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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
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
B. RT s/p gross total resection improves survival for all grades
26
What is the presentation of oligodendroglioma?
Seizures
27
What are the significant findings on CT/MRI for oligodendroglioma?
calcifications and hemorrhage
28
Median survival for oligodendroglioma
2-7 years
29
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
B. Responds to PCV chemo (Procarbazine, Lomustine, Vincristine) A - aggressive resection improves survival C - Chromosomal deletion at 1p19q associated with robust response to temozolamide
30
Neoplasm that arise from cells lining the ventricular system. Presents as headache, nausea, vomiting, vertigo, seconary to hydrocephalus with obstruction of CSF flow.
ependymoma
31
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
D
32
What is the usual presentation of Choroid plexus papillomas?
Symptoms of increased ICP
33
Management of choroid plexus papillomas
Surgical excision is curative
34
What is the most common malignant pediatric brain tumor
Medulloblastomas
35
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
B | Generally not encapsulated
36
What is the treatment of medulloblastomas?
surgical resection radiation therapy chemotherapy
37
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
Medulloblastomas
38
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 ```
C
39
Most common location of ganglioglioma
Medial temporal lobe
40
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. 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
CNS neoplasm that presents with progressive hearing loss, tinnitus or balance difficulty, brainstem compression, obstructive hydrocephalus
Vestibular Schwannoma
42
Where does vestibular Schwannoma arise from?
Vestibulocochlear nerve
43
What is the management of vestibular schwannoma and its complication?
microsurgical resection or SRS; facial nerve dysfunction
44
Therapy for prolactinomas
Dopaminergic therapy (bromocriptine)
45
The preferred surgical approach for decompression of symptomatic pituitary tumors to eliminate mass effect and/or attempt endocrine cure
Trans-sphenoidal approach
46
Where does hemangioblastoma occur almost exclusively.
posterior fossa
47
``` 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 ```
D
48
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
C. Enhance on contrast
49
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.
Craniopharyngioma
50
Cystic lesions with stratified squamous epithelial walls from trapped ectodermal rests that grow slowly and linearly by desquamation into the cyst cavity
Epidermoid
51
most frequent location of epidermoid CNS tumor
cerebellopontine angle
52
What is the management of epidermoid tumor?
Surgical drainage and removal of cyst wall
53
Contain hair follicles and sebaceous glands in addition to a squamous epithelium
Dermoid
54
Common location of dermoid tumor
midline in location
55
Treatment of dermoid tumor
Surgical resection with care to control cyst contents.
56
Where do teratoma arise in the CNS?
pineal region, midline
57
What is the management of teratoma?
Surgical resection but prognosis is poor for malignant teratomas
58
Most common extradural tumor?
Spinal metastatic tumor
59
Where does spinal metastatic tumors usually occur?
thoracic and lumbar vertebral bodies
60
Most common primary sources of spinal metastatic tumors
``` LLBP Lymphoma Lung Breast Prostate ```
61
Management of spinal metastatic tumors
Surgery | Radiation Therapy
62
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)
Spinal Meningioma
63
Where does spinal meningioma most commonly occur?
Thoracic spine
64
management of spinal meningioma
En bloc surgical resection
65
Spinal Schwannoma are derived from
peripheral nerve sheath Schwann cells
66
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
AOTA
67
Fusiform and tend to grow within the parent nerve. Benign but not encapsulated.
Spinal neurofibroma
68
Presentation of spinal neurofibroma
similar to schwannoma | radiculopathy or myelopathy
69
Management of spinal neurofibroma
surgical resection (salvage of parent nerve more challenging)
70
Most common intramedullary tumor in adults
Spinal ependymoma
71
Benign but not encapsulated (2)
Spinal neurofibroma | Spinal ependymoma
72
Treatment of spinal ependymoma
surgical removal can improve function | Post op RT after subtotal resection may prolong disease control
73
most common intramedullary tumors in children
Spinal astrocytoma
74
Where does spinal astrocytoma occur?
All levels
75
Where is spinal astrocytoma most common?
Cervical cord
76
Spinal astrocytoma may interfere with CSF-containing central canal of the spinal cord, leading to a _____
dilated central canal (syringomyelia)

SRGRY3 (44 decks)

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