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** Basic & Applied Science ENT Topics > Basic Surgical Concepts > Flashcards

Basic Surgical Concepts Flashcards

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1
Q

What is the esophagotracheal Combitube?

A

A twin-lumen device with upper and lower balloons that is inserted blindly into the hypopharynx.

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2
Q

How is the gum bougie introducer for endotracheal intubation used in a patient with difficult airway?

A

Any part of the laryngeal airway, usually the posterior glottis, is visualized with the anterior commissure laryngoscope; the bougie is passed through the scope into the larynx; and the ETT is passed over the bougie.

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3
Q

Which laryngoscope blade is especially useful for patients with edematous or redundant tissue obstructing the view of the vocal cords?

A

Bainton blade.

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4
Q

What are the two primary disadvantages of the laryngeal mask airway (LMA) compared with endotracheal intubation?

A

Easier to displace than a secured endotracheal tube (ETT) and does not protect from aspiration.

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5
Q

Why is jet ventilation contraindicated in patients with tracheal stenosis?

A

Expiration of air is more difficult than inspiration during jet ventilation in patients with tracheal stenosis and can result in air trapping and pneumothoraces.

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6
Q

What situations are best for the use of the lightwand during endotracheal intubation?

A

For patients with cervical spine injury, for children with mandibular hypoplasia, or when copious secretions are present.

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7
Q

Which laryngoscope blade has a high-resolution digital camera incorporated into it?

A

GlideScope.

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8
Q

What is the primary advantage of the fast-track LMA?

A

It allows placement of an ETT without direct laryngoscopy.

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9
Q

What is the primary advantage of the ProSeal LMA?

A

It has an extra lumen to allow suctioning of the stomach.

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10
Q

What is the Sanders ventilator?

A

Jet ventilator that delivers 02 at

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11
Q

What are the best options for the “can’t intubate, can’t ventilate” situations after induction of general anesthesia?

A

LMA, transtracheal needle jet ventilation, Combitube, or surgical airway.

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12
Q

What physical features are predictors of difficult intubation in patients with OSAS?

A

Low hyoid (mental protuberance to hyoid distance > 30 em), mandibular deficiency, and large neck circumference (>45 em).

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13
Q

What is the primary advantage of the Combitube over an LMA?

A

Prevents aspiration if the patient vomits.

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14
Q

What are contraindications to LMA?

A

Upper airway obstruction, preexisting pulmonary aspiration, and conditions that restrict pulmonary compliance.

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15
Q

What is the death rate from anesthesia in patients with ar1 ASA class I or II

A

1 in 200,000.

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16
Q

Acute renal failure after major ablative head and neck cancer surgery increases the mortality risk by how much

A

10%.

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17
Q

How much epinephrine is contained in 1cc of 1:100,000 epinephrine?

A

10mcg.

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18
Q

What is the risk of perioperative MI in patients undergoing surgery within 3 to 6 months of an MI

A

16%.

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19
Q

What is the best time to begin prophylactic antibiotic therapy for elective surgery?

A

1hour prior to the operation.

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20
Q

What is the maximum recommended dose of cocaine

A

2 - 3 mg/kg.

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21
Q

What is the maximum recommended dose of bupivacaine

A

2 - 3 mg/kg.

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22
Q

Children may have unlimited clear liquids up to how many hours prior to scheduled anesthetic induction

A

2 to 3 hours.

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23
Q

What are the daily maintenance fluid requirements of a healthy 60-kg woman?

A

2100 cc.

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24
Q

What is the maximum recommended dose ofbupivacaine?

A

2-3 mg/kg.

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25
Q

When should oral hypoglycemics be discontinued prior to surgery

A

24 hours.

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26
Q

What is the duration of action of bupivacaine

A

3 - 10 hours.

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27
Q

What is the maximum recommended dose of lidocaine in a 60-kg woman?

A

300 mg (5mg/Kg) without epinephrine; 420 mg (7mg/Kg) with epinephrine.

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28
Q

What is the duration of action ofbupivacaine?

A

3-10 hours.

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29
Q

When is the risk of rebound hypertension from propranolol withdrawal the greatest

A

4 to 7 days after the drug is discontinued.

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30
Q

What is the maximum recommended dose of lidocaine

A

5 mg/kg without epinephrine; 7 mg/kg with epinephrine.

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31
Q

When should a patient quit smoking to have the greatest decrease in perioperative pulmonary complications

A

8 weeks before the planned procedure.

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32
Q

When should warfarin therapy be discontinued prior to surgery

A

96 to l I 5 hours ( 4 doses).

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33
Q

What is the preferred anesthetic technique for bronchoscopy in adults?

A

A modified endotracheal tube or a jetting system used with a relaxant and controlled ventilation.

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34
Q

What is the preferred anesthetic technique for bronchoscopy in adults

A

A modified endotracheal tube or a jetting system used with a relaxant and controlled ventilation.

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35
Q

What is a reliable alternative induction technique in a 5-year-old struggling child who refuses the mask and cannot be managed by intravenous induction because of lack of accessible veins?

A

A sedating intramuscular injection of ketamine (3 mg/kg).

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36
Q

What is a reliable alternative induction technique in a 5-year-old struggling child who refuses the mask and cannot be managed by intravenous induction because of lack of accessible veins

A

A sedating intramuscular injection of ketamine (3 mg/kg).

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37
Q

What is the esophagotracheal Combitube

A

A twin-lumen device with upper and lower balloons that is inserted blindly into the hypopharynx.

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38
Q

What anesthetic considerations must be taken into account in a patient with sickle cell disease

A

Adequate hydration and oxygenation. Spinal or local anesthesia should be used whenever possible.

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39
Q

What factors increase the risk of postoperative pulmonary embolism (PE)

A

Age > 40 years, history of lower extremity venous disease, malignancy, CHF, trauma and paraplegia.

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40
Q

What factors predispose children with viral URis to airway hyperactivity

A

Age less than 5 years; family history of allergic disease; infections secondary to respiratory syncytial virus; parainfluenza rhinovirus, influenza or M. pneumonia, coexisting malaise; rhinorrhea and excess mucus production; male sex, and preexisting airway reactivity.

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41
Q

What is the standard endocarditis prophylaxis for dental, oral or upper airway procedures in adult patients at risk

A

Amoxicillin 2 gm orally, I hour before the procedure.

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42
Q

What is the appropriate preoperative work-up for a young patient with frequent premature ventricular contractions (PVCs)

A

An ECG, holter monitor and a cardiac stress test.

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43
Q

How is the gum bougie introducer for endotracheal intubation of the “difficult airway” patient used

A

Any part of the laryngeal airway, usually the posterior glottis, is visualized with the anterior commissure laryngoscope, the bougie is passed through the scope into the larynx, and the ETT is passed over the bougie.

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44
Q

What role might oral clonidine play in the preoperative period

A

As an alpha-2 adrenergic agonist, it can reduce anesthetic requirements and has been used to provide sedation and anxiolysis while maintaining hemodynamic stability.

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45
Q

What is the inheritance pattern and incidence of pseudocholinesterase deficiency?

A

Autosomal recessive with an incidence of about 1in 3000.

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46
Q

What is the inheritance pattern and incidence of pseudocholinesterase deficiency

A

Autosomal recessive with an incidence of about I in 3000.

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47
Q

Which hypertensive medications classically cause withdrawal hypertension and, therefore, should not be stopped prior to surgery

A

Beta-blockers and clonidine.

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48
Q

What are the adverse side effects of succinylcholine

A

Cardiac dysrhythmias, fasciculations, hyperkalemia, myalgia, myoglobinuria, increased pressures (ocular, gastric and cranial), trismus, allergic reactions; it can also trigger malignant hyperthermia.

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49
Q

What are the adverse side effects of succinylcholine?

A

Cardiac dysrhythmias, fasciculations, hyperkalemia, myalgia, myoglobinuria, increased pressures (ocular, gastric, and cranial), trismus, and allergic reactions; it can also trigger malignant hyperthermia and cause prolonged paralysis in patients with pseudocholinesterase deficiency.

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50
Q

Why are iodine solutions superior to chlorhexidine as a surgical antiseptic?

A

Chlorhexidine is not effective against viruses and fungi.

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51
Q

Which neuromuscular blocker’s metabolism is independent of renal or liver failure?

A

Cisatracurium.

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52
Q

Which antihypertensive medication prolongs the effect of regional anesthesia with amide anesthetics?

A

Clonidine.

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53
Q

Which antihypertensive medication prolongs the effect of regional anesthesia with amide anesthetics

A

Clonidine.

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54
Q

What are the toxic side effects of local anesthetics

A

CNS excitability or depression, myocardial depression, peripheral vasodilation, methemoglobinemia, allergic reactions.

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55
Q

What are the toxic side effects of local anesthetics?

A

CNS excitability or depression, myocardial depression, peripheral vasodilation, methemoglobinemia, and allergic reactions.

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56
Q

Of Goldmann’s risk factors, which has been shown to be the most significant

A

Congestive heart failure (CHF).

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57
Q

What comorbid factor provides the greatest risk of perioperative myocardial infarction during major elective noncardiac surgery

A

Coronary artery disease.

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58
Q

Where should local anesthetic be injected to anesthetize the subglottis and preepiglottic space?

A

Cricothyroid membrane and thyroid notch, respectively.

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59
Q

Where should local anesthetic be injected to anesthetize the subglottis and Preepiglottic space

A

Cricothyroid membrane, thyroid notch, respectively.

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60
Q

What are the advantages of propofol over volatile agents in pediatric ambulatory patients

A

Decreased postoperative nausea and vomiting and decreased incidence of airway obstruction.

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61
Q

Which a-agonist is five to ten times more potent than clonidine and is approved for use as a sedative and analgesic in the operating room and ICU?

A

Dexmedetomidine.

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62
Q

What is the primary disadvantage of the laryngeal mask airway (LMA) compared to endotracheal intubation

A

Easier to displace than a secured endotracheal tube (ETT).

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63
Q

T/F: Individuals who take clear liquids close to their time of surgery are at greater risk of aspiration than those who remain NPO

A

False.

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64
Q

T/F: All local anesthetics are weak bases and produce vasodilation

A

False. Cocaine and ropivacaine are the exceptions.

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65
Q

True/False: All local anesthetics are weak bases and produce vasodilation.

A

False: Cocaine and ropivacaine are the exceptions.

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66
Q

True/False: All opioids cause bradycardia.

A

False: Meperidine is the exception.

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67
Q

T/F: All opioids cause bradycardia

A

False; meperidine is the exception.

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68
Q

Which medication has been shown to decrease the catecholamine response during suspension laryngoscopy?

A

Fentanyl.

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69
Q

Which medication has been shown to decrease the catecholamine response during suspension laryngoscopy

A

Fentanyl.

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70
Q

What respiratory symptoms are considered contraindications to elective surgery by most anesthesiologists

A

Fever, rhinorrhea and productive cough.

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71
Q

What is a complication of rapid administration of naloxone?

A

Flash pulmonary edema.

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72
Q

What is a complication of rapid administration of naloxone

A

Flash pulmonary edema.

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73
Q

What medication is used to reverse benzodiazepines

A

Flumazenil, 200 micrograms IV over 15 seconds, repeated every 15 seconds up to 1 mg.

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74
Q

What situations are best for the use of the lightwand during endotracheal intubation

A

For patients with cervical spine injury, for children with mandibular hypoplasia, or when copious secretions are present.

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75
Q

Where should local anesthetic be injected to block the superior laryngeal nerve?

A

Halfway between the hyoid and thyroid cartilages.

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76
Q

Where should local anesthetic be injected to block the superior laryngeal nerve

A

Half-way between the hyoid and thyroid cartilages.

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77
Q

What surgical prep solution is contraindicated for use on the face

A

Hibiclens as it is caustic to the eyes.

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78
Q

What surgical prep solution is contraindicated for use on the face?

A

Hibiclens, as it is caustic to the eyes.

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79
Q

What is the single most important factor predicting postoperative cardiac morbidity

A

History of congestive heart failure (CHF).

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80
Q

Which laryngoscopes are best for visualizing the anterior commissure or the subglottis

A

Holinger and Benjamin.

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81
Q

What is the cause of most anesthetic-related deaths

A

Human error (50 to 75%).

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82
Q

What is the accepted stress dose of corticosteroids for patients undergoing major procedures

A

Hydrocortisone, I 00 mg, the night before the procedure with repeat administration every 8 hours until the stress has passed.

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83
Q

How much epinephrine is contained in 1 cc of 1:100,000 epinephrine

A

I 0 micrograms.

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84
Q

What are the negative side effects of ketamine?

A

Increased airway secretions, transient increase in intracranial pressure, and auditory/visual hallucinations.

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85
Q

What is the mechanism of action behind malignant hyperthermia?

A

Inhibition of calcium reuptake into the sarcoplasmic reticulum of skeletal muscle.

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86
Q

What is the mechanism of action behind malignant hyperthermia

A

Inhibition of calcium reuptake into the sarcoplasmic reticulum of skeletal muscle.

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87
Q

How does the presence of an upper respiratory infection (URI) in an infant influence the perioperative risk of respiratory complications

A

Intubation results in edema and a greater reduction in cross-sectional area of the trachea.

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88
Q

What makes midazolam particularly useful in the outpatient setting

A

It has a relatively short onset of action and an elimination half-life of 2 to 4 hours.

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89
Q

What makes midazolam particularly useful in the outpatient setting?

A

It has a relatively short onset of action and an elimination half-life of 2-4 hours.

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90
Q

What are the advantages of using heliox during laser surgery on the airway

A

It reduces the amount of inspired oxygen concentration and thus the chance of tube ignition, and it facilitates rapid dissipation of heat.

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91
Q

Which laryngoscope exposes the vocal folds best

A

Kleinsasser.

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92
Q

Which local anesthetics are amide compounds?

A

Lidocaine, ropivacaine, and bupivacaine.

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93
Q

Which local anesthetics are amide compounds

A

Lidocaine, ropivacaine, and bupivacaine.

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94
Q

What are the best options for the “can’t intubate, can’t ventilate” situations after induction of general anesthesia

A

LMA, transtracheal needle jet ventilation, Combitube, or surgical airway.

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95
Q

Which benzodiazepine is preferred in patients with liver disease?

A

Lorazepam.

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96
Q

Shortly after induction of general anesthesia, the patient’s body temperature significantly rises, PVCs are noted on the electrocardiogram and his skin becomes flushed. What is the likely diagnosis?

A

Malignant hyperthermia; other symptoms include masseter spasm, sustained muscle rigidity, and myoglobinuria.

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97
Q

What are the signs of malignant hyperthermia

A

Masseter spasm, sustained muscle rigidity, myoglobinuria, rapid rise in core body temperature, PVCs, and an erythematous flush.

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98
Q

What medication is used to reverse opioids

A

Naloxone, in 20 - 40 microgram increments.

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99
Q

A 90-year-old woman is given morphine shortly before beside laryngoscopy. Her respiratory rate drops to 6 and her lips turn blue. She responds only to pain. What medication should be given?

A

Naloxone, in 20-40 J…Lg increments.

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100
Q

What are the most common anesthetic complications seen in the PACU

A

Nausea, vomiting and airway compromise.

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101
Q

All of the inhaled anesthetics are bronchodilators except for which one?

A

Nitrous oxide.

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102
Q

Which anesthetic should be discontinued 15 minutes prior to placing a tympanic membrane graft?

A

Nitrous oxide.

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103
Q

Which anesthetic should be discontinued 15 minutes prior to placing a tympanic membrane graft

A

Nitrous oxide.

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104
Q

Which nasal spray has less cardiac toxicity… oxymetazoline or neosynephrine

A

Oxymetazol ine.

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105
Q

Which nasal spray has less cardiac toxicity: oxymetazoline or neosynephrine?

A

Oxymetazoline.

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106
Q

What patient population might have a decreased amount of pseudocholinesterase

A

Patients taking anticholinesterase medications for glaucoma or myasthenia gravis, chemotherapeutic drugs and patients with a genetically atypical enzyme.

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107
Q

What patient population might have a decreased amount of pseudocholinesterase?

A

Patients taking anticholinesterase medications for glaucoma or myasthenia gravis, chemotherapeutic drugs, and patients with a genetically atypical enzyme.

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108
Q

In which patients should the use of topical cocaine be avoided

A

Patients with hypertension and those taking adrenergic modifying drugs such as reserpine, tricyclic antidepressants and monoamine oxidase inhibitors.

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109
Q

What is the single most important factor that determines title length of stay after general anesthesia in ambulatory patients

A

Post-anesthesia nausea.

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110
Q

What is the mechanism of action of local anesthetics?

A

Prevent increases in the permeability of nerve membranes to sodium ions.

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111
Q

What is the mechanism of action of local anesthetics

A

Prevent increases in the permeability of nerve membranes to sodium ions.

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112
Q

Which topical anesthetics have been shown to induce methemoglobinemia

A

Prilocaine, benzocaine, lidocaine and procaine.

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113
Q

Which local anesthetics have been shown to induce methemoglobinemia?

A

Prilocaine, benzocaine, lidocaine, and procaine.

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114
Q

Patients requiring an emergency tracheostomy for an obstructed airway may develop what postoperative pulmonary complication

A

Pulmonary edema.

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115
Q

What is Poiseuille’s law

A

Resistance to airflow is directly proportional to the density of inhaled gases.

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116
Q

How does ropivacaine differ from bupivacaine?

A

Ropivacaine is also a long-acting amide with equivalent anesthetic properties to bupivacaine but has less potential to cause serious cardiotoxic reactions and has intrinsic vasoconstrictive properties.

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117
Q

How does ropivacaine differ from bupivacaine

A

Ropivacaine is also a long-acting amide with equivalent anesthetic properties to bupivacaine but has less potential to cause serious cardiotoxic reactions and has intrinsic vasoconstrictive properties.

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118
Q

What factors are responsible for transfusion-induced immunosuppression?

A

Serum factors and fragmented debris from white blood cells and platelets.

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119
Q

What factors are responsible for transfusion-induced immunosuppression

A

Serum factors, and fragmented debris from white blood cells and platelets.

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120
Q

What is the primary advantage of using remifentanil over fentanyl?

A

Shorter onset of action (within 30-60 seconds of administration) and offset (within 5-10 minutes after discontinuance).

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121
Q

What is the treatment for methemoglobinemia?

A

Slow intravenous infusion of 1% methylene blue solution (total dose, 1-2 mg/kg).

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122
Q

What is the treatment for methemoglobinemia

A

Slow intravenous infusion of I% methylene blue solution (total dose 1 - 2 mg/kg).

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123
Q

Allergy to what substance is a contraindication to the use of propofol?

A

Soy.

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124
Q

Allergy to what substance is a contraindiaction to use of propofol

A

Soy.

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125
Q

What is the preferred anesthetic technique for bronchoscopy in infants and children?

A

Spontaneous respiration with inhalation anesthesia.

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126
Q

What is the preferred anesthetic technique for bronchoscopy in infants and children

A

Spontaneous respiration with inhalation anesthesia.

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127
Q

Which local anesthetic produces toxicity at the lowest dose?

A

Tetracaine.

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128
Q

Which local anesthetic produces toxicity at the lowest dose

A

Tetracaine.

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129
Q

What is the most common site of perforation of the surgeon’s glove during surgery

A

The nondominant index finger.

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130
Q

What are the advantages of a thallium stress test over an exercise stress test

A

The thallium stress test can better identify the location and extent of myocardial ischemia.

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131
Q

What are the most common problems associated with adverse anesthetic outcomes

A

Those related to the airway (i.e., inadequate ventilation, unrecognized esophageal intubation and unrecognized disconnection from the ventilator).

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132
Q

What are the two main classes of local anesthetics?

A

Those with an ester linkage and those with an amide linkage.

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133
Q

What are the 2 main classes of local anesthetics

A

Those with an ester linkage and those with an amide linkage.

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134
Q

How do these classes differ in metabolism?

A

Those with an ester linkage are metabolized in the plasma by cholinesterase; those with an amide linkage are metabolized in the liver by the p-450 system.

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135
Q

How do these classes differ in metabolism

A

Those with an ester linkage are metabolized in the plasma by cholinesterase; those with an amide linkage are metabolized in the liver by the p-450 system.

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136
Q

Which patients are more likely to have adverse reactions to succinylcholine

A

Those with closed-angle glaucoma, space-occupying intracranial lesions, or severe crush injuries of the lower extremity

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137
Q

Which patients are more likely to have adverse reactions to succinylcholine?

A

Those with closed-angle glaucoma, space-occupying intracranial lesions, or severe crush injuries of the lower extremity.

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138
Q

What is the treatment for malignant hyperthermia?

A

Total body cooling, vigorous hydration, dantrolene.

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139
Q

What is the treatment for malignant hyperthermia

A

Total body cooling, vigorous hydration, dantrolene.

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140
Q

True/False: Bupivacaine has a depressant effect on cardiac contractility four times that of lidocaine.

A

True.

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141
Q

T /F: Bupivacaine has a depressant effect on cardiac contractility 4 times that of lidocaine.

A

True.

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142
Q

T/F: Beta-blocker eye drops can cause bronchoconstriction in patients under anesthesia

A

True.

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143
Q

What are contraindications to LMA

A

Upper airway obstruction, preexisting pulmonary aspiration, and conditions that restrict pulmonary compliance.

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144
Q

What should be given to cancer patients who need a blood transfusion to minimize the immunosuppression?

A

Washed RBCs.

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145
Q

What should be given to cancer patients who need a blood transfusion to minimize the immunosuppression

A

Washed RBCs.

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146
Q

What medication is used to reverse benzodiazepines?

A

Flumazenil, 200 11g IV over 15 seconds, repeated every 15 seconds up to 1 mg.

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147
Q

What factor best predicts the risk of a major complication following head and neck oncologic surgery?

A

10% loss of baseline body weight.

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148
Q

What is Grillo’s rule?

A

Any patient who develops symptoms of airway obstruction, who has been intubated and ventilated in the recent past, must be considered to have an airway lesion until proven otherwise.

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149
Q

What is the drug of choice for bradyarrhythmias and heart block?

A

Atropine, 0.5-1.0 mg IV every 5 minutes to a maximum of 2-3 mg.

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150
Q

What factors increase the risk of postintubation tracheal stenosis?

A

Difficult intubation, an over inflated cuff, repeated reintubations, and poorly performed tracheostomy.

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151
Q

What is the treatment for acute airway obstruction secondary to postintubation tracheal stenosis?

A

Dilatation with rigid ventilating bronchoscopes; tracheostomy is only performed if a prolonged period is needed prior to definitive treatment of the stenosis.

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152
Q

What is the treatment of pneumocephalus?

A

Emergent drainage with needle aspiration, airway diversion (i.e., tracheostomy), and nasal repacking.

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153
Q

In emergency surgery following trauma, which organisms are most likely to cause serious sepsis?

A

Gram-negative bacteria.

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154
Q

In patients with postoperative pneumonia, empiric monotherapy should cover which organisms?

A

Gram-negative organisms.

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155
Q

In which patients is isoproterenol contraindicated?

A

In those with coronary artery disease.

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156
Q

What is the treatment for patients on JJ-blockers who are not responding to initial epinephrine treatment?

A

Inhalation or IV infusion of a pure -agonist,isoproterenol or low-dose IV dopamine.

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157
Q

What precautions should be taken to prevent cardiotoxicity during phenol peel?

A

IV fluid hydration and treatment of the face in separate units, 30 minutes apart.

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158
Q

What is the drug of choice for ventricular ectopy?

A

Lidocaine, 1.0-1.5 mg/kg IV bolus; repeat every 3-5 minutes to a maximum of 3 mg/kg; then start IV drip at 2-4 mg/min.

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159
Q

What are the most common anesthetic complications seen in the PACU?

A

Nausea, vomiting, and airway compromise.

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160
Q

Where are postintubation granulomas typically located?

A

On the vocal process of the arytenoid.

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161
Q

What can cause postoperative pneumocephalus after anterior craniofacial surgery?

A

Overly aggressive drainage of CSF via a lumbar drain or ball-valve action of the flaps used to reconstruct the skull base.

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162
Q

What is the treatment for air embolism?

A

Pack wound, compress jugular veins, immediately place the patient in the left lateral decubitus and Trendelenburg position, insert needle into right ventricle from under the xiphoid, switch to 100% O2, and stop nitrous.

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163
Q

What is the drug of choice of treatment of catecholamine-excess hypertensive crisis?

A

Phentolamine in 5- to 10-mg IV increments every 5-15 minutes.

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164
Q

Patients requiring an emergency tracheostomy for an obstructed airway are more likely to develop what postoperative pulmonary complication?

A

Pulmonary edema.

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165
Q

What is the most common organism identified in patients with pneumonia after major surgical resection of the upper aerodigestive tract?

A

Staphylococcus aureus.

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166
Q

After 2 weeks of intubation for ventilatory support, a 32-week premature infant is extubated and severe upper airway obstruction results. What is the most likely cause?

A

Subglottic edema.

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167
Q

During neck dissection, the patient develops sudden, severe bradycardia while the surgeon is dissecting around the carotid bulb. What should be done?

A

Surgeon should inject local anesthetic into the carotid bulb or anesthesiologist should give atropine or glycopyrrolate.

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168
Q

What are the two important techniques to prevent postoperative fistula formation?

A

Tension-free closure and perioperative antibiotics.

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169
Q

During a neck dissection, large bubbles are noted in the internal jugular vein and the anesthesiologist notes a sudden drop in the patient’s blood pressure. What is likely to happen to the end-tidal C0 2?

A

Will decrease (the patient likely has a central venous air embolism).

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170
Q

What is the minimum effective concentration of helium in heliox administration in children with airway obstruction?

A

6o%.

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171
Q

Which laser is primarily used for coagulation of hemangiomas?

A

Argon laser.

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172
Q

What are the three types of infrared lasers with clinical uses?

A

CO2 laser; Erbium:YAG; and Ho:YAG

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173
Q

What is the major complication of laser resurfacing of darker skinned individuals?

A

Depigmentation (hyper- or hypopigmentation).

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174
Q

During surgery to debulk respiratory papillomas using a CO 2 laser, the endotracheal tube cuff is accidentally punctured and a fire starts. What should be done?

A

Discontinue ventilation and oxygen, remove the endotracheal tube, and if a visible flame is still present, douse the field with normal saline. Once the fire has been extinguished, reintubate the patient with a regular endotracheal tube.

175
Q

Which laser is highly absorbed by water and is used mainly for superficial skin resurfacing?

A

Erbium:YAG

176
Q

What are the normal side effects of laser skin resurfacing?

A

Erythema, edema, serous discharge, and crusting.

177
Q

Lasers with wavelengths in the UV range and visible range are minimally absorbed by water but significantly absorbed by what?

A

Hemoglobin and melanin.

178
Q

What is the significance of this difference?

A

If the surgeon operating on the left takes the same straight back approach as the right, he or she will contact the lamina papyracea and enter the orbit.

179
Q

Collateral thermal damage is less with infrared or visible lasers?

A

Infrared.

180
Q

What are the advantages of using heliox during laser surgery on the airway?

A

It reduces the amount of inspired oxygen concentration and thus the chance of tube ignition, and it facilitates rapid dissipation of heat.

181
Q

Which laser works by passing an Nd:YAG laser through a crystal and is mainly used for vascular lesions and turbinate reduction?

A

KTP-532 laser.

182
Q

Which laser in clinical use has the deepest penetration?

A

Nd:YAG (4 mm).

183
Q

Which laser is used for tracheobronchial lesions, hair removal in ethnic patient populations, and nonablative skin resurfacing?

A

Nd:YAG laser.

184
Q

What factors affect the risk of complications after laser skin resurfacing?

A

Number of laser passes, energy densities, degree of pulse or scan overlap, preoperative skin condition, anatomic areas.

185
Q

How does the orbital anatomy viewed through the endoscope differ on the right and left sides to the surgeon?

A

Right nasal meatal anatomy lies visually straight back, whereas on the left, the ethmoids appear to be more medial, especially anteriorly and superiorly.

186
Q

What is plume radiation?

A

When the laser beam hits the smoke plume, its wavelength may change, often in the visible portion of the spectrum, and cause temporary blindness.

187
Q

What is the maximum length-to-width ratio for local flaps?

A

0.125694444444444

188
Q

When is the risk of thrombosis highest after microsurgical reconstruction?

A

15-20 minutes after closure.

189
Q

How long does it take for complete regeneration of the endothelium across a microvascular anastomosis?

A

2 weeks.

190
Q

What is the most common complication from microsurgical reconstruction?

A

35% suffer medical complications (pulmonary problems, prolonged ventilatory support, and acute ethanol withdrawal).

191
Q

What organism lives in the gut of leeches and is the most common organism associated with wound infections when leeches are applied?

A

Aeromonas hydrophila.

192
Q

What are the contraindications to leech use?

A

Arterial insufficiency, severely immunocompromised, and allergic reaction to previous leech application.

193
Q

How does delaying (elevating the flap in two stages 2-3 weeks apart) improve flap survival?

A

Conditions tissue to ischemia, closes A-V shunts, and increases blood flow by sympathectomy.

194
Q

When is arterial thrombosis most likely to occur?

A

First 72 hours.

195
Q

What is the most potent natural inhibitor of thrombin?

A

Hirudin.

196
Q

What is the significance of time to reexploration and flap survival?

A

If flaps are reperfused in 1-4 hours, 100% survival is likely. If reperfusion is established by 8 hours, So% survival is likely. If reperfusion is not reestablished by 12 hours, flap survival is unlikely.

197
Q

If a free flap fails, what is the best option for reconstruction?

A

If medical condition allows, a second free flap should be performed instead of a locoregional flap.

198
Q

What is the initial treatment for any free flap that appears to be failing?

A

Immediate reexploration.

199
Q

When is using a prosthetic preferable to soft-tissue reconstruction in the head and neck?

A

In cancer patients who need ongoing monitoring in the area of the face at risk for recurrence and when surgical reconstruction is too complicated.

200
Q

What is the best level for undermining skin flaps?

A

In the subdermal layer.

201
Q

What is the term for a flap that is raised from a nearby region and moved to a defect across intact skin?

A

Interpolation flap.

202
Q

What is the most secure way to hold a prosthetic in place in the head and neck region?

A

Osseointegration.

203
Q

What sort of intraoral prosthetic can be used to help with swallowing in a patient who has lost a significant amount of tongue tissue?

A

Palatal augmentation device (obturator).

204
Q

What is the typical order of return of sensation in noninnervated flaps?

A

Pinprick, touch, then temperature.

205
Q

Considering rotation flaps, myocutaneous flaps, and random flaps, which of these has the strongest blood supply?

A

Rotation flap.

206
Q

Where is this substance found in nature?

A

Salivary glands of leeches.

207
Q

Most medical prosthetics for the head and neck are made of what material and last how long?

A

Silicone; 2 years.

208
Q

What is the blood supply of a random flap?

A

The dermal and subdermal plexuses.

209
Q

What antibiotics is this organism sensitive to?

A

Third-generation cephalosporins, ciprofloxacin, aminoglycosides, sulfa drugs, and tetracycline.

210
Q

What is the term for a flap that is raised and pivoted into a defect, leaving a secondary defect that must be repaired?

A

Transposition flap.

211
Q

True/False:Axial flaps are more reliable than random flaps.

A

True.

212
Q

True/False: The surviving length of an axial pattern flap remains constant regardless of flap width.

A

True.

213
Q

True/False: Significant return of sensation to a free flap occurs even in the absence of neural anastomosis.

A

True.

214
Q

What is the most common cause of flap failure?

A

Venous thrombosis.

215
Q

When is return of sensation after skin grafting considered maximal?

A

After 2 years.

216
Q

What is the minimum age at which the calvarium can be split?

A

Age 4 or 5 (layers of the skull are not defined until then).

217
Q

How is the diploic layer of the skull recognized during in situ harvesting?

A

Color changes from yellow-white to red and increased bleeding occurs.

218
Q

Why do cranial bone grafts have superior resistance to resorption when compared with other bone graft donor sites (e.g., rib or iliac bone)?

A

Cranial bone originates from membranous bone, whereas the other donor sites originate from endochondral bone; cranial bone revascularizes more quickly.

219
Q

What complications are specific to the cranial bone harvest?

A

Dural exposure, meningitis, CSF leak, sagittal sinus injury, and brain injury.

220
Q

What are the different types of cranial bone grafts?

A

Full-thickness calvarium, split-thickness calvarium, bone chips, and bone dust.

221
Q

What factor is most essential to the success of a vascularized bone graft to the mandible?

A

Good immobilization.

222
Q

What are the advantages of using cranial bone as an autogenous graft compared with other bone grafts for orbital reconstruction?

A

Harvested from the same surgical field; little postoperative pain; donor site complications are rare; large amounts can be harvested; and less likely to resorb than endochondral grafts.

223
Q

What is the major problem of using Mersilene mesh for genioplasty?

A

High potential for resorption.

224
Q

What are the three phases of healing for skin grafts?

A

Imbibition, inosculation, and neovascularization.

225
Q

What complications are specific to the iliac crest donor site?

A

Injury to abdominal contents or the iliofemoral joint, detachment of the inguinal ligament, interference with tensor fascia lata function, or damage to nearby peripheral nerves.

226
Q

What is the best way to avoid injury to the superior sagittal sinus during harvesting of calvarial bone?

A

Maintain at least a 2-cm distance from the sagittal suture.

227
Q

What are the advantages of using mesh implants for repair of orbital floor fractures?

A

No need for a bone or fascial barrier between the orbital contents and the mesh; posterior orbital shape can be simulated more easily than with bone grafts; well tolerated when exposed to open paranasal sinuses; and may facilitate survival of bone grafts in the anterior orbit.

228
Q

What is the preferred site for harvesting calvarial bone?

A

Parietal bone (anterior for a flat graft; posterior for a curved graft).

229
Q

What is the thickest part of the skull?

A

Parietal bone.

230
Q

What can be done to minimize the visibility of the bicoronal incision?

A

Perform a wavy line incision.

231
Q

What process allows survival of skin grafts in the first 48 hours?

A

Plasmatic imbibition.

232
Q

What complications are specific to the rib donor site?

A

Pneumothorax, hemothorax, and intercostal nerve injury.

233
Q

Which alloplastic implant material has been reported to cause the least amount of bony resorption deep to the implant?

A

Porous polyethylene.

234
Q

What is the most important factor in minimizing hyperpigntentation of skin grafts?

A

Protection from lN light for a full year postoperatively.

235
Q

What are the advantages of using porous polyethylene over other alloplastic materials for orbital reconstruction?

A

Semirigid; porous allowing fibrous, vascular, and bony ingrowth; minimal inflammatory reaction; and infection and extrusion are rare.

236
Q

Which alloplastic implant material forms a surrounding capsule?

A

Solid silicone.

237
Q

What is the thinnest part of the skull?

A

Squamous portion of the temporal bone.

238
Q

What is meant by inosculation with regard to skin grafts?

A

The process by which vascular buds from the recipient bed make contact with capillaries within the graft.

239
Q

What are the differences between thin and thick split-thickness skin grafts (STSGs)?

A

Thin grafts take better, but thick grafts have better color match, less contraction, and are more resistant to trauma.

240
Q

True/False: Sagittally oriented scalp incisions tend to cause less scalp sensory disturbance than do coronally oriented incisions.

A

True.

241
Q

What % of patients with sarcoidosis have laryngeal involvement

A

0.01

242
Q

What % of patients with relapsing polychondritis have airway involvement

A

0.6

243
Q

What is the risk of seroconversion following percutaneous exposure to HIV

A

0.31 %.

244
Q

What % of these patients have involvement of the ophthalmic artery

A

1/3.

245
Q

What % of patients with sarcoidosis have parotid gland involvement

A

10%.

246
Q

What are the late manifestations of Lyme disease

A

15% of untreated patients will develop neurological problems within weeks of the tick bite…. Meningitis, encephalitis, cranial neuropathy, radiculoneuritis, mononeuritis multiplex, cerebellar ataxia, myelitis. 60°/o of untreated patients will develop large joint swelling and pain within months of the tick bite. 5°/o of untreated patients will develop chronic neuroborreliosis with spinal radicular pain or distal paresthesias or acute cardiac problems with A V block, acute myopericarditis or mild LV dysfunction.

247
Q

What % of patients with hilar adenopathy will have histologic findings consistent with sarcoidosis on lower lip minor salivary gland biopsy

A

2/3.

248
Q

What % of adults with disseminated disease Histoplasma capsulatum present with oropharyngeal involvement

A

40 - 75%).

249
Q

What is the significance of oral hairy leukoplakia in patients with HIV

A

50% of patients with HIV and hairy leukoplakia will develop AIDS within 16 months and up to 80°/o will develop HI V within 30 months.

250
Q

What is the 5-year survival rate of patients with Churg-Strauss syndrome

A

50%.

251
Q

What is the latency period for seroconversion following exposure to the HIV virus

A

6 to 12 months.

252
Q

What % of patients with sarcoidosis will have an elevated ACE

A

80 - 90°/o.

253
Q

What are the early manifestations of Lyme disease

A

80% will have erythema migrans at the site of the tick bite with flu-like symptoms.

254
Q

What % of patients with cat-scratch disease are under 18

A

90°/o.

255
Q

What is lupus pernio

A

A cutaneous manifestation of sarcoidosis most commonly occurring on the nose, cheeks, or ears that appears as an indurated blue-purple, shiny, swollen lesion.

256
Q

What is the most common ENT manifestation of actinomycosis

A

A red, indurated, non-tender, subcutaneous mass in the submandibular triangle with the overlying skin having a purplish discoloration.

257
Q

What infectious diseases can cause chronic thyroiditis

A

Actinomycosis, TB, and syphilis.

258
Q

Which cardiovascular medication will interfere with radioiodine scanning

A

Amiodarone.

259
Q

What are the head and neck manifestations of rheumatoid arthritis

A

Arthritis of the temporomandibular and cricoarytenoid joints, recurrent laryngeal nerve paresis/paralysis, conductive hearing loss, SNHL.

260
Q

Which area is most commonly involved when TB spreads to the larynx

A

Arytenoids.

261
Q

What disease is characterized by uveitis and oral and genital ulcers

A

Beh9et’s disease.

262
Q

How is Histoplasma capsulatum diagnosed

A

Biopsy or swab is taken from the center of a lesion and cultured on Sabouraud’s medium.

263
Q

What structures are unique to Langerhans cells and are used to diagnose Langerhans cell histiocytosis (LCH)

A

Birbeck granules, or cytoplasmic inclusion bodies.

264
Q

Which body fluids were involved in all reported HI V seroconversions in health care workers

A

Blood and sanguinous fluids.

265
Q

How is Sjogren’s syndrome distinguished from malignant lymphoma

A

By the presence of myoepithelial islands.

266
Q

How is amyloidosis diagnosed

A

Can only be diagnosed by biopsy; amyloid is highly refractile with an affinity for Congo red dye and shows green birefringence with polarized light.

267
Q

What test is most specific for Wegener’s

A

c-ANCA.

268
Q

What is the most common oral manifestation of AIDS

A

Candidiasis.

269
Q

What is bacillary angiomatosis

A

Caused by the same organisms of cat-scratch disease with similar manifestations but occurs in immunocompromised patients and is progressive and fatal if left untreated.

270
Q

Patient with Cogan’s syndrome usually have elevated titers to what organism

A

Chlamydia.

271
Q

What vasculitic disease is characterized by a prodromal stage of allergic rhinitis, nasal polyposis, and asthma

A

Churg-Strauss syndrome.

272
Q

What is the alternate therapy and when should it be initiated

A

Dapsone should be used when severe reactions (e.g., skin blistering, mucosal involvement, or anaphylaxis) to TMP-SMX occur.

273
Q

How is the risk of seroconversion altered with AZT prophylaxis after percutaneous exposure to HIV

A

Decreased by 79%.

274
Q

What laboratory test is associated with lymphoproliferative malignancy in patients with Sjogren’s syndrome

A

Decreased level of serum lgM.

275
Q

What are the head and neck manifestations of scleroderma

A

Dysphagia, hiatal hernia, trismus, thin lips and vertical perioral furrows, gingivitis, xerostomia, hoarseness, Raynaud’ s phenomenon of the tongue, trigeminal neuralgia, facial nerve palsy.

276
Q

What are the ENT manifestations of Histoplasma capsulatum

A

Dysphagia, sore throat, hoarseness, painful mastication, gingival irritation; granulomatous lesions on the lips, gingiva, tongue, pharynx, larynx.

277
Q

What finding is typical of laryngeal involvement of sarcoidosis

A

Edema of the supraglottis.

278
Q

What are the typical laboratory findings in patients with relapsing polychondritis

A

Elevated ESR, moderate leukocytosis, mild to moderate anemia.

279
Q

What are the diagnostic criteria for mixed connective tissue disease

A

Elevated titers of anti-U I RNP (ribonucleoprotein antibody) and three of either hand edema, synovitis, myositis, Raynaud’s phenomenon, or acrosclerosis.

280
Q

What is the term for the localized form of LCH

A

Eosinophilic granuloma.

281
Q

What are the ENT manifestations of Blastomycosis dermatitidis

A

Erythematous hyperplasia of the mucosa in the larynx and hypopharynx, fibrosis of the vocal cords, pharyngocutaneous fistula.

282
Q

What is the treatment for cat-scratch disease and bacillary angiomatosis

A

Erythromycin, doxycycline, rifampin; incision and drainage of necrotic lymph nodes if abscess occurs.

283
Q

T/F: FTA-ABS becomes negative once a patient has been adequately treated for syphilis

A

False.

284
Q

What is the typical appearance of the lesions caused by Histoplasma capsulatum

A

Firm, painful ulcers with heaped-up margins, often with a verrucous appearance.

285
Q

Where are eosinophilic granulomas most commonly located

A

Flat bones of the skull.

286
Q

How long should a patient with Kawasaki’s disease remain on aspirin

A

For at least 6-8 weeks; ECHO is then performed, and if negative, can discontinue.

287
Q

What are the systemic manifestations of Sjogren’s syndrome

A

Glomerulonephritis, vasculitis, sensory polyneuropathy, interstitial pneumonitis, thyroid disease resembling Hashimoto’s thyroiditis.

288
Q

What are the most common causes of hyperthyroidism

A

Graves’ disease, autonomous toxic nodule, subacute thyroiditis, pituitary tumor.

289
Q

What are the ENT manifestations of tertiary syphilis

A

Gumma formation can result in septal and hard palate perforations, laryngeal ulcerations, hearing loss, vertigo, osteomyelitis of the temporal bone.

290
Q

What is the chronic, disseminated form of LCH

A

Hand-Schuller-Christian disease.

291
Q

What are the most common causes of hypothyroidism

A

Hashimoto’s thyroiditis, pituitary tumor, and radioactive I 131 treatment for thyrotoxicosis.

292
Q

What is the most common type of autoimmune thyroiditis

A

Hashimoto’s.

293
Q

Where is gout most commonly located in the head and neck

A

Helix or antihelix of the ear.

294
Q

What is the treatment for Kawasaki’s disease

A

High-dose aspirin and a single dose of IVIG 2 g/kg.

295
Q

Which fungal infection is endemic to the Mississippi and Ohio River valleys

A

Histoplasma capsulatum.

296
Q

What antibodies are most commonly seen in patients with rheumatoid arthritis

A

HLA-DW4 antibodies.

297
Q

What are some common laboratory findings in patients with sarcoidosis

A

Hypergammaglobulinemia, elevated LFTs, calcium, ESR, and angiotensin converting enzyme (ACE).

298
Q

What are the 4 diagnostic criteria for cat-scratch disease

A

I. History of contact with a cat or presence of a scratch. 2. Positive skin test or serologic antibody test. 3. Positive gram stain or culture. 4. Characteristic histopathology.

299
Q

What disease is characterized by the presence of black eschar on the middle turbinate

A

Invasive fungal sinusitis.

300
Q

In which ethnic group is Kawasaki’s disease most common

A

Japanese.

301
Q

Where is necrotizing sialometaplasia most commonly found

A

Junction of hard and soft palate.

302
Q

What are the 2 most common AIDS-related neoplasms

A

Kaposi’s sarcoma and non-Hodgkin’s lymphoma.

303
Q

What disease is characterized by significant painless, posterior triangle cervical lymphadenopathy that typically resolves without treatment within 6 months

A

Kikuchi’s disease.

304
Q

What disease is characterized by Mikulicz’s cells and causes stenosis of the nose, larynx, and tracheobronchial tree

A

Klebsiella rhinoscleromatis (rhinoscleroma).

305
Q

What are the most common laryngeal manifestations of \-‘egener’s

A

Laryngeal ulceration, subglottic stenosis.

306
Q

Which parasitic infection is transmitted to humans by the sandfly

A

Leishmaniasis.

307
Q

What is an abnormal Schirmer test

A

Less than 5 mm wetting after 5 minutes; less than 10 mm wetting after stimulation with 1 O% ammonia.

308
Q

What is the acute, disseminated form of LCH

A

Letterer-Siwe disease.

309
Q

What 2 factors are associated with a higher prevalence of rhinosinusitis in patients with HIV

A

Low CD4 count and bilateral absence of maxillary infundibular patency.

310
Q

What is the most common vector-borne disease in the US

A

Lyme disease.

311
Q

What are the ENT manifestations of systemic lupus erythematosus (SLE)

A

Malar rash, oral ulceration, arthritis of the cricoarytenoid or cricothyroid joints, vocal cord thickening, anterior septal perforations, acute parotid gland enlargement, cranial nerve neuropathy.

312
Q

What is the risk of performing FN A on scrofula

A

May lead to a chronically draining cutaneous fistula.

313
Q

What is the typical histologic appearance of necrotizing sialometaplasia

A

Metaplastic epithelial cells lining salivary ducts with preservation of lobular architecture.

314
Q

What is the treatment for insulin-dependent diabetic patients with sarcoidosis

A

Methotrexate.

315
Q

What tests are use to diagnose Sjogren’s syndrome

A

Minor salivary gland biopsy showing mononuclear cell infiltration, SS-A, SS-8, and ANA, RF.

316
Q

What are Langerhans cells

A

Mononuclear cells normally found in the skin that play a role in various immune functions.

317
Q

What are the head and neck manifestations of mixed connective tissue disease

A

Mucocutaneous changes, malar rash, discoid lupus, sclerodermatous skin changes, septal perforations, esophageal dysfunction.

318
Q

What are the ENT manifestations of leprosy

A

Mucosal nodules at the anterior inferior turbinates, septal perforation, lateral loss of eyebrows, leonine facies.

319
Q

What triad of diseases is commonly seen in patients with Hand-Schuller-Christian disease

A

Multiple calvarial osteolytic lesions (geographic skull), exophthalmos, and diabetes insipidus.

320
Q

What tumors is amyloidosis associated with

A

Multiple myeloma and Hodgkin’s lymphoma.

321
Q

How does TB involvement of the ear most commonly present

A

Multiple TM perforations with thin, watery otorrhea.

322
Q

What are the most common ENT complaints of patients with Wegener’s

A

Nasal obstruction, bloody rhinorrhea, nasal crusting, and nasal pain.

323
Q

What are the typical features of Wegener’s granulomatosis

A

Necrotizing granulomas of the upper airway and lungs, focal necrotizing glomerulonephritis, and disseminated vasculitis

324
Q

What histologic finding is the hallmark of sarcoidosis

A

Noncaseating granulomas.

325
Q

What malignancy is associated with Sjogren’s syndrome

A

Non-Hodgkin’s lymphoma.

326
Q

What is the appearance of the rash in patients with Kawasaki’s disease

A

Non-vesicular polymorphous rash starting in the perineal area and spreading to the trunk.

327
Q

What are the most common presenting symptoms in patients with Kawasaki’s disease

A

Oral cavity erythema and cervical lymphadenopathy.

328
Q

What is the treatment for actinomycosis

A

Oral penicillin or tetracycline for 2 - 4 months or 6 weeks of parental penicillin (for severe cases).

329
Q

What are the ENT manifestations of primary syphilis

A

Painless ulcer (chancre) of the lips, tongue, or tonsils with reactive lymphadenopathy.

330
Q

What are the ENT manifestations of Rhinosporidium seeberi

A

Painless, polypoid, friable lesions on the mucous membranes of the nose, conjunctiva, and palate (“strawberry lesions”).

331
Q

What is the most appropriate treatment for a patient with AIDS who develops bilateral progressive SNHL secondary to otosyphilis

A

Penicillin G, 24 million U daily for 3 weeks.

332
Q

What is the most common ENT manifestation of toxoplasmosis

A

Persistent neck mass.

333
Q

What are the head and neck manifestations of hypersensitivity vasculitis

A

Petechiae and purpura of oral and nasal mucosa, angioedema, serous otitis media.

334
Q

What disease closely resembles Wegener’s granulomatosis and lymphoma clinically but is characterized by angiocentric infiltration of atypical polymorphonuclear cells on histologic exam

A

Polymorphic reticulosis (a.k.a. lethal midline granuloma, lymphomatoid granulomatosis, angiocentric lymphoma).

335
Q

Where is scrofula most commonly located in adults

A

Posterior cervical triangle.

336
Q

What factors significantly increase the risk of Staphylococcus aureus infection in patients with HIV

A

Presence of a vascular catheter, CD4 count < I 00, nasal carriage of S. aureus, neutropenia.

337
Q

What are the differences between primary and secondary Sjogren’s syndrome

A

Primary (a.k.a. sicca syndrome) is isolated to the lacrimal and salivary glands; secondary (a.k.a. sicca complex) is associated with other connective tissue diseases.

338
Q

Which drugs may precipitate a lupus-like reaction

A

Procainamide, hydralazine, pencillin, sulfonamides, and hydantoins.

339
Q

What medications are used for the routine treatment of hyperthyroidism

A

PTU and methimazole.

340
Q

What is the term for a painless, soft lesion found along the gingival mucosa composed of granulation tissue

A

Pyogenic granuloma.

341
Q

What is the treatment for polymorphic reticulosis

A

Radiation.

342
Q

What is the treatment of choice for patients over 40 with Graves’ disease

A

Radioactive I131

343
Q

What are the ENT manifestations of polymorphic reticulosis

A

Rapid necrosis of the external nose, nasal cavity, soft and hard palates, and nasopharynx.

344
Q

What are the diagnostic features of relapsing polychondritis

A

Recurrent chondritis of the auricles, nonerosive inflammatory polyarthritis, chondritis of the nasal cartilages, inflammation of ocular structures, chondritis of laryngeal or tracheal cartilages, cochlear or vestibular damage.

345
Q

What thyroid disorder is characterized by replacement of the thyroid gland with fibrous tissue

A

Reidel’s struma (invasive fibrous thyroiditis, woody thyroiditis).

346
Q

What is the most common cause of arthritis of the cricoarytenoid joint

A

Rheumatoid arthritis.

347
Q

Which fungal disease is endemic to Southern India and Sri Lanka

A

Rhinosporidium seeberi.

348
Q

Which organisms can cause cat-scratch disease

A

Rochalimaea henselae or Afipia felis.

349
Q

What are the ENT manifestations of congenitally acquired syphilis

A

Saddle nose deformity, frontal bossing, short maxilla, Hutchinson’s incisors, mulberry molars, mental retardation, SNHL.

350
Q

What is the most common ENT manifestation of tuberculosis

A

Scrofula.

351
Q

What is the appearance of the Aspergillus fumigatus on microscopic exam

A

Septate, bifurcating hyphae.

352
Q

What are the most common otologic manifestations of Wegener’s

A

Serous otitis media, SNHL.

353
Q

What are the specific otologic manifestations of Cogan’s syndrome

A

Similar to Meniere’s (fluctuating hearing loss, vertigo, tinnitus, aural fullness) but bilateral.

354
Q

What are the ENT manifestations of non-invasive Aspergillus fumigatus infection

A

Single sinus cavity involvement with thick, dark nasal secretions and facial fullness.

355
Q

What diseases are commonly mistaken for necrotizing sialometaplasia

A

Squamous cell and mucoepidermoid carcinoma.

356
Q

What is the treatment for rhinoscleroma

A

Streptomycin or tetracycline.

357
Q

Where is scrofula most commonly located in children

A

Submandibular triangle.

358
Q

What are the head and neck manifestations of polyarteritis nodosa

A

Sudden bilateral SHNL, and vestibular problems; ulceration of nasal, buccal, or soft palate mucosa; facial nerve palsy.

359
Q

What is the characteristic appearance of actinomycosis on microscopic exam

A

Sulfur granules.

360
Q

What are the typical histologic findings of biopsied lymph nodes from patients with cat-scratch disease

A

Suppurative and necrotizing granulomatous lymphadenitis with stellate abscesses.

361
Q

How is temporal arteritis diagnosed

A

Temporal artery biopsy (ESR for screening).

362
Q

What are the head and neck manifestations of temporal arteritis

A

Tender and erythematous temporal artery, jaw claudication, lingual claudication, vertigo and hearing loss, blindness, cranial nerve deficits.

363
Q

Where are reparative granulomas most commonly located

A

The peripheral form is most commonly located on the anterior aspect of the mandible; the central form is most commonly located anterior to the first molar within the bone of the mandible.

364
Q

What is the drug of choice for the prophylaxis of Pneumocystis carinii infections in patients with HIV

A

TMP-SMX.

365
Q

Which area is most commonly involved when TB spreads to the oral cavity

A

Tongue.

366
Q

What antibiotic is effective for treatment of Wegener’s

A

Trimethoprim/sulfamethoxazole.

367
Q

T/F: Most lesions of necrotizing sialometaplasia resolve spontaneously within two to three months and do not require excision

A

True.

368
Q

T/F: Patients with Cogan’s syndrome who are not treated promptly with high-dose corticosteroids will have total permanent hearing loss

A

True.

369
Q

What head and neck malignancies are more common in patients with polymyositis/dermatomyositis

A

Tumors of the parotid gland and tonsil; nasopharyngeal cancer in endemic areas.

370
Q

What % of patients with Kawasaki’s disease will develop coronary aneurysms

A

Up to 30%.

371
Q

What is the latency period for developing antibodies to hepatitis C

A

Up to 4 months.

372
Q

What is the significance of a rising c-ANCA titer in a patient with Wegener’s

A

Usually indicates a relapse of active disease.

373
Q

What is the most common site of involvement of amyloidosis in the larynx

A

Ventricle.

374
Q

What are the characteristics of Cogan’s syndrome

A

Vestibuloauditory dysfunction and interstitial keratitis.

375
Q

What test is used to screen for syphilis

A

VORL.

376
Q

What are the head and neck manifestations of polymyositis and dermatomyositis

A

Weakness of neck muscles, dysphagia, skin rash on the eyelids, nose, and cheeks.

377
Q

What is the most specific test for the diagnosis of Cogan’s syndrome

A

Western blot assay for 55 kD inner ear antigen.

378
Q

What is the most specific test for the diagnosis of autoimmune sensorineural hearing loss

A

Western blot assay for 68 kD inner ear antigen (Otoblot) (95% specific).

379
Q

What are the ENT manifestations of secondary syphilis

A

Widespread mucocutaneous maculopapular lesions, acute rhinitis, pharyngitis, laryngitis, otitis media, loss of eyelashes, localized alopecia.

380
Q

What are the ENT manifestations of Sjogren’s syndrome

A

Xerostomia, dental caries, oral candidiasis, recurrent salivary gland enlargement, keratoconjunctivitis sicca, nasal crusting/epistaxis.

381
Q

Can patients with total hearing loss secondary to Cogan’s syndrome have a cochlear implant

A

Yes.

382
Q

Children may have unlimited clear liquids up to how many hours prior to scheduled anesthetic induction?

A

2-3 hours.

383
Q

What is the most effective duration for perioperative antibiotic administration?

A

24 hours.

384
Q

When should oral hypoglycemics be discontinued prior to surgery?

A

24 hours.

385
Q

What is the incidence of postoperative hypertension in patients with obstructive sleep apnea syndrome (OSAS) without history of hypertension?

A

63%.

386
Q

When should warfarin therapy be discontinued prior to surgery?

A

96-115 hours (4 doses).

387
Q

What anesthetic considerations must be taken into account in a patient with sickle cell disease?

A

Adequate hydration and oxygenation. Spinal or local anesthesia should be used whenever possible.

388
Q

What factors predispose children with viral URis to airway hyperactivity during surgery?

A

Age

389
Q

What factors increase the risk of postoperative pulmonary embolism?

A

Age >40 years, history of lower extremity venous disease, malignancy, CHF, trauma, and paraplegia.

390
Q

What is the standard endocarditis prophylaxis for dental, oral, or upper airway procedures in adult patients at risk?

A

Amoxicillin 2 g orally, 1hour before the procedure.

391
Q

What is the appropriate preoperative workup for a young patient with frequent premature ventricular contractions (PVCs)?

A

An electrocardiogram (ECG), holter monitor, and a cardiac stress test.

392
Q

What role might oral clonidine play in the preoperative period?

A

As an a2-adrenergic agonist, it can reduce anesthetic requirements and has been used to provide sedation and anxiolysis while maintaining hemodynamic stability.

393
Q

When should a patient quit smoking to have the greatest decrease in perioperative pulmonary complications?

A

At least 8 weeks before the planned procedure.

394
Q

What is the ideal MAP after surgery for OSAS?

A

Below 100 mm Hg.

395
Q

How are children with idiopathic thrombocytopenia managed perioperatively?

A

CBC is drawn 1week prior to the procedure, and if thrombocytopenia is present, IVIG is administered preoperatively (400 mg/kg for 4 days).

396
Q

Of Goldman’s risk factors, which has been shown to be the most significant?

A

Congestive heart failure (CHF).

397
Q

A patient with advanced laryngeal cancer comes in for preoperative evaluation. He currently weighs 130 lbs and reports weighing 149 lbs 3 months ago. His serum albumin level is 2.4 g/dL. What should be done prior to his operation?

A

He should be hospitalized for 7-10 days prior to surgery for nutritional repletion.

398
Q

What is the accepted stress dose of corticosteroids for patients undergoing major procedures?

A

Hydrocortisone, 100 mg, the night before the procedure with repeat administration every 8 hours until the stress has passed.

399
Q

What are the primary disadvantages of ketorolac?

A

Impairs platelet function and can lead to mucosal breakdown in the GI tract.

400
Q

How are children with von Willebrand disease undergoing tonsillectomy managed perioperatively?

A

IV administration of desmopressin (0.3 11g/kg) preoperatively, 12 hours postoperatively, and every morning until the fossae are completely healed; aminocaproic acid pre- and postoperatively. Alternatively, Factor VIII concentrate can be given perioperatively.

401
Q

Why are children under 3 routinely admitted after adenotonsillectomy?

A

Less likely to cooperate with oral intake and more likely to have surgery for airway obstruction.

402
Q

Which hypertensive medications classically cause withdrawal hypertension and, therefore, should not be stopped prior to surgery?

A

P-Blockers and clonidine.

403
Q

What are the guidelines set by the AAO-HNS for 23-hour admission after adenotonsillectomy?

A

Poor oral intake, vomiting, hemorrhage, age younger than 3, home more than 45 minutes from the nearest hospital, poor socioeconomic situation with possible neglect, and other medical problems.

404
Q

What is the single most important factor that determines the length of stay after general anesthesia in ambulatory patients?

A

Postanesthesia nausea.

405
Q

How are children with sickle cell disease managed perioperatively?

A

Preoperative transfusion to decrease the hemoglobin S ratio to

406
Q

The above patient is hospitalized and started on high-calorie tube feeds at 50 ccfh. The next day he becomes confused and goes into cardiac arrest. What has happened?

A

Refeeding syndrome.

407
Q

What are the advantages of a thallium stress test over an exercise stress test?

A

The thallium stress test can better identify the location and extent of myocardial ischemia.

408
Q

Which patients are at greatest risk for respiratory problems after adenotonsillectomy?

A

Those with polysomnogram-proven obstructive sleep apnea, Down syndrome, cerebral palsy, or congenital defects.

409
Q

A patient who is to undergo surgery reports a positive result on a latex-specific RAST test as part of a job screening process but denies any symptoms of latex allergies. Should any precautions be taken during surgery?

A

Yes, the procedure should be performed under latex-free conditions.

410
Q

How much time does it take for a surgical wound to fully heal?

A

2 years.

411
Q

What is the absorption rate of chromic catgut sutures?

A

20 days.

412
Q

What is the tensile strength of a wound after 4 weeks?

A

30% of normal.

413
Q

How long does epithelialization take to produce a watertight seal?

A

48 hours.

414
Q

What is the maximum tensile strength of a surgical scar?

A

8o% of normal uninjured tissue.

415
Q

What is the wound bursting strength?

A

A direct measure of the force required to separate a healing, linear incision.

416
Q

What is the major event during the proliferative phase?

A

Accelerated production of collagen.

417
Q

When does the production of collagen peak during wound healing?

A

Day 7 after wound closure (continues at this pace for 2-3 weeks).

418
Q

Poor wound healing after RT is primarily due to injury to which cell?

A

Fibroblasts.

419
Q

What are the second most commonly isolated bacteria?

A

Gram-negative aerobic bacteria.

420
Q

What are the three stages of normal surgical wound healing?

A

Inflammation (d1-3), proliferation (d3-week 4), maturation (week 4-2 years).

421
Q

Which stage is most sensitive to the effects of chemoradiation?

A

Inflammatory stage.

422
Q

What is the function of epidermal growth factor (EGF)?

A

It stimulates DNA synthesis and cell division in a variety of cells, including fibroblasts, keratinocytes, and endothelial cells.

423
Q

What is the tensile strength of a wound during the inflammatory stage?

A

Less than 5% of normal.

424
Q

What perioperative factors are associated with an increased risk of postoperative wound infection?

A

Long preoperative hospitalization; no preoperative shower; early shaving of the operative site; hair removal; and prior antibiotic therapy.

425
Q

Deficiency of which white blood cell is most likely to compromise wound healing?

A

Macrophages.

426
Q

Under what conditions is epithelial migration and replication most facilitated?

A

Moist wound surfaces under gas-permeable dressings.

427
Q

What are the first inflammatory cells to enter the wound space?

A

Neutrophils.

428
Q

When should scar revision take place?

A

Not for at least 1year after injury/surgery.

429
Q

Which suture materials incite the greatest inflammatory response?

A

Plain catgut and chromic catgut.

430
Q

Which suture material loses its strength within 7 days?

A

Plain catgut.

431
Q

What are the main events of the maturation stage?

A

Reduction in the number of fibroblasts and macrophages, increase in collagen content, and gradual increase in tensile wound strength.

432
Q

What effect does radiation therapy (RT) have on the wound bursting strength?

A

Significantly decreases it-after 18 Gy, it is 52% of normal.

433
Q

What are the most commonly isolated bacteria from wound infections following major contaminated head and neck surgery?

A

Staphylococcus aureus and beta-hemolytic streptococci.

434
Q

Why do hematomas increase the risk of infection?

A

They prevent fibroblast migration and capillary formation.

** Basic & Applied Science ENT Topics (6 decks)

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