Quiz: NEURO surgery

Ali presents to his GP as he has been experiencing some odd symptoms. He finds it very difficult to flex the fingers of his right hand. On neurological examination, he can move his shoulders, has normal elbow flexion and extension and normal wrist power. However, his grip strength on the right is noticeably reduced. The GP suspects Ali is suffering from a pinched nerve. Which nerve root is most likely to be affected?

A A. C5 B B. C6 C C. C7 D D. C8

32-year-old tennis player presents to his GP with a 4-week history of progressive neck and right arm discomfort accompanied by numbness on the lateral aspect of the right forearm and thumb, with weakness of elbow flexion. Shoulder abduction is normal. There are no symptoms in the lower limbs, and no bladder or bowel disturbance. He has no significant medical history and is otherwise well. There is no history of significant trauma. Select the most likely cause for his symptoms from the followin

A A. Radial nerve injury B B. C6 nerve root compression C C. CTS D D. Diabetic peripheral neuropathy

30) A 55-year-old woman presents to her GP with low back pain 4 weeks duration accompanied by shooting pains down the lateral aspect of her left thigh and into the dorsal aspect of her left foot. The pain does not keep her up at night, is located in the lumbar region and there are no bladder or bowel symptoms. She feels otherwise well and has not lost weight. Select the most likely cause of her symptoms from the following.

A a. Spondyloradiculopathy (disc prolapse) B b. Spinal tumour C c. Diabetic neuropathy D d. Muscular spasm

In this case wich nerve root most likely to be affected?

A a. L1 nerve root B b. L3 nerve root C c. L5 nerve root D d. S2 nerve roo

A 25-year-old man complains of ongoing back pain for the past month. He is a gymnast who trains at least three times a week. The pain islocated in the lumbosacral area and is much worse after activity. On examination, he is unable to straight leg raise his right leg more than 40 degrees because of pain in the posterior compartment of his thigh. The patient also has reduced sensation in the posteriorlateral aspect of his leg with weakness in ankle plantarflexion. What is the level of his radiculopathy?

A a. L3 B b. L4 C c. L5 D d. S1

Q6) A 60-year-old man presents to his GP with 2 months of progressive back pain, located in the lower thoracic spine, despite analgesia and prevents him from sleeping at night when the pain is worst. He worked until recently as a builder. He has noticed that he has lost weight over the past few months despite an increasingly sedentary lifestyle. He gave up smoking 2 years ago. Which of the following is the most appropriate management?

A a. Referral for physiotherapy B b. Routine referral to spinal surgeon C c. Urgent referral for spinal and chest imaging D d. Increase pain relief, review in 1 month

23-year-old man presented with sensory loss in the medial half of the ring finger and small finger of the right hand. There was also weakness of the intrinsic muscles of the hand and weakness in the flexors of the ring and little finger. The abductor pollicis brevis was preserved. What is the most likely cause?

A a. CTS B b. Musculocutaneous nerve lesion C c. T1 nerve root lesion D e. Ulnar nerve entrapment

A 56-year-old woman presents complaining of severe right lower limb pain. Physical examination is unremarkable except for a grouped vesicular lesion in a dermatomal distribution on the posterior aspect of her right leg. The patient subsequently developed right lower leg weakness 2 weeks later and began ‘dragging’ her foot while walking. What is the most likel diagnosis?

A Diabetes B e. Lumbar disc prolapse C Herpes zoster D Hypothyroidism

47-year-old woman has paraesthesia and severe pain in her left hand. The pain is usually worse after she returns from work as an IT administrator. Recently, she has put on weight and experienced some hair loss. On examination, she has wasting of the thenar muscle group and Tinel’s sign is positive. She is also bradycardic with a pulse of 49 bpm.

A Carpal tunnel syndrome due to myxedema B ii. Diabetes C iii. T1 nerve root lesion D iv. Distal radial nerve compression

1) According to GCS a verbal score 1 indicate.

A 1. No response B 2. 2. Inappropriate speech C 3. Comprehensive sounds D 4. Disorientation response.

3) The Pt. who opens his eye in response to pain, makes no verbal response, but he withdraws from pain has GCS:

A 1. 3 B 2. 2. 5 C 3. 7 D 4. 11

4) As regard median nerve injury following are true except

A 1. Wasting of thenar Ms. Group. B 2. Lost sensation of lateral 2/3 of the hand. C 3. Complete wrist drops. D 4. Investigation by EMG and nerve conduction.

5) As regards epidural hematoma all are true except

A 1. Usually associated with skull fracture B 2. Appears biconvex in CT. C 3. Managed surgically by VP shunt. . D 4. Can be managed medically without surgery.

6) What is the primary goal with mobilizing patient with spinal injury…?

A 1. Limitation of the exact injury. B 2. Limitation whether the Pt. will be paralyzed. C 3. Preventing further injury to the Pt. . D 4. Securing airway of patient.

A 1. Neck stiffness. B 2. Retinal Hge. C 3. Six nerve palsy . D 4. Repeated vomiting

7) Clinical manifestation of acute hydrocephalus including the following…except?

A 1. Neck stiffness. B 2. Retinal Hge. C 3. Six nerve palsy . D 4. Repeated vomiting

The most sensitive methods for detection of carpal tunnel syndrome is…? 1. Needle examination of the abductors pollicis brevis.

A . Needle examination of the abductors pollicis brevis. B 2. Needle examination of second lumbrical muscle. C 3. Motor and of the median nerve. D 4. Palmar sensory conduction of the median nerve.

9) All the following can be seen in ulnar nerve entrapment at the wrist except…?

A 1. Motor deficit in the abductor policis B 2. Motor deficit in the deep hand and flexor policis brevis. C 3. Motor deficit in the third and fourth lumbricals D 4. Sensory deficit in the dorsum of the hand

13) The Radial nerve or one of his branches enervate each of the following except:

A 1. Adductor policis longus. B 2. Adductor policis. C 3. Brachioradialis. D 4. Extensor policis brevis.

12. MENINGEAL TUMORS OF THE BRAIN DO NOT INCLUDE:

A a) meningioma B b) sarcoma C . c) glioblastoma D d) meningosarcoma

: 26-SUBDURAL HEMATOMAS ARE LOCATED

A a) between the aponeurosis and the periosteum B b) between the dura and the arachnoid mater C .c) between the dura and the periosteum D d) in the great occipital cistem

: 30-WHICH OF THE LISTED SYMPTOMS IS NOT INFROMATIVE IN FRACTURE OF THE CRANIAL BASIS:

A a) auricular liquorshoes B b) eyeglasses symptom C a) eosinophilis D c) subarachnoid hemorrhage

11-The evaluation of a comatose patient with a head injury begins with:

A a. The cardiovascular system B b. Pupillary reflexes C c. Maintain airway D d. CT brain

12- The commonest site of extradural hematoma is: :

A a. Subfrontal region B b. Parietal region C c. Parafalcine region D d. Temporal region

13- A patient who has sustained head Injury, and is exhibiting decerebrate posturing, with no eye opening or vocal function has What score on the Glasgow Coma Scale? :

A a. 3 B b. 4 C c. 7 D d. 6

14- What is the primary goal when immobilizing a patient with a spinal injury?

A a. Determining where the exact injury is B b. Determining whether the patient will be paralyzed C c. Preventing further injuries to the patient D d. Securing the airway of a patient

15. Which of the following injuries usually requires surgical treatmen

A a. Open non-depressed skull fracture. B b. Open depressed skull fracture. C c. Closed non-depressed skull fracture. D d. Closed depressed skull fracture.

16. Which is not a sign of skull base fractures:

A a. Battle's sign B b. Raccoon eyes C c. CSF otorrhoea D d. Subconjunctival haemorrhage

17- As regard median nerve injury all are true except :

A a. Wasting in thinner muscle B b. Lost sensation of lateral 2/3 of the hand C c. Complete wriest drop D d. Investigated by EMG and NCV

18. MRI study is contraindicated in:

A a. Posterior fossa tumors. B b.Bullet injuries C c. Cerebellar infarction. D d. Spinal cord injuries.

19- Acute extradural hematoma has the following criteria in CT brain except:

A a. Lenticular shape. B b. Related to skull fracture C c. Crescentic shape intra axial hypo-dense lesion. D d. Biconvex extra axial hyper-dense lesion.

20-The clinical manifestations of acute hydrocephalus include the following except: :

A a. Neck stiffness. B b. Retinal hemorrhage. C c. 6th nerve palsy. D d. Repeated vomiting

2- The Glasgow Coma Scale assesses all of the following parameters EXCEPT?

A a. Motor response B b. Verbal response C c. Eye opening. D d. Memory.

3- A patient who opens his eyes in response to pain, makes NO verbal response, but withdraws from pain has a Glasgow Coma Score :

A a. 3 B b. 5 C c. 7 D d. 11

4- As regard median nerve injury all are true EXCEPT:

A a. Wasting in thinner muscle B b. Lost sensation of lateral 2/3 of the hand C c. Complete wriest drop D d. Investigated by EMG and NCV

5As regard epidural hematoma all are true EXCEPT

A a. Usually associated with skull fracture B b. Appear biconvex in CT brain C c. Managed surgically by urgent VP shunt insertion D d. Can be managed medically without surgical interferen

2Tarsal tunnel syndrme is equivalent to

A a. Carpal tunnel syndrome. B b. Ulnar tunnel syndrome. C c. Radial tunnel syndrome. D 0

3. Cubital tunnel syndrome

A a. entrapment of the median nerve at the wrist joint B b. entrapment of the radial nerve C c. entrapment of the ulnar nerve at the wrist Joint D d. Dentrapment of the median nerve at the elbow joint

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