Cancer

Question 0

Radiation plexopathy

Answer 0

Upper trunk 
Dose related 
Numbness and parasthesia 
Insidious and self limiting
Ct loss of planes but no focal lesions
Edema

Emg
Myokimic discharges

Question 1

CAancer plexopathy

Answer 1

10 times more common than radiation plexopathy

Pain
Slow onset

Lower
Trunk c8-t1
Ct w focal lesions
Horners syndrome

Question 2

What is the most common nonmalignant neuro tumor?

Answer 2

Meningioma, which arise from the arachnoid (cap) Cells of the arachnoid villi. They’re usually benign and are cured by surgical resection. They may present with focal seizures, weakness, a favorite or increased ICP.

Question 3

Most common cause of spinal metastases are

Answer 3

Breast, lung, prostate

Question 4

What are the most common kinds of spinal tumors?

Answer 4

90% of spinal cord compression resulting from cancer comes from extra medullary sources. That includes epidural, intradural and leptomeningeal disease. Intramedullary spinal cord compression is seen in less than 5% of spinal cord tumors and includes gliomas, ependymomas, and astrocytomas

Question 5

What is the earliest presentation of neoplastic spinal cord compromise?

Answer 5

Pain

Question 6

What is trismus?

Answer 6

Trismus is the condition seen as a sequela of radiation therapy in head and neck cancer. It is the inability to open the mouth fully as a result of spasm in the masseter and lateral pterygoid muscles. In addition radiation therapy can affect the surrounding local connective tissue which contributes to spasm.

Question 7

What causes Trismus?

Answer 7

Radiation-induced ectopic activity in the trigeminal nerve leads to neuropathic pain, weakness, spasm of the masseter muscle.

Question 8

Lymphedema is most commonly associated with which cancers?

Answer 8

Breast, pelvic, and head and neck

Question 9

Describe the grading of lymphedema

Answer 9

Grade one is pitting Edema which is partially reversible with elevation.

• Grade 2 is non-pitting edema which is not reduce by elevation is characterized by fibrosis beginning.
• grade 3 swelling of involved extremity described as length of static elephantiasis. Cartilage like.
• grade 4 elephantiasis is enormous swelling of the involved area. Tissue is fibrotic and unresponsive to therapeutic intervention.

Question 10

What nerve is frequently damaged in axillary lymph node dissection in breast cancer?

Answer 10

Intercostobrachial nerve is the lateral cutaneous nerve of the second thoracic nerve root.

It provides innervation to the medial, posterior portion of the arm and axilla and the lateral portion of the chest wall. It is affected by axillary lymph node dissection and presents with absent or abnormal sensation or neuropathic pain

Question 11

What is the most common sight of vertebral metastases?

Answer 11

Body most commonly in the thoracic spine

Question 12

What is the best diagnostic tool for detecting spinal metastases?

Answer 12

MRI has sensitivity of 83% to 93% and specificity and 90% to 97%

Question 13

How do bisphosphonate work?

Answer 13

Inhibit osteoclastic bone resorption

Question 14

Do bone scans show lytic lesions?

Answer 14

No they only show new bone formation. 50% of lesions in bonescans turn out to be cancer. Further imaging is required for a positive bone scan.

Question 15

What kind of lesions are formed in multiple myeloma?

Answer 15

Lytic, therefore will not show up on a bone scan.

Other lytic lesions come from non-small cell lung cancer, renal cancer, melanoma, thyroid, and non-Hodgkin’s lymphoma

Question 16

How does radiation plexitis present?

Answer 16

• Gradual /delayed
• usually with numbness and paresthesias.
• It must be differentiated from tumor recurrence which can cause Brachial
• An MRI of the brachioplexus with contrast can rule out axillary reoccurrence of breast cancer.
• Electrodiagnostic testing can help differentiate brachioplexopathy from other neurologic condition typical findings include myokymia on needle electric.

Question 17

What Cara chemotherapeutic agents can cause hearing loss?

Answer 17

Platinum based agents like cisplatinin.

Question 18

The spine is considered unstable when tumor is involved in….

Answer 18

The spine is unstable when there’s two or more column involvement or if the middle column is involved.

Question 19

What is the best way to treat an unstable metastatic lesion of the spine?

Answer 19

Surgical fixation. Lesions that measure more than two thirds of the cortex and those that present with functional pain are at greater chance of pathologic fracture.

Question 20

What is the highest risk for pathologic fracture?

Answer 20

Functional Pain is a greater risk than weight-bearing versus nonweightbearing and lytic vs blastic