal cistern |
front 55 A basilar tip aneurysm ruptures into the cistern between cerebral
peduncles. Which cistern is involved? | back 55 B. Interpeduncular cistern |
front 56 A PCom aneurysm compresses CN III at its midbrain exit. CN III exits
via the: | back 56 D. Interpeduncular fossa |
front 57 Blood collects just ventral to the pons. Which cistern is
this? | back 57 C. Prepontine cistern |
front 58 A posterior fossa hemorrhage fills the largest cistern beneath the
cerebellum. Which cistern is this? | back 58 C. Cisterna magna |
front 59 The cisterna magna lies adjacent to which skull-base opening? | back 59 D. Foramen magnum |
front 60 A lumbar puncture samples CSF from the cistern containing cauda
equina. Which cistern is this? | back 60 D. Lumbar cistern |
front 61 The blood–brain barrier’s low paracellular permeability is primarily
due to endothelial: | back 61 C. Tight junctions |
front 62 For most nonlipid solutes, BBB passage is mainly by traversing
endothelium via: | back 62 D. Active transport processes |
front 63 Which pair permeates most readily across blood–brain and blood–CSF
barriers? | back 63 A. O2 and CO2 |
front 64 A polar solute crosses using specialized BBB systems. Which mechanism
is listed? | back 64 C. Facilitated diffusion |
front 65 CSF is primarily reabsorbed into venous circulation at the: | back 65 A. Arachnoid granulations |
front 66 Arachnoid villus cells move CSF across to venous blood via: | back 66 A. One-way bulk transport |
front 67 One-way CSF transfer at villi occurs through structures
called: | back 67 B. Giant vacuoles |
front 68 Granulation vacuoles are described as large enough to engulf: | back 68 A. Red blood cells |
front 69 In which regions is the blood–brain barrier interrupted? | back 69 C. Circumventricular organs |
front 70 BBB interruption in these regions primarily allows the brain
to: | back 70 A. Sense blood chemistry changes |
front 71 A lesion in the chemoreceptor trigger zone causes intractable
vomiting. Which structure is involved? | back 71 C. Area postrema |
front 72 Which is the only paired circumventricular organ? | back 72 B. Area postremaa |
front 73 The area postrema lies along the caudal wall of the: | back 73 B. Fourth ventricle |
front 74 The area postrema is located in the: | back 74 A. Medulla |
front 75 Headache pain most directly arises from irritation of: | back 75 A. Meninges and vessels |
front 76 Pain from the supratentorial dura is carried mainly by: | back 76 D. CN V |
front 77 Pain from posterior fossa dura is carried mainly by: | back 77 C. CN X |
front 78 Posterior fossa dura also receives afferents from: | back 78 B. CN IX and C1–C3 |
front 79 Most headaches are broadly classified as: | back 79 C. Vascular and tension |
front 80 The term “vascular headache” includes migraine and: | back 80 B. Cluster headache |
front 81 About 75% of migraine patients have what feature? | back 81 B. Genetic basis |
front 82 A patient with migraine keeps a trigger diary. Which provoker is
explicitly listed as a common trigger? | back 82 D. Sleep-pattern change |
front 83 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? | back 83 A. Fortification scotoma |
front 84 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? | back 84 C. Throbbing pain |
front 85 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? | back 85 D. Photophobia and phonophobia |
front 86 Which duration best fits a typical migraine? | back 86 B. 30 min–24 h |
front 87 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? | back 87 A. NSAIDs |
front 88 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? | back 88 C. Antiemetics |
front 89 A migraine patient fails NSAIDs and needs an acute agent described as
a serotonin agonist. Which class fits? | back 89 D. Triptans |
front 90 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? | back 90 A. Complicated migraine |
front 91 A patient has migraine attacks associated with transient impaired eye
movements and diplopia that resolves after the episode. Which subtype
is described? | back 91 B. Ophthalmoplegic migraine |
front 92 A patient has frequent migraines and needs prevention. Which option
is listed as a prophylactic agent? | back 92 A. Beta-blockers |
front 93 A CT shows distortion of normal brain geometry caused by an
intracranial tumor. Which descriptive term applies to this
distortion? | back 93 D. Mass effect |
front 94 Which pattern best fits cluster headache timing? | back 94 C. Daily weeks, months remission |
front 95 A patient’s cluster attacks are stereotyped and severe. Typical
single-attack duration is: | back 95 B. 30–90 minutes |
front 96 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? | back 96 D. Unilateral autonomic signs |
front 97 A patient describes cluster headache pain as “an ice-pick drill”
behind one eye. Which description best matches the listed
quality? | back 97 A. Steady, boring, retro-orbital |
front 98 A 41-year-old reports a sudden “explosive,” worst-ever headache
peaking immediately. This presentation must prompt concern
for: | back 98 C. Subarachnoid hemorrhage |
front 99 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? | back 99 B. Temporal arteritis |
front 100 For suspected temporal arteritis, which diagnostic approach is
specifically listed? | back 100 A. ESR and biopsy |
front 101 A large mass displaces brain structures from one compartment into
another across dural partitions. What is this situation
called? | back 101 D. Herniation |
front 102 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: | back 102 C. Decreases |
front 103 A patient’s cerebral perfusion pressure drops modestly, but cerebral
blood flow stays nearly stable because arterioles adjust caliber. What
mechanism is responsible? | back 103 B. Cerebral autoregulation |
front 104 Which finding is often the most important indicator of elevated
intracranial pressure? | back 104 D. Altered mental status |
front 105 Funduscopy in suspected elevated ICP shows engorgement and elevation
of the optic disc. What is this called? | back 105 A. Papilledema |
front 106 In papilledema from elevated ICP, which additional finding may be
seen on ophthalmoscopy? | back 106 C. Retinal hemorrhages |
front 107 A comatose patient has high blood pressure, slow pulse, and irregular
breathing. What is this constellation called? | back 107 B. Cushing’s triad |
front 108 In Cushing’s triad, the hypertension most directly serves to: | back 108 A. Maintain cerebral perfusion |
front 109 In Cushing’s triad, the bradycardia is best explained as: | back 109 D. Reflex to hypertension |
front 110 In Cushing’s triad, irregular respirations most directly reflect
impaired: | back 110 C. Brainstem function |
front 111 The immediate management goal in elevated intracranial pressure is
to: | back 111 C. Reduce ICP to safe |
front 112 Lowering ICP to safe levels primarily buys time to treat the: | back 112 B. Underlying disorder |
front 113 A lumbar puncture is avoided when severely elevated ICP is suspected
because it may: | back 113 A. Precipitate herniation |
front 114 Herniation occurs when distortion is severe enough to push structures
across compartments due to: | back 114 D. Severe mass effect |
front 115 Medial temporal lobe tissue (especially the uncus) is forced
inferiorly through the tentorial notch. This is: | back 115 C. Transtentorial herniation |
front 116 A deteriorating patient develops a “blown” pupil, hemiplegia, and
coma after a temporal mass expands. This triad most suggests: | back 116 A. Uncal herniation |
front 117 In uncal herniation, the dilated pupil is usually _____ to the lesion
(most cases). | back 117 D. Ipsilateral |
front 118 In many uncal herniations, hemiplegia is contralateral to the lesion
because of: | back 118 B. Ipsilateral CST or motor cortex |
front 119 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: | back 119 C. Kernohan phenomenon |
front 120 “Central herniation” refers to: | back 120 A. Downward brainstem displacement |
front 121 Mild central herniation causes traction on CN VI over the clivus.
What deficit is expected? | back 121 D. Lateral rectus palsy |
front 122 With severe ICP elevation or a posterior fossa mass, central
herniation can progress downward through the: | back 122 B. Foramen magnum |
front 123 Herniation of the cerebellar tonsils downward through the foramen
magnum is called: | back 123 C. Tonsillar herniation |
front 124 A unilateral mass pushes the cingulate gyrus under the falx cerebri
to the opposite side. This is: | back 124 A. Subfalcine herniation |
front 125 After head trauma, a patient cannot form new memories and also cannot
recall events just before the injury. This finding is: | back 125 B. Anterograde and retrograde amnesia |
front 126 Months after a seemingly minor concussion, a patient has headaches,
lethargy, and mental dullness. This is most consistent with: | back 126 D. Postconcussive syndrome |
front 127 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? | back 127 B. Diffuse axonal shear injury |
front 128 A teenager has head trauma with a rapidly worsening headache. You
suspect an epidural hematoma. Where does it accumulate? | back 128 D. Between skull and dura |
front 129 A patient sustains a temporal bone fracture at the pterion and
becomes progressively obtunded. The most typical bleeding source for
an epidural hematoma is: | back 129 A. Middle meningeal artery rupture |
front 130 CT shows a sharply marginated, lens-shaped extra-axial collection
that does not cross cranial sutures. Which diagnosis best
matches? | back 130 C. Epidural hematoma |
front 131 Why does an epidural hematoma often not spread past cranial
sutures? | back 131 A. Dura tightly apposed at sutures |
front 132 A patient has a crescentic extra-axial collection after trauma. In
which space does a subdural hematoma collect? | back 132 D. Between dura and arachnoid |
front 133 A 74-year-old on anticoagulation has progressive confusion after a
minor fall. The most typical vessel injured in subdural hematoma is
the: | back 133 C. Bridging veins |
front 134 Venous blood dissects easily along a potential space and spreads over
a large surface area. Which CT shape is most characteristic? | back 134 B. Crescent-shaped collection |
front 135 An elderly patient with cerebral atrophy develops a slowly
progressive headache and confusion with minimal trauma history. Which
diagnosis is most typical? | back 135 A. Chronic subdural hematoma |
front 136 For a significant subdural hematoma to occur immediately after
injury, which factor generally must be high? | back 136 D. Impact velocity |
front 137 Immediately after head trauma, CT shows an extra-axial hemorrhage
that spreads broadly over one hemisphere. Which radiologic description
best fits acute subdural hematoma? | back 137 C. Crescent, spreads widely |
front 138 A noncontrast CT shows blood tracking down into the cortical sulci,
following the contours of the pia. This pattern most strongly
indicates: | back 138 D. Subarachnoid hemorrhage |
front 139 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: | back 139 A. Nontraumatic subarachnoid hemorrhage |
front 140 In 75%–80% of spontaneous subarachnoid hemorrhage cases, the source
is rupture of an arterial: | back 140 C. Aneurysm in subarachnoid space |
front 141 Which condition is a recognized risk factor for intracranial aneurysm
formation? | back 141 B. Polycystic kidney disease |
front 142 Saccular (“berry”) aneurysms most often arise from: | back 142 A. Arterial branch points, Circle of Willis |
front 143 Which is the most common berry aneurysm location (descending order
list)? | back 143 D. Anterior communicating artery |
front 144 After identifying a berry aneurysm at the most common site, which
location is next most common? | back 144 B. Posterior communicating artery |
front 145 In the same descending list of common berry aneurysm sites, which
vessel is third most common? | back 145 C. Middle cerebral artery |
front 146 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? | back 146 A. Posterior communicating artery |
front 147 For suspected subarachnoid hemorrhage, why is CT obtained without
contrast? | back 147 D. Blood and contrast both hyperdense |
front 148 A patient has a thunderclap headache. Noncontrast CT is negative, but
suspicion remains high. What is the next diagnostic step per the
described approach? | back 148 B. Lumbar puncture |
front 149 After confirming aneurysmal SAH, which study should be performed to
evaluate both carotids and both vertebrals given frequent multiple
aneurysms? | back 149 C. Four-vessel cerebral angiogram |
front 150 A patient with aneurysmal subarachnoid hemorrhage needs definitive
aneurysm treatment to prevent rebleeding. Which option pair matches
the described definitive therapies? | back 150 C. Neck clip or detachable coils |
front 151 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? | back 151 A. Half; peaks around one week |
front 152 A patient with delayed ischemic deficits after SAH is treated in the
ICU with “triple H” therapy. Which set is correct? | back 152 D. Hypertension, hypervolemia, hemodilution |
front 153 Compared with spontaneous SAH, traumatic SAH is: | back 153 B. More common overall |
front 154 A hemorrhage is described as occurring within the brain tissue itself
and may involve hemispheres, brainstem, cerebellum, or even spinal
cord. This best defines: | back 154 C. Intraparenchymal hemorrhage |
front 155 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: | back 155 A. Hypertension, small penetrating vessels |
front 156 A patient with long-standing hypertension develops an
intraparenchymal bleed at the most common site. Which location is most
likely? | back 156 D. Putamen, basal ganglia |
front 157 In the classic descending frequency list for hypertensive hemorrhage
sites, after basal ganglia (putamen), the next most common location is
the: | back 157 B. Thalamus |
front 158 In the same descending frequency list for hypertensive hemorrhage
sites, the third most common location is the: | back 158 A. Cerebellum |
front 159 In the classic four-site list for hypertensive hemorrhage, the least
common location is the: | back 159 C. Pons |
front 160 After blunt head trauma, otoscopy shows dark discoloration behind the
tympanic membrane consistent with middle-ear hemorrhage. This is
called: | back 160 B. CSF otorrhea |
front 161 A patient with basilar skull trauma has periorbital ecchymoses
described as “raccoon eyes.” This finding most directly reflects
hemorrhage into: | back 161 C. Subcutaneous tissues |
front 162 A newborn develops a scalp collection from delivery-related bleeding
between the skull and external periosteum (pericranium). This
is: | back 162 A. Cephalohematoma |
front 163 A child develops hydrocephalus. Which set lists the three mechanisms
described for hydrocephalus development? | back 163 B. Excess CSF, obstruction, decreased reabsorption |
front 164 A clinician asks which primary mechanism is quite rare as a cause of
hydrocephalus (seen only with certain tumors). The rare mechanism
is: | back 164 D. Excess CSF production |
front 165 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: | back 165 C. Communicating hydrocephalus |
front 166 A patient has hydrocephalus caused by obstruction of CSF flow within
the ventricular system itself. This is: | back 166 A. Noncommunicating hydrocephalus |
front 167 Progressive ventricular dilation compresses descending white matter
pathways from the frontal lobes. Which clinical pair best fits the
resulting frontal-lobe–like abnormalities? | back 167 D. Magnetic gait and incontinence |
front 168 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? | back 168 B. Foramen of Monro |
front 169 An elderly patient has chronically dilated ventricles with gait
difficulty, urinary incontinence, and cognitive decline. The most
likely diagnosis is: | back 169 C. Normal pressure hydrocephalus |
front 170 Which statement correctly distinguishes tumor origin
categories? | back 170 A. Primary CNS origin; metastatic elsewhere |
front 171 In children, the most common brain tumors are astrocytoma and
medulloblastoma, followed by: | back 171 D. Ependymoma |
front 172 Which age-based distribution best matches typical brain tumor
location frequency? | back 172 B. Adults supratentorial; children infratentorial |
front 173 A 34-year-old develops focal seizures and MRI shows a slow-growing
cortical mass. Which tumor type is most commonly associated with
seizures? | back 173 C. Low-grade glioma |
front 174 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? | back 174 A. Meningioma |
front 175 Which tumor typically leads to death within 1–2 years? | back 175 D. Glioblastoma |
front 176 Pathology shows a dural tumor arising from arachnoid villus cells.
Which diagnosis fits best? | back 176 B. Meningioma |
front 177 A meningioma is found at its most common site. Which location is most
likely? | back 177 A. Lateral convexities |
front 178 A meningioma is found at the second most common site. Which location
is most likely? | back 178 D. Falx |
front 179 A meningioma is found at the third most common site. Which location
is most likely? | back 179 C. Basal cranial regions |
front 180 A patient has progressive unilateral hearing loss and tinnitus. A schwannoma is suspected on the most common cranial nerve. Which nerve is it? | back 180 CN VIII |
front 181 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? | back 181 D. Primary CNS lymphoma |
front 182 A 21-year-old has a pineal region mass. Which statement best matches
pineal region tumors overall? | back 182 A. Uncommon, under 1% cases |
front 183 A pineal region tumor is labeled a “pinealoma.” Which pair is listed
under pinealomas? | back 183 B. Pineocytoma and pineoblastoma |
front 184 A pineal region tumor list includes rare entities. Which option is
specifically listed as a rare pineal region tumor type? | back 184 C. Teratoma |
front 185 A patient has multiple brain metastases. Which set lists the three
most common primary cancers? | back 185 B. Lung breast melanoma |
front 186 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? | back 186 D. Lung carcinoma |
front 187 A 6-year-old has a midline posterior fossa tumor. Which age
association is most accurate? | back 187 B. Medulloblastoma usually <10 years |
front 188 A 14-year-old has a cerebellar astrocytoma. Which age range is most
typical? | back 188 C. 2 to 20 years |
front 189 A cancer patient develops neurologic dysfunction from a remote
autoimmune response rather than direct invasion or metastasis. What is
this called? | back 189 A. Paraneoplastic syndrome |
front 190 Infectious meningitis is defined as infection of CSF in which
space? | back 190 D. Subarachnoid space |
front 191 On exam, the patient resists passive neck flexion due to involuntary
neck muscle contraction with pain. What sign is this? | back 191 B. Nuchal rigidity |
front 192 In suspected acute bacterial meningitis, which management principle
is emphasized? | back 192 C. Do not delay antibacterials |
front 193 A patient’s CSF suggests acute bacterial meningitis. Which CSF
pattern best fits? | back 193 D. PMN-predominant WBC elevation |
front 194 The same CSF sample is further characterized by which paired
chemistry pattern is typical of acute bacterial meningitis? | back 194 A. High protein, low glucose |
front 195 A 3-year-old recovers from bacterial meningitis. Which complication
must be screened for because early cochlear implantation can improve
long-term outcomes? | back 195 C. Hearing loss |
front 196 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? | back 196 B. Brain abscess |
front 197 Aspiration of a brain abscess grows common bacterial pathogens. Which
organism is listed among common causes? | back 197 D. Streptococci species |
front 198 Another abscess case involves an organism described as a rare
bacterial cause. Which organism matches that description? | back 198 A. Nocardia |
front 199 Beyond bacteria, which parasite is an important cause of brain
abscess? | back 199 B. Toxoplasma gondii |
front 200 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? | back 200 C. Epidural abscess |
front 201 A patient develops pus in the space between dura and arachnoid after
spread from sinusitis or otitis. What is this called? | back 201 A. Subdural empyema |
front 202 Tuberculous involvement of the epidural space and vertebral bones is
termed: | back 202 D. Pott disease |
front 203 The two most important spirochetal nervous system infections
are: | back 203 B. Neurosyphilis and Lyme disease |
front 204 In meningovascular syphilis, chronic meningeal arteritis of
medium-sized vessels most characteristically causes: | back 204 C. Diffuse white matter infarcts |
front 205 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? | back 205 C. High-stepping tabetic gait |
front 206 A patient with suspected tabes dorsalis has pupils that accommodate
but do not constrict to light. Which finding is this? | back 206 A. Argyll Robertson pupils |
front 207 Which clinical bundle best matches tabes dorsalis? | back 207 D. Incontinence, optic atrophy, ataxia |
front 208 A patient is diagnosed with neurosyphilis after CSF abnormalities and
neurologic deficits. What therapy is indicated? | back 208 B. IV penicillin G |
front 209 After neurosyphilis treatment is started, which follow-up strategy is
specifically recommended to monitor response? | back 209 C. Serial lumbar punctures |
front 210 A hiker develops erythema migrans and later neurologic symptoms after
a deer tick bite. Which pairing is correct? | back 210 C. Borrelia burgdorferi—Ixodes tick |
front 211 A clinician asks where Ixodes-associated Lyme disease is described as
endemic. Which set matches? | back 211 A. United States, Europe, Australia |
front 212 Viral infection of brain parenchyma is called: | back 212 B. Viral encephalitis |
front 213 A previously healthy adult develops acute encephalitis. Which
pathogen is the most common cause? | back 213 B. HSV-1 |
front 214 A patient with advanced HIV develops progressive attention and memory
impairment, more common late in illness. This syndrome is: | back 214 D. HIV neurocognitive disorder |
front 215 In patients with HIV, encephalitis can also be caused by HSV, VZV, or
which additional virus? | back 215 D. Cytomegalovirus |
front 216 A patient with AIDS has retinitis that improves with ganciclovir and
later develops a polyradiculitis involving the cauda equina. Which
diagnosis best fits? | back 216 D. Cytomegalovirus infection |
front 217 A patient with AIDS develops progressive neurologic deficits; MRI
suggests demyelination. Which agent is the cause of Progressive
multifocal leukoencephalopathy (PML)? | back 217 B. JC papovavirus |
front 218 A patient with PML is counseled on prognosis. Typical survival
is: | back 218 C. 3–6 months |
front 219 An HIV-positive patient has chronic headaches; you suspect a fungal
meningitis that is common in HIV. Which diagnosis fits best? | back 219 D. Cryptococcal meningitis |
front 220 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? | back 220 D. Toxoplasmosis |
front 221 Which feature best matches aspergillosis/candidiasis? | back 221 D. Parenchyma infection, intense inflammation |
front 222 A patient develops rapidly progressive dementia with exaggerated
startle, myoclonus, visual distortions, and ataxia. Which diagnosis
fits best? | back 222 A. Creutzfeldt–Jakob disease |
front 223 Before performing a lumbar puncture, the safest routine practice to
reduce herniation risk is to first obtain: | back 223 B. Head CT scan |
front 224 CSF contains red blood cells. Which explanation is specifically
needle-induced rather than pathologic bleeding? | back 224 A. Traumatic tap |
front 225 Centrifuged CSF shows a yellow supernatant several hours after
symptom onset, and RBC counts do not fall across tubes. This pattern
most supports: | back 225 D. Subarachnoid hemorrhage |
front 226 Which pair lists two specific diagnostic uses of lumbar puncture
described here? | back 226 B. Cytology cancer meningitis; MS bands |
front 227 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? | back 227 D. Dura mater |
front 228 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? | back 228 D. Pterional craniotomy |
front 229 A lateral skull approach is used to resect temporal lobe seizure foci
and decompress most traumatic intracranial hematomas. Which approach
is this? | back 229 A. Temporal craniotomy |
front 230 A posterior skull approach provides access to cerebellopontine angle,
vertebral artery, brainstem, and lower cranial nerves. Which approach
is this? | back 230 C. Suboccipital craniotomy |