Sample Written Exam – Neurosurgery

Question 1

A 35-year-old woman presents with a 1-year history of pulsatile tinnitus and diminished hearing on
the left side. She is otherwise neurologically intact.

a. List THREE specific diagnostic possibilities.

MODEL ANSWER: 1 mark each, 3 marks total

• Glomus jugulare tumour (paraganglioma or chemodectoma of the jugular foramen)

• Schwannoma
• Meningioma
• Metastasis
• Primary bone tumour (fibrous dysplasia, sarcoma)

NOTE: Chordoma NOT acceptable (0 marks).

b. Of these, what is the MOST likely diagnosis?

MODEL ANSWER: 1 mark total

• Glomus jugulare tumour (paraganglioma of jugular foramen)

 c. The patient's blood pressure suddenly rises to 220/150 mm Hg during surgical intervention.
What is the MOST likely explanation?

MODEL ANSWER: 1 mark total

• Catecholamine or Norepinephrine release

Question 2
a. What is the BIGGEST risk factor associated with the development of spinal epidural abscess?

MODEL ANSWER: 1 mark total

• IV drug use

b. Name the MOST commonly encountered pathogen in spinal epidural abscess.

MODEL ANSWER: 1 mark total

• Staph Aureus
NOTE: Also accept MSSA

c. In what spinal segment are spinal epidural abscesses LEAST likely to occur?

MODEL ANSWER: 1 mark total

• Cervical

d. In a patient with a spinal epidural abscess who presents with pain and no neurologic deficits,
name TWO factors associated with a HIGHER risk of neurologic deterioration.

MODEL ANSWER: 1 mark each, 2 marks total

• Age > 65
• Diabetes
• Positive blood cultures
• High CRP (> 115)
• MRSA
• Immunosuppression
• Major systemic illness
• Spinal cord compression

2
 e. Provide the TWO MOST important mechanisms responsible for neurologic deterioration in
this setting.

MODEL ANSWER: 1 mark each, 2 marks total

• direct compression
• venous thrombosis/hypertension (septic thrombophlebitis)

NOTE: Arterial thrombosis NOT acceptable (No marks).

Question 3

The following questions pertain to radiographic knowledge in general.

a. List the biochemical compounds that determine image characteristics for functional MRI.

MODEL ANSWER: 1 mark each, 2 marks total

• Oxyhemoglobin
• Deoxyhemoglobin

b. Name TWO physiological processes that influence these biochemical compounds and
therefore functional MR images.

MODEL ANSWER: 1 mark each, 2 marks total

• Cerebral blood flow

• Tissue oxygen consumption

c. List the radiographic characteristics of a mature intracranial abscess found on MR imaging

for each of the following weighting techniques: DWI; T1; T2

MODEL ANSWER: 1 mark each, 3 marks total

i. DWI

• Restricted diffusion (1 mark)

ii. T1

• Diffuse (central AND peripheral) low intensity (1 mark)

NOTE: No marks for Ring Enhancement, contrast NOT given as part of the weighting
technique in the question.

iii. i. T2 / FLAIR

• Diffuse (central AND peripheral) high intensity. ALSO accept “no attenuation” on
FLAIR (1 mark)