Deck 24: Neurosurgery

Question 1

The circle of Willis is a:

A) network of connected arteries at the base of the brain
B) structure of supporting connective tissue for the brain
C) complex neural network that connects the two hemispheres of the brain
D) series of channels and foramina within the cerebrospinal fluid network of the brain

Answer 1

A

Question 2

Which anatomical structure is the tough band that encases the intervertebral disc material?

A) annulus fibrosis
B) circle of Willis
C) intervertebral foramina
D) nucleus pulposus

Answer 2

A

Question 3

What is the distal-most area of the spinal cord or spinal nerves called?

A) corpus callosum
B) filum terminale
C) nucleus pulposus
D) sella turcica

Answer 3

B

Question 4

The instrument called a Kerrison is a(n):

A) clamp
B) rongeur
C) elevator
D) retractor

Question 5

Which instrument could be used for burr-hole cranial perforation if no powered equipment is available?

A) Cloward bit
B) Gigli saw
C) Hudson brace
D) Penfield dissector

Question 6

Which surgical procedure treats compression of the median nerve by a transverse ligament?

A) anterior cervical diskectomy
B) carpal tunnel release
C) lumbar laminectomy
D) rhizotomy

Question 7

Monro, Sylvius, Magendie, and Luschka are:

A) aqueducts and foramina
B) cranial nerves
C) cranial base fossae
D) neural plexuses

Question 8

Which approach is MOST desirable for treatment of herniated cervical disc with subsequent intervertebral fusion?

A) anterior midline
B) anterior medial
C) posterior midline
D) posterior medial

Question 9

What is the name of the structure that produces cerebrospinal fluid (CSF)?

A) cauda equina
B) cavernous sinus
C) choroid plexus
D) corpus callosum

Question 10

Penfield #1 through #5 are:

A) aneurysm clips
B) dissectors
C) drill bits
D) scalp clips

Question 11

For which surgical procedure would petroleum gauze nasal packing be used as part of the dressing?

A) burr holes for evacuation of subdural hematoma
B) carpal tunnel release
C) lumbar microdiskectomy
D) transsphenoidal hypophysectomy

Question 12

What is the name of the structure on which the pituitary gland sits?

A) atlas
B) foramen magnum
C) odontoid process
D) sella turcica

Question 13

What is another name for the first cervical vertebra (C-1)?

A) atlas
B) axis
C) cauda equine
D) odontoid

Question 14

Which of the following is a primary benign tumor that arises from the protective coverings of the brain?

A) astrocytoma
B) ependymoma
C) glioma
D) meningioma

Question 15

How many pairs of cranial nerves are there?

A) 6
B) 8
C) 10
D) 12

Question 16

Which portion of the spinal column consists of five fused vertebrae in the average adult?

A) cervical
B) thoracic
C) lumbar
D) sacrum

Question 17

Which facial sinus is used for surgical approach to a pituitary adenoma rather than traditional craniotomy?

A) ethmoid
B) frontal
C) maxillary
D) sphenoid

Question 18

Which of the following is used for scalp hemostasis and resembles a Crile or Kelly hemostat except the curve is to the side?

A) Cushing
B) Dandy
C) Leksell
D) Raney

Question 19

How many vertebrae are there in the normal adult spine?

A) 12
B) 23
C) 30
D) 33

Question 20

Which of the following results most often from skull trauma over the middle meningeal artery with symptoms progressing to brain-stem herniation if not treated?

A) arteriovenous malformation
B) intracranial aneurysm
C) epidural hematoma
D) subdural hematoma

Question 21

Osteophytes are:

A) bony spurs
B) hardened discs
C) liament attachment points
D) malignant spinal tumors

Question 22

All of the following are examples of congenital anomalies EXCEPT:

A) arteriovenous malformation
B) craniosynostosis
C) herniated nucleus pulposus
D) intracranial aneurysm

Question 23

What is the term for a deep groove in the cerebrum that separates the brain into lobes?

A) gyrus
B) fissure
C) sinus
D) sulcus

Question 24

What is the name of the dural fold that separates the right and left hemispheres of the cerebrum?

A) corpus callosum
B) choroid plexus
C) falx cerebri
D) falx cerebelli

Question 25

Wilson, Andrews, and Hall frames are examples of positioning devices used for:

A) anterior cervical diskectomy and fusion
B) craniectomy for craniosynostosis
C) lumbar hemilaminotomy
D) ulnar nerve transposition

Question 26

Which diagnostic study demonstrates a herniated disc causing spinal compression and radiographic filling defect?

A) angiography
B) electromyogram
C) myelogram
D) cross-table x-ray

Question 27

What is the anatomical area where cerebrospinal fluid circulates over all parts of the central nervous system?

A) circle of Willis
B) epidural space
C) pericranium
D) subarachnoid space

Question 28

Which part of the vertebra projects most posteriorly and is often palpable through the skin in the convex areas of the spine?

A) body
B) lamina
C) spinous process
D) transverse process

Question 29

Into which anatomical structure or area is the distal catheter most often inserted in a V-P shunt procedure?

A) peritoneal cavity
B) pleural cavity
C) pulmonary vein
D) pyloric sphincter

Question 30

Fiducials placed on bony landmarks are used in which type of neurosurgical procedure?

A) transsphenoidal hypophysectomy
B) insertion of ventriculo-peritoneal shunt
C) stereotactic guided-imagery biopsy
D) selective facet rhizotomy

Question 31

What is the name of the horseshoe or pin fixation device for neurosurgical cranial positioning?

A) Dandy
B) Layla
C) Mayfield
D) Penfield

Question 32

Which anatomical structure is the soft, gelatinous part of the intervertebral disc, which is sent as specimen after diskectomy?

A) annulus fibrosis
B) intervertebral foramina
C) nucleus pulposus
D) posterior longitudinal ligament

Question 33

Craniosynostosis is a congenital defect involving:

A) blocked ventricular passages
B) failure of neural tube closure
C) pituitary hormone imbalances
D) premature cranial suture closure

Question 34

What is the largest part of the human brain?

A) brain stem
B) cerebellum
C) cerebrum
D) diencephalon

Question 35

What is the name of the dural fold that separates the cerebrum from the cerebellum and may be used to delineate surgical approach in reference to it?

A) corpus callosum
B) falx cerebri
C) falx cerebella
D) tentorium

Question 36

Which of the following is a radiographic diagnostic procedure performed for suspected aneurysm near the circle of Willis?

A) cerebral angiogram
B) electroencephalogram
C) lumbar myelography
D) pneumoencephalography

Question 37

Posterior fossa craniectomy is performed for pathology involving the:

A) cerebellum
B) frontal lobe
C) parietal lobe
D) lateral ventricles

Question 38

Which of the following is a result of torn bridging veins between the cerebral cortex and venous sinuses?

A) CSF fistula
B) epidural hematoma
C) subarachnoid hemorrhage
D) subdural hematoma

Question 39

Which of the following is the lowest part of the brain stem and contiguous with the spinal cord?

A) hypothalamus
B) medulla oblongata
C) midbrain
D) pons

Question 40

Which of the following are countable surgical sponges used in neurosurgical procedures to protect delicate tissues?

A) compressed Gelfoam
B) Cottonoid patties
C) Kittner dissectors
D) Weck-Cel spears

Question 41

Which of the following neurosurgical retractors has attachments for malleable brain spatulas and retractors?

A) Adson-Beckman
B) Leyla-Yasargil
C) Scoville
D) Taylor

Question 42

Which position is usually used for microdecompression endoscopic diskectomy?

A) lateral
B) lithotomy
C) prone
D) supine

Question 43

Which instrument is used to strip and separate the galea and pericranium from the skull before placement of burr holes?

A) #11 scalpel blade
B) #1 Penfield dissector
C) Gigli saw malleable guide
D) Langenbeck periosteal elevator

Question 44

Papaverine is used in craniotomy for aneurysm clipping to prevent:

A) clotting
B) hemorrhage
C) infection
D) vasospasm

Question 45

Which instrument is used to extract pieces of the nucleus pulposus in a diskectomy?

A) Kerrison rongeur
B) nerve root retractor
C) Penfield dissector
D) pituitary rongeur

Question 46

Where do most intracranial aneurysms occur?

A) arterial bifurcations
B) tunica media
C) venous sinus
D) venous valves

Question 47

What is the name of the group of spinal nerves that continue from the distal spinal cord at about L-2 in the average adult?

A) cauda equina
B) corpus callosum
C) filum terminale
D) foramen magnum

Question 48

What is the name of the measuring device used to assess intraventricular pressure?

A) capnometer
B) manometer
C) oximeter
D) tonometer

Question 49

Which of the following layered structures has the closest and most intimate contact with the brain?

A) arachnoid
B) dura
C) galea
D) pia

Question 50

Which retractor has a proximal hook placed in the wound and a distal hook for attachment of a weight or sandbag using a sterile Kerlix roll for suspension?

A) Cloward
B) Greenburg
C) Love
D) Taylor

Question 51

What part of the body is prepped for ulnar nerve decompression or transposition?

A) anterior neck
B) lower extremity
C) posterior back
D) upper extremity

Question 52

The visual cortex of the brain is located in which region?

A) frontal
B) occipital
C) parietal
D) temporal

Question 53

Which portion of the normal spinal column has five (5) vertebrae?

A) cervical
B) thoracic
C) lumbar
D) coccygeal

Question 54

What is the name of the outfolding convolutions of the brain?

A) fissures
B) foramina
C) gyri
D) sulci

Question 55

What is the name of the set of instruments used for anterior cervical diskectomy and fusion that includes retractors, spreaders, bone dowel cutters, impactors, and others?

A) Cloward
B) Greenburg
C) Mayfield
D) Yasargil

Question 56

Which of the following bilateral paired nerves are the largest in the body and innervate the buttocks and lower extremities?

A) peroneal
B) sciatic
C) trigeminal
D) vagus

Question 57

Carpal tunnel syndrome is treated by:

A) incising the transverse carpal ligament to decompress the nerve
B) placing Gelfoam between nerve and ligament for padding
C) removing or reshaping the surrounding carpal bones
D) transposing the median nerve out of the bony tunnel

Question 58

In which procedure are the esophagus, carotid artery, and trachea retracted medially for access to the area of pathology?

A) anterior cervical diskectomy and fusion
B) fronto-temporal craniotomy for aneurysm
C) placement of ventriculo-atrial shunt
D) rhizotomy for intractable trigeminal neuralgia

Question 59

From which area is an autologous bone graft usually procured for anterior cervical fusion procedures?

A) fibula
B) cervical spinous process
C) iliac crest
D) lumbar spinous process

Question 60

When incising the cranium between burr holes, what attachment to the powered craniotome is necessary to prevent injury of underlying tissues?

A) #3 Penfield dissector
B) dural guard with footplate
C) smoke evacuator
D) wire-pass drill bit

Question 62

The skull flap can be reattached to the cranium by small titanium plates and screws or with stainless steel wire.

Question 63

The foramen magnum is the large opening at the base of the skull and site of irreversible brain stem herniation due to increased intracranial pressure.

Question 64

Herniated nucleus pulposus is a congenital disorder that must be treated surgically in the neonate to prevent quadriplegia.

Question 65

Special attention must be taken during application and removal of the Mayfield cranial fixation device due to the removal of the OR table head piece.

Question 66

The surgical technologist may have up to three separate setups in a transsphenoidal hypophysectomy procedure: nasal access, tumor excision, and fascial graft.