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BoardVitals2 Flashcards

1
Q

What viral infection are inverted papillomas associated with?

A

HPV 6, 11, 16, 18

**16 and 18 carry higher risk of malignant transformation

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2
Q

What are the most common superficial peels?

A

10-25% TCA
Jessner’s (resorcinol, ethanol, salicyclic acid,
40-70% glycolic acid
5-15% salicylic acid

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3
Q

How long should patients be off isotretionoin prior to dermabrasion?

A

6 mo

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4
Q

What is the MC malignancy of the submandibular and minor salivary glands?

A

Adenoid cystic carincoma

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5
Q

What part of the ossicular chain has the most fragile blood supply and is often necrosed in cholesteatomas

A

Long process of the incus

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6
Q

What is glucagon useful in anaphylaxis?

A

Increases cardiac output

Increased HR

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7
Q

What does the ultimobranchial body give rise to?

A

Part of the 4th branchial pouch and gives rise to calcitonin-producing parafollicular cells
**medullary thyroid carcinoma arises from these cells

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8
Q

What is upper airway resistance syndrome?

A

Have the same sx as OSA
Normal AHI <5
Elevated RERAS
CPAP is first line therapy

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9
Q

What is the innervation of the diagastric

A

Anterior belly: CN V

Posterior belly: CN VII

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10
Q

How many minutes after sleep onset is the first REM cycle?

A

90 min

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11
Q

Where do most acoustic neuromas arise?

A

Obersteiner-Redlich zone: zone located within the porus region of the IAC, representing the transition point of central and peripheral myelin
**typically arise here and protrude medially towards the CPA

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12
Q

How long should one wait after medialization laryngoplasty before repeat intubation?

A

6 mo

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13
Q

What scan is positive in malignant OE and will remain indefinitely positive?

A

Technetium bone scan, as it identifies increased osteogenic bone activity characteristic of MOE

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14
Q

What is the MOA of cocaine?

A

Inhibits the reuptake of serotonin, norepinephrine, and dopaime

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15
Q

What is the surgical treatment of choice for nonallergic rhinitis that does not respond to medical therapy and in which no anatomic abnormality can be found?

A

Vidian neurectomy: supplies the parasympathetic innervation to much of the nasal mucosa, formed by the greater superficial and deep petrosal nerves

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16
Q

What is the MOA of aselastine?

A

Second generation H1 antagonist

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17
Q

What are the MRI findings of cholesteatoma on T1 vs T2

A

Hypointense on T1

Hyperintense on T2

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18
Q

What syndrome is characterized by episodic vertigo, interstitial keratitis, and bilateral fluctuating SNHL, usually presenting in the 20s-30s

A

Cogan syndrome

Tx with high dose steroids and possibly immunosuppressants

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19
Q

What are the Kuhn types of frontal cells?

A

I: Single cell above the agger nasi
II: 2 or more cells superior to the agger nasi
III: single cell extenindg from the agger cell into the frontal sinus
IV: isolated cell within the frontal sinus

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20
Q

What is a “marginal” laryngeal tumor

A

Located on the AE fold, marginal as it could be classified as a laryngeal or hypopharyngeal cancer – have a higher rate of basaloid varient of SCC and a more aggressive behavior

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21
Q

What is a normal AHI in children?

A

0 events/hr, anything higher is abnormal

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22
Q

What is the difference between botox types A and B?

A

Type A is the MC type used

Type B acts more quickly, wears off more quickly, and can be used in patient who develop type A tolerance

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23
Q

What is the MC cardiac abnormality seen in OSA?

A

Sinus bradycardia

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24
Q

What is seen in orbital apex syndrome

A

Diplopia, proptosis, mydriasis, decreased visual acuity

CN II, III, IV, and VI affected

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25
Q

What is Hitselberger’s sign

A

Hypesthesia of the posterior canal wall and concha due to compression of the facial nerve, usually seen with AN

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26
Q

What is Gradenigo’s triad?

A

Retroorbital pain
Otorrhea
Abducens palsy
** due to petrous apicitis

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27
Q

What is Heerfordt syndrome

A

Rare manifestation of sarcoidosis involving uveitis, swelling of the parotitis, chronic fever, facial nerve palsy

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28
Q

What are the indications for surgical management of hyperparathyroidism?

A
  1. Serum Ca over 1.0 mg/dL above the upper limit of normal
  2. Cr clearance reduced by more than 30% for age
  3. Patient younger than 50
  4. Measurement of 24 hr urinary Ca is over 400 mg/dL
  5. Bone mineral density is reduced by more than 2.5 standard deviations
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29
Q

What findings suggest acute coalescent mastoiditis?

A
  1. Fluid in the mastoid cavity with bony erosion
  2. Subperiosteal abscess
  3. Mastoid tenderness or erythema
  4. Proptosis of the auricle
  5. Retroauricular fluctuance
  6. Ear drainage
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30
Q

What part of the nasal septum is the ascending pharyngeal artery associated with?

A

Woodruffs plexus – common location of posterior bleeds

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31
Q

What is associated with low CSF hypocretin?

A

Narcolepsy

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32
Q

The round window represents the end of what structure?

A

Scala tympani: lower component of the cochlea

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33
Q

What test can be used to assess for agreement between two interventions

A

Chi squared

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34
Q

What test can be used to compare continuous date from a single group

A

T test

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35
Q

What patients with rhabdomyosarcoma have a worse prognosis

A

Children 1-9 yo

Alveolar subtype

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36
Q

Which form of BCC has the worst prognosis?

A

Morpheaform/sclerosing: appears as a white or pink plaque, associated with unpredictable arms of tumor cells branching from the main lesions

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37
Q

What is the only lesions of the temporal bone that will be hyperintense on both T1 and T2

A

Cholesterol granuloma

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38
Q

What are the cut-offs for mild, moderate, and severe OSA?

A

Mild: AHI 0-15
Moderate: AHI 15-30
Severe: AHI >30

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39
Q

What is dysphagia lusoria?

A

Stridor w exertion and FTT associated with apparent RIGHT subclavian artery

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40
Q

At what point to wounds reach 80% of tensile strength?

A

3 mo

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41
Q

How far apart are mustarde sutures placed?

A

16mm

**need to place at least 3, permanent horizontal mattress

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42
Q

What is a normal MRD

A

3-4.5 mm (between the lid margin and the light reflex)

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43
Q

Difference between MRD 1 and 2

A

i is measurement from the upper lid

2 from lower lid

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44
Q

MC lab to be positive in the setting of Wegners

A

c-ANCA

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45
Q

How should laser resurfacing and botox be staged?

A

Botox first, laser 2 weeks later

** relaxation of the underlying facial musculature facilitated by botox allows enhanced results of laser

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46
Q

How long prior to RAI do synthroid and cytomel need to be stopped

A

Cytomel : 2 weeks

Synthroid : 6 weeks

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47
Q

80% of the time, where does the uncinate process attach?

A

Lamina papyracea–
Frontal sinus will drain medial to the uncinate
The other 20% of the time, the uncinate attaches to the skullbase or the middle turbinate

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48
Q

Where should parietal bone grafts be obtained from?

A

2 cm lateral to the sagital suture over the parietal bone, which avoids the sagittal sinus

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49
Q

What pathogen is rhinophyma associated with

A

Demodex folliculorum

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50
Q

Where can the frontal branch of the facial nerve be found on endoscopic brow lift

A

On the undersurface of the temporoparietal fascia

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51
Q

What is the aplasia where the bony labyrinth is well formed but the organ of Corti is poorly differentiated with a poorly formed tectorial membrane and a collpsed Reissner’s membrane?

A

Scheibe aplasia

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52
Q

What is the aplasia where there is compete agenesis of the petrous portion of the temporal bone, thought to be 2/2 insult prior to wk 3 of devo

A

Michel aplasia

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53
Q

Which NSAID should not be given for more than 5 consecutive days?

A

Ketorolac

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54
Q

What is the blood supply to the temporalis muscle?

A

Anterior and posterior branches of the deep temporal artery which are branches off the second portion of the internal maxillary arter

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55
Q

What are the OSHA noise exposure regulations?

A

<8 hr 90dB
<2 hr 100dB
<30min 110dB
**every increase in 5 dB halves the exposure time

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56
Q

What % of otosclerosis cases have a hereditary basis?

A

70% (AD disease)

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57
Q

What is paracusis of willis?

A

Classic finding of otosclerosis where patients can hear better in noisy environments

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58
Q

When is chemotherapy recommended in addition to radiation treatment for oropharyngeal cancer?

A

When there are positive margins, ENE, or distant mets

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59
Q

In parathyroidectomy, degradation of the serum PTH that exceeds __% of the preexicion level confirms removal of hyperfunctioning tissue

A

40%

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60
Q

What is the primary parasympathetic neurotransmitter of the nose and leads to vasodilation

A

ACh

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61
Q

In what % of patients is the carotid artery dehiscent in the sphenoid?

A

23%

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62
Q

What is first line tx for keloids

A

Triamcinolone (kenalog) injection

Inhibits fibroblast activity and collagen synthesis and increased collagenase production

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63
Q

What is the SMAS continuous with on the face?

A 
Temporoparietal fascia (frontal branch can be found here)
Galea
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64
Q

What is the second MC form of hypogammaglobulimemia and results from a failure of B call maturation, leading to recurrent URI

A

Common variable immunodeficiency

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65
Q

What presents with a triad of thrombocytopenia, eczema, and recurrent sinopulmonary infections and is associated with IgM deficiency, affecting B and T cells

A

Wiskott-Aldrich

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66
Q

Where is nasal skin the thinnest?

A

Rhinion: intersection of the nasal bones and the ULCs

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67
Q

What will be seen on CT chest in the setting of RRP

A

Peripheral nodules that show central cavitation and air-fluid levels

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68
Q

What nerve supplies sensation to the nasal tip?

A

External nasal branch of the anterior ethmoid nerve

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69
Q

What lower lid incision has the highest risk for ectropion

A

Subciliary

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70
Q

What syndrome presents with abnormal thyroid hormone metabolism, goiter, congenital SNHL, and positive perchlorate test

A

Pendred

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71
Q

Adenoid cystic carcinoma is associated with deposition of what substance

A

Amyloid

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72
Q

Distance from the lacrimal crest to the anterior ethmoid

A

24 mm

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73
Q

Distance from the lacrimal crest to the posterior ethmoid foramen

A

36

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74
Q

Distance from the lacrimal crest to the midpoint of the optic foramen

A

42

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75
Q

What is the definition of CPAP compliance

A

CPAP for more than 4 hr a night for 5 nights a week

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76
Q

What is Ohngren’s line

A

Angle of the mandible to the medial canthus, delinates tumors in the superior portion of the paranasal sinuses that have increased predisposition to invade the skull base, therefore poor prognosis

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77
Q

What are vertical glabellar lines caused by? Horizontal?

A

Vertical: corrugator
Horizontal: procerus

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78
Q

What canal is most commonly eroded by cholesteatoma?

A

Horizontal SCC

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79
Q

What is the characteristic appearance of acoustic neuroma on MRI?

A

T1: Iso or hypointense
T2: Heterogenously hyperintense
Marked enhancement with contrast

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80
Q

What is the only nasal spray that is approved for use in rhinitis of pregnancy

A

Budesonide

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81
Q

What is a cyst that arises from a pharyngeal notochord remnant in the nasopharynx and is surrounded by adenoid tissue

A

Thornwaldt’s cyst

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82
Q

Are inferiorly or superiorly based flaps more likely to develop trap door deformities?

A

Superiorly, 2/2 lymphatic flow

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83
Q

What is the malformation limited to the membranous portion of the pars inferior that is the most commonly observed T bone dysplasia in cases of congenital profound SNHL

A

Scheibe aplasia

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84
Q

Blood supply to the SCM (3 parts)

A

Upper: Occipital
Middle: Superior thyroid
Lower: Suprascapular

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85
Q

What is the most consistent laboratory finding in vestibular neuritis?

A

Reduction or caloric response

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86
Q

What is the treatment of vestibular neuritis?

A

Methylprednisolone

**no indication for valacyclovir

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87
Q

Roll of the false vocal folds or vestibular folds

A

Airway protection

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88
Q

Expected functional limitation of donor site after free flap reconstruction

A

Limitation of eversion

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89
Q

The anterior ethmoid artery is always seen between what two lamellae?

A

2nd: bulla
3rd: basal lamella

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90
Q

What is OK-432 and what is it used to treat?

A

Picibanil, comes from strep pyogenes treated with benzylpenicillin
Used as a sclerosing agent for lymphatic malformations (macrocystic has the best response)

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91
Q

Lid elevation via botox injection is best achieved via injection of what structure

A

Crows feet–lateral orbicularis

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92
Q

Which petrous apex lesion is hyper intense on both T1 and T2?

A

Cholesterol granulomas

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93
Q

How can a petrous apex lesion can be diagnosed as a cholesterol granuloma vs cholesteatoma?

A

CG: T1 and T2 hyperintense
Ctoma: Hypointense T1, hyperintense T2

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94
Q

What are the most notable allergens in spring, summer, and fall?

A

Spring: Trees
Summer: Grasses
Fall: Weeds

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95
Q

What is the only instance you’d see a non-recurrent left laryngeal nerve?

A

Situs inversus

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96
Q

What is the most likely cause of a nonrecurrent R laryngeal nerve

A

Retroesophageal R subclavian artery–usually RLN pulled by the R subclavian artery during development

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97
Q

Where is the Killian triangle?

A

Between the inferior constrictor and the cricopharyngeus

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98
Q

What are the two less common sites of diverticula aside from the Killian triangle?

A

Inferiorly: Larimer triangle, between the cricopharyngeus and the superior esophageal circular muscle
Laterally: Killian Jamieson, between the oblique and transverse fibers of the CPM

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99
Q

Hillocks of his derivatives:

A

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

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100
Q

Triad of Gradenigo’s syndrome

A

Abducens palsy (CN VI), retroorbital pain, and otorrhea

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101
Q

What is the role of E6 in HPV?

A

Binds and leads to degradation of p53 tumor suppressor gene product

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102
Q

What is mitomycin derived from and what is the MOA?

A

Streptomyces caespitosus

Alkylating agent to inhibit DNA synthesis

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103
Q

What voice condition often improves with benzos or other sedatives

A

Spasmotic dysphonia

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104
Q

Timeframe for imbibition, inosculation, and angiogenesis

A

Imbibition: first 24-48 hr
Inosculation: 48 hr - 4 days
Angiogenesis: 4-7 dars

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105
Q

What type of HSV is associated with kaposi sarcoma?

A

HSV8

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106
Q

What complication is most likely to be seen in a fracture o the T bone running through the geniculate ganglion of the facial nerve

A

Dry eye

Geniculate ganglion gives of the GSPN which contains parasympathetic innervation to the lacrimal gland

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107
Q

T staging for nasopharyneal carcinoma

A

T1: nasopharynx, can extend to oropharynx
T2: Extension into parapharyngeal space and pterygoid musculature
T3: Invasion of bony structures and/or paranasal sinuses
T4: Intracranial extension, IT fossa, hypopharynx, or orbit

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108
Q

Tumor that is HMB 45 and S-100 positive is most consistent with

A

Melanoma

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109
Q

What marker is esthesioneuroblastoma often positive for?

A

Neuron specific enolase

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110
Q

What is the black box warning for PTU? When should PTU be used instead of methimazole?

A

Liver failure

SHould be used in the first trimester of pregnancy given risk of congenital defects with methimazole

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111
Q

What pressure is needed for cervicofacial liposuction?

A

1 atm (higher perssures are needed for body)

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112
Q

‘Motor oil fluid’ inside a parotid lesion is pathnomic for:

A

Warthin tumor

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113
Q

What happens to collagen and elastin levels in presbylaryngis?

A

Collagen (types I and III) increase

Elastin decreases

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114
Q

MC complication of caldwell luc procedure

A

Nasal obstruction

115
Q

What age can play audiometry be used for?

A

3-5 yo

116
Q

What is the etiologic agent of oral hairy leukoplakia

MC location

A

EBV

Lateral tongue

117
Q

How many hours NPO after ingestion of fatty meal prior to anesthesia?
Light meal?
Breast milk?
Clears?

A

Fatty meal: 8 hr
Light meal: 6 hr
Breast milk: 4 hr
Clears: 2 hr

118
Q

When is ENog useful in facial nerve palsy?

A

Patients with full nerve loss after 3 days

Greater than 90% degeneration would support exploration

119
Q

What modulators are upregulated with intradermal immunotherapy?

A

IL 10
IFG beta
**leads to deviation towards Treg response

120
Q

How can types 1 and 2 Waardenburg syndrome be distinguished

A

Dystopia canthorum: displacement of the inner canthi and lacrimal puncti

121
Q

Majorty of epistaxis occurs at the anastomosis of which 4 arteries

A

Anterior ethmoid
SPA
Superior labial
Greater palatine

122
Q

What is the drainage pathway of the frontal sinus in 80% and 20% of cases

A

80% uncinate attaches to the lamina–drainage medial to the uncinate and infundibulum
20% uncinate attaches to the SB and drainage is lateral to the uncinate into the infundibulum

123
Q

What are the results of the following Z pasty angles on scar rotation and scar elongation?
30 deg
45 deg
60 deg

A

30 deg -> 45 deg scar rot -> 25% elongation
45 deg -> 60 deg scar rot -> 50% elongation
60 deg -> 90 deg scar rot -> 75% elongation

124
Q

MOA of meclizine

A

H1 receptor antagonist w anticholinergic properties

125
Q

Masking should be used on the contralateral ear whenever there is >__ dB air-bone gap

A

10 dB

126
Q

MOA of botox

A

Inhibits presynaptic release of ACTh, preventing conduction of nerve signals

127
Q

When is the highest risk for TI fistula?

A

2-3 weeks after surgery

128
Q

What is the MC type of rhabdomyosarcoma?

What is the MC type in rhabdomyosarcoma in adolescents?

A

Embryonal

Alveolar

129
Q

Based on Freidman staging,, who would benefit most from UPPP

A 
Large tonsils (3-4+)
BMI <40
Grade 1-2 palate
80% success w Stage I
40% success w Stage II
10% success w Stage III (BMI>40)
130
Q

What do the superior and inferior vestibular nerves innervate

A

Superior: Superior SCC, lateral SCC, utricle
Inferior: Posterior SCC, saccule

131
Q

What kind of a flap its a rhomboid?

A

Translational: adjacent tissue is rotated to fill a defect resulting in a secondary defect

132
Q

What malignancy does caustic ingestion put patient at risk for?

A

SCC

133
Q

Superior laryngeal nerve passes through which membrane and travels with which artery

A

Thyrohyoid artery

Superior laryngeal artery

134
Q

What numbers would people with adductor and abductor dysphonia have counting between?

A

Adductor: 80-89, difficulty with vowels
Abductor: 60-69

135
Q

What is the most common midine developmental nasal mass?

A

Dermoid: does not transilluminate, negative Furstenbery test. Fluctuating cyst with a sinus tract. May have intracranial component

136
Q

MC causative agent of croup?

A

Parainfluenza

137
Q

Major blood supply to the adenoids

A

Pharyngeal branch of the imax

138
Q

What is the pathophysiology of postoperative pulmonary edema after tonsillectomy?

A

Loss of auto-PEEP from chronic obstruction and decreased intrathoracic pressure
tx: diuretics, fluid restriction, and CPAP

139
Q

What is PFAPA characterized by and what is the management?

A

Periodic (every 3-5 wk for 6 mo) fevers, aphthous stomatitis, pharyngitis, and cervical lymphadenopathy
Tx w T&A

140
Q

Which syndrome leads to malformation of the 1st and 2nd branchial arches?
What gene?

A

Treacher Collins
TCOF 1
Presents with malformed ossicles, auricular deformity, aural atresia, CHL, preauriclar fistulas, coloboma of the lower lids, mandibular hypoplasia

141
Q

Mutation seen in Stickler syndrome

A

COL2A1 on chrom 12, responsible for collagen II synthesis

PRS, myopia with retinal detachment, joint hypermobiity, SNHL

142
Q

Gene in branch-oto-renal syndrome

Presentation

A

EYA1
Brachial cleft cysts or fistulas
Otologic issues – HL, pre auricular pits (CHL)
Renal dysplasia (genesis, polycystic, duplicated ureters)

143
Q

What syndrome is characterized by SNHL and iodine metabolism defect leading to euthyroid goiter
What structural otologic malformations are associated?

A 
Pendrend syndrome
Modini malformation (1.5 turns) and enlarged vestibular aqueduct
144
Q

What syndrome is characterized by progressive hearing loss and retinitis pigmentosa
MC type of the syndrome

A

Usher syndrome

Type I: profound HL, RP by age 10, absent vestibular response

145
Q

What syndrome is characterized by progressive SNHL and renal disease characterized by defective basement membrane

A

Alport syndrome

146
Q

X linked recessive syndrome characterized by blindness and early onset SNHL

A

Norrie syndrome – NDP gene

147
Q

What X linked recessive syndrome is characterized by Klippel Feil malformation (fusion of the cervical spine), SNHL or mixed HL, and CN VI paralysis

A

Wildervaank syndrome

148
Q

Syndrome characterized by abnormal facies (almond shaped eyes, deficient alas, malar flatness), VPI, and cardiac anomalies (VSD)

A

Velocardiocacial syndrome

149
Q

What are the components of DiGeorge syndrome

A

CATCH-22

  • Cardiac anomalies (TOF)
  • Abnormal facies
  • Thymic aplasia
  • Cleft palate
  • Hypocalcemia, hypoparathyroidism
  • *some present initially with hoarseness associated with anterior glottic web
150
Q

What presents with central megaincisor and cerebral malformations

A

Congenita pyriform aperture stenosis

151
Q

What is the developmental source of choanal atresia

A

Persistent buccopharyngeal membrane

152
Q

What causes cleft palate?

Cleft lip?

A

Palate: failure of bilateral palatine shelves (from maxillary processes) to fuse at the midline with developing nasal septum (from frontonasal processes and bilateral medial nasal processes)
Lip: Failure of fusion of the maxillary swelling with the medial nasal processes

153
Q

What is the rule of 10s for cleft lip repair

A

10 wk old
10 kg
hgb 10

154
Q

New onset biphasic stridor in a patient w no FB history

A

Subglottic hemangioma

155
Q

Stridor in patient with hx of intuition, NICU admission ,or prematurity, consider

A

SGS or subglottic cyst

156
Q

What type of HPV causes RRP?

A

HPV 6 and 11

157
Q

Cotton myer grading system for SGS

A

I: <50%
II: 51-70%
III: 71-99%
IV: complete obliteration

158
Q

MC type of TE fistula

A

Type C: esophageal atresia with distal TE fistula

159
Q

What kind of necrosis does acidic vs alkaline ingestion result in?

A

Acidic: Coagulative (superficial)
Alkaline: Liquidative (deep)

160
Q

What conditions can a pediatric aural polyp be associated with?

A

Chronic OM, w or w/o cholesteatoma
Necrotizing OE: DM or immunosuppression
Rhabdomyosarcoma
Langerhans cell histiocytosis: eosiniophilic granuloma
Hand-Schuller Christian disease: DI, proptosis, lytic lesions
Letterer-Siwe disease: acute disseminated disease

161
Q

Risk factors for OM

A 
Male gender 
Bottle feeding
Older siblings with OM
Daycare attendance 
Low SE status 
Maternal smoking
Craniofacial anomalies 
Immunosuppression
162
Q

What mutation is present in 30% of nonsyndromic congenital HL patients

A

Connexin 26

163
Q

Defective development of the otic placed leading to absence of the cochlea, SCC, and vestibule

A

Michel aplasia

164
Q

What are the types of membranous inner ear malformations?

A

Schiebe (MC)
Bing-Siebenmann
Alexander

165
Q

What is Scheibe malformation

A

MC type of congenital inner ear aplasia
Involves the cochlea and the saccule (membranous)
No abnormalities on imaging
Profound SNHL, but amplification may be helpful

166
Q

What is Alexander malformation?

A

Least severe form
Partial aplasia of the cochlear duct (basal turn)
High frequency HL, amplification helpful

167
Q

Which inner ear aplasia presents with a normal bony labyrinth but a malformed membranous labyrinth almost in its entirety, but radiologically normal

A

Bing-Siebenmann

168
Q

What is the SCC that is most commonly affected by developmental issues

A

Lateral SCC, develops last

169
Q

Enlarged vestibular aqueduct loosely defined as >__ in diameter

A
  1. 5 mm

* * HL associated with this disorder brought on by head trauma

170
Q

What is a narrow (<3mm) vs enlarged (>10mm) IAC associated with

A

Narrow: absent or hypoplastic CN VIII
Enlarged: stapes gusher

171
Q

Causitive agent to rhinoscleroma?

Path will show:

A 
Klebsiella rhinosclertomatis
Mikulicz cells (macrophages with pathogen)
Russel bodies (plasma cells)
172
Q

Contributors to kiesselbach’s plexus

A

SPA
Greater palatine
Anterior ethmoid
Superior labial

173
Q

Keros classification

A

Distance from the cribriform plate to the fovea ethmoidalis
I: 1-3 mm
II: 4-7 mm
III: 8-16 mm

174
Q

Foramina of Breschet

A

Venous perforators connecting intracranial and extracranial vascular supply, most commonly convey infection from the frontal sinuses

175
Q

How can superior orbital fissure syndrome be differentiated from orbital apex syndrome

A

SOFS: ophthalmoplegia, ptosis, proptosis, ipsilateral forehead paresthesia, and fixed dilated pupil
OAS: SOFS + CN II involvement (vision changes or blindness)

176
Q

What is Foster Kennedy Syndrome?

A

Unilateral anosmia, optic atrophy, and papilledema due to frontal lobe mass

177
Q

AR defect in the dyne arms of cilia and of respiratory tract and reproductive system

A

Primary ciliary dyskinesia (PCD)

178
Q

Primary ciliary dyskinesia with situs inverses and bronchiectasis

A

Kartageners syndrome

179
Q

What is the MOA of ASA sensitivity in Sampters triad

A

ASA ingestion -> inhibition of metabolism of arachidonic acid -> stimulation of 5 lipo-oxygenase and production of leukotrienes -> asthma and allergy effects

180
Q

Distance from the anterior lacrimal crest to the AEA
AEA to the PEA
PEA to the optic nerve

A

8-12 mm
10-12 mm
4-6 mm

181
Q

What is a cystic remnant of caudal notochord that can be seen in the midline nasopharynx

A

Tornwaldt cyst

182
Q

Syndrome with polyosteotic fibrous dysplasia, precocious puberty, and cafe-au-lait lesions

A

McCune-Albright syndrome

183
Q

How do Draf I, IIa, and IIb differ

A

I: Removal of anterior ethmoid cells, uncinate, and obstructive frontal cells but no instrumentation of the frontal recess
IIa: I + widening of the frontal recess, w resection of the frontal sinus floor from the lamina to the insertion of the middle turbinate
IIb: IIa + resection of the middle turbinate to widen from the lamina to the septum

184
Q

Hows is a Draf IIb advanced to a Draf III?

A

Removal of the intrasinus septum to connect the bilateral frontal sinuses into ta horseshoe shaped sinus with a common drainage pathway

185
Q

What size wheal would represent a massive rxn that necessitates cessation of intradermal testing?

A

13 mm

186
Q

Clinical diagnostic criteria for Kawasaki disease?

A

Fever >5 days and 4-5 of the following

  1. Cervical lymphadenopathy
  2. Rash of the palms and soles
  3. Truncal rash
  4. Painless conjunctivitis
  5. Tongue erythema
187
Q

What is a late CV risk of Kawasaki disease?

A

Coronary artery dilation and aneurysms (7-20%), can lead to MI 2-12 wk after disease onset

188
Q

Tx of Kawasaki disease

A

IVIg and high dose ASA

189
Q

Jaw pain, flow grade fever, and sometimes visual disturbance

A

Giant cell arthritis/temporal arteritis

190
Q

Dx and tx of temporal arteritis

A

Dx: Elevated ESR, multinucleated giant cells seen on artery bx
Tx: Oral steroids if no vision loss, otherwise IV

191
Q

Interstitial keratitis, vestibular sx, meniere-like HL, all preceded by viral prodrome
Tx?

A

Cogan’s syndrome

Systemic steroids, topical ophthalmic steroids, and cyclophosphamide

192
Q

What virus is found in the lesions of Kaposi sarcoma?

A

HHV-8

193
Q

What is a variant of sarcoidosis that presents with a prodrome of fever, malaise, nausea and night sweats and progresses to parotitis, uveitis, CN VII paralysis, diagnosed with elevated ACE level

A

Heerfordt’s disease

194
Q

What is the key features that will differentiate Churg Struss from Wegners

A

Asthma – Churg strauss presents with eosinophilic infiltrative stage and asthma

195
Q

What is the MC site of amyloid deposition in the H&N region?

A

Larynx–true and false VF, ventricles

Light chain Ig type

196
Q

What kind of hypersensitivity is SLE?

A

Type III: immune complex deposition in the BM of dermal-epidermal junctions

197
Q

What is the difference between acute and chronic laryngeal involvement of rheumatoid arthritis?

A

Acute: tender, erythematous, and edematous arytenoids
Chronic: CA joint involvement with ankylosis, can lead to bilateral VF fixation, can see sublimed CA join. Submucosal nodules

198
Q

What is the triad of symptoms seen in Behcet’s syndrome?

A
  1. Oral aphthous ulceration and genital ulcers
  2. Iritis and uveitis
  3. Progressive SNHL
199
Q

What disease is caused by antibodies against postsynaptic ACh nicotinic receptors leading to insufficient Na entry into myocytes?

A

Myasthenia gravis

200
Q

What is the tx for MG?

A

Acetylcholinesterase inhibitors to increase ACh levels acting on post-synaptic receptors to overcome inhibitory antibiodies

201
Q

What is the difference in where antibiodies are directed in pemphigus vulgaris vs (bullous) pemphigoid?

A

PV: Desmoglein 3, separation of the superficial epithelium from the parabasal epithelium–no separation at the level of the basement membrane, + acantholysis
BP: Multiple antigens at the level of the basement membrane (BP antigen 2, BP hemidesmosomal antigen 180, laminin 5), separation of the epithelium from the LP

202
Q

Palpable firm mass of the neck after dental procedure with a sinus tract

A

Actinomyces: multifilamented anaerobic gram + rod, forms sulfur granules

203
Q

Treatment of actinomyces infection of the neck

A

PCN G IV 2-6 wk (tetracycline or erythro if PCN allergic)

I&D

204
Q

What stain does Bartonella show up on?

A

Intracellular pleomorphic gram negative bacillus, visible on Warthin starry silver stain

205
Q

What cardiologic concern should you have in the setting of tonsillar pseudomembrane with dyshagia and dysphonia

A

20% of myocarditis with diphtheria

206
Q

What pathogen causes Lemierre syndrome

A

Fusobacterium necrophorum – bacterial endotoxin causes platelet aggregation

207
Q

What are Griesinger’s sign and Queckenstadt (Toby-Ayer) test for Lemierres

A

Griesinger: edema and erythema of the mastoid process
Queckenstadt: measuring CSF pressure change w LP with compression of IJ–if no change likely thrombus

208
Q

What kind of virus is EBV

A

ds DNA herpes virus

209
Q

What virus is seen in oral hairy leukoplakia, which is a AID defining infection

A

EBV

210
Q

Though secondary bacterial infection can be seen in the setting of infectious mononucleosis, what abx should be avoided?

A

Ampicillin/Augmentin–can cause maculopapular rash

211
Q

What titer can be used for prognostication in WHO II and III NPC?

A

antibody dependent cellular cytotoxicity titers

212
Q

What non-Hodgkins lymphoma is associated with EBV and what is the translocation seen?
What histology is characteristic
Tx

A

Burkitts
mic gene from chromosome 8 to 14
Starry sky – small non-cleaved cells with minimal variability
ara-c, MTX. Do not give steroids 2/2 risk of tumor lysis syndrome

213
Q

Viral causative agents of RRP vs H&N SCC

A

RRP: HPV 6 and 11
SCC: HPV 16 and 18

214
Q

How can fibrous dysphasia be differentiated from an ossifying fibroma?

A

Ossifying fibroma is encapsulated

215
Q

What mutation is seen in Pagets disease

Diagnosis?

A

Sequestome 1 – AD inheritance

Elevated alkaline phosphatase, lytic lesions of the calvarium

216
Q

What is the name of the vertically oriented fissures in the anteroinferior EAC cartilage that allow spread of infection and tumor to the parotid?

A

Fissures of Santorini

217
Q

Hypogonadotropic hypogonadism and anosmia due to failure of the hypothalamus to secrete GnRH (can be X linked or AD)

A

Kallman syndrome

218
Q

What lesion will be hypointense on T1/T2 with thickening of the maxillary sinus wall

A

Mycetoma

219
Q

What sinonasal lesion will have a ground glass appearance on CT and will be hypointense on T2 MRI?

A

Fibrous dysplasia

220
Q

What is Holman-Miller sign?

A

Anterior bowing of the posterior maxillary wall seen with JNA

221
Q

Which population is more likely to have the following pathogen cause invasive fungal sinusitis?

A

Mucor: DM in DKA
Aspergillus: Immunocompromise

222
Q

Bent and Kuhn classification (6) for AFS

A
  1. Nasal polyps
  2. Allergic mucin (w Charcot Leyden)
  3. Fungal elements
  4. CT findings w heterogenous density, sinus wall expansion
  5. Lack of invasion
  6. Hx of type I hypersensitivity
223
Q

What is Heerfordt’s syndrome?

A

Uveoparotid fever–extrapulmonary form of sarcoidosis, characterized by uveitis, parotid enlargement, and facial palsy

224
Q

What is the name of an autoimmune condition leading to firm enlargement of the SMG, path showing chronic inflammation with cirrhotic changes

A

Kuttner’s tumor (chronic sclerosis siladenitis)

tx: SMG excision for dx and tx

225
Q

What is the best flap for reconstruction of large upper lip defects of more than half up to 2/3 of the lip in which the philtrum is not involved

A

Karapandzic

**Abbe better for defects that involve the philtrum

226
Q

What % of the total nasal resistance is provided by the internal nasal valve

A

50%

227
Q

What is the name of the vertically oriented fissures in the anteroinferior EAC cartilage that allow spread of infection and tumor to the parotid?

A

Fissures of Santorini

228
Q

What is the clinical significance of a persistent foramen tympanum (foramen of Huschke)?

A

Occurs in 5% of the population

Provides a potential communication for spread of infection or tumor into the IT fossa

229
Q

Innervation of tensor veli palatine

Innervation of elevator veli palatini

A

TVP: CN V3
LVP: CN X

230
Q

What nerve crosses over the promontory?

What does it innervate?

A

Jacobson’s nerve (CN IX)

Parotid gland

231
Q

What is the most common site of primary acquired cholesteatoma?

A

Prussak’s space (epitympanum): bordered laterally by the pars flaccida

232
Q

What structure courses from the medial wall of the vestibule to a region of thickened posterior fossa dura?
What structure is continuous with the subarachnoid space of the posterior fossa and courses inferior and parallel to the IAC, opening at the base of the Scala tympani

A

Vestibular aquaduct

Cochlear aquaduct

233
Q

Cochlea and saccule are joined by a segment of membranous labyrinth called the ______

A

ductus reuniens

234
Q

Which components of the cochlea contain perilymph? Endolymph?

A

Perilymph: Scala vestibuli and tympani
Endolymph: Media **contains the organ of corti

235
Q

What separates the scala media from the Scala vestibuli?

A

Reissner’s membrane

236
Q

What supports the organ of corti and separates the Scala media from the Scala tympani?

A

Basilar membrane

237
Q

Which hair cell provides the majority of the afferent stimulation? Receives the effected from superior olivary nucleus?

A

Inner: 90% afferent
Outer: 10% afferent, receives efferent

238
Q

Which otolithic organ senses horizontal vs vertical acceleration?

A

Horizontal: utricle
Vertical: saccule

239
Q

What parts of the labyrinth do the superior and inferior vestibular nerves innervate?

A

Superior: utricle, superior SCC, lateral SCC
Inferior: saccule, posterior SCC

240
Q

Avg of hearing sensitivity at 500, 1000, and 2000 dL

A

PTA

241
Q

Lowest level at which a given word can be repeated 50% of the time

A

SRT

  • *assessed via spondee testing
  • **should estimate PTA within 10 dB
242
Q

What volume should WRS testing be performed at?

A

40 dB greater than SRT

243
Q

What dB reduction is seen in bone and air conduction thresholds in the setting of intraaural attenuation?

A

Bone: none
Air: 40 dB
**crossover is when intramural attenuation is exceeded to stimulate the test ear

244
Q

When should mask be using in air conduction testing?

A

If the signal presented to the tested ear is 40 dB greater than the BC threshold of the non-test ear

245
Q

When should masking be used in bone conduction testing?

A

If there is a suspected difference in bone conduction between test and contest ears

246
Q

When can the following forms of testing be used in children?

  1. Behavioral observation audiometry
  2. Visual reinforcement audiometry
  3. Conditioned play audiometry
A
  1. birth - 6mo
  2. 6 mo - 3 yr
  3. 3 yr to 5 yr
247
Q

How does tympanometry evaluate ear drum mobility?

A

Ear canal volume

248
Q

What are the three kinds of tymaograms?

A

Type A: normal
Type B: flat – low volume (effusion) or high volume (perf)
Type C: negative middle ear pressure, ETD

249
Q

What are the two subsets of type A typanogram

A

Type As: shallow or stiff, normal pressure but decreased compliance–otosclerosis, tympanosclerosis
Type Ad: deep, normal pressure but increased compliance–ossicular discontinuity, flaccid TM

250
Q

What are three general reasons for an absent stapedial reflex?

A
  1. Severe SNHL (over 65 dB), cannot stimulate CN VIII
  2. Any CHL
  3. Facial nerve pathology, defect in efferent pathway to tensor tympani
251
Q

What does a positive stapedial reflex decay test indicate

A

Retrocochlear pathology

252
Q

What does OTE test?

What kind of HL can it pick up?

A

Low energy sounds produced by cochlea in response to clicks, from outer hair cells
SNHL or CHL > 20-40 dB – absent response

253
Q

What are the waveforms assessed by ABR

A 
Wave I: Proximal CN VIII
Wave II: Distal CN VIII
Wave III: Cochlear nuclei
Wave IV: Superior olivary nucleus
Wave V: Lateral lemniscus
Wave VI: Inferior colliculus
254
Q

What is the most important predictor of success with CI?

A

Shorter duration of deafness

255
Q

What study is recommended in all patients with Down syndrome before age 4?

A

PSG

60% risk of OSA by age 4

256
Q

Why is gentamicin the preferred injection of the aminoglycosides for Menderes disease

A

Aminoglycosides are both ototoxic and vestibulotoxic, but gent is the most vestibulotoxic

257
Q

How far out should dermabrasions be spaced for tx of scars?

A

12 mo

258
Q
  1. Broad based osseous lesions of the EAC that are often multiple and bilateral
  2. Solitary pedunculated lesions of the EAC that often occur at the tympanosquamous or tympanomastoid suture lines
A

Exostoses

Osteomata

259
Q

Tx of lesion of cat scratch disease?

A

Azithromycin–no I&D indicated

260
Q

What are the following lines:

  1. Ohngrens
  2. Frankforts
A
  1. Ohngrens: angle of the mandible to the medial canthus, above the line in the sinuses, tumors have increased propensity to invade the skull base
  2. Frankforts: superior EAC to the inferior orbital wall, used in facial analysis
261
Q

What is the only chemical peeling agent that requires neutralization to end its activity?
How is it neutralized?

A

Glycolic acid

Rinsing with water or 5% sodium bicarbonate solution

262
Q

MC quadrant for congenital cholesteatoma

A

anterosuperior quadrant

263
Q

In HPV + BOT SCC, what is the rate of clinically significant cervical mets at the time of dx?
Rate of bilateral cervical mets at the time of dx?

A

60%

20%

264
Q

MC sites of LN mets in BOT cancer

A

Levels II-IV

265
Q

AJCC 8 clinical vs pathological N staging in HPV+ OP SCC

A 
CLINICAL:
cN0: No LN
cN1: One or more ipsilateral nodes <6cm
cN2: Contralateral or bilateral nodes <6cm
cN3: Nodes > 6cm

PATHOLOGIC:
pN0: No mets
pN1: <4 LN
pN2: >4 LN

266
Q

AJCC 8 T staging for HPV+ OP SCC

A

T0: No primary
T1: <2 cm
T2: 2-4 cm
T3: >4 cm or extends to lingual surface epiglottis
T4: Invades larynx, extrinsic muscle of the tongue, medial pterygoid, hard palate, or mandible

267
Q

Wound strength as compared to normal dermis at the following time points after injury
1 wk
3 wk
3 mo

A

1 wk–3%
3 wk–20%
3 mo–80%

268
Q

What is Alexander’s law with regard to nystagmus?

A

Intensity of nystagmus increases when looking toward the direction of the fast phase

269
Q

In what canals is ampullopetal flow excitatory? Ampullofugal?

A

Ampullopetal (towards ampulla): excitatory in lateral SCC

Ampullofugal: excitatory ins superior and posterior SCC

270
Q

What type of nystagmus indicates brainstem disease?

A

Pure vertical

271
Q

Hennebert’s sign

A

Pressure induced nystagmus or dizziness

272
Q

What do VEMPs measure and what is the pathway?

A

Vesticulocollic reflex
Sound -> stapes -> saccule (sound perception) -> inferior vestibular nerve -> medial/lateral vestibulospinal tract ->ipsilateral SCM

273
Q

MC canal affected by BPPV

A

Posterior, less commonly horizontal, rarely superior

274
Q

What kind of nystagmus will a patient with posterior canal BPPV have?

A

Vertical torsional

275
Q

Classic audiogram during Menieres episode?

A

Low frequency SNHL

276
Q

What is a vasodilator shown to decrease dizziness in Menieres in 2 randomized controlled trials

A

Betahistine

277
Q

How can auditory testing be used to distinguish hearing loss in otosclerosis from superior SCC dehiscence

A

Reflexes will be absent in otoslerosis and present in dehiscence

278
Q

Where is a notch typically seen with noise induced hearing loss?

A

4000 Hz

279
Q

What diuretics can be used to decrease calcium? Which ones increase calcium?

A

Decrease: Loop
Increase: Thiazides

280
Q

What is the only immunoglobulin that crosses the placenta

A

IgG

281
Q

What approach to the CPA carries highest risk to the facial nerve

A

Middle cranial fossa

282
Q

What is the maximal HL see with ossicular chain disruption without TM perforation? With TM perforation?

A

Without: min 35 to max 60 dB, unable to conduct sound to oval window with intact drum
With: 50 dB, conduction via TM perf to oval window

283
Q

What is a syndrome of recurrent facial paralysis, facial edema, fissured tongue

A

Melkerson-Rosenthal syndrome

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