Neuro: Head/Neck Flashcards
1
Q
optic canal –> contain what struct? (2)
A
- optic N
- ophthalmic A
2
Q
superior orbital fissure –> contain what struct? (4)
A
- CN III
- CN IV
- CN V1
- CN VI
3
Q
inferior orbital fissure –> contain what struct? (1)
A
- CN V2
4
Q
foramen rotundum –> what struct? (1)
A
CN V2
5
Q
orbit –> extraconal compartmt –> contain what struct? (3)
A
- lacrimal gland
- fat
- bony orbit
6
Q
orbit –> conal compartmt –> contain what struct? (1)
A
EOM
7
Q
orbit –> intraconal compartmt –> contain what struct? (4)
A
- optic N & sheath
- sensory & motor N
- LN
- fat
8
Q
orbital hemangioma –> 2 types?
A
- cavernous
- infantile (capillary)
9
Q
orbital hemangioma –> cavernous vs capillary –> epidemiology?
A
- cavernous: adult
- infantile (capillary): >1yo
10
Q
orbital hemangioma –> infantile (capillary) type –> natural progression?
A
first few mo of life –> enlrg –> then spont involute
11
Q
orbital hemangioma –> cavernous type –> CT appearance? MR?
A
CT: ovoid mass –> enhance
MR:
- T1 iso
- T2 hyper
- contrast: early patchy enhance –> progressive fill-in
12
Q
orbital lymphoma –> MC location?
A
lacrimal gland
13
Q
orbital lymphoma –> classic clinical presentation?
A
lymphoma –> lacrimal gland –> mass effect on globe –> painless downward proptosis
14
Q
orbital mass –> mold to the globe –> ddx? (2)
A
- orbital lymphoma
- orbital pseudotumor
15
Q
orbital lymphoma –> T1/T2 signal?
A
- T1 hypo
- T2 hypo
16
Q
orbital lymphangioma (orbital venolymphatic malformation VLM) –> epidemiology?
A
Ped
17
Q
what is lymphangioma?
A
benign hamartomatous lesion –> slow flow vascular
18
Q
orbital lymphangioma (orbital venolymphatic malformation VLM) –> imaging appearance?
A
multilocular cystic mass –> slight peripheral/septa enhance –> usu complex int contents & fluid levels from prior hemorrhage
19
Q
orbit –> schwannoma vs neurofibroma –> which is more common?
A
Schwannoma
20
Q
orbit –> schwannoma/ neurofibroma –> MC nerve? location in orbit?
A
V1 sensory br –> sup orbit
21
Q
orbit –> schwannoma/ neurofibroma –> MR appearance?
A
circumscribed ovoid mass:
- T1 hypo
- T2 hyper –> sometimes central hypo (target sign)
- enhance
22
Q
adult –> mets to orbit –> which CA? (5)
A
- breast
- lung
- thyroid
- RCC
- melanoma
23
Q
mets to orbit –> enophthalmos –> which CA? (1)
A
scirrhous breast CA
24
Q
ped –> mets to orbit –> which CA? (1)
A
Neuroblastoma
25
lacrimal gland --> composed of what tissue types? (2)
- epithelial salivary tissue
| - lymphoid tissue
26
lacrimal gland --> epithelial tumor --> benign %? Malig?
50% benign, 50% malig
27
what is thyroid ophthalmopathy? MOA?
thyroid dz --> lymphocyte --> hyaluronic acid --> orbit inflamm --> EOM fibrosis
28
thyroid ophthalmopathy --> EOM --> order of involvemt?
I'M SLow:
- inf rectus
- med rectus
- sup rectus
- lat rectus
29
differentiate: thyroid ophthalmopathy vs orbital pseudotumor (2)
thyroid ophthalmopathy:
- bilat
- spare muscle tendon
orbital pseudotumor:
- unilat
- involve muscle tendon
30
what is orbital pseudotumor?
idiopathic orbit inflamm
31
orbital pseudotumor --> clinical presentation?
painful proptosis
32
orbital pseudotumor --> dx of exclusion --> T/F?
T
33
orbital pseudotumor --> MC location?
lacrimal gland
34
orbital pseudotumor --> tx?
Steroid
35
orbital pseudotumor + involve cavernous sinus --> dx?
Tolosa-Hunt synd
36
optic N-sheath complex --> MC tumor? 2nd MC?
- #1 optic N glioma
| - #2 optic N meningioma
37
optic N glioma --> adult vs ped --> prognosis?
- adult: poor prognosis
| - ped: indolent
38
optic N glioma --> ped --> assoc condition? (1)
NF 1
39
optic N glioma --> ped --> usu unilat or bilat?
Bilat
40
optic N glioma --> ped --> MC MRI appearance?
variable appearance: optic N --> fusiform enlrg --> variable enhance
41
optic N glioma --> adult --> MC imaging appearance?
enhancing mass --> involve optic chiasm
42
optic N meningioma --> classic clinical presentation?
mid age F --> slow progress visual impair --> preserved central visual field
43
optic N meningioma --> imaging appearance?
tram-track sign:
- N-sheath --> circumferential thick --> uniform contrast enhance
- central --> optic N --> not enhance
44
ostiomeatal complex/unit --> common pathway for drainage of what sinuses (3) into which meatus?
frontal, ant ethmoid, maxillary --> ostiomeatal complex/unit --> middle meatus
45
post ethmoid & sphenoid sinus --> what is the common pathway? drains into which meatus?
sphenoethmoidal recess --> sup meatus
46
what is agger nasi cell? why is it significant?
ant-most ethmoid air cell located ant to frontal recess
lrg agger nasi cell --> narrow frontal recess
47
sinus: what is supraorbital cell? why is it significant?
ant ethmoid cell --> extend sup to orbit & ant ethmoidal notch (contain ant ethmoidal A) --> inc risk to ant ethmoidal A during surg
48
sinus: what is Haller (infraorbital) cell? why is it significant?
ethmoid air cell --> along medial orbital floor --> if lrg or inflamm --> narrow maxillary ostium
49
sinus: what is Onodi (sphenoethmoidal) cell? why is it significant?
post-most ethmoid cell --> extend sup & lat to sphenoid sinus
inc risk of intraoperative damage to adjacent optic N
50
fungal sinusitis --> MC type?
allergic fungal rhinosinusitis
51
what is allergic fungal rhinosinusitis?
chronic rhinosinusitis subtype/variant --> hypersens rxn to fungi --> nasal polyposis
52
allergic fungal rhinosinusitis --> imaging appearance?
- CT density?
- T2?
mult sinus --> complete opacify --> secretions:
- CT hyper
- T2 hypo
sinus walls:
- expansile remodel
- pressure erosion
53
fungal sinusitis --> what is fungus ball?
aggregate of hyphae + mucin --> often intra-lesional calc --> sep from sinus mucosa
54
immunocomp pt --> invasive fungal rhinosinusitis --> imaging sign that is highly suggestive of necrosis?
"black turbinate" sign --> nasal turbinate nonenhance
55
what is invasive fungal rhinosinusitis?
acute/chronic fungal infx --> invade mucosa, vessel, other sinonasal tissue --> necrosis
56
what is Pott's puffy tumor
acute frontal sinusitis --> c/b osteomyelitis --> subgaleal/subperiosteal abscess
57
sinus: what is mucocele?
paranasal sinus --> obstructed drainage --> fill w mucoid secretions --> expansile remodeling & bony thinning
58
silent sinus synd --> MOA?
maxillary sinus ostium --> chronic obstruct --> air resorb --> max sinus atelectasis
59
silent sinus synd --> imaging features? (3)
- unilat max sinus volume loss
- partial-complete opacification of sinus
- enophthalmos
60
sinus: what is choanal polyp?
polyp --> nasal cavity --> extend to post nasal aperture (choana)
61
sinus: what is antrochoanal polyp?
choanal polyp that originate in max sinus
62
sinonasal (Schneiderian) papilloma --> 3 histologic types?
- exophytic
- inverted
- oncocytic
63
sinonasal (Schneiderian) papilloma --> 3 histologic types --> which have malig potential? (2)
- inverted
| - oncocytic
64
sinonasal (Schneiderian) papilloma --> inverted type --> classic MRI appearance?
alternating curvilinear bands of low & high intensity --> "cerebriform" pattern
65
juvenile nasopharyngeal angiofibroma --> 2 imaging signs?
- salt & pepper appearance --> enhance & vasc flow voids
| - Holmer-Miller (antral) sign --> mass extend into & expend pterygopalatine fossa --> ant displace post max sinus wall
66
pediatric midline nasal mass --> dermoid vs epidermoid cyst --> how differentiate?
dermoid:
- fat
epidermoid cyst:
- restrict diff
67
pediatric midline nasal mass --> ddx? (3)
- epi/dermoid cyst
- encephalocele
- nasal glial heterotopia (nasal glioma)
68
Mc-Cune Albright synd --> synd? (3)
- fibrous dysplasia
- endocrine hyperfx
- cafe au lait macules
69
Mazabraud synd --> synd? (2)
- fibrous dysplasia
| - intramuscular myxoma
70
olfactory neuroblastoma (esthesioneuroblastoma) --> intracranial extension --> what imaging finding is highly suggestive of olfactory neuroblastoma?
intracranial portion --> cysts at margins
71
cavernous sinus thrombosis --> direct imaging findings? (2)
- lat wall --> convex bulge
| - postcontrast --> filling defect
72
cavernous sinus thrombosis --> indirect imaging finding?
sup ophthalmic V --> dilate/thrombosed
73
endophthalmitis --> imaging findings?
- ocular wall thick & enhance
- periocular fat stranding
- vitreous --> hyper
74
what is dacryoadenitis? poss etiologies? (4)
lacrimal gland inflamm:
- virus/bact infx
- idiopathic
- IgG4-related dz
- granulomatous dz
75
dacryoadenitis --> imaging appearance?
lacrimal gland --> diffuse enlrg
76
what is dacryocystitis? MOA?
lacrimal duct obstruct -> bact infx --> lacrimal sac inflamm
77
dacryocystitis --> imaging appearance?
lacrimal fossa near medial canthus --> rim-enhance struct --> adj fat stranding
78
infant --> dacryocystitis --> poss etiologies? (2)
- dacryostenosis
| - dacryocystocele
79
idiopathic orbital inflamm (pseudotumor) --> 3 main anatomic subtypes?
- dacryoadenitis
- orbital fat inflamm
- orbital myositis
80
idiopathic orbital inflamm (pseudotumor) --> orbital myositis subtype --> MC affected EOM?
LR
81
what is IgG4-related dz?
multisystem fibro-inflamm disorder
82
IgG4-related dz --> involve ophthalmic system --> MC involved struct?
lacrimal gland
83
IgG4-related ophthalmic dz --> distinguishing feature?
infiltration/enlrg infraorbital N
84
IgG4-related dz --> lacrimal + major salivary gland involvemt --> dx?
IgG4-related chronic sclerosing dacryoadenitis & sialadenitis
85
sarcoidosis --> extraocular orbit --> MC involved struct?
lacrimal gland
86
granulomatosis w polyangiitis --> orbit involvemt --> 3 MC manifestations?
- #1 infiltrative mass in orbital fat
- dacryoadenitis
- extraocular myositis
87
thyroid orbitopathy --> early dz --> imaging findings? (2)
- proptosis
| - orbital fat expansion
88
thyroid orbitopathy --> late dz --> imaging sign?
fusiform EOM enlrg --> spare tendon --> "Coca Cola bottle" sign
89
what is optic neuritis?
optic N inflamm
90
optic neuritis --> MCC?
MS
91
optic neuritis --> epidemiology? clinical presentation?
YA --> acute painful central vision loss
92
old pt --> central vision loss --> ddx? (1)
ischemic optic neuropathy
93
optic neuritis --> acute dz --> imaging findings? T2? contrast?
optic N:
- enlrg
- T2 hyper
- enhance
94
optic neuritis --> chronic dz --> imaging finding?
optic N atrophy
95
orbital lymphangioma (orbital venolymphatic malformation VLM) --> key imaging clue?
mass --> span mult compts
96
ped --> neuroblastoma --> mets to orbit --> clinical presentation?
periorbital ecchymosis --> "raccoon eye"
97
ped --> neuroblastoma --> mets to orbit --> imaging appearance?
- location
- bone involve?
- calcs?
- extraconal --> orbital wall --> lat or sup
- permeative bony destruction
- calcs
- aggressive periosteal rxn
98
neuroblastoma --> suspect bone mets --> preferred imaging study?
I-123 MIBG scintigraphy
99
orbital venous varix --> etiology? (3) MC?
- #1 congenital malformation
- AVM
- AVF
100
what is Coats dz?
idiopathic --> retina --> telangiectasia + exudate --> retinal detach
101
what is persistent hyperplastic primary vitreous (PHPV)?
vitreous --> persistent embryonic vasc -->
- hemorrhage
- cataract
- retina detach
102
persistent hyperplastic primary vitreous (PHPV) --> imaging sign?
"martini glass" sign
103
septo-optic dysplasia --> part of what dz spectrum?
holoprosencephaly
104
septo-optic dysplasia --> synd? (3)
- optic N hypoplasia
- septum pellucidum agenesis
- hypothal-pit dysfx
105
orbital globe rupture --> imaging sign?
wall irreg & dec globe vol --> "flat tire" sign
106
Le Fort I fx:
- involve fx of what struct?
- free movemt of what struct?
- lat margin of pyriform (nasal) aperture
| - floating palate
107
Le Fort II fx:
- involve fx of what struct?
- free movemt of what struct?
- inf orbit --> med orbit
| - floating maxilla
108
Le Fort III fx:
- involve fx of what struct?
- free movemt of what struct?
- zygomatic arch
- lat orbit --> med orbit
- craniofacial dissociation
109
salivary gland --> MC tumor?
pleomorphic adenoma (benign mixed tumor)
110
pleomorphic adenoma (benign mixed tumor) --> benign or malig?
benign --> risk of malig transform
111
pleomorphic adenoma (benign mixed tumor) --> MR appearance?
- T2
- contrast
well-defined mass --> bosselated margins:
- T2 very hyper
- very enhance
112
Warthin tumor (papillary cystadenoma lymphomastosum, adenolymphoma) --> epidemiology?
old M --> smoke
113
Warthin tumor (papillary cystadenoma lymphomastosum, adenolymphoma) --> MC location?
parotid tail
114
Warthin tumor (papillary cystadenoma lymphomastosum, adenolymphoma) --> benign or malig?
benign
115
Warthin tumor (papillary cystadenoma lymphomastosum, adenolymphoma) --> imaging appearance?
mass:
- well-defined
- hetero
- weak enhance
- some --> complicated cystic compts
116
1ary salivary gland malig --> MC? 2nd MC?
- #1 mucoepidermoid CA
| - adenoid cystic CA
117
pleomorphic adenoma (benign mixed tumor) --> malig transform to what?
CA ex pleomorphic adenoma
118
b/l uvetitis + parotitis + facial N palsy --> dx?
sarcoidosis --> Heerfordt synd (uveoparotid fever)
119
gallium-67 scan --> what is panda sign? dx?
sarcoidosis:
- uptake in b/l lacrimal glands
- uptake in b/l parotid glands
- physiologic uptake in nasopharynx
120
Sjogren synd --> parotid glands --> MRI appearance?
"salt & pepper" or "honeycomb" appearance --> T1/T2 --> mixed low & high signal:
- benign lymphoepithelial lesions
- fibrosis
- calcs
- fatty infiltration
121
1st brachial cleft cyst --> location?
bw ext aud canal & submandibular region --> usu in parotid gland
122
ant pit --> embryologic tissue of origin?
Rathke pouch
123
persistent Rathke pouch --> possible conditions? (2)
- Rathke cleft cyst
| - craniopharyngioma
124
foramen ovale --> contains what struct? (2)
- CN V3
| - access meningeal A
125
severe HA + visual impair + hypopituitarism --> dx? MCC?
pit adenoma --> pit apoplexy
126
pituitary lesion --> "snowman" sign --> dx?
pit macroadenoma
127
Rathke cleft cyst --> intrasellar or extrasellar?
intrasellar
128
sella --> cyst --> nonenhancing intracystic nodule --> dx?
Rathke cleft cyst
129
craniopharyngioma --> intrasellar or extrasellar?
suprasellar
130
craniopharyngioma --> MC subtype in children? In adults?
- child --> adamantinomatous subtype
| - adult --> papillary
131
craniopharyngioma --> adamantinomatous subtype --> MRI appearance?
- complex cystic lobulated mass
- calcs
- "machine oil" cystic contents --> T1 hyper
132
craniopharyngioma --> papillary subtype --> MRI appearance?
- round solid mass
| - no calcs
133
intracranial germ cell tumor --> MC location? 2nd MC?
- #1 pineal
| - #2 suprasellar
134
MC type of intracranial germ cell tumor?
germinoma
135
epidermoid cyst --> MRI signal?
- T1
- T2
- FLAIR
- DWI
- CSF signal --> T1 dark, T2 bright
- FLAIR hyper
- restrict diff
136
what is hypothalamic hamartoma (tuber cinereum)?
gray matter heterotopia bw pit stalk & mammillary bodies
137
precocious puberty + gelastic sz (laughing spells) --> ddx? (1)
hypothalamic hamartoma (tuber cinereum)
138
child --> diabetes insipidus --> suprasellar mass --> pit stalk --> enlrg, enhance --> ddx? (1)
Langerhans cell histiocytosis (LCH) hypophysitis
139
child --> suprasellar mass --> midline mass --> avid enhance --> ddx? (1)
germ cell tumor --> germinoma
140
child --> suprasellar mass --> midline mass --> avid enhance, contain fat --> ddx? (1)
dermoid cyst
141
adult --> diabetes insipidus --> suprasellar mass --> pit stalk --> enlrg, enhance --> ddx? (1)
Langerhans cell histiocytosis (LCH) hypophysitis
142
adult --> suprasellar mass --> cystic, nonenhance, no calcs --> ddx? (1)
Rathke's cleft cyst
143
what is ecchordosis physaliphora?
benign --> ectopic notochord remnant --> dorsal clivus --> project into post cranial fossa
144
chordoma --> ped or adult?
adult
145
chordoma --> 3 MC locations?
- #1 sacrum
- #2 clivus
- #3 vertebra
146
chordoma --> tissue type?
notochord
147
how differentiate chordoma vs benign notochordal tumor? (3)
- bone destruct
- extraosseous extension
- enhance
148
chordoma --> extraosseous extension --> potential imaging sign?
"thumb" sign: post tumor --> indent pons
149
how differentiate clival chordoma vs petroclival synchondrosis chondrosarcoma? (1)
location:
- chordoma --> midline
- chondrosarcoma --> off-midline
150
what is necrotizing otitis externa (malig otitis externa)?
otitis externa + temporal osteomyelitis
151
otitis externa --> chronic --> potential comp?
medial canal fibrosis
152
chronic otitis externa --> medial canal fibrosis --> imaging appearance?
tympanic membrane --> outer surface --> crescentic soft tissue thickening
153
what is keratosis obturans?
keratin plugs --> accum --> occlude & expand ext aud canal --> no bone involvmt
154
keratosis obturans --> usu unilat or bilat?
bilat
155
keratosis obturans --> imaging appearance?
EAC --> soft tissue opacification --> smooth, expansile remodeling of bony canal
156
what is cholesteastoma?
collection of keratin --> lined by squamous epithelium
157
keratosis obturans --> epidemiology?
child & YA
158
cholesteastoma --> epidemiology?
mid to older adult
159
cholesteastoma --> imaging appearance?
EAC --> soft tissue mass --> focal bony erosion or sequestered bone frgmt
160
cholesteastoma --> usu unilat or bilat?
unilat
161
pulsatile tinnitus --> exam --> red retrotympanic mass --> ddx? (2) MCC?
- #1 aberrant int carotid A
| - paraganglioma
162
absent foramen spinosum --> ddx? (1)
persistent stapedial A
163
what is stapedial A?
hyoid A --> br --> connect int & ext carotid A --> normally regress
164
pulsatile tinnitus --> exam --> blue retrotympanic mass --> ddx? (1)
dehiscent jugular bulb
165
what is paraganglioma?
(para)sympathetic paraganglionic tissue --> extra-adrenal neoplasm
166
head & neck --> paraganglioma --> MC locations? (4)
- carotid bifurcation
- suprahyoid neck --> along course of vagus N
- jugular foramen
- middle ear
167
what is glomus tympanicum tumor?
paraganglioma --> isolated to middle ear --> jugular plate intact
168
what is glomus jugulotympanicum tumor?
paraganglioma --> involve middle ear & jugular foramen
169
lrg paraganglioma --> classic MRI appearnce?
"salt & pepper" appearance --> intratumoral flow voids
170
paraganglioma --> most sensitive imaging study?
Ga-68 DOTATE PET-CT
171
epidermoid cyst in the temporal bone is called what?
cholesteatoma
172
cholesteatoma --> CT appearance?
- soft tissue mass --> opacify part of middle ear
| - adj bone erosion
173
foramen spinosum --> contain what struct? (1)
middle meningeal A
174
jugular foramen --> contain what struct? (4)
- pars nervosa: CN9
| - pars vascularis: CN10 & 11
175
internal auditory canal --> contain what struct? (4)
- CN7
- CN8
- sup & inf vestibular compt
176
meckel cave --> contain what struct? (1)
trigeminal ganglion
177
dorello's canal --> contain what struct? (2)
- CN6
| - inf petrosal sinus
178
external carotid branches (in order)? (8)
Some Admin Love Fucking Over Poor Med Students:
- Sup thyroid
- Ascending pharyngeal
- Lingual
- Facial
- Occipital
- Post auricular
- Maxillary
- Sup temporal
179
intracranial ICA --> branches? (3)
- ophthalmic
- post comm
- ant choroidal
180
CN3 palsy --> etiology --> ddx? (1)
Pcomm aneurysm
181
CN6 palsy --> etiology --> ddx? (1)
inc ICP
182
older F --> rapidly expansile, painful thyroid --> what type of thyroid CA?
anaplastic
183
thyroid US --> most suspicious feature?
microcalcs
184
thyroid US --> microcalcs --> hallmark of what dx?
papillary thyroid CA
185
thyroid US --> what echotexture is a feature of malig?
solid hypoechoic
186
bad looking delphian node (level 6) --> dx?
layrngeal CA met
187
thyroid CA --> anaplastic type --> RF? (2)
- elder
| - radiation tx
188
thyroid CA --> papillary type --> US appearance? CT? MR?
- US: hyper compared to normal nodes
- CT: hypervasc
- MRI: T1 bright
189
thyroid CA --> lung mets --> classic pattern?
miliary
190
thyroid CA --> lung mets --> tx: I-131 --> comp? (1)
pulm fibrosis
191
Enhancement of the facial nerve accompanied by enhancement in the internal auditory canal and labyrinth, and vesicles within the EAC --> dx?
Ramsay Hunt syndrome (herpes zoster otica) --> shingles of facial N
192
cervical LN levels: level of submandibular glands --> what level LN? (2)
- ant to submandibular gland --> level 1
| - post --> 2
193
cervical LN levels: how differentiate level 2A & B?
- A: ant to SCM
| - B: post to SCM
194
cervical LN levels: bw level of hyoid & cricoid --> ie. at thyroid cartilage --> what level LN? (2)
- ant to SCM --> 3
| - post to SCM --> 5A
195
cervical LN levels: below cricoid --> ie at thyroid gland --> what level LN? (3)
- midline --> 6
- lat to SCM --> 5B
- post to SM --> 4
