A patient was admitted to the hospital 30 minutes after a fight while intoxicated. They exhibited bruising and abrasions on the left temple region. Six hours later their condition had deteriorated with reduced consciousness, right-sided weakness, and other neurological changes. A CT scan is expected to show an intracranial hematoma. A 14-year-old teenager lost consciousness after a head impact and exhibited symptoms including elevated intracranial pressure on examination. Craniotomy would be the best initial treatment for a 40-year-old patient admitted after a car accident exhibiting signs of increased intracranial pressure. A CT scan of a patient found unconscious with signs of head trauma showed an intracran

1. 1
1. A patient was admitted to hospital 30 min after the fight, in alcoholic intoxication. He was
excited, there were ecchymosis and abrasion, on the left temporal region. 6 hours after the
trauma: consciousness was 8 points by a Glasgow Coma Scale, weakness of the right
extremities, periodic tonic cramps, left mydriasis. What caused the changes of the clinical
picture?
A. Subarachnoidal haemorrhage
B. +Development of the subdural haematoma
C. Intraventricular haemorrhage
D. Focal edema of the brain
E. Alcoholic coma
2. A teenager of 14 years old got impact in the parietotemporal region on the right, lost
consciousness for a short time. In 45 min. — coma 2, pulse — 50 per min., AP on either side —
170/110. The venous congestion was revealed on the eye fundus. Which pathogenetic
mechanisms could cause such symptoms?
A. Epileptic attack
B. Disorder of the cardiac conduction
C. +Rising of the intracranial pressure
D. Sick sinus syndrome
E. Closed hydrocephalus
3. A patient was admitted to hospital 40 minutes after a car accident, the emergency doctor
informed, that the patient had risen and come out of the car by himself. The patient had
vomiting, arrhythmia, loss of consciousness, cramps, accelerated, noisy respiration, AP —
200/120. What is the best treatment for the next 2 hours?
A. +Craniotomy
B. Antihypertensive treatment
C. Installation of the pacemaker
D. Ventriculoperitoneal shunting.
E. Antiepileptic treatment
4. A patient was found in the street without consciousness, with a smell of alcohol from the
mouth. There were mydriasis on the right, the left-hand hemi-paresis, bilateral pathological
plantar marks, abrasion and a swelling in the right temporal region. From a CT-scan of the brain
which has been carried out, it is possible to expect:
A. Normal picture of the brain
B. +Intracranial haematoma
C. Outside and inside hydrocephalus
D. Dilating subarachnoid spaces
E. Multifocal changes of the brain tissue
5. A patient was beaten 2 hours ago, marked a short-term loss of consciousness. Physical
examination: lagophthalmia, paresis of the mimic muscles on the left, reduction of hearing on the
right, giddiness.
Craniograms revealed the fracture of base of the skull, name it.
A. Fracture of scales of the occipital bone
B. Fracture of the facial skull
C. Fracture of the frontal bone
D. +Fracture of the pyramid of the temporal bone
E. Fracture of the parietal bone
6. A patient of 23 years old had a loss of consciousness, vomiting after the transport trauma.
Physical examination: acyanotic, consciousness is clear, the pupils are equal, a horizontal
nystagmus, the motor and sensitive disorders are not present. What CT-signs confirmed the
diagnosis of concussion of the brain?
A. The ventricular systemis deformed

2. 2
B. Dilataion of basal cysterns
C. Focal changes of density of the brain
D. +The pathological changes are absent
E. Increased density of the cerebral cortical layer
7. A patient of 69 years old has received a trauma during falling, without losing consciousness,
nausea, general weakness, a headache. Physical exam-ination: consciousness is clear,
predominance of reflexes on the left, cranio-grams showed linear fracture of the right parietal
bone. On a carotid angiography – intracranial haematoma. What is the main sign of intracranial
haemattoma?
A. Abundantly vascularized region
B. Defect of filling of cerebral vessels
C. Moderately vascularized region
D. The vascular systemis not displaced
E. +Avascular region is like a lens
8. An injured person of 22 years old was admitted after the motorcycle
accident. Consciousness by a Glasgow Coma Scale is 6 points, respiration is
arrhythmic, AP— 170100, paresis of a look upwards, gormeotonic cramps.
On a CT-scan — increased volume of the brain with a ventricular compres
sion, small focal changes in the corpus collosum. What is the diagnosis?
A. Contusion of the brain of the severe degree
B. Intraventricular haemorrhage
C. +Diffuse axonal damage
D. Subarachnoidal haemorrhage
E. Intracerebral haematoma
9. A patient of 38 years old complains of headaches, reduction of memo
ry, sleep disorders. 2 years ago he had contusion of the brain of the moderate
degree. Objectively — microfocal neurological manifestation. The posttrau
matic leptomeningeal fibrosis is diagnosed. What sign on a CT-scan is char
acteristic of this pathology?
A. The median structures are displaced
B. Deformation of lateral ventricules
C. +The subarachnoid spaces are badly differentiated
D. Calcification of vascular plexuses
E. Focal changes of density of the brain
10.A patient of 27 years old has fallen from 3-4 metres of height. Con
sciousness by a Glasgow Coma Scale is 12 points, the pupils are similar, hor
izontal nystagmus, the face is symmetric and the reflexes are reduced, with
out essential asymmetry, linear fracture of the occipital bone. 2 hours later
— oppression of consciousness up to 8 points by a Glasgow Coma Scale. What
will you do?
A. Lumbar puncture
B. Dehydration therapy
C. +Craniotomy in the region of the fracture
D. Craniotomy in the temporal region
E. Carotid angiography
11.A 40-year old patient was admitted to hospital from the place of the
car accident, consciousness by a Glasgow Coma Scale — is 12 points, on
craniograms — linear fracture of the temporal bone on the left side. During
examination: the state of the patient has quickly changed for the worse: an
oppression of consciousness up to 8 points, cramps, the left pupil has extend
ed. Make the diagnosis:

3. 3
A. Contusion of the brain of a severe degree
B. +Epidural haematoma
C. Subdural haematoma
D. Traumatic subarachnoidal haemorrhage
E. Intraventricular haemorrhage
12. A patient of 27 years old fell 2 days ago without losing of consciousness, in 7-8 hours
after a trauma she had intense headache, photophobia, nausea. Physical examination:
consciousness is 13-14 points by a Glasgow Coma Scale, nuchal rigidity, positive Kernig's
symptom, hyperthermia. What preliminary diagnosis can you make on the basis of clinical
picture?
A. Intracranial haematoma
B. +Contusion of the brain, traumatic subarachnoidal haemorrhage
C. Rupture of the arterial aneurysm
D. Meningitis
E. Concussion of the brain
13. A 34-year old patient with the complaints of a headache, giddiness, nausea, weakness. 2
days ago she was beaten, she had a short-term loss of consciousness, vomiting. Physical
examination: there are no signs of the organic pathology of the CNS. Which of the following
methods can confirm the diagnosis of the concussion of the brain?
A. Echoencephaloscopy
B. +Calorical test
C. MRI tomography
D. Rheoencephalography
E. Computer tomography.
14. A 10-year old child has fallen from a sport bar and hit his head. He
has been conscious for several min, there was vomiting. Physical examination: acyanotic,
spontaneous horizontal nystagmus, on craniograms — linear fracture of the occipital bone. A
Kernig's symptom appeared on the 2nd day, the temperature increased up to 37.8 °C. Make the
diagnosis.
A. Concussion of the brain
B. +Contusion of the brain, subarachnoidal haemorrhage
C. Epidural haematoma
D. Subdural haematoma
E. Intraventricular haematoma
15. A child was born at full-term, with the weight of 4,800. Delivery was
prompt. Physical examination: cyanosis, disorder of respiration, absence of sucking reflex,
general rigidity, cramps, nystagmus, unilateral mydriasis, [strain of the large fontanel. What will
the doctor do?
A. Dynamic observation
B. Craniotomy
C. Lumbar puncture
D. +Subdural puncture
E. Dehydration therapy
16. A patient of 60 years old is brought from the place of the car accider in 40 min.
Consciousness by a Glasgow Coma Scale is 8 points, the distinct focal neurological
manifestation is not present, and there is an abrasion i the occipital region. In 1.5 hours
consciousness is 6 points, bradycardia, a intracranial haematoma is suspected. Determine the
place of craniotomy.
A. On the left in the temporal region
B. On the right in the temporal region
C. In the frontal region
D. +On either side in the temporal region

4. 4
E. In the occipital region
17. A 18-year old patient has received a blow on the head with a heavy
object. Consciousness is not lost. There is a contused wound of soft tissues
with the damage of aponeurosis up to the periosteum on the left frontal re
gion. On the X-ray of the skull in 2 projections: the destruction of the bone
tissue is not present. What kind of damage does the patient have?
A. Closed craniocerebral trauma
B. Concussion of the brain
C. +Open craniocerebral trauma
D. Contusion of the brain
E. Contused wound of the head
18. A patient of 24 years old is brought to the neurosurgical department
with a contused wound of the head, fragmental fracture of the temporal bone.
During the examination of the wound the dura mater is not damaged, pulsates,
and of usual colour. What kind of damage of the skull does the patient have?
A. Open penetrated craniocerebral trauma
B. +Open non penetrated craniocerebral trauma
C. Closed craniocerebral trauma
D. Closed fracture of skull bones
E. Subdural haematoma
19.The injured person of 33 years old has received a gunshot wound dur
ing hunting. The inlet opening in the right temporal region bleeds moderate
ly. During physical examination: consciousness by a Glasgow Coma Scale
12 points, anisocoria D>S, left-hand hemiparesis, AP 130/80 mm. Which of medical measures
should be carried out first of all?
A. Haemostatic therapy
B. Dehydration therapy
C. +Primary surgical treatment of the wound
D. Antibiotics
E. First aid, aseptic bandage
20. The patient of 42 years old is brought to hospital after a transport accident. Consciousness
is confused, 11 points by a Glasgow Coma Scale. Psychomotor excitement. The left ear oozes
haemorrhagic discharge with admixture of liquor. On the X-ray of a skull: linear fracture of the
temporal bone on the left. What is the preliminary diagnosis?
A. Concussion of the brain
B. Epidural haematoma
C. +Fracture of the base of the skull, subarachnoidal haemorrhage
D. Closed craniocerebral trauma
E. Contusion of soft tissues of the left ear
21. The patient of 30 years old has fallen from the height, and lost consciousness. On
admission: consciousness by a Glasgow Coma Scale is 12 points, haemorrhagic discharge with
admixture of liquor from the nose. The pupils are equal and react to light. On craniograms in 2
projections there is a fracture of bones of the nose, a fracture of the frontal bone through a frontal
sinus. What is the preliminary diagnosis?
A. Closed fracture of bones of the nose
B. Traumatic nasal bleeding
C. Contusion of the brain
D. +Open craniocerebral trauma
E. Concussion of the brain
22. The patient is brought to the department in a day after a trauma with a
loss of consciousness for 2-3 minutes, vomiting. A lacerated wound in the left temporal region

5. 5
with a damage of the aponeurosis and periosteum, bleeding from the left ear, bradycardia,
meningeal signs, microfocal neurological signs on the left temporal region. What is the scope of
the rendered medical aid?
A. Pretreatment of the left external acoustical passage
B. To excise edges of the wound, to apply deaf sutures
C. +To excise edges of the wound, to make a drainage
D. To suture the wound without exsisting its edges
E. To prescribe antibiotics
23. A patient is brought to the neurosurgical department on the 7th day
after a craniocerebral trauma with high temperature and expressed cephalalgia. Physical
examination: the meningeal signs, increase of the muscle tone on the right, right-hand
hemiparesis are marked. What should be carried out first of all?
A. Blood count
B. +Lumbar puncture-- expressed cephalalgia
C. Roentgenography of the organs of the thorax
D. Echoencephaloscopy
E. General analysis of urine
24. A patient is brought to hospital in the state of alcoholic intoxication.
Psychomotor excitement is marked. There is an ecchymosis on the region of
the left temple, there is a haemorhagic discharge from the left ear. 2 hours
later: spoor and attack of cramps developed, anisocoria appeared. What is
preliminary diagnosis?
A. Acute alcoholic intoxication
B. Fracture of base of the skull, alcoholic intoxication
C. +Epidural haematoma
D. Subdural haematoma
E. Contusion of the brain
25. The patient is brought to the neurosurgical department after the trans
port accident. Loss of consciousness for 2-3 minutes, vomitting are marked.
There are a laceration with damage of aponeurosis and periosteum on the
left temporal area, bleeding from the left ear, bradycardia (pulse 54 per
minute), meningeal symptoms are positive. There is also a paresis of facial
muscles of the peripheral type on the left, symptom of Marinesko — Rodovi-
chi on either side. Psychomotor excitation. By a Glasgow Coma Scale is 11
points. What is your preliminary diagnosis?
A. Concussion of the brain
B. +Fracture of the skull base, a contusion of the brain
C. A contusion of the brain
D. A spontaneous subarachnoidal haemorrhage
E. A contusion of the brain, of a severe degree
26. The patient is brought to the neurosurgical department on the 7th day after an open
craniocerebral trauma (primary surgical treatment of the wound was carried out; the wound was
not followed up). Temperature is 38.5 °C, there are tachycardia, cephalalgia, photophobia. There
are expressed meningeal symptoms, a right-hand hemiparesis with an increase of the muscular
tone. The examination of the wound revealed a purulent discharge. What is your preliminary
diagnosis?
A. An abscess of the brain
B. +A posttraumatic purulent meningoencephalitis
C. A purulent meningitis
D. An infected wound of soft tissues of the head
E. A traumatic subarachnoidal haemorrhage
27. Menses of the patient of 35 years old have stopped; acuity of vision has begun to reduce. In

6. 6
the course of 2 years her vision steadily was changing for the worse with the narrowing of visual
fields. She developed headaches of bursting character. Craniograms showed intensification of a
vascular pattern, enlargement of the turkish saddle. Your preliminary diagnosis.
A. +Adenoma of the pituitary body
B. Tumour of the frontal lobe
C. Basal arachnoiditis
D. Tumour of the occipital lobe
E. Tumour of the temporal lobe
28. A woman of 45 years old has come with the complaints of the steady headaches,
unsteadiness of gait and reduction of hearing in the right ear. Blurred vision has developed
recently. She considers herself ill for 4 years, when tinnitus in the right ear appeared, the hearing
was gradually reduced, and the headaches began. What is your preliminary diagnosis?
A. Tumour of the right hemisphere of the cerebellum
B. Tumour of the right frontal lobe
C. +Neurinoma of an acoustical nerve on the right
D. Tumour of the right temporal lobe.
E. Arachnoiditis of the pontocerebellar angle
29. A patient of 63 years old has come to the clinic on his son's insistence with complaints. From
the words of his son, the patient became aggressive, untidy, periodically excited. Physical
examination: aggressive, inclined to the trivial jokes. On the eyefundus there is a sign of Foster
— Kennedy. What is your preliminary diagnosis?
A. Discirculatory encephalopathy
B. +Tumour of basal region of the frontal lobe
C. Mental disease
D. Tumour of the parietal lobe
E. Alzheimer's disease
30. A mother with a 10-year-old son has come to the clinic. The child had a premature physical
and sexual development, heterophonia. On the eyefun- dus there is congestion of disks of the
optic nerves. On craniograms — ex- pressed "digital" impression. What disease does the child
suffer from?
A. Ependymoma of the third ventricle
B. Glioblastoma of the right temporal lobe
C. +Pinealoma
D. Pinealoma (tumour of the pineal body)
E. Oligoastrocytoma of the temporal lobe
31. A 40-year-old patient complains of general convulsive attacks, without aura in turning of the
head to the left and tonic cramps. Physical examination: mild pyramidal failure on the left, signs
of oral automatism. On the eyefundus congestion discs of the optic nerves more expressed on the
right. Define the preliminary diagnosis.
A. Late epilepsy
B. Tumour of the temporal lobe
C. Transient disorders of the cerebral circulation
D. +Tumour of the right frontal lobe
E. Tumour of the third ventricle
32. A 50-year-old patient complains of development of the general convulsive attacks without
aura for the first time in her life. She suffers from an idiopathic hypertension. A solitary
metastasis in the brain is revealed by a CT-scan, the primary process is not established. What is
the most probable source of the metastatic spread?
A. +Mammary glands
B. Lungs

7. 7
C. Kidneys
D. Uterus
E. Liver
33. A patient of 45 years old referred to the clinic with the complaints of a headache, attacks
of a visual disturbance as "net" and "fog" before eyes, olfactory hallucinations, short-term loss of
consciousness without cramps, episodes of derealization of the situation. On the eyefundus —
congestion of the discs of optic nerves. What is your preliminary diagnosis?
A. +Tumour of the temporal lobe
B. Late epilepsy
C. Tumour of the occipital lobe
D. Mental disease
E. Transient disorder of the cerebral circulation
34. A child of 5 years old, complains of an intense headache in the morning, vomiting at the
height of a headache, change of the gait. Physical examination: a spontaneous horizontal
nystagmus, hypomyotonia and static ataxia, expressed digital impression on craniograms. Define
the preliminary diagnosis.
A. Congenital hydrocephalus.
B. Chronic arachnoencephalitis
C. +Tumour of the vermis cerebelli
D. Tumour of the third ventricle
E. Multiple sclerosis
. 35. A patient of 51 years old developed strangeness in behaviour, became untidy with urine 2
months ago. Disorientation in the place, time, and his own personality increased, the mild speech
disorders appeared. On the eye-fundus: condestion in one eye, atrophy of the optic nerve in
another one. What is your preliminary diagnosis?
A. Tumour of the occipital lobe of the brain
B. Abscess of the brain
C. Tumour of the pituitary body
D. Alzheimer's disease
E. +Tumour of the frontal lobe of the brain
36. A patient of 48 years old with complaints of the progressive left-side hemiparesis,
headaches, increasing in the intensity during 1,5 months, vomiting in the morning. On the
eyefundus there are congested discs of the optic nerves. 6 years ago he was operated on for skin
melanoma. What is the preliminary diagnosis?
A. Chronic failure of the cerebral circulation
B. +Metastatic tumour of the brain
C. Abscess of the brain
D. Disorder of the cerebral circulation in pool of the right middle cerebral artery
E. Tumour of the cerebellum
37. A 41-year-old patient marked gradual enlargement of the nose, lips, fingers and toes
during the last 5 years. The vision has changed for the worse, libido has decreased. On the X-ray
examination: excavation and dilatation of the sinus of the turkish saddle, porosis of its wall.
What kind of diagnosis does the patient have?
A. Tumour of the frontal lobe of the brain.
B.+Tumour of the pituitary body
C.Opticochiasmal arachnoiditis
D.Pinealoma
E. Tumour of the paranephros
38. A 8-year-old patient, with suspicion of a tumour of the vermis cerebelli, the lumbar

8. 8
puncture was performed at the height of a sharp headache. The pathological plantar signs on
either side, disorder of respiration, pulse developed during the puncture. How can we call the
syndrome?
A. Foster — Kennedy syndrome
B. Acute disorder of the cerebral circulation
C. +Bruns' crisis
D. Hypertonic crisis
E. Liquor hypertension syndrome
39. A patient of 49 years old has been suffering from generalized epileptic seizure with aura
as gustatory and acoustical hallucinations for 7 years. A left-side hemiparesis with
hemihypoalgesia gradually increased. On the eye-fundus: congested discs of the optic nerves.
EchoEG showed dislocation of median structures to the left by 6 mm. What is your preliminary
diagnosis?
A. Tumour of the cerebellum
B. Tumour of the occipital lobe
C. +Tumour of the right temporal lobe
D. Tumour of the pituitary region
E. Chronic leptomeningitis
40. The patient of 65 years old, operated on for a carcinoma of the left lung a month ago
began to have headaches, unsteadiness in walking, muscular weakness, choke while taking
eiquid food. The expressed cerebellar signs, congested disc of the optic nerves are marked. What
is the preliminary diagnosis?
A. Discirculatory encephalopathy
B. Tumour of the frontal lobe of the brain
C. Disorder of the cerebral circulation
D. +Metastatic tumour of the posterior cranial fossa
E. Osteochondrosis of the cervical level of the spinal
41. A 10-year-old boy with signs of the accelerated sexual development. He developed
increasing headaches, reduction of hearing in both ears. On the physical examination: paresis of
the vision upwards, rotatory nystagmus while looking to the sides and upwards, depression of the
cornea reflexes. What is your preliminary diagnosis?
A. A tumour of the lateral ventricles
B. +Tumour of the pineal body
C. Endocrinopathy
D. Tumour of the cerebellum
E. Opticochiasmal arachnoiditis
42. A patient of 49 years old has been having the complaints of tinnitus in the left ear,
progressive reduction of hearing on the left for 5 years. On the background of the intensified
headache there appeared unsteadiness in walking, reduction of vision, the timbre of the voice has
changed, the signs of impairment of VII, IX, X, XII cranial nerves on the left. What is your
preliminary diagnosis?
A. Tumour of the frontal lobe of the brain
B. Discirculatory encephalopathy
C.+ Acoustic neurinoma
D. Tumour of the cerebellum
E. Arachnoiditis of the pontocerebellar angle
43. The patient complains of the increasing weakness in the legs, first in the feet, then in shins
with imperative desire to urination. The intense headaches in the morning, nausea, vomiting,

9. 9
blurred vision have developed. EEG showed the focus of pathological activity in parietal parts of
the brain on either side. On the eye fundus: congested papillae of the optic nerves. What is the
preliminary diagnosis?
A. Tumour of the spinal cord
B. +Tumour of the brain-- increasing weakness in the legs, first in the feet,then in shin
C. Stroke
D. Discirculator encephalopaty
E. Myelitis
44. A left lower quadrant hemianopsia is revealed in the patient, pupillary reactions are
preserved. There are anosognosia of hemiparesis, disorder of the scheme of the body,
psychosensor disorders. Where is the focus of affection?
A. In the left visual tract
B. In the right visual tract
C. In a corpus calosum on the left
D. +In the right parieto-temporal area
E. The upper part of calcarinum sulcus
45. A patient has the peripheral paresis of the mimic muscles on the right, active movements
of the face, tonic contraction arises in the paretic muscles, there are facial synkinesias:
palpebromandibular, oculofrontal, oculolingual, and also fascicular twitchings of the cheek and
chin muscles, blinking. What is the name of the syndrome?
A. Rigor contraction of the mimic muscles
B. Facial hyperkinesia
C. Jackson's epilepsy
D. +Kozhevnikov's epilepsy
E. Nothing of those variants
46. A patient complains of tinnitus in the right ear and reduction of hearing on the right.
Objectively: in Weber's test there is a sound in the left ear, in Shvabah experiment shortening of
bone conduction, experiment of Rinne is positive (bone conduction is shorter than air), on
audiogram — reduction of air and bone conduction in all frequencies, especially high, vestibular
and autonomic disorders are expressed. What is affected?
A. A middle or external ear on the left
B. An internal ear (an acoustic nerve at the level of the snail) on the right
C. +The brain stem at the level of acoustic nuclei on the left
D. Suprasylvian sulcus in the temporal lobe on the left
E. Nothing of those variants
47. A young woman has amenorrhea, hyperpigmentation of the skin, swelling of the calves,
pains in the bones of the calves, pseudoradicular pains, inclination to hypodermic haemorrhages,
hypersalivation and sweating. What is affected?
A. Parathyroid glands
B. +A bottom of the 3rd ventricle
C. System of circulation
D. Lateral horns of the spinal cord
E. A sympathetic trunk
48. In the street you have met a man, going in mincing small steps, "bent," his arms and legs
are semibent, his face is amimic, the gaze is not expressive, there are constant movements of the
fingers as if he counts coins. What is the name of the syndrome? Where is the focus?
A.+ A syndrome of parkinsonism. The focus is the in palidonigral structures of the

10. 10
striopalidar system
B.A syndrome of choreoatetosis. The focus is in a striped body of the subcrustal nodes
C.A syndrome of decerebration rigidity. The focus is in the midbrain at the level of red nuclei
D. A convulsive syndrome. The focus is in the anterior adversive field
E. Nothing of those variants
49. A 52-year-old patient complains of attacks of weakness in the left extremities twice a
week. The neurological state has no general cerebral and focal signs. On auscultation the systolic
sound is heard over the right carotid arteries. What is better to do first of all for the establishment
of the cause of the attacks of weakness in the extremeties?
A. Ultrasonic dopplerography of extracranial arteries
B. Transcranial dopplerography
C. +Duplex dopplerography of extracranial arteries
D. CT-scan of the brain
E. Rheoencephalography
50. A 40-year-old patient complain's of a severe headache, photophobia.
He fell ill a day ago, when suddenly he had a severe headache, and lost con-
sciousness for a short time. Physical examination: consciousness is 14 points
by a Glasgow Coma Scale, a meningeal syndrome is expressed. What is it necessary to make for
the preliminary diagnosis?
A. Lumbar puncture
B. +CT-scan of the brain
C. Cerebral angiography
D. Transcranial dopplerography
E. Echoencephalography
51. A 60-year-old patient has been admitted to the neurosurgical depart
ment 3 hours after a sudden loss of consciousness. Physical examination:
consciousness is 7 points by a Glasgow Coma Scale, the eyeballs are turned
to the left, mydriasis on the left; there are no motions in the light extremities,
AP — 200/120. Your diagnosis.
A. +Haemorrhagic stroke --- sudden loss of consciousness
B. Ischemic stroke
C. Rupture of the arterial aneurysm of the brain
D. Rupture of arteriovenous malformation of the brain
E. Haemorrhage in a tumour of the brain
52. A patient of 33 years old, suddenly felt a severe headache, weakness the right extremities,
disorder of speech. On physical examination in 6 hours: consciousness is 13 points by a Glasgow
Coma Scale, sensor aphasia, hemihypoesthesia on the right, moderate central hemiparesis on the
right, AP 130/80 mm. Your diagnosis.
A. Haemorrhagic stroke -- sudden loss of consciousness
B. Ischemic stroke
C. Rupture of an arterial aneurysm of the brain
D. +Rupture of arteriovenous malformation of the brain-- suddenly felt a severe headache
E. Haemorrhage in a tumour of the brain
53. A patient of 55 years old suddenly felt weakness in the left extremities. Physical
examination: consciousness is clear, hemihypoesthesia on the left, central hemiplegia on the left.
On a palpation tenderness on the anterior surface of the sternocleidomastoideus muscle is
revealed, a pulsation of the carotid and temporal superficial arteries on the right is absent. Your
diagnosis:

11. 11
A. Ischemic stroke
B. Haemorrhagic stroke-- sudden loss of consciousness
C. Rupture of the arterial aneurysm of the brain
D. +Ischemic stroke because of a thrombosis of a bifurcation of a dextral common carotid
artery
E. Ischemic stroke because of the thrombosis of the right internal carotid artery
54. A patient of 29 years old hit his head during a transport accident. Physical examination in
1 month after a trauma: consciousness — 15 points by a Glasgow Coma Scale on the left there is
a pulsating exophthalmus, chemosis, ophthalmoplegia, sound disappearing by pressing carotid
arteries on the left on auscultation of the head. Your diagnosis.
A. Traumatic damage of the left oculomotor nerve
B. Traumatic damage of the left orbit
C. +Traumatic carotid-cavernous anastomosis
D. Rupture of aneurysm of the subclinoid part of the left internal carotid artery
E. Rupture of aneurysm of the supraclinoid part of the left internal carotid artery
55. A patient of 56 years old had physical examination in 2 months after
the beginning of the disease: consciousness was clear, partial motor aphasia,
moderate hemihypoesthesia on the right, moderate central hemiparesis on the
right. On a carotid angiography on the left: 90 % stenosis of the left internal
carotid artery. What is better to do first?
A. +Carotid angiography on the right-- beginning of the disease
B. CT-scan of the brain
C. Carotid endarterectomy on the left
D. Duplex dopplerography
E. Extraintracranial microanastomosis (by-pass) on the left
56.A patient of 58 years old had physical examination in 3 weeks after
the beginning of the disease: consciousness was clear, moderate hemihy-
poesthesia on the left, moderate hemiparesis on the left of the central type. A
total cerebral angiography established 80 % stenosis of the ostium of the right
internal carotid arteria. What type of operation is indicated to the patient?
A. +Carotid endarterectomy on the right
B. Resection of the right internal carotid artery
C. Extraintracranial microanastomosis (by-pass)
D. Carotid thrombintimectomy on the right
E. Redressing of the right outside carotid artery
57. A patient of 35 years old had physical examination in 6 hours after
the beginning of the disease: sopor, meningeal syndrome and central hemi
paresis on the right. A CT-scan showed haematoma of the left lateral fissure
(volume 45 cm3), on the angiography: arterial aneurysm of the left middle
cerebral artery. What type of operation is indicated to the patient?
A.+Clipping of aneurysm of the left middle cerebral artery and removal of haematoma
B.Occlusion of aneurysm of the left middle cerebral artery by a balloon-catheter
C. Occlusion of aneurysm of the left middle cerebral artery by platinum spirals
D. Excision of aneurysm of the left middle cerebral artery
E. Extraintracranial microanastomosis (by-pass) on the left
58. A patient of 42 years old had physical examination in 2 days after the beginning of the
disease: deafness, hemihypesthesia on the left, central hemiparesis on the left. A CT-scan

12. 12
showed haematoma in the right parietal lobe (volume 50 cm3), on the angiography: arteriovenous
malformation of the right parietal lobe. What type of the operation is indicated to the patient?
A. +Extirpation of arteriovenous malformation and removal of haemotoma
B. Embolisation of arteriovenous malformation
C. Occlusion of arteriovenous malformation by a balloon-catheter
D. Occlusion of arteriovenous malformation by platinum spirals
E. Thrombosing of arteriovenous malformation with the help of a gamma-knife
59. A patient of 62 years old complains of giddiness, unsteadiness of the gait. Physical
examination: the spontaneous horizontal nystagmus in both parts intensified in turning of the
head, coordinated — cerebellar failure, on auscultation systolic sound is heard in the left
supraclavicular fossa. Your
diagnosis:
A. +Stenosis of the left vertebral artery
B. Occlusion of the left vertebral artery
C. Loop-shaped formation of the left vertebral artery
D. Extravasal compression of the left vertebral artery
E. Osteochondrosis of the cervical spine
60. A patient of 42 years old suddenly felt a bad headache, lost conscious-
less for a short time. Physical examination: psychomotor excitement, menin-;eal syndrome, AP
— 160/100. A CT-scan snowed haematoma of 12 cm3 of a medial part of the right frontal lobe,
blood in chiasmal and sellar region and in the right lateral ventricle. Your diagnosis:
A. Haemorrhagic stroke -- sudden loss of consciousness
B. Rupture of arteriovenous malformation of the brain
C. +Rupture of the arterial aneurysm of the brain
D. Contusion of the brain
E. Haemorrhage in a tumour of the brain
61. A 54-year-old patient had physical examination in 4 weeks after the beginning of the disease:
partial senso-motor aphasia, hemihypoesthesia on the right, moderate central hemiparesis on the
right. On carotid angiography: occlusion of the left internal carotid artery. What type of
operation is indicated to the patient?
A. +Extraintracranial microanastomosis (by-pass) on the left-- partial senso-motor aphasia
B. Carotid endarterectomy on the left
C. Carotid thrombintimectomy on the left
D. Resection of the left internal carotid artery
E. Desympathization of the left internal carotid artery
62.A 36-year-old patient complains of giddiness, unsteadiness of gait in-
tensified on physical exertion in the left arm. Physical examination: a spon
taneous horizontal nystagmus intensified in turning of the head, coordinat-
ed-cerebellar failure, absence of the pulse on the left radial artery. Your di
agnosis:
A. +Occlusion of the left subclavial artery
B. Occlusion of the left radial artery
C. Occlusion of the left vertebral artery
D. Occlusion of the left axilar artery
E. Stenosis of the left vertebral artery
63.A 42-year-old patient had a subarachnoidal haemorrhage a month ago.
There are no complaints. In the neurological state there are no meningeal
and focal signs. CT-scan of the brain hasn't revealed pathological changes.

13. 13
What is it necessary to make for the specification of the diagnosis?
A. +Total cerebral angiography
B.MRI of the brain
C. Transcranial dopplerography
D. Lumbar puncture
B. Nothing
64.A 30-year-old patient fell ill suddenly, when one day before the physi
cal examination a bad headache suddenly developed. Physical examination:
deafness, expressed meningeal syndrome, AP— 160/120. A CT-scan showed
blood in the basal cysterns of the brain, the third ventricle. What is it neces
sary to prescribe?
A. +Antagonists of calcium-- a bad headache suddenly
B. Dehydration therapy
C. Haemostatic therapy
D. Antibiotics
E. Beta-adrenoblockers
65.A patient isn't able to bend aside, extremities at one side are fixed in
Vernike — Mann position, when walking the leg moves aside without bend
ing in the knee, making a semicircumference, touches the floor with toes and
puts it toes, there is no movement of the foot, a height of raising of the leg is
small, walking is slow, walking upstairs is difficult complicated. Name type
of walking.
A.Torzion-distonic type
B. Peripheral paretic type
C. Steppage
D. +Hemyparetic walking of pyramidal type
E. Hemiataxic type
66. A 37-year-old patient with the complaints of frequent general convul-
sive attacks 3-4 times per week, absentia, has referred to the clinic. Four years ago he had a
severe craniocerebral trauma; in 1.5 year the above-stated signs developed. What is the
preliminary diagnosis?
A. Posttraumatic arachnoiditis
B. +Post-traumatic epilepsy
C. Tumour of the temporal lobe
D. Mental disease
E. Chronic cerebral vascular failure
67. A patient developed frequent general convulsive attacks in 4 years af-
fter a severe craniocerebral trauma. Physical examination: aggressive, easily
excited the accent of reflexes on the left, mild disorder of statics. CT-scan
revealed a cyst in the right hemisphere with dislocation of the third ventricle
by 6 mm. Define the tactics of treatment.
A. Dehydration therapy
B. Neuroleptics
C. +Excision of the cyst-- general convulsive attacks
D. Anticonvulsant drugs
E. General strengthening therapy
68. A 28-year-old patient complains of tremor of the right extremities intensified on

14. 14
movements. Two years ago he had a severe contusion of the brain. Physical examination:
passive, apathetic, increase of tone in the right extrem-ities by extrapyramidal type. What is the
preliminary diagnosis?
A. Lateral amiothrophic sclerosis
B. Multiple sclerosis
C. +Syndrome of parkinsonism
D. Tumour of the brain
E. Brain stem encephalitis
69. A 65-year-old patient is in the neurosurgical clinic because of Parkinson's disease. The
patient has been ill for 10 years, the last years the muscle tension and tremor intensified on
movements; it is extremely difficult for him to walk and self-care. Define tactics of treatment.
A. Ventriculoperitoneal shunting
B. +Stereotaxic destruction of the ventrolateral nucleus of the thalamus-- Parkin¬son's disease
C. Stereotaxic destruction of the amigdaloid nucleus
D. Stereotaxic destruction of the medial loop
E. Stereotaxic destruction of the hippocampus
70. A patient of 32 years old has been admitted with the complaints of an intolerable
thermalgia in 1-2 fingers after a gunshot wound in the area of the upper third of the forearm. The
pain strengthens at any touch to the fingers. Physical examination- the hand is swollen, slightly
bloodshot. Define the type of a painful syndrome.
A. Neuralgia
B. +Causalgia
C. Stump neuralgia
D. Neuritis
E. Amputation pain
71. A patient of 49 years old complains of attacks of an intense sharp pain ("as if struck by
electric current") at the root of the tongue, tonsils, irradiating to the ear and accompanied by
dryness in the mouth. The attacks of pain are triggered by mastication, talking and enhance in
time. What is your diagnosis?
A. Sluder's syndrome
B. Scharlen's syndrome
C. +Neuralgia of the glossopharyngeal nerve
D. Epileptiform neuralgia
E. Neuritis of the hypoglossal nerve
72. A patient of 50 years old has been suffering from a trigeminal neuralgia for 15 years.
Attacks of pains are frequent and excruciating, the frequency and intensity of them are increased.
Results of examination — tumour of the trigeminal nerve ganglion. The following surgical
interventions can be carried out except:
A. Cryodestruction of branches of the trigeminal nerve
B. +Destruction of sympathetic ganglia-- suffering from a trigeminal neuralgia
C. Decompression of peripheral branches of the trigeminal nerve
D. Neurotomy of sensitive roots of the trigeminal nerve
E. Stereotaxic operations on subcortical ganglia
73. A 56-year-old patient had a severe contusion of the right femur after a car accident, traumatic
amputation. The stump neuralgia syndrome developed. For 12 years he has been taking
analgetics, somnolents, neuroleptics, the efficacy is minimal. He may be recommended the
surgical interventions except:
A. +Prefrontal leucotomy

15. 15
B. Reamputation
C. Excision of neuromas of the stump
D. Tractotomy
E. Commissurotomy
74. An 11-month-old child has delayed closure of the large fontanel. The child cries irritably
at night, vomits frequently, refuses food. He is a cyanot- ic; his skin is dry, rugose. The facial
skull is of the triangular form, circumference of the head is 52 cm. The large and small fontanels
are intense, their pulsation is weak. What's the preliminary clinical diagnosis?
A. Tumour of the temporal lobe of the brain
B. Tumour of the posterior cranial fossa
C. +Hydrocephalus-- the large fontanel
D. Meningocephalitis
E. Rickets
75. A 2.5-year-old child is restless, complains of a headache. He has physi-
cal and mental retardation, a multiple microfocal neurological manifestation
is marked. The fontanels were closed nearly 5 months after birth. On the eye-
fundus there is congestion of discs of the optic nerves. What is the diagnosis?
A. Microcephalia
B. Rachitis
C. +Craniostenosis
D. Organic lesion of the CNS
E. Encephalopathy of the mixed genesis
76. A 6-year-old child has been examined because of a liquor hyperten
sive syndrome. The sharp headache, nausea, vomiting compelled position of
the head, psychomotor excitation with disorder of consciousness and in-
creased oculomotor disorders, bradycardia, arrhythmia, intensification of the
pyramid signs, tonic cramps developed suddenly. What is such attack called?
A. Hypoglicemic attack
B. Hyperglicemic attack
C. +Occlusive attack-- liquor hypertensive syndrome
D. Convulsive syndrome
E. Syncopal syndrome
77. A congenital tumour of mild consistency measuring 8-10 cm is marked in the lumbar region
of a 4-month-old child. Range of movement in the legs is limited, a muscle tone and force are
reduced. The pelvic functions are normal. There is hypesthesia in the region of the innervation of
the 5 lumbar and 1-4 sacral roots. What is the preliminary diagnosis?
A. Lipoma in the lumbar region
B. Abscess
C. Cystocele
D. +Myelo-radicular cystocele
E. Tumour of the spinal column
78. A patient came to the doctor with the complaints of a girdle pains in the thoracic part of
the spine in the area of the sixth-eighth thoracic roots, which gradually became worse 5 months
ago. There were weakness in the legs, difficulty in urination. Objective data: the low paraparesis,
hypalgesia from the level of D6-D8 segments. What is the preliminary diagnosis?

16. 16
A. Spondylogenous myelopathy
B. +Extraspinal tumour of the spinal cord
C. Intraspinal tumour of the spinal cord
D. Acute disorder of the spinal cord circulation
E. Lumbosacral radiculitis
79. A patient came to the doctor with the complaints of increasing weakness in the legs, first
the feet, then in calves and thighs. On admission there was a girdle pain in the hypochondrium.
The low spastic paraparesis, hypalgesia from the level of segments Th6-Th8. What is the
patient's preliminary diagnosis?
A. +Tumour of the spinal cord-- increasing weakness in the legs
B. Tumour of the brain
C. Acute disorder of the spinal cord circulation
D. Discirculatory encephalomyelopathy
E. Myelitis
80. During the last 6 months a patient began to feel difficulties on walking; weakness in the
legs, numbness, and parasthesia has developed. Pains in the low-thoracic and lumbar levels of
the spine became worse and intensified at night. The muscle tone in the legs, the tendon reflexes
of the legs are increased and there is clonospasm of the feet. What disease is supposed to be?
A. Tumour of the brain
B. +Tumour of the spinal cord
C. Spondylogenous myelopathy
D. Lumbosacral radiculitis
E. Osteomyelitis of the lumbar part of the spine
ANSWERS
l.B 12. B 23. B 34. C 45. D 56 A 67C 78B
2.C 13. B 24. C 35. E 46. C 57 A 68C 79A
3. A 14. B 25. B 36. B 47. B 58 A 69B 80B
4.B 15. D 26. B 37. B 48. A 59 A 70B
5.D 16. D 27. A 38. C 49. C 60 C 71C
6.D 17. C 28. C 39. C 50. B 61 A 72B
7.E 18. B 29. B 40. D 51.A 62A 73A
8.C 19. C 30. C 41. B 52. D 63A 74C
9.C 20. C 31.D 42. C 53. D 64A 75C
10. C 21.D 32. A 43. B 54. C 65D 76C
ll.B 22. C 33. A 44. D 55. A 66B 77D