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Worksheets12/23
Total questions: 133
Worksheet time: 1hrs 7mins
During surgery for a symptomatic herniated lumbar disc, aggressive discectomy (aggressive removal of the fragment with disc curettage) compared to limit with whch of the following complications?
Increased incidence of recruitment leg pain/back pain
Increased risk of nerve root injury
Increased incidence of subsequent fusion
Increased incidence of discitis
Increased incidence of recurrent herniation
Laki-laki berusia 24 tahun datang ke IGD pasca terjatuh dari tangga. CT scan meu. Tatalaksana yang paling tepat ialajh?
Penatalaksanaan medikamentosa jika GCS >11
Evakuasi bedah jika GCS <10kan GCS
Penatalaksanaan medikamentosa jika GCS <10
Evakuasi bedah tanpa mempertimbangkan GCS
Evakuasi bedah jika GCS<11
Pasien laki-laki 46 tahun pasca dilakukan costotransversectomy pada level t10 sisi kiri untuk reseksi tumor metastasis vertebra. Pemeriksaan ekstremitas bawah didapatkan paraplegi dan kelihangan sensasi nyeri dan suhu pada level tersebut kebawah. Sensai setuhan halus pd ekstremitas bawah positif. Berapa derajat cedera pasien tersebut?
ASIA C
ASIA D
ASIA B
ASIA E
ASIA A
A 50 years old man with a recent diagnose of diabetes melitus present with severe, suddent onset right lower extremity pain followed by he has some atrophy of his right quadriceps and tibialis anterior, dense right sensory loss to all modalities in his right led, and absent pattelar and achiles dan ribil, perineal dan tibialisama and tibial motor responses, and diffuse increased do to spontaneous activity intermixed with enlarged motor unit potensials both distally and promally
Compressive lumbosacrasal polyradiculopathy
Conus medularis syndrome
Lumbosacral radiculoplexus neuropathy
Cauda equina syndrome
Sciatic mononeuropathy
Seorang laki-laki 50 tahun dengan riwayat 15 tahun bilateral tremor tangan (kanan lebih berat dari kiri) yang memberat saat bergerak, seperti menulis. Alkohol mengurangi tremor. Pasien tidak didapatkan rigiditas dan resting tremor. Propnolol mereduksi tremor, tetapi adanya efeksamping membatasi penggunaan tersebut. Apa diagnose yang paling mungkin?
Tremor ortostatik
Parkinsons disease
Diskinesia
Tremor distonik
Tremor esensial
Pasien laki-laki usia 50 tahun Riwayat kecelkaan lalu lintas 2 bulan yang lalu. Pasien mengalami fraktur humerus dan dilakukan operasi ORIF. Saat ini pasien... lokasi penyebab kelainan tersebut?
Aponeurosis muskulus biseps
Transverse ligament pada carpal tunnel
Arcade of struthers
Ligamentum pada guyon canal
Aponeurosis fasia pada cubital tunnel
Pasien perempuan 53 tahun dating dengan keluhan gangguan koordinasi saat berjalan dan sering ... didapatkan hiperestesa pada lengan, kekuatan motoric ekstremitas atas 5/4, kekuatan motoric ekstremitas bawah 5//5, pendekatan untuk operasi pada pasien
Retrosigmoin approach
Traanspetropal approach
Midline suboccipital approach
Transoral transclival
Far lateral approach
Which form of systemic cancer therapy is associated with an increased risk of radiation necrosis after stereotactic radiosurgery for cerebral metastases?
Angiogenesis Inhibitors (e.g. Anti-VEGF antibody)
Glucocorticoid Therapy
Tumor Targeted Chemotherapy (e.g. EGFR or ALK antagonists)
Systemic Immunotherapy (e.g. PD-1 inhibitors)
Cytotoxic Chemotherapy (e.g. DNA synthesis / Mitosis Inhibitors)
What infant skull deformity is depicted in these films?
Brachicephal
Trigonocephal
Plagiocephal
Scapocephal
Turricephal
Laki-laki usia 45 tahun menjalani operasi dengan pendekatan subtemporal untuk kasus tumor dengan elevasidura dari lantai fossa media dan tulang petros (?) reseksi tumor. Tindakan apa yang dapat membantu ahli bedah menyelesaikan masalah ini?
Identifikasi segitiga Trautman, dan ekspos ke arah medial dari landmark ini
Drilling lebih lanjut arcuate eminence
Drilling lebih lanjut dari segitiga Glasscock'
Ekspos tambahan melalui kawase quadrilateral
Modifikasi pendekatan dengan mengutilisasi koridor presigmoi
Laki-laki 45 tahun datang dengan keluhan nyeri kepala mendadak, mual, muntah dan gangguan penglihatan. Pada pemeriksaan tidak didapatkan demam, Terdapat hipotensi dan takikardi tetapi tidak memiliki kekakuan leher atau fotofobia. Lapang pandang tampak menyempit pada tes konfrontasi. CT kepala menuniukan hasil tidak normal oleh karena itu dilakukan MRI. Manakah dari berikut yang merupakan manajemen akut yang paling tepat?
pituitary profile dan mulai hidrokortison intravena empiris
Dexamethasone
Tes lapang pandang
Lumbar puncture
Transsphenoidal surgery
A 68 year-old male with a history of prostatic cancer presents with low-grade fever and severe low back pain progressing to include lower extremity numb disc space, as well as a large paraspinous abscess with calcification. Thoracic MRI shows a kyphotic deformity with enhancing soft tissue and bone extends pathologic process is:
Discitis- Staph aureus
Pathologic fracture
Spinal tuberculosis
Osteoporotic compression fracture
Discitis - Staph epidermidis
A pericallosal aneurysm would be found at which location on the lateral projection angiogram shown?
C
A
E
D
B
A 9 month old boy presents with single sutural synostosis (figure 1). On exam his fontanelle is closed and there is no papilledema. What associated finding may be diagnosed in this patient?
Dandv-Walker malformation
Tethered cord syndrome
Increased intracranial pressure
Syringomyelia
Chiari type II malformation
A 42 year old male presents with a 5 year history of Parkinson disease (PD) with severe motor fluctuations. What would be his expected benefit from deep (?):
BS will provide improvement in freezing of gait, a motor symptom frequently associated with Parkinson disease
DBS will result in reduction in progression of the natural history of Parkinson disease.
DBS will eliminate the need for Parkinson medications.
DBS will provide no benefit, because he has not had the disease long enough.
DBS will provide improvement in motor symptoms comparable to the effects of Levadopa medication, with less motor fluctuations and without the medication induced dyskinesia
Parkinsonian tremor can be diminished by high frequency stimulation of:
Globus pallidus externa
Subcaudate white matter
ViM thalamus
Cingulate bundle
Dorsomedial thalamus
Seorang laki-laki berusia 39 tahun datang dengan riwayat kesemutan selama 6 bulan di jari-jari dan kakinya dalam beberap (?)cape-like pattern dan di ekstremitas atas. Ekstremitas atas lemah di distal 4/5, dan refleksnya secara umum meningkat dengan respons ekstensor plantar (?)
Operasi reseksi dilaniutkan dengan syringe shunt
Operasi reseksi, observasi berkala
Operasi reseksi dikuti dengan terapi radiasi
Operasi drainase dilanutkan dengan antibiotika intravena
Dekompresi foramen magnum
Pada saat melakukan pendekatan pterional, Anterior loop pada arteri karotis interna terletak pada dasar dari triangle
Anterior medial triangle
Lateral triangle
Anterior Lateral triangle
Parkinson's triangle
Posterior medial
Pasien laki-laki 45 tahun dengan keluhan gangguan pendengaran sejak 4 bulan yang lalu. Dari pemeriksaan MRI didapatkan gambaran seperti pada gambar 1. pernyataan di bawah ini yang salah berdasarkan mri yang ditunjukkan...
Cacat sporadis pada gen penekan tumor dapat menimbulkan tumor ini
Nyeri kepala, clumsy gait, dan mental confusion dapat terjadi
Gejala awal dari 90% pasien yaitu kehilangan pendengaran unilateral
Pada dasarnya setiap orang yang telah dirawat karena kelainan tersebut mengalami kesulitan dengan keseimbangan dan pusing sampai tingkat tertenti
Nervus kranial VII seringkali terlibat preoperatif
Pasca operasi setelah C3/4 ACDF, seorang pasien merasakan penurunan keringat di sat sisi wajahnya, dan kelopak mata sedikit turun di sisi yang sama.
traction injury pada cutaneous cervical sensory nerves yang menimbulkan penurnan sensasi berkeringat
stroke intraoperative karena disrupsi carotid plaque
thermal injury pada cabang facial nerve di dalam parotid gland
cedera pada sympathetic chain sepanjang longus colli muscle
retraction injury pada nervus vagus di carotid sheath
A patient with a history of left trigeminal neuralgia has undergone a percutaneous radiofrequency rhizotomy, which gave her 2 years of pain relief. This was followed by stereotactic radiosurgery of the trigeminal nerve root, resulting in absence of her lancinating pain. She now has new left facial pain that is constant and aching. On examination, her left face is anesthetic to light touch and pinprick. What is her diagnosis?
Type 2 trigeminal neuralgia
Trigeminal neuropathic pain
Symptomatic trigeminal neuralgia
Anesthesia dolorosa
Trigeminal deafferentation pain
Pasien perempuan 35 thaun dengan burst fracture L1 pasca kecelakaan lalu lintas. Berikut ini karakteristik yang dapat memprediksi instrumentasion failure short segment
Comminuted fracture dan kifosis
Keterlibatan dua vertebral endolate
Disrupsi kompleks ligamen posterior
Kanal stenosis lebih dari 50%
Keterlibatan diskus level di bawah dan di atasnya
Seorang laki-laki 28 tahun kurus dengan nyeri leher kronis dengan nyeri tumpul pada lengan kiri dan secara lambat progresif kehilangan massa otot di tangan (?). hipestesi pada bagian medial dari lengan bawah da tangan. Sensasi pada distribusi nervus median berkurang. Valsava maneuver tidak meningkatkan keluhan (?)berguna untuk menegakkan diagnosis?
Cervical ultrasound
Chest MRV
Cervical spine MRI
Myelogram
Cervical spine plain radiographs
An 8-year-old girl presents with obstructive triventricular hydrocephalus requiring endoscopic exploration of the ventricular system. What is the most appropriate site for surgical fenestration?
Pineal recess
Septum pellucidum superior to the fornices
Third ventricle floor anterior to the mammillary bodies
Third ventricle floor anterior to the infundibular recess
Lamina terminalis above the su
A 37-year-old man presents with seizures. Which one of the following is NOT thought to increase risk
Intracranial aneurysm
Deep venous drainage
Multiple draining vein
Single draining vein
Prior hemorrhage
Pasien laki-laki, usia 5 tahun, dengan keluhan gangguan berjalan sejak 3 bulan yang lalu. Pasien dilakukan pemeriksaan MRI dan didapatkan seperti pada gambar. Manakah subtype yang memiliki prognosis paling baik?
SHH
WNT
Subgroup 3
Subgroup IDH wild type
Subaroup RTK-driven
Pasien laki-laki 60 tahun dengan keluhan kelemahan sisi kiri mendadak 1 jam yang lalu. Saat in pasien sadar penuh. Pemeriksaan imaging terbaik yang adalah?
MRI sekuens DWI
CT scan kepala
MRI sekuens T2
DSA
CT angiografi
A 66-year old male with a history of ACDF performed 3 months ago presented with a 6 week history of fever, dysphagia, and neck pain. The patient was neurologicallay intact. MR imaging is consistent with cervical osteomyelitis and reveals a retropharyngeal abscess. What test is most helpful to diagnose the source of the infection?
Tagged white blood-cell scan
Peripheral blood cultures
Bone scan
Esophagoscopy
Echocardiogram
During resection of a WHO grade II insular glioma, what white matter language tracts run through the tumor and under the insula?
Arcuate fasciculus and medial longitudinal fasciculus
Uncinate fasciculus and inferior fronto-occipital fasciculus
Inferior fronto-occipital fasciculus and superior longitudinal fasciculus-temporal parietal portion
Uncinate fasciculus and arcuate fasciculus
Superior longitudinal fasciculus Ill and arcuate fasciculus
An endoscope assisted strip craniectomy procedure for an infant with sagittal craniosynostosis, shown in this image, followed by helmet therapy will have the best cosmetic outcome if this is performed at what age
6 bulan
9 bulan
12 bulan
18 bulan
3 bulan
A 50-year-old man experiences frequent recurrent pain on the left side of his throat, near his tonsils. He says that this feels like a hot poker. Assuming a radiographic evaluation is unrevealing which of the following is the first line of therapy ....
Carbamazepine
Phenytoin
Oxycodone
NSAID
Gabapentine
What is the maximal total dose of IV rtPA that can be administered for acute ischemic stroke?
0.9 mg/kg
1 mg/kg
0.6 mg/kg
0.8 ma/kg
0.7 mg/kg
Which one of the following is a reasonable guide for weight increments used in cervical traction with Gardener Wells tongs?
0.5 kg per level
5 kg per level
7.5 kg per level
10 kg per level
2.5 kg per level
Seorang wanita kidal berusia 75 tahun datang ke ruang gawat darurat dengan dugaan awal sebagai sebuah stroke. Tidak ada riwayat infeksi baru-baru ini. 26 merupakan langkah selanjutnya yang paling tepat?
Image guided attempted gross total resection
Stereotactic needle aspiration
Cerebral angiogram
Lumbar puncture and oligoclonal bands
Stereotactic biopsy
MRI lumbosacral ini berasal dari seorang wanita berusia 23 tahun yang datang dengan nyeri punggung bawah yang parah menjalar ke kaki kanannya. Akar saraf mana yang... (?)
Traversing L5 nerve root
Traversing L4 nerve root
Exiting L5 nerve root
Exiting S1 nerve root
Traversing S1 nerve root
Seorang laki-laki 64 tahun datang dengan keluhan sakit kepala hebat dan gangguan penglihatan. CT polos menunjukkan adanya massa di sellae tanpa adanya kelainan akut lain. Dengan kontras gambar dibawah, Manakah dari pilihan berikut ini yang merupakan langkah manajemen paling penting selanjutnya?
Image guided biopsy
Pungsi lumbal
ICP monitoring
Pituitarv profile
Tes lapang pandang
Menurut pedoman AHA untuk manajemen stroke iskemik awal, IV PA harus diberikan dalam rentang waktu berapa setelah onset gejala?
5.5 hours
3.5 hours
2.5 hours
4.5 hours
1.5 hours
Seorang perempuan berusia 48 tahun jatuh pada lengan kanannya yang terulur. Pada pemeriksaan, dia tidak memiliki cedera jaringan lunak atau tulang. Dia kemudian mengalami nyeri yang parah... (?) keringat berlebih di tangan, tremor, dan kulit bersisik di tangan. Apa diagnosis yang paling mungkin?
Conversion disorder
Complex regional pain syndrome
Hyperhidrosis
Ravnaud's disease
Diabetic peripheral neuropathy
Pasien anak usia 15 tahun dengan gangguan keseimbangan dan berjalan sempoyongan sejak 1 bulan yang lalu. Pasien dilakukan MRI didapatkan seperti
Reseksi bedah mural node sampai dengan 1 cm bebas tumor
Reseksi bedah mural node dan seluruh dinding kista
Reseksi bedah pada mural node
Reseksi bedah mural node dengan bukti biopsi tumor positif. Aspirasi cairan kista
Drainase kista untuk menurunkan efek massa
Laki-laki 23 tahun mengalami kecelakaan motor dengan didapati penurunan GCS dari 15 ke 8. Pemeriksaan neurologis didapatkan hemiparesis sinistra dan pupil dilatasi sisi kanan, apa tatalaksana awal berikutnya pada pasien (?)
Intubasi dan hiperventilasi
Bolus mannitol 1 mg/kgBB IV
Infus cepat fosphenytoin 15 - 18 mg/kgBB
Dilakukan burrhole temporal dekstra
Bolus hipertonik salin (3%) 250 ml
During lateral osteophyte removal in an anterior decompressive discectomy, you encounter brisk bleeding in the region of the nerve root. What is the best… (?)
Order blood for transfusion
Explore the vertebral artery
Apply gelfoam and pressure
Angiography embolization
Abort the procedure
Pasien perempuan 52 tahun dengan keluhan sakit kepala, dan hemiparesis sejak 4 jam yang lalu. CT scan dilakukan 2 jam pasca onset. Penatalaksaan pada pasien tersebut?
Evakuasi hematoma
Kraniektomi dekompresi
Hiperventilasi
Observasi dan pengaturan tekanan darah
Pemberian steroid
An otherwise healthy 68-year-old woman presents with 1 week Routine blood work including complete blood count, was normal. Her brain magnetic resonance image is shown, including T1 post contrast and the apparent diffusion coefficient (ADC) images. Which of the following is the appropriate management of her symptoms?
Intravenous broad spectrum antibiotics only
Blood pressure control with antihypertension
Burrhole with aspiration and irrigation
Stereotactic biopsy
Cerebral angiography
A 16 year old male with NF1 presents for follow-up 4 years after a diagnosis of a low-grade optic pathway glioma. After initial progression during early puberty, the tumor has been radiographically stable, no visual decline, What is the patients visual prognosis and need for follow-up?
Vision will likely decline until tumor stabilizes, monitor until stabilization is confirmed.
Vision will likely remain stable; no need for continued follow-up.
Vision will likely decline until end of adolescence; monitor until age 18.
Vision will continuously decline in adulthood; long-term follow-up is needed.
Sisterna apakah yang di dalamnya terdapat arteri koroidalis anterior, arteri posterior serebri, arteri koroidalis posterior medial, dan basal vein Rosenthal?
Quadrigeminal
Ambient
Crural
Interpeduncular
Carotid
Di bawah ini mana yang merupakan gejala cardinal motoric dari penyakit Parkinson yang paling dapat dimungkinkan untuk terapi DBS?
Freezing gait, rigiditas, tremor
Bradikinesia, rigiditas, tremor
Distonia, dyskinesia, tremor
Diskinesia, dystonia, dan freezing gait
Diskinesia, bradykinesia, dan rigiditas
Manakah dari berikut ini yang paling akurat mengenai penempatan pedicle screw torakal?
Entry poin dari titik prosesus transversus bertemu dengan posesus artikularis superior sedikit medial dari pars interarticularis
Bervariasi luas tergantung dari level
Pars interarticularis merupakan landmark yang kurang bermanfaat
Trajektori Straight-head screw paralael ke joint facet
Trajektori screw anatomi sepanjang axis panjang dari pedikel
Pasien usia 23 tahun, perempuan, datang dengan keluhan kelemahan sisi tubuh kanan. Pasien dilakukan DSA dengan hasil terlampir. Dimanakah letak patologi pada pasien tersebut(?)
Supraclinoid internal carotid artery
Cervical internal carotid artery
Middle cerebral artery
Proksimal anterior cerebral artery segmen A1
Distal anterior cerebral artery segmen A1
Berikut adalah tampilan endoskopi (ETV). Lokasi melakukan ventrikulostomi ventrikel III terletak pada...
1
2
5
3
4
With respect to microsurgical resection of vestibular schwannomas, when the facial nerve loses intraoperative proximal electrical responsiveness, what factor is the most predictive of facial nerve recovery postoperatively?
Surgical approach
Anatomical preservation of the facial nerve
Surgery for recurrent tumor
Cystic tumor features
Tumor size
A 65 year old woman on warfarin for her chronic atrial fibrillation, has been diagnosed with an intracerebral hemorrhage after presenting to the emergency. Her INR was found to be 6. What is the best next step in the management of the patient?
Administer cryoprecipitate
Administer Fresh Frozen Plasma
Administer Factor VIII
Observe the patient closely
Ultrasound of the liver and liver function tests
A 16-year-old boy presents with headaches, nausea, and blurred vision. His neurological examination is remarkable for impaired upgaze and convergence nystagmus. Contras MRI was shown. Serum beta HCG and ALF levels are normal. What is the most likely diagnosis?
Immature teratoma
Germinoma
Embryonal carcinoma
Choriocarcinoma
Yolk sac tumor
Berapakah Fisher score pada perdarahan subarachnoid CT scan di gambar?
3
2
4
1
6
What is the best method to screen for cervical spine injury in the unconscious, intubated multitrauma patient?
C-Spine MRI
Fluoroscopic Flexion/Extension Imaging
A/P, Lateral, Oblique, and Open Mouth Odontoid radiographs
Dynamic traction fluoroscop
C-spine CT
Saraf aksila berasal dari struktur mana di bawah ini?
Saraf radial
Kord posterior
Akar saraf C6
Trunk atas, divisi anterior
Trunk bawah
Setelah dipukul di kepala, seorang anak laki-laki berusia 12 tahun mengalami luka lacerasi kulit kepala di atas deformitas tengkorak yang dapat diraba. CT scan dilakukan (Gambar 1). GCS-nya 14. Apa manajemen yang paling tepat untuk cedera ini?
Venticulostomy untuk manajemen ICP
Irrigasi di tempat, debridement, dan penutupan luka
Penutupan luka di tempat dan antibiotik IV
Biarkan luka sembuh dengan niat sekunder
Eksplorasi bedah, elevasi fraktur, dan debridement
Seorang wanita 54 tahun menjalani ACDF C6/7 melalui pendekatan sisi kanan dan tidak memiliki defisit baru pasca operasi. Tiga hari kemudian, dia menga...(?) operasi cervical spina tidak menunjukkan kelainan yang berarti. Manakah dari pilihan berikut ini yang paling mungkin?
Hiperekstensi berlebih saat positioning intraoperatif
Sindrom Parsonage turner
Hematoma epidural
Migrasi cage
Traction injury pada plexus brachialis dari perekat bahu
Saat menempatkan sekrup pedikel sakral bicortical, struktur mana yang paling berisiko dengan sekrup yang ditempatkan secara lateral yang menembus korteks anterior?
Plexus lumbosakral
Akar saraf S1
Aorta
Arteri iliaka internal
Akar saraf L5
Seorang anak laki-laki berusia 9 tahun dibawa ke dokter anaknya dengan sakit kepala dan keterlambatan pertumbuhan. Dia ditemukan memiliki tumor di daerah sella. Histologi menunjukkan:
Kista kolloid.
Astrositoma pilositik.
Kraniofaringioma.
Hamartoma hipotalamus.
Adenoma pituitari.
Saat melakukan pendekatan trans-callosal untuk reseksi kista kolloid ventrikel ketiga, struktur mana yang paling berguna sebagai tanda batas?
Tubuh thalamus
Septum pellucidum
Kepala nukleus kaudatus
Vena septal
Vena thalamostriate
Seorang wanita berusia 35 tahun menjalani reseksi transsphenoidal mikroskopis dari makroadenoma pituitari non-fungsional. MRI pasca operasi menunjukkan tumor residual di sinus kavernosus kanan lateral ICA. Dia tidak memiliki defisit neurologis. Apa langkah selanjutnya yang paling tepat?
Kraniotomi untuk reseksi tumor residual
Manajemen ekspektan
Radiosurgery stereotaktik dari nodul residual
Pengobatan medis dengan cabergoline
Reseksi transsphenoidal endoskopik
Seorang pria berusia 45 tahun datang dengan kejang dan sakit kepala. MRI menunjukkan lesi besar, non-enhancing, hiperintens T2 di lobus frontal kanan.
Meningioma
Oligodendroglioma
Medulloblastoma
Glioblastoma multiforme
Schwannoma
Seorang perempuan berusia 29 tahun pasca kecelakaan motor. Dari pemeriksaan didapatkan hemiparesis sinistra, dan pupil kanan dilatasi tidak reaktif. CT scan kepala ditemukan seperti di ini. apa tindakan yang tepat
Burrhole temporal, drainase hematoma
Tatalaksana konservatif
Hemikraniektomi dekompresi kanan, evakuasi hematoma
Ventrikulostomi, ICP monitoring
Kraniotomi, evakuasi hematoma
A 45-year-old female presents with WFNS grade I Subarachnoid hemorrhage on evening. Vascular imaging reveals a 1.2cm left supraclinoid internal carotid artery aneurism. The operating neurosurgeon specialized in functional neurosurgery and elect to perform the clipping the following morning as there is no aneurysm surgeon available for a further 36 h. During the dissection around the aneurysm, an intraoperative rupture struggle to obtain proximal control leading to intraoperative hypotension from blood loss to prolonged cerebral ischemia from temporary clipping. Post operatively the patient wakes up on the neurointensive care unit with complete hemiplegia and global aphasia. Which one of the following factor is LEAST relevant to surgical complication ?
Situational factors
Team factors
Individual factors
Patient factors
Task factors
A patient presents with chronic neuropathic leg pain two years following an L4-S1 laminectomy for spinal stenosis. A current lumbar spine MRI shows no stenosis or nerve root impingement. Flexion and extension x rays show no evidence of instability What is the most appropriate treatment at this time for his pain?
Lumbar interbody fusion
Radiofrequency facet denervation
Sacrioiliac joint injection
Spinal cord stimulator trial
Provocative lumbar discography
What is the approximate seizure freedom rate in patients following non-lesional resective frontal lobe epilepsy surgery?
60-70%
0-10%
20-30%
80-90%
40-50%
Seorang laki-laki 55 tahun dating dengan gangguan gait progresif dan impotensi. Coronal MRA dan angiogram diunjukkan di lumbar spine. Tidak ada bukti adanya perdarhaan. VHL skrining negative, apa diagnosis ?
Aneurisma artery of Adamkiewicz
Cavernoma
Hemangioblastoma
Type I dural AVF
Type II intramedullary glomus AVM
Wanita 54 th, dating dengan nyeri kepala berulang, dikatakan terdapat avm 4cm ukurannya, terletak di primry motor cortex, drainage depp vein. Berapa nilai SM grade ?
5
2
3
4
1
Pasien laki-laki usia 72 tahun dengan keluhan gangguan bicara sejak 7 hari yang lalu. Pasien tidak ada Riwayat trauma atau konsumsi pengencer darah sebelumnya
Kraniotomi evakuasi hematoma
Drain subdural eksternal
Pemberian asam traneksamat
Burrhole evakuasi hematoma dengan undermining subgalea luas
Irigasi dengan air hangat intraoperatif
A 45-year old female presents with an incidentally discovered lesions as shown in the figure. What is her estimated 5-year risk of hemorrhage or new neurology?
21-30%
11-20%
0-10%
31-40%
41-50%
Seorang pasien 30 tahun dilakukan lobektomi anterior temporal untuk epilepsy intractable sekunder untuk mesial temporal sclerosis. Postoperative, pasien memiliki diplopia baru yang membaik dalam 4 bulan. Tilting his head to the right and tucking his chin improves his symptoms. Kerusakan pada struktur apakah untuk komplikasi ini?
Quadrigeminal plate
Nervus troklearis
Arteri communicating posterior
Loop Meyer
Nervus okulomotor
Manakah dari pernyataan berikut yang paling akurat mengenai vertebra C1?
Tumpuan beban teriadi melalui turbekel anterior
Arteri vertebralis melewati foramen transversarium C1
Memiliki groove untuk arteri vertebralis pada aspek anterior-superior
Titik terlemah adalah pada pertemuan antara arkus anterior dan posterior terhubung pada lateral mass
Memiliki superior facets cekung dan inferior facet cembung
Seorang anak 5 tahun menjalani operasi reseksi medulloblastoma fossa posterior yang dikuti dengan kemoterapi dan radioterapi neuroaxis total dengan boost pada fossa posterior. Apakah komplikasi endokrin yang sering setelah radioterapi pada tumor fossa posterior pada anak-anak?
Sindroma Addison
Peningkatan hormon pertumbuhan
Diabetes insipidus
Sindroma Cushing
Defisiensi hormon pertumbuhan
What is the next appropriate step in management following resection of this tumor?
Radiographic surveillance
Prophylactic antibiotics
Fractionated radiotherapy
Brachytherapy
Intracystic chemotherapy
A 32-year-old recent imigran from southeast asia presents with back pain and a new kyphotic deformity after tripping up in his flat. T1 and T2 W MRI are shown which one of the following is mostly diagnoses?
Pyogenic vertebral osteomyelitis
Multible mveloma
Ankylosing spondylitis
Spinal tuberculosis
Discitis
Manakah di antara berikut yang merupakan prediktor terbaik untuk luaran bebas kejang setelah operasi epilepsi untuk kejang fokal dengan focus epilepsi?
EEG preoperasi dan MRI yang sesuai
Low grade temporal glioma
focus kejang extratemporal
riwavat keiang demam
Mesial temporal sclerosis
A 58 year-old man with history of lung adenocarcinoma presents with headaches. MRI of the brain shows 3 supratentorial lesions, the largest of which is st controlled trials, how is the addition of whole brain radiation therapy likely to affect overall survival?
It is likely to shorten overall survival.
It is likely to lengthen overall survival.
There is conflicting evidence regarding overall survival.
It is likely not to affect overall survival
There is insufficient evidence regarding overall survival.
Which genetic or chromosomal alteration is associated with primary adult glioblastoma?
SMARCB1/INI1 mutation or deletion
1p19a chromosomal deletion
Wnt signaling pathway mutations
EGFR and CDNK2A/CDNK2B mutations
TP53 and ATRX mutations
According to Suzuki and Takaku classification of the angiographic appearance of moyamoya disease, what imaging findings are associated with stage 2?
Near complete disappearance of the major cerebral arteries with the cerebral hemispheres receiving blood from the abnormal extracranial-intracranial ar
Stenosis of the carotid artery at the suprasellar portion with no moyamoya vessels
Moyamoya vessels begin to develop at the base of the brain
Diminishing moyamoya vessels with progression of extracranial circulation
In the case of an intracanalicular vestibular schwannoma, what is the advantage of the middle cranial fossa approach over the retrosigmoid approach?
Decreased risk of injuring the greater superficial petrosal nerve
Decreased risk of CSF leak.
Decreased risk of postoperative seizure
Improved preservation of vestibular nerve function.
Early identification of the distal facial nerve.
Tampilan endoskopi dari dalam sinus sphenoid. Manakah dari label berikut yang secara tepat mengidentifikasi resesus optikokarotis?
E
F
H
D
G
Pasien anak laki-laki, lahir secara per vaginam, didapatkan klinis seperti pada gambar. Bagaimana kemungkinan prognosis status ambulasi pasien lahir dengan mielomeningokel tersebut?
. Ambulasi independen
Berdiri tidak bisa ambulasi
Bukan salah satu di atas
Ambulasi dengan ortose atau alat bantu berialan
Ambulasi dengan kursi roda
A 41 year-old woman undergoes gross total resection for the lesion shown (Figure). Pathology confirms a grade e oligodendroglioma. What is the recommended course of treatment?
Clinical observation
Radiological observation
Radiotherapy
Radiation Therapy and Chemotherapy
Chemotherapy
A 55-year old woman developed a severe headache, acute vision loss, and bilateral ptosis. Examination also reveals complete ophthalmoplegia of both eyes. What is the most likely diagnosis:
Myasthenic crisis.
Complicated migraine.
Pituitary apoplexy.
Kearns-Sayre syndrome
PCOM aneurysm.
Struktur otak apakah yang diperdarahi oleh pembuluh darah yang ditunjuk?
Kapsula interna posterior
Thalamus
Kapsula eksterna
Kapsula interna anterior
Nukleus kaudatus anteromedial
Seorang wanita 35 tahun datang untuk evaluasi nyeri tulang belakang lumbal onset baru. Manakah dari temuan pemeriksaan fisik berikut yang menunjukkan ...
gangguan regional yang tidak mengikutin pola dermatomal
straight-leg raise negative dengan distraksi pasien
nyeri superfisial dan non-anatomik
nyeri nocturnal pada thoracic spine
nyeri dengan kompresi axial lumbar spine
You are seeing a patient with neuropathic lower extremity pain. On examination, repetitive pinprick provokes increasingly severe burning pain on the dorsum of the foot. This phenomenon is called:
Mechanical hyperalgesia
Allodynia
Paresthesia
Tinel sign
Hyperpathia
A 45-year-old woman with colon cancer presents with severe bilateral pain in her abdomen and pelvis due to multiple metastases. Although her pain has been responsive to oral narcotics, escalating doses have given her unacceptable sedating effects. Which of the following interventions would be MOST appropriate in this setting?
Oral buprenorphine trial
Spinal cord stimulation trial
Intrathecal morphine trial
Dorsal root entry zone procedure
Percutaneous cordotomy
What are the borders of Kawase's triangle?
GSPN, arcuate eminence, inferior petrosal sinus, V2
Arcuate eminence, inferior petrosal sinus, V2, V3
V2, V3, and a line from the foramen rotundum and foramen ovale
GSPN, arcuate eminence, superior petrosal sinus, V3
Foramen spinosum, arcuate eminence, superior petrosal sinus, V3
Seorang laki-laki berusia 27 tahun datang dengan kejang tonik-klonik umum. Pada pemeriksaan tidak defisit neurologis sisa ataupun ggn bicara, terdapat beberapa titik kalsifikasi pada CT scan. dilakukan MRI. Manakah dari pernyataan berikut mengenai jenis tumor ini yang KURANG tepat?
Prognosis berkaitan dengan ekstensi dari reseksi
Majoritas pasien dengan lesi pada hemisfer dominan memiliki gejala kejang
Functional mapping merupakan keuntungan tambahan untuk dilakukan reseksi
Penemuan MRS dapat meliputi peningkatan 2-hydroxyglutarate
Batasan tumor biasanya paling baik terlihat pada MRI sekuens T1 dengan kontras
When resecting a brain lesion near the corticospinal tract, what modality is best suited to minimize the risk of motor impairment?
Quantitative subcortical motor mapping
Phase-reversal mapping
Direct cortical stimulation motor evoked potential monitoring
Nerve conduction study
Somatosensory evoked potential monitoring
In a patient with the MRI shown in the figure, a tumor in what other location would increase the probability of (?)
Frontal lobe
Suprasellar region
Orbit
Fourth ventricle
Brainstem
A 40 year-old woman presents with acute headache, mild right arm weakness and a CT scan showing a small hemorrhage in the left frontoparietal region. Cerebral angiogram shows a 4 cm compact, superficial AVM with superficial venous drainage and deep perforating arteries. What factor increases this patient's surgical risk?
Ruptured Presentation
Compact architecture
Superficial venous drainage
Superficial location
Deep perforating arteries
A 68-year-old man presents with progressive neurologic deficit due to a spinal dural arteriovenous fistula fed by the left L4 radicular artery. Treatment for (?)
The anterior spinal artery
The L4 radicular artery
The draining vein immediately distal to the fistula.
The draining vein in the spinal cord.
The arterial feeder immediately proximal to the fistula
Pasien anak laki-laki usia 6 tahun dengan keluhan gangguan keseimbangan, yang paling berberan mempengaruhi progression free survival pada pasien ini?
Ukuran tumor pra operasi
Subgroup tumor
Residu tumor pasca operasi
Hidrosefalus
Usia saat didiagnosis tumor
Seorang pasien datang 7 hari setelah reseksi transsphenoidal adenoma hipofisis dengan sakit kepala, leher kaku, demam dan keluarnya cairan bening dari hidung. Apakah terapi yg paling tepat ?
Endoscopic repair
antibiotik empiris dan CT kepala
Tirah baring dan Lumbar drain
Tirah baring dan pungsi lumbal
External ventricular drain
A 21-year-old female presented to the emergency department after a new-onset seizure. Before this, she was complaining of a severe headache with blurred vision for the last two days. Physical exam demonstrated a somnolent female with normal vital signs and bilateral papilledema. She has mild weakness of her right face, arm, and leg. Computed tomographic (CT) imaging of the head without contrast and CT angio of brain with contrast are shown, which the following is the most appropriate treatment?
IV corticosteroids
Intravenous (IV) antihypertensive
IV unfractionated heparin
Hematoma evacuation
Oral aspirin
A 32 year-old man has surgery for a low grade glioma. What genetic profile is associated with the best prognosis?
IDH wild type without TERT promoter mutation
IDH wild type with TERT promoter mutation
IDH wild type without 1p19q co-deletion
IDH mutation without 1p19q co-deletion
IDH mutation with 1p19q co-deletion
A 9-year-old girl visits her optometrist because of a 1-month progressive history of blurry vision and headaches. The optometrist notes papilledema. What course of action is indicated?
Conformal radiation therapy
Lumbar puncture for cytology and markers
LP shunt insertion
Endoscopic third ventriculostomy
Stereotactic biopsy
Foramen Jugularis terbagi menjadipars nervosa dan pars vascularis, Struktur – struktur apakah yang secara umum ditemukan pada kompartemen anteromedial?
Nervus Kranial X dan XI, Arnold’s nerve, dan jugular bulb
Nervus Kranialis IX, Nervus Jacobson’s dan sinus petrosus inferior
Nervus kranialis IX dan X, dan Jacobson’s nerve
Jugular bulbs dan sinus petrosus inferior
Nervus kranial IX, X, dan XI
Pasien laki-laki 61 tahun menjalani operasi reseksi glioblastoma multiformis. Hasil reseksi 99%. Pasien tidak ada defisit neurologis, KPS 80. Bagaimana tatalaksana?
Radiasi eksternal 30 Gy pada bed tumor dengan temozolamide
Radiasi eksternal 30 Gy pada bed tumor
Radiasi eksternal 60 Gy pada bed tumor
Radiasi eksternal 60 Gy pada bed tumor dengan temozolamide
Radiasi stereotaktik 12 Gy pada bed tumor
Kecepatan konduksi potensial aksi ditandai dengan beberapa parameter. Jika kecepatan konduksi ditemukan meningkat, manakah dari pernyataan berikut yang menurun (?)
Kapasitansi membran efektif
Konsentrasi gradien Na+
Densitas Gerbang Na+ seragam pada sepanjang fiber
Amplitudo potensial aksi
Ratio pada saat gerbang Na+ membuka sebagai bentuk respon depolarisasi
A 60 year old female presents with sudden onset of vertigo, headache, vomiting and imbalance. Her imaging (after 2 days) is shown. What is the cause of this (?)
Cerebellar abscess
Multiple sclerosis
Cerebellar infarct
Cerebellar hematoma
cerebellar astrocytoma
A 57-year-old patient presents with head injury after falling backwards and sudden onset of agitation. Two hours later her blood pressure is 220/110 mmHg (?) shown. Regarding this type of lesion and its location, which one of the following is LEAST likely to be an indication for surgical evacuation?
Compression or loss of visualization of the temporal horns
Distortion, dislocation, or obliteration of the fourth ventricle
Presence of obstructive hydrocephalus.
Neurological dvsfunction or deterioration referable to the lesion
Underlying depressed skull fracture
Which one of the following is LEAST likely to be an indication for surgical evacuation?
Compression or loss of visualization of the temporal horns
Distortion, dislocation, or obliteration of the fourth ventricle
Presence of obstructive hydrocephalus.
Neurological dysfunction or deterioration referable to the lesion
Underlying depressed skull fracture
A 46-year-old female presents with sudden onset right facial numbness, hearing loss, and diplopia. CT head was unremarkable. Which one of the following may be most appropriate based on the subsequent imaging shown?
Intra-arterial nimodipine
Thrombolytic therapy
Balloon Angioplasty
Surgical clipping
Anticoagulant therapy
What combination of IDH and 1p-19q status in diffuse glioma is most predictive of detecting a P53 gene mutation?
IDH mutant, 1p-19q co-deleted
IDH mutant, 1p-19q intact
IDH wild-type, 1p-19q intact
IDH mutant, 1p intact and 19q deleted
IDH wild-type, 1p-19q co-deleted
Laki-laki usia 45 tahun menjalani operasi dengan pendekatan subtemporal untuk kasus tumor dengan elevasidura dari lantai fossa media dan tulang petrosus. pasca operasi, pasien mengeluh penurunan lakrimasi sisi ipsilateral. apakah etiologi yang mungkin pada kasus ini?
Cedera Greater petrosal nerve
Cedera Chorda tympani
Cedera Geniculate ganglion
Cedera vidian nerve
Cedera Lesser petrosal nerve
Pasien dengan keluhan baal pada area yang digambar. Nervus apa yang mempersarafi area tersebut?
Nervus ulnaris
Medial cord
Radialis superfisialis
medial antebrachial cutaneous
Muskulokutaneus
A pineal mass was completely resected and the pathologist diagnoses a mature teratoma. What is the best treatment for this patient?
Craniospinal irradiation
Radiosurgery to the resection cavity
Chemotherapy
Observation
Fractionated local radiation therapy
Pasien perempuan 52 tahun dengan keluhan sakit kepala, dan hemiparesis sejak 4 jam yang lalu. CT scan dilakukan (?)
Kraniotomi evakuasi hematoma
Kraniektomi dekompresi evakuasi hematoma
Hiperventilasi
Pembetian mannitol challenge test
Observasi dan pengaturan tekanan darah
What is the most common presentation of a vein of Galen malformation in an adolescent patient?
Hydrocephalus
Headache or seizure
Hemorrhage
Heart failure
Focal neurological deficit
You are performing a percutaneous radiofrequency lesioning procedure in a patient with V3 distribution trigeminal neuralgia. After placing the electrode into the Gasserian ganglion and performing the test stimulation, the patient report tingling in the V2 distribution. You wish to reposition the electrode to achieve V3 stimulation instead. In which direction will you move the electrode?
Inferior and anterior
Inferior and medial
Inferior and lateral
Superior and lateral
Superior and posterior
Which one of the following statements regarding decompressive craniectomies is LEAST accurate?
Primary decompressive craniectomy is usually performed during evacuation of an acute subdural hematoma due to concerns regarding brain swelling
DECRA trial utilized decompressive craniectomy at tier 2 management of ICP
Secondary decompressive craniectomy is usually undertaken as a last-tier therapy when a patient has intractable intracranial hypertension
DECRA trial has shown the utility of early decompressive craniectomy in neuroprotection
Level I evidence of the effectiveness of decompressive craniectomy for refractory intracranial hypertension is still lacking
During a far lateral approach, exposure of what anatomic structure first indicates that more than the posterior one-third of the occipital condyle has been removed?
The vertebral artery
The anterior condylar vein
The dentate ligament
Transverse ligament of atlas
Jugular bulb
Tempat mask (entry point) untuk pedicle screw toraks paling tepat digambarkan dari berikut ini?
Perpotongan dari pars interarticularis dan lamina
Perpotongan dari inferior facet dan lamina
Perpotongan dari superior facet dan lamina
Perpotongan facet joint dan transverse process
Perpotongan dari transverse process dan lamina
What is the most likely hormone being produced?
Prolactin
ACTH
LH/FSH
GH
ADH
What anatomic structure is indicated by the arrow in this image?
Oculomotor nerve
Trochlear nerve
Trigeminal nerve
Abducens nerve
Glossopharyngeal nerve
A 52-year-old woman with a history of decompressive left hemicraniectomy for a large middle cerebral artery territory infarction presents with new-onset headache, vomiting, and lethargy. Her CT scan is shown in this image. What is the next appropriate step for her management?
Cranioplasty
Surgical evacuation
Contralateral craniectomy
Lumbar spinal fluid drain
A 74-year-old woman presents to the emergency room complaining of vertigo and nausea increasing in severity over the past several hours. CT and MRI studies were performed, and representative images are shown here. This lesion likely represents ?
Primary neoplasm
Acute infarction
Metastatic disease
Arachnoid cyst
Epidermoid cyst
A 17-year-old boy with progressive facial swelling underwent a noncontrast CT scan, shown in this image. This imaging finding is consistent with:
Blastic metastasis
Paget disease
Fibrous dysplasia
Plasmacytoma
What abnormality is depicted on this cervical internal carotid angiogram (Figure S.BSQ)?
Arterial dissection
Takayasu's arteritis
Marfan's syndrome
Fibromuscular dysplasia
None of the above
What abnormality is depicted on this cervical internal carotid angiogram
Arterial dissection
Takayasu's arteritis
Marfan's syndrome
Fibromusculardysplasia
None of the above
a frontal view digital subtraction angiogram folowing a right carotid artery injection is shown in this image. what is the likely etiology of the lesion demonstrated?
atherosklerosis
imune vasculitis
congengital
endocarditis
Neurotransmitter yang paling banyak di basal ganglia adalah
Glycine
Glutamate
GABA
Dopamine
Asetilcholine
Pasien usia 18 bulan dengan BB 11 kg menjalani operasi, mengalami perdarahan sebanyak 250cc. Berapa persen perkiraan kehilangan darah pasien tersebut?
10%
20%
30%
40%
50%
A 21-year-old male complains of 1 year duration of neck pain. He denies any recent trauma. He has noticed intermittent episodes of gait imbalance and difficulty with buttoning his shirt over the past 3 months. Physical exam shows normal strength in all four extremities and hyper-reflexic patellar tendons. Neutral and flexion radiographs are awaited. Which one of the following is the most appropriate treatment?
Physiotherapy
Conservative management with avoidance of contact sport
Soft collar during sports
Posterior C1-C2 fusion
Anterior C1-C2 fusion
Which of the following biomech-nical principles explains why a surgeon should consider fixation in addition to bilateral S] pedicle screws when performing a long segment lumbo-sacral fusion?
80% of the axial load is transmitted through the posterior elements placing more strain on the construct
decreased shear forces occur at the L5-S1 disc placing more strain on the consruct
Increased S1 pedicle diameter prevents greater screw purchase at this level
S1 pedicles are very narrow and are at high risk of break through
The configuration of the sacrum prevents S1 screw placement with bi-cortical purchase
A 39 year old ejected during, a motor vehicle accident is brought into the trauma bay with a GCS of 3.
What is the most appropriate initial management?
CT head and cervical spine.
Assessment of airway.
Arterial blood gas.
Placement of cervical collar.
Mannitol administration.
A patient with an intracerebral hemorrhage is noted to have a positive "spot sign" on a CT angiogram.
This indicates a(n):
Underlying neoplasm
Underlying arteriovenous malformation
Increased risk of hemorrhage expansion
Hypertensive hemorrhage
Underlying arteriovenous fistula
What is the impact of 1 level cervical disc arthroplasty compared to anterior cervical discectomy and fusion (ACDF) on the incidence of radiographic adjacent segment disease (ASD) and need for adjacent level surgery at > 2 years follow up?
cervical arthroplasty results in decreased incidence of radiographic ASD, decreased incidence of adjacent level surgery
cervical arthroplasty results in decreased incidence of radiographic ASD, equal incidenciAof adjacent level surgery
cervical arthroplasty results in increased incidence of radiographic ASD, equal incidence of adjacent level surgery
cervical arthroplasty results in increased incidence of radiographic ASD, increased incidence of adjacent level surgery
cervical arthroplasty results in equal incidence of radiographic ASD, equal incidence of adjacent level surgery
A patient with complete quadriplegia secondary to signal cord injury at C6 is complaining of severe rectal pain. On physical examination, he has complete anesthesia below C7.
Anticonvulsant
NSAID
TENS therapy
Lidocaine patch
Botulinum toxin injection
How do cytotoxic and vasogenic edema differ?
Cytotoxic edema responds better to steroids than does vasogenic edema.
The blood-brain barrier is closed in cytotoxic edema and disrupted in jasogenic edema.
Cells shrink in vasogenic edema but expand in cytotoxic edema.
Cytotoxic but not vasogenic edema occurs after ischemic injury.
Proteins expand the extracellular space in cytotoxic edema.
