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ENT > General > Flashcards

General Flashcards

1
Q

What scale is used to grade facial nerve function?

A

House-Brackmann scale

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2
Q

What are the grades in grading facial nerve function?

A

House Brackmann scale

Grade 1: Normal
Grade 4: Incomplete eye closure
Grade 6: No movement

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3
Q

Symptoms of Ramsay-Hunt Syndrome

A

AKA Herpes Zoster Oticus

1) Acute peripheral facial neuropathy
2) Herpetic vesicular rash on the EAC or auricle

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4
Q

Where is the most likely site (on the TM) for cholesteatomas?

A

Congenital: Anterior superior
Acquired: Posterior superior

Congenital - intact TM
Acquired - normally retraction pocket seen

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5
Q

Where to make myringotomy incision

A

Anterior inferior quadrant

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6
Q

What type of skin cancer is more likely found on which lip?

A 
BCCa = upper lip
SCCa = lower lip
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7
Q

What should you check for if bifid uvuala is present?

A

Submucosal cleft palate

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8
Q

Cause of a Thornwaldt cyst

A

Cystic formation during notocord obliteration

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9
Q

What is bright vs. dark on T1?

A

Fat: Bright
Fluid: Dark
Bone: Dark

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10
Q

What is bright vs. dark on T2?

A

Fat: Intermediate
Fluid: Bright
Bone: Dark

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11
Q

Shiley adult cuffless trach tubes offered in what sizes?

A

4, 6, 8, 10

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12
Q

Shiley pediatric cuffless trach tubes offered in what sizes?

A

3.0-6.5

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13
Q

Indications for a cuffed trach

A

1) Aspiration

2) Need for positive pressure ventilation

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14
Q

Shiley laryngectomy tube sizes

A

6, 8, 10

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15
Q

Types of laryngocele

A

Primary: No underlying disease
Secondary: Caused by obstruction of the ventricle (usually by SCC)

*Can be external/internal/mixed and fluid or air filled

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16
Q

What are the absorbable sutures?

A

Vicryl
PDS
Monocryl
Maxon

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17
Q

What are the non-absorbable sutures?

A

Prolene
Ethibond
Dacron
Silk (absorbed after a long time)

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18
Q

How long until absorbable sutures are absorbed?

A

60 days

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19
Q

Where does the RLN run?

A

In the tracheo-esophageal groove

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20
Q

What must be looked for if thyroglossal duct cyst is diagnosed?

A

Where the thyroid is so you don’t excise it

Can be a lingual thyroid

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21
Q

Contents of the carotid sheath

A 
Carotids
Internal jugular
Vagus n.
Sympathetic plexus
LN levels II-IV
Remnants of 2nd branchial cleft (pathologic)
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22
Q

What can the pattern of stridor tell us about location of obstruction?

A

INspiratory stridor = EXtrathoracic

EXpiratory stridor = INtrathoracic

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23
Q

What is included in the VOTE evaluation?

A

Evaluation for DISE

Velum
Oropharyngeal (lateral) walls
Tongue
Epiglottis

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24
Q

What surgery can help patients with OSA due to the palate/velum?

A

UPPP

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25
Q

What is the grading for the modified Malampati?

A

Class 0: Ability to see any part of the epiglottis upon mouth opening and tongue protrusion
Class I: Soft palate, fauces, uvula, pillars visible
Class II: Soft palate, fauces, uvula visible
Class III: Soft palate, base of uvula visible
Class IV: Soft palate not visible at all

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26
Q

Which V cell deficiency syndrome affect T cells too?

A

Common variable immunodeficiency does

X linked Agammaglobulinemia (Brutton’s) does not

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27
Q

What is seen clinically with selective IgA deficiency?

A

Allergies
Transfusion anaphylaxis
Autoimmune disorders

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28
Q

What is seen with Wiskott-Aldrich syndrome?

A

TIE:
Thrombocyopenia
IgM deficiency (and infections)
Eczema

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29
Q

By CD4 counts, what is considered aids?

A

CD4 < 200

CD4 < 14%

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30
Q

Causes of xerostomia

A

Radiation
Systemic disease (Sjogrens)
Medications & anesthesia

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31
Q

Most common pathogen seen in sialadenitis

A

Staph aureus

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32
Q

Risk factors for sialadenitis

A

Dehydration
Post-surgical
Radiation/chemo
Sjogrens

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33
Q

Complications of acute sialadenitis

A

Ducto-cutaneous fistula
Abscess
Ludwig’s angina

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34
Q

Treatment for sialadenitis

A

Antibiotics
Warm compresses
Sialogogues
Massage

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35
Q

Symptoms of sialolithiasis

A

Recurrent pain swelling,

Salivary colic

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36
Q

What is the role of plain films in sialolithiasis?

A

Submandibular calculi are radiopaque

Parotid calculi are radiolucent

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37
Q

Diagnostic modality of choice in sialolithiasis

A

High-resolution CT

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38
Q

What is seen with Heerfordt’s syndrome?

A 
AKA Uveoparotid syndrome (a form of sarcoid)
Anterior uveitis
Parotid gland enlargement
Facial nerve palsy (50%)
Fever
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39
Q

What is seen with Kuttner’s tumor?

A

Firm, tender enlargement of the submandibular gland

autoimmune “cirrhosis” of the gland

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40
Q

What dose of radiation may produce permanent radiation sialadenitis?

A

> 40-50 Gy

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41
Q

What malignancy can be caused by Sjogren’s syndrome?

A

Non-Hodgkin’s Lymphoma

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42
Q

Diagnosis of Sjogren’s

A 
Shirmer test (tissue paper on eye)
Saxon test (chew on sponge)
SS-A &amp; SS-B
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43
Q

What is seen with Mikulicz syndrome?

A

Recurrent lyphocytic parotid gland swelling

Secondary to amyloid, TB, bulimia, lymphadenitis, lead/mercury, EtOH

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44
Q

What can cause sialadenosis?

A 
DM
Cirrhosis
Malnutrition
Endocrine insuff (ovaria, thyroid, pancreatic)
Medications
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45
Q

What salivary gland lesion is seen in HIV patients?

A

Benign lymphoepithelial cysts

pseudolymphoma, multiple parotid cysts

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46
Q

What is a ranula?

A

Mucous retention cyst of the floor of mouth.

May “plunge” into cervical tissues & present as a neck mass.

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47
Q

What is seen in necrotizing sialometaplasia?

A

Ulceration of the hard palate

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48
Q

What causes necrotizing sialometaplasia?

A

Ischemia resulting in necrosis and infection of the minor salivary glands

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49
Q

What is the treatment for necrotizing sialometaplasia?

A

It is self-limited

**Important bc it can clinically and histologically mimic SCCa and mucoepidermoid Ca

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50
Q

What proportion of parotid tumors are benign?

A

80%

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51
Q

Where are the majority of salvary neoplasms found?

A

80% in the parotid

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52
Q

What salivary glands have higher rate of malignancy?

A

The smaller the gland, the more likely it is malignant

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53
Q

What are the benign salivary gland malignancies?

A 
Pleomorphic adenoma
Warthin's tumor
Oncocytoma
Monomorphic adenoma
Hemangioma
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54
Q

What are the malignant salivary gland tumors?

A 
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Acinic cell carcinoma
Malignant mixed tumors (CEPA)
SCCa
Lymphoma
Adenocarcinoma
Clear cell carcinoma
Malignant Oncocytoma
Epithelial-Myoepithelial carcinoma
Salivary duct carcinoma
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55
Q

What is the most common salivary gland tumor?

A

Benign mixed tumor

pleomorphic adenoma

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56
Q

What are the histologic components of a Pleomorphic adenoma?

A

Myoepithelial component
Epithelial component
Stromal component
Fibrous pseudocapsule

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57
Q

What parotid tumor is seen in middle-aged smoking men?

A

Warthin’s

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58
Q

What salivary parotid tumor can be bilateral?

A

Warthin’s

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59
Q

What are the histologic components of Warthin’s tumor?

A

Epithelial component
Lymphoid component
Mucous-secreting cells
Oncocytic cells

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60
Q

What is the difference between monomorphic and pleomorphic adenoma on histology?

A

Monomorphic is predominantly an epithelial component

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61
Q

What blood test can be abnormal in patients with large hemanigomas?

A

Thrombocytopenia

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62
Q

What does a violaceous hue overlying a lymph node indicate?

A

Possible mycobacterium infection

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63
Q

What is the most likely cause of a non-recurrent RLN?

A

Retroesophageal subclavian

arteria lusoria

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64
Q

What are the indications for CPAP?

A 
Moderate OSA (AHI 15-30) with symptoms
Severe OSA (AHI >30)
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65
Q

What is the medical treatment for acute invasive fungal rhinosinusitis?

A

Aspergillus: Voriconazole
Mucor: Amphotericin B

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66
Q

What do the hillocks of His develop into?

A 
I: Tragus
II: Crus of helix
III: Helix
IV: Antihelix
V: Antitragus
VI: Lobule
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67
Q

What is the most common site of facial nerve injury following temporal bone fracture?

A

Near the geniculate

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68
Q

What are the stages of papillary thyroid cancer for patients under age 45?

A

No distant mets: Stage 1

Distant mets: Stage 2

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69
Q

Melanoma T staging

A

T1: <1mm deep
T2: 1mm-2mm deep
T3: 2-4mm deep
T4 >4mm deep

a: no ulceration
b: ulceration

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70
Q

Melanoma N staging

A

N1: 1 node
N2: 2-3 nodes
N3: 4+ nodes

a: micromets
b: macromets

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71
Q

When should a cleft lip be repaired?

A

10, 10, 10 rule
Hgb of 10
10 pounds
10 weeks

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72
Q

When should NOACs be held prior to surgery?

A

2d prior to surgery

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73
Q

When should Coumadin be held prior to surgery?

A

5d prior to surgery

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74
Q

When should a Heparin gtt. be held prior to surgery?

A

6h prior to surgery

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75
Q

When should NOACs be restarted after surgery?

A

Usually on POD1

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76
Q

When should Coumadin be restarted after surgery?

A

12-24h postop

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77
Q

What diet should be used if a chyle leak is present?

A

Medium chain triglycerides

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78
Q

Types of malocclusion

A

Type I: Molars normally placed, subjective malocclusion
Type II: Overbite
Type III: Underbite

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79
Q

What is seen with Cogan’s syndrome?

A

Episodic vertigo
Interstitial keratitis
Bilateral fluctuating SNHL

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80
Q

Treatment for Cogan’s syndrome

A

High dose steroids

It is an autoimmune disease

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81
Q

What is the treatment for congenital torticollis?

A

Physical therapy

SCM section if refractory

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82
Q

What medical treatment can be offered to slow the progression of otosclerosis?

A

Fluoride

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83
Q

What tests should be performed following a Zone 1 injury?

A

CTA
CXR
Gastrografin swallow

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84
Q

What are the trauma neck zones?

A

Zone 1: Clavicles to cricoid
Zone 2: Cricoid to angle of mandible
Zone 3: Angle of mandible to skull base

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85
Q

What paraganglioma site has the highest rate of malignancy?

A

Orbital and laryngeal paragangliomas (25%)

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86
Q

What is the treatment for neonatal rhinitis?

A

0.1% dexamethasone drops

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87
Q

What is ECOG?

A

Electrocochleography

Testing of cochlear potentials in response to sound

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88
Q

What is a VEMP?

A

Vestibular evoked myogenic potential

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89
Q

What parts of the ossicles are formed by the first branchial arch?

A

Malleus (except manubrium)

Incus (except long process)

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90
Q

What parts of the ossicles are formed by the second branchial arch?

A

Manubrium of malleus
Long process of incus
Stapes superstructure

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91
Q

What is the most common cause of stridor in infants?

A

Laryngomalacia

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92
Q

What are the indications for supraglottoplasty in children with laryngomalacia?

A

Apneic events
Cyanosis
Failure to thrive
Cor pulmonale

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93
Q

What is the treatment for laryngomalacia?

A

Observation
Anti-reflux medication
Supraglottoplasty

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94
Q

What nerve is most commonly injured during a facelift?

A

Great auricular nerve

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95
Q

What is a normal SP/AP ratio on ECOG?

A

Less than 0.4

More than that suggests Meniere’s or SSCD

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96
Q

What physical exam finding is most specific for OSA?

A

Next

Males over 17”
Females over 15”

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97
Q

What’s nerves are responsible for taste innervation of the tongue and soft palate?

A

Anterior 2/3 tongue: Chorda tympani (CNVII)
Posterior 1/3 tongue: Lingual n. (CNIX)
Soft palate: Vidian n. (GSPN)

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98
Q

What should be done if a dehiscent ICA in the sphenoid is lacerated?

A

Pack the sinus
Permissive hypotension
Emergent IR and NSGY consult

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99
Q

What is the narrowest point of the pediatric airway?

A

Cricoid

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100
Q

What is the narrowest point of the adult airway?

A

Glottis

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101
Q

Where is the RLN found relative to the ligament of Berry?

A

Lateral and dorsal

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102
Q

Symptoms of lidocaine toxicity

A 
Metallic taste
Tinnitus
Perioral numbness
Vomiting
Tremors
Convulsions
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103
Q

What is the most common site for an esophageal foreign body to lodge in a child?

A

Thoracic inlet

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104
Q

What lymph node levels should electively be taken for cutaneous SCCa?

A

Face: I-III
Anterior scalp/Ear: II-III
Posterior scalp: II-V

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105
Q

How is a vocal cord granuloma treated?

A

PPI’s

Resection only if suspicious for malignancy or failure to resolve with medical therapy

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106
Q

What protein is abnormal in neurofibromatosis type II?

A

Merlin

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107
Q

What protein is abnormal in Treacher-Collins?

A

Treacle

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108
Q

What is seen with Godtfredson’s syndrome?

A

CNVI & CN XII palsies

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109
Q

What causes Godtfredson’s syndrome?

A

Clival tumors

Usually metastatic to clivus, can also be from nasopharyngeal cancer

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110
Q

What is seen with Mobius syndrome?

A

Congenital CNVI and CNVII dysfunction

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111
Q

What is seen with Vernet’s syndrome?

A

AKA Jugular foramen syndrome

CN 9, 10, 11 dysfunction

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112
Q

What is seen with Gardner syndrome?

A

Familial adenomatous polyposis
Multiple osteomas
Soft tissue tumors

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113
Q

What is the first sinus to develop in utero?

A

Maxillary sinus

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114
Q

What is the most developed sinus at birth?

A

Ethmoids

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115
Q

In what stage of sleep our confusional arousals, night terrors, and sleepwalking found?

A

Sleep stage III (Slow wave sleep; NREM)

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116
Q

At what drain output should a chyle leak be surgically repaired?

A

Over 600-1000 cc/day

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117
Q

What is Brown’s sign?

A

Blanching of a middle ear mass when pneumatic otoscopy is performed. Indicates a middle ear glomus tumor.

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118
Q

What is the lyre sign?

A

Splaying of the ICA and ECA by a carotid body tumor

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119
Q

What are the four phases of the hair growth cycle?

A

Anagen (growth)
Catagen (involution)
Telogen (rest)
Exogen (shedding)

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120
Q

What is the best time postoperatively to dermabrade a scar?

A

6w postop

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121
Q

What parotid tumor metastasizes to solid organs instead of LN’s?

A

Adenoid cystic carcinoma

Goes to lungs & liver

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122
Q

What part of the ear is important to preserve if a prosthesis is to be used?

A

Tragus

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123
Q

Scala ________ abuts the oval window

Scala ________ abuts the round window

A

Scala vestibuli abuts the oval window

Scala tympani abuts the round window

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124
Q

What does the GSPN carry?

A

Parasympathetics to the lacrimal gland

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125
Q

What is classically seen on otoscopy for a congenital cholesteatoma?

A

White mass behind the anterosuperior TM

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126
Q

What Jahrsdoerfer score qualifies a patient as a surgical candidate?

A

Jahrsdoerfer score for aural atresia

Score >6 makes a patient a surgical candidate

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127
Q

What is the pathogenesis of Pierre-Robin sequence?

A

Mandibular hypoplasia causes in-utero displacement of the tongue anterosuperiorly, which blocks the fusion of the palatine shelves. Results in micrognathia, glossoptosis, and cleft palate.

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128
Q

What is the cutoff for facial weakness on nerve excitability testing?

A

A difference of >3.5 mA between the two facial nerves to get gross facial movement

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129
Q

What is the Stanford protocol?

A

1st Phase: UPPP + Genioglossus Advancement and/or Hyoid Suspension
2nd Phase: Maxillomandibular advancement.

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130
Q

What subtype of BCC is more aggressive?

A

Sclerosing aka Morpheaform

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131
Q

What muscle is responsible for horizontal rhytids?

A

Procerus (HP-VC)

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132
Q

What muscle is responsible for vertical rhytids?

A

Corrugator (HP-VC)

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133
Q

What muscle is responsible for bunny lines?

A

Transverse nasalis muscle

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134
Q

What is associated with an absent foramen spinosum?

A

Persistent stapedial artery

Courses between crura of stapes

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135
Q

What disease can cause the superior parathyroids to be larger than the inferior parathyroids?

A

Water clear cell hyperplasia

Water clear cell proliferation leads to hypercalcemia.

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136
Q

What is the most common cardiac defect in DiGeorge syndrome?

A

ToF

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137
Q

What disease can cause the superior parathyroids to be larger than the inferior parathyroids?

A

Water clear cell hyperplasia

Water clear cell proliferation leads to hypercalcemia.

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138
Q

What is the most common cardiac defect in DiGeorge syndrome?

A

ToF

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139
Q

What can be used to sclerose lymphatic malformations?

A

OK-432
Bleomycin
EtOH

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140
Q

What type of lymphatic malformation responds to sclerosis?

A

Macrocystic

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141
Q

What percentage of congenital VC paralysis is bilateral?

A

50% bilateral

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142
Q

What viruses carry risk of H&N cancer?

A

EBV: Nasopharyngeal
HPV: Oropharyngeal

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143
Q

What industrial exposures can increase risk of paranasal sinus and nasal cavity cancer?

A

Wood dust
Nickel dust
Formaldehyde

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144
Q

What percent of chronic leukoplakic lesions will become malignant?

A

14%

Median of 5y

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145
Q

How is otosclerosis inherited?

Typical patient?

A

It is autosomal dominant with variable penetrance

White women

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146
Q

Where are the vessels found that supply a random flap?

A

Subdermal plexus

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147
Q

COL4A5 mutation

A

Alport syndrome

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148
Q

GJB2

A

SNHL

Codes for Connexin 26. Responsible for half of all non-syndromic HL.

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149
Q

PDS gene

A

Pendred syndrome

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150
Q

What is seen with Pendred syndrome?

A

SNHL
Euthyroid goiter
+/- EVA & Mondini’s aplasia

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151
Q

KVLQT1

A

Jervell and Lange-Nielsen syndrome

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152
Q

What is the most common feeding vessel for a carotid body tumor?

A

Ascending pharyngeal

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153
Q

How is tissue expander width determined?

A

It should be 2.5x the size of the defect

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154
Q

What plane are tissue expanders placed within?

A

Subgaleal

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155
Q

When does postop tracheoinominate fistula occur most commonly?

A

2-3w postop

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156
Q

How long before dermabrasion can be repeated?

A

1y

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157
Q

What is ASA’s mechanism?

A

COX inhibitor

Increases Leukotrienes, decreases TXA2 & prostaglandins

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158
Q

What sensory nerves supply the auricle?

A

Auriculotemporal (V3; anteriosuperior)
Vagus (conchal bowl)
Lesser occipital (C2; posteroinferior)
Great auricular (C2-3; Lobule)

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159
Q

DiGeorge patient with stridor

A

Anterior laryngeal web

160
Q

What is the nodal staging in thyroid cancer?

A

N1a: Level VI nodes
N1b: Nodes at any other levels

161
Q

What is the T staging for thyroid cancer

A

T1: under 2cm
T2: 2-4cm
T3: over 4cm or limited extrathyroidal extension
T4a: subQ soft tissues, larynx, trachea, esophagus, or RLN
T4b: prevertebral fascia or encases carotid artery or mediastinal vessel

162
Q

What is the most commonly injured EOM during blepharoplasty?

A

Inferior oblique

163
Q

How are bilateral carotid body tumors managed?

A

Surgery for the smaller tumor

Radiation for the larger tumor

164
Q

What is the only reason to delay RT after resection of a cancer?

A

Exposed carotid

165
Q

What are the Bent & Kuhn major criteria?

A

Used for diagnosis of allergic fungal rhinosinusitis

1) Hx of type I hypersensitivity
2) Nasal polyps
3) Characteristic CT findings
4) Eosinophilic mucin without invasion
5) Positive fungal stain

166
Q

What are the risks of Phenol peels?

A

Cardiac arrhythmia
Laryngeal edema in smokers

Should minimize the surface area exposed at one time.

167
Q

What are the fall allergies?

A

Ragweed

Tumbleweed

168
Q

What is the most common spring allergy?

A

Tree pollen

169
Q

What are the most common perennial allergies?

A

Pet dander

Mold

170
Q

What is the most common summer allergy?

A

Grasses

171
Q

What are the side effects of RAI?

A

Sialadenitis
Taste disturbance
Nausea
Epiphora

172
Q

What does cVEMP test?

A

Saccule and inferior vestibular nerve

173
Q

What does oVEMP test?

A

Utricle and superior vestibular nerve

174
Q

Where should the medial brow end?

A

Along a line drawn between the medial canthus and the nasal ala

175
Q

Where should the lateral brow end?

A

Along a line drawn between the lateral canthus and the nasal ala

176
Q

What are the most common causes of primary hyperparathyroidism?

A 
One adenoma (75%)
2 adenomas (26%)
Parathyroid hyperplasia (1.5%)
Carcinoma (1%)
177
Q

What mutation is associated with papillary thyroid carcinoma?

A

BRAF in 40%

178
Q

What cytokines are upregulated in the long run with immunotherapy?

A

IL-10
TGF-beta

These are the Treg cytokines

179
Q

What is it called if the maxillary sinus is seen to be pushed forward by a mass?

A

Holman-Miller sign

It is pathognomonic for JNA

180
Q

What is the preferred method of resection of a JNA?

A

Embolization followed by Endoscopic resection

Endoscopic resection has been shown to have less blood loss.

181
Q

What special scans are used in the evaluation of malignant otitis externa?

A

Technetium: To diagnose (osteoblastic activity)
Gallium: To monitor (inflammation)

182
Q

What is the treatment for Ramsay-Hunt syndrome?

A

Valacyclovir for 14d

Steroids

183
Q

What is the toxic dose of lidocaine in children?

A

4.5 mg/kg of lidocaine

7 mg/kg of Lidocaine with Epi

184
Q

What does 1% lidocaine indicate?

A

10mg in 1cc

185
Q

How much rotation will you get from a Z-plasty with angles of:
30 degrees?
45 degrees?
60 degrees?

A

30: rotates 45 degrees
45: rotates 60 degrees
60: rotates 90 degrees

186
Q

How much increase in length will occur with a Z-plasty with angles of:
30 degrees?
45 degrees?
60 degrees?

A

30: 25%
45: 50%
60: 75%

187
Q

What can be used for truly idiopathic cough?

A

TCA’s
Gabapentin/Lyrica
Baclofen

188
Q

What condition(s) is/are associated with increased VEMP amplitude?

A

Superior SCC dehiscence

189
Q

What condition(s) is/are associated with decreased VEMP amplitude?

A

Meniere’s
Otosclerosis
Acoustic neuromas
Vestibular neuronitis

190
Q

What bacteria can cause an ABRS that is often self-resolving

A

Moraxella

H. flu

191
Q

What is the most common organism in chronic suppurative otitis media?

A

Pseudomonas

192
Q

What is the most effective surgery to increase compliance with CPAP?

A

Nasal surgery (septoplasty)

More effective than any OP surgery to reduce pressures required and increase compliance.

193
Q

What level should TSH ideally be at prior to initiating RAI?

A

TSH > 30 mU/L

194
Q

What is the most important muscle to reconstruct in cleft palate surgery?

A

Levator veli palatini

It closes off the nasopharynx with swallowing and helps in phonation.

195
Q

What are the major tip support mechanisms for the nose?

A

1) Lower lateral cartilage strength
2) Scroll area (overlap of upper & lower lateral cartilages)
3) Attachment of the medial crura to the caudal septum

196
Q

At what age is microtia repair performed?

A

Age 5y

At 5y, the child’s ear size is 95% of the adult’s size.

197
Q

What is the normal nystagmus response to caloric testing?

A

COWS
Cold opposite, Warm same

Indicates which way the nysagmus should beat

198
Q

What do the supraclavicular nodes drain?

A

Esophagus
Abdomen
Lung

199
Q

What is seen on histology in mucoepidermoid carcinoma?

A

Cords, sheets and clusters of mucous, squamous, intermediate and clear cells. Look for mucous.

Can be low grade (glandular) or high grade (squamous)

200
Q

What is the T staging for mucosal melanoma?

A

There is no T1 or T2!
T3: Just mucosal & soft tissue involvement
T4a: Involvement of cartilage, bone, or skin
T4b: Involvement of vital structures or spaces

201
Q

What is the N staging for mucosal melanoma?

A

N0: No regional nodes
N1: Regional nodes involved

202
Q

What physical exam finding is used to test for vestibular neuritis?

A

Reduced or absent caloric testing on the affected side is the most reliable PE finding

203
Q

How is vestibular neuritis treated?

A

Steroids!

Also vestibular therapy & meclizine

204
Q

What causes vestibular neuritis?

A

Reactivation of HSV

205
Q

What is the difference in pharmacologic treatment of Bell’s palsy vs. vestibular neuritis?

A

Bell’s palsy: Steroids and valacyclovir

Vestibular neuritis: Just steroids

206
Q

What drug can be used for RSV prophylaxis in susceptible children?

A

Palivizumab

207
Q

What is the mechanism of Avastin?

A

VEGF inhibitor

208
Q

What chemo drug can be used in RRP?

A

Avastin

VEGF inhibitor

209
Q

What is the ideal nasolabial angle?

A

Men: 90-95 degrees
Women: 95-115 degrees

210
Q

What are the most common primary mandibular tumors?

A

1) Odontoma

2) Ameloblastoma

211
Q

What is seen on histology with ameloblastoma?

A

Central triangular-shaped cystic cells

Border of palisading columnar cells with nuclei pushed away from basement membrane.

212
Q

What is the typical duration of intradermal immunotherapy?

A

3-5y

213
Q

What level should TSH be suppressed to in PTC?

A

Low risk: 0.1-0.5 mU/L

Moderate/High risk: Less than 0.1 mU/L

214
Q

What are the autosomal dominant SNHL syndromes?

A 
WANT CBS
Waardenburg
Apert
NF2
Treacher-Collins
Crouzon
Branchio-Oto-Renal
Stickler
215
Q

How many aesthetic subunits of the nose are there?

A

9

216
Q

What cranial nerve innervates the carotid body?

A

CNIX

217
Q

Which aminoglycosides are vestibulotoxic?

Cochleotoxic?

A

Vestibulotoxic: Streptomycin
Cochleotoxic: Amikacin, Kanamycin, Neomycin

218
Q

What branch of the FN is most vulnerable to injury during sclerotherapy for a venous malformation?

A

Zygomatic branch (up to 40% of the time)

219
Q

What supplements can increase bleeding rates?

A 
Garlic
Ginseng
Gingko
Ginger
Glucosamine
Green tea
220
Q

What is considered compliance with CPAP?

A

4h per night

5 days per week

221
Q

What is considered positive on the ESS?

A

Score >10

222
Q

What is the dosage of epi for anaphylaxis in an adult?

A

0.3-0.5mg

223
Q

What is the dosage of epi for anaphylaxis in a child?

A

0.01 mg/kg

224
Q

What embryologic structure is responsible for a nasal dermoid cyst?

A

Foramen cecum

225
Q

Types of allergic reactions

A

Type I: Anaphylactic
Type II: Cell-mediated
Type III: Immune complex
Type IV: Delayed hypersensitivity

226
Q

What embryologic precursor is responsible for parafollicular cells?

A

C-cells come from ultimobrachial body

227
Q

What are the 2 most common benign masses in the nose?

A

Osteoma

Iverted papilloma

228
Q

What is the criteria for AFRS?

A

1) Atopy
2) Nasal polyposis
3) Asymmetric filling of sinuses
4) Eosinophilic mucin without invasion
5) Positive fungal stain for noninvasie disease

229
Q

What is the mean sleep latency for a normal patient?

OSA patient?

A

Normal: 10-15 minutes
OSA: Under 5 minutes

230
Q

What are the most common pharyngeal dilator muscles?

A

Genioglossus

Tensor veli palatini

231
Q

What defines a hypopnea event?

A

30% decrease in airflow
10 seconds
4% desaturation

232
Q

What audiometry is used for kids 0-6mo old?

A

Behavioral audiometry

233
Q

What audiometry is used for kids 6mo-3y

A

Visual reinforcement audiometry

234
Q

What audiometry is used for kids 3-5y?

A

Conditioned play audiometry

235
Q

What is the blood supply to the parathyroid glands?

A

In most cases, both inf and sup parathyroids are supplied by the inferior thyroid artery

236
Q

What is the nodal staging for NP cancer?

A

N1: Under 6cm, ipsi, above cricoid
N2: Under 6cm, contra/bilat, above cricoid
N3a: Over 6cm
N3b: Extends to supraclavical fossa

237
Q

What are the UPSIT categories?

A

0-4: Malingering
5-18: Anosmia
19-33: Hyposmia

238
Q

What is the most common inhalant allergy associated with spring?

A

Trees

239
Q

What is the most common inhalant allergy associated with summer?

A

Grasses

240
Q

What is the most common inhalant allergy associated with fall?

A

Ragweed

241
Q

What is considered positive in intradermal allergy testing?

A

2mm or larger wheal

242
Q

What are the causes of recurrence of hearing loss following stapedectomy?

A

Displacement of the prosthesis
Necrosis of the long process of the incus
Middle ear adhesions

243
Q

What can cause failure to improve following stapes surgery?

A

Obliterative otosclerosis of the round window

244
Q

What causes oral hairy leukoplakia?

A

EBV in the setting of immunosuppression

245
Q

What causes oral lichen planus?

A

T-cell mediated reaction against the epithelium

246
Q

What is the most common CPA tumor in children?

A

Glioma

247
Q

How long does each stage in skin graft healing last?

A

Plasmatic imbibition: 24-48h
Inosculation: 24h-72h
Vascular ingrowth: 3-5d

248
Q

Where is the Frankfort plane drawn?

A

Superior EAC to inferior orbital rim

249
Q

T-staging for temporal bone carcinoma

A 
Pittsburgh staging:
T1: EAC skin only
T2: Partial thickness bone erosion
T3: Full thickness bone erosion
T4: Into adjacent structures, or over 0.5cm soft tissue involvement or FN paralysis
250
Q

Orientation of cochlear aqueduct and endolymphatic duct

A

Cochlear aqueduct = parallel to IAC

Endolymphatic duct = perpendicular to IAC

251
Q

Which petrosal nerves innervate what

A

GSPN = lacrimal

Lesser petrosal n. = Parotid

252
Q

What nerves constitute the Vidian?

A 
GSPN (parasymp)
Deep petrosal (symp)

This then runs to the pterygopalatine fossa

253
Q

Which muscles cause which glabellar rhytids?

A

Procerus = horizontal
Corrugator supercilii = vertical

Plastics Hates Crappy Views

254
Q

What is the dosage for epi in peds (for anaphylaxis)?

A

0.01 mg/kg IM

255
Q

What kind of hypersensitivity reaction is contact dermatitis?

A

Delayed (Type IV)

256
Q

Where are the most common sites for a dermoid cyst in the H&N?

A

Periorbital
Nasal
Suprasternal
Submental

257
Q

What is telogen effluvium?

A

Alopecia at a surgical site due to the trauma of surgery. Occurs at donor and recipient site & lasts 3mo.

258
Q

What Hillocks of His develop into what?

A

1: Tragus
2: Helical crus
3: Helix

4: Antihelix
5: Antitragus
6: Lobule

1-3 = 1st branchial arch
4-6 = 2nd branchial archd
259
Q

What is the other name for Warthin’s tumor?

A

Papillary cystadenoma lymphomatosum

260
Q

Where do the parathyroids lie relative to the depth of the RLN?

A

Superior parathyroids are deep to RLN

Inferior parathyroids are superficial to RLN

261
Q

When do fibrillation potentials and sharp waves appear on laryngeal EMG?

A

3w

Indicates a poor prognosis for recovery

262
Q

What is rocker deformity?

A

Bone inferior to an osteotomy sinks down, creating a stepoff

263
Q

What is inverted-V deformity?

A

Upper lateral cartilages are not sufficiently reattached to nasal bones or septum, causing them to slide down. Can cause internal nasal valve collapse.

264
Q

What nerve is at risk during tonsillectomy?

A

Lingual branch of the glossopharyngeal nerve (IX)

Sensory to the posterior 1/3 of the tongue

265
Q

What is class I-III occlusion?

A

Class I: MAxillary 1st molar overlies the mandibular groove of mandibular 1st molar
Class II: Overbite
Class III: Underbite

266
Q

What is a possible systemic adverse effect of chemical peels?

A

Phenol can cause cardiotoxicity and arrhythmia

267
Q

What types of collagen are observed in wound healing?

A

Type III –> Type I

268
Q

Which type of chemical peel requires neutralization?

A

Glycolic acid

269
Q

What is the most common fungus causing malignant OE?

A

Aspergillus

270
Q

What can be seen on CT chest in RRP?

A

Cavitary nodules with air-fluid levels

Poor prognostic sign

271
Q

What sites on the H&N has poor prognosis for Merkel cell carcinoma?

A

Scalp (distant mets)
Lip (bone invasion)
Neck

272
Q

When and how does abx-induced hearing loss present?

A

After 3-4d of therapy

High frequency, bilateral SNHL

273
Q

What antiviral can be used in RRP?

A

Cidofivir (DNA polymerase inhibitor)

274
Q

What is seen in CULLP?

A

Congenital Unilateral Lower Lip Paralysis

Depressor anguli oris fails to develop. EMG will show no response.

275
Q

What muscle is responsible for the smiling deformity?

A

Depressor septi nasi

276
Q

What is seen in the smiling deformity?

A

Depressed nasal tip
Shortened upper lip
Transverse crease along the philtrum

277
Q

What are the last paranasal sinuses to develop?

A

Frontal sinuses

278
Q

Where relative to the TM are congenital cholesteatomas observed?

A

Anterior superior (in 2/3)

279
Q

Liothyronine vs. Levothyroxine?

A

Liothyronine can be continued up until 2w prior to RAI therapy, whereas Levothyroxine must be stopped 6w prior

280
Q

When do hemangiomas grow most on children?

A

Majority of the growth is complete by 5mo

281
Q

Alpha waves

What sleep cycle?

A

Wakefulness

282
Q

Vertex sharp waves

What sleep cycle?

A

Stage I

283
Q

Slow eye movements

What sleep cycle?

A

Stage I

284
Q

K complexes

What sleep cycle?

A

Stage II

285
Q

Sleep spindles

What sleep cycle?

A

Stage II

286
Q

Delta waves

What sleep cycle?

A

Stage III

287
Q

What defects can be closed primary following lower eyelid resection?

A

Up to 25% defects can be closed primarily

288
Q

What nerves are affected in Vernet syndrome?

A

Aka jugular foramen syndrome, so IX, X, XI

289
Q

What nerves are affected in Villaret syndrome?

A

Aka retroparotid syndrome

So IX, X, XI, XII, cervical sympathetic chain

290
Q

Where is calvarium harvested from?

A

2cm lateral to the sagittal suture

291
Q

What incisions comprise the delivery method of endonasal rhinoplasty?

A

Full transfixion
Marginal
Intercartilaginous

292
Q

What are the indications for urgent drainage of a peds RPA?

A

Abscess greater than 2cm
Respiratory distress
Failed IV abx

293
Q

Treatment for rhinitis of pregnancy

A

Budesonide

only nasal steroid proven safe in pregnancy

294
Q

How large should margins be for cutaneous melanoma?

A

It mirrors the thickness
1cm thickness = 1cm margins
2cm or greater depth = 2cm margins

295
Q

What is the most common tumor in the pediatric parotid?

A

Mucoepidermoid carcinoma

50% of peds parotid tumors are malignant

296
Q

What is the SMAS contiguous with?

A

TPF

Platysma

297
Q

When is the earliest that microtia reconstruction can occur?

A

6y

Ear growth has reached 95% by age 6.

298
Q

Durations of the stages of skin graft take

A

Day 0-2 = plasmatic imbibition
Day 2-3 = inosculation
Day 3-5 = angiogenesis

299
Q

How long does re-epihelialization take following dermabrasion?

A

A week

300
Q

What abx is indicated for Bartonella lymphadenitis?

A

Azithromycin

301
Q

Where is Donaldson’s line?

A

It is a line running posteriorly through the horizontal semicircular canal. Aids in locating the endolymphatic sac (along line or just inferior).

302
Q

When is the optimal time to perform laryngeal EMG for a vocal cord paralysis?

A

3-6 months post-injury

303
Q

What is the most common cause of congenital hearing loss?

A

Prenatal infections (CMV most common)

304
Q

What is seen in Usher syndrome?

A 
Profound SNHL
Retinitis pigmentosa (poor vision)
Vestibular dysfunction
305
Q

Air-Bone gap patterns in TM perf

A

More severe in lower frequencies

306
Q

Air-Bone gap patterns in partial ossicular discontinuity

A

More in higher frequencies

307
Q

Air-Bone gap patterns in otosclerosis

A

Carhart notch (2k)

308
Q

Air-Bone gap patterns in complete ossicular discontinuity

A

Maximal CHL across all frequencies (60dB)

309
Q

What nerve is available with the RFFF?

A

Lateral antebrachial cutaneous

310
Q

What nerve is available with the ALT free flap?

A

Lateral femoral cutaneous

Also used if doing a PLT flap

311
Q

What nerve is available with the lateral arm flap?

A

Posterior cutaneous nerve

312
Q

What are the 4 parasympathetic ganglia in the Head and Neck?

A

Otic
Submandibular
Pterygopalatine
Ciliary

313
Q

Where does the GSPN synapse?

A

Pterygopalatine ganglion

Carries parasympathetics to lacrimal gland and nasal mucosa

314
Q

What laryngeal muscle receives bilateral innervation?

A

Interarytenoid

315
Q

What is the significance of BRAF?

A

Seen in PTC

Portends a more aggressive cancer

316
Q

What approach is best for treating petrous apex cholesterol granulomas?

A

If possible, transphenoidal approaches have lower recurrence rates than transotic ones

317
Q

What are the T1 and T2 MRI characteristics of cholesteatoma?

A

T1 hypointense

T2 hyperintense

318
Q

What are the T1 and T2 MRI characteristics of schwannomas?

A

T1: Hypointense
T2: Heterogenous hyperintense
Enhances with contrast

319
Q

What is seen on histology with hairy cell leukoplakia?

A

Hyperkeratosis
Acanthosis
Koilocytosis
Fungal elements

320
Q

What subtype of IgG is most commoly deficient?

A

IgG2

321
Q

What determines if a penetrating injury to the FN is likely to heal spontaneously?

A

If it is medial to the lateral limbus of the eye, it is likely to heal spontaneously

322
Q

What is the main blood supply to the temporalis flap?

A

Deep temporal artery (off of maxillary artery)

323
Q

What is considered compliance with CPAP?

A

4+ hours per night

5+ days per week

324
Q

What is seen anatomically with a pulmonary artery sling?

A

Left PA comes off of right PA and runs through tracheo-esophageal groove

325
Q

How does the FN relate to layers of the temporal area?

A

On the undersurface of the TPF

326
Q

Treatment of a central air embolus

A

Left lateral decubitus
Trendelenburg
100% O2

327
Q

What molecular markers are specific for PTC?

A

BRAF
RAF
(RAS less specific ~85%)

328
Q

What is more difficult to treat, microcystic or macrocystic lymphatic malformations?

A

Microcystic. More infiltrative and have higher recurrence.

329
Q

Where in the neck is a lymphatic malformation more likely to be microcystic?

A

Suprahyoid

330
Q

How to manage persistent stapedial artery in stapes surgery

A

If small - laser coagulate and proceed

If over 50% of obturator foramen - abort and amplify

331
Q

What borders the pre-epiglottic space?

A 
Hyoid bone
Thyrohyoid membrane
Hyoepiglottic ligament
Thyroepiglottic ligament
Epiglottis
332
Q

What is the effect of Minoxidil on hair?

A

Makes hairs thicker but not greater in number

333
Q

Where is the most common site of PLF?

A

Anterior to the anterior crus

334
Q

What incisions are used in the midface degloving approach?

A

Sublabial
Full transfixion
Intercartilaginous

335
Q

What testing should be performed following a mumps infection?

A

Audiogram to assess for SNHL

336
Q

What is in the Baker-Gordon peel?

A

Phenol
Tap water
Liquid soap
Croton oil

337
Q

Define rollover

A

Decrease in speech recognition at higher signal intensity

338
Q

Recruitment is specific for pathology where in the hearing apparatus?

A

The cochlea

339
Q

What is the treatment for post-resurfacing hyperpigmentation?

A

Hydroxyquinone
Sunblock
Exfoliation

340
Q

What is a normal MRD1?

A

3-4.5mm

341
Q

What is a normal palpebral fissure measurement?

A

9mm

342
Q

What is seen in Usher syndrome?

A

Hearing loss
Vestibular dysfunction
Retinitis pigmentosa

343
Q

What is seen in Apert syndrome?

A

Stapes fixation

Lobster hands

344
Q

What is seen in goldenhaar syndrome?

A

Hemifacial microsomia
FN abnormalities
Colobomas

345
Q

What is seen in Pendred syndrome?

A

Goiter

SNHL

346
Q

How is Pendred syndrome confirmed?

A

Perchlorate test

347
Q

Plane for an endoscopic brow lift

A

Subperiosteal

348
Q

Plane for a coronal brow lift

A

Subgaleal

349
Q

What depth of invasion for melanoma requires evaluation of the LN’s?

A

0.75 cm or greater

350
Q

Most common site fot pyogenic granuloma in the mouth

A

Gingiva

351
Q

What is seen in Melkersson-Rosenthal syndrome?

A

Recurrent facial edema
Facial paresis
Chelelitis and fissured tongue

352
Q

What is the order in which to address cleft lip and palate defects?

A 
Cleft lip, ear tubes
Palate repair
Collumellar lengthening
Orthodontics
Definitive reconstruction
353
Q

What is Hering’s law?

A

Equivalent innervation of matched muscles means that correcting ptosis may cause unmasking of contralateral subclinical ptosis

354
Q

What is the treatment for thyroid storm?

A

PTU
Steroids (inhibits T4 to T3 conversion)
Iodine solution
+/- lithium

355
Q

What do the utricle an saccule sense?

A

Linear acceleration
Utricle = Horizontal
Saccule = Vertical

356
Q

Where is the site of injury for aminoglycoside ototoxicity?

A

Basal outer hair cells

357
Q

Where is the site of injury for cisplatin ototoxicity?

A

Stria vascularis

Basal outer hair cells

358
Q

Where is the site of injury for carboplatin ototoxicity?

A

Inner hair cells

359
Q

Where is the site of injury for diuretic ototoxicity?

A

Stria vascularis

360
Q

What nasal masses are Furstenburg test positive?

A

Encephaloceles

361
Q

If hereditary hemorrhagic telangiectasia is diagnosed, what should be looked for?

A

Pulmonary AVM

362
Q

What gene is associated with Stickler syndrome?

A

COL2A1

363
Q

What are the most common inner ear malformations?

A

Incomplete partition, common cavity, cochlear hypoplasia

364
Q

What causes dysphagia lusora?

A

Retro-esophageal right subclavian

365
Q

Contraindications to supraglottic laryngectomy

A
  1. Involvement of TVC’s
  2. Immobile TVC
  3. Extension into tongue base (within 1cm of circumvalate papilla)
  4. Poor pulmonary status
366
Q

Who gets Kleine-Levine syndrome?

A

Adolescent males

367
Q

Recurrent hypersomnia with behavioral disturbance a few times per year is known as what?

A

Kleine-Levine syndrome

368
Q

Margin of the midline hairline is called the:

A

Trichion

369
Q

The lowest/anterior point of the nasal bones is called the:

A

Rhinion

370
Q

The soft tissue point at the inferior aspect of the chin is the:

A

Pogonion

371
Q

What is seen on histology of neuroblastomas?

A

Small blue cells

Homer-Wright pseudorosettes

372
Q

What is seen on histology of chordomas?

A

Physaliferous cells

small round nuclei with vacuolated cytoplasm

373
Q

What are the terminal branches of the IJV?

A

Sigmoid sinus

Common facial vein

374
Q

What are the terminal branches of the EJV?

A

Posteior facial vein/retromandibular vein

Posterior auricular vein

375
Q

What is the risk of malignancy associated with oral hairy leukoplakia?

A

None

376
Q

What is the risk of malignancy associated with oral erythroplakia?

A

15-50%

377
Q

What is the risk of malignancy associated with oral lichen planus?

A

1%

378
Q

What is the risk of malignancy associated with oral leukoplakia?

A

5%

379
Q

What is the risk of malignancy associated with white sponge nevus?

A

None

380
Q

What parotid tumor has a femal predominance?

A

Mucoep

381
Q

What antibiotic is a contraindication to Botox?

A

Aminoglycosides

382
Q

What are the indications for postop RAI?

A 
Tumor over 4cm
Suspected metastatic disease
Extrathyroidal extension
Elevated postop thyroglobulin levels
Vascular invasion

True for follicular, well-differentiated PTC, Hurthle cell.

383
Q

What is the upper limit for primary closure of midline lower lip defects?

A

Up to 50%

384
Q

What is the Abbe flap used for?

A

Up to 2/3 of the lip, no oral commisure involvement

385
Q

What is the Estlander flap used for?

A

Up to 2/3 of the lip, with oral commisure involvement

386
Q

What is the Bernard-Burrow flap used for?

A

Midline lower lip defects over 2/3 of the lip

(similar to Karapandzic

387
Q

What is the histology of glomus tumors?

A

Zellballen (cell balls surrounded by stroma)

388
Q

What is the histology of pericytoma?

A

Pericytes of Zimmerman

389
Q

What is the histology of glomus tumors?

A

Pseudoepitheliomatous hyperplasia

390
Q

What is the histology of necrotizing silometaplasia?

A

Pseudoepitheliomatous hyperplasia

391
Q

What is the imgaing modality of choice in 1st branchial clefts?

A

MRI to evaluate its relationship to the facial nerve

392
Q

Where do osteomata in the EAC typically arise?

A

At the tympanosquamous or tympanomastoid suture line

393
Q

Which contains marrow, osteomata or exostoses?

A

Osteomata

394
Q

What is the stapedial artery derived from?

A

2nd branchial arch

395
Q

W/hat is the most common site for labyrinthine fistula?

A

Lateral SCC

396
Q

CHD7 mutation

A

CHARGE syndrome

397
Q

What inner ear deformity is associated with CHARGE?

A

Mondini deformity

ENT (10 decks)

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