Neurosurgery & Cardiothoracic Surgery

Topics in this chapter

• Neurosurgical Trauma
• Cerebrovascular Neurosurgery
• Brain and Pituitary Tumors
• Congenital Cardiac Surgery
• Thoracic Trauma and Emergencies
• Esophageal Surgical Disorders
• Lung Cancer and Thoracic Oncology
• Cardiothoracic Postoperative Care

Practice questions

1. Question 1Q-89AE51

   A 54-year-old man presents with progressive headache, personality changes, and right-sided hemiparesis. MRI reveals a butterfly-like enhancing mass in the corpus callosum with extensive surrounding edema and central necrosis. Which of the following is the most likely pathological diagnosis?

   1. A.Meningioma
   2. B.Glioblastoma multiforme
   3. C.Primary CNS lymphoma
   4. D.Schwannoma
   See the answer and solution
2. Question 2Q-9B65A9

   A 28-year-old male is brought to the emergency department following a high-speed motor vehicle collision. He was unconscious at the scene, briefly regained consciousness ('lucid interval'), and then rapidly deteriorated into a coma with right-sided hemiparesis and a fixed, dilated left pupil. Which of the following vessels is most likely injured?

   1. A.Middle meningeal artery
   2. B.Bridging veins
   3. C.Anterior cerebral artery
   4. D.Vertebral artery
   See the answer and solution
3. Question 3Q-B6668C

   A 65-year-old man with a history of long-standing hypertension presents with sudden onset of the 'worst headache of his life', followed by vomiting and a brief loss of consciousness. On examination, he is stiff-necked and photophobic, but has no focal neurological deficits. Non-contrast CT head shows hyperdensity in the basal cisterns and sulci. What is the most common underlying cause of this condition?

   1. A.Arteriovenous malformation
   2. B.Saccular (berry) aneurysm rupture
   3. C.Hypertensive intracerebral hemorrhage
   4. D.Mycotic aneurysm
   See the answer and solution
4. Question 4Q-02408B

   A 45-year-old woman presents with progressive bitemporal hemianopia and amenorrhea-galactorrhea. Serum prolactin levels are markedly elevated at 4,500 ng/mL. Which of the following is the initial treatment of choice?

   1. A.Transsphenoidal surgical resection
   2. B.Dopamine agonist therapy (e.g., cabergoline)
   3. C.Fractionated stereotactic radiotherapy
   4. D.Observation with serial visual field testing
   See the answer and solution
5. Question 5Q-C17B65

   A 60-year-old man undergoes coronary artery bypass grafting (CABG). On the third postoperative day, he develops sudden-onset severe shortness of breath, restlessness, and a drop in oxygen saturation. Examination reveals absent breath sounds and a dull percussion note over the left hemithorax, with tracheal deviation to the right. Which of the following is the most appropriate immediate intervention?

   1. A.Immediate endotracheal intubation
   2. B.Emergency needle decompression of the left chest
   3. C.Urgent tube thoracostomy (chest tube insertion)
   4. D.Immediate administration of systemic thrombolytics
   See the answer and solution