BMore

Question 1

1. A patient with penicillin allergy. What do you give?

Answer 1

a. Clindamycin

Question 2

2. Wolff-Parkinson-White Syndrome question discussing re-entry.

Answer 2

a. Generally due to atrioventricular (AV) reentry

Question 3

3. Bulimia patient findings?

Answer 3

a. Metabolic alkalosis

Think throwing up all of the acid

Question 4

4. Trigeminal neuralgia patient. Which distribution is more common for trigger points?

a. CN V1 and V2
b. CN V2 and V3

Answer 4

b. CN V2 and V3

Question 5

5. What condition/disease is associated with trigeminal neuralgia in patient under 40?

Answer 5

a. Multiple Sclerosis [Rvw p320]

Question 6

6. Acetaminophen toxicity can be exacerbated by:

Answer 6

a. Phenytoin

Question 7

7. Glucose content for CSF vs serum vs nasal

Answer 7

a. CSF (2.5 - 4.4 mmol/L) < serum (7.8 mmol/L) < nasal in glucose content

Question 8

8. Diabetic ketoacidosis. What do you see in this pt?

( 11 symptoms)

Answer 8

b. Tachypnea – my pick
[Rvw p29] Symptoms include:
-ab pain,
-n/v,
-Kussmaul resp,
-ketone breath,
-anion gap metabolic acidosis,
-marked dehydration,
-tachycardia,
-polydpisia,
-polyuria,
-weakness,
-altered consciousness

Question 9

Kussmaul resp

Answer 9

Kussmaul respirations are fast, deep breaths that occur in response to metabolic acidosis

Question 10

9. Questions on PFT. Which measurement is the same for obstructive vs restrictive lung disease?

Answer 10

a. Tidal volume (TV)

Question 11

10. Know about FRC, FEV1 and how to tell whether they have restrictive or obstructive disease

Answer 11

a. FEV1 is the volume of air expired in 1 second after maximum inspiration.
FVC is the forced vital capacity and is the maximum volume of air forcibly expired after maximum inspiration.
The FEV1:FVC ratio is <80% in obstructive lung disorders (asthma, COPD, etc.). In restrictive disorders (pulmonary fibrosis, sarcoid, etc), the ratio will be normal or >1 since the FVC will be markedly decreased while the FEV1 should be normal. If the ratio is <1, and FEV1 is also decreased, then a mixed disorder is present. In obstructive disease, there is increased FRC and TV

Question 12

13. A patient has developed pulmonary hypertension, which is most likely cause?

Answer 12

a. Mitral stenosis

Question 13

14. A patient with known Aortic Stenosis becomes hypotensive, how do you treat?

Answer 13

a. Phenylephrine in small doses

Question 14

15. ECG leads is best for monitoring P-wave abnormalities?

Answer 14

a. Lead II

Question 15

16. What rhythm least likely to show on EKG after unstable paroxysmal supraventricular tachycardia (PSVT)?
    a. Persistent PSVT
    b. Sinus tachycardia
    c. Ventricular tachycardia
    d. Sinus bradycardia

Answer 15

d. Sinus bradycardia

Question 16

17. What is the first line drug for SVT according to ACLS protocol?

Answer 16

Adenosine-Confirmed
Adenosine is the first-line medical treatment for the termination of paroxysmal SVT. It is a short-acting agent that alters potassium conductance into cells and results in hyperpolarization of nodal cells

Adenosine has a role in slowing down the heart rate enough to assist in diagnosis.

Question 17

18. PE suspected. What’s the most accurate test to confirm?

a. D-dimer
b. CT Angiogram Chest
c. Ultrasound

Answer 17

b. CT Angiogram Chest-Confirmed

Question 18

19. Hylar lymphadenopathy

Answer 18

a. Sarcoidosis

Question 19

20. A patient in renal failure needs emergent surgery and anesthesia, what’s the most important lab value?

Answer 19

a. Potassium

Question 20

21. Cystic Fibrosis (CF) patients overtime develop - understand the disease and what are consequences long term Cystic Fibrosis patients overtime (look up what lung problems this patient will have)
    a. Some other lung problems as answer choice
    b. Develop pulmonary hypertension

Respiratory (7)
GI (9)
Osteoporosis (3)

Answer 20

b. Develop pulmonary hypertension – frequently found in CF
Respiratory: bronchiectasis, chronic lung infection, nasal polyps, hemoptysis, pneumothorax, respiratory failure, acute exacerbations
GI: nutritional deficiencies, diabetes, jaundice, fatty liver disease, cirrhosis, intestinal blockage, intussusception, distal intestinal obstruction syndrome (DIOS)
Reproductive: infertility (men), reduced fertility (women)
Other: osteoporosis, electrolyte imbalances, dehydration, fear

Question 21

22. KNOW all different types of fentanyl and their half life, onset time, metabolism rate.

Answer 21

a. Fentanyl
b. Remifentanyl – this has the shortest half-life & elimination time
c. Sufentanyl

Coinciding with this trend was the introduction of fentanyl analogues with faster and faster elimination. Fentanyl (8–10 hr elimination half-life) was followed by sufentanil (6–9 hr), alfentanil (2 hr), and remifentanil 0.6 hr.

Question 22

23. Question about what pain med to take post-op in someone with GI issues

a. Naproxen
b. Celebrax
c. Diclofenac
d. Ibuprofen

Answer 22

They are all NSAIDs so they all has side effect of stomach ulcers, bleeding, holes, etc. Ibuprofen is known to have the least GI side effect amongst all the NSAIDs.

Question 23

1. Duration of local anesthesia is related to?

Answer 23

a. Degree of protein binding ability

Question 24

2. Onset of local anesthetic depends on

Answer 24

a. Dissociative constant (pKa)

Question 25

3. What determines the potency of a local anesthetic?

Answer 25

a. Lipid solubility

Question 26

4. One question on possible adverse cardiac affect for marcaine

Answer 26

Bupivacaine produces a concentration-related depression of intra-atrial, A-V nodal, intraventricular conduction and myocardial contractility owing to a fast sodium channel blocking in both nerve and cardiac tissue.

Reports of cardiac arrest

Question 27

5. Marcaine toxicity symptoms

a. Tremors
b. Perioral numbness

(10 symptoms)

Answer 27

b. Perioral numbness – this is what I chose
Anesthetic toxicity: agitation, confusion, dizziness, drowsiness, dysphasia, auditory changes, tinnitus, perioral numbness, metallic taste, dysarthria (difficulty speaking )

Question 28

6. Know local anesthetics with its relationship with PABA

Answer 28

Conventional wisdom holds that, if local anesthetics do indeed produce allergies, esters of PABA would be more likely than amide local anesthetics.

para-aminobenzoic acid (PABA)

this moiety is common to other derivatives of para-aminobenzoic acid (PABA) such as methylparaben and some, but not all, ester local anesthetics. In these cases there may be the potential for cross allergenicity among similar compounds because of a common moiety (eg, sulfa antibiotics, methylparaben, and esters of PABA).

It should be clarified that articaine is classified molecularly as an amide, not an ester of PABA, and does not present any concern for cross-allergy to PABA derivatives.

Question 29

7. Know which local anesthetics will worsen hepatic function

Answer 29

The amide local anesthetics including lidocaine, bupivacaine and ropivacaine are commonly used for pain control during minor surgery or invasive procedures such as biopsies, small excisions or dental work. These local anesthetics have not been linked to serum enzyme elevations, but when given as constant infusions or repeated injections have been occasionally mentioned as possible causes of clinically apparent liver injury.

(bupivacaine): C (probable cause of clinically apparent liver injury).

Question 30

8. Know physiologic changes with patients on clonidine receiving marcaine

Answer 30

during anesthesia mean arterial pressure, heart rate, and FeISO were significantly decreased in Clonidine and Control groups compared with Placebo group

Question 31

9. Pre-operative vitals stable. Patient on propranolol and given 3 carpules of 0.5% Marcaine with 1:100:000 epinephrine. What will happen to vitals?

a. BP 140/80, P 120 –
b. BP 140/80, P 40
c. BP 60/40, P 120
d. BP 60/40, P 40

Answer 31

a. BP 140/80, P 120 – Propranolol with Epi will cause hypertensive crisis

Question 32

4-2-1 rule

Answer 32

The 4 – 2 – 1 rule for maintenance IV fluid therapy (Normal Saline or Ringer’s Lactate): 4 ml/kg/hr for the first 10kg of body mass. 2 mg/kg/hr for the next 10 kg of body mass. 1 mg/kg/hr for body mass beyond 20kg.

Question 33

11. How much fluid deficit does a patient that weights 70 kg and has been on NPO from 10 pm to 8 am?

Answer 33

a. Approximately 1L fluid deficit ((40 + 20 + 50)x10 = 1,100 mL)

Remember, 4-2-1 rule x the number of hrs NPO

Question 34

12. What’s true regarding acute bronchitis?

Answer 34

a. Hyperactive for 2-6 weeks (or 3 weeks)

Question 35

13. How long after a URI do you have to delay an elective surgery under general anesthesia?

Answer 35

a. 2 - 6 weeks

Question 36

14. What’s the MOA of dexmedetomidine (Precedex)?

Answer 36

a. α-2 agonist

Question 37

15. Ketorolac (Toradol)

Answer 37

Ketorolac’s anti-inflammatory, antipyretic, & analgesic effects is the inhibition of prostaglandin synthesis by competitive blocking of the enzyme COX

It is a non-selective Cox inhibitor

a. 5 - 6 hours T1/2
b. Will be in the system for 33 hrs
It takes about 5.5 x half life to get back into the system

Question 38

16. If you give a kid both Propofol and Sevoflurane,

Answer 38

a. You don’t have to give as much Sevoflurane

Question 39

17. Kid with no primary heart problem has bradycardia, which drug to give?

Answer 39

a. Epinephrine

Question 40

18. Rash, hypotension with vancomycin, what would be the most appropriate immediate next step to manage?

a. Give oral Benadryl – hmm
b. Give epinephrine
c. Slow infusion – hmm
d. Give fluids

Answer 40

Vancomycin Flushing Syndrome

Vancomycin flushing syndrome (VFS) was previously known as red man syndrome (RMS) is an anaphylactoid reaction caused by the rapid infusion of the glycopeptide antibiotic vancomycin. VFS consists of a pruritic, erythematous rash of the face, neck, and upper torso, which may also involve the extremities, though to a lesser degree. Symptoms may include weakness, angioedema, and chest or back pain. VFS is caused by vancomycin through the direct and non-immune-mediated release of histamine from mast cells and basophils.

Give oral Benadryl would probably be the best

Treatment / Management

When a patient develops VFS, the intravenous antibiotic infusion should be stopped immediately. Supportive care should be provided. H1 (diphenhydramine) and H2 antihistamines (ranitidine or cimetidine) are used in the management of VFS. Future doses of vancomycin may be given at decreased infusion rates in most cases.[1]

Mild cases (mild flushing and mild pruritus) can be managed with antihistamines such as diphenhydramine 50 mg by mouth or intravenously and ranitidine 50 mg intravenously. Most episodes will resolve within 20 minutes, and the vancomycin may be restarted at 50% of the original rate. Future doses should be given at the new, slower rate, typically over two hours.[10]

Moderate to severe cases (severe rash, hypotension, tachycardia, chest pain, back pain, muscle spasms, weakness, angioedema) should be managed according to severity. Patients with severe symptoms should be evaluated for anaphylaxis or other serious cause for their symptoms before assuming vancomycin flushing syndrome (VFS). If, after careful evaluation, the patient is determined to have VFS, antihistamines such as diphenhydramine and ranitidine can both be started intravenously. Normal saline intravenous boluses are used to treat hypotension. After the symptoms resolve, the vancomycin can be restarted and given over four hours. If alternative antibiotics to vancomycin are available, they should be used. If vancomycin must be continued, patients should be premedicated with diphenhydramine 50 mg intravenously and ranitidine 50 mg intravenously 1 hour before each dose, and vancomycin should be administered over four hours under close observation.[11][12]

If the symptoms of anaphylaxis are present, such as altered mental status, hypotension, stridor, difficulty breathing, wheezing, and hives, treatment should be started immediately for anaphylaxis, and the patient needs emergency care. Epinephrine should be given early, and the patient may have an epinephrine auto-injector with them, which can be used. [11][12] Emergency medical services, if available, should be activated immediately to expedite further patient treatment and transport to definitive care.

Patients requiring a rapid infusion of vancomycin may be pre-treated with diphenhydramine and ranitidine. However, the best preventive measure to avoid VFS is maintaining infusion rates below 10 mg/min.[13][14]

Question 41

19. A patient with aortic stenosis develops intra-op hypotension. What’s the most appropriate medication to give?

a. Phenylephrine
b. Ephedrine

Answer 41

Phenylephrine

Oral phenylephrine has a minimal direct effect on heart rate or cardiac output but, as a vasoconstrictor, can increase systolic and diastolic blood pressure at high doses, and thus cause reflex bradycardia.

Question 42

20. What happens to kids when succinylcholine is given

Answer 42

a. Bradycardia

Question 43

21. Obese, asthmatic patient that needs a rapid sequent intubation, use which neuromuscular agent.
    a. Succinylcholine (onset in 45 – 60 sec)–
    b. Rocuronium (onset in 60 – 90 sec)
    c. Atracurium (onset in 120 sec)

Answer 43

Succinylcholine

Question 44

22. Malignant hyperthermia patient, which neuromuscular blocking agent to use?
    a. Succinylcholine
    b. Rocuronium
    c. Atracurium

Answer 44

Rocuronium

Question 45

23. What muscle relaxant is contraindicated in renal failure patients?

Answer 45

a. Vecuronium and pancuronium may result in prolonged relaxation as these drugs are metabolized by the kidneys. Should use Atracurium/cis¬atracurium.

Question 46

24. What drug used to treat laryngospasm in MH patient?

Answer 46

a. Non¬depolarizing muscle relaxant: Rocuronium (onset in 60 – 90 sec), Vecuronium (onset in 90 – 120 sec), Atricurium (onset in 120 sec)

Question 47

25. Which drugs potentiates Versed?

Answer 47

a. Erythromycin & Cimetidine potentiates Versed

Question 48

26. What’s narrowest part of pediatric airway?

Answer 48

a. Below the glottis at the level of the cricoid cartilage

Question 49

27. Evaluating a kid pre-op. What makes difficult airway?
    a. Mallampati is a sole accurate indicator
    b. 3-2-5 rule
    c. Enlarged tonsils

Answer 49

c. Enlarged tonsils

Question 50

28. What do you see with LMA?

Answer 50

a. Arytenoids + vocal cord - this is what I put

Question 51

29. What does a normal Mueller’s maneuver look like?

Answer 51

a. You see arytenoids and vocal cords

Question 52

30. Shown 2 pictures of fiberoptic nasopharyngoscopy with patency and then occlusion. What’s the difference?

Answer 52

a. Mueller’s maneuver
The left picture shows retropalatal level airway collapse during Muller’s maneuver and the right photo shows during induced sleep nasoendoscopy. Note the change in shape of collapse from circular on the left to the coronal airway collapse on the right.

In this maneuver, the patient attempts to inhale with his mouth closed and his nostrils plugged, which leads to a collapse of the airway. Introducing a flexible fiberoptic scope into the hypopharynx to obtain a view, the examiner may witness the collapse and identify weakened sections of the airway.

Question 53

31. What does capnography waveform look like for COPD patients?

Answer 53

Question 54

32. What does this capnography waveform indicates:

Answer 54

Mechanical obstruction

Question 55

Just review

Answer 55

Make sure you pay attention to obese and obstructed patients

Question 56

1. What is the maximum time for a tooth to be out of the mouth for the best prognosis?

Answer 56

a. 120 min

Question 57

2. Pulpitis is most common in:
   a. Incisors
   b. Premolars
   c. Molars

Answer 57

Molars – this is what I picked

Question 58

3. Which nerve is most commonly injured during a ‘block’? (The question didn’t specify what type of block so I assumed IAN block.)

Answer 58

a. Lingual nerve

Question 59

4. When do you do vestibuloplasty?
   a. Not enough keratinized tissue
   b. High-muscle attachment

Answer 59

High-muscle attachment

Not confirmed

Question 60

5. What effects the long term success of the submucous vestibuloplasty?

Answer 60

a. Long-term use of stint

Question 61

6. Best way to close an oro-antral fistula from a first molar?

Answer 61

a. 1 - 4 mm usually heals on its own, otherwise, buccal advancement flap, palatal finger flap, or buccal fat pad advancement

Question 62

7. Oralantral fistula of 8 mm for site #3 closed best with:

a. Dorsal and ventral tongue flap, not lateral tongue
b. Buccal sliding flap
c. Palatal flap will cause less pain and morbidity
d. Buccal fat pad will cause severe maxillary vestibular shallowing/obliteration

Answer 62

Buccal fat pad will cause severe maxillary vestibular shallowing/obliteration – this is what I chose

Question 63

8. What increases risk for alveolar osteoitis (dry socket)?

Answer 63

a. >25 years of age

Question 64

9. After extraction, foul smell and pus from extraction site. Gram stain shows GNR but no growth after 4hrs. What is most likely cause?

Answer 64

a. Bacteroids

Question 65

10. What happens when you place the tip of a TAD into the root of a tooth?

Answer 65

a. External resorption

Question 66

11. You accidentally injure an adjacent tooth while placing an implant. How long does it take cementum to regrow/heal?

Answer 66

a. 6 – 12 weeks

Question 67

12. What is the minimum measurement of an open apex that is required to support revascularization?

Answer 67

a. 1 mm

Question 68

13. How to maximize success of coronectomy?

Answer 68

a. Remove all enamel

Question 69

14. Most common chronic finding after coronectomy?
    a. Periodontal bone loss of adjacent tooth
    b. Raiolucency over the remaining root tip
    c. Superior migration of the remaining root tip

Answer 69

Superior migration of the remaining root tip

Question 70

a. Osteoinduction:

Answer 70

growth factors stimulate mesenchymal cells to differentiate into osteoblastic lineages

Question 71

b. Osteoconduction

Answer 71

acts as a matrix for bone growth

Question 72

c. Osteogenesis

Answer 72

transplanted osteoblasts and periosteum produce own bone

Question 73

BMP

Pros & Cons

Answer 73

i. Pros: no need for 2nd surgical site, favorable soft tissue response, osteoinductive, similar bone volumes result, allows for eruption to teeth
ii. Cons: requires Autogenous graft in older patients, moderate-to-severe post-op edema associated with use, provides questionable support of all, off-label use in pediatric patients

Question 74

2. How is rhBMP produced/manufactured?

Answer 74

BMPs for clinical use are produced using recombinant DNA technology (recombinant human BMPs; rhBMPs). Recombinant BMP-2 and BMP-7 are currently approved for human use. rhBMPs are used in oral surgeries. BMP-7 has also recently found use in the treatment of chronic kidney disease (CKD).

Question 75

What does rhBMP stand for?

Answer 75

It is recombinant human bone morphogenic protein.

The bone formation process develops from the outside of the implant towards the center until the entire device is replaced by trabecular bone.

Question 76

BMP production, just think about it

Answer 76

Bone morphogenetic protein-2 (rhBMP-2) represents the osteoinductive protein factor which plays a dominant role in growth and regeneration of a bone tissue. In clinical practice the bone grafting materials on the basis of rhBMP-2 are widely applied; the Russian analogues of similar materials are not produced. The fragment of the bmp2gene coding for a mature protein was cloned in Escherichia coli. The effective overproducing strain of rhBMP-2 was created on a basis of the E. coli BL21 (DE3). The rhBMP-2 production was about 25% of total cell protein. The biologically active dimeric form of rhBMP-2 was obtained by isolation and purification of protein from inclusion bodies with subsequent refolding. The rhBMP-2 sample with more than 80% of the dimeric form was obtained, which is able to interact with specific antibodies to BMP-2. Biological activity of the received rhBMP-2 samples was shown in the in vitro experiments by induction of alkaline phosphatase synthesis in C2C12 and C3H10T1/2 cell cultures. On model of the ectopic osteogenesis it was shown that received rhBMP-2 possesses biological activity in vivo, causing tissue calcification in the place of an injection. The protein activity in vivo depends on way of protein introduction and characteristics of protein sample: rhBMP-2 may be introduced in an acid or basic buffer solution, with or without the carrier. The offered method of rhBMP-2 isolation and purification results in increasing common protein yield as well as the maintenance of biologically active dimeric form in comparison with the analogues described in the literature.

Question 77

BMP production, just think about it

Answer 77

Bone morphogenetic protein-2 (rhBMP-2) represents the osteoinductive protein factor which plays a dominant role in growth and regeneration of a bone tissue. In clinical practice the bone grafting materials on the basis of rhBMP-2 are widely applied; the Russian analogues of similar materials are not produced. The fragment of the bmp2gene coding for a mature protein was cloned in Escherichia coli. The effective overproducing strain of rhBMP-2 was created on a basis of the E. coli BL21 (DE3). The rhBMP-2 production was about 25% of total cell protein. The biologically active dimeric form of rhBMP-2 was obtained by isolation and purification of protein from inclusion bodies with subsequent refolding. The rhBMP-2 sample with more than 80% of the dimeric form was obtained, which is able to interact with specific antibodies to BMP-2. Biological activity of the received rhBMP-2 samples was shown in the in vitro experiments by induction of alkaline phosphatase synthesis in C2C12 and C3H10T1/2 cell cultures. On model of the ectopic osteogenesis it was shown that received rhBMP-2 possesses biological activity in vivo, causing tissue calcification in the place of an injection. The protein activity in vivo depends on way of protein introduction and characteristics of protein sample: rhBMP-2 may be introduced in an acid or basic buffer solution, with or without the carrier. The offered method of rhBMP-2 isolation and purification results in increasing common protein yield as well as the maintenance of biologically active dimeric form in comparison with the analogues described in the literature.

Question 78

3. You place an autogenous block graft. What do you intend to achieve by ideally preparing the recipient site?

Answer 78

a. Osteogenesis
b. Osteoinduction
c. Osteoconduction

Question 79

4. What’s the minimum thickness required for attached gingiva from implant? Something like that

Answer 79

a. 1.5 mm
b. 2 mm
c. 2.5 mm
d. 3.0 mm
e. 3.0 mm – this is what I picked

I think 3.0 is correct

Question 80

6. What’s minimum amount of bone needed for simultaneous placement of implant while doing a sinus lift?

Answer 80

a. 3-5 mm review book says 3-8 mm

Question 81

7. You are placing 5 standard 4.0 mm implants into anterior mandible of an edentulous patient between the mental foramina. What is the length of bone between the foramina needed?

Answer 81

a. 4 mm for each implant = 20 mm
3 mm between each implant = 12 mm
5 mm between terminal implant and mental foramina x 2 = 10 mm
Total = 42 mm

Question 82

8. Patient who has worn maxillary and mandibular complete dentures without problems desires a new removable prosthesis with implants. He has 7 mm of bone above the mental nerve and IAN canal. What is the most prudent treatment

Answer 82

a. Two implants in parasymphysis with tissue bar or ERA attachments

Question 83

9. Reasoning for placing immediate implants with restoration

Answer 83

a. Better soft tissue contour

Question 84

12. Platform switch?

Answer 84

a. Reduce bacterial load and therefore reduce recession

Question 85

13. What’s the minimum space for hybrid denture?

Answer 85

15 mm

Question 86

14. What’s the minimum space for an overdenture?

Answer 86

a. 12 mm

Question 87

15. Minimum torque for zygomatic implant

Answer 87

a. 40 NCm (should be within 35-45 Ncm

Question 88

Normal implants have a torque value of

Answer 88

30 Ncm

Question 89

16. In planning for zygomatic implants, you must include?

Answer 89

a. Minimum of 2 additional implants in the anterior maxilla (and 10 mm of zygoma)

Question 90

17. Which one will have better result?

Answer 90

a. 7 mm from bone to contact point – This is what I picked since there’s critical point where the papilla doesn’t grow back if the

I would be suspicious of this, it should be 5 moper some reports. Recent study from Palmer suggested 8.5 mm for full papilla growth.

I think 7 is too high, for 75% of patients to fill the embrasure space, it should be 6 mm, but 5.0 mm is a guarantee.

Question 91

18. Which of the following is the most important factor for success of a cantilevered implant-supported denture?

Answer 91

a. A-P spread of the implants (can be 1.5x AP spread)

Question 92

19. Most likely cause of implant failure within a year

a. Thread exposure at the time of placement
b. Screw loosening after osseointegration
c. Implant not submerged (not subcrestal placement)

Answer 92

a. Thread exposure at the time of placement

Question 93

1. Extrusion of incisor and its relationship to tissue migration.
   a. Gingival margin moves but mucogingival junction doesn’t
   b. Mucogingival margin migrates coronary

Answer 93

a. Gingival margin moves but mucogingival junction doesn’t

Question 94

2. Infected #32, tonsillar wall bulging medially. Possibly discussing some Horner syndrome symptoms. Which space infection?

Answer 94

a. Lateral pharyngeal

Question 95

3. What is the eye finding if oculomotor nerve (CN III) is injured?

Answer 95

a. Down & out

Question 96

4. CN VI palsy and eye will move in which direction?
   a. Down and out
   b. In and out
   c. Up and out
   d. Up and in

Answer 96

d. Up and in

Question 97

5. Loss of supra-tarsal fold (lid crease) after trauma is caused by

Answer 97

a. Levator disinsertion – this is what I picked

it pulls the eyelid skin to form the supratarsal fold when the eyes are open

Question 98

6. Lacrimal duct injury
   a. Duct cannulation for 3-4 months
   b. DCR
   c. Immediate repair

Answer 98

Duct cannulation for 3-4 months

Question 99

7. What causes a hyphema?

a. Ciliary body –
b. Lateral ciliary a.
c. Posterior ciliary a

Answer 99

a. Ciliary body – A tear at the anterior aspect of the ciliary body is the most common site of bleeding (71%)
b. Lateral ciliary a.
c. Posterior ciliary a – Frequently, patients develop hyphema at the time of trauma due to tearing of the anterior and posterior ciliary arteries

Question 100

8. Picture of eye with hyphema. Asking when light show in this eye, no response but response in normal eye.

a. Efferent pupillary defect
b. Afferent pupillary defect

Answer 100

b. Afferent pupillary defect

Question 101

9. Eyelid scar. Pt now has ectropion. What type of ectropion does this pt have?

a. Involutional
b. Cicatrical
c. Spastic
d. Congenital

Answer 101

b. Cicatrical – my pick

Cicatricial ectropion is caused by shortening of the anterior lamella, which is comprised of the skin and orbicularis muscle.

Involutional ectropion is caused by increased horizontal laxity of the lower eyelid and disinsertion of the lower eyelid retractors.

An irritation of the eye caused by dryness or inflammation can lead you to try to relieve the symptoms by rubbing the eyelids or squeezing them shut. This can lead to a spasm of the eyelid muscles and a rolling of the edge of the lid inward against the cornea (spastic entropion).

Question 102

10. What muscle originates from the anterior portion of the orbital rim?

Answer 102

a. Inferior oblique muscle

Question 103

11. Maxillofacial trauma patient suddenly develops hypotension and decreased breath sound. Next step is?
    a. Needle chico
    b. Needle thoraco
    c. Fluids

Answer 103

Needle thoraco

Question 104

12. CentraCentral line of subclavian and suddenly the patient’s breath sound decrease. What’s the next step?

Answer 104

a. Needle decompression

Question 105

13. One question on GCS. Which has the worst prognosis or lowest level of consciousness?

a. Eye opening on deep/painful response
b. Eye opening on deep, painful response
c. Flexor movement on painful response
d. Extensor movement on painful response

Answer 105

d. Extensor movement on painful response

Question 106

14. Head + 1 arm + anterior torso burn

Answer 106

a. 36% (= 9% + 9% + 18%)

Question 107

15. Extensive blood transfusion and what is the effects?
    a. Coronary thrombosis
    b. Brain hemorrhage

Answer 107

Coronary thrombosis

RBC and platelet transfusions are associated with an increased risk of venous and arterial thrombotic events and mortality in hospitalized …CONFIRMED

Question 108

16. 1 L of blood loss is equivalent to which hemorrhage classification?

Answer 108

a. Class II: 750 cc – 1,500 cc

Question 109

18. GSW injury and the patient cannot feel anterior 1/3 of tongue and right deviation of tongue is noted. Which nerves are damaged?

a. Lingual, hypoglossal
b. Lingual, glossopharyngeal
c. Hypoglossal, glossopharyngeal

Answer 109

a. Lingual, hypoglossal (CN XII)

the hypoglossal nerve
Damage to the hypoglossal nerve causes paralysis of the tongue. Usually, one side of the tongue is affected, and when the person sticks out his or her tongue, it deviates or points toward the side that is damaged.

Question 110

19. A patient with an ear laceration with small portion of the lacerated ear attached to the ear. No photo shown. It’s asking how to treat.

a. Graft from the other ear to the injured ear
b. Embed the lacerated ear to the post-auricular area or something

Answer 110

Embed the lacerated ear to the post-auricular area or something

Question 111

20. A patient with bite wound to the face. This is best treated by: This is best treated by:

a. High pressure irrigation with PSI >10
b. Hand irrigation with PSI between 5-8
c. Aggressive debridement to remove risk of infection

Answer 111

b. Hand irrigation with PSI between 5-8

Question 112

21. Anterior table comminuted fracture with CSF leak. CT axial view shows. It asks the type of treatment.:

Answer 112

a. Observe and treat if the duct obstructs or CSF leak continues

Question 113

22. Which of these indicates repair of nasolacrimal duct injury not needed or something like that

a. Comminuted anterior and posterior table fractures
b. Observe and if duct obstruction of CSF leak persists then treat

Answer 113

a. Comminuted anterior and posterior table fractures
b. Observe and if duct obstruction of CSF leak persists then treat

Question 114

23. ZMC fracture, binocular diplopiadiploma cause

a. Orbital floor without herniation of contents
b. Inferior displacement of Whitnall’s tubercle
c. Orbital septum displacement

Answer 114

a. Orbital floor without herniation of contents

Question 115

24. ZMC fracture, cannot move upper eyelid. Which nerve is injured?

Answer 115

a. CN III
The oculomotor nerve (CNIII) innervates the main upper eyelid retractor, the levator palpebrae superiorus, via its superior branch. The inferior division of CNIII also innervates the inferior rectus muscle, which by extension via the capsulopalpebral fascia causes lower eyelid retraction in downgaze.

Question 116

25. Bite force in anterior mandible leads to what forces?

Answer 116

a. Tension along superior, compression along inferior

Question 117

26. What is the most common complication of rigid fixation for the treatment of jaw fractures?

Answer 117

a. Malocclusion

Question 118

27. What type of mandible fracture is most susceptible to infection?

Answer 118

a. Angle

Question 119

28. Which type of fracture necessitates rigid fixation?

Answer 119

a. Atrophic mandibular body fracture

Question 120

29. Which of the following fractures requires load bearing fixation?
    a. Atrophic mandible
    b. Angle
    c. Symphysis

Answer 120

Atrophic mandible

Question 121

30. Most common infection in odontogenic infection
    a. Staphylococcus
    b. Streptococcus – GPC, aerobe
    c. Bactericides – GNR, anaerobe

Answer 121

. Streptococcus – GPC, aerobe

Peptostreptococcus is a genus of anaerobic, Gram-positive, non-spore forming bacteria

The most common species of bacteria isolated in odontogenic infections are the anaerobic gram-positive cocci Streptococcus milleri group and Peptostreptococcus.

In this study the most common aerobic organism isolated was streptococcus viridians (34.49%), most common anaerobe was peptostreptococci, (61.11%)

This is a poorly written question. Most odontogenic infection is mixed (60%) followed by anaerobic only (33%) and aerobic only (7%). Since Streptococcu viridans is the most common GPC that’s aerobic, this could be an answer. However, Bacteroids (causes foul smell) along with Fusobacteriumn is the most common GNR and Bacteroids is anaerobic so this could be an answer as well.

Question 122

1. Hemifacial microsomia involves which arches?

Answer 122

a. 1-2 branchial arches

Question 123

2. Development of maxilla and mandible

Answer 123

a. 1st arch and mesoderm

(test said ectoderm, but that is incorrect)

Question 124

3. Young girl with hemifacial microsomia, which syndrome could she have?

Answer 124

a. Goldenhar syndrome

Goldenhar-Gorlin syndrome is a congenital malformation of the structures derived from the first and second pharyngeal arches. Hemifacial microsomia is a flattening of the face due to underdeveloped mandible (micrognathia), maxilla and zygomatic bones with hypoplastic muscles for mastication and facial expression.

Question 125

4. Picture of a child with description of dermis feature

Answer 125

a. Goldenhar syndrome

Ear malformations or microbial, skin tags,

Question 126

5. Tensor veil palatine innervation

a. CN V
b. CN VII
c. CN X

Answer 126

The tensor veli palatini muscle is innervated by the mandibular branch of the trigeminal nerve,

. CN V

Function. The tensor veli palatini tenses the soft palate and by doing so, assists the levator veli palatini in elevating the palate to occlude and prevent entry of food into the nasopharynx during swallowing.

Question 127

6. Which muscle pulls soft palate posteriorly?

a. Levator veli palatini
b. Palatopharyngeal

Answer 127

***Levator veli palatini is the elevator muscle of the soft palate in the human body-elevation and backward extension of posterior soft palate

Palatopharyngeal-Its function is to tense the soft palate and pull the pharyngeal walls superiorly, anteriorly, and medially during swallowing, effectively closing off the nasopharynx from the oropharynx.

Question 128

7. What palatal muscle is most responsible for speech?

Answer 128

a. Levator veli palatini (this is a primary elevator of palate)

Question 129

8. Lateral pterygoid insertion

Answer 129

a. Medial capsule and disc

inserts onto the articular disc and fibrous capsule of the temporomandibular joint.

Question 130

9. Fusion of palatal shelves complete by how many weeks

a. 6
c. 8
d. 10

Answer 130

Suggested mechanisms for palatal fusion Fusion between the two palatal shelves occurs during week 9 of embryonic developmen

John would say 8, I would say 10

I would say 10

Question 131

10. A cleft patient will have deficient maxillary growth

Answer 131

a. Vertical, A-P, transverse

Question 132

11. A patient had cleft palate that was fixed. Later down the road, they did LeFort I advancement.

a. Palatal fistula
b. VPI

Answer 132

VPI

Question 133

12. Most likely reason for alveolar cleft failure
    a. Alveolar cleft malposition
    b. Soft tissue closure under tension
    c. Overpacking the site with cancellous graft

Answer 133

Soft tissue closure under tension

Question 134

13. What is the most likely malocclusion seen in thalassemia patients?
    a. Transverse maxillary excess
    b. Posterior maxillary deficiency
    c. Class III malocclusion
    d. Maxillary hyperplasia

Answer 134

Maxillary hyperplasia
-VME

Question 135

14. DiGeorge (velocardiofacial syndrome)

Answer 135

a. Chromosome 22 deletion

Question 136

15. Which syndrome presents with mandibular hyperplasia?
    a. Apert
    b. Pfeiffer
    c. Crouzon prognathism
    d. Saethre-Chotzen

Answer 136

d. Saethre-Chotzen – mandibular prognathism - my pick’

a. Apert – maxillary hypoplasia
b. Pfeiffer – maxillary hypoplasia
c. Crouzon – maxillary hypoplasia, mandibular prognathism

Intraoral manifestations of SCS include maxillary hypoplasia, mandibular prognathism and high arched palate.

Question 137

16. What cleft repair has the highest incidence of maxillary retrusion?

Answer 137

a. 4-point (VWK) flap

Question 138

17. SARPE indicated in

a. >7 mm transverse expansion
b. To fix multiocclusal discrepancy

Answer 138

> 7 mm transverse expansion

Green book says >10 mm advancemetn

Question 139

18. SARPE changes seen on ceph
    a. Palatal plane changes
    b. Incisor and palatal plane changes
    c. ANB angle decrease
    d. SNB angle decrease

Answer 139

b. Incisor and palatal plane changes – my pick but not sure

PP-SN, SNA, and ANB angles were increased and U1-SN and U1-PP angles were decreased.

Question 140

19. Internal max bleeding during LeFort likely from which osteotomy?

a. Pterygomaxillary junction
b. Lateral maxillary wall
c. Perpendicular plate of maxilla

Answer 140

Pterygomaxillary junction

Question 141

20. How to ensure Distraction Osteogenesis (DO) works?

Answer 141

a. Movement in correct vector

Question 142

21. Difference between DO vs BSSO

Answer 142

a. Same incidence of nerve

Question 143

22. A vascular necrosis prevention. Which blood supply critical?
    a. Descending palatine
    b. Ascending palatine
    c. Internal maxillary?

Answer 143

a. Descending palatine

Question 144

23. Septal deviation after LeFort I
    a. Go back to OR
    b. Fix in clinic or OR ASAP
    c. Observe until swelling reduces

Answer 144

Fix in clinic or OR ASAP

Question 145

24. During BSSO, fracture of buccal plate of proximal segment. What do you do?

a. MMF for 3 weeks and return to complete BSSO later
b. Plate segment to proximal segment and finish osteotomy
c. Complete osteotomy and mobilize distal segment and then plate fractured segment to proximal segment and then plate that proximal segment to distal segment

Answer 145

Plate segment to proximal segment and finish osteotomy

Question 146

25. Most stable fixation for BSSO. Screw pattern for BSSO.
    a. Transoral – 3 screw along the superior border
    b. Transoral – 3 screw along superior border
    c. Transbuccal – 2 superior border screws and 1 inferior
    d. Transbuccal – inverted-L formation

Answer 146

d. Transbuccal – inverted-L formation

Question 147

26. Patient with severe OSA: SNA 79, SNB 76, PAS 5. What’s the most predictable treatment?

Answer 147

a. MMA of 8 mm with CCW rotation of mandible

Question 148

27. A 20-year-old male patient doesn’t know when it started but over the last two year noticed facial asymmetry. No changes in shoe size. Hasn’t seen it get worse over the last two years. When do you think the facial asymmetry started?

a. Started during puberty/growth spurt
b. Started after orthodontic treatment
c. Started recently
d. The patient is still growing

Answer 148

c. Started recently – this is what I picked

Question 149

28. What RDI score is associated with significant increase in mortality?

Answer 149

Respiratory disturbance index

I think it may be greater than 15/hr

of disturbances, calculated by number of hours

Question 150

2. Trichophytic incision best when
   a. Forehead wrinkling
   b. Receding hairline

Answer 150

Forehead wrinkling
-Can shorten long foreheads, can excise thinning hair-bearing areas temporally, bony recon touring possible

Possible visible scar at the hairline

Question 151

4. 15 mm from the tip of upper eyelid to brow and you do upper bleph. What’s the most common complication?

Answer 151

a. Lagophthalmos

Question 152

5. Lagophthalmos due to
   a. Removing too much upper eyelid crease
   b. Removing levator superioris muscle
   c. Removing orbital septum

Answer 152

Removing too much upper eyelid crease

Question 153

6. What separates the fat pads in a lower bleph?

Answer 153

a. The inferior oblique muscle separates the medial from the middle fat pad

Question 154

7. The ability to distract the lower lid more than ___ indicates the need for lid shortening? (Lid laxity or snap-back test)

Answer 154

a. 8 mm / 2 sec

Question 155

8. Lagophthalmos due to
   a. Removing too much upper eyelid crease
   b. Removing levator superioris muscle
   c. Removing orbital septum

Answer 155

Removing too much upper eyelid crease

Question 156

9. Eyelid edema and loss of lid crease

Answer 156

Blepharochalasis or blepharochalasis syndrome is a rare condition characterized by episodic inflammation of the eyelids

Question 157

10. Degree of canting for lay people to visualize

Answer 157

a. 4 degrees

Question 158

11. What do we perform Schirmer’s test before blepharoplasty?

Answer 158

Schirmer’s test determines whether the eye produces enough tears to keep it moist. This test is used when a person experiences very dry eyes or excessive watering of the eyes. It poses no risk to the subject.

Schirmer’s test is used to determine whether the eye produces enough tears to keep it moist. The test is performed by placing filter paper inside the lower lid of the eye. After 5 minutes, the paper is removed and tested for its moisture content.

urgeons might avoid operating on patients who suffer from dry eye due to concern that blepharoplasty could exacerbate symptoms. Some have proposed that these risks necessitate formal tear production testing or specific ophthalmologic evaluation preoperatively.

The Schirmer’s test is one of the most commonly performed tear production tests and is often regarded as the gold standard. In the Schirmer’s I test, the basal and reflex tear formation is measured using filter paper placed inside the lower eyelid, whereas the Schirmer’s II test measures basal tear formation on the filter paper after an anesthetic is applied to the eye. An abnormal Schirmer’s test occurs when the wetting of the filter paper is less than 10 mm after five minutes, whereas normal wetting ranges from 15mm to 30 mm. Performing the Schirmer’s test could potentially be beneficial in identifying patients who may be at risk for developing dry eye postoperatively as well as those who could benefit from more conservative surgical approaches. However, is a Schirmer’s test necessary prior to a blepharoplasty?

Question 159

12. Schirmer’s test. Know normal values and indications.

Answer 159

a. Schrimer’s test determines whether the eye produces enough tears to keep it moist
b. Normal when >10 mm of moisture on the filter paper in 5 minutes

An abnormal Schirmer’s test occurs when the wetting of the filter paper is less than 10 mm after five minutes, whereas normal wetting ranges from 15mm to 30 mm.

Question 160

13. Upper/lower nasal cartilage and bone

a. Interlock
b. Overlap

Answer 160

a. Interlock – upper and lower nasal cartilage interlocks

Overlap – nasal cartilage and bone overlaps

Question 161

14. What do you perform to decrease nasal tip projection?

Answer 161

a. Complete transfixion incision

Placed near the caudal edge of the cartilagenous septum
-transects the attachments of both medial crura to the septum resulting in loss of tip support
-Connects the right & left nares through the columella

Question 162

a. Complete transfixion incision
15. Nasal septal hematoma will cause

Answer 162

a. Binder’s deformity
b. Cartilage necrosis/disruption

Binder’s syndrome with nasal deformity-The nasal deformity is characterised by a shortened columella and underdeveloped nasal bridge.

Question 163

16. Nerve innervation to nasal tip

Answer 163

a. Anterior ethmoidal
supplies the middle vault and nasal tip

The infraorbital nerve supplies the lateral nose and nasal tip.

Question 164

17. Dorsal hump reduction
    a. Bone only
    b. Cartilage only
    c. Dissect above the plane of cartilage and bone
    d. Dissect above the plane of cartilage and below the bone

Answer 164

Dissect above the plane of cartilage and bone

Question 165

18. What’s the complications if you do too aggressive rhinoplasty?

Answer 165

a. A large hump resection produces an open-roof deformity, which requires lateral osteotomies

Question 166

20. Level of depth for medium chemical peel
    a. Papillary dermis
    b. Reticular dermis

Answer 166

a.Reticular dermis-medium peel “absence of pink sign”

-Light peel-paipillary dermis
Deep peel-mid-reticular dermis-gray color

Question 167

21. Resylane (non-animal hyaluronic acid) is replaced by?

Answer 167

a. Cross-linking

Question 168

1. What is the source of pain with disc perforation?

Answer 168

a. Subchondral nociceptors

Question 169

2. Which fibers/nerve carry taste?

Answer 169

a. Facial n. (VII) via chorda tympani

Question 170

3. Gabapentin is useful for

a. Avoids opioid tolerance
b. Sedating and anxiolytic
c. Anti-inflammatory

Answer 170

. Avoids opioid tolerance

Gabapentin is a prescription Painkiller that is less addictive than Opioids. Still, addiction and abuse occur; overdosing is possible.

Gabapentin is also known as nuerontin

Question 171

4. What’s the best diagnostic study for assessing active phase of condylar hypertrophy?

Answer 171

a. Technecium-99 scan

Question 172

5. A patient with scleroderma comes into your office with mandibular asymmetry. What’s the most likely cause?
   a. Muscle fibrosis
   b. Condylar resorption
   c. ??
   d. ??

Answer 172

In scleroderma, structural changes may occur in the osseous tissue and result in mandibular joint restriction (pseudoankylosis) and facial and occlusal disharmonies.

Connective tissue disorders of the skin also show the characteristic activation of fibrosis resulting in excessive production and accumulation of collagen fibers.

PRS, a rare form of scleroderma manifests as progressive shrinking and deformation of one side of the face, thus resulting in unilateral facial atrophy. The deformity effected by PRS is an issue not only of esthetics but also of facial functionality. PRS in fact has been linked with neurologic, ophthalmologic, rheumatologic, maxillofacial, and orthodontic issues

Therefore, we report the rare case of a facial asymmetry patient diagnosed as LS with soft-tissue atrophy.

Question 173

6. Scleroderma – know the underlying cause, about this and any oral/facial manifestation

Answer 173

a. Collagen overproduction
Symptoms: skin tightening, GERD, malabsorption, Raynaud disease
Diagnosis: skin biopsy
Treatment: vasodilatory medicine, NSAIDs, steroids, immune suppressants

Question 174

7. Idiopathic condylar resorption and how it can be prevented

a. Do ortho in childhood to recent
b. Do orthognathic surgery

Answer 174

Treatment Case Study Treatment requires removing compression by fixing the bite and reducing the influence of whole body inflammation on the TM

Anti-inflammatory medications, which can help slow the condition’s progress.
Bite splints or night guards to protect your teeth from damage due to bruxism (grinding and clenching).
Condylectomy, which is surgery to remove your mandibular condyles. After removing them, your surgeon reshapes and repairs your jaw to restore proper function and improve appearance.
Orthodontics, including braces and retainers, which can correct overbite or teeth alignment problems.
Orthognathic surgery, which repositions your upper and lower jaws. This may be done in combination with TMJ reconstruction.

Splint As with all treatments discussed in this review, splint therapy has limited evidence to support it. It has been proposed that splints may alleviate TMJ loading, and TMJ loading may accelerate ICR. Yet, whether this is in fact the true or not, splints will protect the teeth.
The patients should understand in advance that the night guard will be abnormally thick in all, but the posteriormost section to fill the area of open bite and bring all teeth into occlusion. Hard acrylic should be used because a soft vacuform material cannot be made thick enough for the area of natural open bite. Patients may actually have some difficulty adapting to full occlusion when they have not had it for a long time. The unusual thickness may also be a factor is slower patient acceptance.

Removal of hyperplastic synovium Wolford and Cardenas describe 14 cases that underwent this open-joint surgery, in which the condyles were repositioned, the discs stabilized by attachment to implants, and BSSO and maxillary osteotomies were performed. All reported cases treated in this way in the literature were done by one group, with no relapse after an average follow-up of 33.2 months (range 18–68).[2] No adverse outcomes were reported.

Condylectomy and costochondral graft In a study by Troulis et al., fifteen patients with active ICR underwent a minimum of endoscopic condylectomy and costochondral graft. When indicated, Le Forte I maxillary osteotomy and/or genioplasty was done. Orthodontics was done before the surgery. With a mean follow-up of 34 months (range 12–84), no TMD, neuropathy, or any other adverse outcomes were reported. Furthermore, no significant relapse was observed.[9]

Question 175

8. MRI findings in degenerative joint disease

Answer 175

a. Condylar sclerosis

Question 176

9. How does damaged articular cartilage heal?

Answer 176

a. By forming fibrocartilage

Question 177

10. Wilkes Stages. What is the stage for frequent pain, sometimes reducing disc displacement

Answer 177

a. Stage III

Question 178

11. Pain while eating without radiographic perforation. Which Wilkes stage is this?

Answer 178

a. Stage III

Question 179

12. How do you describe the following MRI findings?

Answer 179

a. ADD w/o reduction

Question 180

13. Something about having about cytokines and TMJ disorders.

Answer 180

a. Cytokines not seen in asymptomatic joints: IL-1β, IL-6, IL-8, TNFα
IL-10 has been shown to be elevated in joints that respond well to arthrocentesis as it is an inhibitor of macrophage activation which in turn inhibits the above pro-inflammatory cytokines

Question 181

Which of the following cytokines may predict successful treatment by arthrocentesis when found in TMJ synovial fluid from joints with chronic closed lock?
1. Tumor Necrosis factor alpha (TNF-alpha)
2. Interleukin 1 (IL-1)
3. Interleukin 6 (IL-6)
4. Interleukin 10 (IL-10)

Answer 181

Interleukin 10 (IL-10)

Question 182

4- 68. Internal derangement of the TMJ which presents as a chronic closed lock is most effectively managed by what
surgical procedure?
(A) Arthrocentesis
(B) Arthroscopic lysis and lavage
(C) Arthrotomy with disc repositioning
(D) Discectomy and disc replacement with cartilage

Answer 182

(B) Arthroscopic lysis and lavage

Question 183

Which of the following is most important in maintaining the nasal valve?

a. medial crus
b. intermediate crus
c. collumellar strut
d. upper lateral cartilages

Answer 183

d. upper lateral cartilages

Question 184

Shown pictures of 36yo male patient with painful swelling right maxilla. Pano shows mixed radiopaque/
lucent lesion with cortical perforation right maxillary wall and CT shows orbital encroachment. Histo
shows epithelial cells in uniform background with occasional pink cementum/bone like material. Low
power image looks like could be Liesegang rings but really poor distorted image?
a. CEOT
b. Osteosarcoma

Answer 184

CEOT

Califying Epithelial odontogenic Tumor (Pinborg Tumor)- uncommon lesion that accounts for less than 1%
of all odontogenic tumors. Fewer than 200 cases have been reported to date. Although the tumor is clearly of
odontogenic origin, its histogenesis is uncertain. Tumor cells bear a close resemblance to te cells of the stratum
intermedium. Most often 30-50 yrs. No sex prevalence. About 2/3 are found in the mandible; most often
posterior areas. A painless slow-growing swelling is most common presenting sign.
Radiographically, the tumor shows a unilocular or more often a multilocular radiolucent defect.

Question 185

Brow pexy is indicated on what type of patient?
a. patient with complete bilateral brow ptosis
b. moderate lateral brow ptosis
c. lateral lid hooding
d. dermatochalasis

Answer 185

b. moderate lateral brow ptosis

Question 186

4. Bone Morphogenic Protein is correctly classified as which of the following?
   a. Interleukin
   b. Interferon
   c. Transforming growth factor-cytokine

Answer 186

c. Transforming growth factor-cytokine

Question 187

Which of the following correctly describes Beta2-transferrin?
a. Glycoprotein
b. Isoenzyme
c. Cytokine
d. Interleukin

Answer 187

a. Glycoprotein

Question 188

32. Patient suffers from chronic temporomandibular joint pain. Which category of medications has been shown
    most effective in treated the symptoms?
    a. muscle relaxants
    b. SSRIs
    c. Tricyclic antidepressants
    d. steroids

Answer 188

c. Tricyclic antidepressants

TCAs produce significant analgesia independent of their antidepressant effects. TCA induces analgesia is
typically observed prior to antidepressant effects and at doses that are generally believed to be too low for any
significant antidepressant effect. Amitripyline and imipramine, antidepressants with antinocieptive actions, are
potent inhibitors of serotonin uptake. Though these agents have no direct effect on norepinephine reuptake,
their metabolites are also potent norepinephrine reuptake inhibitors.

Question 189

43. Shown radiograph, clinical picture, histo, of child with single opacity in the posterior mandible. Which is
    the correct diagnosis?
    a. Ameloblastic fibroma
    b. Ameloblastic fibro-odontoma
    c. Calcifying Epithelial Odontogenic Tumor
    d. Plexiform Ameloblastoma

Answer 189

b. Ameloblastic fibro-odontoma

Ameloblastic Fibro-odontoma: Tumor with the general characteristics of an ameloblastic firoma but also
contains enamel and dentin. Some investigators believe that the ameloblatic fibro-odontoma is only a stage in
the development of an odontoma and do not consider it a separate entity. However there are documented cases
of progressive growth and causing considerable deformity and bone destruction.

Question 190

14. Hyaluronic acid in joint helps with what
    a. Reduce pain
    b. Improve opening
    c. Dose nothing
    d. Reduce pain and improve opening

Answer 190

Reduce pain and improve opening

Hyaluronic acid helps in the growth and development of joint’s cartilage and bone by promoting the growth of new cells and tissues. Also plays an important role in reducing joint inflammation and pain caused by injury or tissue degeneration.

Question 191

15. Idiopathic condylar resorption and how it can be prevented
    a. Do ortho in childhood to recent
    b. Do orthognathic surgery

Answer 191

???

Question 192

1. A stupid question on 3D printing asking disadvantages

a. 3D plan sx increases cost?
b. 3D plan sx increases achieving accurate surgical margin precision?

Answer 192

3D plan sx increases cost?

Question 193

2. Sodium alginate, you are trying to use for 3D printing
   a. It’s not biodegradable
   b. ??

Answer 193

Sodium alginate (SA) is a non-toxic, biocompatible, and biodegradable natural polymer. It had good printability, which is why it is often used in inks for 3D printing in tissue engineering fields

Question 194

3. Also question on what to do in your office to reduce error
   a. Talk to your staff about previous errors
   b. Stop all procedures and discuss

Answer 194

a. Talk to your staff about previous errors

Question 195

4. A question on computer-assisted resection of ameloblastoma.
   a. Not recommended due to increase in cost
   b. Not recommended due to increase in operative time
   c. Adequate margin is achieved with computer-assisted resection
   d. Studies has found 50% of cases with positive margin

Answer 195

c. Adequate margin is achieved with computer-assisted resection

Question 196

5. CT-guided OKC resection

Answer 196

a. More predictable

Question 197

2. 3 cm SCCa lesion, and 1x1.5cm ipsilateral lymph node without metastasis. What stage is it?

Answer 197

c. Stage III (T2N1M0)

Question 198

3. FOM lesion (T2N1M0) but doesn’t tell your if pt has lump on the neck. What’s the treatment?

a. Resection with margin
b. Resection with margin and ipsilateral neck dissection
c. Resection with margin and bilateral neck dissection

Answer 198

Resection with margin and ipsilateral neck dissection

Question 199

4. Difference between pTMN vs cTMN system

Answer 199

cTMN (before treatment), pTMN (stage assigned by histopathologic examination), yTMN (after chemotherapy and/or radiation therapy)

Question 200

5. At what level of the neck would you find spinal accessory nerve (shrugging motion)

Answer 200

a. Level IIb (or V but they only gave IIb as an option so this is what I picked)

Question 201

6. A question about mechanism of action of a chemotherapy agent

Answer 201

(-mab)

Question 202

7. Inferior border of level II neck (hyoid wasn’t one of the options)

Answer 202

either hyoid bone or carotid bifurcation?

Question 203

8. Most common presentation of Nevoid Basal Cell Carcinoma Syndrome?

Answer 203

a. Hypertelorism-efers to an abnormal decrease in distance between any two organs although some authors use the term synonymously with orbital hypotelorism meaning an abnormal decrease in the distance between the two eyes (the eyes appear too close together).

Question 204

9. Parotitis – most likely cause
   a. Dehydration
   b. Common in children

Answer 204

Dehydration – this is what I picked

Question 205

10. Most common bacteria in chronic parotitis

Answer 205

a. Staphylococcus aureus

Question 206

11. Complication of Cisplatin chemotherapy

Answer 206

a. Renal issues

Question 207

12. What is Frey’s syndrome

Answer 207

a. Gustatory sweating. Aberrant regeneration of parasympathetics after facial nerve injury. Parasympathetics that went to salivary glands re¬connect with sweat gland sympathetics.

Question 208

13. Melanoma under black guy’s nail

Answer 208

a. Acral lentiginous melanoma (ALM) – a specific type of melanoma that appears on the palms of the hands, the soles of the feet, or under the nails

Question 209

14. Nikolsky’s sign is present in which of the following?

Answer 209

a. Pemphigus vulgaris
Nikolsky’s sign is a skin finding in which the top layers of the skin slip away from the lower layers when rubbed

Question 210

15. Polyostotic fibrous dysplasia is part of what syndrome?

Answer 210

a. McCune-Albright syndrome

Question 211

16. What lesion do you see giant cells in?

Answer 211

a. Aneurysmal bone cyst

Question 212

17. What is the treatment for Aneurysmal Bone Cyst?

Answer 212

a. E&C

50% recurrence) may need more aggressive procedure including resection or cryosurgery for recurrence
Usually occurs in long bones or vertebra of pts under age 30 but may occur in mandible> maxilla.
Unknown cause; seen in younger pts who report rapid development of facial swelling and pain.
May be unilocular or multilocular with expansion and thinning of cortex.
May have significant bleeding of “dark blood” that is difficult to control at time of surgery.
Histo: many spaces containing unclotted blood surrounded by fibroblastic tissue which contains giant cells and osteoid. May resemble giant cell lesion, fibrous dysplasia, or ossifying fibroma.

Question 213

18. Which presents as radiopaque lesion?

a. Parosteal osteosarcoma
b. Ewing sarcoma

Answer 213

a. Parosteal osteosarcoma

Question 214

19. Shown pathology color plate with large radiopacity left maxilla with mixed radiopaque/radiolucent quality. Biopsy shows lesion contains hair, teeth, bone. Which is the correct diagnosis?

Answer 214

a. Teratoma

Question 215

20. Know immunofluorescence used to diagnose pemphigus vulgaris

Answer 215

a. Indirect immunofluorescence shows “fishnet pattern” suggesting the presence of anti-keratinocyte IgG auto-antibiodies. Intracellular

PF shows a DIF pattern characterized by fluorescent staining around keratinocytes, which is known as the intercellular space (ICS) staining patter

Question 216

Pemphigus vs pemphigoid

Answer 216

Pemphigus on left, phemphioid in middle, lichen planu son right

Question 217

Pemphigus vs Pemphigoid

Answer 217

Question 218

Pemphigus-desmosomes or hemidesmosomes

Answer 218

Disease of Desmosome Dysfunction Caused by Multiple Mechanisms. Pemphigus is a severe autoimmune-blistering disease of the skin and mucous membranes caused by autoantibodies reducing desmosomal adhesion between epithelial cells.

Question 219

Pemphigoid-Desmosomes or hemidemosomes

Answer 219

Bullous pemphigoid is a subepidermal blistering skin disease characterized by an autoimmune response against epidermal/dermal proteins. The major autoantigens in bullous pemphigoid are hemidesmosomal proteins such as BP180 or BP230.

Question 220

22. Rhabdomyosarcoma with positive margin after resection, what do you do?

a. Go back to OR for resection
b. Radiation
c. Chemo

Answer 220

Go back to OR for resection

Question 221

23. Pleomorphic adenomaadenoms of deep lobe, treatment option?

a. Total parotidectomy, sacrifice facial nerve
b. Total parotidectomy, preseve facial nerve
c. Superficial parotidectomy

Answer 221

Total parotidectomy, preseve facial nerve

Question 222

24. Ameloblastic fibroma occurs in what age group?
    a. 1-25
    b. 20-40
    c. 35-60

Answer 222

1-25 – Occurs 1st and 2nd decades of life; average age is 14-years [Rvw p200]

1st and 2nd decade of life

Question 223

25. OKC, does it invade soft tissue?

Answer 223

a. Doesn’t invade soft tissue upon perforating cortex

Question 224

26. Actinic cell adenocarcinoma features:

Answer 224

a. Mainly in submandibular minor salivary glands – no, parotid > submandibular gland
b. Mal predilection

Question 225

27. Maxillary myxoma treatment
    a. Resection margin 1 cm
    b. Resection margin 2 cm
    c. E&C

Answer 225

Resection margin 1 cm (recurrence is common

Question 226

28. Epulis in infant similar to what

Answer 226

a. Granular cell tumor

Question 227

29. Acanthoma ameloblastoma similar to

Answer 227

a. SCC

Question 228

30. Where do you find Verocay bodies?

Answer 228

a. Schwannoma

Question 229

31. Melanoma inside the mouth. How do you treat?

Answer 229

Question 230

32. Clinical photo (forehead photo)/histopathology (keratin peral? Schwann cell

a. Ameloblastoma
b. SCC?

Answer 230

Keratin Pearl assocaited with sCC

Question 231

1. Soft tissue grafting most like to fail

a. Large area coverage using small tunnel incision/technique
b. Using palatal connective tissue graft

Answer 231

a. Large area coverage using small tunnel incision/technique

Question 232

2. Which is an advantage of the buccal fat pad graft?

Answer 232

a. Does not require mucosal coverage

Question 233

4. STSG used in specialized tissue.

Answer 233

a. FTSG should be used in special locations such as nose or cheek.

Question 234

a. Short-term shrinkage:

Answer 234

more for FTSG than STSG

Question 235

b. Long-term shrinkage:

Answer 235

more for STSG than FTSG

Question 236

6. How does a STSG receive its nutrition immediately after placement?

Answer 236

a. STSG vary in thickness from .010 to .020 inches (usual is .012 or .014). The donor site is typically the outer thigh region and a dermatome is standardly used. The recipient site is the key to graft survival. The graft survives for the first ¬48 hours or so by diffusion of nutrients from the tissue bed. This is also known as plasmatic imbibition. Between 24 and 72 hours, an ingrowth of capillaries begins which is known as inoscultation

Question 237

7. What is the process called when microvascutures start to form from skin graft to the host?

Answer 237

a. Inoscultation

Question 238

8. Most likely reason for STSG to fail
   a. Placement on cranium bone
   b. Reconstruction of tongue defect
   c. Reconstruction of vestibule after vestibuloplastyvestibuloplastly

Answer 238

my pick

Question 239

10. Full thickness includes what layers:
    a. Epidermis and reticular dermis
    b. Epidermis and papillary dermis
    c. Epidermis and full dermis
    d. Epidermis and subcutaneous

Answer 239

c. Epidermis and full dermis - Confirmed

Question 240

11. Cartilage-skin graft relies on

Answer 240

a. Imbibition

Question 241

12. What graft resorbs the fastest?
    a.
    b. Demineralized cancellous bone
    c. Freeze dried cortical bone

Answer 241

Demineralized cortical bone - less graft material remains in histo studies

Question 242

13. Which of the following is a requirement for a successful anteriorly based tongue flap?
    a. Leave 35% of tongue width
    b. Split in 10-days
    c. Thickness to 5 mm to avoid lingual nerve
    d. Thickness of 5 mm to avoid lingual nerve

Answer 242

Leave 35% of tongue width

NOT SURE ON THIS ONE

Question 243

14. What’s sutured in a nerve repair?

Answer 243

a. Epineurium

Question 244

15. ¼ pentagonal shape defect of upper lip, how will you reconstruct
    a. Karapanzic
    b. Abbe
    c. Primary closure

Answer 244

Primary closure

Question 245

¼ defect of central lower lip, how will you reconstruct

a. Karapanzic
b. Abbe
c. Primary closure

Answer 245

Primary closure

Question 246

17. 40% lower lip defect at the center in block type. How would you reconstruct?
    a. STSG
    b. FTSG
    c. Karapenzic

Answer 246

Karapenzic – my pick

Question 247

18. Approximately 4 hours after a free flap, the flap appears purplish in color. What is the cause?

Answer 247

a. Venous congestion

Question 248

19. Most likely cause of free flap failure

a. Ischemia
b. Congestion

Answer 248

Congestion – my pick

Question 249

20. What test is performed prior to performing radial forearm flap?

Answer 249

a. Allen’s Test (clench fist multiple times while occluding ulnar and radial arteries, when release ulnar a., should have return of color to thenar eminence and thumb showing adequate communication between superficial (ulnar) and deep(radial) palmar arches

Question 250

21. What is secondary blood supply to pectoralis flap? [Rvw p287]

a. Thoracoacromial artery
b. Long thoracic artery

Answer 250

a. Thoracoacromial artery - dominant
b. Long thoracic artery – secondary

Question 251

22. Blood supply to free fibular flap?

Answer 251

a. Branch of the peroneal artery

Question 252

23. What would preclude from using FFF

a. Dominant peroneal
b. Dominant popliteal
c. No perforators
d. Mild to moderate atherosclerotic disease

Answer 252

No perforators

Question 253

24. Patient with severe atherosclerotic disease of both leg vessels, what are reconstructive options
    a. Take FFF from contralateral leg
    b. Take iliac and scapula flaps
    c. Take pectoralis flap
    d. Don’t do reconstruction with free flap due to atherosclerotic disease

Answer 253

Take iliac and scapula flaps

Question 254

25. Most common complication after iliac crest harvest

Pelvis instability
b. Ilium fracture

Answer 254

a. Pelvis instability – Sounds like gait disturbances so I picked this
b. Ilium fracture

*Also a risk of paraesthesia at lateral thigh

Chronic harvest site pain is the most frequently reported complication in most studies. In additional to hematoms