CORE > Neuro: Head/Neck > Flashcards

Neuro: Head/Neck Flashcards

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1
Q

optic canal –> contain what struct? (2)

A
  • optic N

- ophthalmic A

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2
Q

superior orbital fissure –> contain what struct? (4)

A
  • CN III
  • CN IV
  • CN V1
  • CN VI
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3
Q

inferior orbital fissure –> contain what struct? (1)

A
  • CN V2
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4
Q

foramen rotundum –> what struct? (1)

A

CN V2

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5
Q

orbit –> extraconal compartmt –> contain what struct? (3)

A
  • lacrimal gland
  • fat
  • bony orbit
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6
Q

orbit –> conal compartmt –> contain what struct? (1)

A

EOM

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7
Q

orbit –> intraconal compartmt –> contain what struct? (4)

A
  • optic N & sheath
  • sensory & motor N
  • LN
  • fat
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8
Q

orbital hemangioma –> 2 types?

A
  • cavernous

- infantile (capillary)

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9
Q

orbital hemangioma –> cavernous vs capillary –> epidemiology?

A
  • cavernous: adult

- infantile (capillary): >1yo

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10
Q

orbital hemangioma –> infantile (capillary) type –> natural progression?

A

first few mo of life –> enlrg –> then spont involute

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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
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12
Q

orbital lymphoma –> MC location?

A

lacrimal gland

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13
Q

orbital lymphoma –> classic clinical presentation?

A

lymphoma –> lacrimal gland –> mass effect on globe –> painless downward proptosis

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14
Q

orbital mass –> mold to the globe –> ddx? (2)

A
  • orbital lymphoma

- orbital pseudotumor

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15
Q

orbital lymphoma –> T1/T2 signal?

A
  • T1 hypo

- T2 hypo

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16
Q

orbital lymphangioma (orbital venolymphatic malformation VLM) –> epidemiology?

A

Ped

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17
Q

what is lymphangioma?

A

benign hamartomatous lesion –> slow flow vascular

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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

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19
Q

orbit –> schwannoma vs neurofibroma –> which is more common?

A

Schwannoma

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20
Q

orbit –> schwannoma/ neurofibroma –> MC nerve? location in orbit?

A

V1 sensory br –> sup orbit

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21
Q

orbit –> schwannoma/ neurofibroma –> MR appearance?

A

circumscribed ovoid mass:

  • T1 hypo
  • T2 hyper –> sometimes central hypo (target sign)
  • enhance
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22
Q

adult –> mets to orbit –> which CA? (5)

A
  • breast
  • lung
  • thyroid
  • RCC
  • melanoma
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23
Q

mets to orbit –> enophthalmos –> which CA? (1)

A

scirrhous breast CA

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24
Q

ped –> mets to orbit –> which CA? (1)

A

Neuroblastoma

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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
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