Head & Neck Imaging

Question 1

Pleomorphic adenoma on histology

Answer 1

50% of all salivary gland tumours (60% of parotid tumours)

Shows both epithelial and mesenchymal differentiation

Question 2

Most common multifocal salivary gland tumour

Answer 2

Warthin tumour (2nd most common salivary gland tumour)

Usually 60M and 8X more common in smokers

Cystic spaces lined by eosinophilic epithelial cells with a lymphoid stroma (oncocytic appearance)

Question 3

Which NPC is radiosensitive and what % present with nodal mets?

Answer 3

Undifferentiated carcinoma most radiosensitive

keratinising and non-keratinising less

90% have nodal mets at presentation

Question 4

3 types of laryngeal cancer

Answer 4

Glottic (60%): arise from true vocal cords. Nodal mets rare and effectively treated with XRT

Supraglottic (30-35%): arise from false cords, epiglottis, arytenoid. Nodal mets in 40%

Subglottic (less than 5%): nodal mets and tracheal/ oesophageal invasion

Question 5

Name 3 complications of head and neck infections

Answer 5

Epidural abscess

Osteomyelitis

Septic thrombophlebitis and lung abscess

Question 6

Name the top 4 malignant salivary gland tumours

Answer 6

Mucoepidermoid (15% of all tumours)

Adenocarcinoma (10%)

Adenoid cystic carcinoma (5%)

Acinic cell carcinoma (5%)

Question 7

Sudden SNHL after minor trauma

Answer 7

LVAS

Question 8

Histology of inverting papilloma

Answer 8

Respiratory epithelium enclosed by basement membrane

Question 9

Most common location of inverting papilloma

Answer 9

Lateral wall of nasal cavity related to middle turbinate and maxillary ostium

Question 10

Nasopharyngeal tumour with intracranial extension- peritumoral cysts between it and the brain. Dx?

Answer 10

Enthesioneuroblastoma (bimodal- 20 years and 60 years)

Question 11

Most common benign and malignant tumour of lacrimal gland?

Answer 11

Benign: pleomorphic adenoma

Malignant: adenoid cystic carcinoma

Question 12

Most common organism to cause necrotizing otitis externa

Answer 12

Pseudomonas

Question 13

Otosclerosis: 2 types

Answer 13

Fenestral: 80% fixation of stapes to oval window (CHL)

Retro-fenestral: 20% demineralisation of the cochlear capsule (SNHL)

Question 14

Top 3 primary tumours of skull base

Answer 14

Meningioma

Chondrosarcoma

Chordoma

Question 15

What causes epiglottis?

Answer 15

H. Influenza type B

Question 16

How is NPC treated?

Answer 16

radiotherapy +- chemoRx

Surgery is only for histological Dx

Question 17

What is Grisel syndrome?

Answer 17

Associated with RP abscess

Atlanto-axial subluxation due to inflammatory ligament instability

Question 18

Most common organism to cause necrotizing otitis externa

Answer 18

Pseudomonas

Question 19

Otosclerosis: 2 types

Answer 19

Fenestral: 80% fixation of stapes to oval window (CHL)

Retro-fenestral: 20% demineralisation of the cochlear capsule (SNHL)

Question 20

Top 3 primary tumours of skull base

Answer 20

Meningioma

Chondrosarcoma

Chordoma

Question 21

What causes epiglottis?

Answer 21

H. Influenza type B

Question 22

How is NPC treated?

Answer 22

radiotherapy +- chemoRx

Surgery is only for histological Dx

Question 23

What is Grisel syndrome?

Answer 23

Associated with RP abscess

Atlanto-axial subluxation due to inflammatory ligament instability

Question 24

Pertechnetate and radioiodine for the 3 major thyroid ca

Answer 24

PTC: radioiodine but not pertechnetate

FTC: pertechnetate but not radioiodine

MTC: neither (arises from parafollicular cells)- Thallium 201

Question 25

What do you do if FNA shows follicular adenoma?

Answer 25

Need excisional biopsy Overlap between follicular adenoma, follicular carcinoma and FV PTC

Question 26

Name 3 conditions associated with medullary thyroid ca.

Answer 26

MEN type 2 VHL NF-1

Question 27

Name 2 features of Gorlin-Goltz syndrome

Answer 27

Also called basal cell naevus syndrome Multiple BCCs Multiple KCOTs

Question 28

Best Nuc Med test for MTC?

Answer 28

Octreotide scan DMSA

Question 29

Best Nuc Med test for phaeo?

Answer 29

MIBG

Question 30

Coats disease

Answer 30

Retinal telangiectasia Exudative retinal detachment No calcification

Question 31

Name 2 features of NPC on CT

Answer 31

Isodense to muscle Infiltration of parapharyngeal space (T2) in 65-84%

Question 32

Most common location for giant cell reparative granuloma?

Answer 32

Midline mandible

Question 33

Name 3 features of Reidel thyroiditis

Answer 33

Autoimmune thyroiditis Lymphocytic infiltration and replacement of whole gland by fibrous tissue (as opposed to Hashimoto where only capsule becomes fibrotic) Only 30% have hypothyroidism (majority euthyroid)

Question 34

Name 3 features of De Quervain thyroiditis

Answer 34

Post-viral granulomatous thyroiditis (self-limiting) Hyperthyroidism (followed by hypo then return to normal) LOW uptake on thyroid scan (Rx with radioiodine CI!)

Question 35

Most common location of orbital haemangioma and signal characteristics on MR?

Answer 35

83% intraconal (most often lateral retrobulbar- slow painless proptosis) Intermediate T1, high T2 and slow peripheral enhancement with delayed washout

Question 36

What is Gradenigo syndrome and name 3 features

Answer 36

Head and neck infection from pseudomonas and enterococcus Triad of: Apical petrositis CN VI palsy as it passes through Dorello canal Retro-orbital pain or pain in V1-V2 distribution due to involvement of Meckel's cave

Question 37

PG vs SMG calculi. Which more common and which more likely to be radio-opaque?

Answer 37

SMG more common (80% vs 20%) SMG more likely radio-opaque (95% vs 60%)

Question 38

Name 4 conditions associated with Hashimoto

Answer 38

Turner syndrome Primary thyroid lymphoma Down syndrome Other autoimmune disorders: SLE, RA, Sjögren

Question 39

Macroscopic appearance of De Quervain

Answer 39

Unilateral or bilateral enlargement of lobes

Question 40

FNA of parotid lesion shows lymphocytes and polygonal cells

Answer 40

Warthins (papillary cystadenoma lymphomatosum)

Question 41

Normal radioactive iodine uptake value?

Answer 41

10-30% at 24 hours If more and uniform, suggestive of Graves disease

Question 42

Treatment for ameloblastoma and KCOT?

Answer 42

Surgical resection NOT curettage as high risk of recurrence

Question 43

Cholesteatoma- origin?

Answer 43

Chronic inflammation Retraction pocket in pars flaccida of TM Gives rise to cystic lesion with keratinising stratified squamous epithelium

Question 44

Lethal midline granuloma?

Answer 44

NK-cell lymphoma involving nose Poor Px