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Board Review > BoardVitals > Flashcards

BoardVitals Flashcards

1
Q

Best goal for rhinoplasty in Asian nose that is ptotic, bulbous, underprojected, and broad?

A

Tip projection via columellar strut placement

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2
Q

What do ameleoblastomas arise from?

A

Tooth enamel precursor cells

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3
Q

Linear transposition flaps have a tendency towards what kind of deformity?

A

Trap-door deformity (due to underlying scar formation)

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4
Q

What imaging should be obtained in the setting of a post-op chyle leak?

A

CXR to rule out concurrent chylothorax

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5
Q

What medication should be given when a patient has a moderate output chyle leak?

A

Octreotide (100 mcg subq TID) to reduce splanchnic blood flow and decrease GI chyle production

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6
Q

What % of chyle leaks occur on the right side?

A

25%: inturruption of the right lymphatic duct on its path to the right subclavian vein

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7
Q

What cranial nerves are most often impacted by a jugular paraganglionoma?

A

CN IX-XII

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8
Q

What is Vernet syndrome?

A

Paralysis of CN 9, 10, 11

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9
Q

What is Collet-Sicard syndrome?

A

Paralysis of CN 9, 10, 11, 12

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10
Q

In what direction will the internal and external carotid arteries be displaced by a carotid paraganglionoma?

A

Carotid body tumors splay the internal and external carotids, displacing the external anteriorly and the internal posteriorly

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11
Q

What kind of paraganglionoma would displace the external and internal carotids anterior and medial?

A

Vagal paraganglionoma

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12
Q

What is the basic procedure of an anterior cricoid split?

A

Incision of the anterior cricoid and the first two tracheal rings
Stenting with an ETT for 12-14 days

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13
Q

What are the criteria for performing anterior cricoid split in an infant?

A

Failure to extubate on at least 2 occasions
Infant weight > 1500 g
No assisted ventilation for at least 10 days
Minimal supplemental O2 requirements
Absence of CHF
Absence of URI
No need for antihypertensives

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14
Q

What makes anterior cricoid split superior to balloon dilation for long term extubation in subglottic stenosis?

A

Balloon dilation can provide temporary relief but needs to be repeated frequently

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15
Q

Which site of paraganglionomas has the highest risk of malignancy?

A

Orbital and laryngeal (25%)
Vagal (10%)
Jugular and tympanic (5%)
Carotid body (3-6%)

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16
Q

Is acute mastoiditis associated with smoke exposure?

A

No

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17
Q

What joins to form the internal jugular vein? Where does it form?

A

Sigmoid sinus and common facial vein

Starts in the posterior compartment of the jugular foramen at the base of the skull

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18
Q

What joins to form the external jugular vein? Where does it form?

A

Posterior facial and posterior auricular

Forms in the parotid gland at the level of the angle of the mandible

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19
Q

What degree of subglottic extension is a contraindication to a vertical partial laryngectomy?

A

> 10 mm anteriorly

>5 mm posteriorly

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20
Q

What does electrocochleography measure?

A

Neuroelectric events generated by the cochlea and auditory nerve in response to acoustic stimulation

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21
Q

What does an ABR assess?

A

The auditory pathway function in response to auditory stimuli

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22
Q

What is the level at which a patient is aware of a speech signal 50% of the time?

A

Speech detection threshold

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23
Q

What does directional preponderance express?

A

How the amount of right beating nystagmus compares with left beating nystagmus in caloric testing

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24
Q

What is the Brent and Kuhn criteria for the dx of allergic fungal sinusitis?

A
  1. Eosinophilic mucin (charcot-leyden crystals)
  2. Noninvasive fungal hyphae
  3. Nasal polyposis
  4. Characteristic radiographic findings
  5. Type 1 hypersensitivity by hx, skin test, or serology
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25
Q

What does CT and MRI show in allergic funcal sinusitis?

A

CT: rim of hypointensity with hyperdense central material (allergic mucin), speckled areas of increased attenuation due to ferromagnetic fungal elements
MRI: peripheral hyperintensity with central hypointensity on both T1 and T2, central void on T2

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26
Q

What should be done when an acute otitis media is found prior to cochlear implant placement

A

This is a contraindication to placement of the CI, T tubes should be placed and CI should be deferred until the pt is clear of infection for two weeks

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27
Q

What should be done if a serous otitis media is noted before placement of a cochlear implant?

A

Middle ear irrigation
Use of topical antibiotic drops
Post-op antibiotic therapy

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28
Q

What AHI corresponds to mild, moderate, and severe AHI in adults?

A

Mild: 5-15/hr
Moderate: 15-30/hr
Severe: >30/hr

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29
Q

What is MEN IIb characterized by?

A

Medullary thyroid carcinoma
Mucosal neuromas
Pheochromocytoma
Marfinoid habitus

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30
Q

What is MEN I characterizes by?

A

Pituitary tumors
Parathyroid hyperplasia
Pancreatic tumors

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31
Q

What gene is associated with MEN IIa and IIb?

A

RET protooncogene

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32
Q

What is MEN IIa characterized by?

A

Parathyroid hyperplasia
Pheochromocytoma
Medullary thyroid carcinoma

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33
Q

What air-bone gap cut-offs do the following tuning fork frequencies correspond to?

A

256 Hz: 15 dB or more
512 Hz: 25 dB or more
1024 Hz: 35 dB or more

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34
Q

What is the IM dose of epinephrine that should be given to an adult for anaphylaxis?

A

0.3-0.5 mL of 1:1000 solution

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35
Q

What is the IM dose of epinephrine that should be given to a child for anaphylaxis?

A

0.01-0.03mg/kg or 0.1-0.3 mL of 1:1000 solution

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36
Q

In what percent of cases is tracheomalacia noted in substernal multi-nodular goiters?

A

3% of cases

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37
Q

What is the scutum?

A

Lateral wall of the epitympanum

Wedge shaped piece of bone

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38
Q

What is blunting of the scutum on CT scan indicative of?

A

Cholesteatoma

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39
Q

What is the area between the chorda tympani and the facial nerve?

A

Facial recess

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40
Q

What space is bordered superiorly by the ponticulus and inferiorly by the subiculum?

A

Sinus tympani

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41
Q

What structure takes up the largest portion of the medial wall of the mesotympanum?

A

Promontory

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42
Q

What forms the rounded hollow prominence of the promontory?

A

first turn of the cochlea

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43
Q

Orphan annie eyes after thyroid biopsy suggests:

A

Papillary thyroid carcinoma

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44
Q

What is the treatment modality of choice for thyroid lymphoma?

A

Chemo and radiation, not surgery

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45
Q

Are most thyroid lymphomas Hodgkins or non-Hodgkins?

A

Non-Hodgkins

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46
Q

What is the typical patient for a thyroid lymphoma?

A

Female >70 yo with a history of Hashimotos thyroiditis

**rapidly enlarging neck mass causing respiratory difficulty

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47
Q

What plays a significant role in the formation of recurrnet subglottic stenosis after balloon dilation in children?

A

Uncontrolled GERD

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48
Q

What is the treatment for postinflammatory hyperpigmentation as a complication of skin resurfacing procedures with higher Fitzpatrick grades?

A

Hydroquinone (tyrosinase inhibitor, inhibits conversion of tyrosine to DOPA in melanocytes)
Sun block
Exfoliant

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49
Q

What is the treatment of adductor vs abductor spasmotic dysphonia?

A

Botox injection to the:
Adductor: vocalis muscle
Abductor: posterior cricoarytenoid

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50
Q

What are the four kinds of frontal cells as described by Bent and Kuhn

A

Type 1: single frontal ethmoidal cell above the agger nasi
Type 2: multiple cells above the agger nasi
Type 3: cells pneumatize into the floor of the frontal sinus
Type 4: Isolated frontal ethmoidal cells contained entirely in the frontal sinus

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51
Q

What are agger nasi cells?

A

The most anterior ethmoidal air cells lying anterolateral and inferior to the frontoethmoidal recess and anterior and above the attachment of the middle turbinate
Located within the lacrimal bone

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52
Q

What is found immidiately behind the poster-medial wall of the agger nasi cell?

A

Drainage of the frontal sinus

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53
Q

What is the most common causative organism of Lemierre syndrome?

A

Fusobacterium necrophorum

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54
Q

What is the best antibiotic for tx of Lemierres syndrome?

A

Metronidazole (prolonged course up to 6 weeks)

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55
Q

What typically proceeds Lemierres syndrome?

A

Peritonsillar abscess: infection spreads to the adjacent internal jugular vein, creating septic thrombophelbitis

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56
Q

What forms the vidian nerve?

What fibers does it contain?

A

Junction of the greater petrosal and the deep petrosal nerves
Parasympathetic and sympathetic fibers, esp parasympathetic fibers supplying the lacrimal gland

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57
Q

What is an indication for vidian neurectomy?

A

Crocodile tears–tearing while eating

Vidian nerve carries parasympathetic fibers to the lacrimal gland

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58
Q

What is the most common manifestation of MEN2A?

A

Medullary thyroid carcinoma
Pheo in 70%
Hyperparathyroidism in 20-35%

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59
Q

What is the key difference between the Abbe and Estlander flaps for lip reconstruction?

A

Estlander includes the oral commisure

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60
Q

What is the indication for a Karapandzic flap?

A

Reconstruction of a large lower lip defect of more than half and up to 2/3 of the lip

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61
Q

What is the indication for a Gilles flap?

A

Reconstruction of large lower lip defects of greater than 2/3 of the lip tissue

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62
Q

What part of a flow volume loop will be altered in the setting of a variable extrathoracic lesion like fixed vocal folds?

A

Flattening of the inspiratory (bottom) loop

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63
Q

1 mg of protamine negates the effects of ___ units of unfractionated heparin

A

100 units

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64
Q

What is a central megaincisor a pathognomic feature of?

A

Congnital pyriform aperature stenosis

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65
Q

What kind of bacterium causes a violacious hue overlying a subacute neck mass in a child

A

Atypical mycobacterium
56% Mycobacterium acium intracellulare
29% Mycobacterium tuberculosis

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66
Q

What layers does blood collect between in an auricular hematoma?

A

Perichondrium and cartilage

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67
Q

In an auricular hematoma, fibroneocartilage begins to form __ days after injury, resulting in a _____ deformity

A

7-10

Cauliflower

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68
Q

What nerve provides sensory innervation to the superior pinna, helix, and anti-helix

A

Auriculotemporal nerve

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69
Q

When should auricular hematoma pts be seen following bolster placement?

A

24-48 hr

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70
Q

Should a load bearing or load sharing plate be used in an edentulous, atrophic mandible?

A

Load bearing–load sharing requires significant bone to bone contact and the strength to share the load

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71
Q

What is the general MOA of methimazole and propylthiouracil?

A

Inhibition of TH synthesis by inhibiting oxidation and organification of iodine
PTU also disrupts conversion of T4 to T3

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72
Q

Which anti-thyroid med is safe in the first semester of pregnancy?

A

Propylthiourail

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73
Q

What is the feared side effect of anti thyroid drugs?

A

Agranulocytosis (occurs in 0.2% or less of pts)

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74
Q

How does TNM staging for mucosa melanoma differ from that of cutaneous melanoma?

A

No T1 or T2, starts at T3 because mucosal has a worse prognosis
N0 is no LN mets, N1 is regional LN mets

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75
Q

What is the most common presenting sx of nasopharyngeal carcinoma?

A

Neck mass 75%
Nasal sx (obstruction, epistaxis) 73%
Impaired hearing 19%

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76
Q

What changes occur with the following with aging?

  • Epidermis
  • Dermis
  • Elastin
  • Melanocyte count
  • Dermal connective tissue
A
  • Epidermis thins
  • Dermis atrophies
  • Elastin decreases
  • Fewer melanocytes
  • Increase in the ground substance component of dermal CT
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77
Q

What is the course of parasympathetic innervation to the parotid gland from the inferior salivatory nucleus?

A 
Inferior salivatory nucleus (medulla)
Glossopharyngeal nerve
Jacobson's nerve
Tympanic plexus
Lesser petrosal nerve
Otic ganglion
Joins post-ganglionic fibers in the auriculotemporal nerve of V3 division
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78
Q

What type of antibiotic is a contraindication to botox injection?

A

Aminoglycosides: potentiation of neuromuscular blockade

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79
Q

What are CD 19, 20, and 22 markers of?

A

B lymphocytes

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80
Q

What at CD 2, 3, 4, and 8 markers of

A

T lymphocytes

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81
Q

What are CD 16 and 56 markers of?

A

NK cells

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82
Q

What is CD 69 a marker of?

A

Eosinophils

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83
Q

What is the distance from:

  • anterior lacrimal crest to the anterior ethmoid artery
  • anterior lacrimal crest to the posterior ethmoid artery
  • anterior lacrimal crest of the optic foramen
A

24
36
42

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84
Q

What specific area is more likely to get a subglottic hemangioma?

A

Posterior left subglottis

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85
Q

How often are subglottic hemangiomas associated with skin hemangiomas?

A

50% of the time

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86
Q

Pleomorphic ademomas comprise about __% of all parotid tumors

A

65%

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87
Q

How often are Warthin tumors bilateral?

A

5-7.5% (more commonly bilateral than pleomorphic adenomas)

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88
Q

What is the primary treatment of fungal rhinosinusitis 2/2 aspergillus? Mucormycosis?

A

IV voriconozole

IV amphotericin

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89
Q

What organism causes cat scratch fever?

A

Bartonella henselae

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90
Q

What is the most appropriate treatment for cat scratch fever?

A

Azithromycin 5 days

**surgical intervention not indicated

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91
Q

What can occur as a result of auriculotemporal nerve injury in parotid surgeries?

A

Frey’s syndrome: auriculotemporal carries parasymp fibers to the parotid and symp fibers to the skin
Aberrant regerneration an cause gustatory sweating

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92
Q

What perfect of thyroid nodules dx as follicular neoplasms on FNA end up being malignant?

A

20%

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93
Q

What is the most common site of iatrogenic CSF leak during sinus sugery?

A

Lateral lamella of the cribriform plate

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94
Q

What mass of the CP angle will be isointense to brain on T1 and T2, strongly enhances with contrast, and has a broad base of dural enhancement?

A

Meningiomas

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95
Q

How do cholesteatomas appear on T1 vs T2?

A

Hypointense on T1
Hyperintense on T2
Do not enhance with contrast

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96
Q

How do cholesterol granulomas appear on T1 and T2?

A

Hyperintense on T1 and T2

Do not enhance with contrast

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97
Q

How do vestibular schwannomas appear on T1 and T2?

A

Isointense on T1 and T2 with foci of high density on T2

Strongly enhance with contrast but do NOT have broad based dural attachment

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98
Q

Where is nystagmus directed in patient with vestibular neuritis?

A

Fast phase away from the the affected side

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99
Q

What are risk factors for Hashimoto’s thyroiditis?

A

Female gender
Diabetes mellitus
Sjogren’s syndrome
HLA-DR3

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100
Q

Where does the right vs left recurrent laryngeal nerve branch off the vagus?

A

Right: T1-2, anterior to the right subclavian
Left: in the thorax

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101
Q

What is the clinical significance of recurrent laryngeal dysfunction in the setting of normal pharyngeal sensation?

A

Lesion must be distal to the pharyngeal branch of the vagus nerve

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102
Q

What gives rise to the visceral motor fibers of the vagus nerve (pharyngeal branches and superior and inferior laryngeal nerves)

A

Nucleus ambiguous

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103
Q

What contains the cell bodies of visceral sensory nerves that include cerviccal thoracic, and abdominal fibers, innervate the carotid and aortic bodies, and send branches to the epiglottis and taste buds

A

Nucleus tractus solitarius

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104
Q

What are the main functional secretory cells of the parathyroid glands?
What are the less numerous cells that stain more deeply and are rich in mitochondria

A

Chief cells
Oxyphil cells
**may also be intermediate cells

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105
Q

Is clindamycin bacteriocidal or bacteriostatic?

A

Bacteriostatic

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106
Q

What is the auditory pathway from the cochlea to the brain?

A

Cochlear nucleus
Acoustric stria to the
Superior olivary complex and inferior colliculus
Auditory cortex

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107
Q

Match the inferior colliculus and the superior colliculus to visual and auditory

A

Inferior: auditory
Superior: visual

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108
Q

What is a Pott’s Puffy tumor?

A

Non-neoplastic condition occuring as a result of prior frontal sinus trauma, acute/chronic frontal sinusitis, or previous sinus surgery
Leads to mucopyocele formation and subperiosteal abscess with underlying osteomyelitis

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109
Q

What is general tx of a Pott’s Puffy tumor?

A

Surgical drainage and IV abx for 6-8 weeks

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110
Q

What happens to the width and cross sectional area of the choana in congenital nasal pyriform aperture stenosis?

A

Width reduced

Cross sectional area unchanged

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111
Q

What does non-operative treatment of congenital nasal pyriform aperture stenosis include?

A

Topical nasal vasoconstrictors

Nasal tubes

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112
Q

What should you aggressively screen for when you identify a patient with laryngomalacia?

A

GERD: reported as high as 50-100% of laryngomalacia population

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113
Q

What should be done for a child who is noted to have bifid epiglottis?

A

MRI of the brain–high association between bifid epiglottis and hypothalmic dysfunction

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114
Q

What syndrome is associated with polydactyly, pituitary dysfunction, imperforate anus, and hamartoblastomas?

A

Pallister-Hall syndrome

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115
Q

What syndrome encompasses laryngotracheal cleft, hypertelorism, cleft palate, and hypospadias?

A

Opitz-Frias syndrome

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116
Q

What is the medical term for a small chin?

A

Microgenia

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117
Q

What is the definition of class I occlusion?

A

Mesiobuccal cusp of the maxillary front molar is directly in line with the buccal groove of the permanent mandibular first molar

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118
Q

What is the lateral border of the paraglottic space? Medial border? Posterior?

A

Lateral: thyroid cartilage and cricothyroid membrane
Medial: quadrangular membrane, ventricle, conus elasticus
Posterior: pyriform sinus mucosa

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119
Q

What is the equation for calculating dB based on two intensities?

A

x dB = 10log(I1/I2)

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120
Q

What increase in dB will double sound intensity?

A

3 dB

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121
Q

What approach to CPA tumor is best for a patient with good preoperative hearing and a small, intracanalicular tumor?

A

Middle fossa approach

**offers exposure to the IAC but not the CPA

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122
Q

What population should not have a middle fossa approach to a CPA tumor?

A

Geriatric population: 2/2 fragility of dura and the need for temporal lobe retraction

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123
Q

What CPA tumor approach provides superior exposure to the CPA while preserving hearing, but cannot offer good exposure to intracanalicular tumors?

A

Retrosigmoid approach

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124
Q

What two approaches to CPA tumors injure the otic capsule?

A

Transcochlear

Translabyrinthine

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125
Q

What approach to a CPA tumor requires cerebrellar retraction but offers good exposure of the CPA?

A

Suboccipital approach

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126
Q

What is the optimal time to dermabrade scars post-op?

A

6-8 weeks

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127
Q

In transplant patients or those with hematologic malignancies, what PMN count is linked with the onset of acute invasive fungal sinusitis and reduced survival?

A

1000 mm3

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128
Q

In transplant patients or those with hematologic malignancies, what PMN count is linked with the onset of acute invasive fungal sinusitis and reduced survival?

A

1000 mm3

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129
Q

Which of the ossicle is most commonly eroded by a cholesteatoma?

A

Incus

Malleus gets displaced with widening of Prussak’s space

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130
Q

What plane should scalp tissue expanders be placed in?

A

Subgaleal plane, above the periosteum

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131
Q

How long after placement of tissue expander placement can inflation begin?

A

2 weeks (needs sufficient time to heal)

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132
Q

What is a rule of thumb for the base width of a tissue expander for the scalp in relation to the width of the defect?

A

Expander should be about 2.5x the width of the defect

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133
Q

What is the Centor criteria for strep throat?

A

Fever
Tender lymphadenopathy
Exudative tonsillitis
Absence of cough

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134
Q

What is the sensitivity and specificity of the rapid strep test?

A

90% sensitive

95% specific

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135
Q

A Centor score of 4/4 equates with a __% chance of GABHS infection

A

60%

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136
Q

What is the overall incidence of rheumatic fever in pediatric GABHS pharyngitis patients?

A

0.3% (1-3% in the adult population)

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137
Q

What should be done during a stapedectomy with PORP placement if the incus is found to be dislocated?

A

Abort the procedure and complete in 4-6 mo when the incus is reattached to the malleus

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138
Q

What malignancy is a patient with sjogren’s syndrome at higher risk for?

A

Mucosa-associated lymphoid tissue lymphoma

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139
Q

SS-A and SS-B is elevated in what percent of pts with active Sjogren’s

A

50-70%

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140
Q

What is the most common salivary gland malignancy?

A

Mucoepidermoid carcinoma

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141
Q

Are males or females more likelyto get mucoepidermoid carcinoma?

A

Females

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142
Q

What types of cells are more prevalent in high grade mucoepidermoid carcinomas?

A

Higher proportion of epithelial cells, fewer mucoid cells

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143
Q

In what week of development does the extratemporal portion of the facial nerve begin development?

A

6th gestational week, all branches present at the end of the 8th week

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144
Q

The nervus intermedius contains preganglionic parasympathetic nerve fibers supplying innervation to what glands:

A

Lacrimal
Submandibular
Sublingual
Minor salivary glands

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145
Q

What is the diameter of the larybrinthine segment of the facial nerve?

A

0.7 mm

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146
Q

What is the name of the bony prominence which projects from the roof of the epitympanum, superior to the facial nerve as it enters the facial cavity?

A

Cog

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147
Q

What is the tullio phenomenon?

A

Vertigo and nystagmus in response to loud sounds

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148
Q

In what situations is the Tullio phenomenon seen?

A

Superior canal dehiscence

Syphilis

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149
Q

What is the most common location of synovial sarcoma in the head and neck?

A

Hypopharynx–arise from pluripotent mesenchymal cells

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150
Q

What are the two types of synovial sarcomas?

A

Monophasic form composed of spindle cells

Biphasic form composed of epithelial and spindle cells

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151
Q

What is the most common location of osteosarcoma in the head and neck?

A

Mandible and maxilla

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152
Q

What is the most common location of liposarcoma in the head and neck?

A

Neck

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153
Q

What is the most common location for chondrosarcomas?

A

Larynx

Also seen in the petrous temporal bone, clivus, maxilla, and mandible

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154
Q

What are the 4 parasympathetic ganglia in the head and neck?

A
  1. Otic
  2. Submandibular
  3. Pterygopalatine / sphenopalatine
  4. Ciliary
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155
Q

What is the small parasympathetic ganglion located just inferior to the foramen ovale what carries parasympathetic fibers for salivation of the parotid?

A

Otic ganglion

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156
Q

What ganglion is located near the posterior edge of the mylohyoid mucle just over the hyoglossus muscle

A

Submandibular ganglion

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157
Q

Preganglionic parasympathetic fibers within the chorda tympani never travel along with the lingual and synapse in the ____ ganglion before innervating the sublingual and submandibular glands

A

Submandibular ganglion

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158
Q

Preganglionic parasympathetic fibers carried in the greater superficial petrosal nerve synapse in what ganglion

A

Pterygopalatine/spehnopalatine

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159
Q

Post-ganglionic fibers that synapsed in the ___ ganglion innervate the sphincter pupillae and cause miosis

A

Ciliary

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160
Q

What medication can help prevent epistaxis in a patient with chronic kidney disease who is on coumadin

A

DDAVP: uremia can cause inactivation of platelets and desmopressin (intranasal or subcutanous), can also be used for Von Willebrand disease

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161
Q

What are the boundaries of the frontal recess?

A

Medial: middle turbinate
Lateral: lamina papyracea and uncinate
Anterior: posterior wall of the agger nasi
Posterior: anterior edge of the ethmoid bulla

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162
Q

Abnormality of what embryonic process leads to medial cleft lip?

A

Abnormal fusion of the medial nasal processes

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163
Q

What is the epithelium of the supraglottis?

Glottis?

A

Pseudostratified columnar

Stratified squamous

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164
Q

What is a type IV tympanoplasty

A

Absent or eroded suprastructure with the graft or TM overlying mobile stapes footplate

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165
Q

What is a type V tympanoplasty

A

Stapes footplate is fixed
Va: grafting over a fenestration created in the horizontal semicircular canal
Vb: stapedectomy **more common

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166
Q

What are the prognostic factors for papillary thyroid carcinoma according to the AMES criteria?

A

Age: >41 for men, >51 for women
Metastasis
Extrathyroidal invation
Size: >5cm

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167
Q

What type of branchial cleft cyst will drain into the pyriform sinus
Where will it travel with respect to the internal/external carotid, the hypoglossal and glossopharyngeal

A

Third branchial cleft cyst

Posterior to the internal carotid artery and between the hypoglossal and glossopharyngeal

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168
Q

What type of branchial cleft cyst will pass between the internal and external carotid arteries and superficial to the hypoglossal and glossopharyngeal?

A

Second branchial cleft cyst

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169
Q

Where will a first branchial cleft cyst terminate?

A

External auditory canal

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170
Q

What is the most common finding on laryngoscopy in the setting of laryngomalacia?

A

Inspiratory collapse of accessory arytenoid cartilages and mucosa into the glottis
**will also see posteriorly displaced epiglottis and shortened AE folds

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171
Q

What are indications for supraglottoplasty in a child with laryngomalacia

A

History of apneic events/ALTEs
Failure to thrive
Cyanosis
Cor pulmonale

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172
Q

What is the treatment for Stage II lyme?

A

Doxycycline 100 mg BID for 21 days

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173
Q

At what stage of Lyme disease is Bells palsy typically seen?

A

Stage II (disseminated disease), accompanied by migratory myalgias, generalized rash, fevers, and chills

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174
Q

What organism causes Lyme?

A

Borrelia burgdorferi

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175
Q

What is the best treatment for a T2b or T3 melanoma?

A

Wide local excision with 1-2 cm margins with sentinel lymph node biopsy

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176
Q

What is present on pathologic evaluation of a JNA?

A

Gross: sessile, lobulated, rubbery dark red to tan gray mass
Micro: Admixture of vascular tissue and fibrous stroma. Vessel walls have incomplete or absent smooth muscle

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177
Q

What arteries supply the trapezius?

A

Transverse cervical (descending branches)
Dorsal scapular
Occipital

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178
Q

What is the differential blood supply of the following flaps?

  • Inferior trapezius flap
  • Lateral island flap
  • Superior trapezius flap
A

Dorsal scapular and descending branches of the transverse cervical
Superficial branches of the transverse cervical

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179
Q

Which of the trapezius flaps provides the longest pedicle?

A

Inferior trapezius flap

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180
Q

The parotid duct exits the parotid parenchyma, passes over the masseter, and turns medially to pierce the ***

A

Buccinator

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181
Q

Where does stenson’s duct empty into the oral cavity?

A

Second maxillary molar

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182
Q

What are the subsites of the supraglottis?

A 
Aryepiglottic folds
Arytenoids 
Suprahyoid epiglottis
Infrahyoid epiglottis
Arytenoids
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183
Q

What branchial pouches are the inferior and superior parathyroid glands derived from?

A

Inferior: 3rd
Superior: 4th

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184
Q

What structure do the inferior parathyroid glands migrate with caudally and medially during development?

A

Thymus

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185
Q

Where should you look for superior parathyroid glands if they are not in the expected location during an exploration?

A

Tracheoesophageal groove
Posterior mediastinum
Within the carotid cheath

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186
Q

Where should epi be injected during anaphylaxis?

A

Vastus lateralis

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187
Q

What is the dosing of epi for anaphylaxis in adults?

A

Adults: 0.3-0.5 mg of 1:1000

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188
Q

A lymph node that demonstrates __% or greater counters per minute compared with the hottest node ex vivo should be considered a sentinel node and be removed

A

10%

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189
Q

Most common location of involvement of otosclerosis?

A

Bone anterior to the oval window with a small cleft known as the fissula ante fenestrum

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190
Q

What is the risk of malignancy per the Bethesda system for a follicular neoplasm?

A

15-30%

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191
Q

What are features of the lower lateral cartilage in a cleft lip?

A 
Normal size and width
Shortened medial crus
Elongated lateral crus
Blunted dome
Posteriorly, laterally, and inferiorly displaced alar base
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192
Q

Which strains of HPV do gardasil vs cervarix protect against?

A

Gardasil: 6, 11, 16, 18
Cervarix: 16, 18

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193
Q

Is gardasil or cervarix only indicated for women?

A

Gardasil

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194
Q

What embryological precursor forms the eustachian tube?

A

First branchial pouch

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195
Q

What is the MOA of avastin?

What can injection of avastin be used to control?

A

VEGF inhibitor

Respiratory papillomatosis

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196
Q

What is the autoimmune thyroiditis in which normal parenchyma is replaced by extensive fibrosis

A

Riedel’s thyroiditis

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197
Q

What does an UPSIT score less than 5 suggest?

A

Malingering

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198
Q

What scores on the UPSIT test coorespond to anosmia and hyposmia?

A

Anosmia: 5-18
Hyposmia: 19-33
**total score of 40

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199
Q

What is the most common complication following Sistrunk procedure?

A

Recurrence

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200
Q

Primary hyperparathyroidism is caused by one or more adenoma __% of the time and diffuse hyperplasia __% of the time?

A

75-80%

20%

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201
Q

In MEN 1, hypercalcemia is seen in __% of patients

In MEN 2a, hypercalcemia is seen in __% of patients

A

95%

5-20%

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202
Q

What artery is the main pedicle of a paramedian forehead flap?

A

Supratrochlear artery

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203
Q

What is the mechanism of action of mitomycin C?

A

Antitumor antibiotic causing cross linking of DNA

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204
Q

What drug binds dihydrofolate reductase and has a rate limiting step of mucositis, with an increased toxicity in patients with kidney failure given renal excretion

A

Methotrexate

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205
Q

Lund-Mackay system for scoring of chronic rhinosinusitis

A

0: no abnormalities
1: partial opacification
2: complete opacification
* *24 points available, 12 pre side

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206
Q

What is the effect of using antibiotic drops after tympanostomy tube placement?

A

Reduce post-tympanostomy tube otorrhea (most common complication following T tube insertion)

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207
Q

What is used to calculate the OSAHS score

A

BMI
Tonsillar size
Freidman tongue size

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208
Q

Which salivary gland has the highest percentage of malignant tumor formation? Middle? Lowest?

A

Minor salivary glands > submandibular gland > parotid gland

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209
Q

What is the most common malignant tumor of the partoid?

A

Mucoepidermoid carcinoma

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210
Q

What is the most common malignant tumor of the submandibular gland?

A

Adenoid cystic carcinoma

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211
Q

Increase in calcitonin is indicative of what kind of thyroid cancer?

A

Medullary thyroid carcinoma

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212
Q

With papillary thyroid carcinoma, are regional and distant metastases more common in children or adults?

A

Children, though prognosis is favorable

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213
Q

What is the University of Pittsburgh Staging System for temporal bone neoplasms?

A

T1: Tumor limited to the EAC without bonyerosion or evidence of soft tissue extension
T2: Tumor with limited EAC bony erosion or soft tissue involvement (less than 0.5cm)
T3: Tumor eroding the osseous EAC (full thickness) with limited (less than 0.5 cm) soft tissue involvement, or tumor involving middle ear or mastoid
T4: Tumor eroding the

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214
Q

What is the ideal position for the highest part of the brow in women?

A

Above the lateral limbus or lateral canthus

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215
Q

What is the ideal shape of a male brow?

A

No arching, sits at the supraorbital rim

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216
Q

What bacteria should you prophylactically treat for when you are using medicinal leeches

A

Aeromonas hydrophila: gram negative rod in leech gut, sensitive to 3rd generation cephalosporins, ciprofloxacin, aminoglycosides, sulfa drugs, and tetracycline

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217
Q

What bacterial infection is classically associated with Lemierre’s syndrome?

A

Fusobacterium necrophorum

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218
Q

What are the embryonic sources of the ossicles?

A 
First arch:
- malleus (minus the manubrium)
- incus (minus the long process)
Second arch:
- manubrium of the malleus
- long process of the incus
- suprastructure of the stapes

**footplate arises from the otic capsule

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219
Q

What are two species that are often found in patient with allergic fungal sinusitis?

A

Curvularia

Bipolaris

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220
Q

Are children or adults more likely to present with unilateral allergic fungal sinusitis?

A

Children (70%)

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221
Q 
What do the following precursors eventually form:
1st ethmoturbinal
2nd ethmoturbinal
3rd ethmoturbinal
4th and 5th ethmoturbinal
A

1st: agger nasi and uncinate
2nd: middle turbinate
3rd: superior turbinate
4th and 5th: supreme turbinate

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222
Q

In the porus acousticus, where is the facial nerve in relation to Bills bar and the transverse crest?

A

The facial nerve is located anterior and superior

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223
Q

What is produced by the chief cells in the stomach and is enzymatically active at an acidic pH, but has proteolytic activity at normal pH (ie pharynx and larynx)

A

Pepsin

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224
Q

What is the most common causative organism in cavernous sinus thrombosis?

A

Staph aureus

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225
Q

What is the most common inherited form of congenital facial palsy?

A

Congenital unilateral lower lip palsy–atrophy of the depressor anguli oris muscle

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226
Q

Between what two structures can deep lobe parotid tumors extend to the parapharyngeal space, creating a dumbbell appearance?

A

Mandible
Stylomandibular ligament
**through the stylomandibular membrane

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227
Q

Prestyloid tumors lie anterior to the carotid artery and usually arise from:
Poststyloid tumors lie posterior to the carotid artery and usually arise from:

A

Salivary

Neurogenic

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228
Q

What three studies are mandatory for zone 1 neck injuries (clavicles tot he cricoid)

A

CXR
CT angiography
Gastrograffin swallow study

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229
Q

What are the most common sites of cervical metastases in base of tongue cancer?

A

Zones II-IV

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230
Q

Cochlear afferents first synapse in what nuclei?

A

Dorsal and ventral cochlear nuclei

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231
Q

What is Donaldson’s line?

A

Hypothetical line that runs parallel to the horizontal semicircular canal and biscets the dome of the posterior semicircular canal
Marks the superior boundary of the endolymphatic sac

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232
Q

What are the boundaries of the internal nasal valve?

A

Nasal septum
Caudal border of the ULC
Head of the inferior turbrinate

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233
Q

What cartilage is used for an autograft spreader technique to increase the patency of the the internal nasal valve during functional septorhinoplasty

A

ULC: medially infolded and suture stabilization, obviates need for free cartilage graft

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234
Q

What is a sensitive lab test for Wegners?

A

C-ANCA

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235
Q

What is the footplate of the stapes derived from?

A

Otic mesenchyme

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236
Q

What ossicular structures does the first branchial arch give rise to?

A

Head and neck of the malleus

Body and short process of the incus

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237
Q

What ossicular structures does the second branchial arch give rise to?

A

Manubrium of the malleus
Long process of the incus
Stapes superstructure

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238
Q

What is the most muscle to reconstruct in cleft palate surgery?

A

Levator veli palatine: elevates the palate and is responsible for velopharyngeal closure during the swallow mechanism

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239
Q

What is Chandler’s staging system for JNA?

A

Stage 1: confined to the nasopharynx
Stage 2: extends to the nasal cavity or sphenoid
Stage 3: involves the maxillary sinus, ethmoid sinus, infratemporal fossa, orbit, cheeck, cavernous sinus
Stage 4: intracranial extension

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240
Q

What growth arises from the lateral nasal wall in the region overlying the sphenopalatine canal?

A

JNA

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241
Q

What is the Holman-Miller sign?

A

Pathognomonic radiologic sign of JNA where growth of JNA pushes the posterior maxillary wall anteriorly

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242
Q

What is the most common site of metastasis of ACC?

A

Lung: indolent but relentless course, seldom metastasizes to regional lymph nodes

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243
Q

What are the T1 and T2 imaging findings of cholesterol granuloma?

A

T1: Hyperintense
T2: Hyperintense

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244
Q

What is the maximum size upper eyelid defect that can be closed primarily?

A

25% or less

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245
Q

What is the only peeling agent that requires neutralization to end its action (5% sodium bicarbonate)

A

Glycolic acid

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246
Q

What is Ramsay-Hunt syndrome?

A

Varicella zoster visus infection leading to vesicular eruptiong in the conchal bowl and facial palsy (House-Brackmann IV-VI in 50% of patients)

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247
Q

What is standard treatment for Ramsay-Hunt syndrome?

A

Valacyclovir for 14 days OR

Famciclovir of 10 days with steroids

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248
Q

What is Gorlin’s syndrome?

A

AD disorder associated with falx calcifications, multiple cutaneous BCC, odontogenic keratocysts, bifid ribs, scoliosis, and frontal bossing

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249
Q

What is PFAPA syndrome?

A

Periodic fever, aphtous stomatitis, pharyngitis and adenitis: periodic fevers >39 lasting 3-7 days recurring every 21-42 days. Resolution of sx s/p tonsillectomy if abx fail

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250
Q

What is the most common cause of temporary diplopia s/p blepharoplasty?
Permanent?

A

Post-operative edema

Injury to the inferior oblique

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251
Q

What is the area of weakness that leads to a Zenker’s diverticulum?

A

Killian’s triangle: limited superiorly by the inferior constrictor and inferiorly by the cricopharyngeus

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252
Q

What type of thyroid carcinoma is the BRAF V600E mutation associated with?

A

Papillary thyroid carcinoma

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253
Q

What is the most common malignancy to arise within the nasal cavity and paranasal sinuses in children?

A

Rhabdomyosarcoma

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254
Q

What is the grading system for the slope of the skull base, and how many types are there?

A

Keros type I: 1-3 mm
Keros type II: 4-7 mm
Keros type III: 8-16 mm
**measured from the cribriform plate to the fovea ethmoidalis of the frontal bone

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255
Q

What is the criteria for drainage of a PTA in a child?

A

Abscess >2 cm
Respiratory distress
Failure of IV abx

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256
Q

What are the cooresponding structures to hillocks of His 1-6

A

1: Tragus
2: Helical crux
3: Helix
4: Antihelix
5: Antitragus
6: Lobule

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257
Q

What is the most common cause of pediatric facial fractures?

A

MVCs

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258
Q

What condition is often associated with congenital lower lip paralysis (CULLP)?

A

Cardiac defects (Cayler craniofacial syndrome when combined)

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259
Q

What is the source of the majority of hyperparathyroidism?

A

Single parathyroid adenoma (85%)

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260
Q

What % of patients with Downs have atlantoaxial instability (greater than 4mm distance between the dens and the anterior arch of the atlas)?

A

10-20%

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261
Q

What is the name of a painful thyroid following a URI? What is the treatment

A

DeQuervain’s subacute thyroiditis

NSAIDs and corticosteroids

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262
Q

The eustachian tube, middle ear, and mastoid cavity are all derived from what embryologic structure?

A

First pharyngeal pouch

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263
Q

What is appropriate therapy for necrotizing fascititis?

A

Ceftriaxone 2 gm IV q8h
Clindamycin 600 mg IV q8h
Metronidazole 500 mg IV q6h

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264
Q

What mutation underlies Alport syndrome, x-linked form of SNHL associated with progressive glomerulonephritis?

A

COL4A5, product participates in collagen IV synthesis (present in the basement membrane and the inner ear)

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265
Q

Which of the CPA approaches carry the highest risk of facial nerve injury?

A

Middle cranial fossa

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266
Q

What are the primary adductors of the vocal folds?

A

Lateral crico-arytenoid

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267
Q

What is the difference between a subtotal and total temporal bone resection?

A

Subtotal: removal of the otic capsule and facial nerve but spares the petrous apex and carotid artery
**those are removed in a total temporal bone resection

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268
Q

What is the term for decrease in speech recognition performance at higher signal intensity?

A

Rollover

**assoc with RCP

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269
Q

What is the term for poor speech recognition out of proportion to that which would be predicted by PTA results?

A

Phonemic regression

**assoc with RCP

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270
Q

What is the term for a test in which a tone is presented continuously to an ear with a hearing loss until it becomes inaudible?

A

Tone decay

**excessive tone decay associated with RCP

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271
Q

What is the term for increases in perceived loudness of a sound in an ear with SNHL?

A

Recruitment

**assoc with RCP

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272
Q

What is Lugol’s solution?

A

Potassium iodine and elemental iodide in water

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273
Q

Which direction does the columella and nasal septum deviate in a patient with unilateral cleft lip and palate?

A

Towards the noncleft side

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274
Q

What CD markers are found on NK cells?

A

CD16

CD56

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275
Q

What CD markers are found on B cells?

A

CD 19
CD 20
CD 22

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276
Q

ORN rarely occurs in pts who have been exposed to less than __ Gy

A

60

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277
Q

Though Crouzon syndrome presents similarly to Apert and Pfeiffer syndromes wih craniosynstosis, midfaial hypoplasia, and ocular proptosis with a parrot-beak nose, what additional findings are seen in Apert and Pfiffer?

A

Apert: syndactyly
Pffiefer: broad thumbs and toes

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278
Q

What are characteristics associated with central vertigo?

A

Doesn’t extinguish with repeated stimulation
Less severe
Nystagmus that doesn’t improve with fixation and multidirectional

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279
Q

What are the two key types of proteins expressed by HPV?

A 
E proteins (1-7): early
L proteins (1-2): late
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280
Q

What is the major capsid protein in Gardasil and Cervarix?

A

L1: structural protein that encapsulates the viral particle

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281
Q

What are the roles of HPV proteins E6 and E7 (early proteins)

A

E6: inhibits p53
E7: inhibits pRb

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282
Q

The levator palpebrae superioris muscle is suspended by what structure?

A

Whitnall ligament: extends from the fascia of the lacrimal gland laterally to the trochlea attachment medially

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283
Q

What is Lockwood ligament?

A

Thickening of Tenon’s capsule, forms a hammoch stretching below the eyeball between the medial and lateral canthal tendons, encloses the inferior rectus and inferior oblique muscles

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284
Q

What is the involuntary smooth muscle lid retractor that receives sympathetic innervation located beneath the levator aponeurosis

A

Muller muscle

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285
Q

What is the tx for benzo overdose?

A

Flumazenil: initially 0.2 mg IV, increased by to 3 mg/hr if there is no response

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286
Q

What is the difference between N2a, b, and c laryngeal cancers?

A

a: single ipsilateral LN 3-6 cm
b: multiple ipsilateral LN <6cm
c: bilateral or contralateral LN <6cm

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287
Q

What two teeth does a cleft lip form between?

A

Lateral incisors and canines

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288
Q

What is the most important factor for the outcome of atresia repair?

A

Stapes: only element that gets 2 points on the *** scale, implies inner ear pneumatization

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289
Q

What nerve provides cutaneous innervation for the radial forearm free flap?

A

Lateral antebrachial cutaneous nerve

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290
Q

What chemokine is secreted by active T helper cells?

A

IL-2

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291
Q

What is the maximum dose of lidocaine that can be safely given with and without epi? (in mg/kg)

A

WITHOUT 4mg/kg

WITH 7mg/kg

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292
Q

How many mg/ml does 1% lidocaine have?

A

10 mg lidocaine/ml

**4% will have 40 mg/ml

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293
Q

What is the best type of audiologic testing for children from 6 to 30 mo

A

Visual reinforcement audiometry

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294
Q

Is nystagmus enhanced or supressed with ocular fixation in central vertigo?

A

Enhanced

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295
Q

What are the limbs of the nasal tripod?

A

Conjoined medial crura and bilateral lateral crura

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296
Q

What subtypes of HPV cause RRP?

A

6 and 11

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297
Q

How high should you stay above the orbital rim to avoid ptosis with botox injections?

A

1 cm

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298
Q

If ptosis is produced w botox injections, how should it be treated and was it the MOA?

A

Apraclonidine gtts

Alpha 2 agonist which causes Muller muscle contraction

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299
Q

What dose of epi should be given for anaphylaxis?

A

0.01 mg/kg (max 0.5 mg) every 5-15 min if anaphylaxis persists

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300
Q

Which incision allows for a retrograde approach in rhinoplasty?

A

Intercartilaginous: followed by dissection of the vestibular lining retrogrady over the underside of the lateral crus of the lower lateral cartilage

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301
Q

Which two incisions allow for an open approach to rhinoplasty?

A

Marginal

Transcolumellar

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302
Q

What is the best tx option initially for presbylaryngis

A

Voice therapy

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303
Q

What differentiates class IV and V Norwood hair loss classes?

A

IV: Frontal and vertex loss, but still a band of hair separating two areas
V: Loss of separation between frontal and vertex areas of hair loss

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304
Q

What is the 1st ethmoturbinal the precursor for?

A

Agger nasi

Uncinate

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305
Q

What is the internal nasal valve bounded by?

A

Upper lateral cartilage
Septum
Head of the inferior turbinate

306
Q

CRSwNP is defined as the presence of sinonasal mucosal inflammation for more than ___ weeks without symptomatic improvement and with the presence of either endoscopic or CT findings or both

A

12 weeks

307
Q

What is the most common complication of treatment of a subglottic hemangioma with a CO2 laser?

A

SGS (occurs in up to 18% of cases)

308
Q

Is pseudomonas sensistive to clindamycin

A

No

309
Q

What characteristics of a pyriform sinus tumor make it suitable for management w a partial laryngectomy

A

Smaller than 2 cm
At least 1.5 cm above the apex
No not cause VF fixation
Do not involve adjacent structures

310
Q

What kind of canidiasis infection is an AIDS defining illness?

A

Tracheal and esophageal candidiasis

**Oral candidiasis is not

311
Q

What is an autoimmune condition leading to SNHL and intersisital keratitis?

A

Cogan syndrome

312
Q

What is the MC organism that causes Lemierre’s?

A

Fusobacterium necrophorum (anaerobe)

313
Q

What is the MC origin of an acoustic neuroma?

A

Both the superior and inferior divisions of the vestibular nerve
Rarely arise from the facial or cochlear nerves

314
Q

What is the term for the most anterior projection of the mandible at the midline?

A

Pogonion

315
Q

What is the term for the area with the thinnest skin of the nasal dorsum located at the inferior aspect of the nasal bones at the junction with the upper lateral cartilage?

A

Rhinion

316
Q

What is the term for the location where the nasal septum intersects with the upper lip

A

Subnasale

317
Q

What percent of congenital VF paralysis is bilateral?

A

50%

318
Q

What kind of thyroid mass would stain positive for congo red?

A

Medullary thyroid carcinoma–contains amyloid deposits

319
Q

What is Hennebert sign?

A

Pressure-induced vertigo in the setting of a third window–pressure waves taking path of least resistance through vestibular system
Pneumatic otoscopy causing vertigo

320
Q

What chromasome carries the gene that is mutated in Neurofibromatosis type 1?

A

Chromosome 17

321
Q

Why are medium chain triglycerides used in the setting of a chyle leak?

A

They are absorbed directly into portal circulation after absorption in the gut and do not travel in the lymphatic system or require chylomicron absorption

322
Q

Which type of thyroid carcinoma has psammoma bodies

A

Papillary thyroid carcinoma

323
Q

Which type of rhabdomyosarcoma reponds the best to primary chemoXRT?

A

Orbital

324
Q

Do patients with underlying DM vs hematologic malignancy with new fungal sinusitis have a worse prognosis?

A

Hemaologic malignancy

325
Q

What is the most likely etiology of bilateral parotid swelling in a patient with HIV?

A

Lymphoepithelial cysts of Goodwin

**also seen in Sjogrens and sarcoidosis

326
Q

Three instances where lymphoepithelial cysts are most commonly seen

A

Sjogrens
Sarcoidosis
HIV

327
Q

A total loss of the integrity of the ossicular chain and the TM results in how many dB of hearing loss?

A

50 dB, sound reaches the oval and round windows at the same time and results in phase cancellation

328
Q

What is there worse hearing loss in the setting of a disrupted ossicular chain WITH an intact TM than without?

A

An intact TM will reflect sound back into the EAC and will make hearing loss worse (55-60 dB)

329
Q

What are the two most common laryngeal manifestations of rheumatoid arthritis?

A

Cricoarytenoid joint fixation

Vocal fold nodule formation

330
Q

What is the most common cause of primary hyperparathyroidism?

A

Solitary parathyroid adenoma 80%

followed by 4 gland hyperplasia 15%

331
Q

What are the two main limitations of sestamibi scanning?

A

Hyperplasia

Adenomas under 1.5cm

332
Q

What medication will make sestamibi scanning inaccurate?

A

Thyroid hormone replacement therapy

333
Q

How much time after suspected facial nerve injury must ENoG be performed?

A

Up to 2 weeks after injury
**if ENOG is done within 2 weeks and shows greater than 90% degeneration on the affected side as compared to the normal side, surgery is indicated

334
Q

Which etiology of laryngotracheal stenosis is associated with a higher risk of tracheostomy dependence?

A

Iatrogenic

**followed by autoimmune, traumatic, and idiopathic

335
Q

A nodule with a uniform halo is __% specific for benign disease

A

95%

336
Q

A short axis diameter of > __mm in a thyroid nodule is considered to be concerning for malignancy

A

7 mm

337
Q

What is the MOA of cisplatin?

A

Cross-links with purine base pairs of DNA, interfering with DNA repair mechanisms

338
Q

Was is the MOA of methotrexate?

A

Interferes with folid acid metabolism by tightly binding the enzyme dihydrofolate reductase

339
Q

Was is the MOA of mitomycin C?

A

Alkylating agent that binds DNA and RNA

340
Q

What is the MOA of 5-FU

A

inhibits DNA synthesis by binding the enzyme thymidylate synthetase

341
Q

What should be used in the setting of ptosis following botox injection?

A

Apraclonidine gtts (alpha 2 agonist)

342
Q

What is Gradenigo’s syndrome?

A

Triad of symptoms caused by petrous apicitis including

1) Orbital pain
2) 6th nerve palsy
3) Otorrhea

343
Q

Sx of cavernous sinus thrombosis

A

Fever, lethargy, orbital pain, bilateral proptosis, reduced EOM, bilateral dilated pupils with sluggish pupillary light reflex

344
Q

What is the SRT?

A

Level at which pt can repeat 50% of speech material

345
Q

What is the SDT?

A

Level at which pt is aware of a speech signal 50% of the time

346
Q

What kind of tumor is characterized by papillae of eosinophilic ephithlia that project into cystic spaces and lymphoid matrix

A

Warthin tumor or papillary cystadenoma lymphomatosum

**usually slow growing mass in the superficial lobe of the parotid gland at the angle of the mandible

347
Q

What is the most common site for a minor salivary gland pleomorphic adenoma?

A

Palate

**second most common is the upper lip

348
Q

What is the most common benign tumor of the lacrimal gland?

A

Pleomorphic adenoma

349
Q

What are the pathologic findings characteristic of a pleomorphic adenoma

A

Epithelial and mesenchymal components

350
Q

What represents the majority of salivary gland masses in HIV positive patients?

A

Benign lymphoepithelial cysts (BLEC)

**persisent nontender enlargement associated with cervical lymphadenopathy

351
Q

What is the best test for narcolepsy?

A

Multiple sleep latency test: naping at 2 hr intervals after a full nights sleep (min sleep latency <8min char of narcolepsy)

352
Q

What is the earliest age that autologous rib cartilage recon can be considered for microtia?

A

6 yr (auricle reaches adult size at age 6 yr)

353
Q

What is the most common site of distant disease in adenoid cystic carcinoma of the head and neck?

A

Lungs

354
Q

What are the two subtypes of HPV responsible for RRP?

A

Low grade subtypes 6 and 11

high grade 16 and 18 are involved in SCC

355
Q

What are the common sites of upper and lower airway obstruction in mucopolysaccharidosis (MPS) type 1, 2 and 6?

A

GAG deposits in the upper or lower airway leading to adenoid hypertrophy, macroglossia, and laryngomalacia

356
Q

What two points determine occlusion?

A

The mesiobuccal cusp of the first maxillary molar and the mesiobuccal groove of the first maxillary molar

357
Q

What is the orientation of the first maxillary and mandibular molars in class I occlusion?

A

Mesiobuccal cusp of the first maxillary molar sits in the mesiobuccal groove of the first mandibular molar

358
Q

What are the first and second most common types of jugular foramen schwannomas?

A
  1. Vagal (CNX)

2. Glossopharyngeal (CNIX)

359
Q

What is the MC presenting symptom of patients with a glossopharyneal Schwannoma?

A

Mid-frequency hearing loss (80%): due to the posteriorlateral location of CNIX to CNVIII. In contrast, vestibular schwannomas present with high frequency hearing loss

360
Q

EYA1 mutation is found in what syndrome?

What is the inheritance?

A

Branchio-oto-renal syndrome

AD

361
Q

What is the only statistically significant predicator of success in pediatric tympanoplasty?

A

Age

362
Q

What is Schwartze sign?

A

Red hue of the promontory seen in otosclerosis

363
Q

What syndrome is characterized by thyroid goiter and profound SNHL?

A

Pendred

364
Q

What test should be done when Pendred syndrome is suspected on the basis of goiter and hearing loss

A

CT to look for associated anomolies such as enlarged vesibular aquaduct or modini malformation

365
Q

What is the best way to treat vasomotor rhinitis associated with contraceptive use (other than changing the contraceptive)

A

Muscarinic blocker (contraceptives can inhibit anticholinesterase)

366
Q

What are the most common sites of laryngeal involvement of wegners, sarcoidosis, and amyloidosis?

A

Sarcoidosis: Supraglottis
Amyloidoisis: Glottis
Wegners: Subglottis
SAW

367
Q

What is the best anti-thyroid regimen for a pregnant woman with clinically signifiant hyperthyroidism?

A

PTU first trimester
Methimazole for the remainder of pregnancy
**methimazole associated with congential malformations in the first trimester, but PTU can cause liver injury later in pregnancy
**PMS

368
Q

What nerve carries parasympathetic fibers to the parotid land?

A

Auriculotemporal (branch of V3)

369
Q

Which nerve provides parasympathetic innervation to the submandibular and sublingual glands?

A

Chorda tympani

370
Q

Is the position of the superior or inferior parathyroid glands more variable?

A

Inferior

371
Q

Are most superior parathyroid glands found at the cricothyroid junction cranial or caudal to the juxtaposition of the RLN and inferior thyroid artery?

A

Cranial

372
Q

Are the superior parathyroid glands superficial or deep relative to the RLN?
Inferior?

A

Superior: deep to RLN
Inferior: superficial to RLM

373
Q

What quadrant are the majority of congenital cholesteatomas found in?

A

2/3 found in the anterior-superior quadrant

374
Q

Elevated TSH levels are necessary to enhance uptake of iodine by thyroid cancer cells. TSH level greater than ___ assocaited with increased RAI uptake in tumors

A

30 mU/L
**this is why patients are taken off thyroid suppression therapy for 2-4 wk prior to RAI therapy and put on a low iodine diet

375
Q

Do patients with upper or lower lip carcinomas have a worse prognosis?

A

Upper (have a 10-20% worse 5 year survival)

376
Q

Do basal cell carcinomas tend to occur on the upper or lower lips?

A

Upper (though 95% of all lip caricnomas occur on the lower lip)

377
Q

What is the risk of harboring cervical metastases in individuals with lip carcinomas?

A

10%

378
Q

What is hte MC location of aberrant parathyroids?

A

Anterior mediastinum

379
Q

How many mg of epi are in an epi pen?

A

0.3 mg 1:000 (SC/IM)

380
Q

What is the MCC profound SNHL in a newborn?

A

Non-syndromic AR connexin 26 mutations

381
Q

What is the MCC of syndromic profound SNHL

A

Usher syndrome

382
Q

What is a X linked recessive disorder that causes hearing loss and glomerulonephritis

A

Alport

383
Q

What does Schaefer’s classification assess?

A

Post-operative outcomes of laryngeal injury
Group 1: minor hematoma w/o fx
Group 2: non-displaced fx with edema, hematoma
Group 3: massive edema and exposed cartilage
Group 4: massive edema with two of more fx requiring stenting
Group 5: Compete laryngotracheal separation

384
Q

What UPSIT score cooresponds to a normal sense of small?

A

34-40

385
Q

What frequency hearing loss is seen with aminoglycoside toxicity?

A

High frequency

Via destruction of the outer hair cells at the basal turn of the cochlea

386
Q

Which two structures pass between the superior and middle pharyngeal constrictors?

A

Stylopharyngeus muscle

Cranial nerve IX

387
Q

Are suprahyoid lesions more likely to be micro or macrocystic?

A

Microcystic

388
Q

What are the major cytokines involved in allergic inflammation

A

IL 4
IL 5
IL 13

389
Q

MOA Montelukast

A

Leukotriene receptor antagonist

390
Q

What does the Bent and Kuhn classification system address?

A

Allergic fungal rhinosinusitis

391
Q

What are the 5 criteria of Bent and Kuhn criteria?

A
  1. Hx of atopy
  2. Nasal polyposis
  3. Radiographic findings of a heterogenous and expansile filling of the paranasal sinuses, often with orbital or skull base erosion
  4. Eosinophilic mucin without fungal invasion
  5. Positive fungal stain for noninvasive disease
392
Q

What is Browns sign on otoscopy?

A

Blanching of discoloration noted behind the TM

393
Q

What does high grade mucoepidermoid carcinoma resemble pathologically?

A

Squamous cell carcinoma

394
Q

What are the criteria for recurrent acute sinusitis

A

At least 4 episodes per year with interfering asymptomatic periods

395
Q

What is the time course to qualify for subacute sinusitis?

Chronic?

A

4-12 weeks

>12 weeks

396
Q

What is the action of the posterior crico-arytenoid muscle?

A

Abduction of the vocal folds

397
Q

What is the recommended management of Dedo class II?

A

Skin laxity–rhytidectomy

398
Q

What is the embryologic source of the inferior parathyroids and thymus?

A

Inferior parathyroids: superior third branchial pouch

Thymus: inferior third branchial pouch

399
Q

What is the MC presenting symptom of RRP in chidlren?

A

Hoarseness, progresses to stridor followed by respiratory distress

400
Q

What is the incidence of permanent hypoparathyroidism after total thyroidectomy

A

1%

401
Q

What pathogen is most likely to self resolve in the setting of acute bacterial sinusitis?

A

Moraxella catarrhalis

402
Q

Classic triad in Horners syndrome?

A

Miosis (pupillary construction)
Lid ptosis
Anhidrosis

403
Q

What part of the aerodigestive tract do second branchial cleft cysts communicate with?

A

Tonsillar fossae

404
Q

What lab value will confirm a chyle leak?

A

Triglyceride >100 mg/dL

Amylase supports dx

405
Q

What is first line for acute sinusitis in the setting of a PCN allergy?

A

Doxy

**macrolide is also an option

406
Q

What is the importance of the reference point of the lateral limbus of the eue in the setting of facial nerve injusy?

A

Trauma to the facial nerve medial to the lateral limbus of the eye tends to heal spontaneously
Lateral to this landmark patients need to be explored and reanastomosed

407
Q

What branchial arch gives rise of the glottic and subglottis?

A

6th

408
Q

What is the name for muscle spasm of the palate including the tensor veli palatini

A

Palatal myoclonus

409
Q

What is the most common site for cancer in the oral cavity

A

Lip

410
Q

Is basal cell more common on the upper or lower lip?

A

Upper (in contrast to SCC)

411
Q

What muscle creates the vertical rhytids over the glabella

A

sorrugator supercilliais

412
Q

What is the definitive treatment of esophageal achalasia?

A

Heller myotomy

413
Q

What is a Zenkers an outpouching through?

A

Triangle formed by the inferior pharyngeal constrictor and the cricopharyngeus

414
Q

What isa Killian-Jamieson diverticulum an outpouching through?

A

The oblique and transferse fibers of the cricopharyngeus and the longitudinal fibers of the esophagus

415
Q

What risks injury with repair of a Killiam-Jamieson diverticulum?

A

RLN

416
Q

Whats the max dose of epi that should be pushed every 5-15 min

A

0.3 IM

417
Q

What is the risk of malignancy in FDG avid nodules?

A

33%

418
Q

What % of the semicircular canal is occupied by the semicircular duct?

A

25%

419
Q

Which two structures pass between the superior and middle pharyngeal constrictors?

A

Stylopharyngeus muscle

Cranial nerve IX

420
Q

Are suprahyoid lesions more likely to be micro or macrocystic?

A

Microcystic

421
Q

What nerve is stimulatd tin cVEMPS?

A

Inferior vesibular nerve (stimulates the saccule)

422
Q

MOA Montelukast

A

Leukotriene receptor antagonist

423
Q

What does the Bent and Kuhn classification system address?

A

Allergic fungal rhinosinusitis

424
Q

What are the 5 criteria of Bent and Kuhn criteria?

A
  1. Hx of atopy
  2. Nasal polyposis
  3. Radiographic findings of a heterogenous and expansile filling of the paranasal sinuses, often with orbital or skull base erosion
  4. Eosinophilic mucin without fungal invasion
  5. Positive fungal stain for noninvasive disease
425
Q

By the third week after injury, what collagen type predominates?

A

Tyle I collagen (type III reticulate has been replaced)

426
Q

What does high grade mucoepidermoid carcinoma resemble pathologically?

A

Squamous cell carcinoma

427
Q

What are the criteria for recurrent acute sinusitis

A

At least 4 episodes per year with interfering asymptomatic periods

428
Q

What is the time course to qualify for subacute sinusitis?

Chronic?

A

4-12 weeks

>12 weeks

429
Q

For patients younger than 55 with papillary or follicular thyroid cancer, what will change a patient from Stage I to II?

A

Metastasis (any T or N is I unless there is metastasis)

430
Q

What is the recommended management of Dedo class II?

A

Skin laxity–rhytidectomy

431
Q

What is the embryologic source of the inferior parathyroids and thymus?

A

Inferior parathyroids: superior third branchial pouch

Thymus: inferior third branchial pouch

432
Q

What is the MC presenting symptom of RRP in chidlren?

A

Hoarseness, progresses to stridor followed by respiratory distress

433
Q

What is the incidence of permanent hypoparathyroidism after total thyroidectomy

A

1%

434
Q

What pathogen is most likely to self resolve in the setting of acute bacterial sinusitis?

A

Moraxella catarrhalis

435
Q

What is the inheritance pattern of malignant hyperthermia?

A

Autosomal dominant

436
Q

What part of the aerodigestive tract do second branchial cleft cysts communicate with?

A

Tonsillar fossae

437
Q

What lab value will confirm a chyle leak?

A

Triglyceride >100 mg/dL

Amylase supports dx

438
Q

What is first line for acute sinusitis in the setting of a PCN allergy?

A

Doxy

**macrolide is also an option

439
Q

What is the importance of the reference point of the lateral limbus of the eue in the setting of facial nerve injusy?

A

Trauma to the facial nerve medial to the lateral limbus of the eye tends to heal spontaneously
Lateral to this landmark patients need to be explored and reanastomosed

440
Q

What is Jessner’s solution?

A

14g resorcinol
14g salicylic acid
14 mL lactic acid
100 mL ethanol

441
Q

What is the name for muscle spasm of the palate including the tensor veli palatini

A

Palatal myoclonus

442
Q

What is the MCC of facial paralysis in a newborn?

A

Birth trauma (forcept delivery)

443
Q

Is basal cell more common on the upper or lower lip?

A

Upper (in contrast to SCC)

444
Q

What is the most likely location of primary nasopharyngeal carcinoma?

A

Fossa of Rosenmuller

445
Q

What is the definitive treatment of esophageal achalasia?

A

Heller myotomy

446
Q

What is a Zenkers an outpouching through?

A

Triangle formed by the inferior pharyngeal constrictor and the cricopharyngeus

447
Q

What isa Killian-Jamieson diverticulum an outpouching through?

A

The oblique and transferse fibers of the cricopharyngeus and the longitudinal fibers of the esophagus

448
Q

What risks injury with repair of a Killiam-Jamieson diverticulum?

A

RLN

449
Q

Whats the max dose of epi that should be pushed every 5-15 min

A

0.3 IM

450
Q

What is the risk of malignancy in FDG avid nodules?

A

33%

451
Q

What % of the semicircular canal is occupied by the semicircular duct?

A

25%

452
Q

How long after LASIK should people wait before having a bleph?

A

6 months – due to effect on corneal sensation

453
Q

What is the best management of a trap door deformity?

A

Z plasy to redirect the vectors of contraction

454
Q

What nerve is stimulatd tin cVEMPS?

A

Inferior vesibular nerve (stimulates the saccule)

455
Q

What is the Mueller maneuver?

A

Performed with FFL awake in the supine position to assess retropalatal and retrolingual collapse at the end of expiration (abnormal if there is >50% collapse)

456
Q

What is the MOA of cidoforvir?

A

Antiviral that inhibits FNA polymerase to prevent viral replication

457
Q

What is the youngest that a patient with NF2and hearing los can receive a auditory brainstem implant?

A

12 yo

458
Q

By the third week after injury, what collagen type predominates?

A

Tyle I collagen (type III reticulate has been replaced)

459
Q

What kind of flaps are passed over a bridge of tissue and have to be inset with a second procedure?

A

Interpolated (ex paramedian)

460
Q

What kind of hearing loss is seen in SSCD? Are acoustic reflexes present?

A

Conductive

Yes

461
Q

What is there a lower threshold on cVEMP in the setting of SSCD?

A

Third mobile window which increases the sensitivity of the vestibular receptors to sound and pressure stimuli, leading to autophony

462
Q

For patients younger than 55 with papillary or follicular thyroid cance, what will change a patient from Stage I to II?

A

Metastasis (any T or N is I unless there is metastasis)

463
Q

What cytokines are central to the production of IgE?

A

IL4 IL5 IL13

464
Q

What is the first line for treatment of a subglottic hemangioma

A

Propranolol

465
Q

WHat may be seen on imaging in Bells palsy?

A

Contrast enhancement of the facial nerve on MRI

466
Q

What is the only facial muscle that is NOT innervated by the facial nerve?

A

Levator palpebra superioris (controlled by the oculomotor nerve)

467
Q

What is the name for hypoesthesia of the EAC 2/2 facial nerve compression by a CPA tumor?

A

Hitselberger’s sign

468
Q

What is the inheritance pattern of malignant hyperthermia?

A

Autosomal dominant

469
Q

What syndrome is characterized by midfacial hypoplasia and an absent anterior nasal spine?
What is required for nasal reconstruction?

A

Binder syndrome

Premaxillary grafts

470
Q

What is the blood supply of the following?

1) Saccule
2) Utricle, superior and horizontal semicircular canals

A

1) Posterior vestibular artery

2) Anterior vestibular artery

471
Q

What is Melkersson-Rosenthal syndrome?

A

Rare neurologic disorder characterized by recurrent facial paralysis, swelling of the face and lips, and development of folds and fissures in the tongue

472
Q

What provides sensation to the skin of a RFFF?

A

Lateral antebrachial cutaneous nerve

473
Q

What is Jessner’s solution?

A

14g resorcinol
14g salicylic acid
14 mL lactic acid
100 mL ethanol

474
Q

What syndrome is characterzied by underdevelompent of CN VI and VII leading to facial nerve paralysis and strabismus. Normal inteliigence

A

Mobius syndrome

475
Q

What is the MCC of facial paralysis in a newborn?

A

Birth trauma (forcepts delivery)

476
Q

What are the three types of nasopharyngeal carcinoma?

A

I: SCC
II: Non-keritinizing epidermoid
III: Non-keritinizing undifferentiated

477
Q

What is the most likely location of primary nasopharyngeal carcinoma?

A

Fossa of Rosenmuller

478
Q

What phase is approx 90% of hair in?

A

Anagen (growth), lasts 3-10 years

479
Q

Androgenic alopecia is mediated by what enzymes activity?

A

5-alpha reductase, converts testosterone to DHT

480
Q

What is the name of a benign lesion presenting as a punched out crater in older men at the rim of the helix or antihelix?

A

Chondrodermatitis nodularis helicis (Winkler nodule)

481
Q

What is the end point titration of IDT?

A

Increase in the skin reaction wheal by 2 mm (higher concentration with confirmation of the increase in size at the higher concentration)

482
Q

What nerve branches from CN IX as it passes out of the jugular foramen?

A

Jacobsen’s nerve – reenters the inferior tympanic canaliculus with nerves from the sympathetic plexus and the interior tympanic artery (branch of the ascending pharyngeal artery)

483
Q

What should be used for thyroid storm if PTU or methimazole are contraindicated?

A

Lithium

484
Q

What is the best place to harvest calvarial bone grafts from?

A

Parietal area (where bone is thickest), usually 2cm below the suture line

485
Q

How many afferent neurons supply each inner hair cell?

A

10

486
Q

Which vessels are responsible for supplying blodo to the brainstem, cerebellum and occipital lobes?

A

Vertebral arteries

487
Q

What is the only unpaired intrinsic laryngeal muscle and what does it do?

A

Transverse arytenoid

Assists with adduction of the VFs

488
Q

What is the only vocal fold abductor?

A

Posterior cricoarytenoid

489
Q

Which laryngeal muscle assists with VF adduction but also adduction of the false VFs and the aryepiglottic folds

A

Thyroarytenoid

490
Q

What structure is damaged initially by gentamicin leading to ototoxicity?

A

Inner layer of outer hair cells

**patients my initially have a normal audiogram by abnormal OAEs (tests the function of outer hair cells)

491
Q

What is the best treatment for neonatal rhinitis (MCC nasal obstruction in neonates)

A

0.1% dexamethasone gtts for 1 week

492
Q

In Frey syndrome, this is injury to post-ganglionic parasympathetic fibers from CN ___ via the ____ nerve of CN V

A

CN IX

Auriculotemporal

493
Q

What is Gradenigo’s syndrome?

A

Petrous apicitis: pain and drainage from the ear reflecting middle ear/mastoid infx, retrobulbar pain 2/2 irritation of the trigeminal in Meckel’s cave, and abducens palsy 2/2 involvement of Dorello’s canal which also abuts the petrous apex

494
Q

What is Dorello’s canal

A

Canal that houses the abducens nerve (CN VI) and the inferior petrosal sinus as they emerge from the cavernous sinus, it is found at the apex of the petrous apex and can be irritated in Gradenigo’s syndrome (petrous apicitis)

495
Q

What TCA used for tx of tinnitus can lead to torsades?

A

Nortriptyline

496
Q

What is the MC site of involvement of otosclerosis?

A

Fissula ante fenestrum–area anterior to the crura of the stapes footplace

497
Q

Which muscle wraps around the cochleariform notch?

A

Tensor tympani

498
Q

What is the second MC site of involvement of otosclerosis after the fissula ante fenestrum?

A

Round window

499
Q

Vestibular schwannomas comprise __% of all CPA tumors

A

90%

500
Q

What is the name for hypoesthesia of the EAC 2/2 facial nerve compression by a CPA tumor?

A

Hitselberger’s sign

501
Q

What species is most commonly seen in invasive fungal sinusitis in diabetic ketoacidosis vs immunocompromise

A

DKA: Mucor
IC: Aspergillus

502
Q

Where do the afferent and efferent nerves of the cough reflex synapse?

A

Medulla (nucleus tractus solitaries)

503
Q

What is the appropriate starting dose for propranolol for tx of facial infantile hemangioma?

A

0.33 mg/kg PO q6h for 3-7 days, then 0.5mg/kg q6h if tolerated

504
Q

What is Melkersson-Rosenthal syndrome?

A

Rare neurologic disorder characterized by recurrent facial paralysis, swelling of the face and lips, and development of folds and fissures in the tongue

505
Q

What is necrotizing sialometaplasia

A

Uncommon oral lesion in which salivary glandular tissue undergoes infarction and causes an ulcerative lesion, usually presents at the posterior hard palate as a 1-3 cm ulcer with erythematous borders – no intervention, will heal spontaneously

506
Q

What are the two main drugs used for RRP tx

A

Cidofovir: inhibition of DNA polymerase
Avastin: VEGF inhibitor

507
Q

What is the MC CPA tumor in children?

A

Brainstem glioma(10-25% of all intracWhat ranial masses in hcildren)

508
Q

What arises from the 1st ethmoturbinal?

A

Agger nasi and uncinagte

509
Q

What arises from the 2nd ethmoturbinal?

A

Middle turbinate

510
Q

What arises from the 3rd ethmoturbinal?

A

Superior turbinate

511
Q

What arises from the 4th and 5th ethmoturbinal?

A

Supreme turbinate

512
Q

What is the probability of a palpable, hypofunctional thyroid nodule being malignant in a patient with Graves?

A

45%

513
Q

Severely dysplastic lesions of the true vocal folds have what chance of malignancy transformation?

A

30%

514
Q

What is the end point titration of IDT?

A

Increase in the skin reaction wheal by 2 mm (higher concentration with confirmation of the increase in size at the higher concentration)

515
Q

What should be used for tx of thyroid storm?

A

Anti-thyroid medications like PTU, antipyretic, iodine solution, and cooling blankets with ice packs to lower body temperature

516
Q

What should be used for thyroid storm if PTU or methimazole are contraindicated?

A

Lithium

517
Q

What is the most commonly fractured subsite of the mandible in children?

A

Condyle

518
Q

What is a spongiform thyroid nodules?

A

Nodule with microcystic components comprising more than 50% of the nodule

519
Q

What sleep phase syndrome is characterized by early awakenings and early bedtime?

A

Advanced sleep phase syndrome

520
Q

After the first genu, the facial nerve runs parallel and superior to _____ and just superior to the ____ before turning at the second genu

A

Cochleariform process

Oval window

521
Q

What is the N staging system for melanoma

A

N1a: one clinically occult node
N1b: one clinically detected node
N1c: no regional nodes, but in-transit or microsatellite mets
N2a: 2-3 occult nodes
N2b: 2-3 nodes, at least 1 clinically detectable
N2c: One node with in-transit, or microsatellite mets
N3a: 4+ occult nodes
N3b: 4+ nodes at least 1 clinically detected
N3c: 2+ nodes, with in-transit or microsatellite mets

522
Q

What is the next step when oral hairy leukoplakia is diagnosed (white patchy mucosal lesion with severe hyperkeratosis with koilocytosis and possible fungal elements)

A

HIV test

523
Q

What is the found at the N vs C terminus of an antibody?

A

N: Fab or variable segment which binds antigen
C: Fc or constand segment which binds complement or other immune cells

524
Q

What is the path of parasympathetic innervation to the lacrimal gland

A 
Superior salivatory nucleus
Nervus intermedius
Geniculate ganglion
GSPN
Nerve of the pterygoid canal
Zygomaticotemporal nerve
525
Q

What should be avoided in patients with a known latex allergy due to cross reactivity?

A

Bananas
Avocados
Kiwis

526
Q

What is the syndrome characterized by bilateral SNHL, goiter, ilateral enlarged vesibular aqueducts

A

Pendred syndrome

527
Q

What syndrome is characterized by hematuria, proteinuria, and progressive renal failure with ocular lesions

A

Alport syndrome – x linked

528
Q

What nerve supplies the conchal bowl and the posterior portion of the external meatus?

A

Facial nerve (nervus intermedius)

529
Q

What nerve supplies the mastoid, medial pinna, and the posterior portion of the lateral surface of the auricle?

A

Greater auricular nerve

530
Q

What nerve supplies the anterior EAC?

A

Auriculotemporal nerve (branch of V3)

531
Q

What nerve supplies the floor of the EAC

A

Auricular branch of the vagus (Arnolds nerve)

532
Q

What is the Abbe flap used for?

A

Lesions up to 2/3 of the lip NOT involving the oral commissure

533
Q

What is the maximum size lip defect that can be closed primarily

A

Up to 1/2

534
Q

What is the stratification of lip defects based on size that guides reconstruction?

A

Less than 1/2: primary
Less than 2/3: Abbe or Estlander
Greater than 2/3: Bernard-Burow flap
Near total: free flap

535
Q

How many days does it take for a full thickness skin graft to have a new blood supply establshed

A

Imbibition-> inosculation

3-5 days new blood supply

536
Q

What % of oropharyngeal cancer is HPV +

A

50-75%

537
Q

What is the name for the superior margin of the forehead at the hairline?

A

Trichion

538
Q

What does GJB2 encode?

A

Connexin 26: 6 proteins that bind to form a gap junction through which potassium ions are transmitted from OHC through the supporting cells to the stria vascularis

539
Q

What is the name for the root of the nose including the nasion and the sellion?

A

Radix

540
Q

What is the name of the most posterior inferior aspect of the mandible?

A

Gonion

541
Q

Name of the most anterior vs most inferior border of the chin

A

Anterior: Pogonion
Inferior: Menton

542
Q

What is the relationship of a 2nd branchial cleft cyst toe the internal and external carotid arteries?
Where does it enter the aerodigestive tract?

A

Passes between them

Tonsillar bed

543
Q 
What increase in central scar lengths do the following Z plasty angles coorespond to?
30 degrees 
45 degrees 
60 degrees 
75 degrees 
90 degrees
A 
30: 25%
45 50%
60: 75%
75: 100%
90: 125%
544
Q

What is the name of the flap used for unilateral cleft lip that involves advancement of a myocutaneous flap from the lateral lip into the gap of the upper portion of the lip resulting in inferior downward roation of the medial lip element?

A

Millard method (rotation advancement flap)

545
Q

How long after admin of contrast do patients need to wait prior to RAI tx

A

8 weeks

546
Q

What is the AJCC 2017 T staging system for melanoma

A 
Tis: in situ
T1a: <0.8mm w/o ulceration 
T1b: 0.8-1mm w/ or w/o ulceration
T2: 1-2 mm
T3: 2-4 mm
T4: >4 mm
**stratify T2-4 w/ or w/o ulceration
547
Q

What is the MC intracranial complication of otitis media

A

Meningitis

548
Q

What is the greatest predictor of poor prognosis in mucosal melanomas?

A

Depth of invasion

549
Q

What is the loss of gain resulting in impedence mismatching between the air in the EAC and the fluid in the cochlear that must be overcome by the TM and ossicules?

A

30dB (TM accounts for 26 dB of this)

550
Q

What are the 4 most dangerous locations for melanoma?

A 
BANS
Back (upper)
Arm (posterior)
Neck (posterior)
Scalp (posterior)
551
Q

Chandler classification

A 
I: Preseptal cellulitis 
II: Orbital cellulitis
III: Subperiosteal abscess
IV: Orbital abscess
V: Cavernous sinus thrombosis
552
Q

What ocular finding helps distinguish types 1 and 2 of Waardenburg’s

A

Dystopia canthorum: lateral displacementof the inner canthi of the eyes giving an appearance of a widened nasal bridge, seen in 95% type 1

553
Q

What is the product of the causitive gene of NF2?

A

Merlin protein (on chromosome 22q12

554
Q

What is the N staging system for melanoma

A

N1a: one clinically occult node
N1b: one clinically detected node
N1c: no regional nodes, but in-transit or microsatellite mets
N2a: 2-3 occult nodes
N2b: 2-3 nodes, at least 1 clinically detectable
N2c: One node with in-transit, or microsatellite mets
N3a: 4+ occult nodes
N3b: 4+ nodes at least 1 clinically detected
N3c: 2+ nodes, with in-transit or microsatellite mets

555
Q

What is the MCC of croup

A

Parainfluenza I II and II

556
Q

What is the difference between primary and secondary acquired cholesteatoma

A

Primary: 2/2 ETD leading to retraction
Secondary: introduction of epithelial cells into the middle ear

557
Q

What is the path of parasympathetic innervation to the lacrimal gland

A 
Superior salivatory nucleus
Nervus intermedius
Geniculate ganglion
GSPN
Nerve of the pterygoid canal
Zygomaticotemporal nerve
558
Q

What is the histologic appearance of Warthin tumors

A

Papillary cystadenoma lymphamatosum, characterized by cysts lined by double epithelium with papillary fronts and a lymphoid stroma

559
Q

How many times more likely are smokers to develop Warthin tumors?

A

8 times

560
Q

How often are Warthin tumors found bilaterally

A

5-7.5%

561
Q

What are the three stages of wound healing

A
  1. Inflammatory
  2. Proliferative
  3. Maturation
562
Q

By 1 week the wound had what % of its tensile strength

A

10%

563
Q

What kind of collagen conversion happens in the maturation/remodeling phase of wound healing?

A

Type III->type I

564
Q

What waves characterize N2 sleep?

A

Sleep spindles and K complexes

565
Q

What phase of sleep does sleepwalking occur in?

A

Slow wave sleep

566
Q

What structure is found just deep to the lesser cornu of the hyoid?

A

Hypoglossal nerve

567
Q

What are the components of Baker’s solution/ What ingredient allowe for deep wounding

A

Phenol
Septisol
Croton oil ***
Water

568
Q

What pathogen is associated with development of rhinophyma

A

Demodex folliculorum

569
Q

What kind of nasopharyngeal mass will show poorly differentiated cells with Z bands?

A

Rhabdomyosarcoma–mesenchymal muscle will show Z bands of the sarcomere

570
Q

What is the characteristic cell of chordomas

A

Physaliferous cells

571
Q

What is PGAPA syndrome and what is the tx

A

Periodic fevers, aphtous ulcers, pharyngitis, pharyngitis, adenitis (cyclical every 4-6 weeks)
Tonsillectomy (may also benefit from short courses of steroids)

572
Q

Which nerve provides taste sensation to the soft palate?

A

GSPN: travels with the facial nerve and exits at the geniculate ganglion, then travels through the pterygoid canal where is forms the vidian nerve

573
Q

What is the most likely dx of a painless mass of the nose, biopsy shows foamy histiocytes (Mikulicz cells) with a moth eaten cytoplasm as well as large plasma cells (Russell bodies) with birefringent inclusions

A

Rhinoscleroma, caused by klebsiella rhinoscleromatis

574
Q

What is rhinoscleroma caused by?

A

Klebsiella rhinoscleromatis

575
Q

How is rhinoscleroma differentiated from rhinosporidiosis?

A

Both will show chronic granulomatous changes but rhinoscleroma will show Mikulicz cells (foamy histiocytes) and Russel bodies (bloated plasma cells)

576
Q

What will serve to distinguish superior orbital fissure syndrome from orbital apex syndrome?

A

There will be CN II palsy in orbital apex syndrome leading to decreased visual acuity
Also may have papilledema from pressure on the optic nerve

577
Q

What is the MC location for esophageal FB in peds pts

A

Thoracic inlet, due to narrow diameter and the transition from skeletal to smooth muscle

578
Q

What % of patients with idiopathic VF paralysis recover in 1 yr? Never?

A

1 yr: 36%

Never: 25%

579
Q

In what case is post-headshake nystagmus considered clinically significant?

A

If there are at least 3-5 consecutive beats of nystagmus directly following headshak

580
Q

Warm water irrigation to the right EAC should eliicit which kind of nystagmus?

A

Rightward beating (COWS, cold opposite warm same)

581
Q

What defines grade I, II and III SGS?

A

I: 0-50%
II: 50-70%
III: 70-99%

582
Q

What is the Homan Miller sign

A

Anterior displacement of the posterior wall of the maxillary sinus seen in JNA

583
Q

What is the MC area of injury to the facial nerve following T bone fx

A

Perigenicular region (geniculate ganglion and tympanic segment)

584
Q

What is the 10 10 10 rule for cleft lip?

A

Repair should be performed when the child has a hgb of 10, weighs 10 lbs, and is 10 wks old (3 mo)

585
Q

In the setting of bilateral carotid body tumors, what is the recommendation re management of the larger vs smaller tumor?

A

Smaller–surgery

Large–radiation

586
Q

What is the most vulnerable part of dissection of a carotid body tumor

A

at the bifurcation

587
Q

What plane should dissection of a carotid body tumor occur in?

A

Subadventitial plane

588
Q

What is the ocular finding seen in Alport syndrome?

A

Anterior lenticonus: protrusion of the central portion of the lens into the anterior chamber of the eye, causing myopia

589
Q

What is narcolepsy thought to be caused by?

A

Loss of hypocretin neurons in the lateral hypothalamus, leading to low hypocretin CSF levels

590
Q

Degradation of the serum PTH of >__% confirms removal of hyperfunctioning tissue

A

50%

591
Q

What is the N staging for papillary thyroid carcinoma

A

N1a: level VI mets
N1b: any other mets
**no N2

592
Q

What is the MCC infectious congenital hearing loss

A

CMV

Cerebral calcifications, hepatosplenomegaly, jaundice, and intellectual disability

593
Q

In the setting of congenital hearing loss, the presence of cataracts is most commonly associated with ____

A

Intrauterine rubella infection

594
Q

What are absolute indications for open reduction of a subcondylar mandibular fx

A
  1. Lateral displacement of the condylar head (may preclude spontaneous reduction)
  2. Displacement of the condyle into the infratemporal fossa
  3. Penetrating FB
  4. If normal occlusion cannot be obtained
595
Q

Deficiency of which IgG subclass is most common in children?

A

IgG2: manifested by recurrent infections to polysaccharide encapsulated bacteria such as haemophilus influenza, strep pneumonia , and klebsiella pneumonia

596
Q

What is the MC IgG subclass deficiency in adults?

A

IgG3

597
Q

What is seen in CHARGE?

A 
Coloboma
Heart defects
Atresia of the choanae
Retardation
GU abnormalities 
Ear abnormalities
598
Q

What is the main different between Baker-Gordon peel and the Hetter modification?

A

Amts of phenol and croton oil

Hetter has a lower concentration of phenol while varying croton oil concentration

599
Q

How long after dermabrasion does reepithelialization occur?

A

5-7 days

600
Q

What pathogen is associated with development of rhinophyma

A

Demodex folliculorum

601
Q

What laryngeal framework is made up of __ unpaired and __ paired cartilages

A 
3 unpaired (epiglottis, thyroid, cricoid)
3 paired (arytenoids, cornicular, cuneiform)
602
Q

What is the narrowest segment of the adult vs peds airway?

A

Adult glottis

Peds cricoid

603
Q

What medication in contrast to synthroid decreases the time of hormone withdrawal from 6 weeks to 2 weeks?

A

Liothyronine

604
Q

What is the filler or choice for deep lines for the melolabial folds and cheek augmentation?

A

Calcium hydroxyapatite

605
Q

What biologic site in the neuron does lidocaine act on?

A

Inhibits voltage gated sodium channels

606
Q

What ear structuremust remain for successful prosthetic placement?

A

Tragus

607
Q

What view is best for assessing the alar lobular ratio

A

Lateral

608
Q

What is the vascular supply of the ALT flap?

A

Descending branch of the lateral circumflex femoral

609
Q

What mechanism of injury is most likely to cause a transverse temporal bone fx/

A

Impact to the occiput

**only accounts for 10-20% of T bone fx

610
Q

What % of patients w transverse T bone fx presents with facial paralysis on examination?

A

50%

611
Q

What is Bogorad syndrome?

A

aka crocodile tear syndrome
Anomalous reinnervation following facial nerve injury with parasympathetic efferents erroneously innervating the lacrimal gland leading to lacrimation with food intake

612
Q

What are the 3 MCC acute sinusitis

A
  1. Strep pneumonia
  2. NTHI
  3. Moraxella
613
Q

How does the bacterial profile change in patients with chronic sinusitis?

A

Most anaerobic species such as bacteroides fragiles and non-anaerobic species like S aureus

614
Q

What is the distance from the midpoint of the lacrimal crest to the foramen of the anterior ethmoid artery?

A

24 mm

615
Q

What kind of otologic damage is associated with mumps

A

degeneration of the stria vascularis and organ of corti leading to SNHL

616
Q

What is the preepiglottic space bound by?

A 
Hyoid bone
Thyrohyoid membrane
Hyoepiglottic ligament
Thyroepiglottic ligament
Epiglottis
617
Q

What is Jessner solution?

A

Resorcinol
Salicylic acid
Lactic acid
Ethanol

618
Q

What kind of scan should be repeated every 4 weeks in the setting of malignant otitis externa to determine the length of treatment course?

A

Gallium 67 scan

619
Q

What artery usually supplies the superior and inferior parathyroid arteries

A

Inferior thyroid artery

620
Q

What structure seperates the superifical and deep lobes of the parotid

A

Retromandibular vein

621
Q

What should any patient presenting with an osteoma of the sinuses be evaluated for?

A

Gardner’s syndrome: FAP, osteomas of the H&N, supranumerary teeth

622
Q

Degradation of the serum PTH of >__% confirms removal of hyperfunctioning tissue

A

50%

623
Q

What are the parameters on the Jahrdoerfer grading system?

A 
Stapes 2
Oval window patent 1
Middle ear patent 1
Facial nerve position 1
Malleus-incus complex 1
Incus-stapes complex 1
Round window status 1
Mastoid pneumatization 1
External ear 1
624
Q

What score on the Jahrsdoerfer grading system indicates a poor outcome for surgical correction of congenital aural atresia?

A

5/10 or less on the grading scale

625
Q

What are the most common dental cysts?

A

Radicular cysts

626
Q

What kind of cyst presents as a well-defined radiolucency around an unerupted molar?

A

Dentigerous (follicular) cysts

627
Q

Dentigerous cysts carry a slight risk of transitioning into _____ therefore tx involving enucleation with dental extraction is idicated

A

Ameloblastom

628
Q

Multiple basal cell carcinomas are associated with ____ syndrome and odontogenic keratocysts

A

Gorlin syndrome

629
Q

What is the only muscle that receives bilateral innervation by the RLN and would have normal EMG findings in the setting of unilateral VF paralysis

A

Interarytenoid

630
Q

What is the inheritance of aminoglycoside sensitivity

A

Mitochondrial: will only be passed down by females to children

631
Q

What deformity can result from performing lateral osteotomies too high superior to the medial canthus?

A

Rocker deformity: step off appearance of the nasal dorsum

632
Q

What differentiates N1 from N2 in laryngeal cancer staging?

A

N1 single ipsilateal node with no ENE

N2 has ENE

633
Q

Midface lift has the greatest effect on which muscle?

A

Orbicularis oculi

634
Q

Is NF 1 or 2 more common?

A

NF1 is much more common

635
Q

What thyroid suppressant should be given in the first trimester of pregnancy?

A

PTU

Then switch to methimazole as there have been reports of liver injury with PTU later in pregnancy

636
Q

Which why is the caudal septum deviated in a unilateral cleft palate?

A

Away from the celft side

637
Q

Sunderland nerve injury classifciation

A

Grade 1: Neuropraxia, or nerve compression
Grade 2: Axonotmesis, where the axon is transected and there is Wallerian degeneration, but the endoneurial sheath is preserved
Grade 3: Neurotmesis where the neural tube is transected
Grade 4: Violation of the perineurium
Grade 5: Complete transection

638
Q

In what setting can patients develop severe HTN with vagally mediated bradycardia after receiving epinephrine

A

Beta blocker use

639
Q

How does the apearance of cholesteatoma differ on T1 vs T2?

A

Hypointnese on T1

Hyperintense on T2

640
Q

What is the first sinus to begin development in utero?

What sinus is the most deeloped at birth?

A

Maxillary sinus= first to develop

Ethmoids= most developed at birth

641
Q

What is the Lund Mackay scoring system

A 
For severity of sinusitis
0 given for no opacification
1 for partial
2 for full
subsites are the maxillary sinus, anterior ethmoid, posterior ethmoid, sphenoid, OMC, frontal
642
Q

What is recruitment?

A

When patients with hearing loss experience a much more rapid increase in subjective loudness of a stimulus

643
Q

What is the rollover phenomenon

A

Sin of RCP where speech recognition drops with increasing loudness

644
Q

What is the name for an infraorbital ethmoid cell that can lead to maxillary sinus obstruction

A

Haller cell

645
Q

What is the name for a lateral and posterior extension of the ethmoid cells located superior to the sphenoid sinus? clinical implication?

A

Onodi cell

Can contain the optic nerve or dehiscent carotid

646
Q

Does medial or lateral grafting have a higher take rate?

A

Lateral grafting (>90%), but is associated with longer healing times due to more extensive dissection

647
Q

What is the relationship of the supratrochlear nerve to the supraorbital nerve?

A

Supratrochlear nerve is 1 cm medial to the supraorbital nerve

648
Q

What are the Fisch approaches to the infratemporal fossa

A

A: anterior facial nerve transposition for access to the jugular foramen, ICA, and infralabyrinthine regions
B: removal of the zygomatic arch, temporalis muscle, and dissection of the horizontal ICA
C: removal of the pterygoidplates to expose the parasellar region

649
Q

Tx of DeQuervain’s (subacute) thyroiditis

A

NSAIDs and sometimes steroids

650
Q

What is Meckel’s cartilage?

A

Derived from the 1st branchial arch and develops into the mandible and the head of the malleus and body of the incus

651
Q

Which nerve innervates the cornea

A

Nasociliary (from CN V), afferent limb of the blink relex

652
Q

What phase of sleep do night terroirs occur in

A

Slow wave sleep (nightmares in REM)

653
Q

What malignancy is Plummer vinson syndrome assocaited with?

A

(IDA, esohageal webs, atrophic glossitis)

Hypopharyngeal SCC

654
Q

What is Carharts notch

A

CHL which closes at 20000 Hz indicative of otosclerosis

655
Q

What is Pendred syndrome?

A

Congenital SNHL with a thyroid goiter, often with enlarged vestibular aqueduct
SLC26A4 mutation

656
Q

What vertebral levels is the larynx located at?

A

C3-C6

657
Q

What syndrome presents with bilateral palsy of CN VI and VII?

A

Moebius

658
Q

What is the medical treatment for otosclerosis?

A

Fluoride: conversion of the otosponiotic lesion to n otoclerotic lesion

659
Q

What syndrome results from COL2A1 mutation?

A

Stickler syndrome: PRS, cleft palate, hearing loss, arthritis
AD inheritance

660
Q

How long are hemangiomas (infantile) in proliferative stage?

A

5 months (will reach 80% of final size at this time)

661
Q

What is the MC organism in malignant OE

A

Pseudomonas

662
Q

What is the appearance of a congenital chlesteatoma

A

White mass in the anterior-superior quadrant

663
Q

What is the blood supply of the NSF

A

Posterior septal branches of the SPA

664
Q

What is the blood supply of the paramedian forehead flap?

A

Supratrochlear artery

665
Q

The three muscles that receive innervation from the facial nerve on the superior surface

A

Levator anguli oiris
Buccinator
Mentalis

666
Q

Why do alkali materials cause more esophageal injury?

A

Liquifactive necrosis

667
Q

The brachiocephalic (innominate) veins are formed by the union of which veins?

A

IJ

Subclavian

668
Q

What syndrome can an osteoma of the frontal sinus be indicative of ?

A

Gardner–colon polyps, skull osteomas, soft tissue tumors

669
Q

What is Furstenberg test?

A

Pulsation or expansion of a nasal mass with crying, strainings, or compression of the jugular vein

670
Q

What does the lesser palatine artery supply

A

Soft palate

671
Q

What is the MC site of involvement of sarcoidosis in the larynx?

A

Supraglottis, specifically the epiglottis

SAW: supraglottis sarcoid, glottis amyloid, subglottis wegners

672
Q

What muscle depresses and protruded the mandible?

A

Lateral pterygoid

673
Q

What hormone decreases the LES tone

A

Glucagon

674
Q

What is liothyronine

A

T3

675
Q

What mandibular fx can be seen on a reverse Townes view

A

Condylar

676
Q

What is the associated artery and nerve of the first branchial arch?

A

Trigeminal nerve

Internal maxillar arery

677
Q

What is the artery and nerve of the second branchial arch

A

Facial nerve

Stapedial artery

678
Q

What cells do PPIs act on?

A

Parietal cells, which produce gastric acid and IF

679
Q

What are the 5 arteries that supplythe tonsils?

A
  1. Dorsal lingual
  2. Lesser palatine (NOT greater)
  3. Ascending pharyngeal
  4. Tonsillar branch o the facial
  5. Ascending palatine
680
Q

What are the exceptions to the rule that most of the nasal cavity blood supply is from the external carotid system?

A

Anterior and posterior ethmoid arteries which arise from the opthalmic artery off the internal carotid
**SPA, decending palatine, and greater palatine all arise from the IMA

681
Q

What does the presence of Hashimotos in a patient with PTC indicated

A

Protective effect–most likely to have smaller tumor with less advanced TNM stage

682
Q

What is the difference between hyphae of aspergillus vs mucor

A

Aspergillus: septated hyphae with 45 degree branches
Mucor: non-septated hyphae with 90 degree branching

683
Q

What deformities are noted with hyperactivity of the depressor septi muscle

A

Smiling deformity characterized by descending nasal tip, shortened upper lip, and transverse crease in the mid philtral area

684
Q

What is the difference between growth of infantile hemangiomas and vascular malformations

A

IHs are absent at birth, appear early in infancy, and grow rapidly
VMs are present at birth and grow slowly and proportionally with the child

685
Q

What is a normal Schirmer’s test?

A

Greater than 10-15 mm in 5 min

686
Q

What is the blood supply of the NSF

A

Posterior septal branches of the SPA

687
Q

What is the blood supply of the paramedian forehead flap?

A

Supratrochlear artery

688
Q

The three muscles that receive innervation from the facial nerve on the superior surface

A

Levator anguli oiris
Buccinator
Mentalis

689
Q

Why do alkali materials cause more esophageal injury?

A

Liquifactive necrosis

690
Q

The brachiocephalic (innominate) veins are formed by the union of which veins?

A

IJ

Subclavian

691
Q

What syndrome can an osteoma of the frontal sinus be indicative of ?

A

Gardner–colon polyps, skull osteomas, soft tissue tumors

692
Q

What nerve pierces the thyrohyoid membrane?

A

Internal branch of the SLN (sensory innervation to the TVFs, supraglottis, and hypopharynx

693
Q

What is the term of inflection of speech consisting of putting stress on syllabels

A

Prosody

694
Q

What is the MC site of involvement of sarcoidosis in the larynx?

A

Supraglottis, specifically the epiglottis

SAW: supraglottis sarcoid, glottis amyloid, subglottis wegners

695
Q

What muscle depresses and protruded the mandible?

A

Lateral pterygoid

696
Q

What hormone decreases the LES tone

A

Glucagon

697
Q

What is liothyronine

A

T3

698
Q

What mandibular fx can be seen on a reverse Townes view

A

Condylar

699
Q

What is the associated artery and nerve of the first branchial arch?

A

Trigeminal nerve

Internal maxillar arery

700
Q

What is the artery and nerve of the second branchial arch

A

Facial nerve

Stapedial artery

701
Q

What cells do PPIs act on?

A

Parietal cells, which produce gastric acid and IF

702
Q

What are the 5 arteries that supplythe tonsils?

A
  1. Dorsal lingual
  2. Lesser palatine (NOT greater)
  3. Ascending pharyngeal
  4. Tonsillar branch o the facial
  5. Ascending palatine
703
Q

What are the exceptions to the rule that most of the nasal cavity blood supply is from the external carotid system?

A

Anterior and posterior ethmoid arteries which arise from the opthalmic artery off the internal carotid
**SPA, decending palatine, and greater palatine all arise from the IMA

704
Q

What does the presence of Hashimotos in a patient with PTC indicated

A

Protective effect–most likely to have smaller tumor with less advanced TNM stage

705
Q

What is the difference between hyphae of aspergillus vs mucor

A

Aspergillus: septated hyphae with 45 degree branches
Mucor: non-septated hyphae with 90 degree branching

706
Q

What deformities are noted with hyperactivity of the depressor septi muscle

A

Smiling deformity characterized by descending nasal tip, shortened upper lip, and transverse crease in the mid philtral area

707
Q

What is the MC bacteria found in pediatric neck masses

A

S aureus

708
Q

What is a normal Schirmer’s test?

A

Greater than 10-15 mm in 5 min

709
Q

What is the most important layer of the TVFs for vocalization

A

Superficial layer of the lamina propria (Reinkes space)

710
Q

What two layers of the TVF form rthe vocal ligament?

A

Intermediate and deep layers of the lamina propria

711
Q

What is Broyles ligament?

A

Anterior commisure ligament: condensation of fibers with ;insertion into the perichondrium of the laryngeal cartilages

712
Q

What is the macula flava?

A

Thickened lamina propria along the anterior an posterior vocal folds which serves as as transition zone to the tougher anchoring structures

713
Q

What is the only immunoglobulin that crosses the placenta?

A

IgG

714
Q

What laryngeal muscle lengthens the TVF, increases tension, and changes pitch?

A

Cricothyroid (innervated by the external branch of the SLN

715
Q

In what disorder at the superior parathyroid glands noted to be larger than the inferior glands?

A

Water clear cell hyperplasia: proliferation of vacuolated water clear cells of multiple parathryoid glands that leads to severe hypercalcemia

716
Q

What is the term of inflection of speech consisting of putting stress on syllabels

A

Prosody

717
Q

What is the Kasabach-Merritt phenomenon?

A

Occurence of profound thrombocytopenia in association with vascular tumors

718
Q

What are binucleated Reed Sternberg cells pathognomonic for?

A

Hodgkins lymphoma

719
Q

What nutrient deficiency has been shown to contribute to RLS?

A

Iron

720
Q

What are the three MC organism isolated from otitis media with serous effusion

A
  1. H influenza
  2. M catarrhalis
  3. S pneumoniae
721
Q

What is the definitive tx for a neck mass caused by non-tuberculum mycobacterial disease

A

Surgical excision

722
Q

Most effective tx of RLS

A

Dopamine agmonists like pramipexole and ropinirole

723
Q

% of tensile strength of normal dermis of scar after
1 week
3 weeks
3 months

A

1 week 3%
2 weeks 20%
3 months 80%

724
Q

How much bone can be harvested with an osseocutaneous fibular free flap?

A

25 cm bone

725
Q

What is a normal marginal reflex distance/

A

Disance between the upper eyelid margin and the central corneal light reflex

726
Q

MC site of facial nerve injury after T bone fx

A

Perigeniculate reion

727
Q

What syndrome is characterized angioma dvelopment in V1 and V2 and a bort wine stain on the face

A

Sturge-Weber

728
Q

What disease is char by hemanbioblastomas of the retina nad CNS along with renal cysts, clear cell RCC, pehos, and endolymphtic sac tumors

A

von Hippel Lingau

729
Q

What syndrome is characterized by small vessel vasculitis, asthma, and hypereosinophilia

A

Churg-Strauss

730
Q

What is the MC bacteria found in pediatric neck masses

A

S aureus

731
Q

What is the MC benign lesion of the petrous apex

A

Cholesterol granuloma, hyperintense on T1 and T2 - on histology multinucleated giant cells and histiocytes

732
Q

What is the MC malformation of the cochlea?

A

Incomplete partition: cochlea only completes 1-1.5 turns as compared to 2.5 turns

733
Q

What staining should be done for an adenocarcinoma of the head and neck?

A

Thyroglobulin and calcitonin

734
Q

Inheritance of Osler Weber Rendu (epistaxis, telangiectasia, family hx of disorder)

A

AD

735
Q

What is the periotic duct?

A

Runs through the cochlear aqueduct which connects the scala tympani at the basal turn of the cochlea to the subarachnoid space

736
Q

What is the only immunoglobulin that crosses the placenta?

A

IgG

737
Q

How to calculate NNT

A

1/ARR

ARR= control event rate - experimental event rate

738
Q

In what disorder at the superior parathyroid glands noted to be larger than the inferior glands?

A

Water clear cell hyperplasia: proliferation of vacuolated water clear cells of multiple parathryoid glands that leads to severe hypercalcemia

739
Q

WHat is the classic inheritance pattern of otosclerosis?

A

AD

740
Q

What type of HL is seen in otosclerosis?

A

Low frequency CHL

741
Q

How much time should be allowed between dermabrasions for scars

A

12 mo

742
Q

What artery suppies the internal surface of the larynx

A

Superior laryngeal artery

743
Q

What stains are positive in granular cell tumors fo the larynx?

A

PAS
S-100
**arise from Schwann cells

744
Q

WHat is the difference between mechanical and biologic creep?

A

Mechanical: realignment of collagen fibers but no change in the microanatomy or surface area
Biologic: net increase in SA due to permenant tissue changes

745
Q

What is the artery and nerve of the second branchial arech

A

Facial nerve

Stapedial

746
Q

What are the nerve and artery of the first branchial arch

A

Trigeminal

I max

747
Q

Inheritance of branchio-oto-renal syndrome

A

AD

748
Q

In what way does ASA increase leukotriene production?

A

Inhibits COX, pushing AA down the leukotriene pathway via lipooxygenase

749
Q

What is the time limit for chronic sinusitis?

A

12 weeks

750
Q

What incisions will allow endonasal rhinoplasty

A

Marginal
Intercartilaginous
Full transfixion

751
Q

What artery is most commonly damaged during injection into the melolabial fold?

A

Angular

752
Q

Treamtnet of a peds neck infection w actinomyces

A

6 week course of parenteral penicillin

753
Q

What is in Jessners solution

A

Ethanol
Resorcinol
Salicylic acid
Lactic acid

754
Q

What is Kallman syndrome characterized by?

A

Hypogonadotropic hypogonadism
Absent smell
**failure of olfactory axons and GnRH exreting neurons to migrate

755
Q

Which aminoglycoside is the most vestibulotoxic?

A

Streptomycin followed by gentamicin

756
Q

What staining should be done for an adenocarcinoma of the head and neck?

A

Thyroglobulin and calcitonina

757
Q

Inheritance of Osler Weber Rendu (epistaxis, telangiectasia, family hx of disorder)

A

AD

758
Q

What is the mustarde suture technique

A

Use of three permanent horizontal mattress sutures to secure the auricular cartilage without making cartilage incisions

759
Q

What is the toxic level of lidocaine with an without epi?

A

5 mg/kg no epi

7-8 mg/kg with epi

760
Q

What are the most common sites of perilymphatic fistula

A
  1. Anterior to the anterior crus
  2. Anteroinferior to the anterior crus
  3. Anterosuperior to the anterior crus
761
Q

What is the gold standard for surgical treatment of the larynx

A

Surgical excision only

Board Review (3 decks)

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