100+ Free TENC Neurocirurgia Practice Questions

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Key Facts: TENC Neurocirurgia Exam

100 Items

Multiple-choice questions on the official TENC written theoretical paper (1ª Fase)

Edital TENC — SBN / AMB

4 Hours

Examination duration for the written Theoretical Phase (1ª Fase)

Edital TENC — SBN / AMB

R$ 2.400,00

Registration Fee for SBN/AMB Affiliated Members (R$ 4.800 for Non-Members)

Edital SBN / AMB

70%

Minimum Passing Grade Benchmark (7.0 / 10.0 Scale) on Theoretical Phase

Regulamento Oficial TENC / SBN

RQE Neurocirurgia

Specialist Registration Credential Conferred with CFM

Conselho Federal de Medicina (CFM) / AMB

Annual

Official Examination Frequency Conducted by SBN

Sociedade Brasileira de Neurocirurgia (SBN)

The TENC (Título de Especialista em Neurocirurgia) is the official Brazilian neurosurgical board certification examination administered annually by SBN and AMB. It consists of a 100-question written theoretical examination followed by a practical-oral case examination (TOP) testing surgical neuroanatomy, neurocritical care, neurovascular clipping/coiling, neuro-oncology, spine surgery, and pediatric/functional neurosurgery.

Sample TENC Neurocirurgia Practice Questions

Try these sample questions to test your TENC Neurocirurgia exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 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?

A.Hunt & Hess Grade II; Modified Fisher Grade 2

B.Hunt & Hess Grade III; Modified Fisher Grade 4

C.Hunt & Hess Grade IV; Modified Fisher Grade 3

D.Hunt & Hess Grade I; Modified Fisher Grade 1

Explanation: Hunt & Hess Grade III is defined by lethargy, confusion, or mild focal deficit, matching this patient's presentation of drowsiness, confusion, and GCS 14. Under the modified Fisher scale, Grade 4 represents thick diffuse cisternal subarachnoid hemorrhage with intraventricular hemorrhage (IVH), which carries the highest risk of delayed cerebral ischemia and vasospasm.

2The 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?

A.Microsurgical clipping produced a statistically significant reduction in 1-year all-cause mortality compared to endovascular coiling.

B.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.

C.Endovascular coiling resulted in a significantly lower rate of late aneurysm recurrence and rebleeding compared to microsurgical clipping.

D.There was no statistically significant difference in 1-year functional dependency, but microsurgical clipping resulted in shorter intensive care unit stays.

Explanation: The ISAT trial demonstrated that for ruptured aneurysms anatomically amenable to both strategies, endovascular coiling yielded a significant absolute risk reduction of 6.9% in the primary composite endpoint of death or functional dependency (Rankin score 3 to 6) at 1 year (23.5% vs 30.6%). However, long-term follow-up showed that microsurgical clipping yielded superior durability with significantly lower rates of late recurrence and rebleeding.

3A 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)?

A.Aggressive hypervolemic hemodilution using 5 liters of 0.45% saline daily and prophylactic placement of a balloon pump.

B.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.

C.Immediate intravenous administration of high-dose corticosteroids and low-dose unfractionated heparin bolus.

D.Immediate surgical exploration for left carotid artery endarterectomy and bypass.

Explanation: Modern management of delayed cerebral ischemia (DCI) following aneurysmal SAH prioritizes maintenance of strict euvolemia, enteral nimodipine (60 mg every 4 hours for 21 days), and induced hypertension (stepwise elevation of MAP using vasopressors like norepinephrine). The historical 'Triple-H' therapy (hypervolemia, hemodilution, hypertension) has been abandoned because hypervolemia and hemodilution increase cardiopulmonary complications without improving cerebral oxygen delivery.

4A 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?

A.Grade II

B.Grade III

C.Grade IV

D.Grade V

Explanation: The Spetzler-Martin scale assigns points based on three criteria: Size (<3 cm = 1 pt, 3-6 cm = 2 pts, >6 cm = 3 pts), Eloquence of adjacent brain (Non-eloquent = 0, Eloquent = 1 pt), and Venous drainage (Superficial only = 0, Deep venous drainage = 1 pt). Here, size is 3.5 cm (2 pts), location is in the primary somatosensory cortex which is eloquent (1 pt), and venous drainage involves deep internal cerebral veins (1 pt), yielding 2 + 1 + 1 = 4 points (Spetzler-Martin Grade IV).

5What 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?

A.Immediate multimodal interventional eradication (microsurgery, embolization, or radiosurgery) was superior to medical management alone in preventing stroke and death.

B.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.

C.Stereotactic radiosurgery alone demonstrated significant superiority over observation for high-grade (Spetzler-Martin IV-V) unruptured AVMs.

D.Interventional management achieved a 100% cure rate with no increased morbidity compared to conservative medical management.

Explanation: The ARUBA trial was stopped early after finding that conservative medical management alone was significantly superior to interventional therapy (microsurgery, embolization, or radiosurgery, alone or in combination) for unruptured AVMs, with a significantly lower risk of death or stroke over 33 months (10.1% vs 30.7%). Although criticized for short follow-up and heterogeneous interventional techniques, ARUBA established medical therapy as the initial standard for many unruptured AVMs.

6A 28-year-old woman is admitted after experiencing two distinct episodes of transient right hemiparesis and facial numbness over the past 4 months. Brain MRI reveals a 1.8 cm well-circumscribed lesion with mixed core signal intensity ('popcorn' appearance) and a prominent surrounding rim of hemosiderin hypointensity on T2- and susceptibility-weighted (SWI) sequences located in the superficial left middle cerebellar peduncle, reaching the pial surface. There is no flow void or arterial feeder on digital subtraction angiography. What is the most appropriate management for this cavernous malformation (cavernoma)?

A.Emergency endovascular embolization with n-butyl cyanoacrylate (n-BCA) to prevent catastrophic rupture.

B.Microsurgical total resection via a suboccipital retrosigmoid approach to prevent recurrent hemorrhage and progressive neurological deficit.

C.Fractionated whole-brain radiation therapy to 50 Gy.

D.High-dose intravenous corticosteroid pulse therapy and lifelong aspirin anticoagulation.

Explanation: Cerebral cavernous malformations (cavernomas) that present with recurrent symptomatic hemorrhages and are surgically accessible (e.g., reaching a pial or ependymal surface) have a clear indication for microsurgical resection to eliminate the heightened risk of recurrent bleeding. Cavernomas are angiographically occult (no fast flow or feeding arteries), making endovascular embolization impossible and contraindicated.

7In the classification of cranial dural arteriovenous fistulas (dAVFs) described by Cognard and Borden, what is the single most critical angiographic feature that dictates an aggressive natural history with high annual risks of intracranial hemorrhage (up to 8–15% per year) and venous infarction?

A.Presence of multiple external carotid artery arterial feeders from the middle meningeal artery.

B.Retrograde cortical (leptomeningeal) venous drainage / reflux.

C.Location of the fistula along the transverse-sigmoid sinus junction.

D.Absence of an audible cranial bruit on physical examination.

Explanation: In both the Cognard (Types IIb through V) and Borden (Types II and III) classifications, retrograde cortical venous reflux (CVR) is the primary determinant of aggressiveness. Fistulas with cortical venous drainage subject thin-walled pial veins to high arterial pressures, resulting in venous hypertension, cerebral edema, venous infarction, and intraparenchymal or subarachnoid hemorrhage.

8The STICH (Surgical Trial in Intracerebral Haemorrhage) and STICH II trials investigated the role of early surgical evacuation compared to initial medical management for spontaneous supratentorial intracerebral hemorrhage (ICH). According to these trials, which subgroup of patients demonstrated a potential clinical benefit from early surgical hematoma evacuation?

A.Patients with deep basal ganglia or thalamic hemorrhages causing severe hemiplegia and intraventricular extension.

B.Patients with superficial lobar intracerebral hemorrhages extending within 1 cm of the cortical surface without intraventricular hemorrhage who deteriorate neurologically.

C.Comatose patients (Glasgow Coma Scale score 3 to 4) with fixed bilateral dilated pupils.

D.Asymptomatic patients with small (<10 mL) putaminal hematomas.

Explanation: Subgroup analysis of STICH and the targeted STICH II trial demonstrated that patients with spontaneous superficial lobar hemorrhages located within 1 cm of the cortical surface, without intraventricular hemorrhage, who present within 48 hours of ictus may derive a survival and functional benefit from early surgical evacuation over initial conservative treatment.

9A 52-year-old man suffers an acute ischemic stroke due to a right internal carotid artery terminus occlusion. Despite intravenous thrombolysis, he develops progressive hemispheric brain edema with complete effacement of the ipsilateral basal cisterns and a 9 mm midline shift on repeat CT 30 hours after symptom onset. Pooled data from randomized trials (DECIMAL, DESTINY, and HAMLET) support which intervention to significantly reduce mortality and increase favorable functional outcomes in malignant middle cerebral artery (MCA) infarction?

A.Immediate decompressive hemicraniectomy with a large bone flap (diameter >= 12 cm) and duraplasty performed within 48 hours of stroke onset in patients <=60 years of age.

B.Aggressive continuous hyperventilation targeting PaCO2 between 20 and 25 mmHg for 7 consecutive days.

C.High-dose barbiturate coma (pentobarbital) combined with therapeutic hypothermia to 30°C without surgical decompression.

D.Emergent bilateral frontal lobectomy and ventricular shunt insertion.

Explanation: Pooled analysis of DECIMAL, DESTINY, and HAMLET demonstrated that decompressive hemicraniectomy performed within 48 hours of stroke onset in patients aged <=60 years with malignant MCA infarction reduced mortality by more than 50% (absolute risk reduction ~50%) and significantly increased the proportion of patients surviving with moderate or better functional outcomes (mRS <=3 or <=4). A sufficiently large craniectomy flap (>=12-15 cm) is mandatory to prevent brain herniation over the bone edges.

10A 50-year-old woman presents to the neurosurgical clinic with severe retro-orbital headache, complete right ptosis, an unreactive dilated right pupil (mydriasis), and inability to adduct, elevate, or depress the right globe. Digital subtraction angiography confirms an aneurysm at the junction of the internal carotid artery and posterior communicating artery (PComA). Which anatomical structure is directly compressed by this aneurysm dome?

A.Oculomotor nerve (CN III) in the oculomotor triangle / tentorial incisura as it courses lateral to the posterior communicating artery.

B.Trochlear nerve (CN IV) as it exits dorsal to the inferior colliculi.

C.Abducens nerve (CN VI) within Dorello's canal.

D.Optic chiasm at the suprasellar cistern.

Explanation: Aneurysms arising at the junction of the internal carotid artery and posterior communicating artery typically project posterolaterally and inferiorly, directly compressing the pupillomotor fibers on the superomedial surface of the oculomotor nerve (CN III) within the subarachnoid space near the tentorial edge. This produces the classic pupil-involving third nerve palsy, which is a neurosurgical emergency signaling impending aneurysm rupture.

About the TENC Neurocirurgia Exam

The Título de Especialista em Neurocirurgia (TENC) is the official board certification for neurosurgeons in Brazil, awarded by the Sociedade Brasileira de Neurocirurgia (SBN) in partnership with the Associação Médica Brasileira (AMB) and registered with the Conselho Federal de Medicina (CFM). The examination evaluates comprehensive knowledge across microscopic neuroanatomy, surgical approaches, neuro-oncology (WHO 2021 CNS classification), neurotrauma and neurocritical care (Brain Trauma Foundation guidelines), vascular neurosurgery, degenerative and traumatic spine pathology, pediatric neurosurgery, and functional/stereotactic procedures. Attaining the TENC title is the benchmark credential granting the Registro de Qualificação de Especialista (RQE) in Neurosurgery in Brazil.

Assessment

Two-stage specialty board examination administered by the Comissão de Título de Especialista em Neurocirurgia (SBN / AMB), with the dates and venues published by Edital at least four months in advance. 1ª Fase (Prova Teórica): 50 to 100 five-alternative multiple-choice questions covering the residency syllabus — surgical neuroanatomy, neuro-oncology, neurotrauma, neurovascular disease, spine, functional and paediatric neurosurgery. 2ª Fase (Prova Prática-Oral): oral arguição on the topics set out in the Edital, interpretation of imaging studies and discussion of clinical cases before an examining board. Both stages are eliminatory with a minimum grade of 7.0.

Time Limit

Set in the annual Edital, which is published at least four months before the exam date

Passing Score

Minimum grade of 7.0 in each eliminatory stage (Prova Teórica and Prova Prática-Oral); approval requires a final mean of at least 7.0, weighted as defined in the official SBN/AMB Edital

Exam Fee

Set in the annual Edital published by the Sociedade Brasileira de Neurocirurgia with the AMB; consult the current edital for the registration fee and any member discount (Sociedade Brasileira de Neurocirurgia (SBN) — Associação Médica Brasileira (AMB))

TENC Neurocirurgia Exam Content Outline

20%

Neurovascular Surgery & Interventional Neuroradiology

Intracranial aneurysms, subarachnoid hemorrhage (Hunt-Hess, Fisher, WFNS), microsurgical clipping vs endovascular coiling/flow diversion (ISAT, BRAT), arteriovenous malformations (Spetzler-Martin, ARUBA), cavernomas, dural arteriovenous fistulas (Cognard, Borden), spontaneous intracerebral hemorrhage (ICH score, STICH), and malignant MCA infarction decompressive craniectomy.

20%

Neuro-oncology & Skull Base Approaches

WHO 2021 classification of CNS tumors (IDH, 1p/19q, CDKN2A/B, H3K27M), diffuse gliomas, glioblastoma, meningiomas (Simpson grades, WHO grades 1-3), vestibular schwannomas (Koos grading), pituitary adenomas/PitNETs (Knosp/Hardy), craniopharyngiomas, skull base surgical corridors (pterional, orbitozygomatic, retrosigmoid, far lateral, transsphenoidal), and cerebral metastases.

20%

Neurotrauma & Neurocritical Care

Brain Trauma Foundation (BTF 4th ed.) guidelines, Glasgow Coma Scale (GCS), ICP monitoring thresholds (>22 mmHg) and cerebral perfusion pressure management (60-70 mmHg), decompressive craniectomy (DECRA, RESCUEicp), epidural/subdural hematomas, diffuse axonal injury, penetrating brain injury, and acute spinal cord injury (ASIA scale, hemodynamic optimization).

20%

Spine & Peripheral Nerve Surgery

Cervical disc disease and spondylotic myelopathy (mJOA scale, ACDF vs laminoplasty), lumbar disc herniation, spinal canal stenosis, degenerative spondylolisthesis (Meyerding), spinal trauma classifications (TLICS, SLIC, AO Spine), spinal cord tumors (schwannomas, meningiomas, ependymomas, astrocytomas), brachial plexus trauma, and compressive neuropathies.

20%

Pediatric & Functional Neurosurgery

Hydrocephalus management (ETV vs VPS, ETV Success Score), craniosynostosis, open and closed spinal dysraphism (myelomeningocele MOMS trial), Chiari malformations, pediatric brain tumors (medulloblastoma molecular subgroups, pilocytic astrocytoma), Deep Brain Stimulation (STN, GPi, VIM), epilepsy surgery, trigeminal neuralgia (Jannetta MVD), and stereotactic radiosurgery.

How to Pass the TENC Neurocirurgia Exam

What You Need to Know

Passing score: Minimum grade of 7.0 in each eliminatory stage (Prova Teórica and Prova Prática-Oral); approval requires a final mean of at least 7.0, weighted as defined in the official SBN/AMB Edital
Assessment: Two-stage specialty board examination administered by the Comissão de Título de Especialista em Neurocirurgia (SBN / AMB), with the dates and venues published by Edital at least four months in advance. 1ª Fase (Prova Teórica): 50 to 100 five-alternative multiple-choice questions covering the residency syllabus — surgical neuroanatomy, neuro-oncology, neurotrauma, neurovascular disease, spine, functional and paediatric neurosurgery. 2ª Fase (Prova Prática-Oral): oral arguição on the topics set out in the Edital, interpretation of imaging studies and discussion of clinical cases before an examining board. Both stages are eliminatory with a minimum grade of 7.0.
Time limit: Set in the annual Edital, which is published at least four months before the exam date
Exam fee: Set in the annual Edital published by the Sociedade Brasileira de Neurocirurgia with the AMB; consult the current edital for the registration fee and any member discount

Keys to Passing

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TENC Neurocirurgia Study Tips from Top Performers

1Master Surgical Neuroanatomy: Review key operative corridors (pterional, orbitozygomatic, retrosigmoid, far lateral, subtemporal, interhemispheric, transsphenoidal) and cranial nerve relationships in the cavernous sinus, cerebellopontine angle, and jugular foramen.

2Integrate WHO 2021 Molecular Neuropathology: Understand the mandatory molecular markers in diffuse gliomas (IDH1/2 mutation, 1p/19q codeletion, homozygous deletion of CDKN2A/B, EGFR amplification, TERT promoter mutations, H3K27M alterations).

3Apply Neurotrauma Guidelines (BTF 4th ed.): Memorize threshold values: ICP treatment threshold >22 mmHg, CPP target 60-70 mmHg, avoidance of prophylactic hyperventilation (PaCO2 <30 mmHg) and steroids, indications for surgical evacuation of epidural and acute subdural hematomas, and findings from the DECRA and RESCUEicp trials.

4Internalize Vascular Neurosurgery Decision-Making: Know the Hunt-Hess, Fisher, and WFNS scales for SAH; timing of aneurysm obliteration (early <72h); nimodipine administration; vasospasm screening (transcranial Doppler); Spetzler-Martin grading for AVMs; and surgical indications for cavernomas and dural AVFs.

5Review Spine Traumatology & Biomechanics: Master ASIA impairment scale scoring, mean arterial pressure (MAP) targets (85-90 mmHg for 7 days post-SCI), TLICS and SLIC injury severity scores, cervical spondylotic myelopathy grading (mJOA), and criteria for surgical fusion vs decompression.

6Practice Timed Case Synthesis: Solve scenario-based questions focusing on intraoperative complications, neurocritical care calculations, and multimodality neuroimaging interpretation.

Frequently Asked Questions

What is the TENC and why is it essential for neurosurgeons in Brazil?

The Título de Especialista em Neurocirurgia (TENC) is the official medical specialist certification awarded by the Sociedade Brasileira de Neurocirurgia (SBN) and the Associação Médica Brasileira (AMB). Passing the TENC exam allows physicians to register their specialized qualification (Registro de Qualificação de Especialista - RQE) in Neurosurgery with their Regional Medical Council (CRM) and the Conselho Federal de Medicina (CFM), which is legally required to practice and advertise as a board-certified neurosurgeon in Brazil.

What are the prerequisite eligibility requirements to sit for the TENC examination?

Candidates must be fully licensed physicians registered with a Regional Medical Council (CRM) in Brazil and fulfill one of the qualifying training pathways: (1) Completion of an accredited 5-year Medical Residency Program (CNRM/MEC) in Neurosurgery; (2) Completion of an SBN-accredited Neurosurgery Specialization Program; or (3) Documented effective practice in Neurosurgery for at least 10 years (or double the residency duration), verified by surgical logs and institutional documentation satisfying the annual SBN/AMB Edital.

How is the TENC examination structured across its stages?

The examination consists of two main eliminatory phases: (1) Prova Teórica (Theoretical Phase), composed of 100 multiple-choice questions covering surgical neuroanatomy, neuro-oncology, vascular neurosurgery, neurotrauma, spine, pediatric, and functional neurosurgery; and (2) Prova Prática-Oral / TOP (Teste de Observação e Prática), consisting of structured oral examination stations where candidates analyze neuroimaging, surgical anatomy, intraoperative complications, and clinical case scenarios.

What is the passing score and grading criteria for the TENC?

Candidates typically must obtain a minimum score of 70% (7.0 on a 10.0 scale) on the Theoretical Examination (1ª Fase) to qualify for the Practical-Oral Examination (2ª Fase - TOP). Final approval requires meeting passing thresholds across both the theoretical and practical evaluations as defined in the official Edital.

Which classifications and clinical guidelines are essential for the TENC?

Key classifications and guidelines tested include the WHO 2021 CNS Tumor Classification (IDH, 1p/19q, CDKN2A/B), Brain Trauma Foundation (BTF 4th ed.) TBI Guidelines, Hunt & Hess and Fisher scales for SAH, Spetzler-Martin grading for AVMs, ASIA impairment scale for spinal cord injury, TLICS and SLIC scores for spinal trauma, Koos grading for vestibular schwannomas, Knosp/Hardy classification for pituitary lesions, and major clinical trials (ISAT, BRAT, ARUBA, STICH, RESCUEicp, DECRA, MOMS).

Why is this OpenExamPrep practice bank presented in English?

This practice bank is an English-language MCQ study adaptation designed for neurosurgery residents, international fellows, and Brazilian candidates who wish to practice high-yield neurosurgical concepts in English. While the official TENC is conducted in Portuguese, all neurosurgical classification systems, anatomical eponyms, surgical approaches, and clinical trial foundations correspond directly to the official syllabus.