Medicine Cases Quiz

Explanation
The most likely diagnosis in this case is Small cell Lung Cancer. The patient's history of smoking for 40 years, along with symptoms such as weight loss, seizures, and coughing, are consistent with lung cancer. Additionally, the presence of depression and memory impairment could be indicative of paraneoplastic syndrome, which is commonly associated with small cell lung cancer.

Explanation
The primary rationale for placing the baker on oral dexamethasone is to reduce intracranial pressure from edema associated with the tumor. Dexamethasone is a corticosteroid that has anti-inflammatory and immunosuppressive effects. It can help reduce swelling and inflammation in the brain caused by the tumor, thereby relieving the pressure on the surrounding tissues. This can help alleviate symptoms such as headaches and neurological deficits. It is important to note that dexamethasone does not directly shrink the tumor or inhibit tumor markers. Surgical resection of the tumor may be aided by reducing the intracranial pressure beforehand.

Explanation
The most likely neuroimaging modality that was used in this case is cranial MRI with gadolinium contrast administration. This is because MRI (Magnetic Resonance Imaging) is a preferred imaging technique for brain tumors as it provides detailed images of the brain and surrounding structures. Gadolinium contrast administration enhances the visualization of tumors, making it easier to detect and diagnose glial tumors. Skull X-ray is not suitable for imaging brain tumors, and cranial CT scan may not provide as detailed images as MRI.

Explanation
Visual field deficit is not likely to be a presenting feature of a high-grade glial malignant tumor. This type of tumor typically presents with symptoms such as headache, seizure, aphasia, and hemiparesis. Visual field deficits are more commonly associated with tumors that affect the optic nerves or visual pathways, rather than glial tumors. Therefore, it is less likely to be a presenting feature in this case.

Explanation
Visual field deficit is not likely to be a presenting feature when a patient is diagnosed with Meningioma. Meningioma is a type of brain tumor that typically grows slowly and does not cause immediate symptoms. However, as the tumor grows, it can eventually compress surrounding structures and cause symptoms such as headache, seizures, hemiparesis (weakness on one side of the body), and aphasia (difficulty speaking or understanding language). Visual field deficits, which involve a loss of vision in specific areas of the visual field, are not commonly associated with Meningioma as a presenting symptom.