Classification and Epidemiology
Which of the following is the most common specific non-malignant brain tumor histology?
A. Astrocytoma
B. Schwannoma
C. Pituitary adenoma and meningioma
D. Oligodendroglioma
C. Pituitary adenoma and meningioma
A tumor in the pineal region can compress which structure leading to Parinaud’s syndrome?
A. Superior colliculus
B. Optic chiasm
C. Red nucleus
D. Cerebellar vermis
A. Superior colliculus
What is the most appropriate neuroimaging tool to identify motor and speech areas before brain tumor resection?
A. MRI with contrast
B. Functional MRI (fMRI)
C. CT perfusion
D. SPECT
B. Functional MRI (fMRI)
According to the 2021 WHO classification, which mutation defines a diffuse astrocytoma as “IDH-mutant”?
A. TP53 mutation
B. ATRX mutation
C. IDH1 or IDH2 mutation
D. MGMT promoter methylation
C. IDH1 or IDH2 mutation
Why does blood appear white on a head CT?
A. Intracranial blood is more dense than extracranial blood
B. Intracranial blood is less dense than extracranial blood
C. The HUs of blood are at the higher end of the range for a brain window
D. The HUs of blood are at the lower end of the range for a brain window
C. The HUs of blood are at the higher end of the range for a brain window
What is the most common malignant brain tumor histology in adults?
A. Medulloblastoma
B. Glioma
C. Ependymoma
D. Meningioma
B. Glioma
GBM typically arises in which area of the brain?
A. Cerebral hemispheres
B. Brainstem
C. Cerebellum
D. Basal ganglia
A. Cerebral hemispheres
A 58-year-old male with glioblastoma presents 4 months after completing chemoradiotherapy. MRI shows an enlarging area of contrast enhancement. Which test can help differentiate true progression from pseudoprogression?
A. CT scan
B. MR angiography
C. MR spectroscopy or PET
D. Lumbar puncture
C. MR spectroscopy or PET
A 35-year-old woman with neurofibromatosis type 2 (NF2) presents with hearing loss. Genetic testing confirms mutation on chromosome 22. Which tumor is most likely?
A. Pilocytic astrocytoma
B. Meningioma
C. Vestibular schwannoma
D. Craniopharyngioma
C. Vestibular schwannoma
This 3-month old boy presents with increasing head circumference. He underwent a cranial ultrasound. What is the most likely diagnosis?
A. Aqueduct stenosis
B. Choroid plexus papilloma
C. Ependymoma
D. Germinal matrix hemorrhage
E. Medulloblastoma
B. Choroid plexus papilloma
The most recently linked infectious agent associated with an increased risk of glioma is:
A. Epstein-Barr virus
B. Cytomegalovirus
C. Toxoplasma gondii (a protozoan)
D. Human papillomavirus (HPV)
C. Toxoplasma gondii (a protozoan)
Which type of seizure is characterized by a sudden loss of muscle tone and is often associated with generalized tonic-clonic seizures?
A. Absence seizure
B. Myoclonic seizure
C. Atonic seizure
D. Simple partial seizure
C. Atonic seizure
What is the clinical utility of MGMT promoter methylation testing in patients with glioblastoma?
A. Indicates surgical resectability
B. Predicts favorable response to temozolomide
C. Confirms tumor grade
D. Determines need for craniospinal irradiation
B. Predicts favorable response to temozolomide
A 45-year-old patient is diagnosed with a glioma. Molecular testing reveals the presence of an IDH1 mutation and loss of ATRX expression. What does this molecular profile most likely indicate?
A) Primary (de novo) glioblastoma
B) Oligodendroglioma with 1p/19q co-deletion
C) Diffuse astrocytoma, IDH-mutant
D) Ependymoma with RELA fusion
C) Diffuse astrocytoma, IDH-mutant
This 20-month-old child has a history of a facial nevus flammeus on the left side of their face and is now presenting with seizures. Taking into account the findings seen on the accompanying CT, what underlying condition are they most likely to have?
A. Cerebral arteriovenous malformation
B. Parry-Romberg syndrome
C. Rasmussen encephalitis
D. Sturge-Weber syndrome
E. TORCH infection
D. Sturge-Weber syndrome
A 45-year-old man presents with new-onset seizures. MRI shows a ring-enhancing lesion in the frontal lobe. Biopsy reveals pseudopalisading necrosis. What is the most likely diagnosis?
A. Oligodendroglioma
B. Glioblastoma (IDH-wildtype)
C. Ependymoma
D. Medulloblastoma
B. Glioblastoma (IDH-wildtype)
Which of the following WHO CNS tumor classifications is correct?
A. Glioblastoma is classified as a WHO Grade II tumor.
B. IDH-mutant astrocytomas are now termed glioblastoma.
C. Meningiomas can be Grade I, II, or III depending on histological features
D. Pilocytic astrocytomas are WHO Grade IV.
C. Meningiomas can be Grade I, II, or III depending on histological features
Tumor Treating Fields (TTF) slow tumor progression primarily by:
A. Inducing tumor necrosis through focused radiation
B. Inhibiting blood vessel formation in the tumor
C. Disrupting mitosis using alternating electric fields
D. Generating hyperthermia via magnetic pulses
C. Disrupting mitosis using alternating electric fields
According to the 2021 WHO classification, which tumor is now defined by H3 K27M mutation?
A. Medulloblastoma
B. Diffuse intrinsic pontine glioma (DIPG)
C. Ependymoma
D. Subependymoma
B. Diffuse intrinsic pontine glioma (DIPG)
A 9-year-old boy presents with nystagmus and ataxia. He is investigated with a brain MRI. What is the most likely diagnosis?
A. Dandy-Walker malformation
B. Joubert syndrome
C. Lhermitte-Duclos disease
D. Pontocerebellar hypoplasia of Barth
E. Rhombencephalosynapsis
B. Joubert syndrome
Which of the following brain tumors is most commonly associated with 1p/19q co-deletion?
A. Meningioma
B. Oligodendroglioma
C. Pilocytic astrocytoma
D. Glioblastoma
B. Oligodendroglioma
A WHO Grade IV tumor is characterized by which of the following features?
A. Necrosis / microvascular proliferation
B. Lack of mitotic activity and minimal vascularity
C. Encapsulation and absence of edema
D. Indistinct borders and low cellularity
A. Necrosis / microvascular proliferation
Which of the following is the primary limitation of systemic chemotherapy in brain tumor treatment?
A. Development of multidrug resistance
B. Toxicity to healthy brain tissue
C. Inability to cross the blood-brain barrier
D. Requirement for intrathecal administration
C. Inability to cross the blood-brain barrier
A 12-year-old child presents with a midline brain tumor. Molecular studies reveal an H3 K27M mutation and loss of trimethylation at lysine 27 on histone H3. What is the most accurate diagnosis and prognostic implication?
A) Diffuse midline glioma, H3 K27M–mutant; poor prognosis
B) Pilocytic astrocytoma; favorable prognosis
C) Medulloblastoma, WNT subtype; excellent prognosis
D) Ependymoma with RELA fusion; intermediate prognosis
A) Diffuse midline glioma, H3 K27M–mutant; poor prognosis
A 50-year-old man presents with deteriorating memory over the last 3 months. He has a history of right eye rhabdomyosarcoma treated with surgery. No other known illnesses. He is investigated with an MRI of the brain. What is the most likely diagnosis?
A. Cortical laminar necrosis
B. Creutzfeldt-Jakob disease
C. Gliomatosis Cerebri
D. Herpes encephalitis
E. Post-epilepsy change
B. Creutzfeldt-Jakob disease