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 (B)</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 (C)</p> Signup and view all the answers

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

<p>Hyperreflexia (D)</p> Signup and view all the answers

An intracranial mass can cause herniation by:

<p>Disrupting the balance between intracranial compartments (C)</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 (C)</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 (A)</p> Signup and view all the answers

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

<p>Oedema (B)</p> Signup and view all the answers

Hydrocephalus is defined as:

<p>Excess water in the ventricular system (C)</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 (B)</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 (B)</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 (B)</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) (B)</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 (B)</p> Signup and view all the answers

What is the primary cause of cytotoxic cerebral edema?

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

Cytotoxic cerebral edema is most commonly associated with:

<p>Ischemia (A)</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 (B)</p> Signup and view all the answers

In cytotoxic cerebral edema, water accumulates primarily in the:

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

Vasogenic cerebral edema is characterized by:

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

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

<p>Vasogenic (B)</p> Signup and view all the answers

Hydrocephalus is defined as:

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

Hydrocephalus ex vacuo occurs due to:

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

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

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

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

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

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

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

Which of the following is an example of obstructive hydrocephalus?

<p>Blockage of the cerebral aqueduct (B)</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 (A)</p> Signup and view all the answers

Chiari malformation is characterized by which of the following herniations?

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

What structural abnormality is commonly observed in Chiari malformation?

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

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

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

Which condition is commonly associated with Chiari malformation?

<p>Hydrocephalus (B)</p> Signup and view all the answers

Which condition is commonly associated with Chiari malformation?

<p>Hydrocephalus (B)</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 (A)</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 (C)</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 (B)</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 (C)</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 (A)</p> Signup and view all the answers

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

<p>Seizures (A)</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 (B)</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 (A)</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 (B)</p> Signup and view all the answers

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

<p>They always recur locally (C)</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 (A)</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 (B)</p> Signup and view all the answers

Which of the following tumors arise from glial cells?

<p>Glioma (C)</p> Signup and view all the answers

Which cell type gives rise to astrocytomas?

<p>Astrocytes (B)</p> Signup and view all the answers

Oligodendrogliomas arise from which type of cell?

<p>Oligodendrocytes (A)</p> Signup and view all the answers

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

<p>Meningioma (C)</p> Signup and view all the answers

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

<p>Medulloblastoma (A)</p> Signup and view all the answers

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

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

Which type of glioma arises from ependymal cells?

<p>Ependymoma (B)</p> Signup and view all the answers

What type of tumor arises from Schwann cells?

<p>Schwannoma (B)</p> Signup and view all the answers

What is a characteristic of gliomas?

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

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

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

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

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

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

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

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

<p>Mitosis (A)</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 (C)</p> Signup and view all the answers

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

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

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

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

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

<p>National Cancer Strategy (A)</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 (B)</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 (A)</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 (A)</p> Signup and view all the answers

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

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

What is the purpose of Awake Neurosurgery?

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

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

<p>Perfusion scanning (A)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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) (C)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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. (C)</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 (B)</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 (C)</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 (B)</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 (A)</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 (A)</p> Signup and view all the answers

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

<p>CT (A)</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. (B)</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 (B)</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 (B)</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 (A)</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 (D)</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 (A)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</p> Signup and view all the answers

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

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

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

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

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

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

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

<p>Brainstem astrocytoma (B)</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) (B)</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 (B)</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 (C)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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 (B)</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 (C)</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 (A)</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 (D)</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 (C)</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 (C)</p> Signup and view all the answers

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

<p>The spinal cord (B)</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 (B)</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. (B)</p> Signup and view all the answers

What is the primary cause of death in untreated meningiomas?

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

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

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

Which condition is most likely associated with cerebellar hemangioblastomas?

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

What is the most common site of a pituitary macroadenoma?

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

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

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

Which of the following is associated with craniopharyngiomas?

<p>Cystic, calcified, and cholesterol-containing tumor (D)</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 (A)</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 (B)</p> Signup and view all the answers

Flashcards

Meningioma death cause

Untreated meningiomas cause death primarily due to increased intracranial pressure, not malignant transformation, metastasis, or rupture.

Skull base meningioma symptom

A common symptom of a skull base meningioma is loss of smell (anosmia).

Cerebellar hemangioma link

Cerebellar hemangioblastomas are often linked to Von Hippel-Lindau (VHL) disease.

VHL gene mutation

The genetic mutation responsible for Von Hippel-Lindau (VHL) disease.

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Pituitary macroadenoma location

The most common location for a pituitary macroadenoma is the optic chiasm.

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Pituitary macroadenoma vision

A common visual defect in pituitary macroadenoma patients is bitemporal hemianopia.

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Craniopharyngioma characteristics

Craniopharyngiomas are often cystic, calcified, and contain cholesterol.

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Craniopharyngioma child symptom

In children, craniopharyngiomas often cause growth retardation and blindness.

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Pituitary adenoma histology

Pituitary adenomas are characterized by hormone secretion, leading to various clinical syndromes, not by mitosis or hyperplasia.

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