Test 7. Brain tumors


NEUROPATHOLOGY Neurocytology Hypoxia and Stroke Perinatal Disorders Trauma CNS Infections Demyelinating Diseases Brain Tumors Nutritional Disorders Degenerative Diseases Metabolic Disorders Congenital Malformations Peripheral Neuropathy Myopathology Cerebrospinal Fluid TESTS Neurocytology Hypoxia and Stroke Perinatal Disorders Trauma CNS Infections Demyelinating Diseases Brain Tumors Nutritional Disorders Degenerative Diseases Metabolic Disorders Congenital Malformations Peripheral Neuropathy Myopathology Cerebrospinal Fluid NEOUCOM-M2 HOME	Selected Topics TEST-CHAPTER SEVEN BRAIN TUMORS Questions marked with are more appropriate for residents.* 1. Which are most common overall? A. Primary brain tumors B. Metastatic 2. A child with craniospinal irradiation for ALL has a higher risk for developing an astrocytoma compared to other children A. True B. False 3. Radiation to the head and neck is a risk factor for subsequent development of meningioma A. True B. False 4. Most primary cerebral lymphomas are: A. T-cell. B. B-cell. C. They are evenly split 5. Homer-Wright rosettes are relatively uncommon in medulloblastoma A. True B. False 6. Low grade tumors have as many but different chromosomal abnormalities as high grade tumors do A. True B. False 7. A 5 year old boy had multifocal brain lesions one of which is shown below. The most likely underlying factor is: A. Genetic immunodeficiency B. Previous cranial irradiation for ALL C. EBV infection D. None - this is probably a random event 8. Which of the following are the most ubiquitous neurocarcinogens? A. Ambient tobacco smoke B. Industrial solvents C. Nitroso compounds D. Pesticides 9. Which of the following is not a feature of pilocytic astrocytoma? A. Granular eosinophilic droplets B. Brisk mitotic activity C. Drop metastases D. Location in the spinal cord E. Hydrocephalus 10. What finding distinguishes glioblastoma multiforme from lower grade astrocytomas? A. Mitoses B. Cellular density C. Necrosis D. Marked anaplasia (giant cells) 11. Which of the following lesions extends across the corpus callosum? A. Glioblastoma B. Cerebral lymphoma C. Schilder's disease D. All of the above 12. Which of the following may present as a ring enhancing lesion? A. Acute multiple sclerosis plaques B. Metastatic tumors C. Glioblastoma D. All of the above 13. A 3 year old boy with a history of headaches and morning vomiting for 10 days presents to the ER after a bad episode of vomiting. He is afebrile. The diagnostic studies might include all of the following except: A. Fundoscopic examination B. CSF for enterovirus PCR C. GI endoscopy D. MRI 14. The most common intracranial site of germ cell tumors is: A. The pineal gland B. The pituitary gland C. The hypothalamus D. The midline of the cerebellum 15. Which of the following statements about the posterior fossa lesion shown below is not true A. It is classified as WHO Grade I B. It evolves to malignant over many years C. Most such lesions arise in the cerebellum D. It shows vascular endothelial proliferation E. It enhances on MRI imaging 17. Which of the following statements about the lesion illustrated below is not true? A. Most such lesions are WHO grade 2 B. It has the highest incidence of CSF seeding C. It may be exophytic D. It may contain areas indistinguishable from low grade astrocytoma E. It is not highly radiosensitive 18. Which of the following statements about the brain tumor in a 3 year old boy shown below is not true? A. Most such tumors are supratentorial B. It can be familial C. It can cause hydrocephalus D. It may present with blurred vision E. Ataxia is relatively uncommon as a presenting sign 19. A 4 year old boy with a history of headaches and on-and-off vomiting for 2 weeks had the MRI findings shown below. The most likely diagnosis is: A. Medulloblastoma B. Glioblastoma of the cerebellum C. Ependymoma of the 4^th ventricle D. Aqueductal stenosis 20. Which of the following statements about the lesion shown below is not true? A. There are over ten histological subtypes B. The tumor is attached to the dura C. Deletion of chromosome 22 is frequent D. Brain invasion is frequent E. It is more common in women 21. Which of the statements about the lesion shown below is not true? A. It may invade bone and extend into the extracranial soft tissues B. Recurrence indicates malignancy C. It shows folding processes and dense junctions D. It is EMA positive 22. Which of the following statements about the illustrated lesion is not true? A. It is an extra-axial lesion B. It is often seen in neurofibromatosis 1 C. It is benign D. There may be multiple tumors E. It extends along the vertebral foramina 23. Which of the following statements about the lesion shown below is not true? A. It may be an intra-spinal tumor B. Malignant degeneration is more frequent after irradiation C. The optic nerve is a common intracranial location D. It may occur in an autosomal dominant pattern 24. Which of the following is not a feature of the illustrated lesion? A. Infrasellar location B. Calcification C. Gross cysts D. Papillary pattern E. Rosenthal fibers in surrounding tissue 25. Which of the following statements about the lesion shown below is not true? A. The lesion is benign but may recur B. It resembles some tumors arising in the jaws C. It is usually part of a benign teratoma D. It may be intraventricular 26. A 43 year old patient has had headaches and declining mental function for 5 weeks. MRI shows mild hydrocephalus with periventricular enhancing lesions. A stereotactic biopsy is obtained (shown below). The most likely diagnosis is: A. HIV encephalitis B. Progressive multifocal leukoencephalopathy C. Cerebral lymphoma D. HSV encephalitis E. Cereral abscess 27. A 42 year old woman had right-sided weakness progressing to hemiparesis in 3 to 4 weeks. MRI shows an enhancing lesion in the left centrum semiovale adjacent to the corpus callosum. A stereotactic biopsy is obtained (shown below). The most likely diagnosis is: A. An inflammatory demyelinative disease B. Cerebral lymphoma C. CNS vasculitis with ischemic infarction D. Progressive multifocal leukoencephalopathy E. Glioblastoma 28. A 57 year old patient had fever, seizures and obtundation for 4 days. MRI shows a necrotic hemorrhagic lesion of the right temporal lobe with surrounding edema. A stereotactic biopsy is shown below. The most likely diagnosis is: A. Cerebral abscess B. Hemorrhagic infarct C. Cerebral lymphoma D. HSV encephalitis 29. A 6 year old girl with diabetes insipidus, visual disturbances, and headaches for 3 weeks had an MRI scan showing a 2 cm suprasellar mass and mild hydrocephalus. A stereotactic biopsy is shown below. The most likely diagnosis is: A. Craniopharyngioma B. Germ cell tumor C. Langerhans histiocytosis D. Pituitary adenoma 30. A 27 year old woman with headaches and vomiting had a cystic cerebellar mass with a protruding nodule. Stereotactic biopsy is shown below. The most likely diagnosis is: A. Metastatic clear cell carcinoma B. Hemangioblastoma C. Oligodendroglioma D. Old infarct with macrophage reaction 31. The illustrated structures may be present in: A. Pilocytic astrocytoma B. Oligodendroglioma C. Both D.They are non-specific and may be present in diverse neoplastic and non-neoplastic conditions 32. A previously healthy 53 year old man had an insidious onset of headaches, obtundation, and facial paralysis. CSF shows 33 lymphocytes, glucose 36, and protein 72. The most likely diagnosis is: A. Meningeal carcinomatosis B. Tuberculous meningitis C. Subacute encephalitis D. Multiple sclerosis 33. The most common tumors of the pineal gland are: A. Pineal parenchymal tumors (pinealoma and pineoblastoma) B. Germ cell tumors 34. You are called to the OR to do a frozen section of a suprasellar mass in a 5 year old boy. Which of the following would be most likely? A. Pituitary adenoma B. Craniopharyngioma C. Pilocytic astrocytoma D. Endodermal sinus tumor 35-40. Match the following tumors with the underlying conditions A. Neurofibromatosis 1 (VRNF) B. Neurofibromatosis 2 (BANF) C. von Hippel-Lindau disease D. Tuberous sclerosis 35. Spinal schwannoma: 35A, 35B, 35C, 35D 36. Meningioma: 36A, 36B , 36C, 36D 37. Optic nerve astrocytoma: 37A, 37B, 37C, 37D 38. Subependymal giant cell astrocytoma: 38A, 38B, 38C, 38D 39. Pheochromocytoma: 39A, 39B, 39C, 39D 40. UBO-type lesions on MRI: 40A, 40B, 40C, 40D 41-45. Match the numbered tumors with the lettered locations A.Intra-axial B.Extra-axial 41. Meningioma: 41A, 41B 42. Ependymoma of the 4^th ventricle: 42A, 42B 43. Eight nerve schwannoma: 43A, 43B 44. Medulloblastoma: 44A, 44B 45. Pituitary adenoma: 45A, 45B 46. A three year old boy had a cerebellopontine angle tumor with the ultrastructural features illustrated below. The diagnosis is: A. Meningioma B. Ependymoma C. Schwannoma D. Exophytic pilocytic astrocytoma Top of Page
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