Free Clinical Neurosurgery Practice Questions

Question 1

A 37-year-old man is fully oriented after a motorcycle crash. His Glasgow Coma Scale score is 15, his pupils are equal and reactive, and he has no focal weakness. CT shows an isolated acute right convexity subdural hematoma measuring 8 mm at its thickest point, with 7 mm of midline shift. Coagulation studies are normal. Which management plan is justified by these findings?

Accepted Answer

Urgent craniotomy for evacuation of the subdural hematoma

Answer

Close neurological observation with repeat CT in six hours

Answer

Hyperosmolar treatment, reserving surgery for a decline in consciousness

Answer

Intracranial pressure monitoring before deciding whether evacuation is necessary

Question 2

The resection specimen from an adult frontal-lobe diffuse glioma has sparse mitoses, no necrosis, and no microvascular proliferation. Immunohistochemical and molecular studies show an IDH1 mutation, loss of ATRX expression, retained whole arms of chromosomes 1p and 19q, and homozygous deletion of CDKN2A/B. Under the WHO CNS fifth-edition classification, what is the integrated diagnosis?

Accepted Answer

Astrocytoma, IDH-mutant, CNS WHO grade 4

Answer

Astrocytoma, IDH-mutant, CNS WHO grade 2

Answer

Astrocytoma, IDH-mutant, CNS WHO grade 3

Answer

Glioblastoma, IDH-wildtype, CNS WHO grade 4

Question 3

A flooring installer is referred for left foot drop after several days of prolonged kneeling. An outside lumbar MRI reports left L4-L5 lateral-recess narrowing. Examination shows marked weakness of ankle dorsiflexion, great-toe extension, and foot eversion, but normal inversion and hip abduction. Pinprick is reduced over the dorsum of the foot, while plantar sensation is preserved. Where do the examination findings localize the lesion most convincingly?

Accepted Answer

Common fibular nerve near the fibular head

Answer

L5 nerve root within the lumbar lateral recess

Answer

Sciatic nerve proximal to its terminal bifurcation

Answer

Lumbosacral trunk at the pelvic brim

Question 4

The neurocritical care flowsheet for a euvolemic 29-year-old with severe traumatic brain injury shows a sustained mean arterial pressure of 72 mmHg, intracranial pressure of 18 mmHg, and central venous pressure of 6 mmHg. The arterial and intracranial measurements use the same cranial reference level. Oxygenation and hemoglobin are adequate, and the patient is receiving low-dose norepinephrine. Which interpretation should guide the next pressure-directed adjustment?

Accepted Answer

CPP is 54 mmHg; increase arterial pressure while reassessing ICP

Answer

CPP is 66 mmHg; maintain the current vasopressor dose

Answer

CPP is 72 mmHg; reduce vasopressor support to limit pulmonary risk

Answer

CPP is 90 mmHg; lower arterial pressure to reduce cerebral hyperemia

Question 5

An 8-year-old with a ventriculoperitoneal shunt has progressive headache, repeated vomiting, and increasing sleepiness. His mother says this resembles his previous shunt failure. CT shows small ventricles unchanged from his well baseline, and a shunt series shows no disconnection. He is afebrile. The emergency team proposes discharge because the imaging is unchanged. What is the strongest reason not to discharge him?

Accepted Answer

Unchanged ventricular size does not exclude clinically important shunt obstruction

Answer

Small ventricles establish overdrainage and justify increasing the valve setting

Answer

An intact shunt series excludes obstruction but makes infection the leading diagnosis

Answer

Absence of ventricular enlargement makes primary headache more likely than shunt failure

Question 6

A patient had normal urine output before transsphenoidal surgery. During the first postoperative day, urine output rises to 450-550 mL/hour for six consecutive hours. Serum sodium is 153 mmol/L, serum osmolality is 312 mOsm/kg, and urine osmolality is 85 mOsm/kg. Serum glucose and renal function are normal; no osmotic diuretic has been given. Which physiological disturbance best explains this combination?

Accepted Answer

Reduced vasopressin release from the hypothalamic-neurohypophyseal system

Answer

Impaired collecting-duct responsiveness despite adequate circulating vasopressin

Answer

Inappropriate vasopressin secretion despite a hypotonic extracellular compartment

Answer

Increased renal solute excretion drawing water into the urine

Question 7

Seven days after clipping of a ruptured anterior communicating artery aneurysm, a woman develops new aphasia and right-arm weakness. CT excludes rebleeding and hydrocephalus; glucose, sodium, and oxygenation are normal, and EEG shows no seizure. CT angiography demonstrates new left middle cerebral artery narrowing. The aneurysm is completely secured, she is euvolemic, and she remains on enteral nimodipine. Blood pressure is 118/70 mmHg, with no cardiac contraindication to augmentation. Which hemodynamic strategy is appropriate for the suspected delayed cerebral ischemia?

Accepted Answer

Raise blood pressure with vasopressor support while maintaining euvolemia

Answer

Induce hypervolemia with crystalloid while maintaining the current blood pressure

Answer

Lower systolic pressure further to protect against recurrent aneurysmal bleeding

Answer

Maintain the current pressure and use deliberate hemodilution to improve blood flow

Question 8

A reliable spinal cord examination establishes a T10 neurological level of injury and T10 motor levels on both sides. S4-S5 pinprick and deep anal pressure are preserved, but voluntary anal contraction is absent. On each side, hip flexion is 4/5; knee extension, ankle dorsiflexion, great-toe extension, and ankle plantar flexion are all 2/5. There are no non-spinal-cord conditions affecting these scores. Which ASIA Impairment Scale grade should be recorded?

Accepted Answer

AIS C

Answer

AIS A

Answer

AIS B

Answer

AIS D

Question 9

CT after a fall in a previously healthy adult shows an L1 burst fracture with modest height loss and a retropulsed posterior-wall fragment occupying approximately one quarter of the canal. There is no translation, distraction, or substantial kyphotic deformity. MRI confirms an intact posterior ligamentous complex. The patient has normal motor, sensory, and sphincter examinations and can mobilize with analgesia. Applying TLICS to this injury, which score and initial treatment category are supported?

Accepted Answer

2; nonoperative management is favored

Answer

3; nonoperative management is favored

Answer

4; either operative or nonoperative management may be reasonable

Answer

5; operative stabilization is favored

Question 10

At a programming visit six weeks after left subthalamic deep brain stimulation for Parkinson disease, increasing the amplitude produces right facial pulling, sustained right-arm contraction, and dysarthria. All three disappear immediately when stimulation is turned off and recur at the same amplitude. There is no new focal deficit with stimulation off, and postoperative imaging showed satisfactory lead position. What should the clinician do first?

Accepted Answer

Lower stimulation amplitude and assess an alternative active contact

Answer

Reduce levodopa substantially to treat presumed medication-induced dyskinesia

Answer

Arrange lead revision before attempting further programming changes

Answer

Obtain emergency CT for a presumed symptomatic lead-tract hemorrhage

Free Clinical Neurosurgery Practice Questions

Domain 1: Anatomy of the brain, spinal cord, and peripheral nerves

Question 1

Domain 2: Neuropathology and Neuroimaging

Question 2

Domain 3: Neurophysiology and Neuropharmacology

Question 3

Domain 4: Neurological examination and diagnostic techniques

Question 4

Domain 5: Surgical techniques and approaches for brain and spinal cord tumors, vascular disorders, trauma, and infection

Question 5

Question 6

Domain 6: Pediatric neurosurgery

Question 7

Domain 7: Functional neurosurgery

Question 8

Domain 8: Neurotrauma and Critical Care

Question 9

Domain 9: Spinal disorders and surgery

Question 10

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