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CORE Neuro > Neuro H&N CORE - Sheet1 > Flashcards

Neuro H&N CORE - Sheet1 Flashcards

(103 cards)

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1
Q

most common primary petrous apex lesion

A

cholesterol granuloma (T1 + T2 bright)

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2
Q

“smoothly marginated lobulated cystic expansion of the petrous apex”

A

herniation of Meckel’s cave into the superomedial aspect of the petrous apex

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3
Q

what’s another name for an cholesteatoma in the petrous apex?

A

basically an epidermoid (T1 dark, T2 bright, restricts diffusion)

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4
Q

classic triad of Grandenigo syndrome

A

otomastoiditis + face pain (trigeminal neuropathy) + lateral rectus palsy (unilateral cross eye)

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5
Q

petrous apex/CPA tumor with internal calcs on CT + T2 bright/intense enhancement

A

endolymphatic sac tumor - very vascular with flow voids and tumor blush on angio

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6
Q

most common presenting symptom in glomus jugulare/paraganglioma?

A

hoarseness from vagal nerve compression

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7
Q

large vesitbular aqueduct syndrome is associated with what type of hearing loss?

A

progressive sensioneural hearing loss (90% association with absence of bony modiolus)

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8
Q

who gets labyrinthitis ossificans?

A

kids (2-18 months) s/p meningitis - also get sensineural hearing loss

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9
Q

what’s a better term for osteosclerosis

A

“otospongiosus” b/c bone becomes more lytic, not sclerotic

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10
Q

findings in fenestral ostosclerosis

A

bony resorption anterior the oval window

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11
Q

findings in retro-fenestral ostosclerosis

A

more severe form, demineralization around the cochlea, bilateral/symmetric nearly 100%

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12
Q

4 complications of otitis media

A
  1. coalescent mastoiditis 2. facial nerve palsy 3. dural sinus thrombosis 4. meningitis/labrynthitis
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13
Q

order of destruction in cholesteatoma

A
  1. the scutum 2. the ossicles (long process of the incus) 3. lateral segment of the semi-circular canal
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14
Q

most common type of cholesteatoma

A

Pars flaccida (the flimsy, whimpy part of the ear drum)

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15
Q

potential complication of cholesteatoma

A

labryrinthine fistula - bony defect between inner ear + tympanic cavity (usually lateral SCC)

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16
Q

“noise induced vertigo” or “tulio’s phenomenon”

A

superior semicircular canal dehiscence (aunt minnie)

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17
Q

what causes abnormal enhancement of the facial nerve?

A
  1. Bell’s Palsy! 2. Lyme 3. Ramsay hunt 4. cancer
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18
Q

what kind of trauma involves the facial nerve?

A

transverse T-bone fracture

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19
Q

“osteolysis circumscripta”

A

Paget skull changes - well-defined large radiolucent region favoring front/occipital bones (inner table > outer)

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20
Q

4 skull base Paget related complications

A
  1. deafness! 2. cranial nerve paresis 3. basilar invagination -> hydro -> brainstem compression 4. 2/2 (high gr) osteosarcoma
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21
Q

2 most common locations of chordoma

A
  1. sacrum 2. clivus
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22
Q

clivus lesions: chordoma vs. chrondrosarcoma

A

chordoma = midline, chondrosarcoma = lateral to midline (both T2 bright)

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23
Q

primary vascular supply of JNA (juvenile nasal angiofibroma)

A

ascending pharyngeal artery and/or internal maxillary artery

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24
Q

origin/location of JNA (juvenile nasal angiofibroma)

A

centered on the sphenopalantine foramen

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25
10% of inverting papillomas harbor a
squamous cell CA
26
"cerebrifom pattern" (sinus lesion)
inverting papilloma
27
class location of inverting papilloma
lateral wall of the nasal cavity - most frequently related to middle turbinate
28
dumbbell shaped lesion with AVID enhancement
esthesioneuroblastoma - waist of dumbbell at cribiform plate
29
demographic of esthesioneuroblastoma
bimodal - 20s and 60s
30
most common location of SNUC vs. squamous
SNUC(sinonasal undifferentiated carcinoma) large! ethmoid > maxillary; Squamous cell: maxillary antrum
31
"male teenager with nose bleeds"
JNA (juvenile nasal angiofibroma)
32
main vascular supply to the posterior nose (for uncontrolled nosebleeds)
sphenopalatine artery (terminal internal maxillary artery) - watch out for anastomosis btw ECA and ophthalmic
33
midline "sack of marbles" in the mouth
floor of mouth dermoid/epidermoid - fluid sack with globules of fat/midline
34
what's another term for ranula
mucous retention cyst
35
from whence do ranula arise?
sublingual gland/space
36
when do you use the term "plunging" for a ranula?
when it's under the mylohyoid muscle
37
"grandma's dentures won't stay in"
torus palatinus - bony exostosis
38
submandibular gland proper name
Wharton's (most common location for stones)
39
most common cause of odontogenic infection
extracted tooth (not an intact one)
40
what muscle separates the sublingual vs. submandibular space (and thus where infections go)?
mylohyoid (below the mylohyoid are the 2nd and 3rd molars - infections go to submandibular space)
41
most common masticator space "mass" in adult
odontogenic abscess
42
most common cause of Ludwig's angina
odontogenic infection
43
floor of mouth cellulitis + gas everywhere!
ludwig's angina
44
3 causes of osteonecrosis of the jaw
1. bisphosphonate treatment 2. prior radiation 3. licking a radium paint brush
45
cancer of the mouth in a younger person
HPV-related SCC
46
"young adult with new level 2 neck mass"
HPV-related SCC - large necrotic level 2a node
47
most common salivary gland tumor
pleomorphic adenoma aka benign mixed tumor
48
2nd most common benign tumor of the parotid
warthins - only occurs in parotid
49
4 things to know about warthins
1. usually cystic 2. male 3. bilateral (15%) 4. smoker 5. takes up pertechnetate
50
most common malignant tumor of the minor salivary glands
mucoepidermoid carcinoma
51
only salivary gland with lymph nodes
parotid (so it's the only one that can get lymphoma)
52
"bilateral parotid lymphoma"
Sjogrens
53
"bilateral mixed solid/cystic parotid lesions + HIV"
benign lymphoepithelial disease, painless
54
what's in the carotid space?
carotid artery, jugular vein, CN 9, 10, 11, and some nodes
55
glomus tympanicum: location
confined to middle ear, "overlying the cochlear promontory"
56
glomus vagale: location
above carotid bifurcation, but below the jugular foramen
57
glomus jugulare: location
skull base (destruction of jugular foramen)
58
carotid body tumor: location
carotid birfucation (splaying of ICA and ECA)
59
what's in the masticator space?
muscle of mastication, angle/ramus of the mandible, inferior aveloar nerve
60
angry masticator space mass in a kid
rhabomyosarcoma (less angry could be chondrosarc from the TMJ)
61
masticator space mass + phleboliths
cavernous hemangiomas (can also have venous/lymphatic malformations)
62
nerve sheath tumor in the masticator space
schwannoma or neurofibroma of V3
63
what's in the paraphyngeal space?
mostly fat, few branches of the trigeminal nerves and pterygoid veins
64
Grisel's syndrome
torticollis with atlanto-axial joint inflammation seen in H&N surgery or retropharyngeal abscess
65
nasopharyngeal SCC demographics
more common in Asians and bimodal - group 1 = 15-30yo/Chinese group 2 = >40yo
66
most common location of nasopharyngeal SCC
Fossa of Rosenmuller (causing unilateral mastoid effusion/blocking eustaschian tube)
67
3 subtypes of laryngeal SCC
1. supraglottic 2. glottic 3. infraglottic 4. "transglottic" (aggressive, crosses laryngeal ventricle, T3)
68
fixation of the cords indicates what T?
at least T3 laryngeal SCC
69
only reliable sign of cricoid invasion in laryngeal SCC
tumor on both sides of cartilage
70
implication of cricoid invasion in laryngeal SCC
contraindication to all types of laryngeal conservation surgery
71
ipsilateral expanded (vocal cord) ventricle
vocal cord paralysis (tumor is contralateral)
72
left-sided vocal cord paralysis should prompt
chest CT - for recurrent laryngeal nerve involvement at the AP window
73
definition: coloboma
focal discontinuity of the globe (usually posterior)
74
when I say "bilateral coloboma", you say
CHARGE (coloboma, heart, GU, ears)
75
"small eye with increases density of vitreous"
persistent hyperplastic primary vitreous (not calcification, but very dense on CT)
76
Coat's disease
retinal telangiectasia with leaky blood and subretinal exudate (hyperdense back of eye)
77
5 causes of retinal detachment
1. PHPV 2. Coats 3. trauma 4. sickle cell 5. old age
78
who gets optic glioma?
90% < 20 yo; if bilateral = NF-1
79
what's the optic nerve look like in optic glioma?
expansion/enlargement of the entire nerve
80
what's the optic nerve look like in optic nerve sheath meningioma?
"tram-track" calcification, circumferential enhancement around the optic nerve
81
3 syndromes of IgG4
1. orbital pseudotumor 2. Tolosa Hunt (cavernous sinus CN palsies) 3. lymphocytic hypophysitis (pituitary gland)
82
typical findings of orbital pseudotumor
painful, unilateral, lateral rectus, does NOT spare myotendinous insertions (unlike thyroid)
83
who gets lymphocytic hypophysitis
post-partum/3rd trimester woman - enlarged pituitary stalk (looks like adenoma with T2 dark rim)
84
most common benign orbital mass
dermoid - usually superior and lateral, arising from frontozygomatic suture
85
most common extraocular orbital malignancy in kids
rhabomyosarcoma
86
"racoon eyes" on physical exam
metastatic neuroblatoma - periorbital tumor infiltration with proptosis (also, basilar skull fracture)
87
cancer that causes enophlamos
metastatic breast causes a desmoplastic reaction and enophthalmos (primary orbitals cause proptosis)
88
weird associated between Chlamydia psittaci + this orbital tumor
MALT lymphoma of the orbit (enhances homogenously and restricts diffusion)
89
most common intra-ocular lesion in an adult
melanoma "collar button shaped"
90
most common primary malignancy of the globe
retinoblastoma
91
what is trilateral or quadrilateral retinoblastoma?
trilateral = both eyes + pineal gland, quadrilateral = both eyes + pineal + suprasellar
92
most common cause of spontaneous orbital hemorrhage
varix (also distend with provocative maneuvers)
93
2 types of carotid-cavernous fistulae
1. direct = 2/2 trauma 2. indirect = randomly in post-menopausal females
94
most common causes of pulsatile exophtalmos (2)
1. C-C fistula 2. NF-1 from sphenoid wing dysplasia
95
classic findings of C-C fistula
1. prominent superior ophthalmic vein 2. prominent cavernous sinus 3. proptosis
96
most common cause of pre-septal orbital cellulitis
adjacent structures (teeth/face)
97
most common cause of post-septal orbital cellulitis
paranasal sinuses
98
etiology of dacrocystitis
obstructon of lacrimal sac drainage --> bacterial infection (strep + staph)
99
enhancement of the optic nerve WITHOUT enlargement
optic neuritis - usually unilateral and painful
100
order of involvement of extraocular muscles in thyroid orbitopathy
I'M SLOw (inferior, medial, superior, lateral, superior Oblique)
101
thyroid orbitopathy vs. pseudotumor: symptoms
thyroid - not painful, pseudotumor is
102
thyroid orbitopathy vs. pseudotumor: tendon involvement?
thyroid - enlargement of only muscle belly, spares tendon; pseudotumor - involves the whole thing
103
Is pars flaccida or pars tensa more superior?
pars flaccida

CORE Neuro (4 decks)

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