Classification and Epidemiology
Which of the following factors has been associated with an increased risk of childhood brain tumors?
A. Low birth weight
B. Cesarean delivery
C. High birth weight
D. Premature birth
C. High birth weight
Tumors in posterior fossa are most likely to cause:
A. Tonsillar herniation
B. Subfalcine herniation
C. Transtentorial herniation
D. Uncal herniation
A. Tonsillar herniation
Which neuroimaging modality is best suited to detect low-grade gliomas and assess tumor margins?
A. CT with contrast
B. Conventional MRI T1
C. MRI with FLAIR and diffusion-weighted imaging
D. X-ray skull series
C. MRI with FLAIR and diffusion-weighted imaging
Which of the following genetic alterations is most commonly associated with primary (de novo) glioblastoma?
A. IDH1 mutation
B. EGFR amplification
C. 1p/19q co-deletion
D. BRAF V600E mutation
B. EGFR amplification
This 25-year-old female presented with a skull lump. A CT was performed. What is the most likely diagnosis?
A. Fibrous dysplasia
B. Meningioma
C. Metastases
D. Osteopetrosis
E. Paget disease
A. Fibrous dysplasia
What is the most common origin of brain metastasis in males?
A. Liver
B. Kidney
C. Prostate
D. Lungs
D. Lungs
The most common location of ependymomas in children is:
A. Fourth ventricle
B. Lateral ventricles
C. Optic pathway
D. Cerebellopontine angle
A. Fourth ventricle
What is the role of MR spectroscopy in brain tumor evaluation?
A. Identifies calcification
B. Differentiates tumor from abscess
C. Evaluates metabolic profile of lesion
D. Detects bone involvement
C. Evaluates metabolic profile of lesion
Which molecular marker is used to distinguish primary from secondary glioblastomas?
A. IDH mutation
B. MGMT methylation
C. EGFR amplification
D. 1p/19q co-deletion
A. IDH mutation
In the accompanying coronal T2 MRI of the brain, the inferior frontal sulcus is indicated by which letter?
A.
B.
C.
D.
E.
F.
B
A genetic predisposition to which of the following was found to increase the risk of ependymoma in adolescents aged 12–19 years?
A. Shorter telomere length
B. Longer telomere length
C. TP53 mutation
D. BRAF gene rearrangement
B. Longer telomere length
What is the most common WHO Grade IV primary brain tumor in adults?
A. Glioblastoma
B. Meningioma
C. Medulloblastoma
D. Oligodendroglioma
A. Glioblastoma
PET imaging is most effectively utilized in which of the following scenarios?
A. Measuring cerebral blood flow
B. Monitoring seizure activity
C. Localizing eloquent cortex pre-surgery
D. Guiding tumor biopsy
D. Guiding tumor biopsy
Which pediatric brain tumor is most commonly associated with BRAF V600E mutation?
A. Medulloblastoma
B. Diffuse midline glioma
C. Pilocytic astrocytoma
D. Craniopharyngioma
C. Pilocytic astrocytoma
This elderly man develops weakness 6-hours after carotid endarterectomy. A non-contrast CT is obtained (shown below).
What is the most likely diagnosis?
A. Contrast staining
B. Fogging phenomenon
C. Hyperperfusion syndrome
D. Luxury perfusion
E. Subacute infarction
C. Hyperperfusion syndrome
Which tumor is most likely to cause bitemporal hemianopsia in an adolescent?
A. Medulloblastoma
B. Craniopharyngioma
C. Glioblastoma
D. Pinealoma
B. Craniopharyngioma
The presence of necrosis in a brain tumor most commonly upgrades it to which WHO grade?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
D. Grade 4
Bevacizumab, used in brain tumor treatment, works by:
A. Activating p53 tumor suppressor gene
B. Binding VEGF to inhibit angiogenesis
C. Blocking EGFR signaling
D. Targeting mutant IDH1 enzymes
B. Binding VEGF to inhibit angiogenesis
Which molecular group of medulloblastoma has the best prognosis?
A. Group 3 (MYC-amplified)
B. WNT-activated
C. SHH-activated TP53-mutant
D. Group 4
B. WNT-activated
A 2-year-old girl presents with a 15-month history of head shaking and bilateral nystagmus. She is investigated with an MRI. What is the most likely underlying condition?
A. Benign intracranial hypertension
B. Neurofibromatosis type 1
C. Neuromyelitis optica
D. Sturge-Weber disease
E. Tuberous sclerosis
B. Neurofibromatosis type 1
Which of the following statements accurately reflects the epidemiological distribution and classification of primary brain tumors in adults?
A. Meningiomas are the most common malignant primary brain tumors in adults.
B. Glioblastoma multiforme accounts for approximately 45% of malignant primary brain tumors in adults.
C. Primary brain tumors frequently metastasize outside the central nervous system.
D. Pilocytic astrocytomas are the most common primary brain tumors in adults.
E. Medulloblastomas are the most common primary brain tumors in adults.
B. Glioblastoma multiforme accounts for approximately 45% of malignant primary brain tumors in adults
A 52-year-old patient presents with a rapidly progressive neurological decline. MRI reveals a ring-enhancing lesion in the cerebral hemisphere. Histopathology shows marked cellular pleomorphism, microvascular proliferation, and necrosis. Molecular testing reveals wild-type IDH and EGFR amplification. Which of the following is the most accurate diagnosis and associated prognosis?
A) Anaplastic astrocytoma (WHO Grade III) with poor prognosis
B) Glioblastoma, IDH-wildtype (WHO Grade IV) with poor prognosis
C) Oligodendroglioma with 1p/19q co-deletion and favorable prognosis
D) Diffuse astrocytoma, IDH-mutant (WHO Grade II) with favorable prognosis
B) Glioblastoma, IDH-wildtype (WHO Grade IV) with poor prognosis
Which agent is commonly used in the treatment of recurrent glioblastoma?
A. Imatinib
B. Temozolomide
C. Bevacizumab
D. Methotrexate
C. Bevacizumab
16-year-old patient presents with a thalamic mass. Histopathology is inconclusive, and standard immunohistochemistry is non-specific. DNA methylation profiling is performed and reveals a methylation pattern consistent with diffuse midline glioma, H3 K27-altered. Which of the following best explains the clinical utility of methylation profiling in this case?
A. It distinguishes low-grade glioma from ependymoma
B. It identifies MGMT methylation status for chemotherapeutic planning
C. It classifies tumors based on their epigenetic signatures for definitive diagnosis
D. It confirms TP53 mutation presence for tumor grading
C. It classifies tumors based on their epigenetic signatures for definitive diagnosis
This MRI shows a supratentorial brain tumour in the paediatric population which arises from the epithelial remnant of rathke's pouch , has cystic & solid parts & is often filled with "tooth like tissue". What is the diagnosis?
A) Pilocystic Astrocytoma
B) Medulloblastoma
C) Glioblastoma Multiforme
D) Craniopharyngioma
D) Craniopharyngioma