2 Flashcards
1
Q
Blood supply of the iliac free flap?
A
deep circumflex- branch of external iliac
2
Q
Blood supply for the nasolabial flap?
A
angular a
3
Q
Success of submucosous vestibuloplasty based on?
A
Maintenance or prolonged use of a splint
4
Q
Melanoma is measured in mm from the top of the granular cell layer to the deepest identifiable point but what classification?
A
Breslow Breslow’s microstages evals tumor thickness in melanoma. Stage Depth 1 <0.76 mm 2 0.76-1.49 mm 3 1.50-4.00 mm 4 >4.00 mm
Clark’s levels indicate tumor invasion by relating the most deeply invading tumor cells to surrounding structures 1 Intraepidermal 2 Invasion of papillary dermis 3 Fill the papillary dermis 4 Invasion of reticular dermis 5 Invasion of fat
5
Q
Male patient with elevated acid phosphatase
A
prostate cancer
6
Q
Clinical slide of a 27 y/o male with large hyperplastic gingival growth in maxilla and mandible. Histology slide – showed thickened epithelial layer. What is the condition (gingival hyperplasia) due to?
A
Calcium channel blocker (verapamil), phenytoin (dilantin)
7
Q
What is the best radiograph for localizing salivary gland tumors?
A
T2 weighted MRI
8
Q
Contraindications for flumazenil?
A
Mixed drug OD and chronic benzodiazepine use
9
Q
Anisocoria is unequal pupils. What situation is this clinical condition associated with?
A
Uncal herniation
10
Q
Uncal herniation symptoms?
A
Ipsilateral fixed dilated pupil with contralateral hemiparesis
11
Q
Most common complication of ORIF of mandible.
A
Malocclusion
12
Q
Most common bleeding in Le Fort surgery that is difficult to control?
A
Internal maxillary artery
13
Q
Most common bleeding following LeFort surgery?
A
Descending palatine arteries
14
Q
What contributes most to relapse of the inferior positioned Le Fort I?
A
Occlusion
15
Q
Dorsal hump removal. What plane of dissection to be in?
A
superior to the lateral cartilages (suprachondrial) and inferior to the nasal bones periosteum (subperiostial)
16
Q
What layer do you suture in an inferior alveolar nerve repair?
A
Outer epineurium
17
Q
How many sutures are placed in an anastomosis of a nerve?
A
2-4 placed in the epineurium
18
Q
Initial sign of cavernous sinus thrombosis?
A
Abducens paresis - Loss of lateral gaze – CN VI
19
Q
Open bite at the end of a LeFort case. Due to what?
A
Distraction of condyles, unrecognized posterior interferences
20
Q
Most common complication to TMJ arthroscopy?
A
joint surface scuffing
21
Q
Young girl with TMJ and progressive open bite. What is diagnosis?
A
RA
22
Q
Injury to neurovascular bundle with TOVRO?
A
excessive medial dissection
23
Q
What is the stability of a BSSO advancement mainly due to?
A
fixation
24
Q
Where is the needle position during a Gow-Gates block?
A
condylar neck
25
Most important factor with a cortical bone (onlay) graft to the alveolus for future implant is?
fixation to stabilize
26
When to treat retrobulbar hematoma?
Pain, increase intraocular pressure, decreased visual acuity
27
Where do you separate the nasal septum in LeFort III?
Through the perpendicular plate of the ethmoid and the vomer at the posterior plate
28
NF osteotomy during LF III
below NF suture
29
Disinsertion of the levator palpebrae superioris causes what?
Loss of tarsal fold and upper lid ptosis
30
Main etiology of periorbital cellulites?
preseptal infection
31
Proptosis involving orbital cellulitis.
post septal infection
32
Von Willebrand disease. What happens to BT, PT and PTT
increased BT and PTT
33
What process involves the perihilar nodes?
Sarcoidosis
34
MAO inhibitors. Do not use with what medication?
meperidine
35
Pt with JVD and right ventricle and left atrial hypertrophy has what?
mitral stenosis
36
Best monitor for P waves in office anesthesia?
Lead II
37
Aortic Stenosis predisposes to what?
Syncope and sudden death
38
Sudden cardiac death’s etiology usually is of cardiovascular in origin. What rhythm is most seen?
ventricular tachycardia or chaotic ventricular fibrillation or both
39
Patient with angina. What is most ominous sign?
Hypotension with bradycardia
40
Patient with MI, what is the most ominous sign?
Diaphoresis and tachycardia
41
Malignant hyperthermia. What enzyme is elevated?
Creatine Kinase
42
Advantage of costochondral graft for TMJ reconstruction.
adaptive
43
Characteristic of pt w. OSA?
position of hyoid bone, posterior airway space, soft palate length
44
Location of most nasal airway resistance?
internal nasal valve
45
Length of screw in ZF region to reach brain?
8mm
46
Layers encountered with retroseptal transconjunctival dissection of the lowereyelid
Post-septal approach - Conj, retractors, periosteum
47
What is the fluid deficit of a 70kg man NPO for 10 hrs?
110cc/hr x 10 hrs = 1100cc
48
At rest the cell membrane is least permeable to?
Na. At rest membrane is more permeable to K than Na
49
Minimum blood loss in a 70kg male to alter systolic blood pressure?
1500-2000ml Class III shock
50
A 21-year-old female is an unrestrained driver involved in a MVA. She suffers a scalp laceration and is noted to have lost 1000mL of blood at the scene. You would expect her vital signs to be consistent with:
Pulse rate >100, normal systolic blood pressure, decreased pulse pressure, respiratory rate of 20-30, urinary output of 20-30mL/hr.These findings are consistent with a Class II hemorrhage, 750-1500ml, The vitals signs or such a blood loss are consistent with those in response A. Response D reflects the vital signs of a Type IV blood loss, Response C a Type III and Response B a Type I.
51
Primary (direct)- callus free- bone healing involves what?
Direct contact between the bony segments
52
When do you not use propofol?
White soybean oil-egg yolk lecithin emulsion
53
You are uprighting an impacted 2nd molar, you need to do what?
Stabilize to 1st molar, avoid occlusal forces
54
How to distinguish between one or two fractures on panorex?
One fracture – lines converge at inferior borderTwo fractures –lines diverge and separate at inferior border
55
What is synonymous with an allograft?
homologous graft
56
What causes rejection of a facial implant rejection of homograft?
Cell mediated – cellular immunity
57
Which repositioning has the greatest increase in alar flare in a Lefort I?
superior repositioning of the maxilla causes elevation of the nasal tip,widening the alar bases and decrease the nasolabial angle.
58
Loss of articular cartilage, what most likely causes pain in the joint?
Subchondral nociceptive fibers
59
Property of drugs that cross thee BBB?
Lipophilic and nonionized
60
What are the papillary signs seen in severe HTN?
AV nicking
61
A lab report indicates coagulase positive. This refers to what?
Coagulase is an enzyme that coats the bacteria with fibrin and reduces the ability of the host cell to phagocytize it. S. aureus is the only coagulase-positive staphylococci
62
Pt has trismus after injection. Injury to what muscle?
Medial ptyerygoid
63
Complications of massive transfusion.
Dilutional thrombocytopenia
Complications of massive blood transfusion: thrombocytopenia, coagulation factor depletion, oxygen affinity changes, hypocalcemia, hyperkalemia, acid/base disturbances, hypothermia, and ARDS
64
Where are verocay bodies found?
Neurilemoma (Schwannoma)
65
Tzank test used for what?
Tzank smear is used in the diagnosis of herpesvirus infections (Tzank cells also seen in pemphigus vulgaris)
66
Aortic stenosis can lead to what
syncope and sudden cardiac death
67
Female patient, pano left body of mandible with impacted premolar with radiolucent lesion completely surrounding impacted premolar displace to inferior mandible. What is diagnosis?
Adenomatoid Odontogentic Tumor (AOT) - usually associated with anterior maxilla but not always
68
A patient seen in the emergency department presents with: elevated venous pressure, muffled heart sounds, and decreased arterial pressure. What is the most likely diagnosis?
Cardiac tamponade
The patient presents with the classic Beck's triad of increased venous pressure, decreased arterial pressure, distended neck veins and muffled heart sounds indicating cardiac tamponade.
69
What anesthetic gas to avoid with history of atrial fibrillation?
Halothane
70
Widen mediastinum on CXR indicates what?
Aortic dissection
71
Antibiotics most effective when MIC is what?
2-4x
The usual recommended dose of an antibiotic is usually sufficient to provide threefold MIC concentration against the common susceptible organism
72
Resuscitation of kids. What do you do first?
Head Tilt
73
What nerve mediates temperature and pain?
A delta and C
74
What is associated with Plummer Vinson syndrome?
higher incidence of esophageal cancer
Plummer-Vinson syndrome – iron deficiency anemia, esophageal webs, seen in conjunction with glossitis and dysphagia, has been associated with a high frequency of both oral, hypopharyngeal and esophageal squamous cell carcinoma
75
What is a poor prognosis sign of patient with squamous cell carcinoma of maxillary sinus?
pain
76
Neurogenic shock is due to what?
Neurogenic shock is shock caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls.
77
Where is mucosa sutured during Vestibuloplasty procedure?
Mucosa is sutured to the vestibular depth at the area of the periosteal attachment
78
What is the most common cause of impacted second molar?
Impacted 3rd molar
79
What is the advantage of the osteotomy over medpor implant to augment chin?
Less resorption
80
What post operative complication is the most difficult to correct after laser skin resurfacing?
hypopigmentation
81
What subnucleus of the trigeminal brainstem nucleus is primarily involved in the receiving and processing of facial pain?
Subnucleus caudalis of CN 5
82
What is the most common type of condyle fracture in children?
compressive
83
What concerns the anesthesiologist about a patient with rheumatoid arthritis?
Restricted neck mobility and the possibility of dislocation of cervical vertebrae
84
Most common complication associated with compression osteosynthesis?
Necrosis at bone interface
85
When does the blood supply to the STSG begin:
Survives 48 hours by plasmatic imbibition
Revascularization complete in 4-7 days.
86
What percentage of lingual nerve rises above the level of the alveolar crest in the area of the third molar?
10-15%
87
What is the conventional wisdom regarding the maximum time that the tooth has before reimplantation to have a shot at viability?
120 minutes, periodontal ligament fibers become irreversibly necrotic after this time frame
88
Treatment of avulsed tooth, out 3 hrs, but patient kept in mouth. How to treat?
Root canal first before reimplantation
89
Best way to close an oro-antral fistula from a 1st molar of 8 mm?
Openings greater than 6 mm require primary closure
Openings less than 2mm, no surgical treatment is necessary providing adequate hemostasis
Openings 2-6 mm conservative treatment is indicated including placement of figure of eight suture over the socket, gelfoam and sinus precautions.
90
Indications for Buccal Fat pad closure of O-A fistula?
Defects greater than 6 mm
91
A pediatric patient presents to our office 2 weeks following trauma to a primary central incisor. The tooth is now discolored, but otherwise asymptomatic. What is your treatment?
observation
92
What type of mandibular fracture poses the greatest risk of airway obstruction?
Bilateral angle fracture
93
Child bitten by a dog 3 days ago, now infected, what is the most likely organism?
Pasturella multicedins
Augmentin is the antibiotic choice because it is bacteriocidal for the range and spectrum of human and animal bite pathogens including Staphylococcus species and Pasteurella multocida.
94
When you bite on your anterior teeth describe the forces applied over an angle fracture?
Tension at the alveolus, compression at the inferior border
95
Patient has flaccid elbow & wrist reflex, but normal triceps reflex following MVA, what is the level of C-spine injury?
C 5-6 (triceps is C 7)
96
Primary bone healing requires?
Bone-bone contact & compression across the fracture site
97
Bone-bone contact & compression across the fracture site
Neutral zone
However, this is not possible in the mandible, since the neutral zone is in direct line w/ the IAN
98
What is the thickness of the superior tarsal plate
1 mm, (length 25mm, height upper 10mm, height lower 4mm)
99
What is the position of the upper eyelid, at primary gaze, in relation to the limbus?
2-3mm inferior
100
Which fracture would you NOT use a compression plate for?
Oblique fractures are contraindication to compression plate
