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Brain tumours, raised ICP & hydrocephalus flashcards

7 high-yield MRCP Part 1 cards from the Intellect Medicos Neurology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. Glioblastoma: what is the standard treatment after maximal safe resection?

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   Radiotherapy with concurrent and then adjuvant temozolomide.

   Why? Glioblastoma (WHO grade 4) has a very poor prognosis despite treatment.

2. What is the mechanism of temozolomide?

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   An oral alkylating agent that methylates DNA.

   Why? Tumours with a methylated MGMT promoter cannot repair this damage well and respond better.

3. Which drug is used to reduce vasogenic oedema around a brain tumour?

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   Dexamethasone.

   Why? Steroids stabilise the leaky blood-brain barrier around tumours. They do not help cytotoxic oedema after stroke.

4. What is the most common type of brain tumour in adults?

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   Metastases (commonly from lung, breast, bowel, melanoma or kidney).

   Why? Metastases are often multiple and found at the grey-white junction.

5. What is Cushing's triad, and what does it indicate?

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   Hypertension, bradycardia and irregular breathing; critically raised ICP with impending herniation (a late sign).

   Why? Rising ICP reduces cerebral perfusion, so systemic BP rises to keep the brain perfused, and the baroreflex slows the heart.

6. Gait disturbance, urinary incontinence and cognitive decline, with ventricles enlarged out of proportion to atrophy: diagnosis and treatment?

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   Normal pressure hydrocephalus; ventriculoperitoneal shunt.

   Why? It is a reversible cause of dementia. Gait usually improves most after shunting.

7. Name an osmotic therapy used for acutely raised intracranial pressure.

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   Mannitol or hypertonic saline.

   Why? They draw water out of brain tissue. Other measures: head-up 30°, treat the cause, and brief hyperventilation only as a bridge to definitive treatment.