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bv Flashcards

1
Q

arterial supply of SCM

A
  1. occipital 2. superior thyroid vs ECA 3. suprascapular
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2
Q

arterial supply of SAI

A

supraclavicular artery from transverse cervical

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3
Q

Gottfredson’s sd

A

VI and XII palsy; MCC metastatic tumor to clivus, 2nd MCC infiltrating NPC

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4
Q

Vernet’s sd

A

jugular foramen sd (IX, X, XI) out vs Villaret Sd (IX-XII + sympathetic chain) vs Collet Sicard (IX-XII)

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5
Q

majority of submax stones are where? vs parotid stones?

A

proximal duct>distal duct>parynchema vs distal duct>parynchema>proximal

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6
Q

what is Heerfordt’s sd

A

uveoparotid fever–extrapulm form of sarcoid with uveitis, parotid enlargement, SNHL, malaise, fever, facial paralysis 50% of time

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7
Q

Sjogren’s sd is assoc w which malignancy?

A

non Hodgkin’s lymphoma (iMALT being highest risk)

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8
Q

parasympathetic course of parotid innervation

A

inferior solitarius –> IX –> jacobson –> lesser petrosal –> otic ganglion –> auriculotemporal nerve (V3)

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9
Q

mechanism of action of cisplatin?

A

crosslinks DNA

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10
Q

MC site of cancer in oral cavity

A

lip

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11
Q

in unknown primary, if FNA shows adenocarcinoma, which staining is also recommended?

A

thyroglobulin and calcitonin

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12
Q

MC jugular foramen schwannoma

A

vagal –> IX

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13
Q

what’s the common pattern of hearing loss in Meniere’s

A

low freq hL

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14
Q

otitic hydrocephalus is most likely caused by what

A

OM into sigmoid sinus–> lateral sinus thrombosis

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15
Q

thymus is derived from what

A

3rd pharyngeal POUCH

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16
Q

Rhabdomyosarcoma types: embryonal, alveolar, pleomorphic, undifferentiated, anaplastic
MC in which age groups, worst prognosis

A

embryonal MC in H&N
Alveolar (worst) teenager outside of H&N (body)
Pleo: adults
other 2 are rare

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17
Q

MC sensory nerve injured during facelift

A

greater auric

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18
Q

MC motor nerve injured during facelift

A

marg and temporal

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19
Q

MC salivary gland malignancy in pediatrics

A

muco ep; usually lower grade, if pediatric pt has parotid mass is malignant unless proven otherwise

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20
Q

how to stage well diff thyroid CA in pts <45yo

A

stage 1: everything

stage 2: distant mets

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21
Q

most important prognostic factor of stage III melanoma

A

how many LNs involved vs stage I and II is tumor thickness

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22
Q

which chemical peel requires rinsing w water or neutralization with bicarb?

A

glycolic acid

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23
Q

reverse Townes view assess mandible fx where

A

chondyle

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24
Q

congenital vocal cord paralysis is bilateral what % of time?

A

50%

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25
Q

what are the stages of esophageal burn?

A

first degree: mucosa erythema
second degree non-circumferential exudates or ulcer
third degree: circumferential exudate or ulcer
fourth degree perforation
(think burn)

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26
Q

primary treatment of achalasia

A

Heller myotomy

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27
Q

what tests order in injury to zone 1

A

clavicle to cricoid: cxr, ct angio, gastrografin

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28
Q

formula for PPV and NPV

sensitivity, specificity?

A

PPV = TP/TP+FP
NPV: TN/TN+FN
sen: TP/TP+FN (pts w dz)
spec: TN/TN+FP (pts w/o dz)

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29
Q

what percent of patients with idiopathic VF paralysis will recover fully by one year? some recovery?

A

36%, 39%

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30
Q

tx for laryngeal T2 vs T3/T4

A

xrt only vs chemoxrt

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31
Q

criteria for laryngeal trauma?

A

Schaefer’s classification
group 1: minor hematoma w/o fx
Group 2: hematoma, minor mucosal disruption,, non displaced fx
Group3: massive edema, large displaced fx
Group 4: 2+ fx’s
Group 5: separation

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32
Q

after type 1 thyroplasty, how long should wait before next elective intubation?

A

6 months

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33
Q

abductor vs adductor spasmodic dysphonia w what test?

A

abductor 66–consanants

adductor 88–vowels

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34
Q

small laryngeal sessile mass, histo shwos what and stains positive for what?

A

granular cell tumor, histo shows pseudoepitheliomatous hyperplasia, positive for PAS and S100
arise from schwann cells in posterior aspect of TVF, may have 3% risk of malignant degeneration

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35
Q

which statistical parameters are affected by population prevalence?

A

PPV and NPV

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36
Q

severe dysplasia has what risk of malignant transformation? vs mild/moderate dysplasia?

A

30-35% vs mild/moderate 10%

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37
Q

laryngeal EMG in pediatric larynx should be done when after injury/onset?

A

3-6 months

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38
Q

MC area of laryngeal involvement in sarcoidosis, specifically

A

epiglottis>arytenoids>AE folds> false VF

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39
Q

penny stuck at LES; what makes it relax?

A

glucagon

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40
Q

MEN 1 vs 2a vs 2b

A

pit adenoma, parathyroid, pancreas vs medullary, parathyroid, pheo vs pheo, medullary, marfanoid/neuromas of mucosa

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41
Q

EMG waves for re-innervation vs intact nerve vs denervation vs active motor plates

A

polysynaptic or polyphasic signals vs action potentials vs fibrillation potentional, positive sharp waves vs fasiculations

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42
Q

hemangioma time course

A

proliferate up to 12mo, involute 50% by 5, 70% by 7

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43
Q

no olfactory bulb, which sd, what else is wrong?

A

Kallman’s; hypogonadotropic hypogonadism

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44
Q

during cochlear implant, what if find 1. serous fluid 2. purulent fluid

A
  1. place anyway after irrigating, place on cxt

2. place PET, revisit after infx gone x 2 weeks

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45
Q

what malignancy has physaliferous cells

A

chordomas

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46
Q

abr tracings, each correlates to what

A
  • Peak I: distal ipsilateral cochlear nerve
  • Peak II: proximal ipsilateral cochlear nerve
  • Peak III: cochlear nucleus
  • Peak IV: superior olivary nucleus and lateral lemniscus
  • Peak V: inferior colliculus and lateral lemniscus
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47
Q

croup causes narrowing where?

A

subglottis

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48
Q

Chandler criteria?

A 
I: preseptal
II: post septal
III subperiosteal
IV orbit abscess
V cavernous sinus
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49
Q

mechanism of action of mitomycin c?

A

inhibits fibroblast proliferation by alkylating and inhibiting DNA synthesis

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50
Q

arch and artery responsible for nonrecurrent right laryngeal nerve?

A

arch 4 (R subclavian and left AO arch); retroesophageal right subclavian aa

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51
Q

what’s the mortality rate of untreated kawasaki’s?

A

1%

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52
Q

what % of Down’s pts has AA instability

A

10-20%

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53
Q

HPV vaccine based on which protein?

A

L1 (E proteins 1-7 are early, L proteins 1-2 are late–L1 major capsid protein, L2 minor)
E6 P53, E7 Rb

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54
Q

aminoglycoside sensitivity for ototoxcitiy is inherited in what fashion?

A

mitochondrial inheritance

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55
Q

cisplatin ototoxicity is related most to what?

A

age and total dose

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56
Q

what is Scheibe’s anomaly

A

membranous dysgenesis of cochlea and saccule ( the pars inferior); the MC temporal bone dysplasia causing congenital profound SNHL

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57
Q

what differentiates Waardenburge type 1 from 2

A

displaced inner canthi (dystopica canthorum)

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58
Q

footplate of stapes embryologically derived from

A

otic mesenchyme

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59
Q

hennebert sign

A

pressure–>nystagmus

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60
Q

tullio sign

A

loud noise–>nystagmus

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61
Q

brown sign

A

blanching w pressure (glomus)

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62
Q

schwartz sign

A

redness on promontory

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63
Q

saccule senses what direction

A

linear accel in vertical plane

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64
Q

utricle senses what direction

A

linear accel in horiz plane

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65
Q

otosclerosis is what inheritance pattern

A

AD but with variable penetration

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66
Q

COL2A1 is what sd?

A

Stickler Sd

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67
Q

what gene mutation is pendred?

A

SLC26A4

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68
Q

Which NF is more common?

A

NF1, NF2 is rare

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69
Q

MC location of congenital chole

A

anterior superior quadrant

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70
Q

mean age of presentation of congenital chole

A

4-5yo

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71
Q

Hillocks of His

A 
1- tragus
2- helical root
3- helix
4- antihelix
5- antitragus
6- lobule
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72
Q

eya1 mutation is what sd, inheritance pattern?

A

branchio-oto-renal sd, inheritied AD

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73
Q

what does the anterior and posterior vestibular arteries supply?

A

anterior: saccule, part utricle
posterior: utricle, horiz, superior SCC

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74
Q

merlin mutation in what dz?

A

NF2

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75
Q

MC complication of chole?

A

erosion int olateral SCC

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76
Q

Zollner-Wullstein tympanoplasty classification

A 
I: TM repair
II: TM on incus or malleus
III: TM on stapes superstructure/PORP
IV: TM on footplate/TORP
Va: horiz SCC benestration
Vb: stapedectomy
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77
Q

which inner ear structure terminates at the round window?

A

scala tympani

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78
Q

MC patterns of spread from Prussak’s space of chole?

A

posterior epitymp–> posterior mesotymp –> ant epitymp

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79
Q

what glands supplied by superior salivatory nucleus vs inferior?

A

superior: sphenopalantine to lacrimal (via zygomaticotemporal nn) and submax via lingual
inferior: otic to parotid

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80
Q

which dec hearing sd has RP?

A

usher

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81
Q

which physiology of hte middle ear allows for greatest amount of impedence matching?

A

area of TM

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82
Q

what type of HL MC in VS vs facial nn schwannoma?

A

SNHL vs CHL

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83
Q

what tumor on histology has spindle shaped cells arranged in nests and psammoma bodies

A

meningioma

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84
Q

what tumor on histology has dense spindle shaped cells with aligned or palisading nuceli and loosely arranged myxoid stroma?

A

schwannoma

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85
Q

cochlear aqueduct contains which structure?

A

periotic duct aka perilymphatic duct (connects scala tympani to subarachnoid space)

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86
Q

OSHA noise exposure standards, start with what?

A

90dB for 8 hrs

for each 5dB inc, 1/2 the time allowed

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87
Q

what age wait for hair restoration sx?

A

at least 35
35-45 avg candidate
45-50 above ave candidate
>50 excellent

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88
Q

supratrochlear neurovascular bundle travels from where to where?

A

exits 1cm medial from supraorbital foramen and travels from deep to superficial, pierces orbic and frontalis at level of brow to run subq

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89
Q

best view to eval for Ogee line?

A

3/4 view

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90
Q

what ligament suspends levator palpebrae superioris?

A

Whitnall

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91
Q

what ligament suspends the eyeball from below?

A

lockwood

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92
Q

on basal view, lobule to columella should be how much?

A

1/3 lobule, 2/3 columella

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93
Q

columella show should be

A

2-4 mm

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94
Q

Baker’s solution has what in it? what is the key for the depth of wounding? what depth is the peel?

A

phenol, water, **croton oil, septisol

deep

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95
Q

what is in Jessner’s peel? what depth is the peel?

A

superficial; 2 alcohol, 2 acids

ethanol, resorcinol, salicylic acid, lactic acid

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96
Q

stages of wound healing and time periods

A

Inflammation 7-10 days open, 4-5 days sutured
♣ Clotting cascade activated, dominated by neutrophils

Proliferation 2-3 weeks
♣ Angiogenesis with influx of fibroblasts that lay down type III collagen, wound contraction

Maturation week3-3mo
♣ Strong type I replaces type III collagen and scar achieves tensile strength of 80% normal

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97
Q

what is the pogonion

A

most anterior portion of chin vs menton is the lowest point

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98
Q

what is gonion?

A

tip of angles of mandible

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99
Q

carcinoma is responsible for primary hyperparthyroidism in what percent of patients?

A

1%

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100
Q

what are the effects of long term tissue expansion on epidermis, dermis, subq/fat, hair follicles, blood supply?

A

epidermis: thickening
dermis: atrophy/thinning
fat: atrophy
hair follicle: same but density decreases
vascular supply increases

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101
Q

Millard method for unilateral cleft lip repair

A

rotation-advancement flap (flap from lateral lip into gap of upper portion of lip

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102
Q

Mustarde technique for prominauris

A

Mersilene horizontal matress sutures placed 2mm apart with 16mm across the antihelical fold and 1 cm in width

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103
Q

what is the effect of minoxidil?

A

inc follicle size and % of anagen follicles

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104
Q

what is the ideal upper eyelid crease height in women? men?

A

8-11; 6-9mm

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105
Q

what is ropivacaine and why is it better?

A

it’s the L (+) bupivicaine enatniomer thats less potent in blocking cardiac action potential than the racemic which is bupivicaine

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106
Q

what’re the three vessels that supply trapezius flap?

A

occipital, transverse cervical, dorsal scapular

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107
Q

apple green birefringence w congo red indicates

A

amyloidosis

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108
Q

what is an accepted medical tx of otosclerosis?

A

fluoride

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109
Q

what inc in dB is req to double sound intensity?

A

3dB

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110
Q

what is the site of disease in Graves that causes exophthalmos?

A

extraocular mm proliferation of perimysial fibroblasts and lymphocytic infiltration

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111
Q

what is bogorad sd

A

crocodile tear sd: anamalous reinnervation after FN injury: submandibular parasympathetics innervate lacrimal gland–> lacrimation w food

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112
Q

afferent cochlear nerves arise from which hair cells? how many?

A

inner hair cells, 10 afferent neuros supply each inner hair cell

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113
Q

which cochlear neurons are bipolar neurons?

A

afferent nerves

114
Q

effect cochlear nerves serve which hair cells? how many?

A

10 outer hair cells

115
Q

which scan for dx vs monitoring of OE

A

technecium vs gallium

116
Q

MC odontogenic cyst, 2nd MC, surrounds what?

A

periapical cyst aka radicular cyst around nonviable tooth vs follicular cyst aka dentigerous cyst around impacted tooth, small risk of malignant transformation to ameloblastoma or epidermoid carcinoma

117
Q

MC location for perilymphatic fistula of oval window

A

ant to ant crus> anteroinf to anterior crus > anterosuperior to ant crus

118
Q

binder syndrome is what?

A

maxillo-nasal dysplasia: midfacial hypoplasia, absent ant nasal spine

119
Q

what are the first and second MC facial fractures in pediatric?

A

nasal bone, then mandible (chondyle)

120
Q

what’s the timing window for esophagoscopy after caustic ingestion?

A

wait at least 12 hrs otherwise damage may not be apparent, eval after 48 hrs may cause perforation, so 12-24 hrs is the window

121
Q

Usher types

A

type 1: MC syndromic cause of profound hearing loss–vision changes and vestibular dysfunction at young age
type 2: most common, normal vestibualr function, visual and audio changes happen in adolescence
type 3: like type 1 but milder phenotype

122
Q

difference between adult vs pediatric w allergic fungal sinusitis

A

adult more likely aspergillus, children more likely w unilateral dz (70%) vs adult (37%), chidlren more likely to have obvious facial abnormalities

123
Q

pt w congenital VF paralysis, what do next? whats usu time course?

A

MRI head, neck, chest to ID CNS d/o, resolve spontaneously w/o intervention 6-12 months

124
Q

centor criteria? what is the likelihood of GABHS if all positive? what’s the incidence of rheumatic fever?

A
  1. fever 2. tender LAD 3. exudative tonsillitis 4. no cough; 4/4 = 60%
  2. 3% in kids, 1-3# in adults
125
Q

what is restless leg sd vs periodic limb movement disorder

A

PLMD is rep contraction of ant tibialis; most pts with RLS have periodic limb movements, but converse isn’t always true; RLS is subjective discomfort/tingling around bedtime w relief w movement

126
Q

ethmoturbinals derive what?

A

1- uncinate, agger 20 middle turb 3- superior turb 4/5- supreme

127
Q

Jahrsdoerfer’s scale is out of what? What are the cut offs

A

10, >6 candidate for sx

128
Q

mma is what stage of stanford protocol?

A

stage II; first is uppp genioglossus adv hyoid suspension

129
Q

when stop cytomel vs synthroid prior to RAI; what level do you want TSH at before?

A

2 weeks, 6 weeks

>30

130
Q

what can you give in thyroid storm if methimazole and propylthiouracil is contraI?

A

lithium (inhibits iodine coupling and hormone secretion)

131
Q

where are amides metabolized? esters?

A

amide–liver; ester–pseudocholinesterase

132
Q

Th1 cells secrete what?

A

IL-2

133
Q

with signs of lido toxicity, why give supplemental O2?

A

hypoventilation causes acidosis/hypercarbia–> inc cerebral blood flow and dec binding of local anesthetic to serum proteins

134
Q

how long after what procedure have to wait for RAI?

A

8 weeks after IV contrast

135
Q

patient with methemoglobinemia d/t benzocaine–give what dose of what? what dz is contr-I in txt? what do instead?

A

1-2mg/kg IV methylene blue; G6PD def, need txf and dialysis bc can lead to hemolytic anemia

136
Q

what arteries supply septum?

A

Anterior:
greater palatine, SPA (ima)
AP ethmoids (ICA)
septal branch of superior labial (facial)
Posterior:
ascendign pharyngela (ECA), posterior nasal/SPA/post septal (IMA)

137
Q

which anesthetic is a depolarizing neuromuscular blocker? meanign what? why do we use it?

A

succinylcholine, hyperkalemia and cardiac arrest, use bc short acting, can use vec or roc instead (longer acting)

138
Q

cidofovir mechanism

A

antiviral–inhibits viral DNA polymerase/viral replication

139
Q

avastin aka what? MOA?

A

bevacizumab–VEGF inhibitor

140
Q

H1 antagonists are metabolized by what?

A

liver

141
Q

old person w anosmia, MRI normal, what suspect?

A

parkinsons or bulbar issue

142
Q

what are the three major cytokines involved in allergic inflammation? what do each do?

A

IL 4 (promote TH2 prod), 5 (eosinophil differentiation/prolif), 13 (stim B cell and IgE switching)

143
Q

pts w latex allergy also allergic to what

A

30-50% have allergy to bananas, kiwi, avocado, chestnuts

144
Q

aspirin inhibits what pathway and inc what pathway?

A

inhib cyclo-oxygenase (and so dec PG and TXA), inc arachidonic pathway (inc LTE)

145
Q

what is Queckenstedt’s test?

A

indicative of lateral sinus thrombophlebitis; external compression of ipsi IJ doesn’t cause inc CSF pressure, but contra IJ does

146
Q

MC vascular lesion to cause stridor?

A

double aortic arch (proximal arch splits around trachea/esophagus and rejoins for descending aorta

147
Q

MCC of viral rhinitis?

A

rhinovirus

148
Q

first line tx for vasomotor rhinitis?

A

ipratropium

149
Q

adult and pediatric dose of IM epi for anaphylaxis?

A

adult: 0.3-0.5mL 1:1000
peds: 0.01-0.03mg/kg or 0.1-0.3mL

150
Q

common variable immunodef is what?

A

hypogammaglobulinemia dt failure of B cell maturation

151
Q

what seasonal allergy is tree pollen

A

spring

152
Q

what seasonal allergy is grass

A

summer

153
Q

what seasonal allergy is ragweed

A

fall

154
Q

Lund Mackay score of CT includes what?

A

0 normal 1 partial 2 complete
frontal, sphenoid, AE, PE, maxillary, OMC
12 for each side = 24
weak correlation to symptom severity or post intervention outcomes

155
Q

MC bacterial responsible for cavernous sinus thrombosis?

A

staph aureus

156
Q

COL4A5 mutation in what

A

alport

157
Q

COL2A1 mutation in what

A

stickler

158
Q

mucosal melanoma staging T and N

A

starts at T3, T4a vs T4b

N0 nothing, N1 regional LN

159
Q

gentamicin ototoxicity to what part specifically?

A

inner layer of OHC

160
Q

in elderly, what rx increases upper dilator muscle activity and dec upper airway collapse

A

barbituates

161
Q

what do chief cells and parietal cells of stomach produce

A

cheif cells pepsinogen and chymosin

parietal cells gastic acid and intrinsic factor

162
Q

what is propylthiouracil’s black box warning?

A

severe liver injury, possible acute liver failure, and death

163
Q

which med can be used for grave’s in first trimester of pregnancy

A

PTU not methimazole

164
Q

what is the final Ig profile after immunotherapy?

A

initially rise in serum specific IgE levels, over time levelsreturn to baseline, and long term reduction in serum allergen-specific IgE levels; increase in serum specific IgE/total IgE ratio, increase in IgA and IgG levels esp IgG4; and so, looking for decrease in serum specific IgE/IgG4 ratio

165
Q

what food allergy is least likely to resolve in adulthood?

A

tree nuts (worse than peanuts)

166
Q

what meds must be stopped before allergy skint esting

A

amitryptaline and other TCAs at least 4 days
antihistamines at least 1-7 days
theophylline, any topical steroid
oral pred, montelukast, flonase, aspirin all OK

167
Q

Lund-Kennedy system

A

endoscopic findings 0-20
polyp present: middle meatus, beyond middle meatus
discharge: thin, thick/purulent
edema/scaring/crusting: mild or severe

correlates well w patietn symptomology pre and post sx

168
Q

which fungus has 45 degree angles? 90?

A

aspergillus (septated); mucor (nonseptated hyphae)

169
Q

UPSIT score for anosmia

A

5-18 anosmia
19-33 hyposmia
<5 consider malingering

170
Q

what is inheritance pattern of osler-weber-rendu aka HHT

A

AD

171
Q

mm from lacrimal crest - ant ethmoid - post ethmoid - apex

A

24mm-12-6

172
Q

MC Ig hypogammaglobulin deficiency? IgG in kids? IgG adults?

A

IgA; IgG2; IgG3

173
Q

ANC of what decreases survival in invasive fungal?

A

<1000; giving WBC transfusion and GSF shown to improve survival

174
Q

middle turb attaches where what % of the time?

A

lam pap 80%, skull base and middle turb 20%

175
Q

inverted papilloma assoc w which virus

A

HPV

176
Q

what marker specific for B cell

A

CD 19, 20, 22

177
Q

NK t cell markers

A

CD 56, 16

178
Q

rate of dehiscence of ant ethomid, where found?

A

10-40%, between second and third lamella (bulla and basal lamella), 11mm posterior from posterior wall of frontal recess

179
Q

what are the 5 lamella (not ehtmoturbinals)

A 
1- uncinate
2- bulla
3- basal lamella
4- superior turb
5- supreme turb
180
Q

only class b spray for rhinitis of pregnancy

A

budesonide (rhinocort)

181
Q

MC location of oral pyogenic granuloma

A

gingiva

182
Q

in context of laryngeal malignancies, what is meant by a “marginal” tumor

A

along aryepliglottic fold

183
Q

which muscle of mastication depresses and protrudes madible

A

lateral pterygoid

184
Q

what radiation dose nec fo ORN

A

> 60Gy

185
Q

chronic sialadenitis MC bacteria in adults?

A

staph aureus

186
Q

NF1 vs NF2 which chromosomal mutation

A

17 vs 22 (merlin)

187
Q

what is associated w obliterated foramen spinosum?

A

persistent stapedial aa, and so aplasia of middle meningeal aa

188
Q

what abx contraindication for botox injection?

A

aminoglycoside– potentiation of NM blockade that may result in unwanted AEs

189
Q

persistent stapedial aa assoc w what?

A

obliterated foramen spinosum, aplasia of MMA

190
Q

Hashimoto’s thyroiditis with PTC has better or worse presentation?

A

smaller tumor, less likelihood of LN mets, less advanced TNM stage (thought d/t autoI tumor cell destruction)

191
Q

what is the risk of malignant transformation for IP?

A

10%

192
Q

What’s the percentage of OPC cases that are HPV associated

A

60%

193
Q

which pharyngeal mm is innervated by V3?

A

tensor veli palatini

194
Q

WHO classification of NPC

A
  1. SCC 2. nonkeratinizing epidermoid carcinoma (EBV related) 3. MC variant, non keratizing undifferentiated (EBV related)
195
Q

What percent of head and neck paragangliomas secrete catecholamines?

A

2%

196
Q

indication for postop radiation vs chemoxrt

A

xrt: 1. close or positive margins, ECE, 2+ involved LNs, lymphovascular invasion, perineural extension, level 4 or 5 involvement in oral/OP
vs positive margins, ENE, distant mets

197
Q

Ohngren’s line

A

delineates tumors in superior portion of paranasal sinus that have inc predisposition to invade skull base thus have poorer prognosis; line from angle of mandible to medial canthus

198
Q

what’s the longest acting local anesthetic

A

bupivicaine 3-7 hrs

199
Q

what anesthetic has been shown to inc flap survival?

A

isoflurane

200
Q

what layer of dissection for 1. endoscopic brow lift 2. coronal brow lift 3. direct brow lift 4. mid forehead/indirect brow lift

A
  1. subperiosteal 2. subgaleal 3. subcutaneous 4. subcutaneous
201
Q

hillocks of his

A
  1. tragus 2. root of helix 3. helix 4. antihelix 5. antitragus 6. lobule
202
Q

most injured extraocular mm during blepharoplasty

A

inferior oblique

203
Q

perofrming an auriculectomy, which part should be preserved for best prosthetic result

A

tragus

204
Q

Dedo classification of cervical abnormalities

A 
o	I: minimal deformity w acute cervicomental angle, good platysmal tone, little fat accumulation
o	II: lax cervical skin
o	III: fat accumulation
o	IV: platysmal banding
o	V: congenital or acquired retrognathia
o	VI: low hyoid
205
Q

how large should tissue expander be? what layer in scalp?

A

2.5 times width of defect or size of expander base + size of defect
subgaleal layer

206
Q

timing of vessel growth in full thickness skin graft?

A

innoculation 24-48hrs
capillary growth 48-72 hrs
est new blood supply 3-5 days

207
Q

difference bt deep plane rhytidectomy vs composite?

A

composite incorporates orbicularis oculi into flap

208
Q

when can repair infant cleft lip?

A

10-10-10 Hb 10, >10lbs, 10 WGA (3 months)

209
Q

how close eyelid defects?

A

<25% primary closure
50-100 tarsoconjunctival flap (Hughes)
1/3-2/3: lateral canthotomy and semicircular adv flap (Tenzel)

210
Q

what bug must tx when using leeches

A 
aeromonas hydrophilia (gram neg rod)
3rd gen ceph, cipro, aminoglycoside, sulfa, tetracycline
211
Q

cleft lip nasal deformity

A

alar base widened, displaced inferiorly; tip/
caudal septum/ant nasal spine/columella base toward normal side
maxilla underdeveloped on involved side

212
Q

radiological neck levels based on superior or inferior border of hyoid/cricoid?

A

inferior

213
Q

what % ppl have incomplete superficial palamr arch and poor communication bt deep and superficial arches precluding RFFF

A

12%

214
Q

which chemical peel produces perifollicular frosting?

A

salicylic acid bc lipophilic and concentrates w/in pilosebaceous apparatus

215
Q

with aging what happens to epidermis, dermis, elastin, ground substance of dermis?

A

atrophies, atrophies, decreases, increases (fibroblasts, degranulated mast cells, chronic low-grade inflammation)

216
Q

sunderland criteria

A 
I: neuropraxia
II: axontmesis, wallerian degen
III: neurotmesis (endoneurium transected), risk of synkinesis
IV: perineurium, synkinesis present
V: transection, risk of neuroma
217
Q

contents and location of cochlear aqueduct vs vestibular aqueduct

A

cochlear aqueduct connect perilymphatic space of cochlea w subarachnoid space; runs parallel to IAC

VA: has endolymphatic sac regulating volume and pressure of endolymph, immune re of inner ear, and eliminate waste of endolymph by phagocytosis; runs perpendicular to IAC

218
Q

what cVEMP result tells you what? oVEMP?

A

dec threshold SSCD, inc threshold Menierre’s, otosclerosis, inf vestibular nerve lesion, VS
oVEMP dec shows superior vestibular neuritis

219
Q

ECOG SP/AP ratio tell you what?

A

> 0.4 SSCD or Meniere’s

220
Q

what’s the air-bone gap with each fork?

A

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

221
Q

in vestibular neuritis which direction is nystagmus

A

fast phase away from affected side

222
Q

cochlear nerve auditory pathway

A

mostly inner, some outer hair cells -> cochlear nucleus –> superior olivary complex –> lateral lemniscus, inf colliculus, audiotry cortex

223
Q

Melkersson-Rosenthal Sd is what

A

recurrent facial edema, facial paresis, angular chelitis, fissured tongue

224
Q

sup vs inf vastibular nerve innervates

A

superior: superior, lateral, utricle
inferior: posterior, saccule

225
Q

congenital chole more common in male vs female?

A

male 3:1

226
Q

auditory brainstem implant FDA approved for how old in NF2?

A

12yo

227
Q

cornea is innervated by what nerve? of what branch?

what’s the blink reflex

A

opthalmic nerve –> nasocilliary nerve

nasocilliary V1 –> VII orbicularis occuli

228
Q

after dermabrasion, how long wait to repeat?

A

12 months

229
Q

normal MRD1 and MRD2

A

4mm, 5mm

avg palpebral fissure 9mm

230
Q

best way to manage mature trap door scar

A

revisoion z plasties

231
Q

nasal bilobe flap for defect less than how big?

A

<1.5cm at least 5mm from alar rim

232
Q

nasal eval: Crumley’s method

A

3-4-5 triangle (alar base-nasal tip- nasion)–nasal angle 36 degrees ideal

233
Q

nasal eval: Good’s method

A

distance from alar crease to nasal tip (nasal projection) should be 0.55-0.6 of distance from nasal tip to nasion

234
Q

idelal nasofacial angle

A

30-40 degrees

235
Q

what neck dissection for medullary thyroid CA? what if >1cm?

A

VI, if >1cm VII and consider ipsi cervical neck

236
Q

risk of pleomorphic adenoma malignant transformation

A

1.5% in first 5 years, 10% if observed form ore than 15 years

237
Q

z plasty angle with % legthened and scar reorientation

A

30-45-60
25-50-75
45-60-90

238
Q

carotid body afferent via what nerve?

A

afferent IX, efferent unsure–cevical sympathetic ganglion

vagal innervates aortic body

239
Q

On schirmer’s test want what?

A

10-15mm/5mins; if less than, need ophtho eval for pre-surg clearance before bleph

240
Q

cVEMP tests what

A

saccule–> inf nerve

241
Q

oVEMP tests what

A

utricle–>superior nerve

242
Q

what is the aberrant anatomy of a pulmonary artery sling?

A

left pulmo aa takes origin at right pulm aa w/in right mediastinum crosses the right bronchus and loops through TE groove to the left lung

243
Q

what does the ectodermal otocyst become?

A

membranous labyrinth

244
Q

stapes footplate from what?

A

derived from otic capsule

245
Q

temporal bone neoplasm T stage?

A

T1- EAC no bone
T2: partial bony erosion or <0.5cm soft tissue involvement
T3: erode EAC completely w <0.5cm soft tissue involvment, or involve ME or mastoid
T4: erode cochlea, petrous apex, medila wall of ME, carotid/jgular foramen, dura, >5cm soft tissue involvment, facial paralysis

246
Q

MC site of pleomorphic adenoma in minor salivary gland?

A

lips

247
Q

which thyroid CA has amyloid deposits

A

medullary

248
Q

major tip supports

A
  1. lower lateral cartilage
  2. scroll area
  3. attachment of medial cura to caudal septum
249
Q

what %age of pts have cervical mets with BOT tumors? bilateral cervical met?

A

> 60%; up to 20% due to extensive b/l lymphatic drainage

250
Q

what eye symptom can sturge weber pts have?

A

risk of glaucoma

251
Q

when lip defect involveds philtrum, use what recon?

A

usu abbeflap (lipswitch)

252
Q

midface lifting has the greatest effect on what mm?

A

orbicularis occuli

253
Q

where does the levator aponeurosis insert into the upper eyelid?

A

it inserts to the anterior surface of the tarsus

254
Q

what is the NOSE scale for?

A

a QOL instrument to measure nasal obstruction and so effectiveness of septo/turbs, functional rhinoplasty

255
Q

Anterior lamella of lower eyelid comprisedo f what?

A

skin, orbicularis muscle (no subq tissue, no tarsus)

256
Q

how treat a facial cutaneous AVM?

A

surgical excision w/ or w/o presurgical embolization

257
Q

once temporal branch of FN exits parotid gland, where is it in relation to SMAS above the zygomatic arch?

A

within SMAS, otherwise is deep to SMAS

258
Q

What class are the lasers used in ENT?

A

Medical class 4; they have the potential to burn skin, cause eye damage, and ignitefires, they msut have safety devices such as key switch override

259
Q

what is median rhomboid glossitis? how treat?

A

smokers predisposed to candida infection, smoking cessation should be first recommendation, can try antifungal

260
Q

what is central serous retinopathy?

A

fluid accumulates under retina, causes distortion and painless visual loss; pts can have h/o recent systemic steroid use, most patients have spontaneous visual recovery w/in 6 months

261
Q

inc risk of what if use IM vs IV ketamine in peds?

A

IM ketamine higher liklihood of laryngospasm vs IV

262
Q

hypoglossal nerve loops around which structure?

A

occipital artery in type III variant

263
Q

aberrant right subclavian artery in a retroesophageal course arises from…
what od all the arches form?

A 
persistence of seventh intersegmental artery and involution of fourth aortic arch;
3rd arches-carotids
proximal right 4th: brachiocephalic
left fourth: aortic arch
fifth involute
ventral sixth right pulmonary aa
ventral sixth left: left pulmonary
7th intersegmental arterial branches of dorsal aorta: entire left and distal left subclavian aa
264
Q

PET in unknown primary neck SCC changes therapeutic course in what %age of pts

A

25%

265
Q

what is Lhermitte’s sign?

A

sensation of electrical shock going own your spine/arms/legs when neck flexed; can be d/t multiple things but esp radiation myelitis when >50Gy, also in chemo

266
Q

selection bias vs sampling bias
recall bias vs late look bias
procedure bias, confounding bias, lead time bias
pygmalion effect vs hawthorne effect

A

selection: nonrandom assignemnt to study group
sampling: subjects no representative relative to gen pop so results are not generalizable
recall: knowledge of presence of disorder alters recall by subjects
late look bias: info gathered at inappropriate time (using survey to study fatal dz so only pts still allive will answer)
procedure: subjects in diff groups are not treated the same (more attention to treatment group, stimulation greater compliance)
confounding: 2 closely associated factors distorts or confuses the effect of the other
lead time: early detection confused wiht inc survival
pygmalian effect: researcher’s belief in efficacy of tx changes the outcome
hawthorne effect: group being stuudied changes its behavior bc knows being studied

267
Q

epidermis layers

A 
calif lady girls like string binkinis
cornium
lucidum
granulosum
lucidum
spinosum
basale
268
Q

how long should you wait after lasix for bleph?

A

> 6 months

269
Q

most significant prognostic factor in melanoma stage I/II vs stage III?

A

tumor thickness vs number of involved LNs; other poor prognostic factors: ulceration, male, older age

270
Q

PTC in hashimoto’s is likely to be better or worse stage?

A

better stage (not as bad)

271
Q

propranolol dosing for <8 weeks, >8weeks?

A

0.33mg/kg q8H x 1 day, then 0.66mg/kg q8H vs 0.33mg/kg q6H x 3-7 days, then 0.5mg/kg q6H

272
Q

what are the radiologic vs surgical borders of neck level III?

A

radiologic: lateral SCM, medial carotid, inferior hyoid, inferior cricoid
surgical: lateral sensory branches of cervical plexus, sternohyoid, carotid bifurcation, omohyoid

273
Q

what dz have increased cVEMP threshold vs decreased threshold?

A

increased: menierre’s, otosclerosis, VS
decreased: SSCD

274
Q

eya1 mutation is what sd?

A

branchio-oto-renal sd

275
Q

which is most aggressive form of BCC?

A

morpheoform aka sclerosing

276
Q

what are the stages of hair?

A
  • anagen growth phase 90% of hair is in this phase, lasts 3-4 years
  • telogen rest phase 10% in this phase for 3-4 months
  • catagen is involution
  • exogen is shedding
277
Q

what are the arteries for anterior vs posterior epistaxis? what are the areas called?

A

Little’s/Kisselbach’s: superior labial (from facial a), anterior ethmoid (from ophthalmic), sphenopalatine and greater palatine (from IMA)vs Woodruff’s: ascending pharyngeal (ECA), posterior nasal, sphenopalatine, posterior septal (IMA)

278
Q

IX schwannoma vs vestibular shwannoma causes what type of hearing loss?

A

mid frequency vs high frequency

279
Q

which cancers are associated with amyloid deposition?

A

adenoid cystic and medullary thyroid

280
Q

what is the MC dz in MEN2a? how do hyperparahtyroidism compare bt MEN2A and MEN1?

A

medullary thyroid; MEN1 is usu worse wiht four gland hyperplasia

281
Q

tuning fork ab gap? 256, 512, 1024?

A

15-25-35

282
Q

what 3 aa supply trap flap

A

occipital, tca, dorsal scaoular

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