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FRCR 2a Flashcards > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

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

A

Papillary thyroid carcinoma

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2
Q

Thyroid nodule MACROcalcification is most associated with?

A

Medullary thyroid cancer

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3
Q

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

A

Benign thyroid lesions typically colloid thyroid nodules

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4
Q

What are the features of Riedel thyroiditis?

A

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

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5
Q

What is Riedel thyroiditis associated with?

A

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

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6
Q

Where are thyroglossal duct cysts most commonly found?

A

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

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7
Q

Most common location for ectopic thyroid?

A

Base of tongue - lingual thyroid.

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8
Q

What is the most common cause of hyperthyroidism?

A

Graves disease

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9
Q

Typical imaging features of Graves disease?

A

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

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10
Q

What is the most common cause of hypothyroidism and goitre?

A

Hashimotos thyroiditis

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11
Q

Classic findings of Hashimotos thyroiditis

A

Heterogeneous appearance - giraffe skin
Hyperechoic regenerative nodules

Low uptake of Tc99m
Diffuse uptake on PET

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12
Q

How does follicular thyroid cancer typically metastasize?

A

Haematogenous spread i.e. bone, lung

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13
Q

What is medullary thyroid cancer associated with?

A

MEN IIa and MEN IIb

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14
Q

How do thyroid lung mets typically present?

A

Miliary

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15
Q

Most common cause of primary hyperparathyroidism?

A

Parathyroid adenoma.

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16
Q

What is the most sensitive test to identify parathyroid adenoma?

A

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

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17
Q

What is an esthesioneuroblastoma?

A

Tumour of the olfactory cells

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18
Q

What are the typical imaging appearances of an esthesioneuroblastoma?

A

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

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19
Q

Where do chordomas originate from?

A

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

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20
Q

What are the imaging appearances for a chordoma?

A

Very high T2 signal.
Heterogeneous honeycomb enhancement.

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21
Q

How can you differentiate between a chondrosarcoma or a chordoma?

A

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

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22
Q

What are juvenile nasopharyngeal angiofibromas?

A

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

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23
Q

What is Osler-Weber-Rendu syndrome?

A

Hereditary haemorrhagic telangiectasia.
Autosomal dominant
Characterised by multiple AVMs

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24
Q

Where does Osler-Weber-Rendu syndrome typically occur?

A

Nasal 90%
Skin 90%
Liver 70-80%

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25
Q

What is the classical imaging appearances of an antrochoanal polyp?

A

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

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26
Q

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

A

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

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27
Q

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

A

SCC

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28
Q

What is a plunging ranula?

A

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

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29
Q

What is the most common salivary gland tumor?

A

Pleomorphic adenoma

30
Q

What are the common imaging features of a pleomorphic adenoma?

A

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

31
Q

Where are Warthin tumours commonly found?

A

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

32
Q

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

A

Warthin tumours shows uptake of Tc Pertechnetate.

33
Q

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

A

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

34
Q

How do mucoepidermoid carcinoma and adenoid cystic carcinoma typically spread?

A

Perineural spread.
Require careful long term followup

35
Q

Where do mucoepidermoid and adenoid cystic carcinoma typically affect?

A

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

36
Q

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

A

Sjogrens disease.

37
Q

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

A

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

38
Q

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

A

Cavernous sinus or orbital apex via the pterygopalatine fossa

39
Q

What is the “danger space” of the head and neck?

A

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

40
Q

Necrotic retro pharyngeal lymph nodes suggest what pathology?

A

SCC metastatic nodal disease
Papillary thyroid carcinoma nodal disease

41
Q

What is Grisel syndrome?

A

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

42
Q

What is Lemierre syndrome?

A

Jugular vein thrombosis and septic emboli from neck infection.

43
Q

What 4 spaces surround the parapharyngeal space?

A

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

44
Q

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

A

Nasopharyngeal carcinoma

45
Q

What is nasopharyngeal carcinoma typically associated with?

A

EBV

46
Q

What Tulosa Hunt syndrome?

A

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

47
Q

What is the most common malignant orbital tumours in childhood?

A

Rhabdomyosarcoma
Retinoblastoma

48
Q

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

A

Trilateral renitoblastoma - Bilateral retinoblastoma and pineoblastoma

Quadrilateral retinoblastoma - Bilateral retinoblastoma, pineoblastoma, suprasella tumour.

Osteosarcoma

49
Q

What is the classic triad of neuromyelitis optics?

A

Optic neuritis
Myelitis
Anti aquaporin 4 antibody

50
Q

What order does thyroid eye affect the eye muscles?

A

IM SLO

Inferior
Medial
Superior
Lateral
Oblique

51
Q

What are the orbital findings of a carotid cavernous fistula?

A

Pulsatile exophthalmos
Enlargement of the orbital veins

52
Q

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

A

Orbital lymphangioma

53
Q

Parotid lymphoma imaging features?

A

Multicystic appearance of both parotid glands.
Honeycomb appearance on MRI

54
Q

Classic imaging appearance of HIV parotitis?

A

Multiple bilateral hypoechoic cysts without posterior acoustic enchantment

55
Q

How do adenoid cystic carcinomas typically enhance?

A

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

56
Q

What do cholesteatoma look like on MRI?

A

T1 low
T2 bright
Restricted diffusion
No enhancement

57
Q

Most common primary intra ocular malignancy in adults?

A

Malignant uveal melanoma

High T1
Intermediate T2

58
Q

Most common pathogen that results in retropharyngeal abscess

A

Staphylococcus aureus

59
Q

Where are simple rannulas located?

A

Sublingual space

60
Q

What is Gorlin Goltz syndrome?

A

Basal cell naevus syndrome

Multiple odontogenic keratocysts
BCCs

61
Q

What does odontogenic keratocysts look like on CT and MR

A

Unilocular
Expansile
Typically posterior mandible

High T1 due to cholesterol and keratin
Heterogeneous T2
Restricted diffusion

62
Q

How does Horner’s syndrome present?

A
  • Enophthalmos
  • Ptosis
  • Miosis (small pupil)
63
Q

What are causes of Horner’s syndrome?

A

Pancoast tumour
Carotid artery aneurysm/dissection
Caroticocavernous fistula

64
Q

Transverse temporal bone fracture hearing loss type?

A

Sensorineural

65
Q

Longitudinal temporal bone fracture hearing loss type?

A

Conductive due to involvement of ossicles

66
Q

Mucocele Vs antrochoanal polyp?

A

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

67
Q

Classic imaging appearance of ameloblastoma?

A

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

68
Q

Age group of capillary Vs cavernous hemangiomas of the orbit?

A

Capillary hemangioma - child
Cavernous hemangioma - adults

69
Q

Typical appearance of a cricopharyngeal bar?

A

Posterior oesophageal indentation at C5-C6.

70
Q

Most common intraconal vascular lesion?

A

Cavernous haemangioma

71
Q

Cavernous hemangioma MRI appearance?

A

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

FRCR 2a Flashcards (11 decks)

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