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Worksheets

12/24

Total questions: 88

Worksheet time: 56mins

Name
Class
Date
1.

Batas sellar apa yang salah?

a)

Posteriornya clivus

b)

Anterior sphenoid

c)

Bagian superior terdapat diafragma sella

d)

Bagian dasar adalah tulang etmoidalis

2.

Seorang pasien hemiparese 2 jam lalu dengan durasi 30menit kemudian membaik sempurna. dilakukan angiogram terdapat severe stenosis MCA. Tatalaksana?

a)

Konsul neurovascular untuk tindakan angioplasty

b)

Aspirin + CPG

c)

Aspirin

3.

Gambar jejas di sekitar clavicula dan dada, ada gambar vascular doppler. diagnosa?

a)

A. Vertebral Dissection

b)

lupa

c)

lupa

d)

lupa

4.

Gambar MRI axial tumor CPA, di tunjuk artery di bagian medialnya agak besar, apa itu?

a)

SCA

b)

AICA

c)

PICA

5.

Operasi skullbase fosa media, dura dielevasi, landmark superior sircular cannal apa?

a)

Arcuate Iminens

b)

Lupa

c)

Lupa

6.

A 65-year-old female develops slurred speech and mild right arm weakness. Her husband calls emergency medical services, and the patient is transported to a nearby Primary Stroke Center as a stroke alert. Her last known normal was 2 hours ago. In accordance with the hospital's stroke alert protocol, the patient undergoes non-contrast head CT and CT angiography, which demonstrate an area of suspected ischemia in the territory of a small branching vessel of the left middle cerebral artery. There is no evidence of hemorrhage or large vessel occlusion. The patient has no contraindication to intravenous (IV) tPA if indicated. Which of the following are the most appropriate treatment and disposition? (BCR) (kalau ga salah soalnya di ganti jika tidak LVO)

(Tidak ada kunci)

a)

Administer IV tPA and admit the patient to the hospital's stroke unit

b)

Initiate IV tPA and transfer to a Comprehensive Stroke Center for admission

c)

Initiate IV tPA and transfer to a Comprehensive Stroke Center for mechanical thrombectomy

d)

Transfer the patient to a Comprehensive Stroke Center immediately without starting IV tPA

7.

Faktor apakah yang paling mempengaruhi terjadi nya sakit kepala setelah lumbal fungsi?

(Tidak ada kunci)

a)

Kecepatan aliran lumbal pungsi

b)

Kurang hidrasi pasca lumbal pungsi

c)

lupa

d)

lupa

8.

Gambaran MRi axial, kontusio di brainstem anterolateral . struktur apa yg kena?

tidak ada kunci

a)

Spinothalamic tract

b)

Kortikospinal tract

c)

lupa

9.

Gambar mri coronal ada lesi kistik sellar, gangguan visus unilateral pituitari terdorong kemana?

(tidak ada kunci)

a)

Anterolateral kanan

b)

Posterlateral kanan

c)

Inferolateral kanan

d)

Superolateral kanan

e)

Superolateral kiri

10.

Gambar mri coronal ada lesi kistik sellar, ditunjuk bagian atas pituitari itu struktur apa? (gambar sama dengan no. 10)

tidak ada kunci

a)

Acom

b)

Stalk

11.

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?

a)

Identifikasi segitiga Trautman, dan ekspos ke arah medial dari landmark ini

b)

Drilling lebih lanjut arcuate eminence

c)

Drilling lebih lanjut dari segitiga Glasscock

d)

Ekspos tambahan melalui kawase quadrilateral

e)

Modifikasi pendekatan dengan, mengutilisasi koridor presigmoid

12.

Manakah dari berikut ini yang paling akurat mengenai penempatan pedicle screw torakal?

a)

Entry poin dari titik prosesus transversus bertemu dengan posesus artikularis superior sedikit medial dari pars interarticularis

b)

Bervariasi luas tergantung dari level

c)

Pars interarticularis merupakan landmark yang kurang bermanfaat

d)

Trajektori Straight-head screw paralael ke joint facet

e)

Trajektori screw anatomi sepanjang axis panjang dari pedikel

13.

Sel apa yg paling banyak di cns

(tidak ada kunci)

a)

Astrocit

b)

Neuron

c)

Microglia

d)

Ependym

e)

Oligodendroglia

14.

Sel apa yg paling banyak di cns

a)

Astrocit

b)

Neuron

c)

Microglia

d)

Ependym

e)

Oligodendroglia

15.

Keberhasilan fusi pada anak kecil ap, kecuali?

Tidak ada kunci

a)

laminectomy 1-2 level

b)

...

16.

Gambar quadranopsia superior dextra, struktur apa yg terkena?

Tidak ada kunci

a)

meyer loop

b)

optic trac

c)

occipital

d)

thalamus

17.

Stimulation in what peri-Sylvian region would most likely cause speech arrest during awake speech mapping?

a)

Gyrus angularis

b)

Gyrus supramarginalis

c)

Pars opercularis

d)

Pars orbitalis

e)

Pars triangular

18.

(Gambar PA tidak ada keterangan klinis)

a)

WHO Gr I

b)

WHO Gr 1-2

c)

WHO Gr 2-3

d)

WHO Gr 3-4

19.

Materi ini masuk dalam dua soal CBT. Membahas tentang PA bentuk rosette

Jawabannya
- Esthesioneuroblastoma
- terapi surgery dan radiasi

4 lines
20.

Translabyrinthine, trautmann triangle batas"nya kayaknya pilihannya

(tidak ada kunci)

a)

foramen Magnum

b)

jugular vein

c)

lateral --> sinus sigmoid

d)

vidian artery

e)

petrous nerv

21.

Yolk sac tumor, true ?

(tidak ada tumor)

a)

AFP (+)

b)

B-hCG (+)

c)

schiller duval bodies

d)

PLAP (+)

22.

Ada tumor letaknya di daerah meckel cave T1 hiperintense, T2 hiperintense, ADC hiperintense

tidak ada kunci

a)

cholesterol granuloma

b)

trigeminal schwannoma

23.

Berdasarkan denis yg paling tidak stabil kerusakan pada mana :

tidak ada kunci

a)

Anterior half of the bodies

b)

Posterior longitudinale lig.

c)

Anterior lobgitudinale lig.

d)

Ligamentum Flavum

24.

Ada soal tentang Saraf innervasi otot, gerakan, dan refleks juga.

4 lines
25.

A frontal DSA foloowing right carotid artery injection is shown in this image. What is the likely etiology of the lesion demonstrated?

a)

Endocarditis

b)

Atherosclerosis

c)

Immune vasculitis

d)

Congenital

26.

Pasien laki-laki, kecelakan bermotor, pasien sadar, gada nyeri, ga ada defisit neurologis, pemeriksaan paling minimal apa yang dilakukan?

a)

No Radiological study

b)

CT scan cervical potongan tipis

c)

Xray Cervical AP/Lat

27.

Neurophysiological monitoring during translabrynthine resection of a vestibular schwannoma with minimal extension into the cerebellopontine angle includes which of the following?

a)

BAER and IX, X, XI nerve

b)

SSEP and VII nerve

c)

BAER and VII nerve

d)

BAER and SSEP

28.

(Gambar intraoperasi ETV, tampak lamina terminalis sudah jebol) Struktur yang ditunjuk panah kuning?

a)

Hipothalamus

b)

Mammilary body

c)

Thalamus

d)

Head of caudate nucleus

29.

Vestibular schwannoma, ada pembuluh darah diantara basilar dan tumor , yang ditanyakan grading koos (III) (Gambarnya beda)

4 lines
30.

A 53-year-old male had a left acoustic neuroma resected 5 months ago and has had severe, throbbing left-sided headaches that began the week of the resection. He rarely had headaches before surgery. His headaches are without associated symptoms and are not positional. The only relief he gets is from opioid analgesics. What is the next best step in management?

a)

Psychiatric referral

b)

⁠Physical examination

c)

Change to a different opioid analgesic

d)

MRI of the brain with contrast

31.

A 28-year-old left-handed female who is 14 weeks pregnant presented to the emer-gency department with worsening headache, vomiting and drowsiness. CT head scan showed a large right frontal tumor with sig-nificant edema. After 48 h of dexamethasone her headache has improved but she still has a mild left-sided arm weakness. Which one of the following would be most appropriate?

(tidak ada kunci)

a)

Permit gestational advancement to second trimester

b)

Craniotomy and tumor resection followed by chemoradiotherapy

c)

Cesarean section followed by neuro-surgery

d)

Iatrogenic termination followed by neuro-surgery

e)

Radiotherapy alone until fetal maturity established

32.

A 55-year-old male presents with progressive gait disturbance and impotence. Coronal Magnetic resonance angiogram and angio-grams are shown in the lumbar spine. There is no evidence of hemorrhage. VHL screen is negative. Which one of the following diag-noses is most likely?

a)

Aneurysm of artery of Adamkiewicz

b)

Cavernoma

c)

Hemangioblastoma

d)

Type I Dural AVF

e)

Type II intramedullary glomus AVM

33.

An 82-year-old woman presents to the neurosur-gery clinic with typical trigeminal neuralgia. She has substantial medical comorbidities and would like to avoid surgery. The patient opts for stereo-tactic radiosurgery. What factor would predict a favorable outcome?

a)

Absence of atypical pain

b)

Using a radiation dose less than 60 Gy

c)

Prior successful surgical microvascular decompression

d)

Decreased sensation in the affected nerve prior to treatment

e)

Trigeminal neuralgia related to multiple sclerosis

34.

How much of the superior sagittal sinus can be sacrificed without a high risk of inducing venous infarctions?

a)

Anterior two thirds

b)

No more than one third of any portion

c)

Anterior one third

d)

Entire sinus as long as the cortical bridging veins are left intact

e)

None of the sinus but all of the cortical bridg-ing veins can be sacrificed without risk of venous infarctions.

35.

What is the most common location for dural arteriovenous fistulae to drain?

a)

Superior sagittal sinus

b)

Junction of the transverse and sigmoid sinus

c)

Cavernous sinus

d)

Inferior petrosal sinus

e)

Junction of the sigmoid sinus and jugular vein

36.

During an endonasal transsphenoidal approach, what structure limits the working space and ma-neuverability of the instruments?

a)

Inferior turbinate

b)

Middle turbinate

c)

Superior turbinate

d)

Anterior nasal septum

37.

A 58 year-old right handed male presents with bifrontal headaches and a partial left ophthalmoplegia. MRI results are shown. Biopsy revealed this tumor to be a chordoma. An extensive subtotal skull-based resection was performed. Which is the best choice for adjuvant therapy regimen?

a)

Proton beam radiotherapy

b)

Brachytherapy

c)

Stereotactic radiosurgery

d)

Conventional fractionated radiotherapy

e)

Procarbazine, CCNU and vincristine (PCV) chemotherapy

38.

Parkinsonian tremor can be diminished by high frequency stimulation of:

a)

Globus pallidus externa

b)

Subcaudate white matter

c)

ViM thalamus

d)

Cingulate bundle

e)

Dorsomedial thalamus

39.

What is conraindication for posterior foraminotomy as a treatment for cervical radiculopathy due to disc herniation?

a)

Degenerative changes at other level

b)

Ipsilateral vocal cord palsy

c)

Khypotic neck deformity

d)

Associated osteophyte formation

e)

Central disc herniation

40.

Pasien anak laki laki, lahir secara pervaginam, didapatkan klinis seperti pada gambar. bagaimana kemungkinan

a)

Ambulasi independen

b)

Berdiri tidak bisa ambulasi

c)

bukan salah satu diatas

d)

Ambulasi dengan ortose atau alat bantu berjalan

e)

Ambulasi dengan kursi roda

41.

Gambaran MRI Fibrous dysplasia os frontal udh operasi. Tumbuh lagi. Tatalaksananya, kecuali (pertanyaannya kalo ga salah kontraindikasinya)

a)

observation

b)

re surgery

c)

radioterapi

d)

Kemoterapi

e)

Imunoterapi

42.

A 45 yeard old male undergoes a subtemporal approach for tumor resection with elevation of the dura from the middle fossa floor and petrous bone.

Post operatively the patient has decrease lacrimation on ipsilateral side. What is etiology problem?

a)

geniculate ganglion injury

b)

Lesser petrosal nerve injury

c)

Greater petrosal nerve injury

d)

Chorda tympani injury

e)

Injury of Jacobson nerve

43.

A 76-year-old female is undergoing microsurgery

clipping of anterior communicating artery (ACOM) aneurysm. Intraoperatively, there is an inadvertent injury to the recurrent of Huebner (RAH). However, other perforators are well. The postoperative CT image, however, shows hypodens involving the caudate head, anterior limb of the internal caudate well as putamen. What is the most likely cause of the radiology findings?

a)

Diffuse vasospasm

b)

Seizure

c)

Rete communication of RAH with other lenticulostriate from ACA and MCA

d)

Injury to parent ACA vessel

44.

A 30-year-old woman presents for her 1 month follow up after bilateral optic nerve sheath fenestration for malignant pseudotumor cerebri syndrome. Her incisions are healing well, and her orbital edema is resolving, and her eye movements are full. However, her visual fields appear to be worsening despite the apparent improvement of her optic nerve edema clinically and by optical coherence tomography. She continues on 500 mg of PO acetazolamide twice a day but continues to have headaches with pulsatile tinnitus. What is the most likely cause of her symptoms despite the improvement of her edema?

a)

Residual orbital edema that can be observed for now

b)

⁠Development of orbital pseudomeningoceles requiring re-fenestration of the nerves to relieve pressure

c)

Continued intracranial pressure elevation causing optic nerve compression and axonal loss producing optic atrophy

d)

⁠Functional vision loss from stress related her recent diagnosis and surgery

45.

Seorang anak laki-laki berusia 12 tahun mengeluhkan kehilangan penglihatan mata kiri dan sakit kepala sesekali. Evaluasi endokrin menunjukkan adanya diabetes inspidus ringan dan hipotiroidisme. Gambaran MRI ditunjukkan pada Gambar dibawah. Anda merekomendasikan upaya reseksi tumor secara total. Komplikasi apa yang paling mungkin terjadi?

a)

Hydrocephalus

b)

Kebutaan

c)

Gangguan kejang

d)

Pan-hipopituitarism

e)

Mutisme

46.

A 67-year-old woman presents to the emergency room following a motor vehicle collision with a large right-sided subdural hematoma and uncal herniation seen on CT. The Glasgow Coma Scale score is 5. She has a dilated and nonreactive right pupil. She has flexor posturing on the left side and is hemiplegic on the right side. What is the most likely explanation for her right-sided hemiplegia?

a)

Uncal compression of the right midbrain

b)

Compression of the left midbrain

c)

Diffuse axonal injury involving the right internal capsule

d)

Spinal cord injury

e)

Left-side Duret hemorrhages in the pons

47.

A 32-year-old recent immigrant from Southeast Asia presents with back pain and a new kyphotic deformity after tripping up in his flat. T1and T2 WMRI are shown. Which one of the following is most likely diagnosis?

a)

Ankylosing spondylitis

b)

Discitis

c)

Multiple myeloma

d)

Pyogenic vertebral osteomyelitis

e)

Spinal tuberculosis

48.

pertanyaannya lupa, gambarnya kira2 seperti ini (lesi dimanakah ini?)

a)

Meyers loop

b)

Optic tract

c)

Chiasma

d)

Primasy visual cortex

49.

A surgeon decides to utilize an infratentorial­ supra cerebellar corridor to approach a pineal region mass. What blood vessel is frequently cauterized and divided for better exposure of the posterior surface of the tumor during this approach?

a)

Vein of galen

b)

Ipsilateral basal vein of Rosenthal

c)

Posterior cerebral artery

d)

Precentral cerebellar vein

e)

Superior petrosal sinus

50.

What structure does the arrow point to in the figure?

a)

Superior ophthalmic vein

b)

Superior petrosal sinus

c)

Inferior petrosal sinus

d)

Avernous sinus

e)

Internal jugular vein

51.

Gambaran DSA ECA tampak feeder tumor (Convexity meningioma Frontal kiri) Ditanya feeder tumor

tidak ada kunci

a)

ACA + MMA

b)

STA + ACA

c)

STA + ethmoidal artery

52.

Gambaran DSA blush tumor, feeder bernasconi dan cassinary artery, yang ditanya diagnosis?

tidak ada kunci

a)

Tentorial menignioma

b)

--

c)

--

53.

Gambaran MRI pada anak MRI nya beda sama sans

(a)  

54.

SANS


(a)  

55.

SANS, pungsi lumbal

(a)  

56.

Apa komplikasi paling umum dari anterior cervical discectomy and fusion (ACDF)?

a)

Suara serak

b)

Radikulopati baru

c)

Sindrom Horner

d)

Disfagia

e)

Cedera duktus toraks

57.

Soal tentang central tegmental tract

(a)  

58.

Gambar DSA, drainase basal vein rosentral

(a)  

59.

SANS. contraindikasi? Central disc herniation

(a)  

60.

A pericallosal aneurysm would be found at which location on the lateral projection angiogram shown?

a)

A

b)

B

c)

C

d)

D

e)

E

61.

Pasien anak laki-laki lahir secara pervaginam didapatkan klinis seperti gambar. Bagaimanakah penatalksaan yang tepat?

a)

penutupan defek dalam 24 jam

b)

penutupan defek dalam 72 jam

c)

penutupan defek segera

d)

penutupan defek efektif saat usia 3 bulan

e)

Konservatif

62.

Foto klinis pasien asli dengan cele di nasal, MRI protusi brain melalui sinus ethmoid masuk ke nasal, CT scan defek di sinus ethmoid. Jawaban?

(a)  

63.

Dari gambar berikut, dx apa yang paling mungkin?

a)

Hydranencephaly (Gangguan migrasi seluler)

b)

Alobar Holoprosencephaly

c)

Lobar Holoprosencephaly

d)

Anencephaly

e)

Severe hydrocephalus

64.

You plan to perform a foramen magnum decompression on the patient shown below. Which one of the following investigations may be helpful?

a)

CSF flow study

b)

CT cisternography

c)

CT cervical angiogram

d)

Flexion / extension X-Rays

e)

Nerve conduction studies

65.

Soal anak2 dgn VSD post tindakan penutupan defek, setelah beberapa hari mengeluh lumpuh. Gambaran MRI ada lesi extradural mixintense (mirip EDH spinal)

tidak ada kunci

a)

Epidural hematoma

b)

Spinal lipomatosis

c)

Lainnya lupa

66.

Efek peningkatan pCO2?

(a)  

67.

MRI HNP lumbal L4-5, potongan axial herniasi posterolateral kanan (keliatannya belum masuk foraminal)

Tidak ada kunci

a)

Exiting L4

b)

TransversingL4

c)

Exiting L5

d)

Transversing L5

68.

A 58-year-old male who sustained traumatic fractures to the upper cervical spine following a motor vehicle accident. After a detailed evaluation of the fracture characteristics and imaging studies, you recommend posterior instrumentation and fusion from the occiput to C2. The patient asks you how would this affect his range of motion. You should inform him that he would probably experience which one of the following?

a)

A decrease in cervical spine rotation of 50%.

b)

A decrease in cervical spine flexion-extension of 50%.

c)

Decrease of cervical spine rotation of 50% and a decrease of cervical spine flexion-extension of 50%.

d)

Decrease of cervical spine rotation of 50% and a decrease of cervical spine flexion-extension of 10%.

69.

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?

a)

Aponeurosis muskulus biseps

b)

Transverse ligament pada carpal tunnel

c)

Arcade of struthers

d)

Ligamentum pada guyon canal

e)

Aponeurosis fasia pada cubital tunnel

70.

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 it is performed at what age?

a)

18 Months

b)

12 Months

c)

9 Months

d)

6 Months

e)

3 Months

71.

Which of the following are the cardinal motor symptoms of Parkinson disease (PD) that are most amenable to treatment with deep brain stimulation (DBS)?

a)

Dystonia, dyskinesia and tremor

b)

Dyskinesia, bradykinesia and rigidity

c)

Freezing of gait, rigidity and tremor

d)

Dyskinesia, dystonia and freezing of gait

e)

Bradykinesia, rigidity and tremor

72.

Berikut adalah tampilan endoskopi (ETV). Lokasi melakukan ventrikulostomi ventrikel III terletak pada

a)

2

b)

1

c)

3

d)

4

e)

5

73.

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 a(n):

a)

Primary neoplasm

b)

Acute infarction

c)

Metastatic disease

d)

Arachnoid cyst

e)

Epidermoid cyst

74.

Gambaran klinis yang PALING umum dari kejang lobus temporal mesial adalah?

a)

Gerakan bersepeda iktal.

b)

Automatisme oral iktal.

c)

Aura visual.

d)

Postur distonik ipsilateral

75.

Otot mana yang lemah pada hasil pemeriksaan radiologi ini?

a)

Gastrocnemius

b)

Tibialis anterior

c)

Extensor hallucis longus

d)

Iliopsoas

e)

None of above

76.

Axial T2 and postcontrast T1-weighted imaging of the lumbar spine are shown in these images. To what does the abnormality indicated by the arrow correspond?

a)

Disk protrusion

b)

Epidural scar

c)

Disk extrusion

d)

Epidural abscess

e)

Sequestered disk

77.

What is a characteristic of the lesion depicted in this CT image?

a)

Limited by sutures

b)

Usually crosses the midline

c)

Most commonly due to an arterial injury

d)

Occurs between the inner and outer layers of the dura

e)

Limited by dural reflections

78.

What is a characteristic of the injury shown on this CT scan?

a)

Combined offset of the lateral C1 masses relative to C2 greater than 6 mm, which suggests disruption of the alar ligaments

b)

Frequently associated with diving head first into shallow water

c)

⁠High frequency of neurologic injury

d)

Most commonly occurs in infants and young children

e)

Most commonly occurs in infants and young children

79.

Which one of the following is labeled X in the image below?

a)

Ophthalmic division of the trigeminal nerve

b)

Meckel’s cave

c)

Oculomotor nerve

d)

Maxillary division of trigeminal nerve

e)

Abducens nerve

80.

Which one of thef ollowing is most likely in a child with the below MRI appearance pre- senting with increasing head circumference and shortness of breath?

a)

Cavernous malformation

b)

Developmental venous anomaly

c)

Dural AV fistula

d)

Tentorial AVM

e)

Vein of galen malformation

81.

A 50-year-old man complains of 2 days' double vision. Has abducting nystagmus in the right eye and vertical gaze is preserved bilaterally. Which one of the following is most likely?

a)

Left internuclear ophthalmoplegia

b)

Orbital apex syndrome

c)

Left incomplete oculomotor palsy

d)

Superior orbital fissure syndrome

e)

Left one-and-a-half syndrome

82.

Which of the following structures represents a potential site of ulnar nerve entrapment?

a)

Bicipital aponeurosis

b)

Supinator muscle

c)

Pronator teres muscle

d)

Osborne ligament

e)

Struther ligament

83.

A 37-year-old man was diagnosed at age 25 when he had his first generalized tonic-clonic seizure while bowling. He was then noted to have complex partial seizures during which he would repeatedly respond by saying “what” to all questions, lip smack, and throw up his right arm. He was unaware of any auras and was amnestic for his seizures. Most of his seizures were from sleep with a frequency of about 2 per week. He had been involved in sev- eral car accidents secondary to seizures. Which one of the following is most likely?

a)

Absence seizure

b)

Complex partial seizure

c)

Focal motor seizure

d)

Generalized tonic-clonic seizure

e)

Simple partial seizure

84.

Examination of which of the following movements is most helpful in distinguishing an L4 radiculopathy from a femoral neuropathy?

a)

Ankle plantar flexion

b)

Knee extension

c)

Hip flexion

d)

Knee flexion

e)

Thigh adduction

85.

Which of these treatments influences the incidence of chronic subdural hematoma (cSDH) recurrence?

a)

Tranexamic Acid

b)

Burr hole drainage

c)

Amount of irrigation

d)

External subdural drain

e)

Craniotomy

86.

Which one of the following clinical findings would you look for in this patient?

a)

Abducens palsy

b)

Absent corneal reflex

c)

Bitemporal hemianopia

d)

Oculomotor palsy

e)

Pituitary dysfunction

87.

A 75-year-old man with a history of recent memory impairment is admitted with headache, confusion, and a left hom- onymous hemianopsia. There is no history of hypertension or malignancy. Non- contrast CT scan and GRE MRI are shown. Which one of the following is the most likely cause of this patient‘s symptoms and signs?

a)

Multi-infarct dementia

b)

Mycotic aneurysm

c)

Amyloid angiopathy

d)

Undiagnosed hypertension

e)

Gliomatosis cerebri

88.

A 40-year-old male without a significant past medical history presents with a severe headache that started about 14 hours ago. The patient was asleep when his headache started. The patient denies any head trauma and a family history of stroke or sudden death. CT brain without contrast is negative. On physical examination, blood pressure is 200/115 mm Hg, respiratory rate is 25/minute, pulse rate 100/minute, and oxygen saturation is 99% on ambient air. The patient is awake, alert, oriented, and can move all extremities. Which of the following is the best next step in management?

a)

CT angiography head and neck

b)

Magnetic resonance angiography head and neck (MRA)

c)

Lumbar puncture

d)

Digital subtraction angiography

e)

CT Head contrast