MedCosmos Surgery
Surgery Lecture Notes, Books, MCQ and Good Articles
Saturday, September 6, 2008
NeuroSurgery MCQ
1. Which of the following are true about the history of neurosurgery?
A. The history of trepanation dates back to the Neolithic period.
B. The earliest known writing dealing with surgical topics is the Ebers
papyrus.
C. The writings of Hippocrates contain the first recorded descriptions
of trepanation.
D. The three key developments that were necessary to permit
successful intracranial and intraspinal surgery were anesthesia,
asepsis, and the concept of localization of different functions in
different areas of the nervous system.
E. Victor Horsely of London was the first surgeon to specialize in
neurosurgery.
Answer: ACDE
DISCUSSION: Many skulls from the Neolithic period have been found,
some of which contain cranial defects with evidence of bone healing,
indicating that these individuals underwent trepanation during life
and survived the operation. The earliest known writing dealing with
surgical topics is the Edwin Smith papyrus. In the works of
Hippocrates is the first written account of trepanation. During the
second half of the nineteenth century, general anesthesia was
introduced and the principles of asepsis were developed. These steps
were important for all areas of surgery, including neurosurgery. In
addition, it became recognized that certain areas of the nervous
system were especially important for certain neurologic functions and
that intracranial and intraspinal abnormalities might be localized by
the history and neurologic examination findings, thus providing a
more specific target for neurosurgical exploration through the small
bony openings to which surgeons were restricted at the time. Victor
Horsley of London was the first surgeon to prepare himself
specifically for surgery of the nervous system and to concentrate his
efforts in that area.
,2. The neurosurgeon who has had the most profound influence on
the development of neurosurgery is:
A. Fedor Krause of Germany.
B. William Macewen of Scotland.
C. Harvey Cushing of the United States.
D. Egas Moniz of Portugal.
E. Goeffrey Jefferson of England.
Answer: C
DISCUSSION: Harvey Cushing (1869–1939) laid the groundwork for
much of what is done in neurosurgery. For example, he standardized
operative procedures and introduced many techniques and
instruments that are still in use. He also made careful and detailed
studies of intracranial tumors and established their classification. By
his own multifaceted career and through his many students from
around the world he influenced the development of neurosurgery to a
degree not equaled before or since.
3. Which of the following conditions can be evaluated by magnetic
resonance imaging (MRI)?
A. Stroke is suspected in a patient with a cardiac pacemaker.
B. Computed tomography (CT) shows a skull base tumor.
C. A coma patient with CT-demonstrated subarachnoid hemorrhage
and an aneurysmal clip.
D. A patient with intractable complex partial seizure.
E. A lung cancer patient whose plain film of the lumbar spine shows a
compression fracture of the L2 vertebral body.
Answer: BDE
DISCUSSION: MRI has proved to be a better modality than CT for
evaluation of disease of the central nervous system (CNS), such as
diseases at the base of the skull (particularly the sellar and
cerebellopontine angle cistern regions) and for most tumors, white
matter disease (e.g., multiple sclerosis), early stroke, congenital
abnormalities, vascular malformations, and spinal disease. New
techniques of MRI such as fast spin echo (FSE) pulse sequence have
been developed to detect mesial temporal sclerosis, which is the most
common cause of intractable complex partial seizure. Differentiating
pure compression fracture from metastatic disease of the vertebral
bodies in a patient with known primary cancer is also possible by new
MRI technique; however, for patients with certain types of metal
(pacemaker, surgical clip, or foreign body, which may move in the
magnetic field and cause injury to the patient or significant artifacts)
within the bodies, MRI is contraindicated.
, 4. Which of the following statements about neuroradiologic imaging
modalities is/are correct?
A. Diffusion-weighted MRI can differentiate tumor from edema and
identify the nonenhancing part of the tumor.
B. For evaluating the stenosis of the carotid bifurcation, MR
angiography (MRA) is the most accurate imaging modality.
C. Myelography is still useful in detecting some diffuse spinal disease
such as cerebrospinal fluid (CSF) seeding.
D. For evaluating the bony detail of patients with facial trauma, CT is a
better imaging modality than MRI.
E. Decreased amount of N-acetyl aspartate (NAA) and increased
amount of lactate can be shown in the MR spectroscopy (MRS) of a
patient with acute stroke.
Answer: ACDE
DISCUSSION: Diffusion-weighted MR is a new development in MR
applications and is sensitive to microscopic motion of water protons
(Brownian motion). Initial applications have involved imaging of early
stroke and neoplasia. Early evidence also suggests that diffusion-
weighted imaging can differentiate tumoral edema from tumor and
identify the nonenhancing part of the tumor. Doppler sonography,
MRA, and CT angiography (CTA) are all useful for evaluating the
stenotic condition of carotid bifurcation noninvasively. However,
sonography is very operator dependent, and MRA commonly
overestimates the degree of carotid stenosis resulting from the
turbulence, dephasing at points of stenosis or irregularity. CTA
obtained by spiral or helical CT has a good correlation rate with
carotid angiography (92%). Conventional carotid angiography remains
the most accurate imaging modality for evaluation of the stenosis of
carotid bifurcation. Although CT and MRI have taken the place of
myelography in evaluating neurologic diseases, it is still useful in
detecting diffuse subarachnoid seeding, which may be difficult to
identify on MRI. The bone detail and calcification are poorly identified
on MR, so in a patient with facial trauma, CT is a better modality than
MR. With MRS, metabolites within a selected region of interest (ROI)
can be investigated, and spectral peaks that reflect the concentrations
of the metabolite within the ROI can be obtained. The metabolites
include lactate, neuronal marker (NAA), phosphorus metabolites,
creatine, and choline. Reduction in the NAA level and elevation in
lactate level could be noted in acute stroke.
5. Which of the following are true about intracranial tumors?
A. The most common location of brain tumors of childhood is the
posterior cranial fossa.
B. With few exceptions, examination of the CSF is of no value in the
diagnosis of an intracranial tumor.
Surgery Lecture Notes, Books, MCQ and Good Articles
Saturday, September 6, 2008
NeuroSurgery MCQ
1. Which of the following are true about the history of neurosurgery?
A. The history of trepanation dates back to the Neolithic period.
B. The earliest known writing dealing with surgical topics is the Ebers
papyrus.
C. The writings of Hippocrates contain the first recorded descriptions
of trepanation.
D. The three key developments that were necessary to permit
successful intracranial and intraspinal surgery were anesthesia,
asepsis, and the concept of localization of different functions in
different areas of the nervous system.
E. Victor Horsely of London was the first surgeon to specialize in
neurosurgery.
Answer: ACDE
DISCUSSION: Many skulls from the Neolithic period have been found,
some of which contain cranial defects with evidence of bone healing,
indicating that these individuals underwent trepanation during life
and survived the operation. The earliest known writing dealing with
surgical topics is the Edwin Smith papyrus. In the works of
Hippocrates is the first written account of trepanation. During the
second half of the nineteenth century, general anesthesia was
introduced and the principles of asepsis were developed. These steps
were important for all areas of surgery, including neurosurgery. In
addition, it became recognized that certain areas of the nervous
system were especially important for certain neurologic functions and
that intracranial and intraspinal abnormalities might be localized by
the history and neurologic examination findings, thus providing a
more specific target for neurosurgical exploration through the small
bony openings to which surgeons were restricted at the time. Victor
Horsley of London was the first surgeon to prepare himself
specifically for surgery of the nervous system and to concentrate his
efforts in that area.
,2. The neurosurgeon who has had the most profound influence on
the development of neurosurgery is:
A. Fedor Krause of Germany.
B. William Macewen of Scotland.
C. Harvey Cushing of the United States.
D. Egas Moniz of Portugal.
E. Goeffrey Jefferson of England.
Answer: C
DISCUSSION: Harvey Cushing (1869–1939) laid the groundwork for
much of what is done in neurosurgery. For example, he standardized
operative procedures and introduced many techniques and
instruments that are still in use. He also made careful and detailed
studies of intracranial tumors and established their classification. By
his own multifaceted career and through his many students from
around the world he influenced the development of neurosurgery to a
degree not equaled before or since.
3. Which of the following conditions can be evaluated by magnetic
resonance imaging (MRI)?
A. Stroke is suspected in a patient with a cardiac pacemaker.
B. Computed tomography (CT) shows a skull base tumor.
C. A coma patient with CT-demonstrated subarachnoid hemorrhage
and an aneurysmal clip.
D. A patient with intractable complex partial seizure.
E. A lung cancer patient whose plain film of the lumbar spine shows a
compression fracture of the L2 vertebral body.
Answer: BDE
DISCUSSION: MRI has proved to be a better modality than CT for
evaluation of disease of the central nervous system (CNS), such as
diseases at the base of the skull (particularly the sellar and
cerebellopontine angle cistern regions) and for most tumors, white
matter disease (e.g., multiple sclerosis), early stroke, congenital
abnormalities, vascular malformations, and spinal disease. New
techniques of MRI such as fast spin echo (FSE) pulse sequence have
been developed to detect mesial temporal sclerosis, which is the most
common cause of intractable complex partial seizure. Differentiating
pure compression fracture from metastatic disease of the vertebral
bodies in a patient with known primary cancer is also possible by new
MRI technique; however, for patients with certain types of metal
(pacemaker, surgical clip, or foreign body, which may move in the
magnetic field and cause injury to the patient or significant artifacts)
within the bodies, MRI is contraindicated.
, 4. Which of the following statements about neuroradiologic imaging
modalities is/are correct?
A. Diffusion-weighted MRI can differentiate tumor from edema and
identify the nonenhancing part of the tumor.
B. For evaluating the stenosis of the carotid bifurcation, MR
angiography (MRA) is the most accurate imaging modality.
C. Myelography is still useful in detecting some diffuse spinal disease
such as cerebrospinal fluid (CSF) seeding.
D. For evaluating the bony detail of patients with facial trauma, CT is a
better imaging modality than MRI.
E. Decreased amount of N-acetyl aspartate (NAA) and increased
amount of lactate can be shown in the MR spectroscopy (MRS) of a
patient with acute stroke.
Answer: ACDE
DISCUSSION: Diffusion-weighted MR is a new development in MR
applications and is sensitive to microscopic motion of water protons
(Brownian motion). Initial applications have involved imaging of early
stroke and neoplasia. Early evidence also suggests that diffusion-
weighted imaging can differentiate tumoral edema from tumor and
identify the nonenhancing part of the tumor. Doppler sonography,
MRA, and CT angiography (CTA) are all useful for evaluating the
stenotic condition of carotid bifurcation noninvasively. However,
sonography is very operator dependent, and MRA commonly
overestimates the degree of carotid stenosis resulting from the
turbulence, dephasing at points of stenosis or irregularity. CTA
obtained by spiral or helical CT has a good correlation rate with
carotid angiography (92%). Conventional carotid angiography remains
the most accurate imaging modality for evaluation of the stenosis of
carotid bifurcation. Although CT and MRI have taken the place of
myelography in evaluating neurologic diseases, it is still useful in
detecting diffuse subarachnoid seeding, which may be difficult to
identify on MRI. The bone detail and calcification are poorly identified
on MR, so in a patient with facial trauma, CT is a better modality than
MR. With MRS, metabolites within a selected region of interest (ROI)
can be investigated, and spectral peaks that reflect the concentrations
of the metabolite within the ROI can be obtained. The metabolites
include lactate, neuronal marker (NAA), phosphorus metabolites,
creatine, and choline. Reduction in the NAA level and elevation in
lactate level could be noted in acute stroke.
5. Which of the following are true about intracranial tumors?
A. The most common location of brain tumors of childhood is the
posterior cranial fossa.
B. With few exceptions, examination of the CSF is of no value in the
diagnosis of an intracranial tumor.
