Brain Metastases Quiz
Created by Connor Bohlken and Chris Galbraith
Edited by Dr. Paris Ingledew
You are a third year medical student who has just started their third year Oncology rotation. You are working with Dr. Cranium, who loves discussing metastasis and cancer statistics. He asks you, “Any chance you know approximately how many patients with cancer will develop brain metastasis?”. You answer:
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Dr. Cranium was impressed with your cancer statistics knowledge. So impressed in fact that he follows up with a second question. “What cancer most commonly metastasizes to the brain?” You answer:
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You are working as a R2 Family Practice Resident in a small town. You are seeing Mr. Filledhead, a 62 year old male with known lung cancer. He is presenting today with new onset headaches. He gives the following history: “It’s weird Doc, I get this wicked headache every morning that seems to go away when I get up and start moving around. It sometimes comes back when I cough or sneeze, but then it goes away again after about 10 minutes or so. I didn’t think much of it when it first started about a month ago, but it’s only gotten worse and the other day it was so bad I thought I was going to throw up”. What is Mr. Filledhead describing?
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You liked your third year oncology rotation so much that you have chosen a fourth year elective in radiation oncology. You meet you attending, Dr. Encephalon, who is coincidentally the younger brother of Dr. Cranium. Dr. Encephalon is understandably passionate about brain mets, and wants to know how well you know your symptoms. He asks “what is the most common symptom of brain mets”? You answer:
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Which of the following physical exam findings points to a frontal lobe tumor?
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You are working in a family medicine clinic in an urban center. You have just seen Mrs. Cerebro, a 52 year old female with known metastatic RCC. She presented today with new onset morning headaches, and weakness in the right hand and foot. You are suspicious of potential brain metastasis. What is the preferred imaging modality to use in a patient with suspected brain metastasis?
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You are working in the emergency department and have just received the MRI report for Mrs. Smoke. She is a 74 year old highly comorbid female with known lung cancer. She presented to the emergency department with new onset headaches that seemed different than her previous headaches. On physical exam you did not note any mental status changes or neurological abnormalities. The MRI report showed a 3cm mass with surrounding edema. What is an appropriate treatment for her brain edema?
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You are a fourth year medical student on their first day of an Oncology elective. You have just seen Mr. Whattodo, a 43 year old male with metastatic lung cancer. He began treatment for his cancer almost 2 months ago and has been responding very well. He is thought to have a favorable 5 year prognosis. His medical history is also significant for an RCC which was treated with a partial nephrectomy 3 years ago. Unfortunately, 5 days ago he presented to the emergency department with a terrible headache and focal neurological symptoms. On imaging was found to have a single, 3 cm large lesion, with clear appearing margins situated in such a way that his presentation is highly likely to be the result of mass effect. Is this patient a reasonable surgical candidate?
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Mr. Hol LotaMets is presenting to your clinic today to review treatment options. He is a 74 year old male who unfortunately did not notice an acral melanoma growing under his big toe nail. It has since metastasized to multiple locations in his brain. Overall he has a relatively poor performance status, but would like to pursue treatment. What is the best treatment modality for this patient?
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You have just finished seeing a patient with known brain metastasis and are reporting back to your attending. You realize that you do not know a lot about the prognosis of brain metastasis. You ask your attending and they tell you that there are several different prognostic indices. However, a lot incorporate the Karnofsky Performance Score (KPS). Your attending then proceeds to ask if you know what a KPS score of 70 represents. You answer:
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