Focused Review Flashcards
What is better for posterior expansion, 2-piece lefort or SARPE?
2-piece lefort, more relapse
What is the max expansion you can get with a SARPE?
For around 7 mm
What is your SARPE protocol?
-5-7 days latency
-0.5 mm / day within 4 weeks
-4 months consolidation
What do you do if you have a dusky maxilla?
-Concerned for avascular necrosis
-Remove any splints/IMF
-Consider OR to return maxilla back to original position
What is the normal intercanthal and interpupillary distance?
-Intercanthal: 32 mm
-Interpupillary: 60 mm
What is the goal MIO s/p ankylosis?
35 mm
What is the Kaban protocol?
-Resect bony ankylosis
-Ipsilateral coronoidectomy
-Contralateral coronoidectomy prn
-Temporalis flap
-Mobilization after 10 days
-Aggressive PT
What imaging do you obtain for a TMJ ankylosis?
CT Face with contrast (see pterygoid plexus and other vasculature
What are your landmarks for a TMJ arthrocentesis?
-Holmund-Hellsing line.
-10 mm ahead and 2 mm below
-20 mm ahead and 10 mm below
What do you use for your arthrocentesis?
-LR 300 mL
-Kenalog 40 mg/mL
What inflammatory mediators are you attempting to reduce in TMJ?
TNF-a
IL1
IL6
Describe your costochondral graft approach?
-Rib 6 on right side
-5 cm incision along inframammary crease
-Skin, subQ, fascia, plane between pectoralis major and rectus abdominus
-Harvest 1-3 cm of cartilaginous cap
-Check for PTX
Where is most likely bleeding during TMJ surgery?
-Middle meningial: 31 mm medial to zygomatic arch and 2.4 mm anterior to height of glenoid fossa
-Masseteric
-Pterygoid plexus
What is the course of the facial nerve?
-Branch 1.5-2.8 cm anterior to EAC
-Crosses zygomatic arch 8-35 mm anterior to EAC in temporoparietal fascia layer
Describe steps of carotid cutdown.
-Neck incision 5 cm in length, 2 cm below inferior border of mandible over SCM
-Retract SCM posteriorly
-Identify carotid sheath
-Retract IJV posteriorly
-Dissect to carotid bifurcation (ID hypoglossal nerve)
-Ligate above facial (third anterior branch)
What is TMJ concepts made out of?
-Fossa: High molecular weight polyethylene, unalloyed titanium mesh
-Condyle: Cobalt/chronium/molybendum, titanium alloy body
What is Frey’s syndrome, how is it treated?
-Aberrent innervation of parasympathetic and sympathetic fibers of auriculotemporal and glossophrayngeal nerves
-Demarcate area with starch iodine test
-Scopolamine patch or botox 16 units
How is OSA classified?
AHI:
Normal: 0-4
Mild: 5-15
Moderate: 15-30
Severe: 30+
What is apnea?
-Cessation of airflow x10 seconds
What is hypopnea?
-Reduction of airflow resulting in O2 reduction of 3-4%
What is RERA?
-Respiratory event related arousal
What is STOP BANG and how is it interpreted?
-Snoring, tiredness, observed apnea, pressure, BMI, age, neck, gender
-High risk 5-8, intermediate 3-4
What is Epworth sleepiness scale and how is it interpreted?
-Questions likelihood of dozing off during specific tasks
-11-24 excessive, 6-10 higher than normal daytime sleepiness
What is PAS?
Posterior airway space (measured along line B to angle of mandible)
-Less than 11 may indicate base of tongue obstruction
What is P-PNS?
-Length of soft palate
-Over 37 indicated increased risk of OSA
What is H-MP?
Hyoid to mandibular plane
-Longer than 15 mm indicative of longer airway/OSA
What is COVID?
-A viral disease that can cause severe acute respiratory syndrome due to virus attaching to ACE2 receptors in lungs activating inflammatory mediators that can lead to a cytokine storm.
-Spread via direct contact or droplets
What is the rood criteria?
-Darkening, deflection, narrowing or bifid roots
-Diversion, narrowing or interruption of white line of canal
Describe the pupillary reflex.
Afferent CN II
Efferent CN III
Parasympathetic CN III, ciliary ganglion
Sympathetic: Superior cervical ganglion
What are the levels of nerve testing?
A: Aa/Ab: Brush stroke/2 pt discrimination. Normal 2-point 6 mm
B: Ab: Static touch
C: Ad/C: Pain
How is a neuroma managed?
Resect 3 mm each side
How is direct neurorrhaphy completed?
-7/0 nylon (can repair 5 mm primarily)
What is Axogen, how does it work?
-Processed allograft, scaffold for nerve tissue to grow
-Use with entubulation (polyglycolic acid conduit)
What is the failure rate with coronectomy?
30% (root migration)
What are the borders of the pterygomandibular space?
-Buccal to parotid
-Lateral pterygoid to inferior border of mandible
-Medial pterygoid to Ascending ramus
What divides the superficial and deep temporal space?
-Temporalis muscle
What is the route of an infection to the mediastinum?
-Danger space
-Alar and prevertebral fascia
-Enters C6-T4
What is an implant made out of?
-Grade 4 titanium
-Titanium, aluminum, vanadium
What are fast, short and long acting insulin?
-Fast: Lispro, aspart
-Short: Regular
-Long: Glargine, Levemir
What are biguanides and how do they work?
-Metformin
-Decrease hepatic gluconeogenesis
What are sulfonylureas and how do they work?
-Glipizide
-Stimulates beta cells to produce insulin
How does ozempic work?
-GLP-1 agonist
-Stimulates insulin secretion and decreases glucagon secretion
What are the borders of the submasseteric space?
-Buccal-parotid
-Lateral pterygoid to inferior border of mandible
-Ascending ramus to masseter
How is a bowstring test preformed?
-Grab eyelid with fingers or forceps and pull laterally
-Palpate tendon area and detect movement
What are the zones of the neck?
Zone 1: Thoracic inlet to cricothyroid membrane
Zone 2: Cricothyroid membrane to angle of mandible
Zone 3: Above angle of mandible
What is PIerre Robin Sequence?
A congenital birth defect characterized by underdeveloped jaw, backward displacement of tongue and upper airway obstruction. Associated with cleft palate
What is the Cincinnati stroke scale?
-Facial droop, arm drift, abnormal/slurred speech
What is the management of stroke?
-CT within 20 min of ED
-TPA within 60 minutes of ED (within 3 hours of stroke)
What are requirements for TPA in stroke patient?
-Ischemic stroke
-No anticoagulants/antiplatelets x24h
What is T2DM?
-Endocrine disorder characterized by increased blood glucose secondary to insulin resistance
What is HTN?
-Increased arterial pressure diagnosed with 2 elevated readings on 2 occassions
What is CAD?
-Plaque build-up in the wall of the arteries that supply blood to the heart
What is IHD?
-HEart damage caused by reduced blood flow to the heart, inability to match oxygen demand of the heart?
What is MRD1 and MRD2 and measurements?
-MRD1: Corneal reflex to upper eyelid 4 mm
-MRD2: Corneal reflex to lower eyelid, 5 mm
How is botox reconstituted and what is the shelf life?
-50 U vial in 1.25 mL of sterile saline
-4U/0.1 mL
-Use within 4 hours
Pleomorphic Adenoma
-Most common salivary gland neoplasm, benign
-Ductal and myoepithelial cells common
-Resection with 1 cm margins (up to superficial parotidectomy, known to have extracapsular spread)
Carcinoma ex-pleomorphic adenoma
-Malignant transformation of pleomorphic adenoma
-Extent and grading drive treatment
-Wide local excision, neck dissection, consider radiation
Polymorphous adenocarcinoma
-Previously PLGA
-Second most common intraoral malignancy
-Good prognosis
-Surgical resection with 1.5 cm margins
Mucoepidermoid carcinoma
-Most common malignant salivary gland tumor
-Low-high grade affects treatment
-1.5 cm margins (hemimaxillectomy if high grade), consider radiation for high grade
Adenoid Cystic carcinoma
-Salivary gland malignancy
-Perineural invasion and skip lesiosn
-10% 15 year survival
-3 cm margins
Acinic Cell Carcinoma
-Low grade salivary malignancy
->90% survival
-1 cm margins
Neurofibroma
-Most common peripheral nerve sheath tumor
-Consider NF-1 (AD) if cafe au lait spots
-Conservative excision
Schwannoma
-Peripheral nerve sheath tumor with Antoni A&B
-Conservative excision
Osteosarcoma
-Male>female, mean age 30-40
-Swelling with pain, loosening of teeth, paresthesia
-Loss of p53 and Rb tumor suppresor genes
-Pre-op Chemo (doxorubicin, vincristine, cyclophosphamide, prednisone)
-Allow 1 month for marrow recovery
-3 cm bony margin, 2 cm soft tissue margin
-Post-op chemo 6 weeks after resection
-Low grade survivability >80%, high grade <30%
What are the variants of osteosarcoma?
-Chondroblastic (high grade)
-Osteoblastic
-Fibroblastic
-Telangiectatic
-Osteoclast-rich
How is osteosarcoma staged?
-T1 <8cm, T2 >8cm
-G1 (well differentiated, low grade), G2 (moderately differentiated, high grade), G3 (poorly differentiated, high grade)
-T3G1 still IB
Obturator timing
9 months to become dimensionally stable
Describe soft tissue sarcomas and treatment
-Angiosarcoma, rhabdomyosarcoma, leiomyosarcoma, karposi sarcoma
-Wide local excision
Zygomatic Implants
-Straumann 30-60 mm length, 3.3-4.3 mm diameter, 55 degree platform
-ZAGA 0-4 (concavity of maxillary anterior wall)
-Crestal incision, releasing incision at second molar and midline
-Expose infraorbital nerve, body of zygoma and zygomatic arch, palatal flap raised
-Small sinus window cut on lateral aspect of maxillary sinus, reflect sinus membrane if possible
-Entry point located at first premolar-first molar region
-Drill speed 1-1.5k
-Twist drill 2.9 mm, possibly 3.5 mm
-15 rpm on insertion, 50 Ncm max
PA opioid lookup
PDMP (prescription drug monitoring program)
Erythema multiforme
-Acute self-limiting immunological disorder
-Often idiopathic or secondary to a trigger (HSV, medication
-Spectrum and can progress to EM minor/major, SJS, TEN
-Topical/systemic steroids for mild cases
-Hospitalization and supportive care for SJS/TEN
Papillary Cystadenoma Lymphomatosum
-Warthins tumor
-10% bilateral
-Smokers, older males
-Superficial paroticecotmy, 5 mm cuff
Verrucous Carcinoma
-Malignant epithelial neoplasm, exophytic papillary growth
-Locally aggressive
-1 cm margins, 85% survival
Pemphigoid
-Autoimmune destruction at basement membrane zone (hemidesmosome destruction)
-Need ophthalmology consult
-Dexamethasone elixir 0.5 mg/5cc
Pemphigus
-Autoimmune intra-epithelial destruction
-Systemic
Central Giant Cell granuloma
-Multinucleated giant cells
-Non-aggressive <5 cm
-Aggressive >5 cm (adjunct triamcinolone 10 mg/mL for each 1 cm x6 weeks)
Fibrous dysplasia
-Congenital Fibro-osseous disease in GNAS1 gene
-Associated with osteosarcoma
-Mono-ostotic/poly-ostotic
Cemento-osseous dysplasia
-Reactive fibro-osseous disease
-PA, focal, florid presentations
OKC
-Benign neoplasm from dental lamina
-PATCH gene
Odontogenic Myxoma
-Ectomessenchymal tumor
-Benign, locally aggressive
-1 cm border with 1 anatomic barrier
CEOT
Benign odontogenic tumor, asymptomatic expansile lesion
-1 cm margin with uninvolved anatomic barrier
Ameloblastoma
-Benign, locally aggressive odontogenic tumor of inner enamel epithelium
-BRAF mutation
-1 cm with uninvolved anatomic barrier
Aneurysmal bone cyst
-Excision eo en bloc resection
Calcifying odontogenic cyst
-Benign odontogenic cyst
-Common anteiror maxilla
-E&C/excision
Traumatic bone cyst
Curettage
-Ossifying fibroma
-Conservative excision
-Wide local excision, 30-50% recurrence with juvenile
Langerhans Cell histiocytosis
-Surgical curettage
-Low dose radiation, may need chemo if widespread
Vascular malformation
-High flow vascular malformation
-Pre-op embolization, 2 cm margins)
Adenomatoid odontogenic tumor
-Benign odontogenic tumor
-2/3 female, 2/3 maxilla, 2/3 imapcted
-Encapsulated, E&C
Indications for chemo and rad with SCCa
-Radiaiton: Positive margins, T3/T4, ECS, Perineural spread, N2+
-Chemo: ECS, +margins, recurrence, mets
Levels of Neck
-1: Submental/submandibular
-2: Sternohyoid-SCM (divided by CN XI)
-3: SCM Hyoid-cricoid cartilage
-4: SCM Cricoid cartilage to clavicle
-5: Posterior (SCM-Trap), cricoid divides
-6: Hyoid to suprasternal notch, carotid
Radical neck dissectio
-Levels 1-5
-CN XI
-IJV
-SCM
Importance of SCM and XI
SCM Head turning
CM XI: Shoulder use
Elective neck dissection in an N0 neck?
-Occult lympho node metastasis greater than 15-20%
Ideal malar eminence location
10-15 lateral
15-20 inferior to lateral canthus
Ideal nasolabial angle
85-105 degrees
Wits appraisal
-Maxilla and mandible relationship not influenced by cranium
-AO, BO (A and B to occlusal plane)
-Females: AO and BO coincide
-Males: BO 1 mm ahead of AO
Mandibular plane angle
Angle >39 is high
Angle <28 low angle
Whats the ideal occlusal plane angle
-Angle between occlusal plane and anterior cranial base
-14 degrees idea
Holdaway ratio
-Extend NB line to inferior border
-Compare L1 to pogonion
-Ideal ratio is 1:1 in males, 0.5:1 in females
What is in PRF, what is your protocol to make?
-10 mL blood
-Centrifuge 12 min at 2700 rpm
-In middle of tube
-Contains FGF, VEGF, PDGF, IGF1
What is a medrol dose pack?
-Methylprednisone 4 mg tabs
-6 day taper (6, 5, 4, 3, 2, 1): 21 tabs
-1 mg methylprednisone=5 hydrocortisone
Xrays in pregnant patients
-Less than 10 Gy (5 in 1st trimester)
-Pan=0.00001 Gy
TMJ evaluation with tongue depressor
-Mahan’s sign
-Bite on tongue depressor
-Pain on same side: Muscular
-Pain on opposide side: TMJ internal derangement
Radiation in CBCT and pan
CS 9300
-CBCT: 70-100 mSv (9 days background equivalency)
-Pan: 20 mSv
-Flight NY-LA 500 mSv
-Medical grade 7k mSV
DM Criteria
Fasting glucose >126
Non-fasting glucose >200
A1c >6.5
What is the Zurich classification for osteomyelitis?
-Acute osteomyelitis (less than 4 weeks)
-Secondary Chronic Osteomyelitis (more than 4 weeks, cause known)
-Primary Chronic osteomyelitis (more than 4 weeks, cause unknown)
Temporoparietal Fascia Flap
-Supplied by superficial temporal artery and vein
-Map superficial temporal artery via doppler
-Incision through preauricular crease in front of tragus and extends superficially into hemi-coronal incision
-Skin, subcutaneous, fat/fascia
-Incision keeps in mind facial nerve, extend superiorly to scalp
-Check arc of rotation
-Release fascia with desired pedicle from underlying temporalis muscle
-Galea seperated from TP fascia
-Release completed in the subgaleal areolar tissue down to zygomatic arch
-Subcutaneous tunnel formed to allow flap to extend to defect
Botox injections
Frontalis 4 U/site: 2 cm above eyebrow to prevent ptotic brow
Procerus/corrugator: 5U/site
Crows feet: Lateral orbicularis 3 U/site: 5mm from orbital rim and 5 mm medial and lateral to the suprorbital nerve
-Avoid forehead injections lateral to the lateral canthus to prevent inhibition of temporalis
Inability to close eye after botox
Paralysis of orbicularis oculi
Tape eye shut and lubricant
Misch bone classification
Types I-4, 4 being softest. Related to hounsfield units
Cawood ridge classification
1-Dentate
2-Immediate post-extraction
3-Well healed, adequate height/width
4-Knife edged, inadequate width
5-Inadequate height and width
6-depressed ridge, loss of basal bone
What is propofol and how do you use it?
-Sedative-hypnotic
-Potentiation of GABA
-1 mg/kg for induction (3mg/kg children)
-25-100 mcg/kg/min infusion
-Intermittent bolus of 20-50
What is ketamine and how do you use it?
-Dissociative anesthetic with analgesic effects
-NMDA receptor antagonist
-Sympamimetic
-0.5 mg/kg intermittent bolus
-IM 3-5 mg/kg
What is midazolam and how do you use it?
-Sedative-hypnotic
-Potentiates GABA
-0.1-0.2 mg/kg IV
-Oral premed: 1 mg/kg
How is midazolam reversed?
-Flumazenil 0.2 mg over 15 seconds.
-Repeat until max dose 1 mg
-Pediatric: 0.01 mg/kg
What is fentanyl and how is it used?
-Narcotic mostly mu receptor agonist
-1 mcg/kg
How is fentanyl reversed?
-Naloxone (competitive antagonist
-0.4 mg q2 min up to 10 mg
-Pediatric 0.01 mg/kg up to 0.1 mg/kg
Dose of succinycholine/rocuronium
-Sux: 1 mg/kg (20% for laryngospasm)
-Rocuronium: 0.5 mg/kg
ACLS Cardiac arrest algorithm
-Start CPR, give O2, attach monitors/defebrilator
-VF/pVT: Shock, shock, 1 mg epi, shock, 300 amio, shock, 150 amio, shock, 1 mg/kg lido (shock 120-200J)
-Asystole/PEA: CPR, Epi q3-5 min, reversible causes (hypovolemia, hypoxia, acidosis, hypo/hyperkalemia, hypothermia, tension PTX, tamponade, toxins, thrombosis)
Adult Bradycardia algorithm
-HR <50/min. Check for hypotension, AMS, signs of shock, chest discomfort
-Atropine 1 mg q 3-5 min max 3 mg
-Transcutaneous pacing
-Epi 2-10 mcg/min
Adult tachycardia algorithm
-HR >150/min. Check for hypotension, AMS< signs of shock
-Synchronized cardioversion 50-200 J
-Adenosine if narrow complex: 6 mg first dose, 12 mg second dose
-If wide and stable: Adenosine if regular/monomorphic
-If narrow and stable: Vagal maneuvers, beta blocker
-Antiarrhtymic infusions for stable wide QRS: Amiodarone 150 mg over 10 minutes
PALS Cardiac arrest
-Start CPR, attach monitors/defibrillator
-VF/pVT: Shock (2 J/kg), shock (4J/kg), epi 0.01 mg/kg, shock, amio (5 mg/kg), shock, lidocaine 1 mg/kg
-Asystole/PEA: CPR< epi q3-5 min
-Reversible causes: Hypovolemia, hypoxia, acidosis, hypoglycemia, hyper/hypokalemia, hypothermia, PTX, tamponode, toxins, thrombosis
Pediatric bradycardia
-Start CPR at HR <60/min
-Epi: 0.01 mg/kg q3-5 min
-Atropine 0.02 mg/kg max 0.5 per single dose, can repeat once
-Transthoracic pacing
-Treat underlying causes (hypoxia, hypothermia, medications)
Pediatric tachycardia
-Unstable narrow: Adenosine 0.1 mg/kg first dose, 0.2 mg/kg second dose. Synchronized cardioversion 0.5-1 J/kg, increase to 2 J/kg for second dose
-Unstable wide: Synchronized cardioversion
-Stable narrow: Vagal maneuvers, adenosine 0.1 mg/kg
-Stable wide: Adenosine if monomorphic, expert consult
Pediatric airway
Large occiput
Large tongue
Narrowest part is cricothyroid
Superior and anterior larynx
Floppy epiglottis
Age cricothyroidotomy is contraindicated
-Age 6 and less
ZMC fracture classification
Zingg
-A1 isolated arch, A2 Isolated lateral wall, A3 isolated inferior orbital rim
-B: Monogragment with all 4 buttresses
C: Comminution
Knight and north: Direction of displacement
Condylar fracture classifications
Wassmud Scheme
AO: high/low based on sigmoid notch and lateral pole line
Zide condylar fracture criteria
-Middle cranial fossa involvement
-Unable to achieve occlusion
-Invasion of joint space by foreign body
-Lateral capsule violation and displacement
Relative: Bilateral when height needs restored, early/immediate function, medical conditions, delayed tx with misalignment
NOE classification
Markowitz
1-No comminution, tendon intact
2-Central fragment largest with tendon
3-severe comminution with avulsed tendon
Frontal sinus classification
Gontys
1-Isoalted anterior
2-anterior and posterior fractures
3-Posterior only
4-comminuted
TMJ ankylosis classification
Topazian
1-only condyle
2-Condyle/sigmoid notch
3-Condyle/sigmoid notch/coronoid
Osteoradionecrosis classification
Notani
1-alveolar bone
2-Above IAN
3-Below IAN
How does Unasyn work and what is the adult/pediatric dosage?
-Ampicillin/sulbactam
-Beta lactam: Inhibits cell wall synthesis via inhibition of PCN binding proteins
-Beta lactamase inhibitors: Inhibitor of beta lactamase to prevent breakdown of the beta lactam
-3g q6hr.
-300 mg/kg/day
PCN, Augmentin MOA, adult/ped dosage
-PCN: Beta lactam: Inhibits cell wall synthesis
-Augmentin: Amoxicillin/clavulanate (adds beta lactaumase inhibitor)
-Amoxicillin 500 mg q8h. Pediatric: 40 mg/kg/day
-Augmentin 875/125 mg q12h. 45 mg/kg/day
Clindamycin MOA, adult/ped dosage
-50S inhibitor
-300 mg QID
-10 mg/kg/day Peds
Moxifloxacin MOA/adult dosage
-DNA gyrase inhibitor
-400 mg/day
Types of nec fasc
-Type I: Mixed
-Type II: Group A strep
-Type III: Staph
-Type IV: Clostridium
-Type V: Klebsiella
Antibiotics for nec fasc
-Broad spectrum
-Cabapenem (beta lactam), Vanc
Treatment of Torsades
-50 mg/kg (max dose 2g) rapid push if pulseless
-1-2 g over 10-20 minutes if pulse
Antibiotics for cavernous sinus thrombosis
-Rocephin (crosses BBB)
-Flagyl
-Vanc (high likelihood of S. aureus)
-Steroids
Treatment of mucor
Amphotericin B (5 mg/kg)
-Renal toxicity, shake and bake
-Inhibits ergosterol on fungal membrane
Allergic reaction management
-IM Epi 1:1000 0.3 mg (0.15 mg if 10-25 kg) q15 min
-IV Epi: 10 mcg-1 mg q2 min (1-10 mcg/kg peds)
-Albuterol inhaler prn bronchospasm
-Diphenhydramine 0.5 mg/kg IV peds or 50 mg adults
-Dexamethasone 4 mg IV 0.1 mg/kg pediatrics
Submandibular space
-Anteiror to posterior belly of digastric
-Inferior and medial aspect of mandible- digastric tendon
-Platysma to mylohyoid
Lateral pharyngeal space
-Constrictor msucles to alar fascia
-Skull base to hyoid
-Retropharyngeal to medial pterygoid
Implant material?
85% titanium 15% zirconium
Fill technique and types
-Subdermal plane, aspirate
15-25 mg/mL
-Higher G’ more firm
-Juvederm voluma (cheeks/chin)
-Volbella (lips)
-Volux (jawline)
How is filler dissolved?
Hyluronidase 1500 units (dissolve in 5 mL)
Treatment of ectropion/entropion
-Ectropion: Tarsal strip
-Entropion (quickert suture or grafting)
Scar/wound management
-Antibiotic ointment day 2-7
-Petroleum jelly after first week
-Silicone gels/sheets
-Avoid sun exposure
Skin prep for peels/laser
-Tretinoin (allows penetration)
-Glycolic acid (allows penetration)
-Hydroquinone (reduces melanocytic production)
-Sunscreen
-Acyclovir 3 days before, 10 days after
Chemical peel depth
0.45 mm (TCA 35%)
-Medium depth, papillary dermis
Acid base deficit in PD
Respiratory alkolosis
Asthma
-Reversible obstructive respiratory disease characterized by bronchiolar inflammation and hyperresponsiveness
CHF
-Cardiovascular disease characterized by the inability of the heart to pump enough blood to meet the body’s metabolic demands.
-Can see dyspnea, peripheral edema, S3/S4 sounds
IDDM
-Endocrine disordre of autoimmune destruction of beta islet cells in the pancreas that produce insulin
HTN
-Persistently elevated arterial blood pressure of 130/80 in adults. 2 elevated readings on 2 or more visits
ESRD
-Chronic renal disease leading to kidney failure
GFR <15
CAD
Disease of the vasculature of the heart, atherosclerotic plaque causing hardening and stenosis of the vessels supplying blood to the heart
Down Syndrome
Genetic disorder trisomy 21. Characterized by intellectual disability, developmental delay, CV problems
Fibromyalgia
Chronic disorder that causes pain and tenderness throughout the body. Heightened sensitivity to pain
Von Willebrand disease
Hematologic disorder caused by quantitative or qualitative defect of von Willebrand factor
Sickle cell disease
AR hematologic disorder causing structural sickling of RBCs. Crisis treated with bed rest, analgesics, and hydration
Pernicious anemia
Macrocytic anemia caused by B12 deficiency due to autoimmune mediated decrease in intrinsic factor
Congenital Heart Defect
Abnormality of the heart that develops before birth, can be from defective vessels, leaky valves or septal defects
Cystic fibrosis
AR disease resulting in altered chloride and water transport via the CFTR gene, pt with thickened secretions
Myasthenia Gravis
Autoimmune disorder affecting the ACh receptor causing weakness and fatigue
HIV/AIDS
-RNA retrovirus that targets CD4 cells leading to immunodeficiency. AIDS less than 200 CD4 count
Multiple Sclerosis
Inflammatory demyelinating disease of the CNS causing neurological dysfunction, relapses and periods of remission
Transfusion Reaction
Fever, chills, hives, and itching from a transfusion
-Stop transfusion, supportive care, possible neph consult for kidney support
Serotonin syndrome
Excessive serotonin causing diarrhea, flushing, muscle rigidity and seizures
-Treat with lorazepam, labetolol, cyporheptadine, methysergide
Digoxin toxicity
-Nausea, vomiting and visual disturbance
-Treat with digoxin specific antibody
Changes in transplanted heart
-Denervated heart
-Does not respond to indirect acting medications (glycopyrolate, atropine, digoxin, physostigmine)
Allergic rhinitis
IgE mediated inflammatory process of nasopharynx/oropharynx associated with allergen exposure
What is Humate P
-vWF, Factor VIII
What is cryoprecipitate?
-Factors 8, 9, vWF, fibrinogen, fibronectin
ALS
Neurodegenerative disorder of upper and lower motor neurons leading to muscle failure
Alzheimer’s
Neurodegenerative disorder of amyloid plaque and neurofibrillary tangles causing decreased cognition
Parkinsons
Neurodegenerative disorder caused by loss of dopaminergic neurons causing rigidity and resting tremor
Physiologic changes in pregnancy
Increased CO and workload, hypercoagulable, decreased FRC
Can use fentanyl and propofol
TMJ Wilkes
1-Painless clicking
2-intermitent locking/occasional pain
3-Frequent pain
4-Restricted ROM, chronic pain/crepitus
5-Joint pain/crepitus
TMJ ankylosis
Sawhney: 1-flat condyle, decreased joint space, 2-bony fusion on outer aspect of articular surface, 3-bony block ramus-zygomatic arch, 4-wider bony block and change of architecture
Topazian: 1-Condyle only, 2-sigmoid notch, 3-Coronoid
House brackmann
1-Normal
2-Mild
3-Moderate (complete closure with effort)
4-Moderate-severe (incomplete eye closure)
5-Barely perceptible motion
6-Total paralysis, no movement
Classification of frontal sinus fracture
Gontys
1-Anterior table
2-Posterior table
3-Both anterior and posterior
4-Comminuted
Classification of bone quality
Misch (relates to hounsfield units)
D1 Hardest
D4 Softest
Classification of bone quantity
Cawood
1-Dentate
2-Immediate post extraction
3-Well rounded, adequate height/width
4-Knife edge, adequate height, inadequate width
5-Flat- inadequate height/width
6-Depressed ridge, basilar loss
Classification of edentulous mandible
Class 1: 16-20 mm
Class 2: 11-15 mm
Class 3: <10 mm
Nerve injury classification
Seddon: Neuropraxia, axonotmesis, neurotmesis, neuroma
Sunderland:
1-temporary
2-possible recovery, endo/perineurium intact
3-perinuerium intact
4-only epineurium intact
5-Complete transection
6-Neuroma
Orbital infection classification
Chandlers
1-Preseptal cellulitis
2-Postseptal cellulitis
3-Subperiosteal abscess
4-Orbital Abscess
5-Cavernous sinus thrombosis
Nec fascitis classification
1-mixed aerobe/anaerobe
2-Strep pyogens
3-Staph aureus
4-Clostridial
5-Klebsiella
Glogau classification
1-Early, minimal wrinkles
2-Moderate, dynamic wrinkles
3-Advanced, static wrinkles
4-Wrinkles everywhere/photoaging
Fitzpatrick classification
1-White/very fair
2-White/fair
3-White/olive, sometimes burns
4-Light brown, rarely burns
5-Dark brown
6-Black
Dedo classification
1-Normal
2-Excess skin
3-Excess fat
4-Platysmal banding
5-Migrognathia
6-Low hyoid
BUN/Creat ratio
CT contrast in AKI
BUN/Creat 20:1 shows dehydration
Pre-treat with Sodium bicarbonate
Types of brow lift
Trichophytic (lowers hairline): In hairline. Galea/loose areolar tissue/deep temporal fascia
Endoscopic: Raises hairline. 5 incisions, subperiosteal, deep temporal fascia
Upper lid bleph
-MRD1 4 mm
-Eyelid crease ~8 mm
-Pinch test
-Leave 20 mm between margin and eyelid-brow junction
-Skin only dissection. Medial obicularis dissection.
How does an MRI work?
-MRI applies a strong magnetic field to allign protons along a single axis
-RF pulse emitted and knocks proton off axis, magnet ligns up agin. RF waves form an image
