Central Nervous System and Head & Neck - Practice papers

Question 1

@# 1. Regarding sonography of normal neck lymph nodes:
a) There are a total of 100 lymph nodes in the neck
b) At least 5 or 6 normal cervical nodes are identified routinely by sonography of the neck
c) The number of normal cervical lymph nodes that can be detected by ultrasound decreases
with advancing age
d) There is an increase in intranodal fatty infiltration with age
e) The normal submandibular and parotid nodes are usually round

Answer 1

1.
a) False - 300
b) True
c) True
d) True
e) True - elsewhere, malignant nodes tend to be round

Question 2

@# 2. The following are branches of the vertebral artery:
a) Anterior spinal artery
b) Anterior inferior cerebellar artery
c) Posterior inferior cerebellar artery
d) Superior cerebellar artery
e) Pontine artery

Answer 2

2.
a) True
b) False - this is a branch of the basilar artery
c) True
d) False - basilar artery
e) False - basilar artery

Question 3

3. Concerning the differentiation between optic nerve glioma and optic nerve sheath
   meningioma:
   a) Optic nerve sheath meningioma affects an older age group
   b) A widened optic canal is seen more commonly in optic nerve glioma
   c) Calcification is more commonly seen with optic nerve glioma
   d) Optic nerve glioma typically shows the ‘tram-track’ sign on enhancement
   e) Optic nerve glioma may cause orbital hyperostosis

Answer 3

3.
a) True - usually middle-aged women
b) True - in 90%
c) False
d) False - this is seen with optic nerve sheath meningioma
e) False - unlike optic nerve
sheath meningioma

Question 4

@# 4. Regarding the parathyroid glands:
a) Fewer than 2% of superior parathyroid glands are ectopic in location
b) The reported sensitivity of ultrasound in detection of parathyroid adenoma is only 40-45%
c) The parathyroid glands arise from the 3rd and 4th branchial pouches
d) Spin-echo T2 weighted MRI in the coronal plane is the most sensitive imaging sequence
for detection of parathyroid adenoma
e) Typically, parathyroid adenoma is seen as a homogenous hyperechoic nodule on ultrasound

Answer 4

4.
a) True
b) False - 65-85%
c) True
d) False - fat-suppressed T2 weighted MRI in the axial plane
e) False - hypoechoic

Question 5

@# 5. The basal ganglia consist of the following:
a) Corpus striatum
b) Claustrum
c) Fornix
d) Hippocampus
e) Amygdaloid body

Answer 5

5.
a) True - consisting of the caudate and lentiform nuclei
b) True
c) False
d) False
e) True

Question 6

6. Concerning intracranial lymphoma:
   a) It is usually a Hodgkin’s lymphoma
   b) Secondary lymphoma more commonly involves the leptomeninges than the brain
   parenchyma
   c) It is usually hypodense on unenhanced CT
   d) It is normally high signal on T2 weighted images
   e) Toxoplasmosis may mimic lymphoma in the brain

Answer 6

6.
a) False - B-cell non-Hodgkin’s lymphoma
b) True
c) False - hyperdense
d) False - intermediate to low signal on T2 weighted MRI due to high cell packing
e) True

Question 7

@# 7. Causes of loss of the lamina dura of the teeth include:
a) Osteomalacia
b) Hyperparathyroidism
c) Scleroderma
d) Langerhans’ cell histiocytosis
e) Paget’s disease

Answer 7

7.
a) True
b) True
c) True
d) True
e) True

Question 8

@# 8. Regarding fibro-osseous lesions of the face and jaw:
a) Periosteal reaction is not a feature of benign fibro-osseous lesions
b) The monostatic form accounts for 40-50% of cases of fibrous dysplasia
c) In fibrous dysplasia the teeth generally remain undisplaced with resorption
d) Most cemento-ossifying fibromas are treated surgically
e) Site predilection of fibrous dysplasia is for the mandible

Answer 8

8.
a) True
b) False - 80-85%
c) True - whereas cemento-ossifying fibroma may displace them or even resorb their roots
d) True
e) False - maxilla

Question 9

@# 9. Concerning glial tumours of the brain:
a) They account for 40-45% of all intracranial tumours
b) Low grade astrocytomas usually enhance
c) Glioblastoma multiforme is the most common and most malignant glioma
d) Calcification is seen in up to 40% of oligodendrogliomas on CT
e) Oligodendroglioma most commonly affects the parietal and occipital lobes

Answer 9

9.
a) True
b) False - very poor or no enhancement
c) True - accounts for 50% of gliomas
d) False - 70% show calcification on CT. 100% show calcification pathologically. However, a
calcified brain tumour is still more likely to be an astrocytoma
e) False - frontal lobes mostly

Question 10

@# 10. Concerning posterior fossa tumours in children:
a) 80% of medulloblastomas arise from the vermis
b) Juvenile pilocytic astrocytomas are the second commonest posterior fossa tumour
c) Juvenile pilocytic astrocytomas usually calcify
d) Brainstem gliomas mostly affect the midbrain
e) Ependymoma seeds to the CSF in 30% of cases

Answer 10

10.
a) True
b) True - medulloblastoma is the commonest
c) False - 20% calcify
d) False - most commonly affect the pons
e) True

Question 11

@# 11. The following are true regarding multiple sclerosis:
a) Periventricular lesions are aligned parallel to the long axis of the lateral ventricles
b) The thoracic cord is the most common part of the spinal cord to be affected
c) Lesions are typically bright on T2 weighted MRI
d) 40% of spinal cord lesions have associated brain lesions
e) Most spinal cord lesions are low signal on T1 weighted MRI

Answer 11

11.
a) False - perpendicular
b) False - cervical
c) True
d) False - 80%
e) False - this is true for brain lesions but not for spinal cord lesions

Question 12

@# 12. Concerning infraorbital pathology:
a) Optic nerve glioma is the commonest tumour arising from the optic nerve sheath complex
b) Idiopathic inflammatory pseudotumour is unilateral in 40-50% of cases in adults
c) The lacrimal gland is the most frequently involved orbital structure in idiopathic
inflammatory pseudotumour
d) Use of steroids differentiates idiopathic inflammatory pseudotumour from lymphoma
e) Thyroid eye disease is the most common disorder affecting the orbit

Answer 12

12.
a) True
b) False - 85% of cases
c) True
d) False - both pathologies respond in a similar way
e) True

Question 13

@# 13. Regarding paragangliomas:
a) They can arise anywhere from the base of skull to the floor of the pelvis
b) They usually enhance intensely with contrast
c) Glomus jugulare tumours typically produce a ‘salt and pepper’ appearance on CT
d) Glomus tympanicum tumour is the commonest tumour in the middle ear
e) Glomus vagale tumour most commonly affects the vagus nerve within the base of the skull
at the level of the jugular bulb

Answer 13

13.
a) True
b) True
c) False - on MRI, due to multiple small tumour vessels
d) True
e) False - most commonly inferior to base of skull, close to jugular foramen

Question 14

@# 14. The following are causes of white matter demyelination:
a) Behçet’s disease
b) Moya-moya disease
c) Lyme disease
d) Marchiafava-bignami syndrome
e) Subacute sclerosing panencephalitis

Answer 14

14.
a) True
b) True - idiopathic supraclinoid carotid artery obliterative arteriopathy mostly seen in
children
c) True
d) True - seen in red wine drinking alcoholics
e) True - in children with measles

Question 15

@# 15. The following are correct concerning MRI:
a) Spin-echo sequences use 180 degree pulses
b) Gradient-echo sequences use 180 degree pulses
c) Gradient-echo sequences have lower noise compared with spin- echo
d) Echo planar imaging is a fast spin-echo sequence
e) Spatial resolution of MRI is 2 line pairs per mm

Answer 15

15.
a) True
b) False
c) False
d) False - fast gradient-echo sequence used in diffusion imaging
e) False - 0.5 line pairs per mm

Question 16

@# 16. The following are true regarding meningitis:
a) Neisseria meningitides is the commonest cause in children
b) Subdural effusions are common in infants with Haemophilus influenzae
c) Leptomeningeal enhancement is more marked in tuberculosis than bacterial meningitis
d) Hydrocephalus is commonly seen in fungal meningitis
e) Group B haemolytic streptococcus is the commonest cause in neonates

Answer 16

16.
a) False - commonest cause in young adults. Haemophilus influenzae is commonest cause in
children
b) True
c) True
d) True
e) True

Question 17

@# 17. The following are branches of the external carotid artery:
a) Ascending pharyngeal artery
b) Inferior thyroid artery
c) Posterior auricular artery
d) Occipital artery
e) Lingual artery

Answer 17

17.
a) True
b) False - superior thyroid artery
c) True
d) True
e) True

Question 18

@# 18. Concerning neurodegenerative disorders:
a) Marked enlargement of the temporal horns is seen in Alzheimer’s disease
b) Thinning of the pars reticularis is seen on MRI in Parkinsonism
c) Huntington’s disease is inherited in autosomal dominant fashion
d) In Huntington’s disease, atrophy most severely affects the caudate nucleus
e) The Kayser-Fleischer ring is virtually diagnostic of Huntington’s disease

Answer 18

18.
a) True - due to atrophy of the temporal lobes
b) False - the pars compacta is thinned - The pars compacta is one of two subdivisions of the substantia nigra of the midbrain. it is situated medial to the pars reticulata.
c) True
d) True - causing characteristic heart-shaped enlargement of the frontal horns
e) False - Wilson’s disease

Question 19

@# 19. Choroid plexus papilloma:
a) Causes increased production of cerebrospinal fluid
b) Is usually hypodense on unenhanced CT
c) Usually affects the 4th ventricle in adults
d) Is usually low signal on T2 weighted MRI
e) Undergoes malignant degeneration in 2-4%

Answer 19

19.
a) True - leading to hydrocephalus
b) False - iso- or hyperdense
c) True - affects atria of lateral ventricles in children
d) False - high signal on T2 weighted imaging
e) False - 10-20%

Question 20

@# 20. The following will increase signal-to-noise ratio in MRI:
a) Decreasing the matrix size
b) More signal averages
c) Wide receiver bandwidth
d) Increased repetition time
e) Decreasing field strength

Answer 20

20.
a) True - as this will increase voxel size
b) True
c) False - narrow receiver bandwidth
d) True
e) False

Question 21

@# 21. Juvenile angiofibroma:
a) Is the commonest benign nasopharyngeal tumour
b) Almost exclusively affects females
c) Widening of the pterygopalatine fossa is only seen in advanced cases
d) Biopsy is contraindicated
e) Invasion of the sphenoid sinus occurs in up to two thirds of cases

Answer 21

21.
a) True
b) False - males
c) False - seen in 90% of cases
d) True - due to vascularity there is risk of haemorrhage
e) True

Question 22

@# 22. Concerning normal anatomy of the temporal bone:
a) The lateral two thirds of the external auditory canal are cartilaginous
b) The epitympanum contains the malleo-incudal articulation
c) The roof of the epitympanum forms the sinus tympani
d) The tympanic portion of the facial nerve runs posterolaterally and inferior to the lateral
semicircular canal
e) The stapes footplate sits in the round window nidus

Answer 22

22.
a) False - lateral third is cartilaginous. Medial two thirds are bony
b) True
c) False - the tegmen tympani, an important bony landmark. Once this is eroded disease may
spread to the middle cranial fossa
d) True
e) False - oval window niche

Question 23

@# 23. Concerning neurilemmoma (acoustic neuroma):
a) It is the third commonest neoplasm of the cerebellopontine angle
b) The sporadic form is more common in females
c) Bilateral tumours allow a presumptive diagnosis of Type 2 neurofibromatosis
d) It arises from the vestibular portion of the nerve in 85%
e) It is hypointense on T2 weighted MRI

Answer 23

23.
a) False - most common
b) True - ratio of 2:1
c) True
d) True - from cochlear portion in 15%
e) False - hyperintense. However, meningioma remains hypointense or isointense on T2
weighted imaging

Question 24

@# 24. Regarding sonography of abnormal neck lymph nodes:
a) Regardless of the primary tumour, the presence of a metastatic node reduces the 5-year
survival rate by 50%
b) Malignant nodes have sharp borders, whereas benign nodes usually have unsharp borders
c) Metastatic nodes are usually hyperechoic when compared to the adjacent muscles
d) Nodal calcification is common in metastatic nodes from follicular carcinoma of the thyroid
e) The presence of peripheral vascularity is highly suggestive of malignancy

Answer 24

24.
a) True
b) True
c) False - hypoechoic. However metastatic nodes from papillary carcinoma of the thyroid tend
to be hyperechoic
d) False - papillary and medullary carcinoma
e) True

Question 25

@# 25. The following are true concerning variants of the circle of Willis:
a) A ‘foetal’ posterior communicating artery is seen in up to 60-70% of people
b) The anterior cerebral artery may be fused as a single trunk
c) A hypoplastic anterior communicating artery is seen in 20% of people
d) Variation of at least one vessel, enough to affect its role as a collateral route, is found in
60% of people
e) The circle of Willis is complete in 90% of people

Answer 25

25.
a) False - large posterior communicating artery seen in 6-40% of people
b) True
c) False - 3%
d) True
e) True

Question 26

@# 26. Regarding viral central nervous system infections:
a) CSF aspirate is usually negative in Herpes simplex encephalitis
b) Decreased density of the temporal lobe on CT with sparing of the putamen is typical of
Herpes simplex encephalitis
c) Creutzfeldt-Jakob disease causes areas of high signal in the basal ganglia on T2 weighted
MRI
d) In Varicella zoster, cerebral infarcts are seen on the same side as the skin manifestations
e) Acute disseminated encephalomyelitis has a mortality of approximately 80%

Answer 26

26.
a) True
b) True
c) True
d) True
e) False - 20%

Question 27

@# 27. The following are true of MRI:
a) On proton-density weighted images of the brain, the grey matter is brighter than the white
matter
b) Short inversion recovery (STIR) sequences have a short echo time
c) Fluid attenuated inversion recovery is useful for identifying plaques adjacent to the
ventricles
d) Wide slice width requires a wide bandwidth
e) The Larmor frequency is proportional to the gyromagnetic ratio

Answer 27

27.
a) True
b) True - less than 80 ms
c) True
d) True
e) True

Question 28

@# 28. Concerning sellar masses:
a) Craniopharyngioma is the commonest childhood sellar mass
b) Craniopharyngioma is more commonly calcified in adults than children
c) Craniopharyngioma usually contains bright areas on T1 weighted images
d) Craniopharyngioma normally has a regular outline on imaging
e) Rathke’s cleft cyst develops from squamous epithelium in the sphenoid sinus

Answer 28

28.
a) True
b) False - 80% are calcified in children, 40% are calcified in adults
c) True - due to proteinaceous debris
d) False - iobulated and irregular
e) False - squamous epithelial remnants of the anterior lobe of the pituitary gland

Question 29

@# 29. Regarding the leukodystrophies:
a) Metachromic leukodystrophy is the commonest subtype
b) Adrenoleukodystrophy is inherited in autosomal recessive fashion
c) Leigh’s disease affects the basal ganglia
d) Metachromic leukodystrophy affects the basal ganglia
e) Infants with Canavan’s disease may have increased cranial circumference

Answer 29

29.
a) True - these are inherited abnormalities of formation and maintenance of myelin. They are
associated with gradual mental and motor deterioration in childhood. Metachromic
leukodystrophy is autosomal recessive and diffusely affects the white matter tracts
b) False - sex-linked, therefore boys only affected
c) True
d) False
e) True - also seen in Alexander’s disease

Question 30

@# 30. Concerning assessment of the submandibular space:
a) The vast majority of benign submandibular tumours are pleomorphic adenomas
b) Adenocarcinoma is the commonest malignant submandibular tumour
c) Pleomorphic adenomas are typically homogenous hyperechoic lesions on ultrasound
d) Between 80-90% of salivary gland calculi occur in the submandibular space
e) The earliest sign of Sjogren’s disease on ultrasound is hypoechoic glandular enlargement

Answer 30

30.
a) True
b) False - adenoid cystic carcinoma is the commonest
c) False - homogenous hypoechoic lesions producing distal acoustic enhancement
d) True
e) False - hyperechoic glandular enlargement