•53yo M who was diagnosed with renal cell carcinoma s/p nephrectomy 10 years ago. He recently developed issues with headaches and intermittent confusion and difficulty speaking.
•PMH is otherwise unremarkable
•Vital signs normal
•Neurologically intact except for mild word finding difficulty
1. What tests would you order prior to intervention?
2. The patient underwent surgical resection and the pathology was consistent with metastatic renal cell carcinoma. What cancer types most frequently metastasize to the brain?
3. He subsequently underwent stereotactic radiosurgery for small enhancement around the surgical resection cavity. What dose would you prescribe?
4. The patient presents increasing headaches and N/V w/ imaging revealing increased enhancement & edema. He is treated w/ steroids for 4 weeks & cannot be weaned off. What treatment is LEAST likely to result in improvement in brain edema and his symptoms?
5. Which of the following describes you?
6. I practice in one of the following locations.