Bullet Review Flashcards
What % of parotid and submandibular gland calculi are radiopaque on CT scan
1 0% and 90%, respectively.
What percent of parotid and submandibular gland calculi are radiopaque on CT scan?
10% and 80%, respectively.
What % of tympanocentesis specimens are sterile despite apparently active disease
20 - 30%.
What is the incidence of sterile tympanocentesis specimens in the presence of apparently active disease?
20-30%.
What is the minimum systolic arterial pressure required to maintain cerebral perfusion?
50 mm Hg.
Retropharyngeal abscess is most common in what age group?
6 months to 3 years (retropharyngeallymph nodes regress in size after the age of 3).
What is the most common type of tracheoesophageal fistula?
A blind-ending proximal esophageal pouch with a fistula from the lower esophagus to the trachea (85%).
What is rollover?
A decrease in speech discrimination at high intensities suggestive of a retrocochlear lesion.
What is a ranula
A mucous retention cyst involving the sublingual gland in the floor of the mouth characterized by a bluish surface.
An 11-year-old underwent excisional biopsy of a midline cyst adjacent to the hyoid bone. He continues to experience drainage and breakdown of his surgical wound. What is the treatment of choice
A Sistrunk procedure, the definitive procedure for thyroglossal duct cysts.
An infant presents with coughing, choking, and cyanosis during feeding. This clinical triad suggests what process?
A tracheoesophageal fistula.
A patient with HIV presents with gingival pain and a foul mouth odor. Physical examination reveals fever and cervical lymphadenopathy; examination of his oral cavity is shown below. “What is the most likely diagnosis?
Acute necrotizing ulcerative gingivitis, also known as trench mouth or Vincent’s disease. The punched-out ulcerations of the interdental papillae are pathognomonic.
A patient presents with gingival pain and a foul mouth odor. Physical examination reveals fever, lymphadenopathy, bright red gingiva and ulcerated papillae with a gray membrane. What is the most likely diagnosis
Acute necrotizing ulcerative gingivitis; also known as trench mouth or Vincent’s disease.
What is the preferred method of hand hygiene as recommended by the CDC and WHO?
Alcohol-based hand rub except when hands are visibly soiled or after caring for patients with infectious diarrhea, in which soap and water should be used.
Which syndromes are associated with hearing loss and renal abnormalities?
Alport, Branchiootorenal, Fanconi anemia, Turner, and Weil.
What syndromes are associated with hearing loss and renal abnormalities
Alport, Branchiootorenal, Fanconi Anemia, Turner, and Weil.
Six days after parotidectomy, your patient develops a fluid collection at the angle of the mandible. What test would be most helpful in determining the etiology of the fluid
Amylase (to differentiate between sialocele and seroma).
What disorder is characterized by deficiency of C1-esterase inhibitor?
Angioneurotic edema.
Acute, branching, septate hyphae are characteristic of which fungus
Aspergillus fumigatus.
Why is facial electroneurography (ENoG) an unreliable prognostic indicator more than 3 weeks after the onset of facial paralysis
Asynchronous discharge from regenerating nerve fibers can give a false-positive or false-negative report of nerve status.
In the tonotopic organization of the cochlea, where are the low frequencies located
At the cochlear apex.
What is the treatment for alar retraction of> 2 mm?
Auricular microcomposite graft.
What laboratory values are abnormal in patients with von Willebrand’s disease
Bleeding time and PTT.
Where is verrucous carcinoma most likely to arise?
Buccal mucosa.
What is the most common complication of the phenol peel?
Cardiotoxicity.
A 45-year-old man presents with a neck mass anterior to the sternocleidomastoid muscle. The mass is mobile laterally but not vertically. T1 MRI shows a soft tissue mass at the level of the carotid bifurcation that displaces the internal carotid artery posteriorly and the external carotid artery anteriorly. The mass enhances intensely and homogenously with gadolinium. What is the tumor?
Carotid body tumor.
What diagnosis must be investigated in a patient presenting with pulsating exophthalmos?
Carotid-cavernous fistula.
What diagnosis must be investigated in a patient presenting with pulsating exophthalmos
Carotid-cavernous fistula.
What is the most common cause of chronic cervical adenopathy in children and adolescents
Cat-scratch disease.
An ill-appearing patient presents with a fever of 103°F, bilateral chemosis, third nerve palsy, and sinusitis. What is the most likely diagnosis?
Cavernous sinus thrombosis.
An ill-appearing patient presents with a fever of 103 °F, bilateral chemosis, 3rd nerve palsy and sinusitis. What is the most likely diagnosis
Cavernous sinus thrombosis.
What cell bodies are contained within the geniculate ganglion
Cell bodies of somatic and visceral afferents of the mucous membranes of the nose, palate, and pharynx through the greater superficial petrosal nerve.
What tumors are physaliferous cells seen in?
Chordomas.
What is a hamartoma?
Circumscribed overgrowth of tissues, normally present in that part of the body.
What fungus produces a granulomatous tissue reaction and can cause the triad of pneumonitis, erythema nodosum, and arthralgias known as valley fever?
Coccidioidomycosis.
Which autoimmune disease causes both sensorineural hearing loss and interstitial keratitis?
Cogan’s syndrome.
What are the components of the CHARGE sequence?
Coloboma, heart defects, choanal atresia, retarded growth, genital hypoplasia, and ear anomalies.
What muscles create vertical glabellar rhytids?
Corrugator supercilii muscles.
Between what structures does a Killian-Jamieson dehiscence occur
Cricopharyngeus and circular fibers of the esophagus.
What is the etiology of a nasal dermal sinus?
Defective obliteration of the dural projection through the foramen cecum and entrapment of epithelium as the dural tract resorbs.
What bacterium is associated with rhinophyma?
Demodex follicularis.
What bacterium is associated with rhinophyma?
Demodex follicularis.
Which mandibular cyst forms around impacted molars?
Dentigerous cysts.
In a child with bilateral congenital aural atresia, how is normal sensorineural hearing confirmed in the ear to be operated on first
Detection of an ipsilateral wave I on bone conduction ABR.
What is the basic structure of IgA?
Dimer.
What part of the nerve unit is affected by Wallerian degeneration?
Distal axon to the motor end plate and proximal axon to the first node of Ranvier.
What part of the nerve unit is affected by Wallerian degeneration
Distal axon to the motor end plate and proximal axon to the I 51 node of Ranvier.
What is the most common presenting symptom in patients with Zenker’s diverticulum?
Dysphagia.
What is the most common complication ofblepharoplasty?
Ectropion.
What is the most common complication of blepharoplasty
Ectropion.
What is Griesinger’s sign?
Edema and tenderness over the mastoid cortex associated with thrombosis of the mastoid emissary vein secondary to lateral sinus thrombosis.
According to the Spaulding classification system, what level of disinfection must be used on endoscopes?
Endoscopes are considered “semi-critical” and require high-level disinfection prior to reuse.
What is the treatment of choice for granular cell tumor of the larynx?
Endoscopic excision.
What is the treatment of choice for bullous myringitis
Erythromycin.
A 3-year-old boy presents with a midline anterior neck mass just below the hyoid bone that moves with deglutition and tongue protrusion. What is believed to be the cause of this congenital mass
Failure of complete obliteration of the thyroglossal duct.
Why is it important to wear a face mask when inserting a catheter or injecting material into the epidural or subdural space?
Failure to wear face masks during these procedures has resulted in the development of bacterial meningitis in patients undergoing these procedures.
True/False: Most acoustic neuromas are inherited on chromosome 22.
False.
T/F: Most acoustic neuromas are inherited on chromosome 22
False.
T/F: A patient can lose more of the upper lip than the lower lip without cosmetic problems
False. Up to one-third of the lower lip can be avulsed or debrided and the patient may still have an acceptable cosmetic appearance. The upper lip is less forgiving due to the relationship with the columella, alar bases and philtrum.
True/False: Clostridium difficile spores are killed using alcohol-based hand rubs.
False: The best way to remove the spores from the hands is through hand washing and from surfaces is with bleach.
True/False: A patient can lose more of the upper lip than the lower lip without cosmetic problems.
False: Up to one-third of the lower lip can be avulsed or debrided and the patient may still have an acceptable cosmetic appearance. The upper lip is less forgiving due to the relationship with the columella, alar bases, and philtrum.
Nystagmus is defined by which component?
Fast component.
When is arterial thrombosis most likely to occur?
First 72 hours.
From which pharyngeal pouch is the tympanic membrane derived from?
First.
Where is the defect through which a nasal dermoid protrudes
Foramen cecum.
What organism causes Lemierre’s syndrome?
Fusobacterium necrophorum.
What is the most common hereditary cerebellar syndrome?
FXTAS (Fragile X Tremor Ataxia Syndrome).
Where are the cell bodies of special visceral afferent nerves from taste buds in the anterior 2/3 of the tongue?
Geniculate ganglion.
What is the most common tumor of the middle ear?
Glomus tumor.
What physical features constitute the Pierre-Robin sequence
Glossoptosis, micrognathia and cleft palate.
What is the most common cause of a widened dorsum after rhinoplasty?
Greenstick fractures from osteotomies.
Bilateral facial paralysis associated with progressive ascending motor neuropathy of the lower extremities and elevated CSF protein is characteristic of what clinical entity?
Guillain-Barre syndrome.
What is the most common complication of rhytidectomy?
Hematoma.
An 8-year-old boy has a draining ear filled with friable tissue. CT scan demonstrates a punched out lytic lesion of the temporal bone. Biopsies show only lipid-laden histiocytes. What is the most likely diagnosis?
Histiocytosis X.
How would you grade facial nerve function in a patient with facial asymmetry at rest, incomplete eye closure and minimal motion of the mouth with maximal effort
House Grade V.
What is the function of vitamin C?
Hydroxylation of proline and lysine.
What is the significance of time to reexploration and flap survival?
If flaps are reperfused in 1-4 hours, 100% survival is likely. If reperfusion is established by 8 hours, So% survival is likely. If reperfusion is not reestablished by 12 hours, flap survival is unlikely.
What is the initial treatment for any free flap that appears to be failing?
Immediate reexploration.
What is the most common complication of tissue expanders?
Implant exposure.
Where would you expect to find the parathyroid glands in a 1 0-year-old patient with a lingual thyroid gland
In the tracheoesophageal groove.
What is the mechanism of action of botulinum A toxin?
Inhibition of the release of acetylcholine at the presynaptic nerve terminal.
For which penetrating cervical injuries is angiography indicated in almost all cases?
Injuries involving zone 1or 3.
Where is tuberculosis of the larynx most commonly found?
Interarytenoid area and laryngeal surface of the epiglottis.
What are the disadvantages of using technetium scans to monitor therapy for necrotizing otitis externa?
It reflects osteoblastic activity and bone remodeling but is not specific for osteomyelitis. It also has poor spatial resolution and may remain positive long after clinical resolution.
What are the disadvantages of using technetium scans to monitor therapy for necrotizing otitis extern a
It reflects osteoblastic activity and bone remodeling but is not specific for osteomyelitis. It also has poor spatial resolution and may remain positive long after clinical resolution.
What precautions should be taken to prevent cardiotoxicity during phenol peel?
IV fluid hydration and treatment of the face in separate units, 30 minutes apart.
What is the most common site of origin of glomus tympanicum tumors?
Jacobson’s nerve which is a branch of the glossopharyngeal nerve. It contains sensory and secretary fibres. Sensory fibres supply the middle ear cavity. The parasympathetic fibres (lesser petrosal nerve) leave via own canal, enter the infratemporal fossa through foramen ovale. The fibres synapse in the otic ganglion an dare carried by the auriculo-temporal nerve (V3) before reaching the parotid.
Which nevi have the propensity for malignant degeneration
Junctional nevi.
Where are most esophageal foreign bodies found
Just below the cricopharyngeus muscle.
What is the most common complication of recurrent cholesteatoma?
Labyrinthine fistula.
In which LeFort fracture is CSF rhinorrhea most common?
LeFort III.
What is the most common benign tumor of the esophagus?
Leiomyoma.
What benign skin lesion capable of undergoing malignant transformation is characterized by irregular scattering of epidermal melanocytes with deepened rete ridges?
Lentigo maligna.
What benign skin lesion capable of undergoing malignant transformation is characterized by irregular scattering of epidermal melanocytes with deepened rete ridges
Lentigo maligna.
What is the diagnosis and treatment for a patient presenting with nasal obstruction and progressive destruction of the septal wall who is negative for c-ANCA
Lethal midline granuloma; radiation.
What happens if Jacobson’s nerve is divided
Loss of parasympathetic stimulation to the parotid gland.
Recurrent facial paralysis, facial edema, furrowed tongue and cheilitis are consistent with what diagnosis
Melkersson-Rosenthal syndrome.
What is class I occlusion?
Mesiobuccal cusp of the maxillary 1st molar is in occlusion with the buccal groove of the mandibular 1st molar.
What is the drug of choice for pseudomonas enterocolitis
Metronidazole (less expensive than oral vancomycin).
What two congenital malformations of the cochlea are contraindications to a cochlear implant
Michel aplasia and small internal auditory canal syndrome.
What do biopsy specimens of rhinoscleroma show?
Mikulicz cells, histiocytes, and Russell bodies.
What are the most common complications of dermabrasion?
Milia and hypopigmentation.
A 32-year-old sailor presents with a 6 month history of vertigo. On evaluation he has rotary nystagmus, scanning speech, an intention tremor and bilateral intranuclear ophthalmoplegia. What is the most likely diagnosis
Multiple sclerosis.
What finding on biopsy specimen distinguishes Sjogren’s syndrome from lymphoma
Myoepithelial cells are only seen in Sjogren’s syndrome.
A 3-year-old boy presents with a firm neck mass. Examination reveals Horner’s syndrome. What is the most likely diagnosis?
Neuroblastoma.
A 3-year-old male presents with a firm neck mass. Examination reveals Horner’s syndrome. What is the most likely diagnosis
Neuroblastoma.
Two months after autograft hair transplantation, all of the hair falls out. What do you tell your patient
New hair should start to grow about I 0 - 16 weeks after surgery.
After a knife wound to the cheek just inferior to the medial canthus, the patient has buccal branch paralysis. How is this managed?
Observation; exploration is not warranted if the injury occurs medial to the lateral canthus.
What is the blood supply to the sternocleidomastoid flap?
Occipital artery, superior thyroid artery, transverse cervical artery, inferior thyroid artery.
What is the primary treatment for erysipelas involving the ear?
Oral or intravenous antistreptococcal antibiotics.
What is the most common cause of vertigo in a child
Otitis media.
A 7-year-old female presents for evaluation of florid warty lesions growing from both tonsils. Biopsy demonstrates well differentiated, nonkeratinizing squamous epithelium growing over a fibrovascular stalk. What is the most likely diagnosis
Papillomatosis.
What is a ranula? A mucous retention cyst involving the sublingual gland in the floor of the mouth characterized by a bluish surface. A 48-year-old man presents with a high fever, trismus, dysphagia, and swelling inferior to the mandible in the lateral neck. What is the most likely diagnosis?
Parapharyngeal space abscess.
A 48-year-old male presents with a high fever, trismus, dysphagia and swelling inferior to the mandible in the lateral neck. What is the most likely diagnosis
Parapharyngeal space abscess.
What is the most common cause of primary hypercalcemia?
Parathyroid adenoma.
What is the most common cause of voice failures after TEP?
Pharyngoesophageal spasm.
What is the initial treatment for a patient with suspected air embolism?
Placement of the patient in the left lateral decubitus position and Trendelenburg.
What is the most common reason for rhinoplasty revision?
Polly Beak deformity or supratip swelling.
A patient with a frontal sinusitis presents with a large forehead abscess. “What is the most likely diagnosis?
Pott’s puffy tumor.
What is the most feared complication of septal hematoma?
Saddle nose deformity.
A 7-year-old girl presents for evaluation of florid warty lesions growing from both tonsils. Biopsy demonstrates well-differentiated, nonkeratinizing squamous epithelium growing over a fibrovascular stalk. What is the most likely diagnosis. What etiology must be considered in the above patient?
Sexual abuse.
What organism is most commonly involved in bacterial tracheitis?
Staphylococcus aureus.
A 4-month-old female child has had a progressive barking cough and inspiratory stridor for 2 months. Examination reveals a raised, bright red lesion on her back that has been gradually enlarging. High kilovoltage X-rays of her neck demonstrate asymmetric narrowing of the subglottic region. What is the most likely diagnosis?
Subglottic hemangioma.
What complication is seen more often with cricothyroidotomy than tracheotomy?
Subglottic stenosis.
What is the most common complication of acute mastoiditis
Subperiosteal abscess.
What is the blood supply to the cerebellum?
Superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery.
Fourth and sixth arch derivatives are innervated by which nerves
Superior laryngeal nerve and recurrent laryngeal nerve, respectively.
A toddler sustains an electrical injury to the commissure of his mouth after biting through an electrical cord from a floor lamp. What post-injury warning should be given to the parents
The labial artery may hemorrhage if the overlying soft tissue of the commissure breaks down. The parents should be instructed to hold digital pressure on the lip with their thumb and index finger to control the bleeding and seek help immediately.
Which organ in the head and neck is most sensitive to radiation?
The lens.
A 9-year-old boy presents with headaches and a rock-hard left posterior triangle mass. Examination is significant for mouth breathing and bilateral serous otitis media. Fine needle aspiration of the neck mass reveals poorly differentiated malignant cells. What is the most likely source of the tumor?
The nasopharynx.
The incidence of stones is highest in which salivary gland?
The submandibular gland.
In which salivary gland are stones most likely to occur
The submandibular gland.
What do neurofibromatosis, tuberous sclerosis and von Hippei-Lindau disease have in common
These are phakomatoses, a group of hereditary syndromes with neural, ocular and cutaneous manifestations.
What is the primary blood supply to the trapezius muscle
Transverse cervical artery.
A 6-year-old boy is referred because of hearing loss. Audiometric studies reveal a 40 dB conductive hearing loss in the left ear. He is also noted to have downward sloping palpebral fissures, depressed cheek bones, deformed pinnas, receding chin and a large fishmouth. What is the most likely diagnosis
Treacher Collins syndrome.
True/False: A narrow internal auditory canal is a contraindication for cochlear implantation.
True.
True/False: Cephalosporins are contraindicated in patients with a history of anaphylaxis to penicillin.
True.
True/False: Children are more likely than adults to form hypertrophic scars.
True.
True/False: Vancomycin does not cross the blood-brain barrier.
True.
T/F: A narrow internal auditory canal is a contraindication for cochlear implantation
True.
T/F: Cephalosporins are contraindicated in patients with a history of anaphylaxis to penicillin
True.
What is the most common cause of massive hemoptysis (>6oo mL of blood in 24 hours)?
Tuberculosis.
What is scrofula?
Tuberculous or nontuberculous cervical adenopathy.
Which part of the facial nerve would be divided if lacrimation and the stapedial reflex are preserved, but movement of the muscles of facial expression and taste to the anterior 2/3 of the tongue are absent?
Tympanic.
What is the anterior limit of the hiatus semilunaris?
Uncinate process.
What is the most common cause of flap failure?
Venous thrombosis.
An 88-year-old white man presents with a painless mass just below his ear that has been slowly enlarging over 2-3 years. Pathology shows round, plump, granular eosinophilic cells with small indented nuclei. What is the most likely diagnosis?
Warthin’s tumor.
What is another name for papillary cystadenoma lymphomatosum
Warthin’s tumor.
