YearClub 2026 Neurology session (neurosurgery)

Question 1

Symptoms of primary brain tumour?

Answer 1

Progressive neuro deficit
Headache (with N+V, worse on lying down, worse in morning…) - can wake patient up
Seizures - esp if first in an adult

Question 2

Investigations for primary brain tumours?

Answer 2

MRI = gold standard imaging
Biopsy/resection for histology

Question 3

Brain cancer is commonest cause of cancer death in under 40’s and is 2nd most common cancer in children. True/false?

Answer 3

True

Question 4

How many grades of astrocytoma are present?

Answer 4

Grades 1-4

Question 5

What are the 4 grades of astrocytoma?

Answer 5

Grade 1 = (pilocytic) benign. In children + YA with high cure rate

Grade 2 = (low grade) WILL progress
into high grade, but can take decades

Grade 3 (anaplastic astrocytoma) - will progress in GBM but median survival or 5 years

Glioblastoma multiforme (grade 4, GBM) is most common malignant tumour. Median survival is 14 months

Question 6

Pilocytic (grade 1) astrocytoma is most common brain cancer in children. True/false?

Answer 6

False. 2nd most common after medulloblastoma.

Question 7

Treatment for brain cancers?

Answer 7

GET IT OUT ± chemo/radio/both

Question 8

What is the Monroe-kelly hypothesis?

Answer 8

Skull is a box made up of 3 things (brain, blood. CSF), when one increases the other 2 decrease

Question 9

What is the main concern with any obstructions in the brain?

Answer 9

Concern is that blood volume may not be enough to oxygenate the brain, may have obstruction of CSF flow leading to hydrocephalus or brain may herniate

Question 10

Initial symptoms of increased ICP?

Answer 10

Headaches, vomiting, reduced GCS, double vision

Question 11

What is cushing’s triad?

Answer 11

A physiological mechanism that attempts to compensate for acute rise in ICP and decreasing oxygen supply.

Question 12

3 components of cushing’s triad?

Answer 12

Bradycardia (decreased heart rate)

Widened pulse pressure (large difference between systolic and diastolic BP)

Abnormal respirations

Question 13

Treatment of ICP?

Answer 13

Sit patient at 45 degrees
Remove anything compressing their head/ neck
Reduce stress in room (lighting, noise etc)
Hypertonic saline
Intubate patient, create low CO2 by fast resp rate (vasoconstriction of blood vessels)
Mannitol (dexamethasone if space-occupying lesion)
Crainitomy if all else fails