Tumor Classification and General Information

Question 1

In WHO classification of CNS tumors 2021, what does suffix NOS (not otherwise specified) indicate?
● A. Nonconcordance between histological and molecular types
● B. Noncanonical results
● C. New emerging tumor type
● D. Molecular testing not done or uncertain

Answer 1

A. Nonconcordance between histological and molecular types

Question 2

Which of the following is no more a subtype of adult type diffuse gliomas?
● A. Astrocytoma IDH mutant, grade 2
● B. Astrocytoma IDH wildtype, grade 2
● C. Astrocytoma IDH mutant, grade 3
● D. Astrocytoma IDH mutant, grade 4

Answer 2

B. Astrocytoma IDH wildtype, grade 2

Question 3

According to WHO 2021 classification, which lineage of pituitary tumors secretes GH > PRL and a subunit?
● A. Mammosomatotroph pitNET
● B. Mature plurihormonal PIT1 lineage pitNET
● C. Immature PIT1 lineage pit NET
● D. Acidophil stem cell pitNET
● E. Mixed somatotroph–lactotroph PitNET

Answer 3

A. Mammosomatotroph pitNET

Question 4

During the first 6 months of life, infratentorial tumors comprise what percentage of all intracranial tumors?
● A. 15%
● B. 27%
● C. 53%
● D. 74%
● E. 60%

Answer 4

B. 27%

Question 5

A 45-year-old male presented with abulia, dementia, personality changes, apraxia, hemiparesis, and dysphasia. These suggest lesion localized in which area?
● A. Left frontal
● B. Right temporal
● C. Parietal
● D. Occipital
● E. Posterior fossa

Answer 5

A. Left frontal

Question 6

A 40-year-old female presented with auditory and olfactory hallucinations, déja vu, memory impairment, and right superior quadrantanopsia. These suggest lesion localized in which area?
● A. Right frontal
● B. Left temporal
● C. Parietal
● D. Occipital
● E. Posterior fossa

Answer 6

B. Left temporal

Question 7

What is the most common supratentorial tumor in children as well as in adults?
● A. Astrocytoma
● B. Medulloblastoma
● C. Craniopharyngioma
● D. Teratoma
● E. Choroid plexus papilloma

Answer 7

A. Astrocytoma

Question 8

What is the most common brain tumor in neonates?
● A. Astrocytoma
● B. Medulloblastoma
● C. Craniopharyngioma
● D. Teratoma
● E. Choroid plexus papilloma

Answer 8

D. Teratoma

Question 9

A middle-aged patient presented with first-time seizures. CT of brain showed brain tumor. Dexamethasone 10 mg was given intravenously. What will be the usual adult maintenance dose?
● A. 10 mg postoperatively 12 hourly
● B. 6 mg postoperatively 6 hourly
● C. 4 mg postoperatively 6 hourly
● D. 2 mg postoperatively 8 hourly
● E. Repeat 10 mg as needed

Answer 9

B. 6 mg postoperatively 6 hourly

Question 10

An old patient undergoes excision of glioblastoma multiforme. What is the alkylating agent used in chemotherapy?
● A. Carmustine
● B. Lomustine
● C. Temozolamine
● D. Vincristine
● E. Procarbazine

Answer 10

C. Temozolamine

Question 11

During histochemical analysis of a tumor specimen, which agent is used to stain myelin?
● A. Ziehl Neelsen
● B. Gram stain
● C. Reticulin stain
● D. Luxol fast blue
● E. Periodic acid Schiff

Answer 11

D. Luxol fast blue

Question 12

A patient presented with headache, seizures, and monoplegia. What is the tumor marker for meningioma?
● A. Glial fibrillary acidic protein
● B. Epithelial membrane antigen
● C. S-100
● D. Chromogranin A
● E. Synaptophysin

Answer 12

B. Epithelial membrane antigen

Question 13

Ki-67 is expressed in all phases of cell cycle except?
● A. G0
● B. G1
● C. G2
● D. S1
● E. S2

Answer 13

A. G0

Question 14

Any metastatic small-cell tumors to the brain staining positive for neuroendocrine stains are almost all due to primaries in which of the following?
● A. Liver
● B. Bone
● C. Pancreas
● D. Lungs
● E. Prostate

Answer 14

D. Lungs

Question 16

A patient presents in neurosurgical OPD with complaints of auditory and olfactory hallucinations, déjà vu, memory impairment, and contralateral superior quadrantanopsia. What is the most likely part of brain involved by brain tumor in this patient?
● A. Frontal lobe
● B. Parietal lobe
● C. Temporal lobe
● D. Occipital lobe
● E. Posterior fossa

Answer 16

C. Temporal lobe

Question 17

Tumor headache is classically described as headache which is worse in morning, often exacerbated by coughing, straining, bending forward, and associated with nausea and vomiting
with temporarily relieved by vomiting. Following are etiologies of tumor headache except?
● A. Increased ICP which may be due to tumor mass effect, hydrocephalus, mass effect from associated edema, or mass effect from associated hemorrhage
● B. Invasion or compression of brain sensitive structures like dura, vessels, periosteum, and cranial nerves with sensory functions
● C. Difficulty vision which may be because of diplopia due to direct compression of third, fourth, or fifth cranial nerves, abducens palsy from increased ICP
● D. Extreme hypotension resulting from increased ICP
● E. Psychogenic due to stress from loss of functional capacity

Answer 17

D. Extreme hypotension resulting from increased ICP

Question 18

A pediatric patient presents in OPD with complaints of headache, nausea, vomiting, papilledema, vertigo, diplopia, ataxia of extremities, dysmetria, and intention tremors. What is the most likely location of this tumor within brain of this patient?
● A. Lesion of cerebellar vermis
● B. Lesion of cerebellar hemisphere
● C. Brain stem lesion
● D. Supratentorial lesion
● E. Lesion in cerebellopontine angle

Answer 18

B. Lesion of cerebellar hemisphere

Question 19

A patient presents with posterior fossa tumor and the surgeon decides to place a VP shunt in this patient and operate after 2 weeks. Which of the following is a theoretical risk of using this approach?
● A. Placing shunt is a lifelong commitment whereas not all patients with hydrocephalus from posterior fossa tumor requires shunting
● B. Seeding of peritoneum with malignant tumor cells is possible, for example, with medulloblastoma
● C. Shunt infection can occur prior to surgery
● D. Definitive treatment is delayed and there are chances of upward transtentorial herniation
● E. All of the above

Answer 19

E. All of the above

Question 20

An adult patient presents to you with MRI of brain showing multiple brain lesions, and round ring enhancing between gray and white matter with history of weight loss. Steroids are started in this patient with a dosage of 10 mg IV loading dose
and 6 mg every 6 hours postoperatively or IV (pediatric loading dose is 0.5 to 1 mg/kg IV then 0.25 to 0.5 mg/kg/d divided every 6 hours). What is the most likely diagnosis in this patient?
● A. Cerebral abscesses
● B. Cerebral metastasis
● C. Multiple gliomas
● D. Neurofibromatosis type 1
● E. None of the above

Answer 20

B. Cerebral metastasis

Question 21

A patient with brain tumor with no previous history of seizure has to undergo craniotomy for excision of tumor. Prophylactic antiseizure medication (ASM) was started in this patient before surgery. Post surgery, the patient is stable with no distressing
event. How long should ASM be continued in this patient?
● A. For 2 years
● B. Taper off ASM starting 2 weeks postoperatively
● C. Taper off ASM starting 1 week postoperatively
● D. Continue for 2 months
● E. There is no need to give postoperative ASM in this patient

Answer 21

C. Taper off ASM starting 1 week postoperatively

Question 22

Procarbazine, CCNU (lomustine), and vincristine combination therapy is used as either an adjunct (following radiotherapy) or concomitant (simultaneously with radiotherapy) therapy in a number of tumors. What factors make these chemotherapeutic agents efficient instead of presence of blood–brain barrier?
● A. Some CNS tumors may partially disrupt BBB
● B. Lipophilic agents, for example, nitrosoureas, may cross BBB more easily
● C. Selective intraarterial, for example, intracarotid or intervertebral, injection produces higher local concentration which increases penetration
● D. The BBB may be iatrogenically disrupted, for example, by giving mannitol or may be bypassed by intrathecal administration
● E. All of the above

Answer 22

E. All of the above

Question 23

A patient underwent craniotomy for brain tumor. CT of brain without contrast was done after 6 to 12 hours of surgery to assess for acute complications like intraparenchymal hematoma, subdural or epidural hematoma, or for hydrocephalus or pneumocephalus. When should MRI with and without contrast be done in this patient?
● A. It should be delayed at least up to 30 days
● B. It should be done within 2 to 3 days
● C. It should be done after 6 months
● D. It should be done only if symptoms appear
● E. Both A and B

Answer 23

E. Both A and B

Question 24

Stains for organisms include tissue gram stains for bacteria, periodic acid-Schiff stain for fungi, Ziehl-Neelsen stain for acid fast bacilli like tuberculosis, and special stains like Luxol fast blue stains for demyelinating lesions which stain myelin sheath. Which statement is incorrect regarding immunohistochemical stain response of different tumors?
● A. Oligodendroglioma stains positive for glial fibrillary acidic protein (GFAP)
● B. Ependymoma, choroid plexus, chordoma, and oligodendroglioma stains positive for S-100
● C. Chordoma, craniopharyngioma, carcinoma, and PitNET stain positive for both CAM 5.2 (cytokeratins) and EMA epi thelial membrane protein
● D. Meningioma stains positive for EMA
● E. All of the above statements are correct

Answer 24

E. All of the above statements are correct