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Question 1
A 54-year-old woman presents to the emergency department with a sudden-onset thunderclap headache, transient loss of consciousness, and meningism. Non-contrast cranial CT reveals extensive subarachnoid hemorrhage in the basal cisterns with acute ventriculomegaly (Hunt & Hess Grade 3, modified Fisher Grade 3). CT angiography demonstrates a 6 mm saccular anterior communicating artery (ACoA) aneurysm. Her GCS score declines from 13 to 10 in the resuscitation bay with increasing somnolence. What is the most appropriate immediate sequence of interventions?
Correct Answer:
Immediate placement of an external ventricular drain (EVD) to manage acute hydrocephalus, followed by urgent aneurysm securing (coiling or clipping) within 24 to 72 hours
Question 2
A 49-year-old man who underwent successful endovascular coiling of a ruptured right middle cerebral artery (MCA) aneurysm develops new left-sided hemiparesis and pronator drift on post-bleed day 7. His blood pressure is 118/72 mmHg and heart rate is 68 bpm. Daily transcranial Doppler (TCD) shows right MCA mean flow velocities increased from 110 cm/s to 215 cm/s (Lindegaard ratio 4.8). CT angiography confirms focal severe vasospasm of the right M1 segment without intracranial rebleeding or infarction. According to current European guidelines for Delayed Cerebral Ischemia (DCI), what is the first-line therapeutic management?
Correct Answer:
Induced hypertension using continuous noradrenaline/norepinephrine to maintain elevated MAP while maintaining strict euvolemia, alongside continued oral nimodipine
Question 3
A 48-year-old previously healthy woman is found on MRI/MRA to have an incidental, unruptured 7 mm saccular aneurysm of the right middle cerebral artery (MCA) bifurcation. High-resolution catheter angiography reveals a wide neck (dome-to-neck ratio 1.1) with both dominant M2 cortical branches arising directly from the aneurysm base. She has no family history of aneurysms. What is the most appropriate definitive management recommendation?
Correct Answer:
Microsurgical clipping via a right pterional / minipterional craniotomy
Question 4
A 56-year-old man presents with an acute, severe retro-orbital headache, ipsilateral ptosis, a dilated and non-reactive pupil, and an eye positioned 'down and out'. Emergent diagnostic workup demonstrates a 9 mm saccular aneurysm originating at the junction of the internal carotid artery and posterior communicating artery (ICA-PCoA). What is the primary pathophysiological mechanism of the cranial nerve deficit, and what is the urgency of intervention?
Correct Answer:
Direct mechanical compression of the peripheral pupillomotor parasympathetic fibers on the outer surface of CN III; urgent surgical or endovascular aneurysm exclusion
Question 5
A 58-year-old woman is admitted with acute subarachnoid hemorrhage (WFNS Grade 1, Fisher Grade 2). Cerebral angiography reveals a 6 mm saccular basilar apex (bifurcation) aneurysm with a narrow neck pointing superiorly. The posterior cerebral arteries (P1 segments) originate cleanly below the aneurysm neck. Based on landmark randomized evidence from the International Subarachnoid Aneurysm Trial (ISAT) and posterior circulation anatomy, what is the preferred initial treatment modality?
Correct Answer:
Endovascular coil embolization
Question 1
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Prepare with the Facharzt FMH Neurochirurgie Practice Questions - Facharzt FMH für Neurochirurgie Spécialiste FMH en neurochirurgie Exam practice quiz. This question bank includes 100 questions covering year-old, presents, woman, right, and reveals. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Facharzt FMH Neurochirurgie Practice Questions - Facharzt FMH für Neurochirurgie Spécialiste FMH en neurochirurgie Exam

This practice set contains 100 questions from the matching question bank and focuses on year-old, presents, woman, right, and reveals. Work through each question carefully, review the provided solutions, and revisit topics that need more study before your next attempt.

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