2022 Flashcards
1
Q
Normal MRD1 and MRD2
A
Distance from lid margin to light reflex
MRD1 (upper lid) - 4-5mm
MRD2 (lower lid) 5-5.5mm
2
Q
Grettfredsons syndrome
A
CN VI and XII palsies
Cause: Clivus tumor or nasopharyngeal carcinoma
3
Q
tensile strength of a scar at:
- 1 wk
- 1-3wks
- 3 wks
- 12-18 months
A
- 3%
- 30%
- 50-60%
- 80%
4
Q
Jessner’s Solution
A
14g risorcinol
14g salicylic acis
14mL lactic acid + 100mL Ethanol
superficial peel
5
Q
what is the most common site of involvement in inverted papilloma?
A
lateral nasal wall
6
Q
causes for bilateral facial paralysis
A
- stage II Lyme dx
2. Heerfordt dx; uveoparotid fever - acute sarcoidosis
7
Q
what is compressed in the following vascular anomalies?
- double aortic arch/ vascular ring
- abnormal innomonant artery
- pulmonary sling
A
- both esophagus and trachea
- anterior trachea
- right trachea and right main stem bronchus
8
Q
Sleep EEG patterns
A
Awake - alpha
N1 (non-REM) - theta wave
N2 (non-REM) - sleep spindles and K-complexes (low freq and high amp)
N3 (non-REM) - delta waves
REM - similar to awake EEG with rapid eye movement
9
Q
maneuvers that increase nasal tip projection
A
- interdomal sutures
- columellar strut
- shield grafting
- lateral crural steal
- tongue-in-groove
10
Q
when to use image-guidance FESS
A
- revision
- anatomic changes due to congenital, trauma, post-op
- nasal polyps
- pathologies in the frontal, post ethmoid, and sphenoid sinuses
- pathologies involving the ICA, skull base, optic nerve, and orbit
- neoplasms
- CSF leak 2/2 skull base defect
11
Q
contraindications for gamma knife
A
- > 3cm; swelling can cause hydrocephalus
- inferior spread of tumor; does not fit into collimator helmet
12
Q
lidocaine dosing
A
4mg/kg
6mg/kg - with epi
1% lido contains 10mg/1mL
2% - 20 mg/1mL
13
Q
Blood supply for ALT graft
A
lateral descending femoral branch of profunda femoral
14
Q
apnea
A
> 90% reduction in airflow for >10 seconds
15
Q
hypopnea
A
> 30% reduction in airflow + 4% reduction in saturation
16
Q
AHI
A
total sleep time
17
Q
RDI
A
AHI + RERA
18
Q
RERA
A
sleep events leading to arousal that does not meet criteria for apnea or hypopnea
19
Q
what is impedance matching?
A
how loss of sound is prevented as it goes from air to fluid
20
Q
mechanisms of impedance matching and dB for each
A
- TM surface area to oval window ratio (20:1) - 26dB
- Ossicles - 2dB
- TM bucking - 6dB
- stiffness of ossicles
- resonance of ME
- phase difference of round and oval windows
21
Q
list the intrinsic muscles of the larynx and their functions
A
vocalis/thyroidarytenoid - adduct and relax
transverse and oblique cricothyroid (interarytenoid) - adduct and close laryngeal inlet
cricothyroid - lengthen and tense
posterior cricoarytenoid - abduct
lateral cricoarytenoid - adduct
22
Q
nasal features of cleft lip
A
- nasal tip - contralateral
- lateral cruz - caudal and horizontal
- medial cruz - shortened on cleft side
- columella - base is pointed contralateral
- caudal septum - towards contralateral
23
Q
OSA risk factors
A
male neck circumference (15 & 17 cm) soft palate length retropalatal space hyoid position age
24
Q
virus responsible for recurrent Respiratory Papillomatosis
A
HPV 6 and 11
- 11 is more aggressive
25
Bethesda Classification
1. non-diagnostic - repeat FNA with US
2. benign - observe
3. atypia or follicular of undetermined significance - repeat FNA/ molecular testing/ lobectomy
4. (suspicious) follicular neoplasm - molecular testing/ lobectomy
5. suspicious for malignancy - near total/ lobectomy
6. malignant - near total/ lobectomy
26
ages of sinus development
sinus - start - end
1. maxillary - utero - 3 years and again at 7-18 years
* first to develop
2. ethmoids - utero - 12-15 yo
* most developed at birth
3. sphenoid - 4 yo - 12-18 yo
4. frontal - starts at 5-6 yo - 20 yo
27
phases of hair growth
1. anagen
- 90%
- active growth
- male pattern hair loss
2. catagen
- transition
3. telogen
- 10%
- terminated
28
fillers appropriate for lipodystrophy 2/2 antiviral use
calcium hydroxyapetite
| poly-L-lactic acid
29
malignancy rate of inverted papilloma
10%
30
embryonic derivatives of ear bones
manubrium of malleus - 2nd branchial arch
long process of incus - 2nd branchial arch
stapes suprastructure - 2nd branchial arch
stapes foot place - separate; from otic capsule
rest of malleus and incus - 1st branchial arch
31
Eyelid Defect Repair
1. <25%
2. <60%
3. >50% upper lid
4. > 50% lower lid
1. primary closure
2. tenzel semicircular advancement flap
3. cutler-beard flap
4. Huge's tarsoconjunctival flap
32
risk factors for tracheo-innominate fistula
- low placement
- steroids
- radiation
- malnutrition
- hyperextension of neck
- 3-4 weeks
33
what % of congenital VC paralysis is bilateral?
50%
34
features of central vertigo
- does not diminish with repeated stimulation
- nystagmus is in multiple direction and not relieved with fixation
- symptoms are not as bad
- no hearing loss
35
what is the most anterior structure of tympanic cavity?
cochleariform process
36
1st branchial fold
EAC
37
1st branchial arch
A. maxillary a.
N. CN V
M. mastication
S. malleus, incus, sphenomandibular ligament, Meckle's cartilage
38
1st branchial pouch
middle ear cavity
39
2nd, 3rd, and 4th branchial fold
neck
40
2nd branchial arch
A. stapedial a, hyoid a.
N. CN VII
M. facial expression
S. long process of incus, manubrium of malleus, stapedial superstructure, styloid, stylohyoid ligamemt, lesser horn and upper hyoid, Reikerts cartilage
41
2nd branchial pouch
supratonsillar fossa
42
3rd branchial arch
A. ICA
N. CN IX
M. stylopharyngeal
S. greater horn and lower hyoid
43
3rd branchial pouch
thymus & inferior parathyroids
44
4th branchial arch
A. R subclavian and aorta
N. CN X (superior laryngeal)
M. laryngeal & parapharyngeal
S. laryngeal cartilage
45
4th branchial pouch
superior parathyroids, thymus, and ultimobranchial body (parafollicular cells)
46
mucoepidermoid carcinoma
MC malignant ca of salivary glands
affects middle-age females
grades: low vs high based on cellular differentiation and presence of mucinous cyst
47
Superficial Peels
epidermis to superficial dermis
- AHA: glycolic acid, lactic acid, and citric acid
- salicylic acid
- Jessner's solution
48
Medium depth peels
papillary dermis to superficial reticular layer
tricholoroacetic acid (TCA)
- up o 50%
- weight to VOLUME concentration
- risk of scarring
- can be used with glycolic acid or Jessner's solution (these are applied first)
49
Deep peels
penetration into the reticular dermis
Baker-Gordon solution
50
baker gordon solution
phenol 88% - 3cc
distilled water - 2cc
croton oil - 3 drops
septisol - 8 drops
51
Hyperthyroidism treatment for pregnancy
PTU - 1st trimester
| Methimazole - 2-3 trimesters
52
E6 + E7
suppresses p53 (E6) and pRB (E7)
53
Gilles approach - what is the plane of dissection?
deep to deep layer of temporals fascia
54
risk factors for developing ex-pleomorphic carcinoma
- fast growth
- facial nerve paralysis
- malignant cells on histological slide
- pain
55
how does non-recurrent RNL from on the right?
RLN comes from 6th arch
subclavian artery comes from 4th arch and pulls RLN down as heart descends
if it regresses, the subclavian artery arises from left aorta and takes a retroesophageal course
occurs 0.5-5% of the time
56
how does left non-recurrent RLN form?
situs inversus
57
acidic vs. alkali ingestion
acidic
- causes coagulation necrosis
- low depth of penetration
alkali
- cause liquefaction necrosis
- high depth of penetration
- higher risk of perf
58
orbital apex syndrome vs. superior orbital fissure syndrome vs. cavernous sinus syndrome
OAS - CN II, III, IV, VI, V2
SOFS - CN III, IV, VI, V2
CSS - CN III, IV, VI
59
histopath stain positivity
- melanoma
- sinonasal undifferentiated carcinoma
- Ewing
- rhabdomyosarcoma
- esthesioblastoma
- melanoma: HMG 45, s-100, melanin-A
- SUC: cytokeratin
- Ewing - neuron specific enolase
- rhabdomyosarcoma - design
- esthesioblastoma - neuron specific enloase
60
Factors that improve overall survival in IFS
diabetes
liposomal amphotericin B
surgery
61
Describe each type of Dedo Classification
```
I: Youthful
II: jowling and skin laxity
III: submental fat
IV: platysmal banding
V: micro or retrognathia
VI: low hyoid bone
```
62
treatment options for T1 and 2 glottic cancers
radiation or partial laryngectomy (CI in with poor lung function)
63
US findings suspicious for thyroid malignancy
1. hypo echoic
2. taller than wide
3. calcifications
4. central vascularity
5. solid
6. extension
7. CLAD
64
US nodal findings suspicious for metastasis
1. round
2. microcalcifications
3. loss of fatty hilum
4. central vascularity
5. hypo echoic
65
Path of cochlear afferent
ECOLI-MA
Inner hair (90%)/ outer hair (5-10%) cells
```
eighth nerve
cochlear nuclei
olivary complex (superior)
lateral lemniscus
inferior colliculus
-
medial geniculate body
auditory cortex
```
66
disadvantage of lateral graft tympanoplasty
- blunting
- cholesteatoma
- more intensive technique
- longer healing time
- laeralization
67
Hitselberger sign
numbness of the conchal bowl and posterior EAC due to compression of facial nerve from schwannoma
68
Hennebert's sign
pressure induced nystagmus
perilymphatic leak
69
what are the 3 stages of skin graft take
1. imibition - first 24-48 hours - nutrients from tissue beneath
2. inosculation - starts at 48 hours - small vessels from the tissue beneath and the graft start to grow toward each other
3. angiogenesis - days 4-7 - new, permanent blood vessels are formed from recipient to graft
70
what is lyer sign?
splaying of the ICA posteriorly and ECA anteriorly due to presence of carotid body tumor
71
what are the phases of wound healing?
1. inflammatory - duration: 3-7 days - PMN/macrophage, vasodilation, phagocytosis
2. proliferative - peaks at 3 weeks
2a. superficial reepithelialization
2b. fibroblast and collagen synthesis
3. remodeling - ends: 18 months - replacement of type III to type I collagen
72
ototoxic characteristic of the following:
- aspirin
- carboplatin
- cisplatin
many affect outer hair cells of the base
- aspirin: mild-moderate reversible hearing loss in 24-72 hrs
- carboplatin: affect inner hair cells
- cisplatin: stria vascularis, outer hair cells, spiral ganglion cells
73
what does mitomycin C do?
it alkylates DNA leading to crosslinking
74
distance from lacrimal crest - ant eth - post eth - optic canal
24-12-6
75
how is prominaris measured?
mastoid to lateral helical rim >2-2.5cm
| auriculocephalic angle >25-35º
76
what are the main features of prominaris
unfolded antihelix
large conchal bowl
distal insertion of anti-tragicus muscles (pulls helix laterally)
77
what is the most common sinus of involvement in inverted papilloma?
maxillary sinus
78
what is the most commonly injured sensory nerve during a face lift?
greater auricular nerve
79
what are the most commonly injured motor nerve during a face lift?
marginal and temporal CN VII
80
contents of the infra temporal fossa
1. medial and lateral Pterygoid muscles
2. mandibular branch of V
3. chorda tympani
4. deep lobe of pterygoid
5. otic parasympathetic ganglion
6. maxillary artery and branches
81
Kadish staging system
esthesioblastoma
A: limited to nasal cavity
B: limited to nasal cavity and paranasal sinuses
C: extends beyond nasal cavity and paranasal sinuses
D: involved nodes/mets
82
Gradenigo Syndrome
petrous apecitis
- retrorbital pain (trigeminal nerve, ophthalmic division)
- abducens palsy (Derello canal)
- otorrhea
83
z-plasty angles, scar rotation and elogation
angles rotation elongation
30 45 25%
45 60 50%
60 90 75%
84
ototoxicity of aminoglycosides
- irreversible
- high frequency (starts at the base)
- affects the outer hair cells
- dose-dependent
- streptomycin and gentamicin are vestibulotoxic
- sensitivity is passed through mtDNA (maternal)
85
how many dB increase will double the sound intensity
3dB
86
what is recruitment?
outer cell hair damage causes recruitment of normal functioning cells
outcome: there is a lower threshold for louder sounds because the gap between soft and loud sounds become smaller
if recruitment is absent in SNHL, indicates retrocochlear lesion
87
asymptomatic vs symptomatic pt with caustic ingestion
(-) sx: observe
| (+) sx: esophagoscopy in 12-24 hrs
88
Lund Mckay score
for each sinus 0-2 on sinus opacification
| for OMC blockage 2
89
vernet syndrome
Jugular foramen
CN IX, X, XI involvement
cause: lesion involvement jug foramen (tumor, trauma, thrombophlebitis, LAD of nodes of Krause)
90
Villaret Syndrome
retroparotid space
| CN IX, X, XI, and XII involved
91
Treatment for botox
Apraclonidine
| Alpha 2 agonist to activate muller muscle
92
OHSA noise exposure limits
90dB over 8 hours
for additional 5dB, half the allowable hours of exposure
e.g. 95 dB over 4 hrs
100 dB over 2 hrs
...
93
incisions of mid-face degloving approach
full transfixion
bilateral intercartilagenous incisions
sublabial incision from molar to moalar
94
boundaries of the frontal recess
anterior: aggar nassi cell
posterior: anterior ethmoid cell/basal lamella
medial: middle turb
lateral: lamina papyracea
95
ohngren's line
line from angle of mandible to the medial canthus
| sinus cancer above this line = poor prognosis
96
when to repair a clef lip
10-10-10
| hgb-weight-weeks
97
laryngeal dysplasia - malignant potential
10-30% from ild to severe/CIS
will occur ~5yrs after dysplasia diagnosed
98
protein targeted in HPV vaccine
L1 (structural surface proteins)
