Head and Neck Flashcards
(Ped) 16. Which of the following are correct regarding retinoblastoma (T/F)
(a) Is the most common intra-ocular malignancy in childhood.
(b) Ultrasound demonstrates a hypoechoic mass in the posterior globe.
(c) Is associated with pineblastoma.
(d) Is bilateral in 66 %.
(e) CT shows calcification in 90 %.
Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Retinoblastoma is the most common intraocular neoplasm of childhood. It appears as hyperechoic mass on ultrasound with variable shadowing due to calcification and heterogeneity due to necrosis and/or hemorrhage.
- Concerning orbital mass lesions: (T/F)
(a) 50% of patients with optic nerve glioma have neurofibromatosis Type 1.
(b) On MRI, retinoblastoma usually enhances following intravenous gadolinium.
(c) Rhabdomyosarcoma of the orbit presents with rapid onset proptosis and visual loss.
(d) Inflammatory orbital pseudotumour involves the muscle tendons.
(e) 60-80% of children with retinoblastoma have bilateral tumours.
Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
25% of the patients with optic nerve glioma have neurofibromatosis type I however only 15% of the patients with neurofibromatosis type I have optic nerve glioma. In the rhabdomyosarcoma of the orbit, there is rapid onset of proptosis however vision is spared. Only 20-40% of retinoblastomas occur bilaterally in children.
- Concerning the differentiation between optic nerve glioma and optic nerve sheath meningioma: (T/F)
(a) A widened optic canal is seen more commonly in optic nerve glioma.
(b) Optic nerve sheath meningioma affects an older age group.
(c) Optic nerve glioma typically shows the ‘tram-track’ sign on enhancement.
(d) Calcification is more commonly seen with optic nerve glioma.
(e) Optic nerve glioma may cause orbital hyperostosis.
Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Optic nerve sheath meningioma affects older age usually middle aged woman. Calcification can be seen with optic nerve meningioma but is the rarely seen with optic nerve glioma. Optic nerve sheath meningioma typically shows the tram track sign on enhancement Optic nerve sheath meningioma causes orbital hyperostosis.
- Concerning intraorbital pathology: (T/F)
(a) The lacrimal gland is the most frequently involved orbital structure in idiopathic inflammatory pseudotumour.
(b) Idiopathic inflammatory pseudotumour is unilateral in 40-50% of cases in adults.
(c) Optic nerve glioma is the commonest tumour arising from the optic nerve sheath complex.
(d) Use of steroids differentiates idiopathic inflammatory pseudotumour from lymphoma.
(e) Thyroid eye disease is the most common disorder affecting the orbit.
Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Pseudotumour is unilateral in 80% of the cases in adults. Use steroids in differentiating pseudotumour from lymphoma is not useful.
- Which of the following statements are correct about Congenital cholesteatoma of the middle ear: (T/F)
(a) 80 % of middle ear cholesteatoma are congenital in origin
(b) Facial nerve palsy is a recognized complication.
(c) The anterosuperior aspect of the middle ear is a typical location.
(d) MRI is the imaging modality of choice.
(e) Is associated with poorly pneumatised mastoid air cells:
Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Congenital cholesteatoma accounts for 2% of all cholesteatomas and are clinically differentiated from acquired as they occur behind an intact tympanic membrane in patients without a history of tympanic perforation or otorrhoea. CT provides more accurate information regarding the mass and bony structures than MRI. Well pneumatised mastoid air cells are seen in congenital cholesteatomas than in acquired.
(Ped) 25. Which of the following statements are correct about Juvenile angiofibromas: (T/F)
(a) Biopsy is contraindicated.
(b) Almost exclusively affects females.
(c) Widening of the pterygopalatine fossa is only seen in advanced cases.
(d) Is the commonest benign nasopharyngeal tumour.
(e) Invasion of the sphenoid sinus occurs in up to two thirds of cases
Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Juvenile angiofibromas affects only males. Widening of pterygopalatine fossa is seen in 90% of the cases. Due to significant vascularity and the risk of haemorrhage, biopsy is always contraindicated.
- Concerning the submandibular space: (T/F)
(a) Anteriorly there is free communication between the submandibular space and the sublingual space.
(b) The superficial lobe of the submandibular gland lies inferolateral to mylohyoid.
(c) Intraglandular ducts are seen as linear hypoechoic structures on ultrasound.
(d) Stenson’s duct exits in the floor of the mouth at the base of the frenulum.
(e) As with the parotid gland, normal lymph nodes are found within the submandibular gland.
Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Submandibular and sublingual space communicates posteriorly. Intraglandular ducts are seen as linear hyperechoic structures on USG. Wharton’s duct exits in the floor of mouth at the base of frenulum. Normal lymph nodes are not found in the submandibular gland.
- Which of the following are correct regarding lesions of the jaw? (T/F)
(a) Simple bone cysts are more common in the maxilla than the mandible
(b) A dentigerous cyst develops around an unerupted tooth.
(c) Dentigerous cysts are associated with basal cell naevi.
(d) Radicular cysts arise in relation to the tooth apex.
(e) Ameloblastoma occurs more frequently in the maxilla.
Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Bone cysts are unilocular and well-defined. They may be trauma-related and typically arise in the body of mandible. About 75% of neuroblastomas arise in the mandible, usually at the angle. The may be multilocular and are cystic expansile lesions, which often recur after excision.
- Regarding sonography of abnormal neck lymph nodes: (T/F)
(a) Malignant nodes have sharp borders, shereas benign nodes usually have unsharp borders.
(b) Regardless of primary tumour, the presence of a metastatic node reduces the 5-year survival rate by 50%.
(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.
Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Metastatic nodes are usually hyperechoic compared to the adjacent muscles. However metastatic nodes from papillary carcinoma of thyroid tend to be hyperechoic. Nodal calcification is seen in metastatic nodes from papillary and medullary carcinoma thyroid.
- Regarding Tornwaldt’s cysts, which of the following are correct? (T/F)
(a) They do not enhance after contrast on computed tomography (CT).
(b) They are midline in location.
(c) They are usually low signal on T1 weighted MRI sequence.
(d) The erode bone.
(e) They typically arise caudal to Rathke’s pouch cyst
Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Tornwaldt cyst usually show high signal on T1-weighted MR images due to high protein content in the cyst. They do not cause bony erosion. They are rarely calcified and usually appear hypodense on CT.
- Concerning imaging of the larynx, which of the following are correct? (T/F)
(a) Cricoid cartilage typically fractures in at least two places following trauma.
(b) More than 90% of laryngeal cancers are squamous cell tumours.
(c) The arytenoids usually dislocate rather than fracture during trauma.
(d) Glottic cancers typically arise from the anterior half of the vocal cord.
(e) AT presentation, subglottic tumours are frequently non-operative.
Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Following trauma, the arytenoids dislocate anteriorly and superiorly . Squamous carcinoma of larynx occurs most commonly at glottic location. Subglottic tumours are rare and involves trachea, oesophagus and thyroid and hence have a poor prognosis.
- Which of the following statements are correct about Thyroglossal duct cyst: (T/F)
(a) Is usually located the level of or immediately below the hyoid bone.
(b) Accounts for 70 % of all congenital neck anomalies.
(c) Is usually located in the midline.
(d) Typically presents as a painful neck lump.
(e) During embryological development, the thyroid gland migrates down behind the hyoid bone.
Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
The thyroid is gland begins to develop in the third week of gestation as a median outgrowth from the floor of the primitive pharynx at the level of foramen Caecum which lies at the junction of the anterior two thirds and posterior third of the tongue. It descends down on the floor of the mouth, anterior to the hyoid bone, to each its final position in the inferior part of the neck by 7th week of gestation. It typically presents as a painless lump. A painful lump can occur if there is imposed infection.
- Regarding thyroid carcinoma, which of the following are correct? (T/F)
(a) Lymph node spread occurs in 90% of patients with papillary cell carcinoma.
(b) Follicular carcinoma accounts for 60% of all thyroid carcinomas.
(c) Early haematogenous spread occurs in follicular carcinoma.
(d) Anaplastic carcinoma demonstrates no radioiodine uptake.
(e) Multiple endocrine neoplasia (MEN) type IIb may be associated with medullary cell carcinoma.
Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Papillary carcinoma of thyroid accounts for 60%, follicular 20%, anaplastic 10% and medullary 5% . Metastasis to nodes from papillary carcinoma occurs in 40% of adult cases and 90% of child cases.
- Which of the following are correct regarding salivary gland calculi? (T/F)
(a) Most submandibular stones are radio-opaque.
(b) Submandibular stones typically occur within Wharton’s duct.
(c) Asymptomatic Intraductal parotid stones can be an incidental finding on CT.
(d) More than 80% of salivary gland stones occur in the submandibular gland.
(e) About 25% of patients have multiple stones.
Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
About 10% to 20% of salivary gland calculi occur in parotid gland. About 80% of submandibular stones and 60% of parotid stones are radiopaque.
