BigBrother CNS Pathology Qs

CNS

PATHOLOGY Questions For 3rd year

Basic pathology of CNS 1

Previous exams & Formative:

1- Which of the following is expected after subarachnoid hemorrhage over the convexities of the brain?

a. Non- communicating hydrocephalus b. Communicating hydrocephalus

c. Increased reabsorption of CSF by arachnoid villi d. Increased production of CSF e. Obstructive hydrocephalus

2- What is the cause of vasogenic cerebral edema?

a. Increased permeability of capillaries b. Intracellular accumulation of excess fluid c. Increased permeability of neuronal membranes d. Increased production of CSF e. Greater swelling in gray matter than in white matter

3- A structural defect in the cerebellum, characterized by downward displacement of of cerebellar tonsils through the foramen magnum:

a. Chiari malformation. b. Porencephaly. c. Dandy-Walker syndrome, d. Spina bifida. e. Hydranencephaly

4- It is the absence of a major portion of the brain, skull and scalp:

a. Hydrocephalus. b. Anencephaly.

d. Hydrocephalus e. Myelocele.

5- A female baby neonate is noted to have a pronounced enlargement of her head. She developed seizures. MRI (Magnetic resonance image) revealed excessive accumulation of CSF fluid and dilatation of the ventricles with partial atrophy of the cerebral cortex. What is the diagnosis of this condition?

a. Anencephaly. b. Hydrocephalus. c. Hydranencephaly. d. Porencephaly. e. Microcephaly.

6- Hydrocephalus is disease of children only

a. True b. False 1-a 2-b 3-d 4-d 5-b 6-b

Cerebrovascular diseases

Previous exams & Formative:

1- Global brain ischemia is caused by:

a. Atherosclerotic cerebral aneurysm

b. Severe hypotension

c. Meningitis d. Ruptured aneurysm of cerebral artery e. Thrombosis of cerebral artery

2- Petechial cerebral hemorrhage is:

a. Induced by ruptured aneurysm

b. Associated with systemic hypertension c. A common complication of brain tumors. d. Capillary hemorrhage e. All the above

3- Mycotic cerebral aneurysm is due to:

a. Atherosclerosis of the cerebral vessels b. Increased intracranial tension c. Hypertension

d. Congenital weakness of the wall of cerebral vessels e. Septic emboli from subacute bacterial endocarditis

4- Hypertensive patients are at high risk of:

a. Massive intracerebral hemorrhage

b. Subdural hemorrhage

c. Petechial intracerebral hemorrhage d. Extradural hemorrhage e. Subarachnoid hemorrhage

5- 42-year-old woman presents to the emergency department at 8 PM, mildly somnolent and complaining of the “worst headache of her life,” which began at 6 AM on the same day, awakening her. Then, she started to have nausea with vomiting, and by 3 PM she had developed right arm and leg weakness. She denies any head trauma. Which of the following is the most likely diagnosis? a. Hypoglycemia b. Transient ischemic att c. Contusion

10- One of the following is correct for subdural hemorrhage:

a. The blood is arterial in origin

b. The blood is venous in origin

c. The blood is capillary in origin d. Caused mainly by rupture of middle meningeal artery e. Caused mainly by rupture of berry aneurysm

11- One of the following is incorrect for global brain ischemia:

a. May have good prognosis

b. May induce brain death

c. May induce neuronal damage d. Caused by septic shock e. Caused by cerebral thrombosis

12- Cerebral infarction is characterized by:

a. Liquefaction with cavity formation

b. Formation of brain hematoma

c. Dense infiltration by lymphocytes and plasma cells d. Shrinkage of infarcted area after 2 days e. None of the above

13- Massive cerebral hemorrhage is due to the following except:

a. Ruptured aneurysm

b. Systemic hypertension c. Capillary hemorrhage

d. Brain tumors e. All of the above

10-b 11-e 12-a 13-c

Extra:

1- Subdural hemorrhage occurs:

a. Between dura and skull bones

b. Between dura and arachnoid

c. In subarachnoid space

d. Intracerebral 1- b

CNS Infections

Previous exams & Formatives:

1- Cerebellar brain abscess is usually a complication of: a) Suppurative otitis media b) Suppurative lung diseases c) Mastoiditis d) Skull fractures e) Systemic pyemia

2- CSF in acute septic meningitis doesn’t show:

a) Increase amount b) Increase protein content c) Increase sugar content d) Increase polymorphonuclear cells e) Organisms

3- TB meningitis complications don’t Show:

a) Increase intracranial tension b) Compression of the cranial nerves leading to their paralysis c) Hydrocephalus d) May result in tuberculoma e) May result in brain abscess

1-c 2-c 3-e

Extra questions:

1- Modes of infection in pyogenic meningitis include all except: a) Blood spread b) Blood transfusion c) Local spread from paranasal sinuses d) Via skin e) Direct implantation in case of skull fracture 2- CSF shows cob web coagulum of fibrin on standing in case of: a) Acute pyogenic meningitis b) Chronic meningitis c) Brain abscess d) D)encephalitis

6- The commonest causative organism of septic meningitis: a) Streptococci b) Staphylococci c) Pneumococci d) Meningiococci

1-b 2-b 3-c 4-b 5-d 6-d

7- local effects and complications of septic meningitis include all of the followings except:

a) Thrombosis of pial arteries b) Healing by fibrosis c) Compression of cranial nerves d) Waterhouse-friderchsen syndrome

8- CSF in aseptic meningitis shows: a) Increase number of lymphocytes b) Protein elevation c) Normal glucose d) All of the above

9- Temporal lobe abscess is usually a complication of: a) Mastoiditis b) Sinusitis c) Otitis media d) Lung infection

10- CSF in brain abscess shows:

11- Complications of brain abscess don’t show:

a) Increased intracranial tension b) Brain herniation c) Septic meningitis d) Non of the above

7-d 8-d 9-c 10-d 11-d 12-d 13-a

Neurodegenerative & demyelinating diseases

Previous exams & Formative:

1- Lewy bodies are present in:

a. Alzheimer' disease b. Idiopathic Parkinson disease c. Multiple sclerosis d. All of the above 2- Multiple sclerosis is a: a. Congenital disease b. Inflammatory disease c. Demyelinating disease d. Metabolic disease 3- Alzheimer' disease is a: a. Congenital disease b. Inflammatory disease c. Degenerative disease d. Demyelinating disease 1- b 2- c 3- c

Extra:

1- Which of the following characterizes Alzheimer disease?

a. IgG composed of oligoclonal bands. b. Liquefactive necrosis.

c. Decreased number of dopaminergic neurons in substantia nigra d. Atrophy in the caudate and putamen e. Deposition of amyloid in neurotic plaques & in the wall of cerebral vessels

2-Which of the following is the most characteristic histological finding of Alzheimer disease? a. Neurofibrillary tangles b. Amyloid angiopathy c. Lewy bodies d. Hirano bodies e. Senile plaques

3- Which of the following mechanisms best explain the pathogenesis of multiple sclerosis? a. Ionizing radiation b. Metabolic error c. Immune reaction d. viral infection e. Bacterial toxin

4- Neurons remaining in substantia nigra of the patient with Parkinson disease may exhibit: a. Amyloid plaque b. Intranuclear inclusion bodies c. Neurofibrillary tangles d. Neurotic plaques e. Intracytoplasmic inclusion bodies 1- e 2- e 3- c 4- e 5- The most common cause of dementia in elderly is: a. Parkinsonism disease

b. Huntington disease c. Alzheimer disease d. Multiple sclerosis

6- Clinical syndrome characterized by tremors and diminished fascial expression: a. Parkinsonism b. Alzheimer disease c. Reye's syndrome d. Multiple sclerosis 7- Lewy bodies are found in: a. Alzheimer disease b. Parkinson disease c. Meningitis d. Encephalitis

Tumors 5

Previous exams & Formative:

e. None of the above

5- Gliomas include all except:

a. Astrocytoma b. Glioblastoma multiform c. Oligodendroglioma d. Medulloblastoma e. Ependymoma

6- A male patient 40 years old,presented with hemiplegia and deafness. Radiologic examination show a tumor at the cerebelloperative angle. Biopsy from this tumor shows a neurogenic tumor formed of hypercellular and hypocellular areas the most possible diagnosis is:

a. Neuroblastoma b. Schwannoma c. Ganglioneuroma d. Ganglioneuroblastoma e. Neurofibroma Answers: 1.e 2.b 3.d 4.d 5.d 6.b

II- EXTRA

1- Astrocytoma is a:

a. Glial tumor b. Neuronal tumor c. Tumor of undifferentiated cells d. Nerve sheath tumor e. Malformative tumor

2- Medulloblastoma is a:

a. Glial tumor b. Neuronal tumor c. Tumor of undifferentiated cells d. Nerve sheath tumor e. Malformative tumor

3- The tumor which is formed of two growth patterns(Antoni A and b) is:

a. Astrocytoma b. Oligodendroglioma c. Medulloblastoma d. Schwannoma e. Ependymoma 4- The following malignancy sends metastases mainly to meninges: a. Breast carcinoma b. Bronchogenic carcinoma c. Renal cell carcinoma d. Acute leukaemia e. Laryngeal carcinoma Answers: 1.a 2.c 3.d 4.d 5- Gliomas include all except:

a. Astrocytoma b. Glioblastoma multiform c. Oligodendroglioma d. Medulloblastoma e. Ependymoma

10- The most common tumor in children is:

a. Brain tumors b. Lymphoma d. Renal tumors e. Leukemia

11- Intracranial metastatic tumors originate from:

a. Sarcomas b. Lymphomas c. Carcinoma of breast d. Choriocarcinoma e. All of the above

12- Site of intracranial metastatic tumors:

a. Junction of gray&white matter b. Cerebellum c. Spinal cord d. Meninges e. All of the above Answers: 9.d 10.d 11.e 12.e

13- schwannoma is characterized by all of the followings except:

a. Solitary tumor b. Non capsulated c. Along one side of nerve d. Capsulated 14- Antoni type B schwannoma characterized by all of the followings except:

a. Cells are large b. Hypocellular c. Pleomorphic d. Stroma is scanty 15- Neurofibroma characterized by:

a. Multiple b. Not capsulated c. Fusiform d. Along the nerve fibre e. All of the above 16- Neurofibromatosis type 1 characterized by all of the followings except:

a. Multiple neurofibromas b. Cafe au lait skin pigmentation a. C. Lisch nodules c. Acoustic neuromas Answers:

6 CNS Tumors II

Previous exams & Formative:

1- Gliomas include all EXCEPT:

a. Astrocytoma b. Glioblastoma multiforme. c. Oligodendroglioma. d. Medulloblastoma. e. Ependymoma.

2- A male patient 40 years old, presented with hemiplegia and deafness. Radiologic examination shows a tumor at the cerebellopontine angle. Biopsy from this tumor shows a neurogenic tumor formed of hypercellular and hypocellular areas. The most possible diagnosis is:

a. Neuroblastoma. b. Schwannoma. c. Ganglioneuroma. d. Ganglioneuroblastoma. e. Neurofibroma.

3- Astrocytoma is a: Select one:

a. Nerve sheath tumor. b. Neuronal tumor. c. Malformative tumor d. Tumor of undifferentiated cells. e. Glial tumor

4- Pilocytic astrocytoma is characterized by all EXCEPT: Select one:

a. It is of bad prognosis. b. It is usually cystic.

c. It is of a good prognosis. d. Usually occurs in the cerebellum. e. Usually occurs in children

5- A 65-year-old man develops new-onset seizures and headaches. A CT scan reveals a 6-cm left-sided intracerebral mass. Which of the following is the most likely diagnosis? Select one:

a. Schwannoma. b. Pilocytic astrocytoma. c. Glioblastoma multiforme. d. Metastatic testicular carcinoma. e. Meningioma. 1- d 2- b 3- e 4-a 5- c

6- A 76-year-old man has a single episode of grand mal seizure. On physical examination, he is afebrile and normotensive. Motor strength is intact, and there is no loss of sensation. Cranial nerves are intact. His mental function is not diminished. There is a 1-cm, darkly pigmented skin lesion on the upper back. Brain MRI shows three solid, 1- to 3-cm mass lesions, without ring enhancement or surrounding edema, located at the gray-white junction in the right and left frontal lobes. The cerebral ventricles appear normal in size. What is the most likely diagnosis? Select one:

a. Oligodendroglioma. b. Non-Hodgkin lymphoma c. Meningioma. d. Metastatic melanoma. e. Glioblastoma.

7- A patient with multiple skin nodules and skin hyperpigmentation, biopsy from the nodules shows a benign connective tissue neoplasm composed of spindle cells. The most possible diagnosis is: Select one:

a. Schwannoma.

b. Meningioma.

c. Leiomyoma.

d. Lipomatosis.

e. Neurofibromatosis.

6- d 7-e

8- A 45-year-old woman has had unilateral headaches on the right for the past 5 months. Physical examination yields no remarkable findings. CT scan of the head revealed mass which is surgically removed and microscopic examination shows elongated cells with pale, oblong nuclei and pink cytoplasm with occasional psammoma bodies. What is the most likely diagnosis? Select one:

a. Ependymoma

b. Tuberculoma

c. Meningioma

d. Medulloblastoma

e. Astrocytoma

9- A 10-year-old girl develops ataxia and hydrocephalus. CT scan shows a midline cerebellar mass. Which of the following is the most likely diagnosis? Select one:

a. pilocytic astrocytoma

b. Astrocytoma

c. Medulloblastoma

d. Neurofibroma

e. Meningioma

10- A patient suffered from deafness, ataxia and hemiplegia Examination showed a well –circumscribed encapsulated tumor mass attached to the 8th cranial nerve. the tumor is characterized by the following except:

a. Could be seen with neurofibromatosis type 2 b. Alternating hypocellular with hypercellular areas c. Common turn malignant d. Good prognosis after resection e. Verocay bodies

11- A child presents with a cerebellar tumor that consists of malignant small round cells with rosette formation. the most possible diagnosis is: a. Meningioma b. Gliablastoma multiform c. Diffuse astrocytoma d. Oligodendroglioma e. Medulloblastoma

12- Atypical meningioma is considered WHO grade: a. 1 b. 2 c. 3 d. 4 e. None of the above 13- Pilocytic astrocytoma is characterized by all Except:

a. Usually occurs in children b. Usually occurs in the cerebellum c. It is usually cystic d. It is of bad prognosis e. Rosenthal fibers

14- The characteristic feature of glioblastoma multiform is:

a. Microvascular proliferation b. Pseudo palisading necrosis c. Nuclear atypia

d. All of the above e. None of the above

8- c 9-c 10-c 11- e 12-b 13- d 14- d

15- The extradural spinal cord tumors could arise from:

a. Meninges b. Bone c. Nerves d. All of the above e. None of the above

Extra:

1- Astrocytoma is not:

a. A glial tumor b. The commonest primary brain tumor in adults c. Always in the cerebral hemispheres d. Classified into grades according to the degree of nuclear atypia

2- The following histologic picture is not characteristic of glioblastoma multiform:

a. highly anaplastic tumor cells b. papillary formation c. necrosis d. tumor giant cells

3- Pilocytic astrocytoma is characterized by all except:

a. usually occurs in children b. usually occurs in cerebellum c. it is usually cystic

8- A 5-year-old child suffered from headache and blurring of vision. Radiologic examination showed a cerebellar tumor. microscopic examination of a biopsy specimen from this tumor revealed diffuse infiltration by malignant small round cells with rosette formation. the most possible diagnosis is:

a. Anaplastic astrocytoma

b. Glioblastoma multiform

c. Ependymoma

d. Neuroblastoma

e. Medulloblastoma

9- A 10 years old child suffered from severe headache and vomiting radiologic examination showed a firm tumor tissue occupying the fourth ventricle of the brain. biopsy revealed infiltration by small cells with rosette formation. the most possible diagnosis is:

a. Neuroblastoma

b. Ependymoma

c. Medulloblastoma d. Oligodendroglioma e. Astrocytoma

10- Psammoma bodies are characteristic of:

a. Serous cystadenocarcinoma of the ovary

b. Meningioma

c. Papillary carcinoma of the thyroid d. All of the above

e. None of the above

11- A patient with multiple skin nodules and skin hyperpigmentation, biopsy from the nodules show a benign connective tissue neoplasm. The most possible diagnosis is:

a. Lipomatosis

b. Neurofibromatosis

c. Neurofibroma d. Schwannoma e. Leiomyoma

12- The following is not a feature of meningioma:

a. Usually occurs in adults b. Usually, a benign tumor c. Has a whorly cut surface d. Characterized by psammoma bodies e. It is classified into various types according to the degree of nuclear atypia

13- All of the followings are characteristic to pilocytic astrocytoma except:

a. Often cystic b. Low to moderate cellularity c. GFAP positive d. Bipolar neoplastic cells e. None of the above 8-e 9- b 10- d 11-b 12-e 13-e

14- Which one of the following is the most common type of astrocytoma:

a. pilocytic astrocytoma b. diffuse astrocytoma c. anaplastic astrocytoma d. glioblastoma multiform

15- Which one of the following show pseudopalisading necrosis:

a. Oligodendroglioma b. Glioblastoma multiform c. Pilocytic astrocytoma

d. Ependymoma

16- Which one of the followings show homer-wright rosette:

a. Ependymoma

b. Pilocytic astrocytoma c. Meningioma d. Medulloblastoma

17- All of the followings are benign meningioma except:

a. Syncytial meningioma b. Fibroblastic meningioma c. Mixed meningioma d. Psammomatous meningioma e. None of the above 14-b 15-b 16- d 17- e

18- Angiomatous meningioma characterized by: a. Have relative high male to female ratio b. Rich in blood vessels c. Moderate to marked degenerative nuclear atypia d. All of the above

19- When meningioma containing 4 or more mitotic figures per 10 high power microscopic fields this is referred to:

a. Benign meningioma b. Psammomatous meningioma c. Atypical meningioma d. Anaplastic meningioma

20- When meningioma loss of differentiated features resulting in carcinoma like appearance:

a. Benign meningioma

b. Psammomatous meningioma

c. Atypical meningioma

d. Anaplastic meningioma

18-d 19-c 20-d