bv Flashcards
1
Q
arterial supply of SCM
A
- occipital 2. superior thyroid vs ECA 3. suprascapular
2
Q
arterial supply of SAI
A
supraclavicular artery from transverse cervical
3
Q
Gottfredson’s sd
A
VI and XII palsy; MCC metastatic tumor to clivus, 2nd MCC infiltrating NPC
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)
5
Q
majority of submax stones are where? vs parotid stones?
A
proximal duct>distal duct>parynchema vs distal duct>parynchema>proximal
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
7
Q
Sjogren’s sd is assoc w which malignancy?
A
non Hodgkin’s lymphoma (iMALT being highest risk)
8
Q
parasympathetic course of parotid innervation
A
inferior solitarius –> IX –> jacobson –> lesser petrosal –> otic ganglion –> auriculotemporal nerve (V3)
9
Q
mechanism of action of cisplatin?
A
crosslinks DNA
10
Q
MC site of cancer in oral cavity
A
lip
11
Q
in unknown primary, if FNA shows adenocarcinoma, which staining is also recommended?
A
thyroglobulin and calcitonin
12
Q
MC jugular foramen schwannoma
A
vagal –> IX
13
Q
what’s the common pattern of hearing loss in Meniere’s
A
low freq hL
14
Q
otitic hydrocephalus is most likely caused by what
A
OM into sigmoid sinus–> lateral sinus thrombosis
15
Q
thymus is derived from what
A
3rd pharyngeal POUCH
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
17
Q
MC sensory nerve injured during facelift
A
greater auric
18
Q
MC motor nerve injured during facelift
A
marg and temporal
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
20
Q
how to stage well diff thyroid CA in pts <45yo
A
stage 1: everything
stage 2: distant mets
21
Q
most important prognostic factor of stage III melanoma
A
how many LNs involved vs stage I and II is tumor thickness
22
Q
which chemical peel requires rinsing w water or neutralization with bicarb?
A
glycolic acid
23
Q
reverse Townes view assess mandible fx where
A
chondyle
24
Q
congenital vocal cord paralysis is bilateral what % of time?
A
50%
25
what are the stages of esophageal burn?
first degree: mucosa erythema
second degree non-circumferential exudates or ulcer
third degree: circumferential exudate or ulcer
fourth degree perforation
(think burn)
26
primary treatment of achalasia
Heller myotomy
27
what tests order in injury to zone 1
clavicle to cricoid: cxr, ct angio, gastrografin
28
formula for PPV and NPV
| sensitivity, specificity?
PPV = TP/TP+FP
NPV: TN/TN+FN
sen: TP/TP+FN (pts w dz)
spec: TN/TN+FP (pts w/o dz)
29
what percent of patients with idiopathic VF paralysis will recover fully by one year? some recovery?
36%, 39%
30
tx for laryngeal T2 vs T3/T4
xrt only vs chemoxrt
31
criteria for laryngeal trauma?
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
32
after type 1 thyroplasty, how long should wait before next elective intubation?
6 months
33
abductor vs adductor spasmodic dysphonia w what test?
abductor 66--consanants
| adductor 88--vowels
34
small laryngeal sessile mass, histo shwos what and stains positive for what?
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
35
which statistical parameters are affected by population prevalence?
PPV and NPV
36
severe dysplasia has what risk of malignant transformation? vs mild/moderate dysplasia?
30-35% vs mild/moderate 10%
37
laryngeal EMG in pediatric larynx should be done when after injury/onset?
3-6 months
38
MC area of laryngeal involvement in sarcoidosis, specifically
epiglottis>arytenoids>AE folds> false VF
39
penny stuck at LES; what makes it relax?
glucagon
40
MEN 1 vs 2a vs 2b
pit adenoma, parathyroid, pancreas vs medullary, parathyroid, pheo vs pheo, medullary, marfanoid/neuromas of mucosa
41
EMG waves for re-innervation vs intact nerve vs denervation vs active motor plates
polysynaptic or polyphasic signals vs action potentials vs fibrillation potentional, positive sharp waves vs fasiculations
42
hemangioma time course
proliferate up to 12mo, involute 50% by 5, 70% by 7
43
no olfactory bulb, which sd, what else is wrong?
Kallman's; hypogonadotropic hypogonadism
44
during cochlear implant, what if find 1. serous fluid 2. purulent fluid
1. place anyway after irrigating, place on cxt
| 2. place PET, revisit after infx gone x 2 weeks
45
what malignancy has physaliferous cells
chordomas
46
abr tracings, each correlates to what
- 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
47
croup causes narrowing where?
subglottis
48
Chandler criteria?
```
I: preseptal
II: post septal
III subperiosteal
IV orbit abscess
V cavernous sinus
```
49
mechanism of action of mitomycin c?
inhibits fibroblast proliferation by alkylating and inhibiting DNA synthesis
50
arch and artery responsible for nonrecurrent right laryngeal nerve?
arch 4 (R subclavian and left AO arch); retroesophageal right subclavian aa
51
what's the mortality rate of untreated kawasaki's?
1%
52
what % of Down's pts has AA instability
10-20%
53
HPV vaccine based on which protein?
L1 (E proteins 1-7 are early, L proteins 1-2 are late--L1 major capsid protein, L2 minor)
E6 P53, E7 Rb
54
aminoglycoside sensitivity for ototoxcitiy is inherited in what fashion?
mitochondrial inheritance
55
cisplatin ototoxicity is related most to what?
age and total dose
56
what is Scheibe's anomaly
membranous dysgenesis of cochlea and saccule ( the pars inferior); the MC temporal bone dysplasia causing congenital profound SNHL
57
what differentiates Waardenburge type 1 from 2
displaced inner canthi (dystopica canthorum)
58
footplate of stapes embryologically derived from
otic mesenchyme
59
hennebert sign
pressure-->nystagmus
60
tullio sign
loud noise-->nystagmus
61
brown sign
blanching w pressure (glomus)
62
schwartz sign
redness on promontory
63
saccule senses what direction
linear accel in vertical plane
64
utricle senses what direction
linear accel in horiz plane
65
otosclerosis is what inheritance pattern
AD but with variable penetration
66
COL2A1 is what sd?
Stickler Sd
67
what gene mutation is pendred?
SLC26A4
68
Which NF is more common?
NF1, NF2 is rare
69
MC location of congenital chole
anterior superior quadrant
70
mean age of presentation of congenital chole
4-5yo
71
Hillocks of His
```
1- tragus
2- helical root
3- helix
4- antihelix
5- antitragus
6- lobule
```
72
eya1 mutation is what sd, inheritance pattern?
branchio-oto-renal sd, inheritied AD
73
what does the anterior and posterior vestibular arteries supply?
anterior: saccule, part utricle
posterior: utricle, horiz, superior SCC
74
merlin mutation in what dz?
NF2
75
MC complication of chole?
erosion int olateral SCC
76
Zollner-Wullstein tympanoplasty classification
```
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
```
77
which inner ear structure terminates at the round window?
scala tympani
78
MC patterns of spread from Prussak's space of chole?
posterior epitymp--> posterior mesotymp --> ant epitymp
79
what glands supplied by superior salivatory nucleus vs inferior?
superior: sphenopalantine to lacrimal (via zygomaticotemporal nn) and submax via lingual
inferior: otic to parotid
80
which dec hearing sd has RP?
usher
81
which physiology of hte middle ear allows for greatest amount of impedence matching?
area of TM
82
what type of HL MC in VS vs facial nn schwannoma?
SNHL vs CHL
83
what tumor on histology has spindle shaped cells arranged in nests and psammoma bodies
meningioma
84
what tumor on histology has dense spindle shaped cells with aligned or palisading nuceli and loosely arranged myxoid stroma?
schwannoma
85
cochlear aqueduct contains which structure?
periotic duct aka perilymphatic duct (connects scala tympani to subarachnoid space)
86
OSHA noise exposure standards, start with what?
90dB for 8 hrs
| for each 5dB inc, 1/2 the time allowed
87
what age wait for hair restoration sx?
at least 35
35-45 avg candidate
45-50 above ave candidate
>50 excellent
88
supratrochlear neurovascular bundle travels from where to where?
exits 1cm medial from supraorbital foramen and travels from deep to superficial, pierces orbic and frontalis at level of brow to run subq
89
best view to eval for Ogee line?
3/4 view
90
what ligament suspends levator palpebrae superioris?
Whitnall
91
what ligament suspends the eyeball from below?
lockwood
92
on basal view, lobule to columella should be how much?
1/3 lobule, 2/3 columella
93
columella show should be
2-4 mm
94
Baker's solution has what in it? what is the key for the depth of wounding? what depth is the peel?
phenol, water, **croton oil, septisol
| deep
95
what is in Jessner's peel? what depth is the peel?
superficial; 2 alcohol, 2 acids
| ethanol, resorcinol, salicylic acid, lactic acid
96
stages of wound healing and time periods
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
97
what is the pogonion
most anterior portion of chin vs menton is the lowest point
98
what is gonion?
tip of angles of mandible
99
carcinoma is responsible for primary hyperparthyroidism in what percent of patients?
1%
100
what are the effects of long term tissue expansion on epidermis, dermis, subq/fat, hair follicles, blood supply?
epidermis: thickening
dermis: atrophy/thinning
fat: atrophy
hair follicle: same but density decreases
vascular supply increases
101
Millard method for unilateral cleft lip repair
rotation-advancement flap (flap from lateral lip into gap of upper portion of lip
102
Mustarde technique for prominauris
Mersilene horizontal matress sutures placed 2mm apart with 16mm across the antihelical fold and 1 cm in width
103
what is the effect of minoxidil?
inc follicle size and % of anagen follicles
104
what is the ideal upper eyelid crease height in women? men?
8-11; 6-9mm
105
what is ropivacaine and why is it better?
it's the L (+) bupivicaine enatniomer thats less potent in blocking cardiac action potential than the racemic which is bupivicaine
106
what're the three vessels that supply trapezius flap?
occipital, transverse cervical, dorsal scapular
107
apple green birefringence w congo red indicates
amyloidosis
108
what is an accepted medical tx of otosclerosis?
fluoride
109
what inc in dB is req to double sound intensity?
3dB
110
what is the site of disease in Graves that causes exophthalmos?
extraocular mm proliferation of perimysial fibroblasts and lymphocytic infiltration
111
what is bogorad sd
crocodile tear sd: anamalous reinnervation after FN injury: submandibular parasympathetics innervate lacrimal gland--> lacrimation w food
112
afferent cochlear nerves arise from which hair cells? how many?
inner hair cells, 10 afferent neuros supply each inner hair cell
113
which cochlear neurons are bipolar neurons?
afferent nerves
114
effect cochlear nerves serve which hair cells? how many?
10 outer hair cells
115
which scan for dx vs monitoring of OE
technecium vs gallium
116
MC odontogenic cyst, 2nd MC, surrounds what?
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
MC location for perilymphatic fistula of oval window
ant to ant crus> anteroinf to anterior crus > anterosuperior to ant crus
118
binder syndrome is what?
maxillo-nasal dysplasia: midfacial hypoplasia, absent ant nasal spine
119
what are the first and second MC facial fractures in pediatric?
nasal bone, then mandible (chondyle)
120
what's the timing window for esophagoscopy after caustic ingestion?
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
Usher types
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
difference between adult vs pediatric w allergic fungal sinusitis
adult more likely aspergillus, children more likely w unilateral dz (70%) vs adult (37%), chidlren more likely to have obvious facial abnormalities
123
pt w congenital VF paralysis, what do next? whats usu time course?
MRI head, neck, chest to ID CNS d/o, resolve spontaneously w/o intervention 6-12 months
124
centor criteria? what is the likelihood of GABHS if all positive? what's the incidence of rheumatic fever?
1. fever 2. tender LAD 3. exudative tonsillitis 4. no cough; 4/4 = 60%
0. 3% in kids, 1-3# in adults
125
what is restless leg sd vs periodic limb movement disorder
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
ethmoturbinals derive what?
1- uncinate, agger 20 middle turb 3- superior turb 4/5- supreme
127
Jahrsdoerfer's scale is out of what? What are the cut offs
10, >6 candidate for sx
128
mma is what stage of stanford protocol?
stage II; first is uppp genioglossus adv hyoid suspension
129
when stop cytomel vs synthroid prior to RAI; what level do you want TSH at before?
2 weeks, 6 weeks
| >30
130
what can you give in thyroid storm if methimazole and propylthiouracil is contraI?
lithium (inhibits iodine coupling and hormone secretion)
131
where are amides metabolized? esters?
amide--liver; ester--pseudocholinesterase
132
Th1 cells secrete what?
IL-2
133
with signs of lido toxicity, why give supplemental O2?
hypoventilation causes acidosis/hypercarbia--> inc cerebral blood flow and dec binding of local anesthetic to serum proteins
134
how long after what procedure have to wait for RAI?
8 weeks after IV contrast
135
patient with methemoglobinemia d/t benzocaine--give what dose of what? what dz is contr-I in txt? what do instead?
1-2mg/kg IV methylene blue; G6PD def, need txf and dialysis bc can lead to hemolytic anemia
136
what arteries supply septum?
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
which anesthetic is a depolarizing neuromuscular blocker? meanign what? why do we use it?
succinylcholine, hyperkalemia and cardiac arrest, use bc short acting, can use vec or roc instead (longer acting)
138
cidofovir mechanism
antiviral--inhibits viral DNA polymerase/viral replication
139
avastin aka what? MOA?
bevacizumab--VEGF inhibitor
140
H1 antagonists are metabolized by what?
liver
141
old person w anosmia, MRI normal, what suspect?
parkinsons or bulbar issue
142
what are the three major cytokines involved in allergic inflammation? what do each do?
IL 4 (promote TH2 prod), 5 (eosinophil differentiation/prolif), 13 (stim B cell and IgE switching)
143
pts w latex allergy also allergic to what
30-50% have allergy to bananas, kiwi, avocado, chestnuts
144
aspirin inhibits what pathway and inc what pathway?
inhib cyclo-oxygenase (and so dec PG and TXA), inc arachidonic pathway (inc LTE)
145
what is Queckenstedt's test?
indicative of lateral sinus thrombophlebitis; external compression of ipsi IJ doesn't cause inc CSF pressure, but contra IJ does
146
MC vascular lesion to cause stridor?
double aortic arch (proximal arch splits around trachea/esophagus and rejoins for descending aorta
147
MCC of viral rhinitis?
rhinovirus
148
first line tx for vasomotor rhinitis?
ipratropium
149
adult and pediatric dose of IM epi for anaphylaxis?
adult: 0.3-0.5mL 1:1000
peds: 0.01-0.03mg/kg or 0.1-0.3mL
150
common variable immunodef is what?
hypogammaglobulinemia dt failure of B cell maturation
151
what seasonal allergy is tree pollen
spring
152
what seasonal allergy is grass
summer
153
what seasonal allergy is ragweed
fall
154
Lund Mackay score of CT includes what?
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
MC bacterial responsible for cavernous sinus thrombosis?
staph aureus
156
COL4A5 mutation in what
alport
157
COL2A1 mutation in what
stickler
158
mucosal melanoma staging T and N
starts at T3, T4a vs T4b
| N0 nothing, N1 regional LN
159
gentamicin ototoxicity to what part specifically?
inner layer of OHC
160
in elderly, what rx increases upper dilator muscle activity and dec upper airway collapse
barbituates
161
what do chief cells and parietal cells of stomach produce
cheif cells pepsinogen and chymosin
| parietal cells gastic acid and intrinsic factor
162
what is propylthiouracil's black box warning?
severe liver injury, possible acute liver failure, and death
163
which med can be used for grave's in first trimester of pregnancy
PTU not methimazole
164
what is the final Ig profile after immunotherapy?
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
what food allergy is least likely to resolve in adulthood?
tree nuts (worse than peanuts)
166
what meds must be stopped before allergy skint esting
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
Lund-Kennedy system
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
which fungus has 45 degree angles? 90?
aspergillus (septated); mucor (nonseptated hyphae)
169
UPSIT score for anosmia
5-18 anosmia
19-33 hyposmia
<5 consider malingering
170
what is inheritance pattern of osler-weber-rendu aka HHT
AD
171
mm from lacrimal crest - ant ethmoid - post ethmoid - apex
24mm-12-6
172
MC Ig hypogammaglobulin deficiency? IgG in kids? IgG adults?
IgA; IgG2; IgG3
173
ANC of what decreases survival in invasive fungal?
<1000; giving WBC transfusion and GSF shown to improve survival
174
middle turb attaches where what % of the time?
lam pap 80%, skull base and middle turb 20%
175
inverted papilloma assoc w which virus
HPV
176
what marker specific for B cell
CD 19, 20, 22
177
NK t cell markers
CD 56, 16
178
rate of dehiscence of ant ethomid, where found?
10-40%, between second and third lamella (bulla and basal lamella), 11mm posterior from posterior wall of frontal recess
179
what are the 5 lamella (not ehtmoturbinals)
```
1- uncinate
2- bulla
3- basal lamella
4- superior turb
5- supreme turb
```
180
only class b spray for rhinitis of pregnancy
budesonide (rhinocort)
181
MC location of oral pyogenic granuloma
gingiva
182
in context of laryngeal malignancies, what is meant by a "marginal" tumor
along aryepliglottic fold
183
which muscle of mastication depresses and protrudes madible
lateral pterygoid
184
what radiation dose nec fo ORN
>60Gy
185
chronic sialadenitis MC bacteria in adults?
staph aureus
186
NF1 vs NF2 which chromosomal mutation
17 vs 22 (merlin)
187
what is associated w obliterated foramen spinosum?
persistent stapedial aa, and so aplasia of middle meningeal aa
188
what abx contraindication for botox injection?
aminoglycoside-- potentiation of NM blockade that may result in unwanted AEs
189
persistent stapedial aa assoc w what?
obliterated foramen spinosum, aplasia of MMA
190
Hashimoto's thyroiditis with PTC has better or worse presentation?
smaller tumor, less likelihood of LN mets, less advanced TNM stage (thought d/t autoI tumor cell destruction)
191
what is the risk of malignant transformation for IP?
10%
192
What's the percentage of OPC cases that are HPV associated
60%
193
which pharyngeal mm is innervated by V3?
tensor veli palatini
194
WHO classification of NPC
1. SCC 2. nonkeratinizing epidermoid carcinoma (EBV related) 3. MC variant, non keratizing undifferentiated (EBV related)
195
What percent of head and neck paragangliomas secrete catecholamines?
2%
196
indication for postop radiation vs chemoxrt
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
Ohngren's line
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
what's the longest acting local anesthetic
bupivicaine 3-7 hrs
199
what anesthetic has been shown to inc flap survival?
isoflurane
200
what layer of dissection for 1. endoscopic brow lift 2. coronal brow lift 3. direct brow lift 4. mid forehead/indirect brow lift
1. subperiosteal 2. subgaleal 3. subcutaneous 4. subcutaneous
201
hillocks of his
1. tragus 2. root of helix 3. helix 4. antihelix 5. antitragus 6. lobule
202
most injured extraocular mm during blepharoplasty
inferior oblique
203
perofrming an auriculectomy, which part should be preserved for best prosthetic result
tragus
204
Dedo classification of cervical abnormalities
```
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
how large should tissue expander be? what layer in scalp?
2.5 times width of defect or size of expander base + size of defect
subgaleal layer
206
timing of vessel growth in full thickness skin graft?
innoculation 24-48hrs
capillary growth 48-72 hrs
est new blood supply 3-5 days
207
difference bt deep plane rhytidectomy vs composite?
composite incorporates orbicularis oculi into flap
208
when can repair infant cleft lip?
10-10-10 Hb 10, >10lbs, 10 WGA (3 months)
209
how close eyelid defects?
<25% primary closure
50-100 tarsoconjunctival flap (Hughes)
1/3-2/3: lateral canthotomy and semicircular adv flap (Tenzel)
210
what bug must tx when using leeches
```
aeromonas hydrophilia (gram neg rod)
3rd gen ceph, cipro, aminoglycoside, sulfa, tetracycline
```
211
cleft lip nasal deformity
alar base widened, displaced inferiorly; tip/
caudal septum/ant nasal spine/columella base toward normal side
maxilla underdeveloped on involved side
212
radiological neck levels based on superior or inferior border of hyoid/cricoid?
inferior
213
what % ppl have incomplete superficial palamr arch and poor communication bt deep and superficial arches precluding RFFF
12%
214
which chemical peel produces perifollicular frosting?
salicylic acid bc lipophilic and concentrates w/in pilosebaceous apparatus
215
with aging what happens to epidermis, dermis, elastin, ground substance of dermis?
atrophies, atrophies, decreases, increases (fibroblasts, degranulated mast cells, chronic low-grade inflammation)
216
sunderland criteria
```
I: neuropraxia
II: axontmesis, wallerian degen
III: neurotmesis (endoneurium transected), risk of synkinesis
IV: perineurium, synkinesis present
V: transection, risk of neuroma
```
217
contents and location of cochlear aqueduct vs vestibular aqueduct
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
what cVEMP result tells you what? oVEMP?
dec threshold SSCD, inc threshold Menierre's, otosclerosis, inf vestibular nerve lesion, VS
oVEMP dec shows superior vestibular neuritis
219
ECOG SP/AP ratio tell you what?
>0.4 SSCD or Meniere's
220
what's the air-bone gap with each fork?
256: 15dB or more
512: 25dB or more
1024: 35dB or more
221
in vestibular neuritis which direction is nystagmus
fast phase away from affected side
222
cochlear nerve auditory pathway
mostly inner, some outer hair cells -> cochlear nucleus --> superior olivary complex --> lateral lemniscus, inf colliculus, audiotry cortex
223
Melkersson-Rosenthal Sd is what
recurrent facial edema, facial paresis, angular chelitis, fissured tongue
224
sup vs inf vastibular nerve innervates
superior: superior, lateral, utricle
inferior: posterior, saccule
225
congenital chole more common in male vs female?
male 3:1
226
auditory brainstem implant FDA approved for how old in NF2?
12yo
227
cornea is innervated by what nerve? of what branch?
| what's the blink reflex
opthalmic nerve --> nasocilliary nerve
| nasocilliary V1 --> VII orbicularis occuli
228
after dermabrasion, how long wait to repeat?
12 months
229
normal MRD1 and MRD2
4mm, 5mm
| avg palpebral fissure 9mm
230
best way to manage mature trap door scar
revisoion z plasties
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nasal bilobe flap for defect less than how big?
<1.5cm at least 5mm from alar rim
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nasal eval: Crumley's method
3-4-5 triangle (alar base-nasal tip- nasion)--nasal angle 36 degrees ideal
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nasal eval: Good's method
distance from alar crease to nasal tip (nasal projection) should be 0.55-0.6 of distance from nasal tip to nasion
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idelal nasofacial angle
30-40 degrees
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what neck dissection for medullary thyroid CA? what if >1cm?
VI, if >1cm VII and consider ipsi cervical neck
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risk of pleomorphic adenoma malignant transformation
1.5% in first 5 years, 10% if observed form ore than 15 years
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z plasty angle with % legthened and scar reorientation
30-45-60
25-50-75
45-60-90
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carotid body afferent via what nerve?
afferent IX, efferent unsure--cevical sympathetic ganglion
| vagal innervates aortic body
239
On schirmer's test want what?
10-15mm/5mins; if less than, need ophtho eval for pre-surg clearance before bleph
240
cVEMP tests what
saccule--> inf nerve
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oVEMP tests what
utricle-->superior nerve
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what is the aberrant anatomy of a pulmonary artery sling?
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
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what does the ectodermal otocyst become?
membranous labyrinth
244
stapes footplate from what?
derived from otic capsule
245
temporal bone neoplasm T stage?
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
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MC site of pleomorphic adenoma in minor salivary gland?
lips
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which thyroid CA has amyloid deposits
medullary
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major tip supports
1. lower lateral cartilage
2. scroll area
3. attachment of medial cura to caudal septum
249
what %age of pts have cervical mets with BOT tumors? bilateral cervical met?
>60%; up to 20% due to extensive b/l lymphatic drainage
250
what eye symptom can sturge weber pts have?
risk of glaucoma
251
when lip defect involveds philtrum, use what recon?
usu abbeflap (lipswitch)
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midface lifting has the greatest effect on what mm?
orbicularis occuli
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where does the levator aponeurosis insert into the upper eyelid?
it inserts to the anterior surface of the tarsus
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what is the NOSE scale for?
a QOL instrument to measure nasal obstruction and so effectiveness of septo/turbs, functional rhinoplasty
255
Anterior lamella of lower eyelid comprisedo f what?
skin, orbicularis muscle (no subq tissue, no tarsus)
256
how treat a facial cutaneous AVM?
surgical excision w/ or w/o presurgical embolization
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once temporal branch of FN exits parotid gland, where is it in relation to SMAS above the zygomatic arch?
within SMAS, otherwise is deep to SMAS
258
What class are the lasers used in ENT?
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
what is median rhomboid glossitis? how treat?
smokers predisposed to candida infection, smoking cessation should be first recommendation, can try antifungal
260
what is central serous retinopathy?
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
inc risk of what if use IM vs IV ketamine in peds?
IM ketamine higher liklihood of laryngospasm vs IV
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hypoglossal nerve loops around which structure?
occipital artery in type III variant
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aberrant right subclavian artery in a retroesophageal course arises from...
what od all the arches form?
```
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
PET in unknown primary neck SCC changes therapeutic course in what %age of pts
25%
265
what is Lhermitte's sign?
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
selection bias vs sampling bias
recall bias vs late look bias
procedure bias, confounding bias, lead time bias
pygmalion effect vs hawthorne effect
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
epidermis layers
```
calif lady girls like string binkinis
cornium
lucidum
granulosum
lucidum
spinosum
basale
```
268
how long should you wait after lasix for bleph?
>6 months
269
most significant prognostic factor in melanoma stage I/II vs stage III?
tumor thickness vs number of involved LNs; other poor prognostic factors: ulceration, male, older age
270
PTC in hashimoto's is likely to be better or worse stage?
better stage (not as bad)
271
propranolol dosing for <8 weeks, >8weeks?
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
what are the radiologic vs surgical borders of neck level III?
radiologic: lateral SCM, medial carotid, inferior hyoid, inferior cricoid
surgical: lateral sensory branches of cervical plexus, sternohyoid, carotid bifurcation, omohyoid
273
what dz have increased cVEMP threshold vs decreased threshold?
increased: menierre's, otosclerosis, VS
decreased: SSCD
274
eya1 mutation is what sd?
branchio-oto-renal sd
275
which is most aggressive form of BCC?
morpheoform aka sclerosing
276
what are the stages of hair?
- 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
what are the arteries for anterior vs posterior epistaxis? what are the areas called?
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
IX schwannoma vs vestibular shwannoma causes what type of hearing loss?
mid frequency vs high frequency
279
which cancers are associated with amyloid deposition?
adenoid cystic and medullary thyroid
280
what is the MC dz in MEN2a? how do hyperparahtyroidism compare bt MEN2A and MEN1?
medullary thyroid; MEN1 is usu worse wiht four gland hyperplasia
281
tuning fork ab gap? 256, 512, 1024?
15-25-35
282
what 3 aa supply trap flap
occipital, tca, dorsal scaoular
