Neuro and Head and Neck – Autumn 2012
1. Young woman involved in RTA, weakness in hands, cystic lesion next to spinal cord with cord
in opposite direction – which level is the lesion:
a. C4/5
b. C5/6
c. C6/7
d. C7/T1
2. Old accident with non specific arm symptoms, fluid filled spaces at C6/7 exit foramina with
nerve roots not visualised and weakness in right distribution –
a. Nerve root avulsion
b. Torlov cyst
3. MRI for brain lesion 3-4/52. Now presents with pain and itching over foot, ankle, red
indurating rash, parasthesia and SOB on lying flat and upright
a. NSF
b. Sarcoid
4. Young man, headache, supra anterior part of 3rd ventricle, hyperintense on CT- Colloid cyst
5. Young woman with parotid mass, unilateral, multicystic, low on T2
a. Pleomorphic adenoma
6. Diabetes insipidus, which lesion can it not be ? LCH
7. Midline mass mainly cystic with some Calcs closely assoc with pineal gland
a. dermoid
b. pineoblastoma
c. germinoma
d. pineocytoma
8. subarachnoid haermorrhage 2/52 ago, MRI appearances
9. What is best sequence of vertebral artery dissection
a. Time of flight
b. 2D/3D gad enhanced
c. T1 Fat sat
d. T2 Fat sat
10. Young man, cystic lesions in parotids bilaterally with bilateral Lymph nodes
a. Sarcoid
b. HIV
c. TB
d. Warthins
11. Young man in RTA, intracranial blood at vertex crossing the midline, straddling the falx
a. Intercerebral parafalcine
b. Subdural
c. EDH
d. Combined
12. 41 year old man with seizures, symmetrical high T2 hyperintensities in ext capsule,
periventricular and temporal
a. cadasil
b. Moyamoya
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c. SLE
Facial rash and seizures – SLE
Tram track calc in optic sheath – NF2
80 year old man mass in corpus callosum with T2 changes in periventricular regions
?lymphoma/GBM
16 year old girl, confusion, low attenuation ring enhancing lesions on T2- abscess
Arachnoid cyst – CSF density, no restriction, disappears on FLAIR
Epidermoid at CPM – restricts on DWI
Post trauma, which on is abnormal
a. Air in Prussak
b. Air in ventricle
c. Air in epitympanic recess
d. Fluid in cochlear
CN6/7
a. Clival chondrosarcoma
b. Cavernous sinus meningioma
c. Facial nerve schwanomma
d. Positive cavernoma
e. Midbrain demyelination
MS – optic neuritis, now loss parathesia? Where is the lesion in the brain?
a. Calloseptal interface
b. Cortical
Bells’ palsy – which part of the facial nerve enhances?
80 year old man. Lytic, sclerotic and subperiosteal bone resorption . Peripheral soft mass,
past medical history.
a. Bisphophanate
b. Ameloblastoma
c. Osteonecrosis
d. Dentigerous cyst
Orbital pseudotumour vs thyroid
a. Not involvement
b. Involvement of lacrimal
c. Single muscle
d. Extraconal
Lymph node levels –
a. Above hyoid
b. Tonsillar cancer
c. Level II/III
Nasopharyngeal cancer. RCA totally occluded, left carotid – 90%
a. Medical
b. Stenting on right
c. Endarterectomy
d. Surgical revasc
e. Endovasc stenting
Alobar holoprosencephaly
28. Difference between benign intracranial hypertension and sagittal sinus thrombosis
a. Subtle bleed in ventricle
b. Prominent temp horns
c. Slit like lateral ventricles
d. Bilateral haemorrhages
29. Pregnant pre eclampsia pt then cortical thickness where is the lesion – bilateral occipital
haemorrhages
30. Young man with HIV, nodular enhancement of basal ganglia
a. Cypto
b. Toxo
c. HIV encephalopathy
31. Badly controlled DM and hypertension- CSF spaces in basal ganglia, no DWI
a. Perivascular
b. Lacunar infarcts
32. Enhancement of leptomeninges, nodular enhancement of spine – sarcoid
33. Soft tissue calc in hip and calc lesion in brain and oedema – neurocystercis
34. MRI/CT of sagittal sinus thrombosis
35. CNIII palsy, then SAH – where is aneurysm?
a. ACOM
b. Ophthalmic artery
36. Horner syndrome – T2 crescentic high signal
37. Differential BP, collapse when playing golf, reveral of flow in left vertebral, biphasic in
axillary artery, biphasic is brachial
38. HIV encephalopathy
39. HIV – PML
40. Seizures in young man, temporal lobe lesion – DNET
41. Thoracic cord lesion extramedullary, intradural mass does not affect exit foramina ?
a. Neurofibroma
b. Meningioma
42. Dural fistula vs AVM
43. Cerebellar atrophy with T2 hyperintense ring, ataxia, hameosisderin
44. Anti-onconeuroantibodies in CSF – where is the primary – breast, lung, colon, thymoma
45. High T2 in mesial temporal lobe and confusion – paraneoplastic syndrome
a. Bronchus
b. Breast
c. Renal
d. Thyroid
e. Melanoma
46. Describe mesial temporal sclerosis – small hippocampus with high T2
47. B12 deficiency – signal change in dorsal columns, loss in T1 in vertebral bodies
48. Thyroid, calc, positive lymph node, young woman - papillary, medullary, nothing?
49. Parathyroid PTH raised, raised calc but US normal – what next? PET,CT, MRI, sestamibi
50. Lymph node, Level II- normal mediastinoscopy – FNA – SCC, CT Normal, what next? PET/CT
51. Something moves PPS forward – where is the lesion? Parotid, masticator, carotid,
retropharayngeal
52. Describe paraganglioma – pulsatile tinnitus, flow voids, avid enhancement
53. CN6 palsy, retrobulabar pain and otitis media, fluid in mastoid and middle ear, ill defined
change in petrous apex
a. mastoiditis,
b. Cholesterol granuloma
c. Petrous apex apicitis
54. Cholesteotoma – area least likely to be involved – semi circular canal
55. HMPAO SPECT – post temporal and parietal low activity and reduced in frontal area –
a. Alzheimers
b. Lewy body dementia
56. RTA – mass, swelling in eye – carotico cavernous fistula
57. CN 7 supplies all these muscles except one – masseter
58. Antrochoanal polyp
59. 15 year old boy, widened pterygopalatine fossa – juvenile angiofibroma
60. Cyst at base of tongue – homogenously enhancing
a. Thornwaldt cyst
b. Thyroglossal
c. Lingular thyroid
61. What structures would definitely be missing in radical neck dissection
a. SCM and submandibular
b. Digastric and parotid
c. Medial part of clavicle
d. Mandible
e. Carotid