Forty questions across both levels — every unit from the cerebral circulation to decompressive craniectomy. It is longer than anything else here and it is meant to be: the point is to find what did not survive the eight weeks, while there is still time to go back and read it.
01
What this is
no new material
**Everything, in one sitting.** Forty questions over all twenty-nine reading days — sixteen from Neuro 1 and thirteen from Neuro 2.
This is not a gate and it decides nothing. Nobody is told your score, it enters no evaluation, and your completion record lives in the GME system where it always did. It exists because eight weeks is long enough that some of what you read in week one is gone, and the only reliable way to find out which parts is to try to retrieve them.
Expect it to be harder than the Fridays. Most items ask you to use two days at once, several turn on a distinction the source itself states carelessly, and a few are built around numbers that are worth knowing exactly rather than approximately — the ones where being an order of magnitude out changes what happens to a patient.
**Sit it in one go, without looking anything up.** Then go back to what you got wrong, and read that day again rather than the explanation.
Answer first, then read. Checking the day before answering turns retrieval
practice into rereading, and the two feel identical while you are doing them.
03
The exam
35 of 40 application or analysis
Item 1Analysis Neuro 2 · Week 4
Which single statement about the cerebral autoregulation curve is best supported by Neuro 1 day 02?
Item 2Recall Neuro 2 · Week 4
On neuronal activation, how do cerebral oxygen consumption and cerebral blood flow change relative to one another?
Item 3Analysis Neuro 2 · Week 4
A patient has an external ventricular drain open to drainage at 15 cm above the external auditory meatus. The nurse charts an ICP of 15 mm Hg from the same system. What is the problem?
Item 4Application Neuro 2 · Week 4
A team wants to lower a patient's intracranial pressure by dropping the external ventricular drain chamber from 20 cm to 5 cm above the foramen of Monro. What have they actually done, and what should worry them?
Item 5Analysis Neuro 2 · Week 4
A spine surgeon reports troublesome venous bleeding an hour into a prone multilevel fusion. Which explanation is best supported by this curriculum, and what is the corresponding action?
Item 6Application Neuro 2 · Week 4
Which statement best reflects the leading explanation for perioperative ischaemic optic neuropathy after prolonged prone spine surgery?
Item 7Analysis Neuro 2 · Week 4
During a thoracic deformity correction the SSEPs are unchanged. The surgeon asks whether it is safe to continue the derotation. What is the correct reply?
Item 8Analysis Neuro 2 · Week 4
Which pairing of alarm criteria to modality is correct?
Item 9Analysis Neuro 2 · Week 4
A colleague cites the noncardiac surgery trial of tranexamic acid as showing that TXA is "safe and effective". What is the more accurate reading?
Item 10Application Neuro 2 · Week 4
Which analgesic intervention has the cleanest evidence in posterior spinal fusion, and what did it show?
Item 11Analysis Neuro 2 · Week 4
The teaching that spinal cord perfusion pressure should be held above a MAP of 85 to 90 for seven days has been revised. What changed, and why?
Item 12Application Neuro 2 · Week 4
A patient with a large glioma and surrounding oedema is deteriorating. A second patient has cerebral oedema after a middle cerebral artery infarction. What is the role of dexamethasone in each?
Item 13Analysis Neuro 2 · Week 4
Why does albumin offer no advantage over crystalloid for limiting cerebral oedema, when oncotic pressure governs fluid movement elsewhere in the body?
Item 14Analysis Neuro 2 · Week 4
Anaesthetic-induced burst suppression and therapeutic hypothermia are both described as cerebral protection. What is the mechanistic difference, and what did the trials show?
Item 15Analysis Neuro 2 · Week 4
A patient on apixaban has an intracerebral haemorrhage. Andexanet alfa is considered. Which summary of the evidence is accurate?
Item 16Application Neuro 2 · Week 4
Day 6 after subarachnoid haemorrhage: sodium 128, urine sodium 60, urine osmolality 500, serum osmolality 265. The patient is tachycardic with a low CVP and a negative fluid balance. What is the diagnosis and treatment?
Item 17Recall Neuro 2 · Week 4
What rate limits apply to the correction of chronic hyponatraemia in this curriculum?
Item 18Analysis Neuro 2 · Week 4
A patient is extubated after an uneventful craniotomy with a brief hypertensive surge. The surgeon is unconcerned because the patient is neurologically intact in recovery. What does this curriculum say?
Item 19Recall Neuro 2 · Week 4
Which statement about imaging safety and interpretation is correct?
Item 20Analysis Neuro 2 · Week 4
Imaging shows tonsillar herniation. The medical team requests a lumbar puncture to exclude meningitis. What is the correct response, and why?
Item 21Analysis Neuro 2 · Week 4
A patient with a large acute subdural haematoma becomes profoundly hypotensive moments after the clot is evacuated. What happened?
Item 22Application Neuro 2 · Week 4
A patient has received 1 g/kg of mannitol and the measured serum osmolality is 322 mOsm/kg. The brain is still tight. What is the defensible position on further mannitol?
Item 23Application Neuro 2 · Week 4
Which statement about awake craniotomy technique is best supported?
Item 24Analysis Neuro 2 · Week 4
Observational data consistently showed worse outcomes after general anaesthesia than sedation for thrombectomy. Three randomised trials then found no disadvantage. What is the correct inference?
Item 25Application Neuro 2 · Week 4
A patient is 8 days out from transsphenoidal resection of a pituitary macroadenoma and presents confused with a sodium of 124. What is the most likely explanation?
Item 26Analysis Neuro 2 · Week 4
Why should a good-grade patient with an unsecured aneurysm not be hyperventilated?
Item 27Application Neuro 2 · Week 4
Which patient tolerates a larger fall in blood pressure during aneurysm surgery, and why?
Item 28Analysis Neuro 2 · Week 4
During carotid cross-clamping under general anaesthesia the EEG slows. The team raises the blood pressure. What is the limitation of that response?
Item 29Recall Neuro 2 · Week 4
How complete is the circle of Willis in healthy people, and what follows?
Item 30Analysis Neuro 2 · Week 4
A patient is in the sitting position for a posterior fossa craniotomy. The arterial transducer is at the level of the right atrium and the head is 25 cm above it. The monitor reads a MAP of 65. What is the cerebral arterial pressure, and what is the fix?
Item 31Application Neuro 2 · Week 4
A seizure begins during an awake resection with the patient's head in pins. What is the first action?
Item 32Analysis Neuro 2 · Week 4
What is the specific hazard of using methohexital during epilepsy surgery?
Item 33Application Neuro 2 · Week 4
A patient in the angiography suite deteriorates neurologically mid- procedure. What is the first thing to establish, and why?
Item 34Analysis Neuro 2 · Week 4
Why are pallidal microelectrode recordings often impossible under general anaesthesia while subthalamic recordings frequently survive sedation?
Item 35Recall Neuro 2 · Week 4
Which sedation target has become preferred for microelectrode recording in deep brain stimulation?
Item 36Analysis Neuro 2 · Week 4
The Brain Trauma Foundation's 2020 update on decompressive craniectomy is often summarised as "recommended for refractory intracranial hypertension". What does it actually say?
Item 37Analysis Neuro 2 · Week 4
A resident argues that because decompressive craniectomy reliably lowers intracranial pressure, it must improve outcome. Which reply is best grounded in this curriculum?
Item 38Application Neuro 2 · Week 4
An emergency craniotomy patient with a spent intracranial compliance becomes hypotensive at induction. Why is this more dangerous here than in a patient with normal compliance?
Item 39Analysis Neuro 2 · Week 4
A patient wakes from a long prone fusion with weakness that is worse proximally than distally, sparing the face. Which combination of this rotation's ideas best explains a plausible mechanism?
Item 40Analysis Neuro 2 · Week 4
Across this rotation, several interventions have a sound mechanism and no demonstrated outcome benefit. Which grouping is correct?