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50 Cards in this Set
- Front
- Back
Benign anterior skull base neoplasms (2)
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Juvenile nasopharyngeal angiofibroma
olfactory groove meningioma |
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Who gets juvenile nasopharyngeal angiofibroma and how does it present?
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adolescent boys with nasal obstruction and epistaxis
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Where does JNA arise?
Imaging appearance? 3 classic findings? |
around medial boundary of the pterygopalatine fossa
enhances avidly and centered on the nasopharynx. extends into the pterygopalatine fossa or the orbits. 1. nasopharyngeal mass 2. expansion of pterygopalatine fossa. 3. anterior bowing of the posterior maxillary sinus wall. |
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Differential for malignant anterior skull base neoplasms
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esthesioneuroblastoma
squamous cell carcinoma adenoid cystic carcinoma rhabdomyosarcoma |
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What is the age distribution for esthesioneuroblastoma?
Imaging characteristics |
bimodal
intermediate on T1 and T2, avidly enhancing. calcs commonly seen. **peripheral tumor cysts considered to be pathognomonic at the itnracranial portion of the mass. |
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What is the most common head and neck tumor in kids?
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rhabdomyosarcoma
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What is a common finding of adenoid cystic carcinoma in the region of the anterior skull base?
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perineural spread along the trigeminal nerve.
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Middle ear tumors (4)
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glomus tympanicum
facial nerve schwannoma cholesterol granuloma Cholesteatoma |
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Between cholesterol granuloma and cholesteatoma, what is a differentiating imaging finding in the middle ear?
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cholesteatoma shows diffusion restriction. They also do not enhance.
Also, appears as a white mass on otoscopic exam as opposed to blue mass for cholesterol granuloma |
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In thyroid ophthalmopathy, what extraocular muscle is affected first?
What is the sequence of muscles affected? |
Inferior rectus
IM SLow |
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How is thyroid ophthalmopathy contrasted from orbital pseudotumor?
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thyroid: symmetrical and does not involve the tendons.
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Orbital pseudotumor:
1. Causes painful proptosis, contrasting with what? 2. Most commonly involved orbital structure? 3. Other imaging findings? 4. This finding + cavernous sinus involvement =? |
1. lymphoma, painless proptosis
2. lacrimal gland. 3. orbit fat stranding, icnreased orbital soft tissue, and enlargement of the extraocular muscles. 4. Tolosa-Hunt syndrome |
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Bilateral optic nerve gliomas in a child suggests what?
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NF1
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Classic appearance of retinoblastoma
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hyperattenuating enhancing retinal mass with calcification in a normal sized globe
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VAscular retinal disease with subretinal lipoprotein exudates leading to retinal detachment
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Coats disease
-usually a bit older than retinoblastoma patients -globe normal size. |
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REtinopathy of prematurity can demonstrate intraocular calcifications similar to retinoblastoma. How is it differentiated?
What causes it? |
Micropthalmia
Prolonged oxygen therapy causes it. |
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A different entity causes micropthalmia with increased attenuation of the vitreous.
What makes this different? |
PHPV
-hemorrhage, cataracts, retinal detachment ABSENT calcifications |
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DDX micropthlamia (2)
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PHPV
ROPrematurity coloboma |
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Characteristic finding of sphenoid wing dysplasia?
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Pulsatile exophthalmos
can be seen in NF1 |
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If there is a lesion in the masticator space, what nerve is important to assess for perineural spread?
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V3
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What is the ddx for a masticator space lesion? (3)
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odontogenic disease
mandibular lesion (osteosarcoma and mets) rhabdomyosarcoma |
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Carotid space mass differential
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paraganglioma
schwannoma neurofibroma |
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What is the only nerve the is in the carotid space through its entirety?
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vagus nerve.
9,11,12 pass through transiently |
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In addition to paraganglioma of the the vagus, what else can push the ICA and ECA anterior and medially?
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Schwannoma
-is not nearly as vascular as paraganglioma |
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intramedullary spinal lesions (4)
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ependymoma
astrocytoma hemangioblastoma demyelinating lesion |
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intradural extramedullary lesions
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schwannoma
neurofibroma meningioma myxopapillary ependymoma epidermoid/dermoid arachnoiditis |
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Extradural spinal lesions
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degenerative disease
vertebral neoplasm epidural mets hemangioma epidural lipomatosis. |
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Petrous apex lesions (9)
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Cholesterol cyst (granuloma)
apical petrositis congential cholesteatoma schwannoma Langerhans cell histiocytosis chondrosarcoma chordoma meningioma mets |
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Expansile mass with internal hemorrhage in the petrous apex without fat suppresion
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cholesterol cyst
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Apical petrositis
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Complication of infectious otomastoiditis
bony demineralization and resorption Gradenigo triad |
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What is the gradenigo triad?
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Otomastoiditis
facial pain from trigeminal neuropathy at meckels cave lateral rectus palsy fomr 6th nerve palsy at Dorellos canal |
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Vascular complications of apical petrositis
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internal carotid arteritis
dural venous thrombosis |
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What is a typical MR finding of congenital cholesteatoma?
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restricted diffusion.
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What nerves could a schwannoma at the petrous apex originate from?
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5,7,8
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Most common site of skull base involvement in langerhans histiocytosis
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temporal bone
CT: well circumscribed destructive lesion with NONsclerotic margins MR: soft tissue masses with surround marrow and edema. MARKED enhancement. |
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Petrous apex ring and arc chondroid matrix. Lobular, CAULIFLOWER shaped T2hyperintense mass.
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Chondrosarcoma
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Petrous apex: well circumscribed lytic lesion in a child?
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Langerhans
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Petrous apex: intralesional cysts, smoothly enhancing, bony remodeling?
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Schwannoma
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Clivus ddx
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chordoma
chondrosarcoma mets |
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Common locations for chordomas
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near sacrum, clivus, some in vertebral column
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Common mets to the clivus?
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Breast
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Glomus tumors characteristic bony destruction
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moth-eaten
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DDX retro-tympanic mass
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Glomus tympanicum
aberrant carotid artery tympanic membrane hemangioma |
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All of the extraocular muscels arise from a common fibrous ring called the annulus of Zinn except for:
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Inferior oblique
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What passes through the superior orbital fissure (5)
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3,4, V1, 6
superior ophthalmic vein |
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Where is the most common site of orbital lymphoma?
Classic appearance? |
lacrimal gland
downward painless proptosis |
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Extraconal orbital multilocular cystic mass with fluid levels in a pediatric patient
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lymphangioma
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Classic imaging finding for metastatic breast cancer to the orbit
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enophthalmos due to fibrosis
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Most common expansile lesion of the paranasal sinuses
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Mucocele
-frontal sinus most common, then ethmoid sinus |
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CN7 exits the brainstem in whwat relation to CN8?
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Anterior.
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