CNS tumors - In-class quiz using Electgronic Student Response System (ESRS).

1. “There are forces in life working
for you and against you. One
must distinguish the beneficial
forces from the malevolent ones
and choose correctly between
them”
- Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.

2. Quick Pathology Review
Pathology of
CNS Tumors & Meningitis
Shashidhar Venkatesh Murthy
A/Prof.& Head of Pathology
School of Medicine & Dentistry
James Cook University Australia.

3. CPC 35 – CNS- Seizure – Tumours, meningitis
Major CLI:
• Increased intracranial pressure – Pathogenesis &
pathology. Pathology of common CNS tumours.
• Astrocytoma – grades, clinical types, presentation &
complications.
• Pathology & Microbiology of Meningitis – common types
* Bacterial, Viral & TB.
Minor CLI:
• Epilepsy, types, clinical features & Pathogenesis.
• Toxic meningitis – Kernicterus.
• Meningitis other types – viral, fungal (Cryptococcus),
carcinomatous etc.

4. Look for good in others…
no one is without faults and
everyone has some good
qualities!
BK.

5. A 36y woman with 18month history of progressively increasing headaches which
increases with her menstrual cycle. Her daughter is also concerned with her recent
memory problem and emotional outbursts. Image shows MRI of her head.
What is the most likely diagnosis?
A. ACA infarct.
B. Glioblastoma multiforme.
C. Frontotemporal dementia.
D. Brain Metastases.
E. Meningioma.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly discuss origin & pathogenesis of this condition?
B. List 3 gross and Microscopic feature of this disease?
C. What is the relation to menstrual cycle.

6. 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. Fundoscopy.
B. CSF examination.
C. GI Endoscopy.
D. MRI.
E. Haemogram/FBC.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly discuss complications of spinal tap?
B. List 3 laboratory features of CSF in infective types of meningitis?
C. Briefly discuss locations and clinical features of brain herniation?

7. A 56 year old woman has a grand mal seizure. Her CSF values reveal a high
protein, normal glucose and a normal WBC counts, culture was negatie. A large right
cerebral mass is resected and has the microscopic appearance shown.
What is the most likely diagnosis?
A. Cerebral infarct.
B. Fungal Abscess.
C. Glioblastoma multiforme.
D. Brain Metastases.
E. Meningioma.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly discuss origin & pathogenesis of this condition?
B. List 3 gross and Microscopic feature of this disease?
C. Briefly discuss prognosis of this condition?

8. 52y, F, morning headache 1year, mood changes:
Specimen of brain. ? diagnosis
A. Glioblastoma multiforme.
B. Astrocytoma grade 2.
C. Meningioma.
D. Ependymoma.
E. Metastases.
0% 0% 0% 0% 0%
A. B. C. D. E.

9. 52y, Fem, Menstrual headache: ? diagnosis
1. Glioblastoma m.
2. Astrocytoma
3. Metastases
4. Medulloblastoma
5. Meningioma
0% 0% 0% 0% 0%
1 2 3 4 5

10. 52y, Fem, Headache, seizure 4 weeks. ? diagnosis
A. AV malformation.
B. Glioblastoma
C. Astrocytoma
D. Meningioma
E. ACA Stroke
20% 20% 20% 20% 20%
A. B. C. D. E.

11. 52y, F, parasagittal tum attached to falx: ? diagnosis
A. Glioblastoma m.
B. Astrocytoma
C. Meningioma
D. Ependymoma
E. Medulloblastoma
0% 0% 0% 0% 0%
A. B. C. D. E.

12. Commonest primary CNS tumor in Adults ?
A. Glioblastoma multiforme
B. Lowgrade Astrocytoma
C. Meningioma
D. Ependymoma
E. Medulloblastoma
0% 0% 0% 0% 0%
A. B. C. D. E.

13. 60y smoker, chronic bronchitis complains of difficulty
walking. PE: stiff, expressionless face. A resting tremor
of his fingers (pill rolling). Image shows his brain stem .
Diagnosis ?
A. Alzheimers disease
B. Lacunar infarcts
C. Picks disease
D. Parkinsons disease
E. Durett hemorrhages
0% 0% 0% 0% 0%
A. B. C. D. E.

14. 55y Female. Died following car crash. Coroners
autopsy Image shows Brain stem- What is the likely
cause of death?
A. Herniation of cerebral tonsil
B. Intracerebral hemorrhage.
C. Subdural hemotoma
D. Subarachnoid hemorrhage.
E. Glioblastoma multiforme.
0% 0% 0% 0% 0%
A. B. C. D. E.

15. 56y, F Rapidly growing parietal lobe tumor:? diagnosis
A. Glioblastoma m.
B. Astrocytoma
C. Meningioma
D. Ependymoma
E. Medulloblastoma
0% 0% 0% 0% 0%
1 2 3 4 5

16. 49y, M, CNS tumor: ? diagnosis
A. Metastases
B. Astrocytoma sy.
C. Meningiomatosis
D. Neurofibromatosis
E. Lipomatosis
0% 0% 0% 0% 0%
1 2 3 4 5

17. 54y woman dies 48 hours after suffering severe head injuries
in an automobile accident. Just before her death, her left pupil
becomes fixed and dilated. An inferior view of the patient's
brain at autopsy is shown. Most likely cause of death?
A. Diffuse axonal shearing
B. Laminar necrosis
C. Thrombosis of sagittal sinus
D. Transtentorial herniation
E. Watershed infarct
0% 0% 0% 0% 0%
A. B. C. D. E.

18. 48y male, headache 2months, Frontal lobe well
demarcated mass lesion. Most likely diagnosis?
A. Glioblastoma multiforme.
B. Astrocytoma Lowgrade
C. Meningioma
D. Ependymoma
E. Medulloblastoma
20% 20% 20% 20% 20%
1 2 3 4 5

19. A 49y man with a 3 month history of worsening headaches, vomiting and blurring
vision has a seizure. Image shows MRI of her head. He undergoes surgical debulking
followed by radiation and chemotherapy.
What is the most likely diagnosis?
A. ACA infarct.
B. Meningioma
C. Glioblastoma multiforme.
D. Frontotemporal dementia.
E. Brain Metastases.
F. .
0% 0% 0% 0% 0% 0%
A. B. C. D. E. F.
A. Briefly discuss origin & pathogenesis of this condition?
B. List 3 gross and Microscopic feature of this disease?
C. Briefly discuss prognosis of this condition?

20. A 49y man presents with rapidly progressive decline in mental function over 4 weeks.
He has clumsiness of motor movements, difficulty eating or walking. Impaired attention
span, memory, and judgement. Image shows microscopic appearance of his
cerebrum. What is the most likely diagnosis?
A. ACA infarct.
B. Viral Meningitis.
C. Creutzfeldt-Jakob disease
D. Pick’s disease.
E. Spongiform encephalopathy.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly discuss origin & pathogenesis of this condition?
B. List 3 gross and Microscopic feature of this disease?
C. Briefly discuss prognosis of this condition?

21. A 19y female develops sore throat, 3 days later presents with severe headache, neck
rigidity. CSF examination reveals High protein, low sugar with plenty of neutrophils.
Image shows appearance of CSF Gram stain. What is the most likely diagnosis?
A. Tuberculous meningitis.
B. Viral Meningitis.
C. Candida meningitis.
D. Streptococcal meningitis.
E. Neisseria meningitidis.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly discuss origin & pathogenesis of this condition?
B. List 3 gross and Microscopic feature seen in her cerebrum?
C. Differentiate CSF findings in different types of meningitis?

22. A 61 year old woman with a 8 month history of worsening headaches develops new
unilateral anosmia. She has also developed obsessive anxiety about her health and
her children safety with no apparent reason. A left subfrontal 3 cm discrete mass is
resected. Image shows it’s histopathological appearance.
What is the most likely diagnosis?
A. Olfactory Neuroblastoma.
B. Lowgrade Glioma.
C. Brain Metastases.
D. Meningioma.
E. Glioblastoma multiforme.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly discuss origin & pathogenesis of this condition?
B. List 3 gross and Microscopic feature of this disease?
C. Briefly discuss prognosis of this condition?

23. A 8 year old girl presents with severe headache, abnormal gait & MRI reveals third and
lateral ventricular enlargement. Image shows gross specimen showing likely gross
features. What is the most likely diagnosis?
A. Medulloblastoma
B. Pilocytic astrocytoma.
C. Neuroblastoma.
D. Retinoblastoma metastases.
E. Ruptured AV malformation.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly describe pathological features seen in the image?
B. Explain the symptoms? What is the prognosis?
C. List two microscopic features?

24. A 31 year old man with no significant past medical history has a sudden new-onset
grand mal seizure. No Diabetes, he is normotensive. Image shows the angiogram of
his left internal carotid artery. What is the most likely diagnosis?
A. Berry aneurysm.
B. Vascular malformation.
C. AV fistula in MCA.
D. Atherosclerosis of MCA.
E. Fusiform aneurysm.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly discuss origin & pathogenesis of this condition?
B. List 3 clinical features of this disease?
C. Briefly discuss prognosis of this condition?

25. A 51 year old previously healthy woman with a sudden severe headache has the
vertebral artery angiogram shown. What is the most likely diagnosis?
A. AV malformation.
B. Fusiform aneurysm.
C. AV fistula in MCA.
D. Atherosclerosis of MCA.
E. Berry aneurysm.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly discuss origin & pathogenesis of this condition?
B. List 3 complications of this condition? How common is this?
C. Briefly discuss prognosis of this condition?

26. A 86 year old man with a 7 year history of progressive withdrawal and apathy is found
on formal examination to have severe short term memory loss and is unoriented to
place or time. The image shows brain appearance similar to his. What is the most
likely diagnosis?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Astrocytome low grade.
D. Vascular dementia.
E. Pick’s disease
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly describe pathological features seen in the image?
B. Explain the symptoms? What is the prognosis?
C. List three microscopic features?

27. A 68 year old woman with a 4 year history of progressive withdrawal, irritable,
irresponsible with speech difficulties. The image shows brain appearance similar to
her. What is the most likely diagnosis?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Astrocytome low grade.
D. Vascular dementia.
E. Pick’s disease
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly describe pathological features seen in the image?
B. Explain the symptoms? What is the prognosis?
C. List two microscopic features?

28. A 4 year old boy presents with a wide based gait and truncal ataxia. MRI reveals thisrd
and lateral ventricular enlargement, along with the lesion shown. What is the most
likely diagnosis?
A. Medulloblastoma
B. Pilocytic astrocytoma.
C. Neuroblastoma.
D. Retinoblastoma metastases.
E. Ruptured AV malformation.
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly describe pathological features seen in the image?
B. Explain the symptoms? What is the prognosis?
C. List two microscopic features?

29. A 56 year old man develops 2 year history of increasing hand and forearm weakness
and clumsiness. Later develops dysarthria and dysphagia. A year later he dies of
pneumonia. Image shows two sections of spinal cord with arrows showing the
pathology. What is the most likely diagnosis? MND .. many subtypes:
• Amyotrophic Lateral Sclerosis.
A. Parkinsonism. • Progressive muscle atrophy (LMN)
B. Multiple Sclerosis. • Primary lateral sclerosis (UMN)
• Progressive bulbar palsy
C. Vitamin B12 deficiency (CDC)
D. Motor Neurone Disease (MND)
E. Amyotrophic Lateral Sclerosis (ALS)
0% 0% 0% 0% 0%
A. B. C. D. E.
A. Briefly describe pathological features seen in the image?
B. Explain the symptoms? What is the prognosis?
C. List one microscopic feature?

30. 50y Female, Smoker, Headache, Diagnosis?
1. Glioblastoma
2. Astrocytoma
3. Ependymoma
4. Medulloblastoma
5. Meningioma
A. Briefly describe pathological features seen in the images?
B. Explain 0% symptoms? What0% the prognosis?
0%
the 0% 0%
is
C. List two microscopic features?
1 2 3 4 5

31. • 40y fem, post therapy for Breast Ca – seizures, cognitive changes.
38y Man with AIDS – Headache, arm weakness, gait disorder.
Images Gross & MRI Diagnosis?
1. Glioblastoma
2. Astrocytoma
3. PML
4. Ependymoma
5. Medulloblastoma
A. Briefly describe pathological features seen in the images?
B. 0%
What 0% the0%
is Etiology? 0%
0%
- JC virus
1 2 3 4 5
C. What is the pathogenesis? - Oligodendrocytes - demyelination

32. “If we are not free, no one will
respect us.”
- Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.