SOLs

Question 1

TRUE/FALSE

More than 2/3 of tumours present with focal localising symptoms

Answer 1

TRUE

Question 2

Why are headaches worse in the morning?

Answer 2

Slightly hypercapnic overnight as we retain CO2 while we sleep
Result in increasing cerebral blood flow and a commensurate increase in the size of the brain

Question 3

Brain tumours are what percentage of childhood tumours?

Answer 3

20%

Question 4

Why is the tentorium cerebella important in brain tumours?

Answer 4

In children- 70% arise below tentorium cerebelli

In adults- 70% arise above the tentorium cerebelli

Question 5

What is the most subtype of brain tumour in adult?

Answer 5

Astrocytoma

Question 6

What is the most common brain tumour in children?

Answer 6

Pilocytic astrocytoma

Question 7

What are the most common tumour within the cranial cavity?

Answer 7

Metastases

Question 8

What is the classic presentation of brain tumour?

Answer 8

Progressive neurological deficit
Motor Weakness
Headache
Seizures
Tiptoeing/Ataxia
Vomiting

Question 9

If headache with tiptoeing, ataxia and vomiting in children what is the differential you are considering?

Answer 9

Posterior foss tumour

Question 10

What are the 5 aetiologies of tumour headache?

Answer 10

1-Raised ICP
2-Invasion/Compression of dura or periosteum
3-Secondary to diplopia or difficulty focusing
4-Extreme hypertension (as part of Cushing’s triad)
5-Psychogenic

Question 11

If someone comes in with a headache what investigation should always be done?

Answer 11

Fundoscopy

Question 12

What are the stem cells of the nervous system?

Answer 12

Neuroepithelial cells

Question 13

What do neuroepithelial cells derive from?

Answer 13

Pluripotent stem cells

Question 14

What defines grade IV astrocytic tumours?

Answer 14

If necrosis then glioblastoma multiform (grade IV)

Question 15

Post astrocytic tumour removal it is safe to drive TRUE/FALSE

Answer 15

BOI ARE YA PLAYING

Not safe if there is a seizure risk or if left with some degree of visual field deficit. Have to inform DVLA

Question 16

If you leave grade 1 astrocytic tumours alone they will go away TRUE/FALSE

Answer 16

FALSE
surgery is curative
If you leave them alone they will go blind

Question 17

How do low grade astrocytoma present?

Answer 17

Seizures

Question 18

Where are grade 1 tumours found?

Answer 18

Cerebellum

Question 19

Where are grade II tumours commonly found?

Answer 19

Temporal bone

Question 20

How do grade IV astrocytic tumours spread?

Answer 20

Via white matter tracking/CSF pathways

Question 21

All astrocytic tumour surgery and treatment is curative TRUE/FALSE

Answer 21

Sadly not
Grade 1-Curative
Grade 2-?
Grade 3/4- Non-curative

Question 22

Which group of tumours are described as having “toothpaste morphology”

Answer 22

Oligodendroglia tumours

Question 23

What is the median survival with oligodendrocyte tumours?

Answer 23

10 years

Question 24

What are the 5 types of brain tumours?

Answer 24

Astrocytic tumours
Oligodendroglia tumours
Meningiomas
Nerve Sheath Tumours
Germ cell Tumours

Question 25

Which types of tumour coexist with astrocytic cells in a neoplastic collision type tumour?

Answer 25

Astrocytic tumours

Question 26

What are meningiomas?

Answer 26

Tumours that form on the membranes that cover the brain and spinal cord just inside the skull

Question 27

Most meningiomas are asymptomatic. If there is symptoms what will they be?

Answer 27

Headaches Cranial nerve neuropathies Regional autonomic disturbances

Question 28

What do meningiomas form due to?

Answer 28

Radiation exposure

Question 29

What is the grading tool used for meningioma resection?

Answer 29

Simpson grading | this predicts symptomatic recurrence based on how well you resect the tumour

Question 30

What are the 3 types of nerve sheath tumours?

Answer 30

Schwannoma Neurofibroma Malignant Peripheral Nerve Sheath Tumour

Question 31

What is another name for vestibular schwannoma of the 8th nerve?

Answer 31

Acoustic neuroma

Question 32

The midline brain tumour known as a germ cell tumour has a classic age range of...

Answer 32

10-12 y/o males

Question 33

How do germ cell tumours mainly metastasise?

Answer 33

Via the CSF

Question 34

AFP is raised in which brain tumours?

Answer 34

Yolk sac tumours

Question 35

HCG is raised in which brain tumours?

Answer 35

Choricocarcinoma Germinoma Many others

Question 36

Where do multiple abscesses tend to occur?

Answer 36

At grey and white matter boundry

Question 37

Why does the effect of the SOL tend to be much greater than the SOL itself?

Answer 37

Generalised oedema round the SOL

Question 38

What is used in the diagnosis of abscess in the brain?

Answer 38

CT (with contrast)

Question 39

How is brain abscess treated

Answer 39

Drainage of pus if there is any | Antibiotics- Ceftriaxone and Metronidazole empirically (modify post colture 6wks)