General Otolaryngology

Question 1

Define minimum alveolar concentration

Answer 1

Alveolar concentration of vapor needed to suppress movement in response to pain in 50% of people

Question 2

Rank the following gases in order of increasing MAC: sevoflurane, desflurane, nitrous oxide

Answer 2

Sevo < Desflurane < NO2

Question 3

What is the difference between amide and ester local anesthetics in terms of metabolism?

Answer 3

Esters are metabolized in plasma by pseudocholinesterase and produce PABA (para-aminobenzoic acid), making them more prone to cause allergic reactions. Amides are degraded by liver and excreted in urine, and do not create a byproduct.

Question 4

Classify the following into amide vs ester: cocaine, lidocaine, procaine, tetracaine, mepivacaine, benzocaine, bupivacaine.

Answer 4

AmIdes have an “I” before the “caine.” Esters do not.

Question 5

Which local anesthetics cause methemoglobinemia?

Answer 5

prilocaine, benzocaine, lidocaine, and tetracaine

Question 6

What is the first-line treatment for methemoglobinemia? When is that treatment contraindicated?

Answer 6

Methylene Blue. Contraindicated in G6PD.

Question 7

What enzyme metabolizes codeine?

Answer 7

CYP2D6

Question 8

What opioid is typically used in TIVA and why?

Answer 8

Remifentanyl; quick-on and quick-off. It’s highly lipid soluble at physiologic pH and thus crosses BBB quickly. Also has a short half life with metabolism by plasma and tissue esterases.

Question 9

Name that headache: A. Pulsatile, unilateral, frontotemporal/orbital area, associated with auras, nausea/vomiting, photophobia. B. Bilateral, throbbing, fronts-occipital tightening, C. Shock-like sensations from corner of mouth to angle of jaw or upper teeth to eye area, worsens in < 20s and lessens to burning, D. Severe, unilateral pain that is temporal, orbital, or Supra orbital and associated with conjunctival injection, lacrimation, congestion/rhinorrhea, may occur 1-8 times daily.

Answer 9

Migraine, tension, trigeminal neuralgia, cluster headaches

Question 10

Name three medical/nonoperative treatments/strategies for elevated ICP

Answer 10

Raise HOB, hypertonic saline, mannitol, chemically induced coma, hyperventilation, acetazolamide, lasix

Question 11

What kind of tumor arises from the Rathke cleft?

Answer 11

Craniopharyngioma

Question 12

What are some common supplements that are associated with increased bleeding?

Answer 12

ginkgo baloba, vitamin E, magnesium, chamomile (among others)

Question 13

What is the mechanism of action of rivaroxaban, apixaban (Eliquis), edoxaban?

Answer 13

Factor Xa inhibitor (they “ban” Xa, as in they inhibit Factor Xa)

Question 14

What are some common drugs that interact with direct oral anticoagulants?

Answer 14

Bisphosphonates (dronedarone), CYP450 drugs, amiodarone, verapamil, dilt, a bunch of antiepileptics

Question 15

What is enveloped in the superficial, middle, and deep layers of the deep cervical fascia?

Answer 15

superficial - SCM, strap muscles, muscles of mastication, salivary glands. middle (visceral) - pharynx, thyroid/parathyroid, larynx, cervical esophagus. constrictors and buccinator. deep (prevertebral) - cervical spine, paraspinal muscles.

Question 16

What is special about the carotid sheath fascia?

Answer 16

Carotid sheath fascia comprises of all 3 layers, the “lincoln highway” of infectious spread

Question 17

Where does the retropharyngeal space lie?

Answer 17

Between middle/visceral and ala layers of the deep layer of the deep cervical fascia.

Question 18

Where does the prevertebral space lie?

Answer 18

Prevertebral space is posterior to the prevertebral fascia, anterior to spine.

Question 19

Where is the danger space?

Answer 19

Danger space is between the ala and prevertebral layer. Ala goes to mediastinum and prevertebral layer goes to coccyx

Question 20

Contents of pre vs post styloid space?

Answer 20

Pre - fat, deep lobe of parotid, V3, lingual, imax, medial/lateral pterygoids. Post - carotid, IJV, sympathetic chain

Question 21

In what space/fossa is V2? What space/fossa(s) does V3 run through?

Answer 21

Pterygomaxillary fossa - V2. V3 runs in the prestyloid parapharyngeal space.

Question 22

what structures divides the submandibular space into submaxillary and sublingual?

Answer 22

Mylohyoid

Question 23

What structure causes retropharyngeal space abscesses to be unilateral?

Answer 23

Midline raphe (superior constrictor)

Question 24

Cutoff for mm thickening at C2 on lateral neck films suggestive of retropharyngeal infection?

Answer 24

5mm in kids; 7mm in adults

Question 25

Name 1-2 indications/considerations for quinsy tonsillectomy?

Answer 25

Gigantic tonsils causing airway obstruction, already going to OR due to inability to drain at bedside

Question 26

What is Lemierre’s? Most common organism in this condition?

Answer 26

IJV thrombophlebitis; Fusobacterium necrophorum (gram neg bacillus, anaerobe).

Question 27

What is the Tobey-Ayer test?

Answer 27

Tobey-Ayer - LD placement; compression of the IJV does not increase CSF pressure on the diseased side but it does on the non-diseased side