Head and Neck

Question 1

What are micro-calcifications in a thyroid nodule most associated with?

Answer 1

Papillary thyroid carcinoma

Question 2

Thyroid nodule MACROcalcification is most associated with?

Answer 2

Medullary thyroid cancer

Question 3

Comet tail artifact is most commonly seen with what, in the neck?

Answer 3

Benign thyroid lesions typically colloid thyroid nodules

Question 4

What are the features of Riedel thyroiditis?

Answer 4

Replacement of the thyroid gland with fibrous tissue.
Enlargement of the thyroid with compression of adjacent structures

Question 5

What is Riedel thyroiditis associated with?

Answer 5

It is an IgG4 disease so associated with other IgG4 diseases.
- retroperitoneal fibrosis
- sclerosing cholangitis
- orbital pseudotumour
- Autoimmune pancreatitis

Question 6

Where are thyroglossal duct cysts most commonly found?

Answer 6

Midline.
Infrahyoid 45%
At the hyoid 30%
Suprahyoid 25%

Question 7

Most common location for ectopic thyroid?

Answer 7

Base of tongue - lingual thyroid.

Question 8

What is the most common cause of hyperthyroidism?

Answer 8

Graves disease

Question 9

Typical imaging features of Graves disease?

Answer 9

Enlarged thyroid.
Thyroid inferno pattern on colour Doppler.
Increased uptake on Tc99m Pertechnetate, and I-123

Question 10

What is the most common cause of hypothyroidism and goitre?

Answer 10

Hashimotos thyroiditis

Question 11

Classic findings of Hashimotos thyroiditis

Answer 11

Heterogeneous appearance - giraffe skin
Hyperechoic regenerative nodules

Low uptake of Tc99m
Diffuse uptake on PET

Question 12

How does follicular thyroid cancer typically metastasize?

Answer 12

Haematogenous spread i.e. bone, lung

Question 13

What is medullary thyroid cancer associated with?

Answer 13

MEN IIa and MEN IIb

Question 14

How do thyroid lung mets typically present?

Answer 14

Miliary

Question 15

Most common cause of primary hyperparathyroidism?

Answer 15

Parathyroid adenoma.

Question 16

What is the most sensitive test to identify parathyroid adenoma?

Answer 16

4D CT I.e. triple phase.
Appear as oval lesions
Avidly enhances arterial phase more than thyroid.
Washes out on delayed phase more than thyroid

Tc99m Sestamibi scan

Question 17

What is an esthesioneuroblastoma?

Answer 17

Tumour of the olfactory cells

Question 18

What are the typical imaging appearances of an esthesioneuroblastoma?

Answer 18

Solid AVIDLY enhancing mass centered on the cribiform plate.
Dumbbell shaped and extends upwards into the brain.

Question 19

Where do chordomas originate from?

Answer 19

Originate from the primitive notochord (earliest foetal axial skeleton).
They occur most typically in the sacrum and the clivus.

Question 20

What are the imaging appearances for a chordoma?

Answer 20

Very high T2 signal.
Heterogeneous honeycomb enhancement.

Question 21

How can you differentiate between a chondrosarcoma or a chordoma?

Answer 21

Chondrosarcoma are more lateral within the clivus.
Chordomas are within the midline.

Question 22

What are juvenile nasopharyngeal angiofibromas?

Answer 22

Benign but locally aggressive, highly vascular tumours, centered on the sphenopalatine foramen.
Occurs most in teenagers with nosebleeds.

Question 23

What is Osler-Weber-Rendu syndrome?

Answer 23

Hereditary haemorrhagic telangiectasia.
Autosomal dominant
Characterised by multiple AVMs

Question 24

Where does Osler-Weber-Rendu syndrome typically occur?

Answer 24

Nasal 90%
Skin 90%
Liver 70-80%

Question 25

What is the classical imaging appearances of an antrochoanal polyp?

Answer 25

Well defined mass in the maxillary sinus. Widening of the maxillary ostium, WITHOUT bony destruction

Question 26

What is an inverted papilloma and what are its classical MRI appearance?

Answer 26

Sinonasal tumour. Cerebriform pattern on T2 and T1 (looks like brain) Can have bony destruction.

Question 27

Inverted papillomas undergo malignant transformation, what do they turn into?

Answer 27

SCC

Question 28

What is a plunging ranula?

Answer 28

Sublingual mucous retention cyst that extends down into the submandibular space, crossing the mylohyoid muscle

Question 29

What is the most common salivary gland tumor?

Answer 29

Pleomorphic adenoma

Question 30

What are the common imaging features of a pleomorphic adenoma?

Answer 30

USS - hypoechoic, posterior acoustic enhancement MRI - very T2 bright

Question 31

Where are Warthin tumours commonly found?

Answer 31

Parotid gland. Can be bilateral in 15% of cases.

Question 32

How can you tell the difference between Pleomorphic adenoma and Warthin tumours?

Answer 32

Warthin tumours shows uptake of Tc Pertechnetate.

Question 33

What are the most common malignant tumours of the salivary glands?

Answer 33

1st. Mucoepidermoid carcinoma 2nd. Adenoid cystic carcinoma.

Question 34

How do mucoepidermoid carcinoma and adenoid cystic carcinoma typically spread?

Answer 34

Perineural spread. Require careful long term followup

Question 35

Where do mucoepidermoid and adenoid cystic carcinoma typically affect?

Answer 35

Minor salivary glands - the small and unnamed salivary glandular tissue scattered throughout the oral cavity

Question 36

Patient has bilateral lymphoma of the parotid glands. What underlying disease do they classically have?

Answer 36

Sjogrens disease.

Question 37

What is a paraganglioma and what are its classical imaging appearances on MRI?

Answer 37

They are also called glomus tumours. Neuroendocrine tumor. Highly vascular, containing micro haemorrhages, causing salt and pepper appearance on MRI.

Question 38

Masticator spaces malignancy/infection can spread to which other structures?

Answer 38

Cavernous sinus or orbital apex via the pterygopalatine fossa

Question 39

What is the "danger space" of the head and neck?

Answer 39

Space anterior to the cervical spine (prevertebral deep cervical fascia) that extends from the skull base to the mediastinum

Question 40

Necrotic retro pharyngeal lymph nodes suggest what pathology?

Answer 40

SCC metastatic nodal disease Papillary thyroid carcinoma nodal disease

Question 41

What is Grisel syndrome?

Answer 41

Retropharyngeal abscess causing: - Torticollis - Subluxation of the atlantoaxial joint.

Question 42

What is Lemierre syndrome?

Answer 42

Jugular vein thrombosis and septic emboli from neck infection.

Question 43

What 4 spaces surround the parapharyngeal space?

Answer 43

Anterior - masticator space Lateral - parotid space Posterior - carotid space Medial - superficial mucosal space

Question 44

Which tumour is classically found in the fossa of Rosenmuller, in typically Chinese patients?

Answer 44

Nasopharyngeal carcinoma

Question 45

What is nasopharyngeal carcinoma typically associated with?

Answer 45

EBV

Question 46

What Tulosa Hunt syndrome?

Answer 46

Orbtal pseudotumour (inflammation of the extra ocular muscles) also involving the cavernous sinus

Question 47

What is the most common malignant orbital tumours in childhood?

Answer 47

Rhabdomyosarcoma Retinoblastoma

Question 48

Children with bilateral retinoblastomas are also at risk of which other tumours?

Answer 48

Trilateral renitoblastoma - Bilateral retinoblastoma and pineoblastoma Quadrilateral retinoblastoma - Bilateral retinoblastoma, pineoblastoma, suprasella tumour. Osteosarcoma

Question 49

What is the classic triad of neuromyelitis optics?

Answer 49

Optic neuritis Myelitis Anti aquaporin 4 antibody

Question 50

What order does thyroid eye affect the eye muscles?

Answer 50

IM SLO Inferior Medial Superior Lateral Oblique

Question 51

What are the orbital findings of a carotid cavernous fistula?

Answer 51

Pulsatile exophthalmos Enlargement of the orbital veins

Question 52

What is the most common cause of exophthalmos after a viral illness in children?

Answer 52

Orbital lymphangioma

Question 53

Parotid lymphoma imaging features?

Answer 53

Multicystic appearance of both parotid glands. Honeycomb appearance on MRI

Question 54

Classic imaging appearance of HIV parotitis?

Answer 54

Multiple bilateral hypoechoic cysts without posterior acoustic enchantment

Question 55

How do adenoid cystic carcinomas typically enhance?

Answer 55

Both high grade and low grade adenoid cystic carcinomas typically enhance homogenously.

Question 56

What do cholesteatoma look like on MRI?

Answer 56

T1 low T2 bright Restricted diffusion No enhancement

Question 57

Most common primary intra ocular malignancy in adults?

Answer 57

Malignant uveal melanoma High T1 Intermediate T2

Question 58

Most common pathogen that results in retropharyngeal abscess

Answer 58

Staphylococcus aureus

Question 59

Where are simple rannulas located?

Answer 59

Sublingual space

Question 60

What is Gorlin Goltz syndrome?

Answer 60

Basal cell naevus syndrome Multiple odontogenic keratocysts BCCs

Question 61

What does odontogenic keratocysts look like on CT and MR

Answer 61

Unilocular Expansile Typically posterior mandible High T1 due to cholesterol and keratin Heterogeneous T2 Restricted diffusion

Question 62

How does Horner's syndrome present?

Answer 62

- Enophthalmos - Ptosis - Miosis (small pupil)

Question 63

What are causes of Horner's syndrome?

Answer 63

Pancoast tumour Carotid artery aneurysm/dissection Caroticocavernous fistula

Question 64

Transverse temporal bone fracture hearing loss type?

Answer 64

Sensorineural

Question 65

Longitudinal temporal bone fracture hearing loss type?

Answer 65

Conductive due to involvement of ossicles

Question 66

Mucocele Vs antrochoanal polyp?

Answer 66

Antrochoanal polyp widens the maxillary sinus ostium and can extend into the nasopharynx

Question 67

Classic imaging appearance of ameloblastoma?

Answer 67

"Soap bubble" appearance Resorption of adjacent teeth Avidly enhancing papillary projections are common

Question 68

Age group of capillary Vs cavernous hemangiomas of the orbit?

Answer 68

Capillary hemangioma - child Cavernous hemangioma - adults

Question 69

Typical appearance of a cricopharyngeal bar?

Answer 69

Posterior oesophageal indentation at C5-C6.

Question 70

Most common intraconal vascular lesion?

Answer 70

Cavernous haemangioma

Question 71

Cavernous hemangioma MRI appearance?

Answer 71

T1 - iso to muscle T2 - hyperintense to muscle, dark capsule Gd - slow irregular enhancement