ABOMS Flashcards
Is extension or flexion worse in a brain injury?
extension
What is seen 1st on the retina during ocular exam in people diabetes
micro aneurysms
Why does propofol cause bradycardia and hypotension?
inhibits baroreceptors
Transcaruncular incision landmarks
Incise between caruncle and plica semilunaris
Sensory nerve to tip of nose
ext ciliary
nasociliary nerve
anterior ethmoidal nerve
Nerve injured in hip graft
iliohypogastric nerve
Deltopec artery supply
internal mammary artery
Hypokalemic periodic paralysis vs GBS after surgery
hypokalemia has low K and recovers quickly
Tissue layer depth for chemical peels
superficial-0.06
medium-0.45
deep-0.60
Hardest tooth position for coronectomy
position most likely to mobilize roots
What is type 4 nec fasc?
fungal
Body burn % estimate
Rule of 9s
18: chest, back
9: each arm, head, each leg surface
Min % Improvement in fev1 with bronchodilator
12%
Exact insertion point of superior head lateral pterygoid
Originates from greater wing of sphenoid
Inserts into articular disc and fibrous capsule
What type of flap is a buccal fat pad?
axial
Precedex MOA
alpha-2 agonist
What size LMA would you use on a patient who weighs 50kg?
4
A NIDDM pt with hyperosmolar nonketotic state would have hyponatremia?
false: Normal lytes, increased Cr and osms
Why fat graft after superficial parotidectomy
prevent frey’s syndrome
During trauma which nerve is injured with which bone fracture? CN 1,3,4,6
1-ethmoid
3-
4-occipital
6-temporoparietal
Which part of face loses the most volume with age
malar
During neck trauma what is the most frequent indication for trach?
blunt neck trauma
How do you prevent recurrence of odontogenic myxoma
cryotherapy
How does a myxoma grow?
mitosis
Change on lateral ceph after SARPE
clockwise rotation of maxilla
To prevent iatrogenic fracture of the sphenoid and orbital bone during sarpe which cuts have to be done adequately?
pterygomaxillary/tuberosity
Most common cardiac side effect of peds with succinylcholine
bradycardia
A lefort 2 is done for which developmental abnormality?
Binder’s syndrome
Maxillary and mandibular alveolar bone is derived from which arch?
1st branchial, ectoderm
What does BMP stimulate?
mesenchymal stem cells
What ABG value will lead you to believe that an ashthmatic is pending respiratory failure?
increased CO2
Trauma to face anterior 2/3 tongue have anesthesia and tongue drops to side of injury. What nerves are damaged?
lingual and hypoglossal
What preoperative treatment could you do to avoid hyperpigmentation after laser?
trentoin and azaleic acid
Ex fix is indicated for which fracture?
resorbed edentulous mandible
Eyelid test shows laxity on lower lid, what procedure would you do?
canthopexy
Surgery in which zone can result in shoulder injury?
2B
Local anesthesia toxicity is increased in pediatric patient with simultaneous use of
opioids
An increased dose adjustment is needed for patients with myasthenia gravis for which paralytic?
succ
During cleft lip repair which layer of orbicularis oris needs to be re- approximated for good white roll?
horizontal
What do you use to treat cocaine induced HTN?
diltiazem
Frey’s syndrome crossover
damage to auriculotemporal
PS connected to sympathetic
When placing extraoral drain draining pterygomandibular abscess drain is placed where?
superficial to medial pterygoid, deep to ramus
Pt with fever malaise horners syndrome has abscess where?
post styloid lateral pharyngeal abscess
What is true about skin graft around implant indications?
may be the only choice due to volume in cancer patients
What percentage of full bony impacted canines come into occlusion after uncovering?
75
Maximum relapse you would expect after maxillary down graft
2.3mm
What is the disadvantage of using DO on a 20mm high anterior mandible to fill a defect of 20mm?
vector maintenance
An orbital abscess causes vision loss by:
venous thrombosis
Where does reduction of dorsal hump take place?
superficial to bone and cartilage
Chronic TMJ pain and GI problem which NSAID is best?
etodolac
Which medicine should you not use on a patient with parkinsons?
droperidol
What is same for both obstructive and restrictive lung disease?
TV
Nonunion after LF I most commonly caused by:
bruxism
When do you cranialize frontal sinus?
comminuted anterior and posterior table
Trigger zones for Trigeminal neuralgia are distributed in areas innervated by which nerves?
CN V2 and 3
Normal RR for 3 year old
24-40
Which is not a good choice for cranial and frontal developmental abnormality?
a. autograft
b. allograft
c. cranial advancement
d. subcranial LF3
D
MC bacteria in odontogenic infections
a. strep
b. staph
c. bacteroides
d. actino
a.strep
Pulseless rhythm is seen in:
WPW
Ion uptake by Fentanyl in the stomach where acid is present leads to:
a. faster onset
b. short acting
c. delayed onset
c. delayed onset
What is beneficial for someone with Hypertrophic cardiomyopathy?
expand volume
Homograft rejection is mediated by:
cellular immunity
What is true about burkitts?
extranodal spread is seen in GI Tract of Americans
23 yo AA M with maxillary submucosal painful swelling for the past 2 months
actino
Orbital trauma what causes loss of crease in upper eyelid?
levator disinsertion
Lab value you check to see muscular dystrophy
creatinine kinase
How is BMP made?
a. distillation from freeze dried bone
b. polymerizing BMP amino acids
c. gene splicing into cells
b
How do you correct ectropion with 4mm scleral show?
lateral canthopexy
Implant placed in incisor region the tooth was previously endo treated then had infection and was removed how will you ensure papilla will grow
papilla will grow if the distance from the bone crest to contact is 5mm
What determines longevity of implant placed in posterior maxilla?
use of a longer implant than shorter implant
Thalessemia and facial deformity leads to what kind of hypoplasia?
sagittal (vertical)
First stage of metabolic phases
ebb
Difference between imbibition and inosculation
Imbibition- graft absorbs (imbibe) nutrients from underlying recipient bed
Inosculation- blood vessels in skin graft grow to meet the vessels (inosculate = kiss) of the recipient bed
Doing a vestibulopathy and floor lowering procedure with a 0.7mm skin graft, what is most likely late complication?
hair growth
papillary dermis is 0.45, reticular (has hair follicles) is 0.6, so this depth would grow hair
Normal STSG is ~0.015”
Precedex – Alpha 2 agonist, how does it affect a child also getting sevoflourane?
requires less sevo
Crouzon’s – how does it affect mandible growth?
variable
What does mineralized bone graft provide better?
osteoconduction
Maxilla and mandible are from which brachial arches?
1st
Minimal space required “for an implant-supported overdenture”
12
Definition of the Keystone area
where nasal bones and upper lateral cartilages overlap
Treatment of lacrimal duct injury
cannulation for 3-4 months
Minimum amount of time for consolidation of distraction for implant placement
2 months
Large parotid mass with nerve-involvement symptoms… what is the next step?
FNA
Where do you see a pterygomandibular space infection?
Above the angle and below the ear
What determined onset of a local anesthetic?
dissociation constant (pKa)
Triceps out but biceps work.. where is the lesion?
C7/8
Some lady with gingival overgrowth.. they show histology which is full of lymphocytes… what is the lesion?
leukemia
What is responsible for cat scratch disease?
Gm – bacillus, bartonella
In an oculomotor palsy, where does the eye look?
down and out
What is the test for hyperparathyroidism?
Parathyroid immunoassay
What is protective against PONV?
smoking
Which increases the risk of alveolar osteitis?
age >25
What is treatment for serotonin syndrome?
cyproheptadine
Where will a STSG not work?
scalp avulsion to skull
Artery supplying the scapular free flap
Circumflex scapular
Artery supplying the iliac crest free flap
deep iliac circumflex
Which is true of lichen planus?
it can become malignant
Young lady with boyfriend with history of an STI now has TMJ septic arthritis…bacteria?
gongococcal
On pediatric rheumatoid arthritis of the TMJ – do steroid injections work?
no
Why wait 3 months for primary cheiloplasty?
muscle maturation
What is a contraindication to an LMA?
Limits to positive pressure, cannot position other than supine, doesn’t prevent aspiration
Feature most likely to indicate nerve injury during thirds removal?
darkening of root
Medial osteotomy of a BSSO too high what happens?
condyle stays on distal segment
Rushton Bodies are found in:
Lateral radicular cysts
Correct dose of lidocaine in micrograms/min/kg to treat ventricular fib
1-1.5mg
position of upper eyelid in primary gaze in relation to limbus
2-3mm inferior
best way to monitor blood loss in trauma patient
CVP
position for CSF leak
semi fowler
osteotomy for LF III
FZ suture extending into inferior orbital fissure
temperature that necrosis bone during implant
47
In lip switch where is mucosa sutured to?
periosteum at depth of vestibule
difference between staple and TMI
TMI requires less bone
what percentage of discs recapture after arthroscopy
0-10
which noise of TMJ has best prognosis
early opening and late click
how is pain felt if disc perforation
subchondral nociceptors
what nerve is damaged above condylotomy
auriculotemporal
RA diagnostic aid
ANA
MC AVM site after LFI
descending palatine
area most resistant to RPE
mid palatal suture
stripping of which muscles causes condylar sag after IVRO
medial pterygoid and masseter
what causes immediate relapse following BSSO
proximal segment distraction during fixation
What do patients with VME have?
decreased masticatory force
SARPE in which patients?
> 18 with >5mm transverse
MC bad split in BSSO
buccal plate fracture
microscopic anatomy of lingual nerve
10-25 fascicles
graft with more long term shrinkage
STSG
maxillary vein plus what make retromandibular vein?
superficial temporal
what type of bond exists between HA and bone?
chemical
cant feel pulse in anterior temporalis, what to do next?
discard and use posterior
mentalis I/O
I-dermis of skin
O-mental tubercle
how does freeze dried bone work?
osteoconduction/provides BMP
pec major blood supply
thoracoacromial
what muscle during AICBH causes limp
tensor fascia lata, psoas
best age for hard tissue manipulation in cleft kids
9-11
Fetal alcohol characteristics
epicanthal folds, indistinct philtrum
moebius syndrome
CN 6 and 7 palsy
facial droop, crossed eyes
- Symptoms: malaise, cramps, weakness, constipation
* EKG: ST segment depression, inverted T waves, large U waves, prolonged PR interval.
hypokalemia
- > 5.5 mmol/L
- Symptoms: palpitations, muscle pain, muscle weakness, numbness
- EKG: peaked T waves, prolonged PR interval, widened QRS complex, small P waves
- Tx: calcium gluconate, insulin/glucose
hyperkalemia
contraindication to lag screws
comminuted fractures, oblique fractures
absolute indication for hardware removal
loose
oral and esophageal candidiasis treatment
nystatin or systemic fluconazole
Cerebellopontine angle tumor causing symptoms of trigeminal neuralgia. What kind of tumor most likely
schwannoma
long term complication of hyphema
glaucoma
tidal volume for child on ventilator
5-10
staging of cancer patient with boney involvement
T4
what kind of cells are associated with epulis of newborn?
granular cells
blood supply of inferior turbinate
sphenopalatine from internal maxillary
muscle that closes eustachian tube
levator
muscle not important in velopharyngeal competance
superior constrictor
buccal cellulitis with blue hue in child
hemophilus
Want antibiotic concentration to be what in relation to minimum inhibitory concentration?
less than
when to have abx before OR?
30 min
hypoglossal nerve in relation to hyoglossus and mylohyoid
lateral and above hyoglossus, medial to mylohyoid
accessory TMJ ligaments
stylo and sphenomandibular
Relation of the upper lateral cartilages to the nasal bones:
underneath
Murmur that is continuous through systolic and diastolic
PDA
valve most commonly involved in endocarditis
tricuspid
best screening for cardiac contusion
ekg
paralytic for renal failure
atracurium
siadh treatment
fluid restriction, conivaptan
eye findings in hypertension
Funduscopic examination shows arteriolar constriction, arteriovenous nicking, vascular wall changes, flame-shaped hemorrhages, cotton-wool spots, yellow hard exudates, and optic disk edema.
cluster headache characteristics
unilateral, congestion, lacrimation
What RDI is indication for treatment in child with craniofacial anomaly?
10
After birth what part of the mandible shows the least growth?
symphysis
Muscle of facial expression that does not attach to bone?
risorius
chance of unaffected parents having second cleft child
4
Cl +/- CP: 1: 700
CP only: 1:2000
Primary relative: CL +/- CP: 3.3%
CP only: 2%
One affected child: 2-5% Second child
Two affected children: 9-12%
Craniopharyngeoma resembles what histologiclly
ameloblastoma
Innervation of Palatoglossus
vagus, it’s the only tongue muscle not innervated by XII
thyroid IMA rate
7.5%
dysphagia, cheilosis, esophageal webs
plummer vinson, esophageal cancer
MC tooth to show hyperplastic pulpitis
primary molar
Fungal infection the Type I diabetics
mucor
when eyelid raises w/ pterygoid function
marcus gunn/jaw winking
medial strabismus is caused by damage to what muscle
lateral rectus
ewings sarcoma is most related to
non-hodgkin’s lymphoma and neuroblastoma histologically
digastric innervation
anterior: CN V
posterior: CN VII
tongue drops down before palatal closure
true
temporal branch muscles
frontalis
orbic oculi
zygomatic branch muscles
orbic oculi
zygomaticus major/minor
levator labii superioris
levator labii superioris alaeque nasi
buccal branch muscles
buccinator
orbic oris
mandibular branch muscles
depressor anguli oris
depressor labii inferioris
mentalis
cervical branch muscles
platysma
what does aortic stenosis do to MAP?
decreases
What factor in the coagulation cascade activates complement, clotting and kinin?
Extrinsic pathway: activated by TF/trauma
Intrinsic pathway: activated by HMW kininogen, prekallekerin
Pros and cons of DCIA hip graft
Pros
- excellent source of both BONE and SOFT TISSUE for composite defects
- most ANATOMIC reconstruction of the mandible
- can provide HEIGHT & WIDTH of the native mandible
- great for implant placement
- internal oblique muscle: can be used for soft tissue component and avoid bulky cutaneous skin paddle
Cons
- skin paddle has limited mobility
- bone stock limited to 16cm
- NOT sufficient for total mandibular recon
- osteotomies have to be performed lateral to the ilium to preserve the vascular supply on the medial surface
- vascular pedicle is short
MC arrhythmia in sudden cardiac death
V fib
Marcus-Gunn: Pupil and the Jaw-winking phenomenon
An aberrant connection appears to exist between the motor branches of the trigeminal nerve (CN V3) innervating the external pterygoid muscle and the fibers of the superior division of the oculomotor nerve (CN III) that innervate the levator superioris muscle of the upper eyelid
what does maxillary sinus drain into
middle meatus
When do palatal shelves fuse-related to tongue dropping down?
8 weeks
muscle not involved in speech and most involved in speech
tensor
levator
pt with congenital micrognathia also has defect in what bones
malleus, incus
minimum bone to allow immediate implant at sinus lift
4-5mm
what does a minor salivary gland in sjogrens show
50+ lymphocytes, 1 focus per 4mm
venoirritation and thrombophlebitis during injection versed
propylene glycol
criteria for positive DPL
100k RBC
500 WBC
+ gram stain
MC arrhythmia in hyperthyroid
sinus tach
MOA of metformin
Decreases glucose production and increases insulin sensitivity
MOA cyclosporine
inhibits t cell proliferation and activation
distance from upper brow to center of pupil
25mm
what syndrome is associated with coup-de-gras defect
romberg (progressive facial atrophy)
malar eminence relationship to lateral canthus
10mm lateral, 15mm inferior
normal palpebral fissure
8-12mm women
7-10 men
relationship of medial and lateral canthus
lateral is 4mm superior
most likely prognostic factor for OKC recurrence
type of keratin
3 muscles surrounding scap flap
teres major, minor, tricep
blood supply to genioplasty
periosteum
MC ped orbital fx
roof
ramsey hunt syndrome
caused by herpes
facial paralysis plus auditory nerve damage
MOA TCA
blocks NE reuptake
pregnancy PFT
dec FRC, inc TV
least predictable area of soft tissue during BSSO
lower lip
what does wedge pressure of pulm catheter measure
L end diastolic
nerve most at risk during subgaleal brow lift
supraorbital
what is exposed during open sky approach to bleph
septum
the ability to distract the lower lid by how much means need for eyelid procedure
8mm
arch length discrepancy is MC associated with
impacted 3rds, buccal canines
latency time from benign tumor to sarcoma
5-12 years
max bone tibia
40cc
what causes loss of supraorbital crease after orbital trauma
enophthalmos
what causes tinnel’s sign
percussion proximal to injury
increased alk phos but normal calcium and phos
pagets
branchial cleft cyst is located where?
lateral
acute sinusitis bacteria
step pneumo
staph aureus
h inf
m catarrhalis
nosocomial sinus infection bacteria
pseudomonas
chronic sinusitis bacteria
bacteroides
proprionobacteria
alpha/beta hemolytic strep
cavernous sinus thrombosis affects what first
CN VI
how does TB spread?
hemotologically
b fragilis tx
flagyl
clinda
MC location for pindborg
CEOT mand, then max molar
what are lisegang rings seen in
CEOT (pindborg)
recurrent ranula tx
excise sublingual gland
abx that interfere with protein binding
aminoglycosides
tetracyclines
clinda
erythromycin
muellers muscle is under what type of control
sympathetic
kcal in 2400 of D5LR
480
enzyme elevated in MI
CK-MB, troponin
why cant do trap flap after neck dissection
transverse cervical a may be disturbed
what inhalational shouldnt be used in children
desflurane
what makes local more potent?
lipid solubility
how does damaged articular cartilage heal?
forming fibrocartilage
What happens to the synovial fluid in the TMJ in a patient w/RA?
decreased viscosity
After a Lefort I osteotomy, a patient has a strange aura and diplopia, what is the cause?
cavernous sinus thrombosis
What type of occlusal splint will cause more loading on the TMJ?
anterior primary contact
Compression of which part of the brain, or what type of herniation will result in anisicoria
temporal lobe compression
transtentorial herniation
What type of flap is the temporalis flap?
Axial
What is the correct pressure setting of CPAP for a patient with OSA?
7-15
What artery does not contribute to the frontal flap to the nose?
Superficial temporal
-Supratrochlear, supraorbital & dorsal nasal DO
Why do skin grafts differ between children & adults?
Child – no redundant skin, more elasticity
What separates the fat pads in the lower lid?
Inferior oblique separates medial & central pads
What is the pathway of dissection for an open rhinoplasty?
Over perichondrium, under periosteum
Where is the sensation lost after harvesting a sural nerve graft?
Dorsal & lateral foot/ankle
What is the major disadvantage of Abbe flap?
commissure recon
Which is the most potent vasoconstrictor?
NE
What is minimum that is required on the lower lateral cartilages for tip support?
5-7mm
What bacteria are most involved with pericoronitis?
a. Peptostreptococcus
b. Fusobacterium
c. Spirochetes
d. Bacteroides
What bacteria from the maxillary sinus is the most likely cause for meningitis?
h flu
What muscle opens the Eustachian tube?
tensor
What is the length of the nares, when compared to the columella?
2:3
You displace a 5 mm portion of the palatal root of a 1st molar into the sinus, what do you do first?
irrigate & suction then X-ray in 2 planes
Von Willebrand’s disease labs
elevated PTT and BT
What is the dose of lidocaine to treat multifocal PVC’s?
2-4
Where should you set the low limit alarm on a pulse oximeter?
94
A pulse oximter reading of 90% corresponds to a pO2 of?
60mm hg
How does heparin work?
Inactivates Xa and potentiates antithrombin III
What is the pollybeak deformity?
a. Convexity of nasal supratip, relative to the rest of the nose.
b. Complication following rhinoplasty – inadequate reduction of the superior
septal angle, a transfixion incision that is not adequately reconstructed
and/or postoperative scarring in the supratip region
c. Also called parrot’s beak deformity
Duration of local anesthesia is related to?
Degree of protein binding ability
An increase of 25% in the diameter of an implant gives what increase in the surface area of the implant?
10%
What are the risks of total parathyroidectomy
osteomalacia
What is the source of bleeding in an epidural hematoma
Middle meningeal or posterior meningeal arteries
What are the signs & symptoms associated with an epidural hematoma
Pupil dilation, hemiparesis, decerebration, LOC
What are the most common signs associated with a subdural hematoma
Anisicoria & motor deficit
what structures are damaged with deep laceration anterior to masseter
facial nerve, parotid duct, transverse facial artery
why do kids have higher incidence of ankylosis
thin cortical bone
soft tissue requirement for extraoral implant
1mm thick without hair follice
max bone pos iliac crest
100-120
when harvesting dermis graft, what structures survive
sebaceous gland
nitrous contraindication
repeat otitis media
sinus infection
GI obstruction
closed head injury
eye symptom of SLE
iritis
what cranial nerve leads to no consensual, direst reaction in affected eye and normal function in unaffected eye
CN III
vascular supply to inferior turbinate
sphenopalatine
what type of injuries can lead to anisicoria
temporal lobe compression
transtentorial herniation
what separates fat pads in lower lid
inferior oblique separates medial and central pads
sensation of sural nerve
dorsal and lateral foot/ankle
minimum LLC for tip support
5-7
bacteria for pericoronitis
peptosctreptococcus
fusobacterium
spirochetes
bacteroides
increase by 25% of diameter gives what increase to surface area
10%
signs and symptoms of epidural hematoma
pupil dilation
hemiparesis
decerebrate
LOC
signs and symptoms of subdural hematoma
anisicoria
motor defecit
what DFD does thalessemia lead to
VME
class II heart failure meds
beta blocker and ACE
which rib for costochondral graft in child
7
or 8-9
what do you see on arthroscopy in someone with late osteoarthritis
subchondral bone exposure
rhythm strip with double humped p wave
lef atrial enlargement
how does radiofrequency coblation work
radiofrequency plasma field
taste nerve tongue
pos third is CN IX
ant 2/3 is CN VII
ideal TAD placement
between premolars
cytokine seen in TMJ Synovium
TNF-alpha
what drug are people with MG sensitive to?
non depolarizing paralytics
labs in hyper para
low phos, high alk phos
paralysis of lower half of face
central
inferior border of level II
hyoid and carotid
what does IS measure
VC
where do osteoprogenitor cells come from 8 days after surgery
macrophages
most likely sign of IAN injury
darkening of root canals
which fracture is lowest prognosis
root fracture with intrusion
pradaxa MOA
direct thrombin inhibitor
degrees difference between frankfurt horizontal and natural head position M/F
male: 3.18
female: 4.41
what happens when HA injected into TMJ space
crystal induced arthropathies
minimum opening for pulp revascularization
1mm
rate of pulp revascularization
0.5-1mm per day
cytokine for healthy TMJ
IL-10
desmoplastic fibroma characteristics
effects children, benign
damage to the lingual nerve can cause atrophy of what?
fungiform papilla
what does acanthomatous ameloblastoma resemble?
SCCa
digeorge syndrome triad
palate disfunction, learning disability, chromosome 22 deletion
how can you give more distance to fibula flap
ligation of deep tibial artery
proper therapy for partial ear avulsion
dermabrasion with posterior pouch
how to preserve autologous fat grafting
atraumatic dissection of adipose tissue
split thickness graft location most likely to fail
exposed calvarial site
how does AML present intraorally
hyperplastic gingiva
rdi formula
RERA+hypopnea+apneax60
apnea definition
desat by 4% for 10 sec
how does globus pharygeus present
pharyngeal pain
dissection of what zone can damage trapezius
2b
orbital injury has what chance of blindness
3/1000
left sided face paralysis except frontalis has damage where?
cerebral opposite side
brown recluse spider bite treatment
dapsone
MC fungal infection in max sinus
aspergillus
MC bacteria in odontogenic infection
s viridans for aerobes
bacteroides/prevotella anaerobe
drain for lateral pharyngeal space
medial to medial pterygoid
max dose of dantrolene
2.5mg/kg
damage to what leads to hyphema
circulus iridis major artery-ant/pos ciliary a
