Brain Metastases Quiz

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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:

1 point

0.5%

1-5%

10-30%

20-40%

50%

Clear selection

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:

1 point

Colorectal

Breast

Melanoma

RCC

Lung

Clear selection

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?

1 point

Recurrent Seizures

A "Head Cold"

Hemiparesis

Increased ICP

Thunderclap Headache

Clear selection

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:

1 point

Altered Mental Status

Seizures

Ataxia

Focal Weakness

Headache

Clear selection

Which of the following physical exam findings points to a frontal lobe tumor?

1 point

Anosmia

Impairment of Upward Gaze

Ataxia

Nystagmus

Homonymous Hemianopia

Clear selection

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?

1 point

Contrast CT

Ultrasound

Contrast Enchanced MRI

XRay

Fluoroscopy

Clear selection

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?

1 point

Ibuprofen 400mg PO q6hr

Amitriptyline 25mg PO q24hr

Dexamethasone 4mg PO q12hr

Levetiracetam PO 500mg PO q12hr

Acetaminophen 1000g PO q6hr

Clear selection

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?

1 point

Yes, his tumor and patient factors make surgery a reasonable option.

Yes, his age is the primary reason to consider surgery.

No, his tumor and patient factors make surgery unreasonable.

No, his risk of complications from the surgery is too great.

Leave this decision to your attending.

Clear selection

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?

1 point

Chemotherapy

Surgery

Cryogenic Freezing

Stereotactic Radiosurgery

Whole Brain Radiation Therapy

Clear selection

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:

1 point

Minor signs and symptoms of disease.

Cares for self but cannot do active work.

Requires frequent care.

Severely disabled, hospitalization indicated.

Moribund

Clear selection

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Helpful

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