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Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

brain tumours are more primary or secondary in origin

A

secondary

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2
Q

what are common sites for tumours to metastasise to the brain

A 
lung - esp small cell carcinoma 
breast 
thyroid
colon
renal
malignant melanoma
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3
Q

in children brain tumours are usually supratentorial or infratentorial

A

infratentorial

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4
Q

what is the general presentation of brain tumours

A 
headache - wakes patient up 
papilloedema 
focal neurology
vomiting
seizures 
ataxia 
personality change
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5
Q

what are the 3 symptoms to be aware of in children that is suggestive of a brain tumour

A

vomiting with headache
ataxia
tip toeing
VAT

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6
Q

what imagine is useful for diagnosing brain tumours

A

CT first line

MRI useful to characterise the tumour

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7
Q

what drug is given to manage cerebral oedema with a brain tumour

A

dexamethasone - can also reduce nausea by reducing oedema

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8
Q

what drug is given to manage seizures with a brain tumour

A

anti epileptics

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9
Q

what is the most common type of brain tumour

A

glioma

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10
Q

which two subtypes of tumours are classified as a glioma

A

astrocytomas

oligodendrocytomas

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11
Q

what is the only known risk factor for gliomas

A

exposure to ionising radiation

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12
Q

what are the names of the types of astrocytomas grades I-IV

A

pilocytic astrocytoma
diffuse astrocytoma
anaplastic astrocytoma
glioblastoma multiforme

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13
Q

describe a pilocytic astrocytoma

A

benign - limited potential to proliferate and no infiltration
surgery is curative
common in children and young adults

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14
Q

describe a diffuse astrocytoma

A

infiltrative but low level of proliferative activity
surgery then chemo and radiotherapy
average survival is 4 years

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15
Q

describe an anaplastic astrocytoma

A

some malignant activity, nuclear atypic, increased mitotic activity and cellular anaplasia
average survival is 2 years

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16
Q

describe a glioblastoma

A

malignant activity, high nuclear atypia, mitotic activity and necrosis

17
Q

what are the 2 ways a glioblastoma can arise

A

primary - de novo with no preceding tumour, usually older patients or p53 mutation
secondary - progression from low grade astrocytoma, usually in younger patients

18
Q

describe the imaging appearance of GBM

A

solitary
heterogenous with necrotic centre
ring enhancing
oedema/midline shift

19
Q

how is GBM managed

A

not curative management, more to improve functional status
maximal debunking surgery to reduce mass effect
radiotherapy
chemotherapy - oral temozolomide

20
Q

where in the brain are oligodendromas commonly seen

A

commonly frontal lobe with invasion to subarachnoid space

21
Q

subarachnoid invasion of an oligodendroma shows what morphology

A

toothpaste morphology

22
Q

what is a very common clinical feature of an oligodendroma

A

seizures

23
Q

what are some histological features that differentiate an oligodendroma from an astrocytoma

A

oligodendromas also have calcification, cysts and haemorrhage around the tumour

24
Q

how are oligodendromas managed

A

surgery

chemotherapy - very chemosensitive

25
Q

which chemotherapy agents are used for oligodendromas

A

PCV - procarbazine, lomustine and vincristine

26
Q

medulloblastomas are almost exclusively seen in which age group

A

children - second most common brain tumour in children after astrocytoma

27
Q

what causes a medulloblastoma to arise

A

embryonal tumour - poorly differentiated and occurs in the midline of the cerebellum

28
Q

describe the appearance of medulloblastomas

A

crumbly, chalky appearance and form drop down metastases down the spinal cord

29
Q

how does a medulloblastoma present

A

raised ICP symptoms

cerebellar signs

30
Q

medulloblastomas are particularly sensitive to which treatment

A

radiotherapy - however contraindicated in under 3s due to neurocognitive impairment

31
Q

what is a meningioma

A

extra-axial tumour of arachnoid cap cells

either benign or malignant, majority are benign

32
Q

how is a meningioma managed

A

watch and wait if patient asymptomatic
surgical resection
radiotherapy

33
Q

what is the prognosis of meningioma

A

good - 90% survival at 5 years

34
Q

what is a vestibular schwannoma

A

rare benign tumour arising from the internal auditory meatus
affects the vestibular portion of CN VIII

35
Q

if a vestibular schwannoma is bilateral and in a young person, what condition should you think of

A

neurofibromatosis 2

36
Q

what are the clinical features of vestibular schwannoma

A

unilateral SN hearing loss
tinnitus
progressive imbalance
absent corneal reflex

Neurology (19 decks)

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