MOZAIK CBT JUNI

Which one of the following is the LEAST appropriate indication for placement of ICP monitor in TBI?

• GCS 3-8 with abnormal CT scan

• GCS 3-8 with normal CT scan age >40 years and SBP <90 mmHg

• Postoperative period after removal of acute subdural hematoma

• GCS of 3-8 and diffuse injury type III (Marshall CT classification)

• Diffuse injury type II (Marshall CT classification)

A 76 year old female presents today with progressive, severe low back pain. She has a history of osteoarthritis, type 2 diabetes, osteoporosis, hypertension, COPD, and osteoporotic compression fractures. Her last osteoporotic compression fracture was 2 years ago. She has been on alendronate since her last fracture. Pain is described as dull and achy, nine out of 10 in severity, without radiation pain. Her walking is limited due to her back pain. She denies any numbness or tingling into her lower extremities, or bowel or bladder incontinence at this time. On physical exam, there is point tenderness over her lower lumbar spine at the L4-L5 vertebral levels. Muscle strength examination of lower extremities is difficult to perform due to pain. However, plantar flexion and dorsiflexion muscle strength is 5/5 bilaterally, and lower extremity sensation is otherwise intact. Deep tendon reflexes for the L4, S1, are 2/4 bilaterally. Special tests cannot be performed to pain. Pain is elicited immediately upon the patient lying on her back. Kyphoplasty is being considered for the patient.

• Metastatic vertebral fracture

• Complete vertebral body collapse

• Vertebral body fracture with a posterior cortical breach

• Osteoporotic compression fracture

A sagittal T2-weighted image of a patient with a tethered cord is shown in this image. What is a characteristic of the pathology represented here?

• Reduced risk following folic acid supplementation

• Associated with Chiari 2 malformations

• Secondary to premature disjunction of the neural ectoderm

• Most cases are familial

A frontal view digital subtraction angiogram following a right carotid artery injection is shown in this image. What is the likely etiology of the lesion demonstrated?

• Atherosclerosis

• Immune vasculitis

• Congenital

• endocarditis

The ventral cervical plate pictured below spans three vertebral levels, and reveals a pseudoarthrosis. It consists of two screw at each end that are rigidly affixed to the plate. Which of the following biomechanical properties best describe the type of fixation pictured in the radiograph that lead to the pseudoarthrosis?

• A. Constrained cantilever beam

• B. Constrained three-point bending

• C. Constrained

• D. Semi-constrained cantilever beam

• E. Semi-constrained four point bending

Prognosa GBM dari paling baik ke paling buruk

• IDH Mutant Gr 3 > IDH Mutant Gr 4 > IDH Wildtype Gr 3 > IDH Wildtype Gr 4

• IDH Mutant Gr 3 > IDH Wildtype Gr 3 > IDH Mutant Gr 4 > IDH Wildtype Gr 4

• IDH Wildtype Gr 3 > IDH Mutant Gr 4 > IDH Mutant Gr 3 > IDH Mutant Gr 4

• IDH Wildtype Gr 3 > IDH Wildtype Gr 4 > IDH Mutant Gr 3 > IDH Mutant Gr 4

• IDH Mutant Gr 3 > IDH Mutant Gr 4 > IDH Wildtype Gr 3 > IDH Wildtype Gr 4

A 64 year old Northern Indian man with past medical history of diabetes mellitus and heterozygous MTHFR gene mutation was brought by his son to the emergency department for fever, eye discharge on the right side, painful eye movement on the right side for three days. The patient also reported a headache and vision changes on the right side for two weeks which are unusual for him. He takes only metformin mg BID and insulin shots with meals. There is no significant family history. Blood pressure 110/65 mmHg, heart rate 105 bpm, and temperature 38.5 C. he is alert and oriented to person and place but not time, chemosis, periorbital edema and proptosis on the right eye and mild drooping of the right eyelid. There was poor effort during strength exam. The rest of the exam is unremarkable. WBC, ESR, CRP, and D-dimer are mildly elevated. CT head is unremarkable. Lumbar puncture is done with no WBCs but mildly elevated protein of 120 mg/dL. Brain MRI shows an isointense lesion in the right cavernous sinus close to cranial nerve III with a decreased caliber of the intracavernous internal carotid artery on T1 and hypointense mass on T2. the lesion was well enhanced on T1 contrast. MR angiography shows a cavernous sinus mass and occlusion of the intracavernous carotid artery on the right side.

• Carotid-cavernous fistula

• Cavernous sinus tumors

• Cavernous sinus thrombosis

• Carotid-cavernous aneurysm

Endoscopic view from within sphenoid sinus. Which one of the following labels identifies the Opticocarotid recess?

• A

• B

• C

• D

• E

The husband of a 73 year old female calls emergency medical services (EMS) after noticing slurred speech and right-sided weakness in his wife. EMS personnel evaluates the patient and suspects a possible large vessel occlusion stroke using the Los Angeles Motor Scale. The patient’s last know normal was 30 minutes ago. According to the American Heart Association and American Stroke Association ‘Severity-Based Stroke Triage Algorithm for EMS’, to which of the following facilities should the patient be transported?

• The closest acute stroke-ready hospital 45 minutes away

• The closest primary stroke center 55 minutes away

• The closest comprehensive stroke center 60 minutes away

• The closest hospital regardless of stroke center certification

A 91 year old female becomes acutely unresponsive in her assisted living care facility. She is taken to the hospital for a stroke workup and found to have a right frontal intraparenchymal hemorrhage with intraventricular extension. The estimated blood volume of the hemorrhage is 65 mL. She takes warfarin for non valvular atrial fibrillation and has an INR of 2.1. She has reflux disease, and stress incontinence. On initial exam, her eyes do not open to painful stimuli, she moans and withdrawals to noxious stimuli in the right arm and has extensor posturing in the left arm with an extension of bilateral legs.

• 26%

• 72%

• 97%

• 100%