Brain Tumor + LMN

Question 1

Who gets brain tumors more, M or W?

Answer 1

They get them both the same

Question 2

In children under 15… brain cancer

Answer 2

Is the number 1 solid malignancy and number 1 cause of death

Question 3

What are Lisch nodules?

Answer 3

Growths on the eye in NF-1

Question 4

Neurofibrosarcomas can develop in:

Answer 4

NF1

Question 5

Neurofibromatosis genetics:

Answer 5

Variable expression, 100% penetrance

Question 6

Schwannomas (benign) develop bilaterally in:

Answer 6

NF2

Question 7

NF2 pathognomonic findings:

Answer 7

Bilateral schwanomas + Cafe au lait spots

Question 8

Von-hippel-lindau syndrome is autosomal dominant and causes:

Answer 8

Mutation in TS VHL; tumors are hemangioblastomas, pancreatic cysts, kidney tumors and pheochromocytoma

Question 9

What are the 5 (2S, 3B) cancers you get with p53 mutation (Li Fraumeni):

Answer 9

• Soft tumor
• Sarcoma
• Brain
• Breast
• Blood

Question 10

What does Turcot’s refer to?

Answer 10

Link between brain and colon cancer

Question 11

Turcots:

Familial adenomatous polyposis is linked to what type of CA?

Answer 11

Medulloblastoma

FAP:M

Question 12

Turcots:

HNPCC is linked to what kind of CA?

Answer 12

Glioma

HNPCC: G

Question 13

WHO criteria: CAME

Answer 13

I: Cell
II: Atypia
III: Mitotic
IV: Endothelial

Question 14

> 95% of tumors fall into:

Answer 14

GME:

glioma, meningioma, ependyma

Question 15

Circumscribed WHO I are what type of glioma?

Answer 15

Pilocytic

Question 16

Ependyomas follow what WHO criteria?

Answer 16

I-III: affect low grade adult spinal cord but high grade in the brains of kids

Question 17

Most common brain tumor (WHO grade?):

Answer 17

Meningioma (I-II) - Most prevalent after age 35

Question 18

What CA arises from an arachnoid cap cell?

Answer 18

Meningioma

Question 19

Most common complaint and then they have CA is:

Answer 19

HA

Question 20

Increased ICP at what part increases nausea and vomiting?

Answer 20

Postrema of the medulla

Question 21

If there is aphasia, where is the lesion most likely?

Answer 21

The left frontal or parietal lobe

Question 22

What is the gold standard for Brain tumor Dx?

Answer 22

MRI with gadolinium

Question 23

What does SPECT look at?

Answer 23

BBB

Question 24

What would Diffusion Tensor Imaging be used for?

Answer 24

Imaging water within white matter - currently used in babies

Question 25

Most common types of brain tumors from mets (3):

Answer 25

1. Lung 2. Breast 3. Colorectal

Question 26

What two areas are brain mets formed?

Answer 26

- Watershed areas | - At the gray/white matter junction

Question 27

Treatment with surgery for larger lesions over:

Answer 27

4 cm

Question 28

Stereotactic radio surgery is for:

Answer 28

Small deer lesions in important areas; no anesthesia

Question 29

2/3 of patients have seizures after gliomas, treat them with:

Answer 29

High dose dexamethasone (10mg) acutely

Question 30

Postoperatively brain tumor DVT prophylaxis

Answer 30

LMWH for within 12-24 hours and SCDS + ambulation ASAP

Question 31

5 Year survival rate:

Answer 31

34.2%

Question 32

When do you refer to ortho for LMN disorders?

Answer 32

Root, plexus and nerve problems

Question 33

What are syrinx cavities

Answer 33

Acquired cavitation of the spinal cord that are necrotic

Question 34

What can you get a syrinx from?

Answer 34

Trauma, myelitis, necrotic spinal cord syndromes and TB (arachnoiditis)

Question 35

More than 1/2 of the cases of syringomelia are associated with Chiari type 1 which is:

Answer 35

When the cerebellar tonsils poke down and cause increased pressuer

Question 36

Clinical presentation of Syringomelia is Central cord syndrome which is:

Answer 36

Cape distribution of SENSORY loss and areflexia in the upper limbs (can still feel touch and vibration)

Question 37

When the cavity in syringomelia gets too big you can get (2):

Answer 37

Urinary defecation issues; spasticity

Question 38

Amyloid Lateral Sclerosis has degeneration in what two ares of the brain?

Answer 38

Frontal and Temporal

Question 39

ALS is also called what two things?

Answer 39

Motor neuron disease; Lou Gehrig's

Question 40

Age of people that get ALS:

Answer 40

Risk goes up over 40 with highest incidence at 75

Question 41

Mechanism of ALS: Too much ___

Answer 41

Glutamate (neurotoxicity)

Question 42

Most common presentation of ALS:

Answer 42

Unilateral arm weakness (Distal > Proximal)

Question 43

ALS walkers may have:

Answer 43

Slap gait - worsening as the day goes on

Question 44

Most common cause of death in an ALS patient:

Answer 44

Respiratory failure

Question 45

Definite diagnosis of ALS is a diagnosis of UMN and LMN in:

Answer 45

3 regions

Question 46

What test would you order for someone with ALS?

Answer 46

EMG studies, nerve conduction studies

Question 47

Two medications that are disease-modifying for ALS:

Answer 47

Riluzole: Reduce glutamate excito-toxicity Edaravone: Reduce oxidative damage