FRCR

Question 1

Branchial cleft cysts

Answer 1

1st - preparotid
2nd - posterior to SM gland, anteromedial to SCM, lateral or anterolateral to carotid space. Can be anywhere from oropharynx to supraclav fossa - 95% - surgically remove if don’t resolve
Can present with otorrhoea if connects with EAM
3rd - posterior cervical space (tract from pyriform sinus)
4th - left pyriform sinus sinus tract (left 80% - can be down to mediasinum but more commonly at level of thyroid)

Question 2

Necrotic neck node

Answer 2

SCC

Papillary thyroid Ca

Question 3

Intracranial hypotension cause

Answer 3

Primary (spontaneous) or secondary to LP, surgery, overshunting
Primary from calcified thoracic disc protrusion causing dural tear, or dural dehiscence of diverticulum (perineural cyst), or sphenoid meningocele
Risk factors of Marfans, Ehlers Danllos, ADPKD
MR or CT myelography to identify leak, blood-patch to treat

Question 4

Intracranial hypotension signs

Answer 4

Present as postural headache, relieved recumbent
Subdural collection
Tonsillar ectopia
Sagging brainstem
Pachymeningeal enhancement
Prominent venous sinuses

Question 5

Dural tail

Answer 5

Seen in 72% of meningioma

Also seen in mets (breast, prostate) and granulomatous disease (sarcoid, TB)

Question 6

Meningioma, cranial and spinal locations

Answer 6

Cranial: parasagittal, convexities, sphenoid wing, CP angle, olfactory groove, planum sphenoidale
Spine: thoracic > cervical > lumbosacral
Meningiomas arise from cap cells in arachnoid layer

Question 7

CP angle mass

Answer 7

Schwannoma, meningioma, epidermoid cyst, arachnoid cyst, ependymoma, met

Schwannoma v meningioma:
Schwannoma more heterogeneours
Schwannoma widen IAM
Mengioma more likely to calcify
And meningioma broad dural base
Schwannoma haemorrhaga rare, 15% have cysts

Question 8

Mixed vascular malformation

Answer 8

Cavernoma + DVA

Question 9

Cavernous malformation

Answer 9

1/3 have multiple (familial, radiation)
Angiographically occult
Differential other causes of cerebral microhaemorrhage e.g. amyloid, HTN, DAI, vasculitis, mets
Low signal rim of haemosiderin
Commonly have a DVA
5th decade
Familial AD with incomplete penetrance

Question 10

HSV encephalitis

Answer 10

1/3 primary, 2/3 reactivation

Retrograde neuronal extension along nerved 1 and 5

Question 11

Subdural acuity

Answer 11

<3 days acute
3 days - 3 months subacute
> 3 months chronic
Stretching and tearing of briding cortical veins

Question 12

Bilateral subdural risk

Answer 12

Elderly with recurrent falls
Shunted hydrocephalus
Intracranial hypotension

Question 13

Heterotopia types

Answer 13

Subependymal, focal subcortical, band
Onset of epilespy is usually in 2nd decade in patients with isolated heterotopia
Subependymal nodular type is the most common type
Some cases are X-linked or AR
May be associated with schizencephaly, corpus callosum abnormalities, Dandy-Walker malformation

Question 14

Olfactory neuroblastoma

Answer 14

Bimodal peak - 10-15, 40-50
Peritumoural cysts
Arises from olfactory epithlium in cribriform region, upper third of nasal septum, superior and supreme turbinates.
Moderate to marked enhancement
Differential: SNUC (sinonasal undifferentiated carcinoma - very similar on imagine), sinonasal carcinoma (SCC), sinonasal adenocarcinoma, sinonasal adenoid cystic Ca.

Question 15

Rathkes cleft cyst

Answer 15

Fluid-fluid level (may be seen)
Intracystic non-enhancing nodule pathognomnic
May present with visual disturbance, diabetes insipidis, headache, hormonal dysfunction
Can have high T1 from protein, but variable

Question 16

Craniopharyngioma

Answer 16

Adamantinomatous (paeds) - machine oil, calcify, mixed solid and cystic
Papillary (adult) - calc rare, more solid
WHO 1
Can look like macroadenoma
Suprasellar

Question 17

Thalassaemia, non-skeletal manifestations

Answer 17

Splenomegaly, gallstones, haemosiderosis (liver and pancreas)
Die from chronic cardiac iron overload
T2* imaging for prognostication

Question 18

Thalassaemia, cause of decreased T1 signal in marrow

Answer 18

Marrow hyperplasia
Iron deposition from repeated transfusion
(can occur in untransfused from increased iron absorption)

Question 19

DNET

Answer 19

Temporal (50%), frontal (30%)
Male predominance
Focal cortical dysplasia associated in 50%
WHO 1
T2 bubbly, T1 low
Ca in 30%. May haemorrahge

Question 20

NPH

Answer 20

Increased flow velocity in cerebral aqueduct >24.5mL/min 95% specific

Question 21

Oropharyngeal cancer differential

Answer 21

SCC, minor salivary gland tumour, lymphoma

Question 22

NF

Answer 22

1 - 17

2 - 22

Question 23

Up to case 19

Answer 23

.

Question 24

Dural venous sinus thrombosis

Answer 24

50% associated with infarct

Diffusion restriction of venous infarct may be irregular