Deck 5: Eyes, Ears, Nose, and Throat

Question 1

This coronal image from paranasal sinus CT depicts a patient with:

A) mucoperiosteal thickening and fluid in the sphenoid sinus.
B) invasive squamous cell carcinoma of the maxillary sinus.
C) temporalis muscle calcification indicating the presence of temporal arteritis.
D) an incidental pituitary macroadenoma.

Answer 1

mucoperiosteal thickening and fluid in the sphenoid sinus.

Question 2

This image is a transverse ultrasound scan of a thyroid gland. The structure indicated by the red arrows is:

A) the trachea.
B) a thyroid nodule.
C) the common carotid artery.
D) a parathyroid gland.

Answer 2

a thyroid nodule.

Question 3

Based on this sagittal CT, you can conclude that the patient:

A) was upright when the CT was done and has circumferential mucoperiosteal thickening of the maxillary sinus.
B) was supine when the CT was done and the patient has fluid in the dependent portion of the maxillary sinus.
C) has had a blowout fracture of the orbit.
D) has a maxillary sinus tumor.

Answer 3

was supine when the CT was done and the patient has fluid in the dependent portion of the maxillary sinus.

Question 4

This CT scan depicts a patient with:

A) right maxillary and right-sided ethmoid sinusitis.
B) acute right orbital blow-out fracture with hematoma in the right orbit.
C) right-sided invasive sino-nasal tumor that involves the orbit.
D) commonly seen asymmetry in the development of the paranasal sinuses.

Question 5

Based on this axial CT, this patient would likely:

A) have pain when eating.
B) need immediate surgery because of epiglottitis.
C) have had a stroke because of an occluded vertebral artery.
D) have dental pain because of an abscessed incisor.

Question 6

This coronal CT shows:

A) a patient with severe dyspnea.
B) a patient with lymphoma.
C) a patient with chronic dysphagia.
D) a patient with cervical pain.

Question 7

This image shows a pediatric patient that has:

A) a maxillary sinus abscess.
B) enlarged adenoids.
C) epiglottitis.
D) periodontal abscess.

Question 8

The esophagram shows a patient with:

A) progressive dysphagia caused by esophageal cancer.
B) regurgitation of undigested food from a Zenker's diverticulum.
C) tracheobronchial fistula.
D) hiatal hernia and GERD.

Question 9

This contrast-enhanced coronal MRI of the orbits shows a finding related to one of the extraocular muscles associated with:

A) trauma.
B) acute onset of blindness.
C) Graves' disease.
D) strabismus.

Question 10

Based on this image, this patient is being followed for which of the following?

A) Response to radiation therapy for a paranasal sinus tumor
B) Response to medical treatment for acute sinusitis
C) Reaction to the inhalation of noxious fumes
D) Post-surgical complications after sinus surgery

Question 11

This coronal CT depicts a patient who:

A) caught a softball with her left eye.
B) has a left nasal tumor.
C) has seasonal sinus allergies.
D) has exophthalmos.

Question 12

Which of the following is NOT considered a role for imaging when sinusitis is suspected?

A) Imaging is always required for treatment of clinically diagnosed sinusitis.
B) Imaging is used to establish the presence or absence of paranasal sinus inflammatory disease (especially purulent sinusitis).
C) Imaging is used to evaluate any structural impairment to sinus drainage.
D) Imaging is used to evaluate suspected complications of sinusitis.

Question 13

A Waters radiographic view is used to evaluate:

A) sinusitis.
B) odontoid fractures.
C) dysphagia.
D) laryngeal cancer.

Question 14

The initial imaging modality for palpable thyroid nodules is:

A) MRI.
B) CT.
C) radiography.
D) ultrasound.

Question 15

Which of the following is NOT true for radionuclide thyroid scanning?

A) It should be done immediately after an IV contrast CT scan.
B) It is useful for assessing hyperthyroidism.
C) It is useful for determining the functional status of thyroid nodules.
D) It can be done immediately after a gadolinium-enhanced MRI scan.

Question 16

The imaging modality of choice in a child with suspected cervical adenopathy is:

A) MRI.
B) CT.
C) nuclear medicine.
D) ultrasound.

Question 17

A uniformly hyperechoic thyroid nodule is:

A) typically malignant.
B) referred to as a "white knight" and is benign.
C) always palpable.
D) referred to as a "hot nodule."

Question 18

Which of the following statements regarding cervical lymph nodes is NOT true?

A) Nodes that are larger than normal are suspicious for significant pathology but may just be "reactive nodes" that represent normal nodal response to a regional inflammatory process.
B) Children tend to have larger nodes than adults.
C) Normal-sized lymph nodes can be shown to harbor metastatic malignancy on PET scanning.
D) Imaging for adenopathy is not needed if there are no palpable nodes.

Question 19

Which of the following statements regarding imaging of a patient with Bell's palsy is NOT true?

A) The hallmark MRI finding is abnormal enhancement of the seventh cranial nerve and/or the geniculate ganglion.
B) In unusual cases, MRI may show an infiltrating malignancy of the parotid gland involving the seventh nerve.
C) Imaging is mandatory for all patients with Bell's palsy.
D) A CT scan can show seventh-nerve abnormalities within the facial canal.

Question 20

A routine upper GI series would be the ideal imaging study for all of the following suspected clinical conditions EXCEPT:

A) Zenker's diverticulum.
B) hiatal hernia.
C) esophagitis.
D) GERD.

Question 21

Recommended imaging for a patient with exophthalmos is:

A) CT scan, without and with IV contrast enhancement.
B) MRI of the orbits without and with gadolinium-based contrast enhancement.
C) Water's view of the orbits.
D) FDG-PET scan.

Question 22

Facial trauma with suspected orbital injury is BEST done with:

A) a complete orbit and facial series of radiographs.
B) MRI without and with contrast enhancement.
C) maxillofacial CT scan.
D) head CT scan.

Question 23

In a patient with progressive sensorineural hearing loss, the ideal imaging procedure would be:

A) intracranial CTA with volume-rendered displays of the circle of Willis.
B) carotid duplex sonography and carotid MRA if positive.
C) routine unenhanced MRI of the brain.
D) MRI of the brain and IACs without and with contrast enhancement.

Question 24

When a patient is found to have a carotid bruit, the appropriate initial examination is:

A) carotid ultrasonography.
B) catheter angiography of the carotid arteries.
C) contrast-enhanced carotid MRA.
D) CTA with volume-rendered and multiplanar displays.