Brain tumours (clinical)

Question 1

List the 3 main common types of primary brain tumour

Answer 1

pituitary adenoma
gliomas
meningioma

Question 2

What is the most aggressive type of glioma?

Answer 2

GBM

Question 3

Most likely cancers causing secondary cerebral metastases

Answer 3

renal cell carcinoma 
breast carcinoma 
melanoma 
lung carcinoma 
GI tract

Question 4

Are brain primary or secondary tumours more common?

Answer 4

secondary

Question 5

What are gliomas derived from?

Answer 5

astrocytes

Question 6

How does GBM spread?

Answer 6

through white matter and CSF pathway

Question 7

What does meningiomas derive from?

Answer 7

arachnoid

Question 8

Characteristics of meningiomas

Answer 8

slow growing and benign

Question 9

Location of meningiomas

Answer 9

along falx or sphenoid bone

Question 10

What % of pituitary adenomas are malignant?

Answer 10

1%

Question 11

Effects of pituitary adenoma

Answer 11

visual disturbance and hormone imbalance

Question 12

4 clinical presentations of brain tumours

Answer 12

raised ICP
focal neurological defecit
epilepsy
CSF obstruction

Question 13

List some symptoms of raised ICP

Answer 13

morning headache 
visual disturbance 
nausea and vomiting 
somnolence 
cognitive impairment 
altered consciousness

Question 14

Signs of raised ICP

Answer 14

papilloedema
3rd/6th nerve palsy
cognitive impairment
altered consciousness

Question 15

How much CSF produced per day?

Answer 15

400-450 cc

Question 16

3 main features of brain tumours that can result in hydrocephalus

Answer 16

posterior fossa
children
in or near CSF pathway

Question 17

Diagnosing brain tumour

Answer 17

biopsy
CT/MRI
history and examination
sources of 2nd tumours eg CXR

Question 18

What is meant by focal neurological defecit? examples

Answer 18

hemiparesis 
hemianopia 
dysphasia 
cognitive impairment 
cranial nerve palsy 
endocrine disorders

Question 19

Ataxia

Answer 19

Lack of voluntary movement and co-ordination of muscle movements

Question 20

Are lesions above or below tentorium likely to cause epilepsy?

Answer 20

above

Question 21

Investigations of brain tumour

Answer 21

imaging eg CT/MRI/PET/ angiography
CT chest/abdo/pelvis
biopsy skin lesions
mammography

Question 22

List some treatments of brain tumours

Answer 22

surgery
radiotherapy 
chemotherapy 
CCS 
anticonvulsants 
analgesics and antiemetics 
endocrine replacement 
counselling

Question 23

Managing GBM

Answer 23

no surgery - only biopsy or debulk
CCS and anticonvulsant
radio and chemo

Question 24

Managing mets

Answer 24

confirm diagnosis and surgery

CCS, radio and anticonvulsant

Question 25

Prognosis of astrocytoma, meningioma and mets

Answer 25

astrocytoma: low grade - good, GBM - 1 yr
meningioma: surgery cures and anticonvulsant
mets - good medium term remission