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Neurology 1 > Neurosurgery - Brain Tumours > Flashcards

Neurosurgery - Brain Tumours Flashcards

1
Q

symptoms of a brain tumour

A

focal generalised

raised intracranial pressure - headache, papilledema, vomiting

mental disturbances eg drowsiness, coma, personality changes

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2
Q

headache, papilledema, and voimiting is the classic triad of what

a.brain tumours
b.migraine
c.raised intracranial pressure
d.subarachnoid haemorrhage

A

c.raised intracranial pressure

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3
Q

which of these best describes a headache due to raised intracranial pressure

a. on waking gone within 1-2 hrs, disapears for days- weeks, throbbing and aggravated by coughing/sneezing, relived by aspirin and going to bed

b.on sleeping, lasting days, stabbing pain, relieved by coughing, made worse by resting

A

a. on waking gone within 1-2 hrs, disapears for days- weeks, throbbing and aggravated by coughing/sneezing, relived by aspirin and going to bed

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4
Q

an occipital headache radiating down the neck can indicate a tumour where

a.temporal lobe
b.occipital lobe
c.frontal lobe
d.brain stem
e.cp angle

A

e.cp angle

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5
Q

when does vomiting in raised intracranial pressure usually occur

a.at night
b.early morning

A

b.early morning

accompanying the headache

projectile and without warning no nausea

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6
Q

who is more likely to vomit in raised intracranial pressure states

a.children
b.adults
c.elderly

A

a.children

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7
Q

patients with which tumour type are more likely to vomit

a. post fossa
b.supraentorial

A

a. post fossa

supraentorial - ventricles and cerebrum

post fossa- brain stem and cerebellum

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8
Q

visual symptoms of raised ICP

A

asymptomatic

eventually vision affected and numerous tumours found

enlarged blind spot

intermittent more common than detiriorating
eg few mins amaurosis fugal

attacks precipitated by getting up from sitting or lying ie morning

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9
Q

intracranial tumours are classified based on what

a.cell of origin
b.location
c.size
d.symptoms

A

a.cell of origin

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10
Q

where do gliomas arise

a.glial cells
b.arachnoid cap cells
c.pituitary cells
d.schwann cells

A

a.glial cells

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11
Q

where do meningiomas arise

a.glial cells
b.arachnoid cap cells
c.pituitary cells
d.schwann cells

A

b.arachnoid cap cells

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12
Q

where do pituitary adenomas originate

a.glial cells
b.arachnoid cap cells
c.pituitary cells
d.schwann cells

A

c.pituitary cells

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13
Q

where do pituitary schwanomas originate

a.glial cells
b.arachnoid cap cells
c.pituitary cells
d.schwann cells

A

d.schwann cells

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14
Q

which cancers most commonly metastatsise to the brain

a.lung and liver
b.breast and lung
c.lung and pancreas
d.breast and cervical

A

b.breast and lung

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15
Q
A

a.benign

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16
Q

the majority of malignant tumours are..

a.gliomas
b.schwanomas
c.pituitary adenomas
d.meningiomas

A

a.gliomas

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17
Q

what type of tumour is a astrocytoma

a.gliomas
b.schwanomas
c.pituitary adenomas
d.meningiomas

A

a.gliomas

-astrocytes

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18
Q

what type of tumour is a oligodendroglioma

a.gliomas
b.schwanomas
c.pituitary adenomas
d.meningiomas

A

a.gliomas

  • oligodendrocytes
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19
Q

what type of tumour is a ependymomas

a.gliomas
b.schwanomas
c.pituitary adenomas
d.meningiomas

A

a.gliomas

  • ependymal cells
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20
Q

what grade is a slow growing astrocytoma that is likely to eventually become malignant with a survival of 5-7 yrs

a.1
b.2
c.3
d.4

A

b.2

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21
Q

which of these describes a glioblastoma

a.grade 2 slow growing and eventual progress to malignant grade
b. grade 3 , higher proliferation rate (more mitotically active)
c.grade 4 characterised by elevated tumour cell proliferation , endothelial proliferation , necrosis

A

b. grade 3 , higher proliferation rate (more mitotically active)

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22
Q

what is the mean survival for a grade 2 diffusely infiltrating astrocytoma

a.5-7 years
b.2-3 years
c. 12 -18 months

A

a.5-7 years

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23
Q

what is the mean survival for a grade 4 glioblastoma characterised histologically by elevated tumour cell proliferation , endothelial proliferation and necrosis

a.5-7 years
b.2-3 years
c. 12 -18 months

A

c. 12 -18 months

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24
Q

what is the more definitive diagnosis method for gliomas

a.histology
b.ct brain
c. mri
d.x ray

A

a.histology

tumour debulking of focal tumours to relieve mass or pressure effect

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25
Q

what eventually happen in the majority of glioma patients

a.haemorrhage
b.seizures
c.wound infection

A

b.seizures

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26
Q

surgical treatment in cortical and subcortical low density presenting with seizures and progressive headache is limited to what

a. diagnostic biopsy
b.debulking of tumours

A

a. diagnostic biopsy

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27
Q

which of these surgical techniques helps to visualise malignant gliomas

a.image guidance with pre op scans
b.real time intra operative imaging
c. tumour fluorescens eg gliolan
d.awake surgery

A

c. tumour fluorescens eg gliolan

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27
Q

which of these surgical techniques helps to visualise malignant gliomas

a.image guidance with pre op scans
b.real time intra operative imaging
c. tumour fluorescens eg gliolan
d.awake surgery

A

c. tumour fluorescens eg gliolan

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28
Q

what is given in combination with temozolomide for glioblastomas which may extend survival by a few months especially if there is methylation of the MGMT promoter site

a.radiotherapy
b.chemotherapy
c.tumour debulking

A

a.radiotherapy

29
Q

temozolomide and radiotherapy ma extend survival in malignant glioma by a few months especially if there is ……………………. of the MGMT promoter site

a. acetylation
b.methylation
c.oxidation
d.reduction
e.desreuction

A

b.methylation

down regulation of DNA damage repair gene so higher liklehood of tumour cell death

30
Q

what is given for anaplastic oligodendrogliomas to extend life for a few years

a.radiotherapy and temozolomide

b.radiotherapy + PCV chemotherapy

A

b.radiotherapy + PCV chemotherapy

procarbazine, lomustine, vincristine

co deletion of 1p and 19q

31
Q

how does radiotherapy and pcv chemotherapy given for anaplastic oligodendrogliomas extend life for a few years

a.methylation of MGMT promoter regions

b.co deletion of 1p and 19q

A

b.co deletion of 1p and 19q

32
Q

what is done post operatively for glioblastoma

a.chemotherapy p,c,v

b.radiotherapy and temozolamide

c.fractionated radiotherapy

A

c.fractionated radiotherapy

33
Q

low grade gliomas are more likely in…

a.children
b.young adults
c.elderly

A

b.young adults

34
Q

what do low grade gliomas typically present with

a.headaches
b.seizures
c.focal neuropathy
d.visual disturbance
e.motor and sensory defects

A

b.seizures

35
Q

what is the life expectancy for an grade 1 astrocytoma (pilocytic astrocytoma)

a.normal
b.5-10 years
c.2-3 years
d.12-15 months

A

a.normal

36
Q

what is the life expectancy for an grade 2 astrocytoma (low grade astrocytoma)

a.normal
b.5-10 years
c.2-3 years
d.12-15 months

A

b.5-10 years

37
Q

what is the life expectancy for an grade 3 astrocytoma (anaplastic astrocytoma)

a.normal
b.5-10 years
c.2-3 years
d.12-15 months

A

c.2-3 years

38
Q

what is the life expectancy for an grade 4 astrocytoma ( glioblastoma )

a.normal
b.5-10 years
c.2-3 years
d.12-15 months

A

d.12-15 months

39
Q

what is the life expectancy for an grade 2 oligodendrocytoma )

a.normal
b.5-10 years
c.2-3 years
d.12-15 months
e.10-15 years
f.3-6 years

A

e.10-15 years

40
Q

what is the life expectancy for an grade 3 oligodendrocytoma (anaplastic oligodendrocytoma)

a.normal
b.5-10 years
c.2-3 years
d.12-15 months
e.10-15 years
f.3-6 years

A

f.3-6 years

41
Q

type 1 meningioma is ..

a.benign
b.atypical
c.malignant

A

a.benign

42
Q

type 2 meningioma is ..

a.benign
b.atypical
c.malignant

A

b.atypical

43
Q

type 3 meningioma is ..

a.benign
b.atypical
c.malignant

A

c.malignant

44
Q

majority of meningiomas are ……….

a.benign
b.malignant

A

a.benign

45
Q

meningiomas arise from the ………….. cap cells of the meninges

a.dura
b.pia
c.subarachnoid
d.arachnoid

A

d.arachnoid

46
Q

which grade of meningiomas have a higher propensity to recur locally requiring a closer follow up with regular scans

a.benign meningiomas
b.atypical meningiomas
c.malignant meningiomas

A

b.atypical meningiomas

47
Q

which type of meningioma is likely to recur within aa shorter period and also carry a risk of extracranial metastases

a.benign meningiomas
b.atypical meningiomas
c.malignant meningiomas

A

c.malignant meningiomas

48
Q

what is the primary site for brain metastases

a. lung
b.breast
c.skin
d.thyroid

A

a. lung

49
Q

what is used to treat brain metastases in the form of solid large tumours causing pressure effects

a.surgical resection
b.tumour debulking
c.radioterapy and temozolomide
d.radiotherapy and PCV chemotherapy

A

a.surgical resection

50
Q

what is used to treat brain metastases in the form of small- medium sized tumours (up to 4 lesions)

a.surgical resection
b.tumour debulking
c.radioterapy and temozolomide
d.radiotherapy and PCV chemotherapy
e.focused beams of radiation
f.full brain radiotherapy

A

e.focused beams of radiation

51
Q

what is used to treat brain metastases in a palliative care setting in cases of widespread disease

a.surgical resection
b.tumour debulking
c.radioterapy and temozolomide
d.radiotherapy and PCV chemotherapy
e.focused beams of radiation
f.full brain radiotherapy

A

f.full brain radiotherapy

52
Q

what is the optimal primary treatment for childhood brain tumours in the infratentorial compartment

a.surgical resection
b.tumour debulking
c.radioterapy and temozolomide
d.radiotherapy and PCV chemotherapy
e.focused beams of radiation
f.full brain radiotherapy

A

a.surgical resection

53
Q

complete resection of which childhood tumour may lead to a normal life expectancy

a.pilocytic astrocytoma
b.medulloblastoma
c. ependyoma

A

a.pilocytic astrocytoma

54
Q

where do childhood brain tumours usually develop

a.cerebellum and fourth ventricle
b.third and fourth ventricle
c.cerebrum and cerebellum
d.frontal lobe

A

a.cerebellum and fourth ventricle

infratentorial compartment

55
Q

which of these childhood brain tumours can metastatsize through csf pathways including the spine with patients usually requiring post surgical radiotherapy

a.pilocytic astrocytoma
b.medulloblastoma
c.ependyoma

A

b.medulloblastoma

56
Q

which childhood brain tumour is generally not as aggressive as medulloblastomas but have a tendency to recur and metastatsize

a.pilocytic astrocytoma
b.medulloblastoma
c.ependyoma

A

c.ependyoma

57
Q

csf seeding may occur in cases of which childhood brain tumour

a.pilocytic astrocytoma
b.medulloblastoma
c.ependyoma

A

c.ependyoma

58
Q

if possible radiotherapy is avoided under which age due to the effect of CNS toxicity on developing brain and spinal cord

a.10
b.20
c.4
d.16

A

c.4

59
Q

which tunours are slow growing benign sheath tumours arising on the vestibular nerve

a.pilocytic astrocytoma
b.medulloblastoma
c.ependyoma
d. vestibular shwannomas
e.pituitary tumours

A

d. vestibular shwannomas

60
Q

which nerve sheath do slow growing benign tumours arise on

s.trigeminal
b.occipital
c.vestibular
d.trochlear
e.abducens

A

c.vestibular

61
Q

hearing loss, tiniitus and balance problems are associated with which tumours?

a. slow growing astrocytoma
b.anaplastic astrocytoma
c.pilocytic astrocytoma
d.medulloblastoma
e.ependyoma
f.vestibular schwannomas

A

f.vestibular schwannomas

62
Q

hearing loss, tiniitus and balance problems are associated with which tumours?

a. slow growing astrocytoma
b.anaplastic astrocytoma
c.pilocytic astrocytoma
d.medulloblastoma
e.ependyoma
f.vestibular schwannomas

A

f.vestibular schwannomas

63
Q

what is vestibular schwannoma associated with

a.fibromyalgia
b.MS
c.motor neurone disease
d.Neurofibromatosis
e.glioblastoma

A

d.Neurofibromatosis

NF2

64
Q

What is indicated for small volume lesions less than 3cm in diameter

a.surgical resection
b.tumour debulking
c.radioterapy and temozolomide
d.radiotherapy and PCV chemotherapy
e.focused beams of radiation
f.full brain radiotherapy
g.stereotactic radiosurgery

A

g.stereotactic radiosurgery

65
Q

what is the classical presentation for large pituitary adenomas

a.unilateral hemianopia
b.bitemporal hemianopia
c.homonymous hemianopia
d.homonymous hemianopia w macular sparing

A

b.bitemporal hemianopia

compression of adjacent structures eg optic nerves

66
Q

………… pituitary tumours may cause cushings or acromegaly

a.small
b.large

A

a.small

67
Q

stereotactic radiosurgery is used for

A

benign brain tumours of small volume
brain metastatses

68
Q

what is given for peri tumoral oedema in palliative care

a.dexamethosone
b.prednisolone
c.beclomethasone
d.hydrocortisone

A

a.dexamethosone

69
Q

angiogenesis

A

recruitment of blood supply to feed the tumour

Neurology 1 (44 decks)

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