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SRGRY3 > NRSRGRY - TMRS > Flashcards

NRSRGRY - TMRS Flashcards

1
Q

intracranial tumors can cause brain injury from (4)

A

MADS

Mass effect
Abnormal electrical activity
Dysfunction or destruction of adjacent neural structures
Swelling

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2
Q

Common symptoms of supratentorial tumors (4)

A

Clever Velvet Hercules Sang

Contralateral limb weakness
Visual field deficit
Headache
Seizure

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3
Q

What are the effects of infratentorial tumors? general (3)

A

I see baby (ICB)
Increased intracranial pressure
Cerebellar hemisphere involvement
Brainstem dysfunction

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4
Q

Effect of infratentorial tumors due to increased intracranial pressure leading to compression of the 4th ventricle (4)

A 
HVND
Headache
Nausea
Vomiting
Diplopia
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5
Q

Symptoms of cerebellar hemisphere involvement due to infratentorial tumors (2)

A

Ataxia

Nystagmus

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6
Q

Symptoms of cerebellar involvement due to brainstem dysfunction (1)

A

Cranial nerve palsies

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7
Q

Gold standard for imaging of brain tumors

A

Cranial MRI with and without gadolinium contrast

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8
Q

Known case of brain tumor, presents with weakness, lethargy or hydrocephalus. What’s your management?

A
  1. Admit
  2. Dexamoethasone
  3. Anticonvulsant
  4. Osmotic diuretic
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9
Q

What is the rationale behind giving dexamethasone in a patient with hydrocephalus presenting with weakness and lethargy?

A

to reduce vasogenic edema

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10
Q

prognosis for patients with brain tumors are dependent on 2 things

A

Histology

Anatomy

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11
Q

What is the most common intracranial tumor?

A

Metastatic tumor

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12
Q

Arrange the following in order of most common primary for brain metastasis.

A. Melanoma
B. Kidney
C. GI
D. Lung
E. Breast
A

DEBCA

Lung
Breast
Kidney
GI
Melanoma
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13
Q

Where does metastatic tumors frequently seed?

A

Tumors have Good Moral Character (GMC)

Gray-white junction
Meninges
Cerebellum

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14
Q

Management of metastatic tumors depend on (5)

A 
The primary tumor
Overall tumor burden
Patient's medical condition
Location of metastases
Number of metastases
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15
Q

Treatment options for metastatic tumors (3)

A

CWS
Craniotomy
Whole Brain Radiotherapy
Stereotactic surgery

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16
Q

Median survival of metastatic brain tumor treated with RT alone

A

15 weeks

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17
Q

Median survival of metastatic brain tumor treated with craniotomy + WBRT

A

40 weeks

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18
Q

Most common primary CNS neoplasm

A

Astrocytoma

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19
Q

Low Grade astrocytoma

a. I
b. II
c. I and II
d. II and III
e. III

A

C

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20
Q

Grade III astrocytoma

a. Low-grade astrocytoma
b. anaplastic astrocytoma
c. Glioblastoma multiforme

A

B

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21
Q

Which astrocytoma has the worst prognosis?

a. Anaplatic astrocytoma
b. Glioblastoma multiforme
c. Low-grade Astrocytoma

A

B

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22
Q

Prognosis of Low-grade astrocytoma

A

8 years

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23
Q

Prognosis of Grade III astrocytoma

A

2-3 years

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24
Q

Prognosis of Grade Glioblastoma multiforme

A

1 year

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25
Q

The following is/are true of management of astrocytoma EXCEPT

a. gross total resection should be attempted
b. RT s/p gross total resection improves survival for Grade I astrocytoma only
c. Chemotherapy is of limited efficacy
d. Temozolomide is reserved for GBM

A

B. RT s/p gross total resection improves survival for all grades

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26
Q

What is the presentation of oligodendroglioma?

A

Seizures

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27
Q

What are the significant findings on CT/MRI for oligodendroglioma?

A

calcifications and hemorrhage

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28
Q

Median survival for oligodendroglioma

A

2-7 years

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29
Q

True of management of oligodendroglioma

a. Aggressive resection increases complication without improving survival
b. Responds to procarbazine, lomustine, vincristine chemotherapy
c. Chromosomal deletion at 19p1q has been associated with a robust response to Temozolamide
d. AOTA
e. NOTA

A

B. Responds to PCV chemo (Procarbazine, Lomustine, Vincristine)

A - aggressive resection improves survival
C - Chromosomal deletion at 1p19q associated with robust response to temozolamide

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30
Q

Neoplasm that arise from cells lining the ventricular system. Presents as headache, nausea, vomiting, vertigo, seconary to hydrocephalus with obstruction of CSF flow.

A

ependymoma

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31
Q

True of management of ependymoma
A. achieve maximal resection without induring the delicate brainstem
B. postoperative RT improves survival
C. Whole spine radiation for CSF spread with “drop metastases”
D. AOTA

A

D

32
Q

What is the usual presentation of Choroid plexus papillomas?

A

Symptoms of increased ICP

33
Q

Management of choroid plexus papillomas

A

Surgical excision is curative

34
Q

What is the most common malignant pediatric brain tumor

A

Medulloblastomas

35
Q

True about medulloblastomas EXCEPT

a. Most occur in the cerebellum
b. Generally encapsulated
c. Symptoms of increased ICP
d. histology: densely packed small round cells with large nuclei and scanty cytoplasm

A

B

Generally not encapsulated

36
Q

What is the treatment of medulloblastomas?

A

surgical resection
radiation therapy
chemotherapy

37
Q

Most common malignant pediatric brain tumor that usually occur in the cerebellum, on histology composed of densely packed small round cells with large nuclei and scanty cytoplasm

A

Medulloblastomas

38
Q

Mixed tumor in which both neurons and glial cells are neoplastic. Occur in the first 3 decades of life, often in medial temporal lobe. Presents as seizure. Managed by complete surgical resection.

A. Medulloblastooma
B. Ganglioma
C. Ganglioglioma
D. Vestibula Schwannoma
E. Meningioma
A

C

39
Q

Most common location of ganglioglioma

A

Medial temporal lobe

40
Q

True about meningioma

a. arise from arachnoid cap cells
b. Most are fast growing, unencapsulated, aggressive
c. cannot be cured by resection
d. small asymptomatic meningiomas should be removed right away.

A

A.

B - slow-growing, encapsulated, benign tumors
C - total resection is curative
D - small asymptomatic meningiomas can be followed until symptomatic or until significant growth is documented.

41
Q

CNS neoplasm that presents with progressive hearing loss, tinnitus or balance difficulty, brainstem compression, obstructive hydrocephalus

A

Vestibular Schwannoma

42
Q

Where does vestibular Schwannoma arise from?

A

Vestibulocochlear nerve

43
Q

What is the management of vestibular schwannoma and its complication?

A

microsurgical resection or SRS; facial nerve dysfunction

44
Q

Therapy for prolactinomas

A

Dopaminergic therapy (bromocriptine)

45
Q

The preferred surgical approach for decompression of symptomatic pituitary tumors to eliminate mass effect and/or attempt endocrine cure

A

Trans-sphenoidal approach

46
Q

Where does hemangioblastoma occur almost exclusively.

A

posterior fossa

47
Q 
Appear as cystic tumors with an enhancing tumor on the cyst wall known as a mural module.
A. Meningioma
B. Ganglioblastoma
C. Craniopharyngioma
D. Hemangioma
A

D

48
Q

True of lymphoma EXCEPT

a. Always arise secondarily from systemic disease
b. presentation: mental status changes, headache due to increased ICP, cranial nerve palsies due to lymphomatous meningitis
c. Hyperdense due to dense cellularity, does not enhance on contrast
d. Management includes stereotactic needle biopsy, steroids, wbrt, chemotherapy

A

C. Enhance on contrast

49
Q

Benign cystic lesion occurring frequently in children. Presents with visual deficit due to compression of optic chiasm, pituitary or hypothalamic dysfunction, hydrocephalus. Managed by surgical excision.

A

Craniopharyngioma

50
Q

Cystic lesions with stratified squamous epithelial walls from trapped ectodermal rests that grow slowly and linearly by desquamation into the cyst cavity

A

Epidermoid

51
Q

most frequent location of epidermoid CNS tumor

A

cerebellopontine angle

52
Q

What is the management of epidermoid tumor?

A

Surgical drainage and removal of cyst wall

53
Q

Contain hair follicles and sebaceous glands in addition to a squamous epithelium

A

Dermoid

54
Q

Common location of dermoid tumor

A

midline in location

55
Q

Treatment of dermoid tumor

A

Surgical resection with care to control cyst contents.

56
Q

Where do teratoma arise in the CNS?

A

pineal region, midline

57
Q

What is the management of teratoma?

A

Surgical resection but prognosis is poor for malignant teratomas

58
Q

Most common extradural tumor?

A

Spinal metastatic tumor

59
Q

Where does spinal metastatic tumors usually occur?

A

thoracic and lumbar vertebral bodies

60
Q

Most common primary sources of spinal metastatic tumors

A 
LLBP
Lymphoma
Lung
Breast
Prostate
61
Q

Management of spinal metastatic tumors

A

Surgery

Radiation Therapy

62
Q

Tumor that arise from arachnoidea mater, enhancing dura tail may be seen on MRI, present as cord compression and progressive myelopathy (hyperreflexia, spasticity and gait difficulty)

A

Spinal Meningioma

63
Q

Where does spinal meningioma most commonly occur?

A

Thoracic spine

64
Q

management of spinal meningioma

A

En bloc surgical resection

65
Q

Spinal Schwannoma are derived from

A

peripheral nerve sheath Schwann cells

66
Q

True of spinal schwannoma

a. Derived from peripheral nerve sheath Schwann cells
b. benign encapsulated tumors that rarely undergo malignant degeneration
c. Presents as radiculopathy or myelopathy
d. management is surgical resection with preservation of parent nerve root

A

AOTA

67
Q

Fusiform and tend to grow within the parent nerve. Benign but not encapsulated.

A

Spinal neurofibroma

68
Q

Presentation of spinal neurofibroma

A

similar to schwannoma

radiculopathy or myelopathy

69
Q

Management of spinal neurofibroma

A

surgical resection (salvage of parent nerve more challenging)

70
Q

Most common intramedullary tumor in adults

A

Spinal ependymoma

71
Q

Benign but not encapsulated (2)

A

Spinal neurofibroma

Spinal ependymoma

72
Q

Treatment of spinal ependymoma

A

surgical removal can improve function

Post op RT after subtotal resection may prolong disease control

73
Q

most common intramedullary tumors in children

A

Spinal astrocytoma

74
Q

Where does spinal astrocytoma occur?

A

All levels

75
Q

Where is spinal astrocytoma most common?

A

Cervical cord

76
Q

Spinal astrocytoma may interfere with CSF-containing central canal of the spinal cord, leading to a _____

A

dilated central canal (syringomyelia)

SRGRY3 (44 decks)

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