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Space occupying lesion / progressive unilateral weakness

Clinical Discipline(s)/Organ System(s)
Nervous System, Neurology, Neurosurgery, Anatomical Pathology, Oncology, Infectious Diseases
Progress Test Topic(s)
A 48 year old Māori man presents with progressive left sided weakness. His partner tells you that he has been increasingly difficult to live with over the last few months with inability to make decisions and is becoming increasingly forgetful.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Anatomy of the cerebrum and cerebellum
   - Physiology of cerebrospinal fluid production and neuronal conduction
   - Pathophysiology and microbiology of cerebral abcesses
   - Histopathology and natural history of meningiomas, gliomas, neurofibromas and pituitary tumours
   - Natural history of malignancies that are likely to metastasise to the brain
Clinical and Communication Skills 
   - History from a patient with an intracerebral lesion
   - Perform a cranial nerve examination (including fundoscopy) and a peripheral nervous system examination
   - Interpret common electrolyte abnormalities associated with intracerebral lesions
   - Indications for CT and MRI
   - Differential diagnosis of a patient with headache
   - Emergency management of seizures and investigation of the cause
   - Outline the management of acutely raised intracranial pressure
   - Role of surgery, radiotherapy and palliative care in the management of cerebral tumour
   - Management and complications of reduced level of consciousness
Personal and Professional Skills 
   - Importance of having a plan and information to answer patient's questions when you break bad news
   - Consent in a patient with decreased mental capacity
   - Impact on the patient and family/whānau concerning prognosis
Hauora Māori 
   - Cancer inequalities of Māori vs non-Māori
   - The importance of Māori access to kaupapa Māori services
   - Disproportionate impact of illness of whānau employment/income and, therefore, availability of and models of care-giving
   - Culturally appropriate communication with whānau regarding prognosis that recognises differential health literacy needs
Population Health 
   - Epidemiology of intracranial tumours, including prognosis and survival
   - Provision of cancer services and cancer networks
Conditions to be considered relating to this scenario
primary tumour (glioma, meningioma), secondary tumour, aneurysm, abscess, chronic subdural haematoma, cerebral cyst, seizures
Less common but 'important not to miss'
multiple sclerosis, tuberculous meningitis, acute psychosis
primary central nervous system lymphoma, medulloblastomas, pseudotumour cerebri, granulomatous disease