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WorksheetsBrain tumors/palliative care
Total questions: 22
Worksheet time: 11mins
A lesion in the medial medulla would most likely cause which of the following findings?
Contralateral hemiparesis and ipsilateral tongue weakness
Ipsilateral facial paralysis and loss of taste from anterior 2/3 tongue
Contralateral loss of pain and temperature from the body and face
Bilateral limb ataxia
A stroke affecting the lateral medulla (PICA territory) would most likely damage which of the following tracts?
Corticospinal tract
Medial lemniscus
Spinothalamic tract and spinal trigeminal nucleus
Medial longitudinal fasciculus
A patient presents with contralateral loss of vibration and proprioception, contralateral hemiparesis, and ipsilateral tongue deviation. The lesion is most likely located in:
Midbrain tegmentum
Medial medulla
Lateral medulla
Pons
The red nucleus is located in which region of the brainstem?
Midbrain tegmentum
Basilar pons
Medial medulla
Cerebellar peduncle
Damage to the red nucleus would most directly impair:
Voluntary motor control of the face
Coordination of flexor muscle tone via the rubrospinal tract
Regulation of respiratory rhythm
Proprioceptive input from the dorsal column nuclei
A lesion of the medial longitudinal fasciculus (MLF) classically causes which eye movement abnormality?
Bilateral ptosis
Loss of pupillary constriction
Internuclear ophthalmoplegia
Oculomotor nerve palsy
A dorsal midbrain lesion compressing the superior colliculi would most likely result in:
Loss of vertical gaze (Parinaud syndrome)
Contralateral hemiparesis
Loss of pain and temperature from the face
Ataxia
A lesion of the lateral pons (AICA stroke) is most likely to damage which cranial nerve nuclei?
III and IV
IX and X
XII
V, VII, and VIII
The typical presenting symptom of a brainstem glioma is:
Seizures
Hemiplegia without cranial nerve deficits
Cranial nerve palsies with ataxia and long tract signs
Visual field deficits only
Diffuse intrinsic pontine glioma most often arises from which region?
Midbrain tectum
Pons
Cerebellar vermis
Medulla
A 6-year-old presents with cranial nerve palsies, ataxia, and long tract signs. MRI shows a diffuse pontine mass without a clear margin. The next best step is:
Surgical resection
Biopsy
Corticosteroids only
Radiation therapy
Why is surgical resection typically not feasible for diffuse intrinsic pontine glioma?
The tumor is highly radiosensitive
It infiltrates vital brainstem nuclei and tracts diffusely
It is usually metastatic
The tumor is encapsulated and easily removed
Which of the following is TRUE about the prognosis of diffuse intrinsic pontine glioma?
Median survival is <1 year despite treatment
Complete surgical resection is curative
Median survival is >5 years with current therapy
It frequently metastasizes to the liver
Which of the following is part of management of glioblastoma multiforme?
Chemotherapy only
Surgical resection followed by radiation and temozolomide
Whole-brain radiation alone
Observation and repeat MRI in 6 months
A 58-year-old man with glioblastoma decides to decline further chemotherapy after progression despite initial treatment. What is the most appropriate next step by the physician?
Attempt to convince him to continue therapy
Explore his goals and values to guide a care plan aligned with his wishes
Discharge him from the practice
Immediately refer him to hospice without discussion
Which of the following best describes palliative care?
Symptom-focused care aimed at improving quality of life at any stage of serious illness
Care provided only in the last 6 months of life
Treatment limited to cancer patients who decline therapy
Care provided exclusively in hospice settings
A patient with a brainstem glioma refuses radiation therapy. His family insists you “convince him” to change his mind. What is the most appropriate response?
Tell the patient his family knows best
Ignore the patient’s refusal and proceed with treatment
Contact hospital ethics committee immediately
Support the patient’s decision and facilitate an open discussion with the family
A woman with progressive glioblastoma expresses fear about “losing control” at the end of life. What is the most appropriate physician response?
“I'm sorry that you feel that way. There’s nothing we can do now.”
“I want to understand your fears and talk about how we can support your comfort and dignity.”
“It’s best not to think about that. Just try to stay positive throughout this process”
“I’ll increase your chemotherapy dose.”
A patient with glioma opts for hospice care. Which of the following is TRUE about hospice in the U.S.?
It is for patients with an expected prognosis of ≤6 months who forego curative therapy
It requires the patient to be in a hospital
It focuses on extending life at all costs
It cannot include medications
Which of the following best demonstrates appropriate physician behavior when a patient declines glioma treatment?
Respect the decision, offer symptom management
End the doctor-patient relationship
Order the treatment anyway for their own good
Refer them for psychiatric evaluation for refusing care
Which team member is most appropriate to involve early in palliative planning for a patient with glioma who is declining therapy?
Dermatologist
Palliative care specialist
Psychologist
Family member
During a family meeting, the daughter of a patient with glioblastoma says, “You’re giving up on my dad.” What is the most appropriate response?
“That’s not true. You're abandoning him.”
“It’s your father’s fault for refusing care, don't blame me.”
“Let’s stop discussing this.”
“We’re not giving up — our focus is shifting to comfort, dignity, and quality of life.”
