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CORE Neuro > Neuro H&N CORE - Sheet1 > Flashcards

Neuro H&N CORE - Sheet1 Flashcards

1
Q

most common primary petrous apex lesion

A

cholesterol granuloma (T1 + T2 bright)

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2
Q

“smoothly marginated lobulated cystic expansion of the petrous apex”

A

herniation of Meckel’s cave into the superomedial aspect of the petrous apex

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3
Q

what’s another name for an cholesteatoma in the petrous apex?

A

basically an epidermoid (T1 dark, T2 bright, restricts diffusion)

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4
Q

classic triad of Grandenigo syndrome

A

otomastoiditis + face pain (trigeminal neuropathy) + lateral rectus palsy (unilateral cross eye)

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5
Q

petrous apex/CPA tumor with internal calcs on CT + T2 bright/intense enhancement

A

endolymphatic sac tumor - very vascular with flow voids and tumor blush on angio

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6
Q

most common presenting symptom in glomus jugulare/paraganglioma?

A

hoarseness from vagal nerve compression

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7
Q

large vesitbular aqueduct syndrome is associated with what type of hearing loss?

A

progressive sensioneural hearing loss (90% association with absence of bony modiolus)

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8
Q

who gets labyrinthitis ossificans?

A

kids (2-18 months) s/p meningitis - also get sensineural hearing loss

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9
Q

what’s a better term for osteosclerosis

A

“otospongiosus” b/c bone becomes more lytic, not sclerotic

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10
Q

findings in fenestral ostosclerosis

A

bony resorption anterior the oval window

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11
Q

findings in retro-fenestral ostosclerosis

A

more severe form, demineralization around the cochlea, bilateral/symmetric nearly 100%

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12
Q

4 complications of otitis media

A
  1. coalescent mastoiditis 2. facial nerve palsy 3. dural sinus thrombosis 4. meningitis/labrynthitis
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13
Q

order of destruction in cholesteatoma

A
  1. the scutum 2. the ossicles (long process of the incus) 3. lateral segment of the semi-circular canal
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14
Q

most common type of cholesteatoma

A

Pars flaccida (the flimsy, whimpy part of the ear drum)

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15
Q

potential complication of cholesteatoma

A

labryrinthine fistula - bony defect between inner ear + tympanic cavity (usually lateral SCC)

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16
Q

“noise induced vertigo” or “tulio’s phenomenon”

A

superior semicircular canal dehiscence (aunt minnie)

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17
Q

what causes abnormal enhancement of the facial nerve?

A
  1. Bell’s Palsy! 2. Lyme 3. Ramsay hunt 4. cancer
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18
Q

what kind of trauma involves the facial nerve?

A

transverse T-bone fracture

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19
Q

“osteolysis circumscripta”

A

Paget skull changes - well-defined large radiolucent region favoring front/occipital bones (inner table > outer)

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20
Q

4 skull base Paget related complications

A
  1. deafness! 2. cranial nerve paresis 3. basilar invagination -> hydro -> brainstem compression 4. 2/2 (high gr) osteosarcoma
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21
Q

2 most common locations of chordoma

A
  1. sacrum 2. clivus
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22
Q

clivus lesions: chordoma vs. chrondrosarcoma

A

chordoma = midline, chondrosarcoma = lateral to midline (both T2 bright)

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23
Q

primary vascular supply of JNA (juvenile nasal angiofibroma)

A

ascending pharyngeal artery and/or internal maxillary artery

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24
Q

origin/location of JNA (juvenile nasal angiofibroma)

A

centered on the sphenopalantine foramen

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25
Q

10% of inverting papillomas harbor a

A

squamous cell CA

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26
Q

“cerebrifom pattern” (sinus lesion)

A

inverting papilloma

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27
Q

class location of inverting papilloma

A

lateral wall of the nasal cavity - most frequently related to middle turbinate

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28
Q

dumbbell shaped lesion with AVID enhancement

A

esthesioneuroblastoma - waist of dumbbell at cribiform plate

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29
Q

demographic of esthesioneuroblastoma

A

bimodal - 20s and 60s

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30
Q

most common location of SNUC vs. squamous

A

SNUC(sinonasal undifferentiated carcinoma) large! ethmoid > maxillary; Squamous cell: maxillary antrum

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31
Q

“male teenager with nose bleeds”

A

JNA (juvenile nasal angiofibroma)

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32
Q

main vascular supply to the posterior nose (for uncontrolled nosebleeds)

A

sphenopalatine artery (terminal internal maxillary artery) - watch out for anastomosis btw ECA and ophthalmic

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33
Q

midline “sack of marbles” in the mouth

A

floor of mouth dermoid/epidermoid - fluid sack with globules of fat/midline

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34
Q

what’s another term for ranula

A

mucous retention cyst

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35
Q

from whence do ranula arise?

A

sublingual gland/space

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36
Q

when do you use the term “plunging” for a ranula?

A

when it’s under the mylohyoid muscle

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37
Q

“grandma’s dentures won’t stay in”

A

torus palatinus - bony exostosis

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38
Q

submandibular gland proper name

A

Wharton’s (most common location for stones)

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39
Q

most common cause of odontogenic infection

A

extracted tooth (not an intact one)

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40
Q

what muscle separates the sublingual vs. submandibular space (and thus where infections go)?

A

mylohyoid (below the mylohyoid are the 2nd and 3rd molars - infections go to submandibular space)

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41
Q

most common masticator space “mass” in adult

A

odontogenic abscess

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42
Q

most common cause of Ludwig’s angina

A

odontogenic infection

43
Q

floor of mouth cellulitis + gas everywhere!

A

ludwig’s angina

44
Q

3 causes of osteonecrosis of the jaw

A
  1. bisphosphonate treatment 2. prior radiation 3. licking a radium paint brush
45
Q

cancer of the mouth in a younger person

A

HPV-related SCC

46
Q

“young adult with new level 2 neck mass”

A

HPV-related SCC - large necrotic level 2a node

47
Q

most common salivary gland tumor

A

pleomorphic adenoma aka benign mixed tumor

48
Q

2nd most common benign tumor of the parotid

A

warthins - only occurs in parotid

49
Q

4 things to know about warthins

A
  1. usually cystic 2. male 3. bilateral (15%) 4. smoker 5. takes up pertechnetate
50
Q

most common malignant tumor of the minor salivary glands

A

mucoepidermoid carcinoma

51
Q

only salivary gland with lymph nodes

A

parotid (so it’s the only one that can get lymphoma)

52
Q

“bilateral parotid lymphoma”

A

Sjogrens

53
Q

“bilateral mixed solid/cystic parotid lesions + HIV”

A

benign lymphoepithelial disease, painless

54
Q

what’s in the carotid space?

A

carotid artery, jugular vein, CN 9, 10, 11, and some nodes

55
Q

glomus tympanicum: location

A

confined to middle ear, “overlying the cochlear promontory”

56
Q

glomus vagale: location

A

above carotid bifurcation, but below the jugular foramen

57
Q

glomus jugulare: location

A

skull base (destruction of jugular foramen)

58
Q

carotid body tumor: location

A

carotid birfucation (splaying of ICA and ECA)

59
Q

what’s in the masticator space?

A

muscle of mastication, angle/ramus of the mandible, inferior aveloar nerve

60
Q

angry masticator space mass in a kid

A

rhabomyosarcoma (less angry could be chondrosarc from the TMJ)

61
Q

masticator space mass + phleboliths

A

cavernous hemangiomas (can also have venous/lymphatic malformations)

62
Q

nerve sheath tumor in the masticator space

A

schwannoma or neurofibroma of V3

63
Q

what’s in the paraphyngeal space?

A

mostly fat, few branches of the trigeminal nerves and pterygoid veins

64
Q

Grisel’s syndrome

A

torticollis with atlanto-axial joint inflammation seen in H&N surgery or retropharyngeal abscess

65
Q

nasopharyngeal SCC demographics

A

more common in Asians and bimodal - group 1 = 15-30yo/Chinese group 2 = >40yo

66
Q

most common location of nasopharyngeal SCC

A

Fossa of Rosenmuller (causing unilateral mastoid effusion/blocking eustaschian tube)

67
Q

3 subtypes of laryngeal SCC

A
  1. supraglottic 2. glottic 3. infraglottic 4. “transglottic” (aggressive, crosses laryngeal ventricle, T3)
68
Q

fixation of the cords indicates what T?

A

at least T3 laryngeal SCC

69
Q

only reliable sign of cricoid invasion in laryngeal SCC

A

tumor on both sides of cartilage

70
Q

implication of cricoid invasion in laryngeal SCC

A

contraindication to all types of laryngeal conservation surgery

71
Q

ipsilateral expanded (vocal cord) ventricle

A

vocal cord paralysis (tumor is contralateral)

72
Q

left-sided vocal cord paralysis should prompt

A

chest CT - for recurrent laryngeal nerve involvement at the AP window

73
Q

definition: coloboma

A

focal discontinuity of the globe (usually posterior)

74
Q

when I say “bilateral coloboma”, you say

A

CHARGE (coloboma, heart, GU, ears)

75
Q

“small eye with increases density of vitreous”

A

persistent hyperplastic primary vitreous (not calcification, but very dense on CT)

76
Q

Coat’s disease

A

retinal telangiectasia with leaky blood and subretinal exudate (hyperdense back of eye)

77
Q

5 causes of retinal detachment

A
  1. PHPV 2. Coats 3. trauma 4. sickle cell 5. old age
78
Q

who gets optic glioma?

A

90% < 20 yo; if bilateral = NF-1

79
Q

what’s the optic nerve look like in optic glioma?

A

expansion/enlargement of the entire nerve

80
Q

what’s the optic nerve look like in optic nerve sheath meningioma?

A

“tram-track” calcification, circumferential enhancement around the optic nerve

81
Q

3 syndromes of IgG4

A
  1. orbital pseudotumor 2. Tolosa Hunt (cavernous sinus CN palsies) 3. lymphocytic hypophysitis (pituitary gland)
82
Q

typical findings of orbital pseudotumor

A

painful, unilateral, lateral rectus, does NOT spare myotendinous insertions (unlike thyroid)

83
Q

who gets lymphocytic hypophysitis

A

post-partum/3rd trimester woman - enlarged pituitary stalk (looks like adenoma with T2 dark rim)

84
Q

most common benign orbital mass

A

dermoid - usually superior and lateral, arising from frontozygomatic suture

85
Q

most common extraocular orbital malignancy in kids

A

rhabomyosarcoma

86
Q

“racoon eyes” on physical exam

A

metastatic neuroblatoma - periorbital tumor infiltration with proptosis (also, basilar skull fracture)

87
Q

cancer that causes enophlamos

A

metastatic breast causes a desmoplastic reaction and enophthalmos (primary orbitals cause proptosis)

88
Q

weird associated between Chlamydia psittaci + this orbital tumor

A

MALT lymphoma of the orbit (enhances homogenously and restricts diffusion)

89
Q

most common intra-ocular lesion in an adult

A

melanoma “collar button shaped”

90
Q

most common primary malignancy of the globe

A

retinoblastoma

91
Q

what is trilateral or quadrilateral retinoblastoma?

A

trilateral = both eyes + pineal gland, quadrilateral = both eyes + pineal + suprasellar

92
Q

most common cause of spontaneous orbital hemorrhage

A

varix (also distend with provocative maneuvers)

93
Q

2 types of carotid-cavernous fistulae

A
  1. direct = 2/2 trauma 2. indirect = randomly in post-menopausal females
94
Q

most common causes of pulsatile exophtalmos (2)

A
  1. C-C fistula 2. NF-1 from sphenoid wing dysplasia
95
Q

classic findings of C-C fistula

A
  1. prominent superior ophthalmic vein 2. prominent cavernous sinus 3. proptosis
96
Q

most common cause of pre-septal orbital cellulitis

A

adjacent structures (teeth/face)

97
Q

most common cause of post-septal orbital cellulitis

A

paranasal sinuses

98
Q

etiology of dacrocystitis

A

obstructon of lacrimal sac drainage –> bacterial infection (strep + staph)

99
Q

enhancement of the optic nerve WITHOUT enlargement

A

optic neuritis - usually unilateral and painful

100
Q

order of involvement of extraocular muscles in thyroid orbitopathy

A

I’M SLOw (inferior, medial, superior, lateral, superior Oblique)

101
Q

thyroid orbitopathy vs. pseudotumor: symptoms

A

thyroid - not painful, pseudotumor is

102
Q

thyroid orbitopathy vs. pseudotumor: tendon involvement?

A

thyroid - enlargement of only muscle belly, spares tendon; pseudotumor - involves the whole thing

103
Q

Is pars flaccida or pars tensa more superior?

A

pars flaccida

CORE Neuro (4 decks)

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