All Practice Exams
100+ Free FRCS Neurosurgery Practice Questions
Intercollegiate Specialty Fellowship Examination in Neurosurgery (FRCS SN) practice questions are available now; exam metadata is being verified.
✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately
100+ Questions
100% Free
1 / 100
Question 1
Score: 0/0
A newborn has a fluctuant midline lumbar swelling covered by a thin membrane through which neural tissue is visible, with leaking cerebrospinal fluid and lower limb weakness. What is the diagnosis?
A
B
C
D
to track
Same family resources
Explore More MRCS & FRCS Surgical Exams
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
Sample FRCS Neurosurgery Practice Questions
Try these sample questions to test your FRCS Neurosurgery exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 58-year-old presents with a 6-week history of progressive headache and dysphasia. MRI shows a peripherally enhancing left temporal mass with central necrosis and surrounding T2/FLAIR signal. Histology confirms a WHO grade 4 IDH-wildtype astrocytic tumour. Which molecular marker most strongly predicts benefit from temozolomide and a better prognosis?
A.MGMT promoter methylation
B.EGFR amplification
C.TERT promoter mutation
D.Chromosome 10 loss
Explanation: In glioblastoma (IDH-wildtype, WHO grade 4), MGMT promoter methylation silences the DNA repair enzyme, leaving temozolomide-induced DNA damage unrepaired. Methylated tumours have significantly better response to temozolomide and longer survival, and the marker is used to guide therapy in elderly patients.
2According to the WHO 2021 classification of CNS tumours, which combination of molecular features defines a 1p/19q-codeleted oligodendroglioma?
A.IDH-wildtype with EGFR amplification
B.IDH-mutant with whole-arm codeletion of 1p and 19q
C.IDH-mutant with ATRX loss and TP53 mutation
D.H3 K27M mutation with loss of nuclear H3 K27me3
Explanation: Oligodendroglioma in the WHO 2021 scheme requires both an IDH mutation (IDH1 or IDH2) AND whole-arm codeletion of chromosomes 1p and 19q. Both features are mandatory for the integrated diagnosis; this combination also confers chemosensitivity (PCV) and favourable prognosis.
3A 45-year-old has a well-circumscribed, dural-based, homogeneously enhancing extra-axial mass with a dural tail on MRI. At operation the lesion is firm and attached to the dura. Which is the single most appropriate grading system to apply to the resection achieved?
A.Hunt and Hess grading
B.Spetzler-Martin grading
C.Simpson grading
D.Fisher grading
Explanation: The lesion is a meningioma (dural-based, enhancing, dural tail). The Simpson grade classifies the completeness of meningioma resection from grade I (complete removal with excision of dural attachment and abnormal bone) to grade V (decompression only) and correlates with recurrence risk.
4A 35-year-old presents with progressive hearing loss, tinnitus and unsteadiness. MRI shows an enhancing mass in the left cerebellopontine angle extending into the internal auditory meatus, with an 'ice-cream cone' appearance. Which cranial nerve does this tumour most commonly arise from?
A.Trigeminal nerve (V)
B.Cochlear division of cranial nerve VIII
C.Facial nerve (VII)
D.Superior vestibular division of cranial nerve VIII
Explanation: Vestibular schwannomas most commonly arise from the Schwann cells of the vestibular (typically superior vestibular) division of the eighth cranial nerve, near the Obersteiner-Redlich zone in the internal auditory canal. They present with sensorineural hearing loss, tinnitus and imbalance.
5A 30-year-old woman has secondary amenorrhoea and galactorrhoea. Serum prolactin is markedly elevated at 8,000 mU/L and MRI shows a 1.5 cm pituitary macroadenoma. There is no visual field defect. What is the most appropriate first-line management?
A.Dopamine agonist (cabergoline)
B.Transsphenoidal surgical resection
C.Stereotactic radiosurgery
D.Bilateral adrenalectomy
Explanation: Prolactinomas, even macroadenomas, are first-line treated medically with a dopamine agonist such as cabergoline, which normalises prolactin and shrinks the tumour in the majority of patients. Surgery is reserved for medication intolerance, resistance, apoplexy or CSF leak.
6A 52-year-old presents with bitemporal hemianopia. MRI demonstrates a sellar/suprasellar mass with elevation of the optic chiasm. Which structure is most directly responsible for the visual field defect?
A.Compression of the optic tract
B.Compression of the crossing nasal retinal fibres at the optic chiasm
C.Compression of the lateral geniculate nucleus
D.Compression of the temporal retinal fibres in the optic nerve
Explanation: The nasal retinal fibres, which carry information from the temporal visual fields, decussate at the optic chiasm. A suprasellar mass elevating and compressing the chiasm interrupts these crossing fibres, producing a bitemporal hemianopia.
7A 6-year-old presents with morning headache, vomiting and truncal ataxia. CT shows a midline posterior fossa mass arising from the cerebellar vermis with hydrocephalus. Histology shows small round blue cells with Homer Wright rosettes. What is the most likely diagnosis?
A.Ependymoma
B.Pilocytic astrocytoma
C.Medulloblastoma
D.Haemangioblastoma
Explanation: A midline vermian posterior fossa tumour in a child with small round blue cells and Homer Wright rosettes is a medulloblastoma, a WHO grade 4 embryonal tumour. It commonly causes obstructive hydrocephalus and can disseminate through the CSF, requiring craniospinal staging.
8A 60-year-old with known metastatic non-small cell lung cancer develops a single 3 cm enhancing cerebellar metastasis causing fourth ventricular effacement and early obstructive hydrocephalus, but is otherwise neurologically intact with good performance status. What is the most appropriate management of the lesion?
A.Chemotherapy alone
B.Whole brain radiotherapy alone
C.Best supportive care
D.Surgical resection followed by adjuvant radiotherapy
Explanation: A single, surgically accessible metastasis causing mass effect and threatened hydrocephalus in a patient with good performance status is best treated by surgical resection to relieve mass effect, followed by adjuvant radiotherapy (cavity radiosurgery or whole brain) to improve local control.
9A 28-year-old man with a family history of bilateral vestibular schwannomas is found to have multiple meningiomas and an ependymoma. Which gene is most likely mutated?
A.NF2 (merlin)
B.NF1 (neurofibromin)
C.VHL
D.TSC1
Explanation: Bilateral vestibular schwannomas are pathognomonic of neurofibromatosis type 2, caused by mutation of the NF2 gene encoding merlin (schwannomin) on chromosome 22. NF2 is also associated with multiple meningiomas and spinal ependymomas.
10During an awake craniotomy for a left frontal glioma, intraoperative direct cortical stimulation of an area immediately anterior to the inferior precentral gyrus causes speech arrest. Which functional region has most likely been identified?
A.Wernicke's area
B.Broca's area (pars opercularis/triangularis of the inferior frontal gyrus)
C.Primary motor cortex of the hand
D.Supplementary motor area
Explanation: Speech arrest on stimulation of the dominant inferior frontal gyrus (pars opercularis and triangularis) localises Broca's area, the expressive language centre. Mapping and preserving this region during awake surgery reduces the risk of permanent expressive dysphasia.
About the FRCS Neurosurgery Practice Questions
Verified exam format metadata for Intercollegiate Specialty Fellowship Examination in Neurosurgery (FRCS SN) is pending. The practice questions above remain available while official exam length, timing, passing score, fee, and administrator details are reviewed.