Medicine Cases Quiz

1. A 60 years old baker was diagnosed of a Primary Brain tumor. He was placed on oral dexamethasone 16 mg daily in divided dose by the managing Oncologist. The primary rationale for such action is

To reduce intracranial pressure from edema associated with the tumor

To aid the shrinking of tumor

To inhibit tumor markers produced by the tumor

To aid subsequent surgical resection of tumor

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 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.

2. A 80 years old retired military man was diagnosed of glial tumor after recurrent episodes of seizures. Which is the most likely neuroimaging modality that was used?

Cranial MRI with gandolium contrast adminstration

Skull X-ray

Cranial MRI

Cranial CT scan

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

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.

3. A 70 years old man who has been smoking for 40 years was observed to be losing weight,having occasional seizures and coughing for 3 weeks. Three months to presentation he was noted during a clinic visit to be depressed and having memory impairment.Which is the most likely diagnosis?

Small cell Lung Cancer

Squamous Cell Cancer

Mesothelioma

Pulmonary Tuberculosis

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 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.

4. A patient presented to the hospital and was subsequently diagnosed of High grade glial malignant tumor. Which of the following is not likely to be a presenting feature?

Visual field deficit

Headache

Seizure

Aphasia

Hemiparaesis

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 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.

5. After extensive investigation a patient was diagnosed of Meningioma. Which is not likely to be presenting features when he presented to the hospital?

Visual field deficit

Hemiparaesis

Headache

Aphasia

Seizure

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.

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.