What pain procedure is best for nerve avulsion pain?

A representative scan from a susceptibility-weighted MRI sequence of a patient’s brain is shown in this image. What is correct about this patient’s disease entity?

A study has been designed to test the association between weight lifting and the likelihood of developing lumbar back pain. The following results have been obtained:

Z-test

What ganglion receives fibers from the anterior two thirds of the tongue?Pterygopalatine

A 2-year-old boy presents with an inability to track objects without turning his head. He is noted on exam to have a static facial expression, and no movement in the facial musculature is seen bilaterally. He also is noted by his parents to be able to push up when he is in the prone position. What is the patient’s diagnosis?

A man with HIV, who is a poorly compliant patient, presents with new-onset seizures. An MRI of the brain shows a ring-enhancing lesion with an eccentric “target” sign on contrast enhanced T1 images. This finding likely represents:

Babies with postinfectious and posthemorrhagic hydrocephalus can have the highest success rate of treatment with what procedure?

What nerve endings are nonencapsulated and are found in the alimentary tract, between epithelial cells of the skin, in the cornea, and in connective tissues?

What is a characteristic imaging finding of metachromatic leukodystrophy?

What is the outcome of activating the carotid sinus reflex in a patient with a normal blood pressure and heart rate?

What agent reverses angiographic vasospasm following aneurysmal subarachnoid hemorrhage?

A 40-year-old man underwent an MRI of the brain, demonstrating the lesion shown in these images. The lesion was resected and stained positive for vimentin and CD34, with histological analysis demonstrating uniform spindle cells and staghorn vessels. What is the patient’s likely diagnosis?

According to the North American Symptomatic Carotid Endarterectomy Trial (NASCET), a carotid endarterectomy is indicated for what type of carotid artery stenosis?

A 24-year-old man presents with progressive back pain. Imaging demonstrated an expansile osteolytic lesion in the posterior elements of the middle thoracic spine with a fluid–fluid level. What is the patient’s likely pathology?

In the electron micrograph shown in this image, what component of the sarcomere contains only myosin?

. A 45-year-old woman who underwent total bilateral adrenalectomies for Cushing disease 3 years ago returns to clinic with skin hyperpigmentation. What is cause of the hyperpigmentation in this patient?

At what segment of the vertebral artery shown in this image is the arrow pointing?

 A 4-week-old neonate presents with progressive macrocrania. The Brain MRI, shown in this image, suggests:

. What chemotherapy agent used for central nervous system tumors works by carbamylating amino groups and inducing DNA cross-linking?

What is the infusion volume of one unit of packed red blood cells in children, and by how much is it expected to increase hemoglobin?

What structure is deep to the arrow in this view from the endoscope during a resection of a pituitary macroadenoma using a transnasal transsphenoidal approach?Pituitary gland

What target for deep brain stimulation is thought to provide the best control of essential tremors?

A patient with severe, large-amplitude hemiballismus in his right upper extremity most likely has a lesion involving what basal ganglia structure?

Fibers from the flocculonodular lobe of the cerebellum synapse on the vestibular nuclei after first synapsing on what nuclei?

What organ would respond to systemic cocaine administration but not to systemic atropine administration?

A 20-year-old man with a history of bipolar disease presents with an acute onset of right-sided hemiparesis and expressive aphasia. According to the CT shown in this image, and assuming the most likely diagnosis, what is the risk of re-hemorrhage?

A woman presents to the emergency department with dizziness, nystagmus, and a feeling of falling toward the left. An MRI of the brain was performed, and a representative scan is shown in this image. What vessel likely is involved in this patient’s condition?

A sharply circumscribed, lucent lesion with beveled edges is demonstrated on a skull radiograph of a child. What is the likely diagnosis?

The afferents from the mammillothalamic tract project from the mammillary bodies to what thalamic nuclei?

What muscle typically is innervated by the radial nerve itself and not by one of its terminal branches?

A 78-year-old woman presents to the emergency room complaining of weakness and long-standing headaches. She reports that the weakness began in the right upper extremity and then proceeded to involve the right lower extremity followed by the left lower extremity and, most recently, the left upper extremity. Based on these clinical findings, what is the most likely pathological cause of the patient’s symptoms?

The most important predictor of outcome in children with pediatric ependymomas is:

A 5-month-old boy underwent an MRI of the brain,shown in these images. What may be a related finding?Abdominal mass

If additional sodium channels were opened on a neuron at its maximal point of depolarization during an action potential, what would happen to sodium ion flux and membrane potential?

The sural nerve is formed from the combination of two nerves arising from what larger branches?

This image shows cerebral vessels stained with Congo red. What is the underlying disease process represented in the image?

A patient presents with exophthalmos and an Orbital bruit. What is the likely finding on CT of the brain and orbits?

The cerebral venous angle occurs at what junction?

What is the standard radiation regimen for stereotactic radiosurgery for trigeminal neuralgia?

The tumor shown in these images was found to have rosettes and perivascular pseudorosettes on microscopic examination, and stained positive for glial fibrillary acidic protein. What is a characteristic of the lesion?

Cheyne-Stokes respirations are characterized by increasing followed by decreasing tidal volumes separated by periods of apnea. They are seen in heart failure, with rapid blood sugar changes, and in stroke. Where do Cheyne-Stokes respirations originate?

A patient with bluish pigmentation of the auricles and sclerae presents for evaluation. Levels of homogentisic acid in his urine are elevated. What finding is likely to be seen on a CT of the patient’s spine?

A 58-year-old man presents with delusions and hallucinations. His wife reports that he has been complaining recently of headaches, irritability, and sleep disturbance, and that he has had a progressive memory decline over the past month. Brain MRI shows high T2 signal without enhancement, mostly in the left mesial temporal lobe. Chest radiograph shows a centrally located pulmonary mass. Cerebrospinal fluid examination shows elevated lymphocytes, elevated protein, normal glucose, elevated IgG index, and oligoclonal bands. Herpes virus PCR is negative. What is the most likely diagnosis?

What type of receptor is found on sweat glands along postganglionic sympathetic fibers?

Sagittal balance is measure from what two positions?

A 33-year-old, otherwise healthy man underwent an MRI, shown in these images. Histological analysis of his lesion revealed a large amount of mucin with formation of rosettes and pseudorosettes. “Collagen balls” were evident on periodic acid-Schiff staining. This lesion is consistent with a:

What is the best route for vitamin K administration in the setting of life-threatening hemorrhage in a patient on warfarin

A 68-year-old man with a history of diabetes, hypertension, and multiple prior transient ischemic attacks presents to the emergency department with left-sided hemiplegia and a facial droop. Conventional angiography is performed after MRI of the brain. A digital subtraction image of the patient’s right carotid artery bifurcation is shown in this image. What is the angiographic finding?

A 9-month-old, nonvaccinated girl is brought to the emergency room for generalized seizures. She has a stiff neck, is poorly responsive, and has a temperature of 39.1°C. Her parents report that she had one episode of diarrhea earlier in the day. Cerebrospinal fluid Gram stain is negative. What pathogen most likely is the origin of these symptoms?

Representative scans of a brain MRI examination in a child are shown in these images. What likely is related directly to the neuroimaging findings?

What triangle of the skull base is formed by the lateral border of cranial nerve IV, medial border of the ophthalmic division of the trigeminal nerve, and dura between the dural entry points of both cranial nerves IV and the ophthalmic division of V?

What feature of a burst fracture may imply instability and the need for surgery?

A patient presents with a nystagmus described as the eyes moving up and down discordantly with intorsion of the rising eye and extorsion of the falling eye. What visual field abnormality might be seen on exam?

Compared to primary glioblastomas, secondary glioblastomas tend to express what histopathological characteristics?

You perform surgery on a patient with a far lateral herniated disk at L4/L5. You use a lateral approach, and the pars interarticularis is identified. The L4 nerve root can be found anterior to what structure?

What muscle is innervated by the superior laryngeal nerve?

The cerebellum projects to what thalamic nucleus (nuclei)?

. What type of nystagmus can be associated with Parinaud syndrome?

A 65-year-old man undergoes an MRI of the brain.

The enhancing lesion shown in these images demonstrates

diffuse low apparent diffusion coefficient

values. What is the patient’s likely diagnosis?

What feature can distinguish a foot drop caused by L5 nerve root pathology from a foot drop caused by a common peroneal nerve (CPN) palsy?

An MRI of the brain was obtained in an 8-year-old boy during a workup for macrocephaly. Axial T2 and FLAIR scans are shown in these images. What is the boy’s likely diagnosis?

What are the electroencephalographic changes seen in herpetic encephalitis?

21-year-old man presents to the emergency room with a radial fracture and wrist drop. What finding supports the diagnosis of injury to the radial nerve and not the posterior cord?

When considering a surgical approach to the L4/L5 level, what complication is seen with an anterior lumbar interbody fusion (ALIF) that generally is avoided with an extreme lateral interbody fusion (XLIF)?

A 56-year-old man underwent an uneventful craniotomy for the resection of a meningioma. On the second postoperative day, he started complaining of increasing headaches and subsequently became unresponsive. An emergent CT of the head is shown in this image. What therapy should be administered or performed next?

 A 44-year-old man presents to clinic with new double vision and uncoordinated walking. You notice that he has trouble smiling due to weakness on both sides of his face. No other weakness is noted on physical exam. He states that he just recovered from the flu. What is the most likely diagnosis?

What is the term for stimulation of the median or tibial nerve with averaging of the electroencephalographic waveforms to null out activity that is not time locked to the stimulus?

A 12-year-old child with shunted hydrocephalus since birth presents with severe abdominal pain and vomiting. Ultrasound is concerning for a large pseudocyst around the peritoneal catheter tip. The next step in this patient’s management should involve:

Which Modic type change is hyperintense on T1 and iso- to hyperintense on T2 MRI?

What is the function of the nucleus ambiguus?

What abnormality is seen on the axial T1-weighted MRI of the lumbar spine shown in this image?

After suffering a skull base fracture in a motor vehicle collision, a patient presents with persistent rhinorrhea. The most specific finding to determine if this fluid is cerebrospinal fluid is:

What deficit is expected with an S1 nerve injury?

A patient presents with unilateral decreased visual acuity over 2 days. She complains of severe eye pain. What is the most likely cause of the symptoms?

What is the Evans ratio?

What paralytic has the shortest time to onset and duration?

What feature favors a chordoma over a chondrosarcoma?

A patient presents with severe back pain that is worse at night and improves when taking aspirin. CT shows an expansile, radiolucent, 2-cm sclerotic lesion in the thoracic pedicle with cord compression and a contralateral spondylolysis. The optimal treatment includes:

Subthalamic nucleus deep brain stimulation is a surgical treatment for Parkinson disease. Where is the subthalamic nucleus located?

What are the radiographic and clinical incidences, respectively, of vasospasm after aneurysmal subarachnoid hemorrhage?

What percentage of children with a Chiari 2 malformation become clinically symptomatic and require surgical decompression?

Horner syndrome can be associated with what lesion or pathology?

. Axial contrast-enhanced T1- and T2-weighted MRI scans of the brain of a 33-year-old man are shown in these images. What is the patient’s likely diagnosis?

What is the formula for estimating a patient’s lumbar lordosis (LL)?

A 9-year-old boy presents with a headache, upgaze palsy, and pineal region mass. A cerebrospinal fluid analysis was performed showing elevated β-HCG levels. What tumor type is suspected?

What is the best description for the acidotic/alkalotic state for a patient with the following set of lab values?

pH: 7.44

PaCO2: 26 mm Hg

HCO3 –: 20 mEq/L

PaO2: 53 mm Hg

What are the criteria for monitoring personnel to notify the surgeon about during somatosensory evoked potential recording intraoperatively?

How does the syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect cerebral edema?

 A 45-year-old man has paralysis in cranial nerves IX through XII. What is the most likely diagnosis?

A 38-year-old woman with a history of Hodgkin lymphoma treated with brentuximab presents with altered mental status. Axial T2- and postcontrast T1-weighted images of the brain are shown in these images. The lesions did not show restricted diffusion. What is the likely diagnosis?

Nociceptive pain travels along what spinal tract?

What is the Magerl technique for placement of lateral

mass screws?

A 53-year-old man patient with a sudden onset of headache and meningismus underwent a CT of the head that showed a small amount of subarachnoid blood limited to the prepontine and interpeduncular cisterns. Conventional angiography at admission and 2 weeks later was negative for a vascular lesion. What is a characteristic of this patient’s likely entity?

In patients with intracranial pressure monitors, what waveform is characterized by Traube-Hering arterial waves that have variable intracranial pressure elevations with a frequency of 4 to 8 per minute?

A man with clinical hypercortisolism undergoes a dexamethasone suppression test. He has no changes in his cortisol levels with low-dose dexamethasone administration; however, cortisol is suppressed with high-dose dexamethasone. What is the most likely diagnosis?

What is the likely diagnosis represented in the gradient echo based and diffusion-weighted sequences shown in these images?

What is the etiology of blindness unique to the transseptal approach to the sella turcica?

A patient presents with polytrauma after a motor vehicle collision, with multiple skull base and facial fractures. The patient is discharged and returns with chemosis, pulsatile proptosis, and an ocular bruit. Angiogram reveals a low-flow shunt feeding from meningeal branches of the external carotid artery. What type of carotid-cavernous fistula does this patient have?

. What is the precursor amino acid involved in the synthesis of melatonin?