Miscellaneous

Question 1

The most common type of primary brain tumour is…

Answer 1

Glioma

Question 2

Over half of all brain tumours are…

Answer 2

Metastatic

Question 3

Which primary cancers are associated with brain metastases?

Answer 3

PoRTaBLe:

• Prostate
• Renal
• Thyroid
• Breast
• Lung

Question 4

What are the clinical features of brain tumour?

Answer 4

Raised ICP:

• Headache (made worse by lying down, bending forwards, coughing)
• Vomiting
• Papilloedema
• Seizure

Focal neurology (varies depending on site of lesion)

‘Red flag’ symptoms (cancer):

• Weight loss
• Malaise
• Night sweats

Question 5

Describe the investigation of suspected brain tumour

Answer 5

Brain imaging (CT/MRI)

Question 6

Describe the management of brain tumour

Answer 6

• Neurosurgery

- Radiotherapy

Question 7

Which nerve is affected if a patient develops wrist drop?

Which fracture is associated with this presentation?

Answer 7

• Radial nerve

- Fracture of the shaft of the humerus

Question 8

Which nerve is affected if a patient develops foot drop?

Answer 8

Peroneal nerve

Question 9

What are the three components of the Glasgow Coma Scale (GCS) and what are they scored out of?

Answer 9

• Eye opening (scored out of 4)
• Verbal response (scored out of 5)
• Motor response (scored out of 6)

Question 10

Explain the scoring criteria for each of the components of the GCS score

Answer 10

Eye opening:

4. Spontaneous
5. To speech
6. To pain
7. None

Verbal response:

5. Orientated
6. Confused
7. Words
8. Sounds
9. None

Motor response:

6. Obeys commands
7. Localises to pain
8. Withdraws from pain
9. Flexion to pain
10. Extension to pain
11. None

Question 11

What is the minimum possible GCS score?

Answer 11

3

Question 12

What is the mechanism of inheritance of tuberous sclerosis?

Answer 12

Autosomal dominant

Question 13

Give some examples of clinical features of tuberous sclerosis

Answer 13

Clinical features are mostly neurocutaneous…

Cutaneous:

• Depigmented ‘ash leaf’ spots
• Rough patches of skin over lumbar spine (Shagreen patches)
• Angiofibroma (butterfly distribution over nose)

Neuro:

• Epilepsy
• Developmental delay

Question 14

What are the types of neurofibromatosis?

Which type is more common?

Answer 14

Two types - NF1 and NF2

NF1 is more common

Question 15

Both forms of neurofibromatosis are inherited in the same way - describe the pattern of inheritance

Answer 15

Autosomal dominant

Question 16

Describe the clinical features of NF1 and NF2

Answer 16

NF1:

• Cafe au lait spots
• Peripheral neurofibromas

NF2
- Bilateral vestibular schwannomas

Question 17

What are the symptoms of normal pressure hydrocephalus?

Answer 17

Triad:

• Cognitive impairment
• Ataxia
• Urinary incontinence

Question 18

What are the clinical features of Horner’s syndrome?

Give some causes of Horner’s syndrome.

Answer 18

Clinical features:

• Ptosis
• Miosis (small pupil)
• Anhidrosis (loss of sweating on one side)

Causes:

• Stroke
• Tumour
• Trauma

Question 19

Do cranial nerve lesions cause an ipsilateral or contralateral deficit?

Answer 19

Ipsilateral

Question 20

Which nerve is affected if a patient cannot abduct the thumb?

Which fracture is commonly associated with this presentation?

Answer 20

Median nerve

Colle’s fracture (distal radius)

Question 21

What kind of visual field defect would you get as a result of a…

i) Pituitary adenoma
ii) Craniopharyngioma

Answer 21

i) Bitemporal superior quadrantanopia

ii) Bitemporal inferior quadrantanopia