Week 4 part 2

Question 1

What is the commonest extra-axial tumour?

Answer 1

Meningioma

Question 2

What presents with progressive neurological deficit, motor weakness, headache and seizures?

Answer 2

Brain tumour

Question 3

What is a headache due to if its worse in the morning, wakes them up, increases with coughing/leaning forward and decreased with vomiting?

Answer 3

ICP

Question 4

What can be secondary to diplopia (CN VI) and secondary to difficulty focusing?

Answer 4

Tumour headache

Question 5

A tumour where affects perserveration?

Answer 5

Frontal lobe

Question 6

A tumour where affects dyspraxia and neglect?

Answer 6

Parietal lobe

Question 7

How do you investigate bran tumour?

Answer 7

CT, MRI LP

Question 8

What two cells make up neuroepithelial tissue?

Answer 8

Astrocytes

Oligodendroglial cells

Question 9

What do glial tumours arise from?

Answer 9

Astrocytes or oligodendrocytes

Question 10

What grade of astrocytoma is truly benign, slow growing, children young adults, pilocytic astrocytomas and treatment of choice is surgery?

Answer 10

grade 1 astrocytomas

Question 11

What do low grade astrocytomas present with?

Answer 11

Seizures

Question 12

Where do low grade astrocytomas want to occur?

Answer 12

IN temporal lobe
Posterior frontal
anterior parietal

Question 13

What grades are malignant astrocytomas?

Answer 13

Grades III - IV

Question 14

How common is glioblastoma multiforme (malignant)?

Answer 14

Most common primary tumour - spreads white matter tracking

Question 15

Tumours are solid, appear grey/whiteish and subarachnoid accumulations are grossly characterised by surgeons as having toothpaste morphology

Answer 15

oligodendroglial tumours

Question 16

How do you treat oligodendroglial tumours?

Answer 16

Chemosensitive - procarbazinr, lomustine, vincristine

Question 17

Arachnoid cap cells, extraaxial, 20% of intracranial neoplasms, majority asymptomatic ?

Answer 17

Meningiomas

Question 18

What condition has vestibular schwannomas?

Answer 18

NF type II

Question 19

hEARING Loss, tinnitus, dysequilibrium?

Answer 19

Acoustic neuromas

Question 20

What are the red flag s for headaches?

Answer 20

1. New onset over 55 years
2. Known/previous malignancy
3. Immunosuppressed
4. Early morning headache
5. Exacerbation by valsalva

Question 21

In the pathophysiology of a migraine what chemical irritates nerves and blood vessels causing pain?

Answer 21

Substance P

Question 22

What do the dorsal raphe nucleus and the locus coeruleus make up?

Answer 22

Migraine center

Question 23

What is more common - migraine with or without aura?

Answer 23

Without (flashibg kights, weakness, balance problems)

Question 24

What abortive drugs can you give for migraines +/- an anti-emetic?

Answer 24

Aspirin
Naproxen
Ibuprofen

Question 25

When should you give triptans fot a migraine?

Answer 25

At start of headaceh

Question 26

What kind of relief does frovatriptan give for migraines>

Answer 26

SUSTAINED

Question 27

When might you consider prophylactic migraine treatment?

Answer 27

If nmroe thanb three attacks per month or very severe consider prophylaxis

Question 28

When beta blockers are given for migraines qwhat do you need to be careful for?

Answer 28

Avoid asthma, PVD (heart gfaiure)

Question 29

A carbonic anhydrase inhibityor topiramate can be used for migraine - give some adverse effects?

Answer 29

1. Weight loss 2. Paraesthesia 3. Imparied concentration 4. Enzyme inducer

Question 30

Amitriptyline can be given for migraines - give some adverse effects?

Answer 30

1. Dry mouth 2. Postural hypotension 3. Sedation

Question 31

What are the trigeminal autonomic cephalgias (TACs)?

Answer 31

A group of primary heache disorders characterised by unilateral trigeminakl distribution pain that occurs in association with prominent ipsilateral cranial autonomic features

Question 32

What are ptosis, miosis, nasal stuffiness, nausea, teareing and eye lid oedema?

Answer 32

Ipsilateral cranial autonomic features

Question 33

What are cluster, paroxysmal hemicrania, hemicrania continua and SUNCT?

Answer 33

TCA types - trigeminal autonomic cephalgias

Question 34

What kind of age group get cluster headaches?

Answer 34

30s and 40s

Question 35

When do people get cluster headaches?

Answer 35

Striking circadian (around sleep) nd seasonal variation

Question 36

Severe unilateral headache, duration 45-90 minutes, 1 to 8 a day and cluster bout may last from a few weeks to months?

Answer 36

Cluster headache

Question 37

How is cluster headache treated?

Answer 37

1. High flow oxygen 2. Sub cut sumatriptan 3. Steroids 4. Verapamil for prohpylaxis

Question 38

Who gets paroxysmal hemicrania?

Answer 38

Elderly 50s and 60s, women more than men

Question 39

Severe unilateral headache, unilateral autonomic features, 10-30 minutes, 1 to 40 a day?

Answer 39

Paroxysmal hemicrania (shorter duration and more frequent than cluster)

Question 40

How is paroxysmal hemicrania treated?

Answer 40

Absolute response to indomethicin

Question 41

What is short lived, unilateral, neuralgiaform headache, conjunctival injetions and tearing?

Answer 41

SUNCT

Question 42

How is SUNCT treated?

Answer 42

Lamotrigine | Gabapentin

Question 43

What is done for patients with new onset unilateral cranial autonomic features?

Answer 43

MRI brain and MR angiogram

Question 44

Who gets trigeminal neuralgia?

Answer 44

Elderly ikder than 60, women more than men

Question 45

What headache s triggered by touch, usuall V2/3?

Answer 45

Ttrigeminal neuralgia

Question 46

Severe stabbing unilateral pain, 1 second to 90 seconds, 10 to 100 a day, bouts of pain may last from few weeks to months before remission?

Answer 46

Trigeminal neuralgia

Question 47

If a patinet has trigeminal neuralgia and signs of atypical features, poor response to treatment what might yoyu do?

Answer 47

MRI

Question 48

How is trigeminal neuralgia trated?

Answer 48

Carbamazepine Gabapentin Phenytoin Baclofen

Question 49

Name a trigger for cluster headache?

Answer 49

Alcohol (more common in males)

Question 50

Are the majority of adult brain tumours supratentorial or infratentorial?

Answer 50

Supratentorial - children infratentorial

Question 51

What brain tumour: pleomorphic tumour cells border necrotic areas?

Answer 51

Gliolastoma multiforme - most common primary brain tumour

Question 52

What brain tumour: spindle cells in concentric whorls and calcified psammoma bodies?

Answer 52

Meningioma

Question 53

What schwannoma is seen in cerebellopontine angle?

Answer 53

Acoutic neuroma

Question 54

What is the most common primary brain tumour in children?

Answer 54

Pilocytic astrocytoma

Question 55

What brain tumour: rosenthal fibres (corkscrew eosinophilic bundle)?

Answer 55

Piloctic astrocytoma

Question 56

What brain tumour: benign, slow growing common in frontal lobes, calcifications with fried egg appearance?

Answer 56

Oligodendroma

Question 57

What are these all patterns of: amyotrophic lateral sclerosis, progressive muscular atrophy and bulbar palsy?

Answer 57

MND

Question 58

wHAT IS associated with low levels of orexin (hypocretin), a protein responsivle for appetite and sleep patterns?

Answer 58

Narcolepsy

Question 59

Typical onset teenage years, hypersomnolence, cataplexy (sudden loss of muscle tone triggered by emotion), sleep paralysis and vivid hallucinations on going to sleep or waking up?

Answer 59

Narcolepsy

Question 60

How do you investigate narcolepsy?

Answer 60

Multiple sleep latency EEG