Welcome to your 🦠 CNS Infections & Nervous System Tumours Arena — 40 Integrated MCQs
1.
A 40-year-old patient has gradually progressive lower-limb weakness and sensory disturbance. MRI shows a tumour expanding the spinal cord from within. Which finding is most directly explained by involvement of descending motor pathways below the lesion?
2.
A 35-year-old man has a slowly enlarging painful mass along a peripheral nerve. At surgery, the lesion is encapsulated and grows to one side of the nerve, displacing rather than incorporating most nerve fibres. Which tumour best fits this pattern?
3.
A 52-year-old woman develops progressive leg weakness, sensory change and urinary urgency. A spinal tumour is suspected. Before surgical planning, MRI is obtained. Which information from MRI is most important for determining the operative approach?
4.
A small peripheral nerve mass is excised from a young adult. Histology shows an unencapsulated lesion containing spindle cells with elongated wavy nuclei in a collagenous and myxoid background. Which diagnosis is most likely?
5.
A patient with suspected viral encephalitis develops repeated seizures and worsening consciousness. Which complication should be considered as the most immediate neurological concern?
6.
A 6-year-old child presents with fever, severe headache, vomiting and progressive lethargy. Examination shows neck stiffness and a petechial rash. Which organism should be strongly suspected from this combination of findings?
7.
A patient with neurofibromatosis has numerous stable cutaneous lesions but also develops progressive neurological symptoms from one deeper tumour. Which management strategy best reflects the principles of care?
8.
A 36-year-old woman has headache, low-grade fever and progressive drowsiness for three weeks. MRI shows basal meningeal enhancement and early hydrocephalus. Which pathological process best explains both imaging findings?
9.
A 7-day-old neonate becomes lethargic, feeds poorly and has two episodes of apnea. The temperature is unstable, and meningitis is suspected despite the absence of neck stiffness. Which principle best explains the atypical presentation?
10.
A 32-year-old man presents with high fever, severe headache and progressive confusion. Blood cultures are obtained, but lumbar puncture will be delayed because he has a new focal neurological deficit and features suggesting raised intracranial pressure. What is the most appropriate immediate management principle?
11.
A 29-year-old woman presents with fever, confusion, recurrent seizures and impaired memory. CSF shows a lymphocytic inflammatory response with relatively preserved glucose. Which finding would most strongly indicate that the primary process involves brain parenchyma rather than meninges alone?
12.
A patient has a large tortuous enlargement involving several fascicles of a peripheral nerve. The lesion is multinodular rather than forming a single encapsulated mass. Which tumour pattern is best represented?
13.
A patient with tuberculous meningitis develops sudden right-sided weakness during treatment. Imaging confirms a cerebral infarct. Which underlying process is the most likely cause?
14.
A student asks why rabies vaccine and rabies immunoglobulin have different roles in post-exposure prophylaxis. Which statement best explains the distinction?
15.
A 65-year-old man with a known systemic malignancy develops severe back pain followed by rapidly progressive leg weakness. Imaging demonstrates destruction of a vertebral body with extension of tumour into the spinal canal. What most directly accounts for the neurological deterioration?
16.
A patient with infective endocarditis develops headache, seizures and a focal neurological deficit. Brain imaging shows a localized ring-enhancing lesion. Which mechanism most likely produced the intracranial infection?
17.
A 45-year-old man with new-onset seizures has an infiltrating frontal-lobe glioma. Molecular testing demonstrates an IDH mutation. Which additional abnormality would support classification as an oligodendroglioma?
18.
A 4-year-old child with bacterial meningitis improves after treatment but is later found to have difficulty hearing. Which mechanism best explains this sequela?
19.
A patient with progressive myelopathy has a well-circumscribed intradural-extramedullary spinal tumour. Neurosurgical excision is considered technically more feasible than removal of a diffusely infiltrating intramedullary lesion. Which feature best explains this difference?
20.
A 47-year-old man develops fever and meningism followed several hours later by a generalized seizure. His CSF culture confirms bacterial meningitis. Which mechanism most directly contributes to seizure development in this condition?
21.
A 39-year-old man develops focal seizures. MRI shows a poorly defined cerebral hemispheric lesion. Biopsy demonstrates neoplastic astrocytic cells dispersed between relatively preserved neural structures rather than forming a discrete mass. Which property best explains the indistinct tumour margin?
22.
A patient with a brain abscess is initially stable but later develops abrupt severe deterioration, fever and signs of widespread meningeal irritation. Which complication should be strongly suspected?
23.
A 67-year-old man develops rapidly progressive personality change, headache and left-sided weakness. MRI shows an irregular necrotic tumour extending from one cerebral hemisphere into the other. Which structure most likely permits this pattern of spread?
24.
A 3-week-old infant with suspected meningitis is hemodynamically unstable and has recurrent seizures. Which management principle is most appropriate?
25.
A severely immunocompromised patient presents with fever, confusion and focal weakness. Imaging shows several intracerebral lesions with surrounding edema. Which feature most strongly favors toxoplasmosis over a solitary bacterial brain abscess?
26.
A patient with a hereditary tumour-predisposition disorder has bilateral vestibular nerve tumours but retains useful hearing. Which component of follow-up is particularly important for detecting functional deterioration?
27.
A 40-year-old man with chronic mastoid infection develops progressive headache, vomiting and weakness of the left arm. Imaging demonstrates a focal intracerebral lesion with surrounding edema. Which route most likely allowed infection to reach the brain?
28.
A 56-year-old woman has slowly progressive focal seizures. Imaging demonstrates a sharply defined extra-axial lesion attached to the cerebral convexity. At surgery, the mass displaces the cortex rather than diffusely invading it. Which growth pattern best explains her gradual presentation?
29.
A healthcare worker previously completed an appropriate rabies vaccination course. Several months later, he sustains a significant exposure to a suspected rabid animal. Which principle should guide management?
30.
A man is bitten on the leg by a dog suspected of having rabies. He presents immediately after the bite. Which intervention should be performed first as part of rabies prevention?
31.
A previously unvaccinated woman sustains several scratches from a suspected rabid animal. The scratches penetrate the skin and bleed. Why is rabies immunoglobulin added to vaccine in this situation?
32.
A 61-year-old patient develops progressive cognitive change and focal neurological deficits. MRI demonstrates deep periventricular cerebral lesions. Biopsy reveals a malignant lymphoid population predominantly of B-cell origin. Which diagnosis is most likely?
33.
A 27-year-old man is diagnosed with neurofibromatosis. Several family members have similar manifestations. He asks why his relatives may also be affected. Which explanation is most appropriate?
34.
A patient with no previously diagnosed cancer presents with headache and weakness. MRI shows several well-demarcated cerebral lesions. Biopsy of one lesion shows malignant cells resembling a non-neural epithelial malignancy rather than cells native to the CNS. Which interpretation is most appropriate?
35.
A 24-year-old patient develops progressive bilateral hearing impairment and imbalance. Imaging demonstrates tumours involving both vestibular nerves, and additional intracranial meningiomas are identified. Which underlying disorder is most likely?
36.
A young patient with an inherited tumour-predisposition syndrome has multiple neurofibromas and an optic pathway glioma. Loss of function of which type of gene best explains the tendency to develop these tumours?
37.
A 48-year-old woman develops thoracic radicular pain followed months later by progressive stiffness and weakness of both legs. MRI shows a well-defined mass inside the dura but outside the spinal cord. Which sequence best explains her neurological progression?
38.
An 8-year-old child undergoes treatment for a malignant cerebellar embryonal tumour. Several months later, MRI demonstrates new tumour deposits along the spinal subarachnoid space. Which process best explains this finding?
39.
A patient being treated for acute bacterial meningitis becomes increasingly drowsy and develops a sixth cranial nerve palsy. Which complication best explains this deterioration?
40.
A patient with subacute meningitis has lymphocytic CSF, markedly raised protein and reduced glucose. Neuroimaging also shows hydrocephalus. Which additional clinical finding would best support the same disease process?
