Neurosurgery - Brain Tumours Flashcards
symptoms of a brain tumour
focal generalised
raised intracranial pressure - headache, papilledema, vomiting
mental disturbances eg drowsiness, coma, personality changes
headache, papilledema, and voimiting is the classic triad of what
a.brain tumours
b.migraine
c.raised intracranial pressure
d.subarachnoid haemorrhage
c.raised intracranial pressure
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. on waking gone within 1-2 hrs, disapears for days- weeks, throbbing and aggravated by coughing/sneezing, relived by aspirin and going to bed
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
e.cp angle
when does vomiting in raised intracranial pressure usually occur
a.at night
b.early morning
b.early morning
accompanying the headache
projectile and without warning no nausea
who is more likely to vomit in raised intracranial pressure states
a.children
b.adults
c.elderly
a.children
patients with which tumour type are more likely to vomit
a. post fossa
b.supraentorial
a. post fossa
supraentorial - ventricles and cerebrum
post fossa- brain stem and cerebellum
visual symptoms of raised ICP
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
intracranial tumours are classified based on what
a.cell of origin
b.location
c.size
d.symptoms
a.cell of origin
where do gliomas arise
a.glial cells
b.arachnoid cap cells
c.pituitary cells
d.schwann cells
a.glial cells
where do meningiomas arise
a.glial cells
b.arachnoid cap cells
c.pituitary cells
d.schwann cells
b.arachnoid cap cells
where do pituitary adenomas originate
a.glial cells
b.arachnoid cap cells
c.pituitary cells
d.schwann cells
c.pituitary cells
where do pituitary schwanomas originate
a.glial cells
b.arachnoid cap cells
c.pituitary cells
d.schwann cells
d.schwann cells
which cancers most commonly metastatsise to the brain
a.lung and liver
b.breast and lung
c.lung and pancreas
d.breast and cervical
b.breast and lung
a.benign
the majority of malignant tumours are..
a.gliomas
b.schwanomas
c.pituitary adenomas
d.meningiomas
a.gliomas
what type of tumour is a astrocytoma
a.gliomas
b.schwanomas
c.pituitary adenomas
d.meningiomas
a.gliomas
-astrocytes
what type of tumour is a oligodendroglioma
a.gliomas
b.schwanomas
c.pituitary adenomas
d.meningiomas
a.gliomas
- oligodendrocytes
what type of tumour is a ependymomas
a.gliomas
b.schwanomas
c.pituitary adenomas
d.meningiomas
a.gliomas
- ependymal cells
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
b.2
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
b. grade 3 , higher proliferation rate (more mitotically active)
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.5-7 years
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
c. 12 -18 months
what is the more definitive diagnosis method for gliomas
a.histology
b.ct brain
c. mri
d.x ray
a.histology
tumour debulking of focal tumours to relieve mass or pressure effect
what eventually happen in the majority of glioma patients
a.haemorrhage
b.seizures
c.wound infection
b.seizures
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. diagnostic biopsy
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
c. tumour fluorescens eg gliolan
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
c. tumour fluorescens eg gliolan
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.radiotherapy
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
b.methylation
down regulation of DNA damage repair gene so higher liklehood of tumour cell death
what is given for anaplastic oligodendrogliomas to extend life for a few years
a.radiotherapy and temozolomide
b.radiotherapy + PCV chemotherapy
b.radiotherapy + PCV chemotherapy
procarbazine, lomustine, vincristine
co deletion of 1p and 19q
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
b.co deletion of 1p and 19q
what is done post operatively for glioblastoma
a.chemotherapy p,c,v
b.radiotherapy and temozolamide
c.fractionated radiotherapy
c.fractionated radiotherapy
low grade gliomas are more likely in…
a.children
b.young adults
c.elderly
b.young adults
what do low grade gliomas typically present with
a.headaches
b.seizures
c.focal neuropathy
d.visual disturbance
e.motor and sensory defects
b.seizures
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.normal
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
b.5-10 years
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
c.2-3 years
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
d.12-15 months
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
e.10-15 years
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
f.3-6 years
type 1 meningioma is ..
a.benign
b.atypical
c.malignant
a.benign
type 2 meningioma is ..
a.benign
b.atypical
c.malignant
b.atypical
type 3 meningioma is ..
a.benign
b.atypical
c.malignant
c.malignant
majority of meningiomas are ……….
a.benign
b.malignant
a.benign
meningiomas arise from the ………….. cap cells of the meninges
a.dura
b.pia
c.subarachnoid
d.arachnoid
d.arachnoid
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
b.atypical meningiomas
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
c.malignant meningiomas
what is the primary site for brain metastases
a. lung
b.breast
c.skin
d.thyroid
a. lung
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.surgical resection
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
e.focused beams of radiation
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
f.full brain radiotherapy
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.surgical resection
complete resection of which childhood tumour may lead to a normal life expectancy
a.pilocytic astrocytoma
b.medulloblastoma
c. ependyoma
a.pilocytic astrocytoma
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.cerebellum and fourth ventricle
infratentorial compartment
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
b.medulloblastoma
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
c.ependyoma
csf seeding may occur in cases of which childhood brain tumour
a.pilocytic astrocytoma
b.medulloblastoma
c.ependyoma
c.ependyoma
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
c.4
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
d. vestibular shwannomas
which nerve sheath do slow growing benign tumours arise on
s.trigeminal
b.occipital
c.vestibular
d.trochlear
e.abducens
c.vestibular
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
f.vestibular schwannomas
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
f.vestibular schwannomas
what is vestibular schwannoma associated with
a.fibromyalgia
b.MS
c.motor neurone disease
d.Neurofibromatosis
e.glioblastoma
d.Neurofibromatosis
NF2
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
g.stereotactic radiosurgery
what is the classical presentation for large pituitary adenomas
a.unilateral hemianopia
b.bitemporal hemianopia
c.homonymous hemianopia
d.homonymous hemianopia w macular sparing
b.bitemporal hemianopia
compression of adjacent structures eg optic nerves
………… pituitary tumours may cause cushings or acromegaly
a.small
b.large
a.small
stereotactic radiosurgery is used for
benign brain tumours of small volume
brain metastatses
what is given for peri tumoral oedema in palliative care
a.dexamethosone
b.prednisolone
c.beclomethasone
d.hydrocortisone
a.dexamethosone
angiogenesis
recruitment of blood supply to feed the tumour
