【註解來源：Youmans Neurological Surgery、Radiopaedia.org】
台大題庫
台大題庫
1. Which one is not true for “Active Acromegaly”
(1) Basal HGH > 5ng/ml.
(2) Elevation of somatomedin C.
(3) Non-suppression of HGH with oral glucose load.
(4) Increase of HGH secretion response to L-Dopa.
(5) Increased secretion of HGH by TRH injection.
Ans. (4)
endocrine criteria：
1. elevated basal GH level (>5 ng/mL)
2. insufficient GH suppressibility (>2 ng/mL) on OGTT
3. elevation of serum IGF-1 levels
endocrinologic remission；
1. suppression of GH levels to less than 1 ng/mL during OGTT
2. normalization of age-adjusted plasma IGF-1 levels
(3. mean GH level of less than 2.5 ng/mL)
Pharmacologic Therapy：somatostatin analogues (octreotide), dopamine agonists (bromocriptine), and GH receptor blockers (pegvisomant).
endocrine criteria：
1. elevated basal GH level (>5 ng/mL)
2. insufficient GH suppressibility (>2 ng/mL) on OGTT
3. elevation of serum IGF-1 levels
endocrinologic remission；
1. suppression of GH levels to less than 1 ng/mL during OGTT
2. normalization of age-adjusted plasma IGF-1 levels
(3. mean GH level of less than 2.5 ng/mL)
Pharmacologic Therapy：somatostatin analogues (octreotide), dopamine agonists (bromocriptine), and GH receptor blockers (pegvisomant).
42. Glioblastoma Multiforme在MRS會有下列發現
(1) Choline下降
(2) NAA下降
(3) Creatine 變少
(4) Lactate下降
(5) Choline/NAA 下降
Ans. X
As the grade increases, NAA and creatine decrease; choline, lipids and lactate increase.
My ChoCrNaaLa (think of a new chocolate energy bar or something)
My: Myoinisitol 3.3
Cho: Choline 3.2
Cr: Creatine 3.0
Naa: Naa 2.0
L: Lactate 1.3
43. 下列有關craniopharygioma的敘述何者為非
(1) Pituitary stalk可被往前推至腫瘤前方
(2) 其cystic wall才是活動的腫瘤
(3) 可以做Intracavity 32P brachytherapy
(4) 可做intracavity methotraxate治療
(5) 其cystic content在MRI影像在T1為high signal
Ans. (4)
Craniopharyngioma is thought to arise from ectodermally derived epithelial cell remnants of Rathke’s pouch and the craniopharyngeal duct. Neoplastic transformation of cells derived from tooth primordia gives rise to adamantinomatous craniopharyngioma, whereas such transformation in cells derived from buccal mucosa primordia gives rise to the papillary type.
Intracavitary Radiotherapy：phosphorus-32、yttrium 90
effective but fail to treat the solid component of the tumor
Cyst Chemotherapy：intracystic bleomycin、subcutaneous/intracystic interferon alfa
44. 下列有關acoustic tumor的敘述何者為非 （多選題）
(1) 即使3cm腫瘤也鮮少有明顯的顏面神經麻痺
(2) 腫瘤生長慢, intracanalicular tumor可能數年不長大
(3) >3cm腫瘤以手術切除, 最好的結果<30%顏面神經功能保留
(4) 以gamma knife治療其邊緣劑量多採18 Gy
(5) Cystic type腫瘤宜採gamma knife治療
Ans. (345)
The growth rate also varies from 0.4 to 2.4 mm/yr. Stangerup and colleagues, in a large series of 522 patients with a mean observation time of 3.6 years, found that tumors demonstrating growth did so in the first 5 years after diagnosis. Interestingly, they also found that intrameatal and extrameatal tumors had a statistically different rate of growth, with 17% and 29% of these tumors demonstrating growth within 4 years of diagnosis, respectively.
In one series, the percentage of patients with House-Brackmann grade 3 or higher in the immediate postoperative period was 62.5% in those with tumors larger than 4 cm, whereas only 35.3% of patients had a House-Brackmann grade 3 or higher if the tumor size was less than 2.5 cm. However, 75% of the patients at 6 months had normal or nearly normal facial nerve function, thus demonstrating that although there is an effect related to tumor size, excellent results are still possible even with the largest tumors.
Numerous authors have reported that patients with cystic tumors have a greater likelihood of postoperative facial paresis than do those with more solid tumors. Samii and Matthies found that the anatomic preservation rate of the facial nerve decreased from 93% to 88% in patients with cystic tumors.
A marginal dose of approximately 12 to 13 Gy probably limits the side effects while maintaining therapeutic effect. Recently, several series using lower marginal doses from 12 to 13 Gy have produced excellent results in terms of tumor control, facial nerve preservation, trigeminal preservation, and hearing preservation.
The growth rate also varies from 0.4 to 2.4 mm/yr. Stangerup and colleagues, in a large series of 522 patients with a mean observation time of 3.6 years, found that tumors demonstrating growth did so in the first 5 years after diagnosis. Interestingly, they also found that intrameatal and extrameatal tumors had a statistically different rate of growth, with 17% and 29% of these tumors demonstrating growth within 4 years of diagnosis, respectively.
In one series, the percentage of patients with House-Brackmann grade 3 or higher in the immediate postoperative period was 62.5% in those with tumors larger than 4 cm, whereas only 35.3% of patients had a House-Brackmann grade 3 or higher if the tumor size was less than 2.5 cm. However, 75% of the patients at 6 months had normal or nearly normal facial nerve function, thus demonstrating that although there is an effect related to tumor size, excellent results are still possible even with the largest tumors.
Numerous authors have reported that patients with cystic tumors have a greater likelihood of postoperative facial paresis than do those with more solid tumors. Samii and Matthies found that the anatomic preservation rate of the facial nerve decreased from 93% to 88% in patients with cystic tumors.
A marginal dose of approximately 12 to 13 Gy probably limits the side effects while maintaining therapeutic effect. Recently, several series using lower marginal doses from 12 to 13 Gy have produced excellent results in terms of tumor control, facial nerve preservation, trigeminal preservation, and hearing preservation.
45. Please matching the lesion site with visual field defect in optic pathway（配合題）
a) optic nerve injury 1) bitemporal hemianopsia
b) pituitary tumor 2) homonymous superior quadrantanopsia
c) temporal lobe lesion 3) homonymous hemianopsia
d) parietal lobe lesion 4) one eye blindness
e) occipital lobe lesion 5) homonymous hemianopsia with macular sparing
Ans: a-4, b-1, c-2, d-3, e-5
46. Please matching the description with the appropriate peripheral nerve（配合題）
a) wrist drop 1) lateral femoral cutaneous nerve
b) carpal tunnel syndrome 2) posterior tibia nerve at medial mallealus
c) meralgia paraesthetica 3) peroneal nerve at neck of fibula
d) tarsal tunnel syndrome 4) radial nerve at spiral groove of humerus
e) drop foot with weakness of eversion 5) median nerve at wrist
Ans: a-4, b-5, c-1, d-2, e-3
Tarsal tunnel syndrome (TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle). 【Wikipedia】
Tarsal tunnel syndrome (TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle). 【Wikipedia】
47. Microphotograph below is a microscopic section taken from substantia nigra.
Please identify the lesion and diagnosis
a) Nuclear inclusion body 1) S.L.E.
b) Lafora body 2) Herpes simplex
c) Lewy body 3) Familiar myoclonic epilepsy
d) Foreign body giant cell 4) Sarcoidosis
e) Hematoxylin body 5) Parkinson disease
Ans: C, 5
Inclusion bodies are nuclear or cytoplasmic aggregates of stainable substances, usually proteins. They typically represent sites of viral multiplication in a bacterium or a eukaryotic cell and usually consist of viral capsid proteins. Inclusion bodies can also be hallmarks of genetic diseases, as in the case of neuronal inclusion bodies in disorders like frontotemporal dementia and Parkinson's disease.
Cowdry bodies are eosinophilic nuclear inclusions composed of nucleic acid and protein seen in cells infected with Herpes simplex virus, Varicella-zoster virus, and Cytomegalovirus.
Lafora disease, also called Lafora progressive myoclonic epilepsy or MELF, is a fatal autosomal recessive genetic disorder characterized by the presence of inclusion bodies, known as Lafora bodies, within the cytoplasm of the cells of the heart, liver, muscle, and skin. In a later study, Lafora disease has been and is now viewed as a neurodegenerative disease, since prior to the actual formation of Lafora bodies there has been seen to be an impairment in the development of cerebral cortical neurons. It was further concluded that Lafora disease is a complex neurodegenerative disease and also a glycogen metabolism disorder. 【Wikipedia】
沒有留言:
張貼留言