Brain [& Spinal ] Tumours
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Questions and Answers

Which of the following components makes up the largest portion of the intracranial contents?

  • Cerebrospinal Fluid (CSF)
  • Blood
  • Glial Cells (correct)
  • Extracellular Fluid

    • According to the Monro-Kellie doctrine, if intracranial blood volume increases, which of the following must decrease to maintain normal intracranial pressure (ICP)?

  • Brain tissue
  • CSF volume (correct)
  • Neuronal volume
  • Extracellular fluid (ECF) volume

    • In infants, intracranial pressure is lower than in adults due to:

  • Larger blood volume in the brain
  • Presence of open fontanelles (correct)
  • Smaller brain size
  • Increased production of CSF

    • What is the normal range of intracranial pressure (ICP) in adults?

    <p>5–15 mmHg</p> Signup and view all the answers

    Which of the following is most likely to cause a sudden increase in ICP?

    <p>Coughing or sneezing</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with raised ICP?

    <p>Hyperreflexia</p> Signup and view all the answers

    An intracranial mass can cause herniation by:

    <p>Disrupting the balance between intracranial compartments</p> Signup and view all the answers

    What is the primary consequence of an intracranial mass on brain tissue?

    <p>Compression of brain tissue on the same side</p> Signup and view all the answers

    Which structure is most likely to be affected when the brainstem is displaced due to mass effect?

    <p>Basilar artery</p> Signup and view all the answers

    What term describes excess water in the extracellular space due to intracranial mass effects?

    <p>Oedema</p> Signup and view all the answers

    Hydrocephalus is defined as:

    <p>Excess water in the ventricular system</p> Signup and view all the answers

    Which of the following is a common vascular consequence of brainstem compression?

    <p>Disruption of basilar artery function</p> Signup and view all the answers

    A midline shift caused by an intracranial mass results in:

    <p>Herniation of brain tissue to the opposite side</p> Signup and view all the answers

    Which of the following is most likely to occur due to compression of the brainstem by an intracranial mass?

    <p>Disruption of respiratory centers</p> Signup and view all the answers

    What prevents the development of brain edema under normal conditions?

    <p>Tight junctions in the blood-brain barrier (BBB)</p> Signup and view all the answers

    Which of the following conditions can disrupt tight junctions and lead to brain edema?

    <p>Traumatic brain injury</p> Signup and view all the answers

    What is the primary cause of cytotoxic cerebral edema?

    <p>Failure of Na+/K+ ATPase pump</p> Signup and view all the answers

    Cytotoxic cerebral edema is most commonly associated with:

    <p>Ischemia</p> Signup and view all the answers

    Which type of cerebral edema involves the disruption of tight junctions in the blood-brain barrier?

    <p>Vasogenic edema</p> Signup and view all the answers

    In cytotoxic cerebral edema, water accumulates primarily in the:

    <p>Intracellular space</p> Signup and view all the answers

    Vasogenic cerebral edema is characterized by:

    <p>Extracellular water accumulation due to increased capillary permeability</p> Signup and view all the answers

    Tight junction disruption in the blood-brain barrier occurs in which type of cerebral edema?

    <p>Vasogenic</p> Signup and view all the answers

    Hydrocephalus is defined as:

    <p>Excess water in the ventricular system</p> Signup and view all the answers

    Hydrocephalus ex vacuo occurs due to:

    <p>Loss of brain tissue creating space for CSF</p> Signup and view all the answers

    Which of the following can cause overproduction of cerebrospinal fluid (CSF)?

    <p>Choroid plexus papilloma</p> Signup and view all the answers

    Blockage of which structure can cause non-communicating (obstructive) hydrocephalus?

    <p>Foramen of Monro</p> Signup and view all the answers

    A failure of reabsorption of CSF typically occurs due to dysfunction in:

    <p>Arachnoid granulations</p> Signup and view all the answers

    Which of the following is an example of obstructive hydrocephalus?

    <p>Blockage of the cerebral aqueduct</p> Signup and view all the answers

    Which foramina are involved in the circulation of CSF that may lead to hydrocephalus if blocked?

    <p>Foramen of Monro and Foramen of Luschka</p> Signup and view all the answers

    Chiari malformation is characterized by which of the following herniations?

    <p>Cerebellar tonsillar herniation</p> Signup and view all the answers

    What structural abnormality is commonly observed in Chiari malformation?

    <p>Elongated brainstem</p> Signup and view all the answers

    A reduced size of which structure is a feature of Chiari malformation?

    <p>Fourth ventricle</p> Signup and view all the answers

    Which condition is commonly associated with Chiari malformation?

    <p>Hydrocephalus</p> Signup and view all the answers

    Which condition is commonly associated with Chiari malformation?

    <p>Hydrocephalus</p> Signup and view all the answers

    Which imaging feature is diagnostic of Chiari malformation?

    <p>Herniation of the cerebellar tonsils below the foramen magnum</p> Signup and view all the answers

    How many new primary brain tumors are diagnosed annually in Ireland? What trend is observed regarding brain tumor incidence in the elderly?

    <p>400–450</p> Signup and view all the answers

    Which of the following advancements has contributed to better diagnosis and management of brain tumors?

    <p>Improved imaging and neurosurgical techniques</p> Signup and view all the answers

    Which of the following is NOT an example of a pre-malignant lesion with known progression?

    <p>Gliomas in the brain</p> Signup and view all the answers

    Which of the following is a common clinical presentation of a brain tumor?

    <p>Progressive and focal neurological deficit</p> Signup and view all the answers

    Which of the following is a typical symptom associated with brain tumors?

    <p>Seizures</p> Signup and view all the answers

    Raised intracranial pressure in brain tumors is typically associated with: A. Fluid retention in the limbs B. Nausea, vomiting, and headache C. Excessive sweating and fever D. Rapid heartbeat and dizziness

    <p>Nausea, vomiting, and headache</p> Signup and view all the answers

    Which of the following is a characteristic of brain tumors compared to systemic cancers?

    <p>Brain tumors never metastasize</p> Signup and view all the answers

    Why are brain tumors considered lethal despite their small size?

    <p>Even a small change in the brain leads to significant effects on function</p> Signup and view all the answers

    Which of the following best describes the behavior of brain tumors?

    <p>They always recur locally</p> Signup and view all the answers

    The progression of brain tumors can lead to normal brain function until:

    <p>The tumor reaches a large size</p> Signup and view all the answers

    Which of the following genetic conditions is associated with an increased risk of brain tumors?

    <p>Neurofibromatosis 1</p> Signup and view all the answers

    Which of the following tumors arise from glial cells?

    <p>Glioma</p> Signup and view all the answers

    Which cell type gives rise to astrocytomas?

    <p>Astrocytes</p> Signup and view all the answers

    Oligodendrogliomas arise from which type of cell?

    <p>Oligodendrocytes</p> Signup and view all the answers

    Which of the following is a non-glial brain tumor?

    <p>Meningioma</p> Signup and view all the answers

    Which of the following is an embryonal tumor commonly found in children?

    <p>Medulloblastoma</p> Signup and view all the answers

    Which tumor originates from the pituitary gland? (Select one)

    <p>Pituitary adenoma</p> Signup and view all the answers

    Which type of glioma arises from ependymal cells?

    <p>Ependymoma</p> Signup and view all the answers

    What type of tumor arises from Schwann cells?

    <p>Schwannoma</p> Signup and view all the answers

    What is a characteristic of gliomas?

    <p>They arise from glial cells, which support neurons</p> Signup and view all the answers

    Which of the following is a characteristic of a WHO Grade I glioma?

    <p>Pilocytic astrocytoma</p> Signup and view all the answers

    What is the 5-year survival rate for a WHO Grade I glioma?

    <p>95%</p> Signup and view all the answers

    What is the median survival for a WHO Grade II glioma?

    <p>10 years</p> Signup and view all the answers

    Which of the following features is present in a WHO Grade III glioma?

    <p>Mitosis</p> Signup and view all the answers

    A glioma classified as WHO Grade IV is characterized by which of the following?

    <p>Mitosis, microvascular proliferation, and necrosis</p> Signup and view all the answers

    The prognosis for a glioma depends on all of the following except:

    <p>Tumor location</p> Signup and view all the answers

    Gliomas with the highest grade are characterized by all of the following except:

    <p>Pilocytic astrocytoma</p> Signup and view all the answers

    What strategy was introduced to improve the management and treatment of gliomas?

    <p>National Cancer Strategy</p> Signup and view all the answers

    What was the role of the 'Lead Clinician' in the National Cancer Strategy?

    <p>To coordinate glioma treatment plans</p> Signup and view all the answers

    Which of the following is an imaging technique used to track the progression of gliomas?

    <p>Functional MRI</p> Signup and view all the answers

    What does the term 'Minimal Residual Disease' refer to in glioma imaging?

    <p>Detection of minimal signs of cancer cells after treatment</p> Signup and view all the answers

    Which imaging method uses 5-ALA to enhance glioma tissue visibility during surgery?

    <p>Fluorescence-guided surgery</p> Signup and view all the answers

    What is the purpose of Awake Neurosurgery?

    <p>To monitor brain activity during surgery</p> Signup and view all the answers

    What is 'Pseudoprogression' in the context of glioma treatment?

    <p>A false positive result showing tumor growth in imaging</p> Signup and view all the answers

    Which imaging technology assists in distinguishing between tumor progression and post-treatment changes?

    <p>Perfusion scanning</p> Signup and view all the answers

    Which of the following is true about gliomas treated with the National Imaging Strategy?

    <p>It aids in detecting minimal disease and tracking response</p> Signup and view all the answers

    What is a major limitation of glioma survival despite advances in imaging and treatment techniques?

    <p>Some types of gliomas still have poor survival rates</p> Signup and view all the answers

    What is the role of MGMT promoter methylation in glioma treatment?

    <p>It silences the MGMT gene, increasing the tumor's susceptibility to temozolomide</p> Signup and view all the answers

    Which of the following is true about Isocitrate Dehydrogenase (IDH) mutations in gliomas? (Select one)

    <p>IDH mutations lead to the accumulation of an oncometabolite, 2-hydroxyglutarate</p> Signup and view all the answers

    What does the 1p19q co-deletion indicate in glioma diagnosis?

    <p>It is associated with a better prognosis and response to therapy in certain gliomas</p> Signup and view all the answers

    How does methylation profiling assist in glioma management?

    <p>It provides insight into the genetic and molecular characteristics of the tumor</p> Signup and view all the answers

    Why is precision oncology important in glioma treatment?

    <p>It targets treatments based on the genetic and molecular characteristics of individual tumors</p> Signup and view all the answers

    What can potentially happen if a drug is not appropriately matched to a patient's genetic profile in glioma treatment?

    <p>It can result in problems and reduced efficacy of the drug</p> Signup and view all the answers

    What is the role of MGMT (O-6-methylguanine-DNA methyltransferase) promoter methylation in glioblastoma treatment?

    <p>It enhances the efficacy of temozolomide (TMZ)</p> Signup and view all the answers

    Which of the following molecular changes is associated with early events in gliomagenesis?

    <p>Mutations in Isocitrate Dehydrogenase (IDH) 1 and 2</p> Signup and view all the answers

    What is the primary role of the 1p19q co-deletion in glioma diagnosis?

    <p>It is a marker for oligodendrogliomas and predicts response to chemotherapy</p> Signup and view all the answers

    What is the significance of epigenetic modifications in gliomagenesis?

    <p>They alter the structure of histones and DNA, impacting gene expression</p> Signup and view all the answers

    Which of the following is associated with an early event in glioma formation due to mutations in Isocitrate Dehydrogenase (IDH)?

    <p>Production of 2-hydroxyglutarate (2HG), an oncometabolite</p> Signup and view all the answers

    What is the primary aim of DNA methylation-based classification of human central nervous system (CNS) tumors?

    <p>To define distinct methylation classes within one histologic entity</p> Signup and view all the answers

    What does the brain tumour methylome reflect?

    <p>Somatically acquired DNA methylation changes and characteristics reflecting the cell of origin</p> Signup and view all the answers

    Which of the following statements is true regarding the use of DNA methylation in classifying CNS tumors?

    <p>DNA methylation profiling can reveal distinct histologic entities within a single methylation class.</p> Signup and view all the answers

    Low-grade gliomas are characterized by which of the following features?

    <p>Diffuse infiltration into surrounding brain tissue</p> Signup and view all the answers

    Which of the following imaging techniques is commonly used to better estimate the extent of a low-grade glioma?

    <p>18FET-PET</p> Signup and view all the answers

    Why is it difficult to completely remove a low-grade glioma via surgery?

    <p>Isolated tumor cells infiltrate widely beyond the visible tumor boundary</p> Signup and view all the answers

    In the resection of a glioblastoma (GBM), which surgical techniques are typically used to aid in tumor removal?

    <p>Intraoperative neuronavigation and 5-ALA fluorescence techniques</p> Signup and view all the answers

    Which of the following is the primary limitation in resecting tumors located in the dominant hemisphere (e.g., speech area)?

    <p>High risk of major neurological deficit</p> Signup and view all the answers

    Which imaging modality tends to underestimate the extent of low-grade gliomas?

    <p>CT</p> Signup and view all the answers

    Why is 18FET-PET considered more accurate than MRI in estimating the extent of gliomas?

    <p>It detects areas of metabolic activity, even in non-enhancing tumor regions.</p> Signup and view all the answers

    Which of the following is the primary goal in the surgical management of glioblastoma (GBM)?

    <p>Maximum safe debulking</p> Signup and view all the answers

    Which technique is commonly used during glioma surgery to ensure maximal tumor resection while preserving neurological function?

    <p>Awake surgery with intraoperative mapping</p> Signup and view all the answers

    What is the advantage of using stereotactic volumetric resection in glioma surgery?

    <p>It allows for precise localization of the tumor and avoids critical brain regions</p> Signup and view all the answers

    Which of the following radiation therapies is considered an option for glioma treatment, particularly when precision is crucial?

    <p>All of the above</p> Signup and view all the answers

    What is the benefit of using proton beam radiation in glioma management?

    <p>It delivers a higher dose of radiation to the tumor while sparing surrounding healthy tissue</p> Signup and view all the answers

    Which of the following chemotherapy strategies is commonly used in the systemic treatment of gliomas?

    <p>Systemic chemotherapy with agents like temozolomide</p> Signup and view all the answers

    What is the significance of 'maximum safe debulking' in glioma surgery?

    <p>It refers to removing as much of the tumor as possible without causing irreversible damage to surrounding brain structures</p> Signup and view all the answers

    What is the role of awake surgery in glioma resection?

    <p>It helps preserve brain function by monitoring patient response during the surgery</p> Signup and view all the answers

    Which of the following is a reason why brain tumors in children are considered more devastating than those in adults?

    <p>The impact of treatments on the developing nervous system</p> Signup and view all the answers

    What is one of the main long-term effects of brain tumors in children due to treatment?

    <p>Endocrine and neurodevelopmental effects</p> Signup and view all the answers

    Approximately what percentage of brain tumors in children are located below the tentorium?

    <p>70%</p> Signup and view all the answers

    What age group is most commonly affected by brain tumors in children?

    <p>Preschool-age children</p> Signup and view all the answers

    Which of the following treatments for brain tumors in children can have significant endocrine effects?

    <p>Radiation therapy</p> Signup and view all the answers

    Which of the following is a characteristic feature of cystic cerebellar astrocytomas in children?

    <p>They are typically easily resected</p> Signup and view all the answers

    What is the prognosis for children with cerebellar astrocytomas, particularly those that are cystic?

    <p>Excellent long-term survival with no additional therapy required</p> Signup and view all the answers

    Which genetic signature is commonly associated with pilocytic astrocytomas, particularly in the cerebellum?

    <p>BRAF fusion</p> Signup and view all the answers

    Which childhood brain tumor is most commonly associated with the brainstem?

    <p>Brainstem astrocytoma</p> Signup and view all the answers

    Which of the following childhood brain tumors has a cystic appearance, is easily resected, and shows excellent long-term survival?

    <p>Pilocytic astrocytoma (cerebellar astrocytoma)</p> Signup and view all the answers

    What is the typical treatment approach for cystic cerebellar astrocytomas?

    <p>Surgical resection, often without the need for additional therapy</p> Signup and view all the answers

    Which of the following is true about brain stem astrocytomas in children?

    <p>The location of the tumor, not the histological grade, is the key determinant of outcome</p> Signup and view all the answers

    Which of the following is a typical clinical manifestation of brain stem astrocytomas?

    <p>Major neurologic deficits, including cranial nerve involvement</p> Signup and view all the answers

    What is the primary treatment approach for brain stem astrocytomas?

    <p>Palliative care, as these tumors are difficult to resect</p> Signup and view all the answers

    What is commonly observed in the imaging of a brain stem astrocytoma?

    <p>Hydrocephalus due to obstructive tumor growth</p> Signup and view all the answers

    What is the prognosis for a child with a pilocytic astrocytoma (cerebellar astrocytoma)?

    <p>Excellent long-term survival with complete surgical resection</p> Signup and view all the answers

    Which of the following is typically seen on MRI in a patient with pilocytic astrocytoma?

    <p>Cystic tumor with enhancing solid portions</p> Signup and view all the answers

    Which of the following symptoms is most commonly associated with medulloblastoma in children?

    <p>Effortless vomiting and head tilt</p> Signup and view all the answers

    What is the typical histological feature of medulloblastoma?

    <p>&quot;Small round cell tumor&quot; with high mitotic index</p> Signup and view all the answers

    What is the most common site of tumor involvement in medulloblastoma?

    <p>Cerebellum, often in the posterior fossa</p> Signup and view all the answers

    What is the role of genetics in the treatment of medulloblastoma?

    <p>Genetics help guide therapy by identifying specific molecular subtypes</p> Signup and view all the answers

    Which factor is NOT typically considered when determining the treatment plan for a child with medulloblastoma?

    <p>The patient's blood type</p> Signup and view all the answers

    What is a common feature of medulloblastoma on MRI imaging?

    <p>A solid mass in the cerebellum, often with ventricular obstruction</p> Signup and view all the answers

    What does the term 'external granular layer' refer to in the context of medulloblastoma?

    <p>A normal region in the cerebellum that remains unaffected by the tumor</p> Signup and view all the answers

    Medulloblastoma has a strong tendency to spread to which of the following regions?

    <p>The spinal cord</p> Signup and view all the answers

    What is the prognosis for a child with medulloblastoma generally based on?

    <p>The tumor's molecular subtype, stage, and age of the child</p> Signup and view all the answers

    What is a common characteristic of meningiomas?

    <p>They are easy to resect and typically do not invade the brain.</p> Signup and view all the answers

    What is the primary cause of death in untreated meningiomas?

    <p>Raised intracranial pressure (ICP)</p> Signup and view all the answers

    Which symptom would most likely be associated with a skull base meningioma?

    <p>Loss of smell (anosmia)</p> Signup and view all the answers

    Which condition is most likely associated with cerebellar hemangioblastomas?

    <p>Von-Hippel Lindau (VHL) disease</p> Signup and view all the answers

    What is the most common site of a pituitary macroadenoma?

    <p>Optic chiasm</p> Signup and view all the answers

    What visual disturbance is commonly seen in patients with pituitary macroadenomas?

    <p>Bitemporal hemianopia</p> Signup and view all the answers

    Which of the following is associated with craniopharyngiomas?

    <p>Cystic, calcified, and cholesterol-containing tumor</p> Signup and view all the answers

    What is the primary histologic feature of pituitary adenomas?

    <p>Secretion of hormones that can cause clinical syndromes</p> Signup and view all the answers

    Which of the following is a common clinical presentation of craniopharyngiomas in children?

    <p>Childhood growth retardation and blindness</p> Signup and view all the answers

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