TENC Neurocirurgia Practice Questions - TENC - Título de Especialista em Neurocirurgia (Sociedade Brasileira de Neurocirurgia AMB) Exam - TENC Neurocirurgia Practice Questions - TENC - Título de Especialista em Neurocirurgia (Sociedade Brasileira de Neurocirurgia AMB) Exam

Question 1

A 54-year-old woman presents to the emergency department with the sudden onset of the worst headache of her life ('thunderclap headache'), neck stiffness, and persistent vomiting. On physical examination, she is drowsy and confused but opens her eyes to voice, follows commands, and has no focal cranial nerve or motor deficits (Glasgow Coma Scale score 14). A non-contrast head CT demonstrates thick diffuse subarachnoid blood in the basal cisterns and interhemispheric fissure measuring greater than 1 mm in thickness, along with intraventricular hemorrhage in both lateral ventricles. Digital subtraction angiography confirms a ruptured 7 mm anterior communicating artery (ACom) aneurysm. According to the Hunt & Hess and modified Fisher grading systems, how is this patient's subarachnoid hemorrhage classified?

Hunt & Hess Grade II; Modified Fisher Grade 2 Hunt & Hess Grade III; Modified Fisher Grade 4 Hunt & Hess Grade IV; Modified Fisher Grade 3 Hunt & Hess Grade I; Modified Fisher Grade 1

Correct Answer:

Hunt & Hess Grade III; Modified Fisher Grade 4

Question 2

The landmark International Subarachnoid Aneurysm Trial (ISAT) randomized patients with ruptured intracranial aneurysms suitable for both treatments to either microsurgical clipping or endovascular coiling. What was the primary finding of ISAT regarding 1-year clinical outcomes?

Microsurgical clipping produced a statistically significant reduction in 1-year all-cause mortality compared to endovascular coiling. Endovascular coiling was associated with a statistically significant 23.9% relative reduction (6.9% absolute risk reduction) in 1-year dependency or death compared to microsurgical clipping. Endovascular coiling resulted in a significantly lower rate of late aneurysm recurrence and rebleeding compared to microsurgical clipping. There was no statistically significant difference in 1-year functional dependency, but microsurgical clipping resulted in shorter intensive care unit stays.

Correct Answer:

Endovascular coiling was associated with a statistically significant 23.9% relative reduction (6.9% absolute risk reduction) in 1-year dependency or death compared to microsurgical clipping.

Question 3

A 48-year-old man undergoes successful endovascular coiling of a ruptured anterior communicating artery aneurysm within 18 hours of ictus. On post-bleed day 6, he develops new expressive aphasia and right arm weakness (4/5). Bedside Transcranial Doppler (TCD) ultrasonography reveals a mean flow velocity of 210 cm/s in the left middle cerebral artery with a Lindegaard ratio of 4.8. What is the most appropriate initial medical management for this delayed cerebral ischemia (DCI)?

Aggressive hypervolemic hemodilution using 5 liters of 0.45% saline daily and prophylactic placement of a balloon pump. Maintenance of euvolemia, continuous oral nimodipine (60 mg every 4 hours), and induction of hypertension using intravenous vasopressors (such as norepinephrine) to improve cerebral perfusion. Immediate intravenous administration of high-dose corticosteroids and low-dose unfractionated heparin bolus. Immediate surgical exploration for left carotid artery endarterectomy and bypass.

Correct Answer:

Maintenance of euvolemia, continuous oral nimodipine (60 mg every 4 hours), and induction of hypertension using intravenous vasopressors (such as norepinephrine) to improve cerebral perfusion.

Question 4

A 32-year-old man is evaluated after a first unprovoked generalized tonic-clonic seizure. Brain MRI and catheter cerebral angiography demonstrate a 3.5 cm arteriovenous malformation (AVM) located in the left postcentral gyrus (primary somatosensory cortex). Venous drainage is directed into the internal cerebral veins via the deep striothalamic venous system. According to the Spetzler-Martin AVM grading scale, what is the score for this lesion?

Grade II Grade III Grade IV Grade V

Correct Answer:

Grade IV

Question 5

What was the primary conclusion of the ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) trial regarding the short-to-medium-term management of unruptured brain AVMs?

Immediate multimodal interventional eradication (microsurgery, embolization, or radiosurgery) was superior to medical management alone in preventing stroke and death. Medical management alone was superior to interventional eradication in reducing the risk of death or symptomatic stroke over a mean follow-up of 33 months. Stereotactic radiosurgery alone demonstrated significant superiority over observation for high-grade (Spetzler-Martin IV-V) unruptured AVMs. Interventional management achieved a 100% cure rate with no increased morbidity compared to conservative medical management.

Correct Answer:

Medical management alone was superior to interventional eradication in reducing the risk of death or symptomatic stroke over a mean follow-up of 33 months.

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Prepare with the TENC Neurocirurgia Practice Questions - TENC - Título de Especialista em Neurocirurgia (Sociedade Brasileira de Neurocirurgia AMB) Exam practice quiz. This question bank includes 100 questions covering year-old, brain, right, presents, and artery. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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TENC Neurocirurgia Practice Questions - TENC - Título de Especialista em Neurocirurgia (Sociedade Brasileira de Neurocirurgia AMB) Exam

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TENC Neurocirurgia Practice Questions - TENC - Título de Especialista em Neurocirurgia (Sociedade Brasileira de Neurocirurgia AMB) Exam

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