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Medical Sciences B > Neoplasms, demyelinating diseases > Flashcards

Neoplasms, demyelinating diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the neoplasms of the NS?

A 
CNS
• Brain and coverings
    ->Primary
         -neuroepithelial
         -non-neuroepithelial
    ->Secondary
• Spinal cord and coverings
PNS
    ->Extradural
    ->Intradural-extramedullary
    ->Intramedullary
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2
Q

Intracranial neoplasms: incidence and site

A

Incidence:
• early adult or mid life
• male > female
• 2nd most common malignancy in kids

Site:
• 2/3 are supratentorial
• 2/3 in pre-pubescents are infratentorial
• most are medulloblastomas and cerebellar astrocytomas

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3
Q

Compare the pathology of benign vs malignant intracranial neoplasms?

A 
Benign:
• slow growing
• large before symptoms
• can still be lethal
• no necrosis, no oedema
Malignant:
• rapid growth
• invasive
• cause necrosis, vascular proliferation, endothelial hyperplasia
• rarely metastasise
• death by local growth and high ICP
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4
Q

What are the neuroepithelial tissue intracranial neoplasms?

A
  • Astrocytic: astrocytoma, anaplastic astrocytoma, glioblastoma multiforme, pilocytic astrocytoma
  • oligodendroglial
  • ependymal
  • mixed gliomas
  • embryonal: medulloblastoma, neuroblastoma, retinoblastoma
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5
Q

What are the non-neuroepithelial tissue intracranial neoplasms?

A
  • meningiomas
  • pituitary adenomas
  • acoustic neuroma
  • metastatic tumours (50% of all intracranial neoplasms)
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6
Q

What are the most common source of metastases to the brain?

A
  • lung
  • breast
  • melanoma
  • colon
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7
Q

What are the clinical features of intracranial neoplasms?

A
  • present insidiously over a few weeks
  • sometimes present acutely if haemorrhage or hydrocephalus
  • s&s of raised intracranial pressure (from mass, oedema, or hydrocephalus)
  • neurones irritation (convulsions)
  • headache: early not severe, morning, worse by strain or dehydration
  • s&s of primary tumour (if metastatic)
  • focal symptoms
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8
Q

What is the pathophysiology of headache in intracranial neoplasms?

A
  • space occupying lesion stretches vessels and surrounding tissue as it expands
  • contracts during dehydration
  • pain is due to displacement and stretching of pain sensitive intracranial tissues (blood vessels)
  • later… from intracranial pressure
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9
Q

What are the stages of astrocytoma development?

A

Grade 1 & 2:
• slow growing, contained
• brainstem, cerebellum, hypothalamus

Grade 3 & 4:
• fast growing
• tendrils that branch into brain
• malignant
• cortex
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10
Q

What are the signs and symptoms of a neoplasms in the frontal lobe?

A
  • personality change
  • return of primitive reflexes
  • motor issues (paresis, paralysis)
  • convulsions
  • Broca: expressive aphasia (can understand but can’t express)
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11
Q

What are the signs and symptoms of a neoplasms in the parietal lobe?

A
  • special awareness
  • sensory hallucinations
  • seizures
  • bilateral homogenous quadrant anopia (loose 1/4 vision in each eye
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12
Q

What are the signs and symptoms of a neoplasms in the temporal lobe?

A
  • memory loss
  • hearing changes
  • smell changes
  • wernickes area: receptive aphasia (can’t choose correct words when talking)
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13
Q

What are the signs and symptoms of a neoplasms in the occipital lobe?

A
  • cortical blindness

* flashing lights

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14
Q

What are the signs and symptoms of a neoplasm in the cerebellum?

A
  • lost balance
  • ataxic gait
  • lost coordination
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15
Q

What are the signs and symptoms of a neoplasm in the brainstem?

A
  • trigeminal nerve (loose face sensation)

* squint (ocular muscles)

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16
Q

What is the clinical significance of secondary brain tumours?

A
  • already have the primary cancer
  • by this point, the cancer is very good at expanding and taking blood and metastasizing
  • very aggressive at this point
17
Q

What is a demyelinating disease?

A
  • damage to myelin sheath in CNS or PNS
  • caused by infection, autoimmunity, genetic factors, toxins, idiopathic
  • loss of myelin sheath
  • most common are Multiple sclerosis and Guillain-Barre syndrome
18
Q

What is multiple sclerosis?

A
  • disease of CNS, where malign becomes damaged
  • PNS spared
  • random areas of demyelination
  • nerve impulses are blocked or distorted
  • not just a motor disorder
19
Q

What is the aetiology and epidemiology of Multiple sclerosis?

A
  • unknown cause
  • immunologi and viral causes maybe
  • family tendency
  • people with >15yrs temperate climate
  • onset 20-40yrs
20
Q

What is the pathology of Multiple sclerosis?

A

Demyelination occurs in:
• white matter of brain (periventricular areas, optic nerve, optic chiasm)
• brain stem & cerebellum
• spinal cord - lateral & posterior columns
• some grey matter
• acute demyelination results in plaques (hallmark), discrete, smooth edges, sclerotic

21
Q

What are the stages of Multiple sclerosis?

A

1) Sequential development of small inflammatory lesions

2) Lesions extend to cause demyelination and gloss (scarring)

22
Q

What are the clinical features of multiple sclerosis?

A
  • episodic events that are focal and waxes and wanes
  • diagnosed if 2 or more different neuropathies that spontaneously resolve
  • symptoms increase with temp
People complain of:
• visual complaints
• sensory disorders
• spastic weakness of limbs
• cerebellar signs
• bladder dysfunction
• disorder of mood
23
Q

What are the 4 most common symptoms in multiple sclerosis?

A
  • unilateral vision loss
  • diplopia
  • clumsiness of gait or hand movement
  • extremity weakness or sensory loss
24
Q

What is the progression of multiple sclerosis?

A
  • exacerbations and remissions
  • complete remissions at first
  • less and less complete
  • more and more severe symptoms

• better prognosis if vision loss is 1st symptom

25
Q

What are the 4 major types of multiple sclerosis?

A
  • Relapsing-remitting: 90% of cases, acute attacks with full or partial recovery, no progression btw episodes
  • Primary progressive
  • Secondary progressive
  • Progressive-relapsing
26
Q

What is the pathophysiology in multiple sclerosis?

A

oligodendrocyte not working well

  • > neuron exposed
  • > inflammation
  • > regeneration
  • > scar tissue (plaques)
27
Q

What are possible causes of peripheral neuropathy?

A
  • diabetes
  • tumour
  • pregnancy
  • carpal tunnel
  • bone or tendon compressing nerve
  • led
  • compartment syndrome
  • trauma
  • disc herniation squashing nerve root
  • compression (Saturday night palsy)
  • Guillain bar syndrome

Medical Sciences B (23 decks)

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