Brain Tumours: MCQ bank

In adults over 40, what is the commonest type of intracranial tumour?

1. APituitary adenoma
2. BMetastasis from a systemic cancer
3. CPrimary CNS lymphoma
4. DGlioblastoma
5. EMeningioma

Which is the commonest malignant primary brain tumour in adults?

1. AGlioblastoma, IDH-wildtype
2. BEpendymoma
3. COligodendroglioma
4. DPilocytic astrocytoma
5. EMedulloblastoma

Which is the only firmly established environmental risk factor for glioma and meningioma?

1. AMobile phone use
2. BIonising radiation to the head
3. CLiving near power lines
4. DProcessed meat
5. EHead injury

What is the commonest presenting symptom of a low-grade (IDH-mutant) glioma in a young adult?

1. AHemiplegia
2. BSeizure
3. CComa
4. DPapilloedema
5. ESevere morning headache

Which statement about brain tumour headache is correct?

1. AIt is usually tension-type and rarely occurs without other symptoms
2. BHeadache alone for 6 months is typical
3. CMost patients have the classic early-morning headache with vomiting
4. DIt is always on the side of the tumour
5. EIt is relieved by lying flat

Which headache feature is a red flag that warrants brain imaging?

1. AHeadache after missing a meal
2. BLifelong episodic migraine unchanged in pattern
3. CNew headache after age 50, or a change in pattern
4. DBilateral pressing headache relieved by paracetamol
5. EHeadache with neck stiffness after exercise that settles in an hour

Which investigation is best for a suspected brain tumour?

1. APlain CT head
2. BLumbar puncture
3. CMRI brain with and without contrast
4. DSkull X-ray
5. EEEG

Which molecular pair defines oligodendroglioma in the 2021 WHO classification?

1. ABRAF V600E with CDKN2A deletion
2. BH3 K27M mutation
3. CIDH-wildtype with EGFR amplification
4. DATRX loss with TP53 mutation
5. EIDH mutation with 1p/19q codeletion

Methylation of which gene promoter predicts benefit from temozolomide in glioblastoma?

1. AIDH1
2. BMGMT
3. CPTEN
4. DTERT
5. EEGFR

What is the standard first-line treatment for a fit 55-year-old after resection of glioblastoma?

1. ATemozolomide alone
2. BRadiotherapy alone
3. CRadiotherapy 60 Gy with daily temozolomide, then 6 monthly cycles of temozolomide
4. DWhole-brain radiotherapy
5. EBevacizumab with radiotherapy

The classic "fried egg" cells with chicken-wire capillaries and calcification describe:

1. AMedulloblastoma
2. BGlioblastoma
3. CMeningioma
4. DOligodendroglioma
5. EPilocytic astrocytoma

A biopsy shows a highly cellular astrocytic tumour with a band of crowded nuclei around necrosis (schematic shown). In an adult with an IDH-wildtype tumour this is:

1. APilocytic astrocytoma
2. BMeningioma
3. CGlioblastoma
4. DEpendymoma
5. EOligodendroglioma

A patient with a brain tumour has never had a seizure. What should be done about antiseizure medication?

1. AStart phenytoin for life
2. BNo prophylactic antiseizure drug
3. CStart carbamazepine during radiotherapy
4. DStart valproate and check levels
5. EStart levetiracetam for 1 year

Which antiseizure drug is preferred for a patient with a brain tumour who has had a seizure and is receiving chemotherapy?

1. ACarbamazepine
2. BLevetiracetam
3. CPhenytoin
4. DPhenobarbital
5. EOxcarbazepine with rifampicin

Dexamethasone is preferred over other steroids for brain tumour oedema mainly because:

1. AIt prevents seizures
2. BIt crosses into tumour but not normal brain
3. CIt shrinks the tumour cells directly
4. DIt is potent with almost no mineralocorticoid effect
5. EIt has no effect on glucose

A 60-year-old smoker has three ring-enhancing lesions at the grey–white junction with extensive oedema. Which is the most useful next test?

1. ALumbar puncture
2. BRepeat MRI in 6 months
3. CCT chest, abdomen and pelvis
4. DEEG
5. ESerum CEA only

Which treatment is usually preferred for 1–4 small brain metastases in a patient with controlled systemic disease?

1. AObservation only
2. BProphylactic phenytoin
3. CWhole-brain radiotherapy alone
4. DStereotactic radiosurgery alone
5. ECraniospinal irradiation

Patients with brain tumours who develop a deep vein thrombosis should usually:

1. ABe anticoagulated after a CT shows no bleeding
2. BNever receive anticoagulants
3. CReceive an IVC filter routinely
4. DReceive aspirin only
5. EReceive anticoagulation only if the tumour is benign

What is the commonest group of brain tumours in children?

1. AGlioblastomas
2. BLow-grade gliomas
3. CMeningiomas
4. DMetastases
5. EPrimary CNS lymphomas

Roughly what proportion of childhood brain tumours arise in the posterior fossa?

1. AOne-third to one-half
2. BAbout 90%
3. CNone in infants
4. DLess than 5%
5. EAll medulloblastomas and no gliomas

A 5-year-old has early-morning vomiting for 6 weeks, a broad-based gait and a head tilt. The best next step is:

1. AEye refraction
2. BStool examination
3. CUrgent brain MRI (or CT if MRI unavailable)
4. DAntihelminthic treatment
5. EProton pump inhibitor trial

The commonest malignant brain tumour of childhood is:

1. AGlioblastoma
2. BCraniopharyngioma
3. CMedulloblastoma
4. DOligodendroglioma
5. EMeningioma

Optic pathway glioma is most strongly associated with:

1. ATuberous sclerosis
2. BVon Hippel-Lindau disease
3. CNeurofibromatosis type 1
4. DLi-Fraumeni syndrome
5. EDown syndrome

Subependymal giant cell astrocytoma is associated with:

1. ANF2-related schwannomatosis
2. BGorlin syndrome
3. CLynch syndrome
4. DTurcot syndrome with APC
5. ETuberous sclerosis complex

Bilateral vestibular schwannomas are diagnostic of:

1. ANF1
2. BLi-Fraumeni
3. CTuberous sclerosis
4. DNF2-related schwannomatosis
5. ECowden syndrome

A cystic cerebellar mass with an enhancing mural nodule in a child (schematic shown) is most likely:

1. AMedulloblastoma
2. BMetastasis
3. CPilocytic astrocytoma
4. DGlioblastoma
5. EMeningioma

DIPG can usually be diagnosed without a biopsy because:

1. ABlood tests are diagnostic
2. BTypical MRI appearance in the right clinical setting is sufficient
3. CBiopsy is impossible
4. DIt never progresses
5. EIt is always benign

The main treatment for DIPG is:

1. ATemozolomide alone
2. BSurgical resection
3. CCraniospinal irradiation
4. DObservation
5. EFocal radiotherapy

What is the first step in management of most accessible diffuse gliomas?

1. AWhole-brain radiotherapy
2. BMaximal safe resection
3. CTemozolomide alone
4. DWatch and wait without tissue
5. ESteroids alone

After resection of a high-grade glioma, postoperative MRI should be done:

1. AOnly if symptoms appear
2. BAfter radiotherapy
3. CAt 6 weeks
4. DAt 3 months
5. EWithin 24–48 hours

Which statement about mobile phones and brain tumours is supported by evidence?

1. AThey cause most brain metastases
2. BEarphones increase the risk
3. CThey cause meningiomas in children
4. DThey are a proven cause of glioma
5. ENo causal link has been shown in large studies

Whole-brain radiotherapy added to radiosurgery for 1–3 metastases:

1. AIs required in all patients
2. BImproves overall survival
3. CHas no effect on intracranial control
4. DReduces new brain metastases but worsens cognition without improving survival
5. EPrevents seizures

Which side effect is NOT typical of long-term dexamethasone?

1. AWeight loss and low blood sugar
2. BHyperglycaemia
3. CInsomnia and mood change
4. DProximal myopathy
5. EOral thrush

Tumour-treating fields are:

1. AA form of proton therapy
2. BA vaccine
3. CA scalp-worn device delivering alternating electric fields, used with adjuvant temozolomide
4. DAn implanted chemotherapy wafer
5. EA radiosurgery technique

A 61-year-old man has 3 weeks of right-sided weakness. Post-contrast MRI (schematic) shows a large left hemispheric mass with a thick irregular enhancing rim, central necrosis, oedema and midline shift. He has no history of cancer. The most likely diagnosis is:

1. AGlioblastoma
2. BPilocytic astrocytoma
3. CMeningioma
4. DLow-grade oligodendroglioma
5. EColloid cyst

A 38-year-old has a non-enhancing right frontal tumour. MRI (schematic) shows a mass bright on T2 but dark in its centre on FLAIR with a bright rim. This sign suggests:

1. ALymphoma
2. BIDH-mutant, 1p/19q-intact astrocytoma
3. CGlioblastoma
4. DOligodendroglioma
5. EAbscess

CT of a 42-year-old with a frontal mass shows clumped calcification reaching the cortex (schematic). Which diagnosis is suggested?

1. AOligodendroglioma
2. BGlioblastoma
3. CPilocytic astrocytoma
4. DMeningioma
5. EMetastasis

A histologically grade 2 IDH-wildtype diffuse astrocytoma in a 63-year-old carries a TERT promoter mutation. The WHO 2021 diagnosis is:

1. AAstrocytoma, IDH-mutant, grade 2
2. BPleomorphic xanthoastrocytoma
3. COligodendroglioma
4. DDiffuse astrocytoma, grade 2
5. EGlioblastoma, IDH-wildtype, grade 4

An IDH-mutant astrocytoma with no necrosis has homozygous CDKN2A/B deletion. Its CNS WHO grade is:

1. A4
2. B1
3. C2
4. D3
5. EGrade not assigned

Immunohistochemistry for IDH1 R132H is negative in a grade 2 diffuse glioma in a 35-year-old. What next?

1. ATreat as glioblastoma
2. BTest MGMT and stop
3. CRepeat IHC on the same block
4. DDiagnose IDH-wildtype glioma
5. ESequence IDH1 codon 132 and IDH2 codon 172

In an IDH-mutant glioma, retained ATRX expression and no p53 overexpression suggest:

1. AEpendymoma
2. BH3 K27M glioma
3. CGlioblastoma
4. DIDH-mutant astrocytoma
5. E1p/19q codeletion (oligodendroglioma)

In the EORTC/NCIC trial, about how much did temozolomide improve 2-year survival in glioblastoma?

1. AFrom 1% to 2%
2. BFrom 50% to 90%
3. CNo difference
4. DFrom 27% to 11%
5. EFrom about 11% to 27%

In MGMT-methylated glioblastoma (Hegi analysis), median survival with RT + temozolomide versus RT alone was about:

1. A21.7 vs 15.3 months
2. B48 vs 31 months
3. C9 vs 8 months
4. D12.7 vs 11.8 months
5. E60 vs 15 months

A 74-year-old with glioblastoma, KPS 80, MGMT methylated. Which first-line option has randomised support?

1. ABevacizumab alone
2. BNivolumab with RT
3. CRT 60 Gy alone only
4. DShort-course RT (40 Gy in 15) with temozolomide
5. EWhole-brain RT

A 78-year-old with unmethylated glioblastoma, KPS 60, lives far away. A reasonable plan is:

1. ART 60 Gy with temozolomide and lomustine
2. BBevacizumab first line
3. CTemozolomide alone
4. DShort-course RT alone (25 Gy in 5 or 40 Gy in 15) or best supportive care
5. ETumour-treating fields alone

Bevacizumab in newly diagnosed glioblastoma (AVAglio, RTOG 0825):

1. AProlonged overall survival by 6 months
2. BProlonged PFS but not overall survival
3. CWas better tolerated than placebo
4. DHad no effect on any endpoint
5. EIs the standard of care

A patient on daily temozolomide during RT is taking dexamethasone and has lymphopenia. What prophylaxis is suggested?

1. AProphylactic antifungal fluconazole
2. BPneumocystis jirovecii prophylaxis
3. CRoutine G-CSF
4. DRoutine antibacterial ciprofloxacin
5. EAntiviral acyclovir for all

Ten weeks after chemoradiation for MGMT-methylated glioblastoma, MRI shows new enhancement at the cavity rim. The patient is well. Best approach?

1. AUrgent re-resection
2. BHospice referral
3. CStart whole-brain RT
4. DStop temozolomide and start bevacizumab
5. EContinue adjuvant temozolomide and repeat MRI in 4–8 weeks

A 32-year-old has a residual, non-enhancing IDH-mutant astrocytoma (grade 2) after surgery; seizures are controlled. Which option has phase 3 evidence of delaying progression?

1. AVorasidenib
2. BBevacizumab
3. CLomustine alone
4. DWhole-brain radiotherapy
5. ENivolumab

In RTOG 9802 (high-risk low-grade glioma), adding PCV to radiotherapy changed median overall survival from about:

1. A13.3 to 7.8 years
2. B15 to 16 months
3. C2 to 3 years
4. D7.8 to 13.3 years
5. ENo change

In CATNON, which component improved survival in IDH-mutant grade 3 astrocytoma?

1. AConcurrent daily temozolomide only
2. BTwelve cycles of adjuvant temozolomide after RT
3. CBevacizumab
4. DWhole-brain RT
5. ELomustine maintenance

Which approach is recommended for dexamethasone in a patient with a brain metastasis and no neurological symptoms?

1. A16 mg daily until RT ends
2. B4 mg daily lifelong
3. CSteroids only during SRS, always
4. DMethylprednisolone pulses
5. ENo steroid

A fit 55-year-old with controlled breast cancer has a single 3.8 cm cerebellar metastasis with fourth-ventricle compression. Best initial local treatment?

1. ASurgical resection followed by cavity SRS
2. BSRS alone in a single fraction
3. CWhole-brain RT alone
4. DObservation
5. ESteroids alone

After complete resection of a brain metastasis, observation without radiotherapy leads to local recurrence at 12 months in about:

1. AAll patients
2. B1% of patients
3. CIt cannot recur
4. DHalf of patients
5. E10% of patients

A patient needs WBRT for 30 metastases. Which measures reduce cognitive decline?

1. ASteroids for 1 year
2. BProphylactic levetiracetam
3. CAdding temozolomide
4. DHigher dose per fraction
5. EHippocampal-avoidance IMRT plus memantine

A never-smoker with EGFR exon 19-deleted lung cancer has three asymptomatic 5–9 mm brain metastases. Which plan is reasonable?

1. AProphylactic phenytoin and chemotherapy
2. BOsimertinib with MRI in 6–8 weeks, SRS if lesions grow or cause symptoms
3. CUpfront whole-brain RT then gefitinib
4. DDexamethasone and observation only
5. ECraniotomy for all three

A patient with a glioblastoma has a pulmonary embolism. CT head shows no bleeding. Which anticoagulant is suggested?

1. AIVC filter only
2. BAspirin
3. CWarfarin as first choice
4. DA direct oral anticoagulant (or LMWH if unsuitable)
5. ENo anticoagulation

Which brain metastases carry a higher risk of spontaneous haemorrhage, so anticoagulation needs extra caution?

1. AOvarian and bladder
2. BMelanoma, renal cell, thyroid and choriocarcinoma
3. CLymphoma and myeloma
4. DSmall cell lung and colorectal
5. EBreast and prostate

A patient with a glioma has been seizure-free for 2 years on levetiracetam and asks to stop. Approximately what proportion of glioma patients relapse after withdrawal?

1. AAbout 90%
2. BAbout 2%
3. CAll
4. DAbout a quarter
5. ENone

A 40-year-old with HIV has a single ring-enhancing basal ganglia lesion. Which conditions top the differential?

1. AColloid cyst and craniopharyngioma
2. BOligodendroglioma and DNET
3. CToxoplasmosis and primary CNS lymphoma
4. DMeningioma and schwannoma
5. EPilocytic astrocytoma and ependymoma

A 45-year-old on antituberculous treatment for 3 months for a "tuberculoma" has a growing periventricular, homogeneously enhancing, diffusion-restricting lesion. She is stable. What should be done?

1. AExtend antituberculous treatment to 18 months
2. BGross total resection
3. CWithhold steroids if possible and arrange stereotactic biopsy for suspected lymphoma
4. DDouble the steroid dose
5. EWhole-brain RT empirically

Which feature favours neurocysticercosis over a metastasis?

1. ADural-based enhancement
2. BA thick irregular ring with necrosis
3. CA small cyst with an eccentric dot (scolex) and calcified lesions elsewhere
4. DMultiple large lesions with extensive oedema in a smoker
5. ELesions at the grey–white junction that grow over weeks

Which MRI feature best distinguishes a pyogenic abscess from a necrotic tumour?

1. AMass effect
2. BSurrounding oedema
3. CRestricted diffusion in the cavity centre
4. DEnhancement
5. ET2 hyperintensity

Which is the best option at first recurrence of glioblastoma in a fit patient with a small, focal recurrence 14 months after diagnosis?

1. AWhole-brain RT
2. BBevacizumab plus lomustine because it prolongs survival
3. CHigh-dose dexamethasone only
4. DConsider re-resection and/or re-irradiation, or a single agent such as lomustine, after MDT review; offer a trial
5. ENivolumab because it beat bevacizumab

A 7-year-old has a progressive unresectable hypothalamic low-grade glioma with BRAF V600E. Compared with carboplatin–vincristine, dabrafenib plus trametinib gave:

1. AShorter PFS
2. BIdentical outcomes
3. CMore grade 3–4 toxicity
4. DNo responses
5. EHigher response (47 vs 11%) and longer PFS (20.1 vs 7.4 months)

For a child with progressive low-grade glioma and a KIAA1549-BRAF fusion, which targeted drug has single-arm phase 2 evidence (FIREFLY-1)?

1. ATovorafenib
2. BVorasidenib
3. COsimertinib
4. DImatinib
5. ELarotrectinib

Long-term overall survival in paediatric low-grade glioma is about:

1. A50% at 1 year
2. B30% at 5 years
3. C100% with no progression
4. D10% at 5 years
5. E90% at 20 years, though about half progress at some point

Which staging is needed after surgery for medulloblastoma?

1. ABone marrow biopsy only
2. BMRI of the whole spine and lumbar CSF cytology
3. CNo staging
4. DChest X-ray only
5. EPET-CT only

A 2-year-old has a completely resected malignant embryonal tumour. Why is radiotherapy usually delayed or avoided?

1. AChildren do not tolerate MRI
2. BEmbryonal tumours do not recur
3. CCranial RT in very young children causes severe neurocognitive and endocrine harm
4. DRT does not work in children
5. EChemotherapy is never used in infants

Hypofractionated radiotherapy for DIPG (39–45 Gy over about 3 weeks):

1. AWas non-inferior to conventional RT in a randomised trial of 253 children
2. BDoubled survival
3. CWas inferior
4. DReplaces the need for steroids
5. EIs never used

After gross total resection of a posterior fossa ependymoma in a 6-year-old, what is suggested?

1. ACraniospinal RT plus maintenance chemotherapy
2. BObservation alone
3. CBevacizumab
4. DFocal conformal radiotherapy
5. ETemozolomide alone

Loss of H3K27 trimethylation on immunohistochemistry in a posterior fossa ependymoma indicates:

1. AMedulloblastoma
2. BSupratentorial ZFTA fusion ependymoma
3. CPosterior fossa group A (PFA), the higher-risk group
4. DSubependymoma
5. EMyxopapillary ependymoma

In SHH-activated medulloblastoma in a 10-year-old, which germline test is particularly important?

1. AHER2
2. BIDH1
3. CTP53 (Li-Fraumeni)
4. DAPC
5. EBRCA1

A patient with glioblastoma on dexamethasone needs gastric protection. Which choice is suggested by recent pooled data?

1. AHigh-dose omeprazole
2. BAn H2 blocker rather than a proton pump inhibitor
3. CSucralfate with PPI
4. DPantoprazole for life
5. ENo protection ever

Which follow-up schedule is appropriate after chemoradiation for glioblastoma?

1. ACT every 2 years
2. BPET-CT monthly
3. CMRI about 4 weeks after RT, then every 2–3 months for 2–3 years
4. DMRI only at symptoms
5. ENo imaging after 6 months

India records about how many new malignant brain and CNS tumours a year (GLOBOCAN 2022)?

1. AAbout 32,000
2. BAbout 3,200
3. CAbout 1.5 million
4. DAbout 320,000
5. EAbout 1,000

A 45-year-old with MGMT-methylated glioblastoma, KPS 90, asks whether lomustine plus temozolomide is better than standard temozolomide. Which statement is most accurate?

1. AIt is the standard for unmethylated tumours
2. BCeTeG/NOA-09 suggested longer survival, but the trial was small and toxicity higher; it is an option, not the standard
3. CIt removes the need for radiotherapy
4. DIt doubled PFS in a large phase 3 trial
5. EIt is inferior and should not be used

Which first-line strategy WORSENED survival compared with temozolomide in MGMT-unmethylated glioblastoma?

1. AShort-course RT in the elderly
2. BLomustine–temozolomide
3. CRadiotherapy plus temozolomide
4. DRadiotherapy plus nivolumab (CheckMate 498)
5. ETumour-treating fields

A patient with glioblastoma is stable after 6 adjuvant temozolomide cycles and asks to continue to 12. The best evidence shows:

1. ABetter survival only if unmethylated
2. BA 6-month survival gain
3. CNo survival benefit from extending beyond 6 cycles, with more toxicity
4. DThat 24 cycles are standard
5. EThat stopping causes immediate relapse

In EF-14, which limitation is most important when interpreting the survival gain with tumour-treating fields?

1. ASurvival was worse
2. BIt tested RT dose escalation
3. CIt enrolled only unmethylated patients
4. DNo sham device; open-label design
5. EToo few patients

A 29-year-old with a grade 3 IDH-mutant astrocytoma (CDKN2A/B intact) after resection. Best evidence-based adjuvant plan?

1. ATemozolomide alone without RT
2. BVorasidenib alone
3. CObservation
4. DRT (about 59.4 Gy) followed by 12 cycles of temozolomide
5. ERT alone

For a newly diagnosed codeleted grade 3 oligodendroglioma, the evidence for RT plus PCV is strongest for which outcome?

1. ASeizure control only
2. BProgression-free survival only, no OS data
3. CQuality of life only
4. DResponse rate only
5. EOverall survival nearly doubled with long-term follow-up

A 50-year-old with a bihemispheric, multilobar codeleted oligodendroglioma would need near whole-brain RT. A reasonable initial approach is:

1. AResection of both hemispheres
2. BNo treatment ever
3. CChemotherapy first (PCV or temozolomide), deferring RT
4. DBevacizumab
5. EWhole-brain RT immediately

INDIGO enrolled patients with residual grade 2 IDH-mutant glioma. Which patient was outside its eligibility?

1. AA patient with an enhancing tumour on steroids with uncontrolled symptoms
2. BA patient with an oligodendroglioma after surgery only
3. CA 40-year-old with measurable non-enhancing residual tumour
4. DA 16-year-old with an astrocytoma
5. EA patient with KPS 90

A 22-year-old has a thalamic diffuse glioma with H3 K27M. Which statement is correct?

1. ASurgery is usually curative
2. BIDH testing defines it
3. CIt is a diffuse midline glioma, CNS WHO grade 4, regardless of histology
4. DIt is grade 2 if there is no necrosis
5. EIt responds to vorasidenib

An adult with a recurrent BRAF V600E-mutant glioma. Which treatment showed responses in a basket trial?

1. ACetuximab
2. BOsimertinib
3. CImatinib
4. DDabrafenib plus trametinib (ROAR)
5. EVorasidenib

Dose escalation of radiotherapy above 60 Gy for glioblastoma:

1. AHalves toxicity
2. BHas not improved survival with photons
3. CIs standard with brachytherapy
4. DIs required for MGMT-unmethylated tumours
5. EDoubles survival

Why is a margin of about 2 cm used around the gross tumour in glioblastoma radiotherapy?

1. ATo treat the spinal cord
2. BTo cover the other hemisphere
3. C80–90% of recurrences arise within 2 cm of the original tumour
4. DBecause glioblastoma metastasises to bone
5. EBecause steroids shrink the tumour

A woman on concurrent temozolomide has platelets of 60 × 10⁹/L in week 3. What is appropriate?

1. ASwitch to lomustine immediately
2. BStop RT and temozolomide permanently
3. CHold temozolomide, continue RT, monitor counts
4. DContinue temozolomide unchanged
5. EGive G-CSF

In the randomised trial of SRS vs hippocampal-avoidance WBRT for 5–20 brain metastases (Aizer 2026), which was found?

1. ABetter symptom scores with SRS and similar survival; more new lesions but less progression of treated lesions
2. BBetter survival with WBRT
3. CSRS was not feasible beyond 10 lesions
4. DMore fatigue with SRS
5. EIdentical rates of new lesions

In QUARTZ, adding WBRT to dexamethasone and supportive care in NSCLC patients unsuitable for surgery or SRS:

1. AIncreased survival by 6 months
2. BWas only tested in breast cancer
3. CImproved quality of life markedly
4. DDoubled survival
5. EDid not improve survival or quality-adjusted life

Which variables feed the lung adenocarcinoma Graded Prognostic Assessment?

1. AHistological grade only
2. BTumour size only
3. CCEA and LDH
4. DSex and smoking only
5. EKPS, age, extracranial metastases, number of brain metastases and EGFR/ALK status

After radiosurgery for melanoma brain metastases on immunotherapy, new enhancement appears at 6 months with low perfusion. The patient is well. Likely diagnosis?

1. AAbscess
2. BNew primary glioma
3. CDefinite progression requiring WBRT
4. DRadiation necrosis
5. EHaemorrhage

A meta-analysis comparing DOACs and LMWH in primary brain tumours found intracranial haemorrhage rates of about:

1. A15% with DOACs vs 1% with LMWH
2. BHigher with DOACs
3. CEqual at 50%
4. D3% with DOACs vs 26% with LMWH
5. E0% with both

For which patient is pharmacological VTE prophylaxis recommended?

1. AEvery outpatient with glioblastoma
2. BA patient in the immediate postoperative period after craniotomy
3. CNobody, ever
4. DAll patients receiving temozolomide
5. EAll patients with brain metastases on SRS

A patient on a CYP3A-metabolised TKI has a seizure from a brain metastasis. Which drug would you avoid?

1. ALamotrigine
2. BLacosamide
3. CBrivaracetam
4. DCarbamazepine
5. ELevetiracetam

Which statement about postoperative SRS versus WBRT after metastasis resection (N107C) is correct?

1. ANeither was better on any measure
2. BSRS reduced cognitive deterioration but had lower surgical-bed control
3. CWBRT caused less cognitive decline
4. DSRS improved survival
5. EBoth had identical local control

A 14-year-old with a hemispheric high-grade glioma has café-au-lait spots, consanguineous parents and a sibling with lymphoma. The tumour is hypermutated. Which approach is suggested after RT?

1. ADabrafenib plus trametinib
2. BVorasidenib
3. CObservation
4. DAnti-PD-1 therapy, with germline testing for constitutional MMR deficiency
5. EHigh-dose methotrexate

For a 5-year-old with a hemispheric H3-wildtype/IDH-wildtype high-grade glioma after maximal resection, which post-operative approach is most used outside a trial?

1. AObservation
2. BCraniospinal irradiation alone
3. CBevacizumab added to RT and temozolomide
4. DVincristine and carboplatin only
5. EFocal RT with temozolomide, then adjuvant temozolomide and lomustine

A child with DIPG asks about chemotherapy with RT. What does the evidence show?

1. ATemozolomide doubles survival
2. BHigh-dose chemotherapy with stem cell rescue cures most
3. CBevacizumab is standard
4. DNo systemic therapy has improved survival; trials are encouraged
5. EChemotherapy replaces RT

Which radiation-related late effect is most strongly associated with young age at treatment and larger fields?

1. AHair greying only
2. BCataract only
3. CSkin cancer only
4. DNeurocognitive decline (falling IQ)
5. ECardiomyopathy

In COG A9952 (young children with progressive LGG), carboplatin–vincristine versus thioguanine-procarbazine-lomustine-vincristine (TPCV) showed:

1. ATPCV doubled overall survival
2. BSimilar overall survival (86–87% at 5 years), with CV better tolerated
3. CBoth arms had 20% survival
4. DNeither drug regimen was tolerated
5. ECV was clearly inferior

An NF1-associated optic pathway glioma is enlarging slightly on MRI but vision is stable. The best approach is:

1. AStart carboplatin for size increase alone
2. BContinue surveillance with regular ophthalmology; treat for visual decline
3. CImmediate radiotherapy
4. DBiopsy now
5. EResection of the optic nerve

Which statement about BRAF V600E paediatric low-grade glioma is correct?

1. AIt is best treated with vorasidenib
2. BIt responds poorly to chemotherapy and better to BRAF/MEK inhibitors
3. CIt never transforms
4. DIt predicts cure with surgery alone in all cases
5. EIt is the commonest alteration in cerebellar pilocytic astrocytoma

A 26-year-old with a glioma has multiple café-au-lait macules and a sister with colon cancer at 30. The glioma is IDH-wildtype and hypermutated after no prior therapy. Which germline condition should be considered?

1. AMEN1
2. BFamilial hypercholesterolaemia
3. CLynch syndrome or constitutional mismatch-repair deficiency
4. DHereditary spherocytosis
5. EBRCA2

Dordaviprone was approved for recurrent H3 K27M-mutant diffuse midline glioma on the basis of:

1. AIDH inhibition
2. BEfficacy in DIPG only
3. CA randomised phase 3 survival benefit
4. DResponses in all patients
5. EA pooled analysis of selected patients with response rate about 20%; confirmatory randomised trial ongoing

In RTOG 1205, adding re-irradiation to bevacizumab for recurrent glioblastoma:

1. AWas tested only in children
2. BImproved PFS but not overall survival
3. CImproved overall survival by a year
4. DHad no effect on PFS
5. EWorsened survival

Which feature best predicts benefit from surgical resection of a single brain metastasis in Patchell-era trials?

1. AActive widespread metastases
2. BControlled extracranial disease and good performance status
3. CAge over 70
4. DMultiple brain lesions
5. ELow Karnofsky score

Within what distance of the hippocampi do metastases make hippocampal-avoidance WBRT inappropriate?

1. A2 cm
2. B10 cm
3. C5 mm
4. D5 cm
5. EAny distance

Mutant IDH1/2 enzymes produce which oncometabolite?

1. ASuccinate
2. BAlpha-ketoglutarate
3. CCitrate
4. DLactate
5. E2-hydroxyglutarate

Loss of nuclear ATRX staining in an IDH-mutant diffuse glioma indicates:

1. APilocytic astrocytoma
2. BGlioblastoma, IDH-wildtype
3. COligodendroglioma
4. DA failed stain only
5. EAstrocytic lineage (IDH-mutant astrocytoma)

Which marker is diagnostic, prognostic AND predictive in oligodendroglioma?

1. AChromosome 7 gain
2. BEGFR amplification
3. CATRX loss
4. DKi-67 index
5. E1p/19q codeletion

FISH shows 1p/19q "codeletion" but IDH sequencing is wild-type in a 64-year-old with an enhancing tumour. What is the most likely explanation?

1. AMetastasis
2. BOligodendroglioma, IDH-wildtype
3. CPilocytic astrocytoma
4. DPartial 1p/19q losses in an IDH-wildtype glioma such as glioblastoma
5. EA false-negative IDH test, so treat as oligodendroglioma

A 17-year-old has a hemispheric high-grade glioma with ATRX loss and strong p53, but IDH1 R132H is negative and IDH sequencing is wild-type. Which test is most important next?

1. ABRAF fusion
2. BMGMT methylation
3. CEGFR amplification
4. DH3 G34 mutation
5. E1p/19q codeletion

A pathology report reads "Diffuse astrocytoma, NOS". What does NOS mean?

1. ABenign tumour
2. BMolecular testing was not done or failed, so the integrated diagnosis cannot be made
3. CNo residual tumour
4. DNot of glial origin
5. ETesting was done and the tumour fits no defined type

A recurrent glioblastoma treated with temozolomide is now hypermutated with MSH6 loss. Which statement is correct?

1. ATreatment-induced hypermutation does not reliably predict benefit from checkpoint inhibitors, and MSH6 loss confers temozolomide resistance
2. BPembrolizumab is the standard of care
3. CIt indicates a new IDH mutation
4. DIt proves Lynch syndrome
5. EIt predicts response to more temozolomide

An IDH1 R132C (not R132H) mutation is found in a 30-year-old with an astrocytoma whose mother had breast cancer at 32. What should be offered?

1. ABRCA testing only
2. BVorasidenib is contraindicated
3. CGermline TP53 testing for Li-Fraumeni syndrome
4. DRepeat IDH IHC
5. ENo further action

Which statement about MGMT testing is correct?

1. AIt is not useful in older adults
2. BAssays vary and there is no universal cut-off; if the result is unavailable, fit patients still receive temozolomide
3. CIt defines oligodendroglioma
4. DIt is tested by IHC for IDH
5. EUnmethylated tumours should never receive temozolomide

Why should first-generation BRAF inhibitors be avoided in KIAA1549-BRAF fusion-positive pilocytic astrocytoma?

1. AThey can paradoxically activate MAPK signalling in fusion-positive tumours
2. BFusions are always benign
3. CThey cause DIPG
4. DThey do not cross the blood-brain barrier at all
5. EThey are only licensed in adults

Which is the earliest (founding) genetic event in IDH-mutant astrocytoma and oligodendroglioma?

1. APTEN loss
2. BMGMT methylation
3. CCDKN2A/B deletion
4. DIDH1 or IDH2 mutation
5. EEGFR amplification

Which three core pathways are altered in nearly all glioblastomas (TCGA 2008)?

1. AMismatch repair, base excision and nucleotide excision repair
2. BWNT, Hedgehog and Notch
3. CRTK/RAS/PI3K, p53 and RB
4. DBRCA, ATM and PALB2
5. EJAK-STAT, NF-kB and TGF-beta

How does mutant IDH lead to widespread DNA hypermethylation?

1. AIt deletes the MGMT gene
2. BIt causes 1p/19q loss
3. C2-hydroxyglutarate inhibits alpha-ketoglutarate-dependent TET demethylases
4. DIt directly methylates CpG islands
5. EIt activates DNMT3A transcription

How is the whole-arm 1p/19q codeletion of oligodendroglioma generated?

1. AGradual point deletions over many years
2. BChromothripsis of chromosome 7
3. CViral integration
4. DLoss of the whole of chromosomes 1 and 19
5. EAn unbalanced t(1;19) translocation followed by loss of the derivative chromosome

Why do IDH-wildtype glioblastomas often lie next to the lateral ventricles?

1. AThey appear to arise from subventricular-zone neural stem cells carrying low-level driver mutations
2. BRadiotherapy targets the ventricles
3. CThey are metastases
4. DEpendymal cells always transform
5. ECSF carries tumour cells from elsewhere

Why does bevacizumab shrink enhancement and oedema quickly in glioblastoma without prolonging survival?

1. AIt kills all tumour cells within days
2. BIt normalises leaky VEGF-driven vessels without eliminating the infiltrating tumour cells
3. CIt reverses MGMT methylation
4. DIt repairs TP53
5. EIt blocks IDH

Single-cell RNA sequencing of glioblastoma (Patel 2014) showed:

1. AMesenchymal cells are absent
2. BGlioblastoma cells are genetically identical
3. CSeveral expression subtypes coexist within one tumour
4. DEach tumour has a single uniform subtype
5. EAll cells carry EGFRvIII

How does the histone H3 K27M mutation drive diffuse midline glioma?

1. AIt produces 2-hydroxyglutarate
2. BIt inhibits PRC2, causing global loss of H3K27 trimethylation
3. CIt amplifies EGFR
4. DIt activates BRAF
5. EIt silences MGMT