FRCR 2A

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Central Nervous and Head & Neck (including spine, eyes, ENT, salivary glands and dental)

1. A 22 year old female is admitted with acute onset headaches, confusion and drowsiness. She is transferred to ITU for ventilation. Her WBC is 11.5. A CT scan of her brain shows oedema in the medial left temporal lobe with significant mass effect and central haemorrhage and marked diffuse enhancement post contrast. What is the likely diagnosis?
		Lymphoma
		Herpes encephalitis
		Bacterial abscess
		Acute metabolic encephalopathy
		Bacterial meningitis

Herpes encephalitis often affects the anteromedial temporal lobe and is often unilateral in the early stages.

2. A 33 year old gentleman presents with headaches which are frequently worse on leaning forward. He undergoes a non-contrast CT scan of his brain which shows a dense round mass in the midline in the region of the Foramen of Munro. On MRI, the lesion is high signal on T1 and on T2w images. What is the likely diagnosis?
		Colloid cyst
		Epidermoid cyst
		Dermoid cyst
		Choroid plexus papilloma
		Choroid plexus carcinoma

Colloid cysts arise exclusively from the posterior lip of the Foramen of Munro. They can cause positional headaches due to transient obstruction at the Foramen of Munro. Itâ€™s appearances on non-contrast CT can depend on its composition; many appear hyperdense due to mucinous fluid.

3. A 46 year old male undergoes an MRI for unilateral sensorineural hearing loss. An incidental, well defined 1cm lesion is noted in the pons which has a popcorn appearance with very mixed signal on T2 with very low signal rim. What is the likely diagnosis?
		Dermoid
		Brainstem glioma
		Cavernoma
		AVM
		Infarct

True, Cavernoma

4. A 20 year old patient with a known genetic condition with renal and pancreatic cysts is noted to have a cystic lesion in the cerebellum with a mural nodule. What is the most likely diagnosis of the cerebellar lesion?
		Medulloblastoma (pilocystic astrocytoma)
		Neurofibroma
		Arachnoid cyst
		Chordoma
		Hemangioblastoma

Haemangioblastoma can occur in Von Hippel-Lindau syndrome

5. A 62 year old female on warfarin has an MRI for confusion. An extra-axial haematoma is noted over the temporo-parietal region which is concave on its deep surface. The abnormality is low on T2 and high T1. What is the likely diagnosis?
		Extradural haematoma
		Acute subdural haematoma
		Early subacute subdural haematoma
		Late subacute subdural haematoma
		Chronic subdural haematoma

True, Early subacute subdural haematoma

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