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a Prometheus book FRCR Part 2A flashcards > Module 6: H + N (not spine) > Flashcards

Module 6: H + N (not spine) Flashcards

1
Q

petrous apex
can get asymmetric marrow

what MRI sequence is useful and why

A

STIR fat satruation.
remove fat, can show a cholestrol grnauloma which might otherwise be hidden

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2
Q

Cephaloceles

what is it

A

herniation of CNS content through a cranium defect

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3
Q

two important carotid artery variant anatomy to be aware of

A

stapedial artery

aberrant internal carotid

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4
Q

what is the most common petrous primary lesion

A

cholestrol granuloma

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5
Q

cholestrol granuloma on MRI

A

T1 and T2 bright

T2 dark haemosiderin ring

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6
Q

what is a cholestrol grnauloma made from

A

blocked air cells with haemorrhage and inflammation continuining

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7
Q

What is a cholesteatoma

A

epidermoid (ectopic epithelial tissue)

congenital

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8
Q

How to define a choleastoma from a cholestrol granuloma

A

T1 dark for choleastoma and restrict diffusion

granuloma T1 and 2 are bright

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9
Q

otomastoiditis
trigeminal neuropathy
lateral rectus palsy

A

grandenigo syndrome

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10
Q

Endolymphatic sac tumour

ax to what condition
grow into where
how will they appear on CT
MRI?

A

vHL

CPA

calcifcaiton on CT

MRI - T2 bright

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11
Q

Paraganglioma in jugular region present with q

A

hoarse voice from vagus nerve

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12
Q

Large vestibular aqueduct syndrome is what

A

bony canal between vestibulae(inner ear) and endolymphatic sac.

enlarged causes progressive sensorineural hearing loss

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13
Q

VA vs PSCC size

in vestibular aqueduct syndrome

A

normall VA is not larger than the PSCC.

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14
Q

MRI appearance of labyrinthitis

A

inflammation of the membranous labyrinth.

cochlea and semicircular cancals enhance on T1 post contrast

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15
Q

what happens in layrinthitis ossificans

A

ossification of the membranous labyrinth

causes sensori neural hearing loss

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16
Q

two types of otosclerosis

A

fenestral

retrofenestral

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17
Q

Fenestral otosclerosis

A

bony resorption anterior to the oval window,

Footplate will fuse to the oval window

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18
Q

Retrofenstal otosclerosis

A

more severe form.

demineralization around the cochlea.

sensori neurla component. Bilateral and symeetric nearly 100% of the time

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19
Q

otitis media is infection where

A

middle ear
effusion

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20
Q

why do downs more commonly get otitis media

A

horizontal eustachian tube

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21
Q

definition of chronic for otitis media

A

6 weeks of fluid

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22
Q

complications of otitis media

A

coalescent mastoiditis

facial nerve pasly

dural sinus thrombosis

meningitis and labyrinthitis

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23
Q

Labyrinthine fistula can result from

A

a cholesteatoma

lateral semicircular canal most often involved in a fistula

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24
Q

superior semicircular canal dehiscene can cause

A

noice induced vertigo

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25
Q

causative bug of necrotising external otitis

A

pseudomonas

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26
Q

which bits of the facial nerve don’t enhance

A

cisternal
canalicular
labyrinthine

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27
Q

what can cause abnormal enhancement of the facial nerve

A

Bells palsy
Lymes
Ramsay hunt
Cancer

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28
Q

what are some compication of the pagets skull

A

deafness
cranial nerve paresis
if invading basilar, brainstem compression

high grade osteosarcoma

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29
Q

age variation of pagets vs fibrous dysplasia

A

pagets is over 80

Fibrous dysplasia is under 30

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30
Q

location variaton of pagets vs fibrous dysplasia

A

Fibrous dysplasia spares the otic capsule

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31
Q

What do McCune albright syndrome get

A

multifocal fibrous dysplasia
cafe au lait spots
precocoiuos puberty

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32
Q

Juvenile nasal angiofibroma is found on the ….

get expansion of the

A

sphenopalatine foramen

expansion of the pterygopalatine fossa

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33
Q

Juvenile nasal angiofibroma get blood supply fomr

A

ascending pharnygeal artery and internalmaxillary

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34
Q

inverting papilloma are found where

A

lateral wall of the nasal cavity

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35
Q

appearance of an inverting papilloma

A

focal hyperostosis at the tumour origin

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36
Q

Esthesioneuoblastoma is found where

….. and therefore appearance is

A

starts at cribiform plate

dumbell appearance

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37
Q

most common location for squamous cell sinuses

A

maxillary antrum

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38
Q

squamous cell sinuses mri appearance

A

low T21 due to packed cells.

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39
Q

with epistaxis, posterior bleeds can be N-IR embolised via what vessel

A

sphenopalatine artery.

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40
Q

with embolising nose bleeds what to watch out for

A

variant anastomosis between the ECA and opthalmic artery.

don’t want to embolize the eye

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41
Q

dermoid /epidermoid in the floor of the mouth has what appearance

A

sack of marbles

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42
Q

what is a Ranula

in the mouth

A

mucous retention cyst

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43
Q

Torus palatinus can be mistaken for what

A

cancer as it looks nasty

just bone overgrowth at the hard palate

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44
Q

Ludwigs angina is what (mouth)

A

aggro cellulitis.
gas everywhere

starts from odontogenic infection

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45
Q

What are the classical associated causes of ON of the mandible

A

bisphosphonates
radium paint licking
radiation

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46
Q

thyroglossalo duct cyst can appear where?

A

anywhere between the foramen cecum and the thyroid gland

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47
Q

thyroid nodules

microcalcificaitons think

A

papillary thyroid cancer

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48
Q

thyroid nodules

comet tail

A

colloid nodule

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49
Q

cause of large thyroid in UK vs AFrica

A

graves

africa likely low idoine

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50
Q

how does graves cause hyperthyroidims

A

antibodies directed towards tsh receptor

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51
Q

orbit and graves featurs

A

spares tendon insertion
IMSLO
Increased intra-orbital fat

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52
Q

hashimotos can cause increased risk of

A

primary thyroid lymphoma

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53
Q

what are the antibodies in Hashimotos

A

TPO and antithyroidglobulin

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54
Q

Level 6 node - delphian - think

A

laryngeal cancer met

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55
Q

subacute thyroiditis / De Quervains can be in repsonse to

A

upper airway infeciton

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56
Q

Reidels thyroiditis is one of what tpye of conditions

A

igG4 conditions

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57
Q

WHAT ARE THE OTHER iGg4 CONDITIONS

A

Orbital pseudo tumour
retroperitoneal fibrosis
sclerosing cholangitis

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58
Q

Papillary is…

A

popular

most common

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59
Q

Papillary cancer seen on imaging

A

microclacifications

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60
Q

How does follicular cancer metastatis

A

via blood

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61
Q

Medullary thyroid cancer is associated with what

A

MEN2

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62
Q

Medullary thyorid produces what

A

calcitonin

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63
Q

DOes medullary cancer respond to I-131

A

no

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64
Q

ANaplastic thyroid seen in

A

elderly

not repsond to i131 due to heavy differnetiation and no sodium idoine transporters

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65
Q

parathyroid anatomy

A

superior 2 from 4th branchial pouch

inferior 2 are from the 3rd

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66
Q

what are the causes of hyperparathyroidism ?

A

Hyperfunctioning adenoma

Multi-gland hyperplasia

Cancer

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67
Q

What factors does sestamibi prathyroid imaging depend on ?

A

mitochondrial density and blood flow

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68
Q

the partodi space contains

A

parotid gland
cranial nerve 7
retromandibular vein

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69
Q

Pleomorphic adneoma

MRI appearance

A

T2 bright

can be in parotid, submandibular and sublingual

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70
Q

Warthins will normally affect who

A

male
bilateral, smoker

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71
Q

most common malignant tuimour of the minor salivary glands

A

mucoepidermoid carcinoma

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72
Q

adnoid cystic carcinoma love what kind of spread

A

perineural

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73
Q

neural foramen widerning - what type of malignancy is ax

A

schwannoma

74
Q

bilateral parotid lymphoma diagnosis

A

Sjogrens

75
Q

benign lymphoepitheliam disease seen in which dieases

A

HIV

76
Q

what exists in the carotid space?

A

carotid artery
jugular vein
portions of CN9,10,11
Internal jugular chain lymph nodes

77
Q

what are the classic carotid space tumours

A

paraganglioma
schwannoma
neurofibroma

78
Q

what are the three paragangliomas and how to differentiate them

A

Glomus Tympanicum - confined middle ear

GLomus jugulare - skull base

Glomus vagale - below Jugular formane

79
Q

Nuclear medicine for paragangliomas is

A

In - Octreotide avid

80
Q

what is Lemierre syndrome

A

thrombophlebitits of jugular veins.

distant metatstatic sepsis.

get in recent ENT surgery or oropharyngeal infection

81
Q

a masticator space mass - most commonly is a

A

odontogenic infeciton

82
Q

if there is a masticator space infection where to look

A

bone windows at the mandible

spread via the pterygopalatine to orbital apex and cavernous sinsu

83
Q

perineural spread you think

A

adneoid cystic minor salivary tumour

melanoma

84
Q

where does the retropharyngeal space sit

A

behind the middle layer of the deep cervical fascia

anterior to the alar fascia

85
Q

what is the danger space

A

potential space, behind the alar fascia

only if distended

86
Q

what is bad about danger space

A

can track to the mediastinum

87
Q

Necrotic nodes can be due to

A

supparative infection

SSC mets

88
Q

What is Griesels syndrome

A

Torticollis from atlanto axial joint inflammation or retropharyngeal abscess

89
Q

relevance of the parapharyngeal space

A

based on its displacement can work out where there mass elegion is arsing from other areas

90
Q

what seperates neck segments 1a and 1b

A

anterior belly of digastric

91
Q

what seperates 1b from 2a

A

stylohyoid muscle

92
Q

what spereates 2a from 2b

A

spinal accessory nerve

93
Q

most common location for an nasopharyngeeal SCC

A

fossa of rosenmuller

94
Q

unilateral mastoid opacification can be due to

A

SCC at the fossa of rosenmuller

95
Q

laryngeal scc - fixation of the vocal cords indicates a

A

T3 tumour

96
Q

laryngocele - what is

A

laryngeal saccule dilates with fluid or air

due to obstruction (15% of the time due to tumour)

97
Q

if there is an expanded vocal cord ventricle - what to do next

A

look at the AP window for damage to the recurrent laryngeal nerve

98
Q

bilateral Coloboma is a part of what syndrome

A

CHARGE

99
Q

What is charge snydomr e

A

Coloboma
Heart
GU
Ears

100
Q

coats disease

A

retinal telangiectasis

101
Q

how to differentiate Coats disease and retinoblastoma

A

coats small globe and NO calcification

102
Q

tram track on the optic nerve think

A

Meningioma

103
Q

Optic nerve gliomas if bilateral think

A

NF1

104
Q

Orbital pseudotumour - features to distinguish it

A

lateral rectus
Painful
unilateral
doesn’t spare the myotendinous insertions

MRI T2 dark

105
Q

how to treat orbital pseudotumour

A

steroids

106
Q

Tolosa hunt syndrome found where

A

cavernous sinus

107
Q

Lymphocytuc hypophysitis

A

same as orbital pseudotumour but on pituitary gland

108
Q

most common benign congenitla orbital mass

A

dermoid

fat containing

109
Q

most common extra occular orbital malignancy in kids

A

rhabdomyosarcoma

110
Q

breast cancer mets to the orbits cause what

A

enopthalmos due to desmoplastic reaction

111
Q

two types of globe tumours are

A

Melanoma

retinoblastoma

112
Q

varix vs lymphangioma

A

varix distent with valsalva

lymphangioma have fluid fluid level

113
Q

NF1 patients can get pulsatile exopthalmus frommmmmm

A

sphenoid wing dysplasia

114
Q

what is dacrocystitis

A

inflammation of the lacrimal sac

115
Q

anterior spinal artery arises from where

A

termination of the vertebral arteries.

116
Q

what is the artery of adamkieicz

A

reinforcer of the anterior spinal artery.
comes off left aorta between T8 and T1.

supplies lower 2/3

117
Q

posterior spinal artery arises from where?

A

vertebral arteries or the posterior inferior cerebellar artery.

discontinous throughout

118
Q

conus medullaris: temrinates at L2/ L3 think

A

tethered cord

119
Q

epidural space in the cervical cord vs the lumbar spine

A

cervical cord mostly venous plexus

in the lumbar spine its mostly fat

120
Q

focal henriation

A

less than 90 degress of disc circumference

121
Q

boradbased herniation

A

more than 90

122
Q

protrusion vs extrusion

A

to do with the base width

123
Q

what is a schmorl node

A

herniation of disc material through a defect in the vertebral body endplate into the actual marrow

124
Q

what is scheuermanns

A

multi level Schmorls nodes in the spine of a teenager

kyphotic demority.

125
Q

what is a limbus vertebra

A

fracture mimic

herniated disc material between non fused apophysis and adjacent vertebral body

126
Q

what are the modic changes that can happen in the lumbar spine

A

edema

fat

scar

127
Q

describe the modic change based on differing MRI signals

A

T1 - edema. T1 dark, T2 bright.

2 - fat - T1 and T2 bright

T3 scar - T1 and T2 dark

128
Q

annular tears on MRI

appearance is

A

T2 bright and curvilinear look

129
Q

complications post spine surgery

arachnoiditis is seen as what on imaging

A

cclumped nerve roots. Empty thecal sac.

post 6 weeks is abnormal.

130
Q

Conjoined nerve roots

A

two nerve roots sharing an enalrge common sleeve

131
Q

scar vs residual disc post operatively

how to tell

A

with contrast

scar will enhance

132
Q

Hangman fracture is caused by

A

hyperextension

bilateral pedicle or pars fracture

133
Q

Chance fracture is found where

A

Horizontal fracture through the thoracolumbar spine

seatblet injury

134
Q

Jefferson fracture

A

burst C1

axial load

135
Q

odontoid fracture classications

A

1 - 3

1 - top
2 - base
3 - body of C2

only 1 is stable (maybe) - others unstable

136
Q

felxion teardrop in spine fracture is found where

A

anterior inferior vertebral body

137
Q

concern of a teardrop fracture

A

extensive underlying ligamentous injury
instability !

138
Q

anterior cord syndrome

what happens

A

motor function and anteiror column snesiaton is gone

139
Q

inverted hambruger sign on axial imaging

A

unilateral facet dislocation

140
Q

benign vs malignant

retropulsed fragment

A

benign!

141
Q

convex posterior vertebral body cortex think

A

malignant

142
Q

terminal ventricle in the spine whatn

A

development variant

no complications

normally about 4mm

143
Q

two types of spina bidifa

A

open - spinar bifida aperta

closed - occulta

144
Q

spina bifida: myelomeningoceles are assocaited with what

A

Chiari II malformations

145
Q

lipomyelocele are associated with

A

tethered cord

146
Q

Closed spinal dysraphisms without a subcut mass

what are they

A

INtradural lipomas

fibrolipoma

filum terminale (tight)

Dermal sinus

147
Q

What is the currarino triad

A

anterior sacral meningocele

anorectal malformation

sacrococcygeal osseous defect

148
Q

What is diastematomyelia

A

sagiital split in the spinal cord.

149
Q

how many types of spinal AVM / AVFs are there

A

4 types

150
Q

list types of spinal AVMs/ AVfs

A

Type 1 - dural AVF (single coiled vessel)

2 - intramedullary nidus (HHT and KTS)

3 - Juvenile - complex and bad

4 - perimedullary (noear conus)

151
Q

Foix Alajouanine Syndrome

A

myelopathy ax with dural AVF.

152
Q

ivory vertebrae and picture frame vertebrae

A

Pagets

153
Q

rugger jersey

A

renal osteodystrophy

hyperparathyroidism

osteopetrosis

154
Q

H shaped vertebra is

A

sickle cell

155
Q

TB in the spine

what can happen to the disc space

A

it can be spared

156
Q

calcified psoas abscess think

A

TB

157
Q

categorise cord pathology in what 5 categories

A

Demyelinating
Tumour
Vascular
Inflammatory
infectious

158
Q

common demyelinating conditions

A

MS (most)

Neuromyelitis optica
ADEM
Transverse Myleitis

159
Q

MS lesion s are typcially what length

A

short

2cm

160
Q

most common MS lesion site in the spine

A

cervical spine

if in spine will be in brain 90% of the time

161
Q

focal inflammation of the cord can be called

A

Transverse myellitis

162
Q

where can ADEM occur that you wouldn’t expect in MS

A

basal ganglia and pons

163
Q

bilateral symmetrically increased T2 signal in dorsal columns

result of

A

B12 deficiency

164
Q

GBS on MRI

A

enhancement of the nerve roots of the cauda equina

ant more than pos

165
Q

thickened, enhancing, onion bulb nerve roots

A

Chronic Inflammatory Demyelinating Polyneuropathy

166
Q

Timeframe of Chronic Inflammatory Demyelinating Polyneuropathy vs Guillain Barre Syndrom e

A

8 weeks

167
Q

Spine

intramedullar tumour types

A

astrocytoma
ependyomoma
haemangioblastoma

168
Q

Spine

extramedullar intradural

A

shwannnoma
meningioma
neurofbiroma
drop mets

169
Q

Extra dural types of cancer in spine

A

disc disease, bone tumours, mets, lymphoma

170
Q

most common intramedullary malignancy adults vs paeds

A

paeds - astrocytoma

adults - ependymoma

171
Q

features of astrocytoma in the spine

A

cervical

ecentric

long segment

172
Q

Ependyomoma features in spine

A

lower cord
central
short segment
haemorrhage with a dark cap

173
Q

haemangioblastoma appearance in spine

A

lots of oedema

VHL ax

thoracic favoured

174
Q

what shape do schwannomas make

A

dumbell around formane

175
Q

nf1 and Nf2

neurofibromas
schwannomas

A

neurofibromas are ax with NF1

Schwannomas are ax with NF2

176
Q

drop mets from

A

medulloblastoma

177
Q

most common paeds infratentorial tumour

A

medulloblastoma

178
Q

vertebral haemangioma will appear as

A

corduroy appearance

t1 and t2 bright

179
Q

osteoid osteoma vs osteoblastoma

A

SIZE 1.5vcm

180
Q

where in the spine can you get Giant Cell Tumour

A

Sacrum

181
Q

chordoma found in the

A

sacrum

clivus second

182
Q

vertebral plana in kid

A

Eosinophilic Granuloma

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