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Diplomate exam > Head And Neck Surgery > Flashcards

Head And Neck Surgery Flashcards

1
Q

Mutations in RET oncogene are responsible for what three inheritable syndromes associated with mtc?

A

Men 2a, men 2b, familial mtc

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2
Q

What are the components of men 2a?

A

Mtc
Pheochromocytoma
Primary parathyroidism as a result of parathyroid adenomas

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3
Q

What are the components of men 2b?

A 
Mtc
Pheochromocytoma
Marfanoid habitus
Mucosal neuromas if the lips and tongue
Ganglioneuromas of the git
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4
Q

What are the components of familial mtc?

A

Variant if men 2a without pheochromocytoma or primary parathyroidism

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5
Q

Useful markers for long term surveillance in addition to routine neck utz and body imaging in mtc?

A

Calcitonin and cea

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6
Q

What is more aggressive, men 2b or men 2a?

A

Men 2b thus need to perform central neck dissection.

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7
Q

What type of tumor is ewings sarcoma?

This primarily affects?

A

Peripheral primitive neuroectodermal tumor. Affects long bones and pelvis

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8
Q

Characteristic microscopic appearance of ppnt?

A

Small round blue cell tumor with characteristic fibrovascular cores. Ppnet will demonstrate pseudorosettes and mitosis.

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9
Q

Current standard of therapy for ES treatment?

A

Neoadjuvant chemotherapy followed by resection with negative margins

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10
Q

Most common extracerebral solid tumor of infancy and childhood?

A

Neuroblastoma

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11
Q

Origin of neuroblastoma?

A

Arise from primitive neuroectodermal cells of neural crest origin as embryonal tumors of the sns

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12
Q

Most unusual aspect of neuroblastoma?

A

Frequent occurence of spontaneous regression.

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13
Q

Most common site of origin of neuroblastoma?

A

Adrenal medulla or adjacent retroperitoneum, but 2-5% develop in head and neck region

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14
Q

What does en sablier tumors refer to?

A

Paraspinal neuroblastoma that extends through adjacent intervertebral foramina into spinal cord to produce paraplegia. Most commonly associated with mediastinal and retroperitoneal tumors

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15
Q

What may be used to screen for neuroblastoma?

A

Catecholamines and their metabolites (vma, homovanillic acid, dopamine), elevated in 90-95% of patients

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16
Q

Treatment of stage 1 neuroblastoma?

A

Surgical removal. In intermediate and high risk patients, chemotherapy is the main modality

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17
Q

Histopathology of neuroblastoma?

A

Small uniform cells 7 to 10mm in diameter with dense hyperchromatic nuclei and minimal perinuclear cytoplasm

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18
Q

Most common etiology of salivary gland lesions in children?

A

Inflammatory

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19
Q

After how many weeks of completion of chemotherapy may a second surgical procedure be done for neuroblastoma?

A

12-24weeks after completion of chemotherapy

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20
Q

Most frequently encountered benign tumors in the parotid area?

A

Hemangioma

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21
Q

Most common benign intrinsic parotid tumor?

A

Pleomorphic adenoma

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22
Q

Solid, firm, fixed salivary mass that persists for more than ____ usually an indication for open surgical biopsy and/or excision.

A

4-6 weeks.

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23
Q

What is a minimally invasive and effective tool for the diagnosis of salivary gland ductal pathology?

A

Sialoendoscopy

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24
Q

What separates the parotid gland from the submandibular gland?

A

Stylomandibular ligament. Both glands are covered by the superficial portion of the deep cervical fascia.

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25
Q

All salivary glands are derivatives of ______.

A

Ectoderm

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26
Q

Largest salivary gland and first to develop in utero?

A

Parotid gland

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27
Q

Detached accessory salivary glands in _____ of cadaver specimens?

A

21%

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28
Q

Length of stensen duct and diameter?

A

4-7cm and diameter between 0.5mm and 1.4mm

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29
Q

Description of whartons duct?

A

5cm long, mean diameter of 0.5 and 1.5mm, opens in the floor if the mouth through a papilla lateral to the tongue frenulum

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30
Q

What is the percentage of stones in the submandibular and parotid duct which are radiolucent?

A

20%, 80%

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31
Q

Ultrasound can detect up to what percentage of stones greater than 2mm in diameter?

A

90%

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32
Q

Another name for human herpesvirus 4?

A

Epstein barr virus

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33
Q

IP of ebv?

A

30-50days

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34
Q

Percentage of children with hiv who present with head and neck masses?

A

50%

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35
Q

Pathognomonic for hiv infection if the salivary (parotid) glands?

A

Bilateral cystic and painless enlargement

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36
Q

Majority of cases of hiv infected parotid glands represent?

Other 7% represent?

A

Reactive lymphadenopathy
Benign lymphoepithelial cysts
Underlying infection

Underlying neoplasm including pleomorphic adenoma, lymphoma, Kaposi sarcoma

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37
Q

Slow-growing atypical mycobacterium species which require a few weeks to grow on culture which can affect parotid gland? (3)

Fast growing? (3)

A

M. Avium
M. Marinum
M. Kansasii

M. fortuitum
M. chelonae
M. abscessus

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38
Q

Most common manifestation of Nontuberculous mycobacteria?

A

Cervicofacial lymphadenopathy which usually involves submandibular and parotid areas

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39
Q

How to diagnose cat-scratch disease?

A

B. henselae antibody titers, positive warthin-starry stain, pcr analysis of tissue

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40
Q

Treatment for CSD?

A

5 day course of azithromycin 10mg/kg on day 1 (maximum 500mg) and 5 mg/kg the subsequent 4days (max 250 mg)

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41
Q

What are the components of uveoparotid fever or Heerfordt syndrome?

A

Anterior uveitis, parotid gland enlargement, facial palsy, fever

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42
Q

Systemic autoimmune disease characterized by infiltration of glandular tissue by predominantly CD4 T lymphocytes. There is also evidence of B cell activation with autoantibody production.

A

Sjogren syndrome

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43
Q

Mc rheumatic condition associated with sjogren syndrome?

A

Rheumatoid arthritis

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44
Q

Mc presenting clinical manifestation of sjogren syndrome in children?

A

Recurrent swelling of the salivary glands

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45
Q

What are the glands affected in sialolithiasis?

A

80-90% submandibular gland
6-20% parotid gland
1-2% sublingual gland

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46
Q

What are the components of salivary stones?

A

Calcium phosphate

Hydroxyapatite

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47
Q

Sialolithiasis stones this diameter may pass spontaneously?

A

Less than 2mm

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48
Q

Most commonly involved in necrotizing sialometaplasia, which is a benign, self-limited inflammatory salivary gland lesion that can occur in adolescents and adults and mimic malignancy?

A

Mucus secreting minor salivary glands

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49
Q

Mc presentation necrotizing sialometaplasia?

A

Painless ulcerated lesion or a nodular swelling at junction of hard and soft palate which resolves in 2-3months

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50
Q

What are type 1 branchial anomalies?

A

Duplications of the membranous external auditory canal and are composed of ectoderm, course lateral to the facial nerve, and end in a cul-de-sac on a bony plate near the mesotympanum

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51
Q

What are Type 2 brachial anomalies?

A

Duplications of the membranous EAC and pinna and are composed of ectoderm and mesoderm and may contain cartilage; pass medial to facial nerve and present as swellings inferior to angle of the mandible

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52
Q

Pathology of pre tragal cysts or sinuses?

A

From failure of auricular hillocks to fuse

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53
Q

Salivary gland tumors constitute ____ of pediatric head and neck tumors and are the 4th most frequent after nasopharynx, skin and thyroid

A

8%

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54
Q

Most common salivary masses identified in children

A

Vascular tumors

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55
Q

Most common vascular tumors in children?

A

Infantile hemangioma

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56
Q

Mc non epithelial tumors?

A

Hemangioma

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57
Q

Percentage of hemangiomas present at birth?

A

30%, the rest arise within the first 6 weeks of life

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58
Q

Distinct pattern of development for hemangioma?

A

Proliferate rapidly during the first 1-2mos of life, second growth spurt between 4-6mos of life

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59
Q

Pattern of involution for hemangioma?

A

50% have complete involution by age 5
70% by age 7
90% by age 9

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60
Q

Pattern of occurence of hemangioma?

A

80% parotid gland
18% submandibular gland
2% minor salivary gland

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61
Q

2 types of hemangiomas?

A

Capillary form - present at birth, rapid growth, involution by age 1 year

Cavernous form - tendency to bleed and cause deformity

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62
Q

A highly selective and diagnostically useful marker for infantile hemangiomas?

A

GLUT-1 immunoreactivity

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63
Q

2nd most common vascular anomaly that affects salivary structures after hemangioma?

A

Lymphatic malformations (previously called cystic hygroma or lymphangioma)

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64
Q

Pattern of appearance of lymphatic malformation?

A

Present in perinatal period, 50-60% within first year of life, 90% by 2nd year of life

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65
Q

Lymphatic malformations can be divided into 3 categories on the basis of the size of their lymphatic channels?

A
  1. Microcystic lesions - small cysts that are less than 2 cm
  2. Macrocystic lesions - made of channels larger than 2 cm
  3. Mixed lesions contain both microcysts and macrocyst
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66
Q

Mc epithelial tumor of salivary glands in pediatric population, found mainly in pubertal age?

A

Pleomorphic adenoma

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67
Q

Cell of origin of pleomorphic adenoma?

A

Intercalated duct reserve cell

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68
Q

Recurrence rate of BMT with enucleation?

A

40%

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69
Q

Warthins tumor accounts for ___ of benign salivary gland tumors?

___ bilateral?

A

2%

10%

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70
Q

Mc radiation induced tumor in children?

A

Mucoepidermoid carcinoma

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71
Q

2nd mc salivary malignancy in children?

A

Acinic cell ca

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72
Q

Age when sialorrhea decreases in children?

A

By 18mos

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73
Q

2 types of sialorrhea?

A

Anterior (drooling)

Posterior - spill over tongue into supraglottic and laryngeal area

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74
Q

Anterior sialorrhea pathologic beyond what age?

A

4 years old

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75
Q

What botulinum toxin may be used for sialorrhea?

A

A - widest pharmaceutical use. Prevents presynaptic release of ach by secretory parasympathetic nerve terminal fibers through inactivation of SNAP-25 (25-kDa synaptosome-associated protein), which is essential for the fusion and release of ach-containing vesicles at the cell membrane.

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76
Q

When does botulinum toxin take effect?

A

2-3 days after injection

Lasts average 3-9mos

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77
Q

Blood supply of parotid gland? (Arterial)

A

ECA courses medial to parotid gland into

  1. Maxillary aa
  2. Superficial temporal aa

Superficial temporal aa -> transverse facial aa

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78
Q

Venous drainage of parotid gland?

A

Maxillary and superficial temporal vein —-> retromandibular vein ——-> posterior facial vein ——-> external jugular vein

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79
Q

Stensens duct opens into oral cavity:

A

Adjacent to 2nd molar

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80
Q

GAN arises from?

A

C2 ans C3 cervical branches

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81
Q

Anatomic landmarks to identify the facial nerve? (5)

A

Pt. TAPR

  • Tragal pointer
  • tympanomastoid suture line
  • stylomastoid artery
  • posterior belly of digastric mm
  • retrograde tracing from peripheral branch of facial nerve
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82
Q

Autonomic nerve supply of parotid gland?

A

Sympathetic: superior cervical ganglion

Parasympathetic: cn 9

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83
Q 
Parapharyngeal space boundaries?
Base?
Medial boundary?
Lateral boundary?
Posterior boundary?
Anterior boundary?
A
  • Petrous bone of the skull base
  • lateral pharyngeal wall
  • medial pterygoid muscle
  • carotid sheath and vertebral bodies
  • pterygomandibular raphe
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84
Q

Arterial anatomy of the SMG?

A

Facial aa. Deep to posterior belly of digastric mm

Facial vein lateral to the gland

*whartons duct opens in the floor of the mouth and crosses deep to the lingual nerve

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85
Q

What nerves innervate the SMG?

A
  1. Facial nerve via chorda tympani - secretomotor innervation to SMG and SL glands
  2. Lingual nerve - sensory nerve. Deep to floor of mouth and attaches to deep superior surface of SMG via submandibular ganglion
  3. Hypoglossal nerve - motor fxn to tongue. Medial to digastric muscle and SMG
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86
Q

Where do sublingual glands drain?

A 
Rivinus ducts (floor of mouth) or
Bartholins duct (submandibular duct)
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87
Q

Minor salivary glands are concentrated on hard palate and number?

A

600-1000

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88
Q

AOG parotid gland develops?

A

7th week

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89
Q

Dominant ANS stimulation of parotid gland?

A

Parasympathetic cholinergic stimulation - acetylcholine to activate phospholipase C -> activates 2nd messenger Ca

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90
Q

Electrolyes secreted into the acinar cell lumen?

A

Na, Cl, HCO3

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91
Q

Saliva is ______ water.

A

99.5%

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92
Q

Humans secrete ____ of saliva in 1 day.

A

1 liter

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93
Q

Electrolyte which is concentrated twice as high in the smg.

A

Calcium

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94
Q

Submandibular gland saliva has high content if?

A

Mucin

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95
Q

Most abundant protein in saliva?

A

Alpha-amylase. 40% of body amylase produced by salivary glands

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96
Q

Starts digestion of starch.

A

Amylase.

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97
Q

Saliva buffers with _______.

A

HCO3

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98
Q

Antibacterial proteins in saliva?

A

HAIL LiM

Histamine
Amylase
Ig A
Lysozyme

Lactoferrin
mucin

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99
Q

This disease condition results in abnormal chloride regulation with failure of reabsorption of nacl in the ductal cells resulting in more viscous saliva with decreased flow rates and sludging of saliva.

A

Cystic fibrosis

100
Q

Most common source of xerostomia? (2)

A

Antihistamines

Antidepressants

101
Q

What salivary gland cells can modify the salivary gland composition? (2)

A

Intercalated and striated cells

102
Q

What percentage of the smg is serous cells?

A

10%

103
Q

What are serous minor salivary glands located posteriorly on the tongue?

A

Ebner glands

104
Q

Where are sebaceous glands usually found if affecting the salivary gland? What are sebaceous cells in the oral mucosa?

A

Parotid gland.

Fordyce granules.

105
Q

How to diagnose amyloidosis?

A

Positive congo red stain (apple green birefringence on polarized view)

106
Q

In chronic sialedenitis px, how many will improve with conservative measures?

A

50%

107
Q

Heavy lymphoid infiltrate in smg, may mimic neoplasm?

A

Kuttner tumor

108
Q

Solid mass in parotid gland fir hiv px, percentage chance malignant?

A

40%

109
Q

Treatment of actinomycosis (gram positive anaerobic actinomyces, sulfur granules)?

A

Penicillin G IV x 6 weeks, then PO erythromycin or clindamycin

110
Q

Large polygonal thyroid follicular cells with abundant granular cytoplasm and numerous mitochondria?

A

Hürthle cell ca

110
Q

Calcified laminated bodies called psammoma bodies; elongated, pale nuclei with a ground glass appearance (Orphan Annie eyes)?

A

Papillary thyroid ca

111
Q

Nests of small, round cells; amyloid; dense, irregular areas of calcification?

A

Medullary thyroid ca

112
Q

Cuboidal epithelial cells with large nuclei in a well-structured follicular pattern extending beyond the tumor’s capsule?

A

Follicular thyroid ca

113
Q

What is Ackerman’s tumor?

A

Verrucous carcinoma, thought to be less radiosensitive and less likely to metastasize than SCCA.

114
Q

Unencapsulated tumor that arises from within a nerve; 15% become malignant, when associated with von Recklinghausen’s disease?

A

Neurofibroma

115
Q

Arise from pericytes of Zimmerman and considered neither benign nor malignant?

A

Hemangiopericytoma

116
Q

Most common tumor to metastasize to the sinonasal area?

A

Renal cell

117
Q

Well-circumscribed, mobile, painless benign lesion most commonly found on the tongue that has malignant potential and histopathology shows polygonal cells with abundant eosinophils?

A

Granular cell tumor

118
Q

Metastasizes to the brain more frequently than any other soft-tissue sarcoma?

A

Alveolar soft part sarcoma

119
Q

From which part of the nasal cavity does JNA arise from?

A

Trifurcation of the palatine bone, horizontal ala of the vomer, and the root of the pterygoid process.

120
Q

What are the high risk features in well-differentiated thyroid carcinoma?

A

Gross extrathyroidal extension
Incomplete tumor resection
Distant metastasis
Tumor lymph node >3cm

121
Q

What are the intermediate risk features in well-differentiated thyroid carcinoma?

A

Aggressive histology
Minor extrathyroidal extension
Vascular invasion
>5 lymph nodes involved (0.2-3cm)

122
Q

What are the low risk features in well-differentiated thyroid carcinoma?

A

Intrathyroidal DTC

<=5 lymph nodes (0.2 cm)

123
Q

What is the ATA classification for ocular involvement in Grave’s disease?

A

Class I-Lid lag and the appearance of a stare
Class II-Conjunctival chemosis, epiphora, periorbital edema, and photophobia
Class III-Proptosis
Class IV-Decreased ocular mobility and diplopia
Class V-Corneal ulceration
Class VI-Optic nerve involvement.

124
Q

What are the three most important factors leading to osteoradionecrosis?

A

Hypovascularity
hypocellularity
hypoxia (the “3Hs”)

125
Q

What are the three types of ORN?

A

Type I occurs soon after radiation therapy
Type II occurs long after radiation therapy and is induced by trauma
Type III occurs long after radiation therapy and occurs spontaneously.

126
Q

What are the indications for parathyroid exploration in patients with asymptomatic or minimally symptomatic hyperparathyroidism?

A

Age less than 50
History of a life-threatening hypercalcemic episode
Kidney stones on abdominal X-rays
Serum calcium 1 mglmL above the upper limits of normal for the lab
Creatinine clearance reduced by 30% or more compared with age-matched normal persons
24-hour urinary calcium excretion >400 mg
T-score at lumbar spine, hip, or distal radius less than -2.5
Poor follow-up expected
Coexistent illness complicating conservative management.

127
Q

What is the most effective regimen for anaplastic thyroid carcinoma?

A

Doxorubicin with Valproic acid

128
Q

Virchow’s node located?

A

Level 4

129
Q

How many days prior to surgery stop warfarin?

A

3 days or reverse 6 hours prior using vitamin k

130
Q

How many weeks prior to surgery stop aspirin?

A

2 weeks prior to surgery

131
Q

How many weeks stop smoking prior to surgery?

A

1 week

132
Q

How to do lateral view of xray?

A

5 degree off the lateral plane to avoid superimposition of posterior wall of maxillary sinus

133
Q

How to perform caldwell view?

A

Pa view with 15 degree caudal angulation of the beam

134
Q

How to perform waters view?

A

Pa with 33 degree neck extension

135
Q

How to perform smv view?

A

Ap with 90 degree neck extension

136
Q

What is the view for lower cervical spine?

A

Swimmers aka twining view

137
Q

How to obtain schullers view?

A

Lateral view of the mastoid with 30 deg cephalocaudal angulation

138
Q

How to perform stenvers projection?

A

For petrous bone, head slihtly flexed, turned 45 degree to opposite side, beam at 15 deg angle

139
Q

How to perform transorbital view?

A

Frontal projection of the mastoid and petrous bone

140
Q

How many HU fat?

A

-80-100

141
Q

HU bone?

A

100 - 400

142
Q

Soft tissue window?

A

40 - 70, 250 - 400 HU width

143
Q

Width of bone window? Window level?

A

2000 - 4000 HU, 0 - 400

144
Q

A sinus ct gives ____ more radiation than a sinus series with 4 films.

A

4 - 6 times

145
Q

How many MHz used in ultrasound?

A

5 - 10

146
Q

Disadvantage of PET?

A

Lack of anatomic information

Poor spatial recognition 5 - 6mm

147
Q

Useful in salivary gland function in autoimmune and inflammatory disease. Can pathogmonically demonstrate Warthin’s tumor and oncocytoma. Has spatial resolution of 1.5 cm.

A

Technetium - 99m pertechnetate

148
Q

FDG - PET is deferred until how many months after treatment?

A

4 months

149
Q

What is contained in the pre styloid parapharyngeal space? (5)

A

Fat, cn v3, internal maxillary aa, ascending pharyngeal aa, pteryoid venous plexus.

150
Q

What is contained in the parotid space?

A

Parotid gland, lymph nodes, facial nerve, retromandibular vein, branches of the eca

151
Q

Separates carotid space and parotid space?

A

Posterior belly of digastric

152
Q

Which is usually bigger, the right or left ijv?

A

Right

153
Q

Contents of masticator space?

A

Muscles of deglutition, cn v3, cn v, ima, pterygoid venous plexus, ramus and posterior body of mandible.

154
Q

Retropharyngeal space extends?

A

Skull base to t3

155
Q

What may have a “bowtie” appearance on axial imaging?

A

Infection/mass in the lateral portion of the infrahyoid rps on axial imaging.

156
Q

Contained in the prevertebral space?

A

Prevertebral, scalene, paraspinal muscles, branchial plexus, phrenic nerve, vertebral artery and vein.

157
Q

Contained in the sublingual space?

A

Anterior part of the hyoglossus, lingual nerve, chorda tympani, lingual artery and vein. Deep portion of the submandibular gland and duct, sublingual glands and ducts.

158
Q

Common pseudomass in the infrahyoid rps?

A

Tortuous internal or common carotid artery in the elderly.

159
Q

Posterior (lateral) cervical space corresponds to?

A

Posterior triangle, containing ijv, transverse cervical lymph nodes, cn 11, phrenic nerves

160
Q

Corresponds to muscular triangle in neck?

A

Visceral space.

161
Q

When does a lesion become transglottic?

A

Fat interface between the thyroarytenoid muscle (tvf) and paralaryngeal fat (fvf) is eliminated, indicating the tumor has crossed the laryngeal ventricle. The anterior commisure should be <1mm thick.

162
Q

Gold standard for detecting and identifying LAD as benign or malignant?

A

CECT

163
Q

Normal thickness of maxillary and frontal sinus mucosa?

A

1-3mm

164
Q

Appearance of mucocoele in MRI?

A

Concentric rings of variable dessicated mucous, with the center being the most dessicated.

165
Q

Superior in detecting recurrent tumors from muscular and vascular invasion?

A

MRI

166
Q

What is the most critical cellular target in radiotherapy?

A

Nuclear dna. Other targets are mitochondria and cell membrane.

167
Q

Why are larger tumors less radiosensitive?

A

Large tumors overgrow their blood supply so are in a hypoxic state where radiation is not very effective.

168
Q

What are the 4 rs of radiation?

A

Repair
Redistribution
Repopulation
Reoxygenation

169
Q

What is the standard fractionation?

A

70 Gy, 2 Gy/Fx, 35 fx, 5d/week

170
Q

How many hours does it take for normal tissue to repair after radiation damage?

A

4 - 6 hours

171
Q

When and how to perform intraoprative rt?

A

Usually done in abdomen and pelvis, using 12.5 Gy

172
Q

Mechanism of action for cell death for hyperthermia and radiation therapy?

A
  1. Altered membrane permeability
  2. Microtubule breakdown
  3. Enhancement of antigen exprssion or antigen-antibody complexation
173
Q

Most studied radioprotectant?

A

Amifostine

174
Q

Survival time of patients with locally advanced of disseminatd recurrent scca?

A

6-8mos.

175
Q

MOA of methotrexate?

A

Folic acid analogue, s-phase specific

176
Q

Increases therapeutic index of methotrexate?

A

Leukovorin

177
Q

Chemotherapeutic agent which is a metal coordination complex. Binds to dna to cause inter and intra strand cross linking?

A

Cisplatin.

178
Q

Major toxic reaction to cisplatin?

A

Renal dysfunction. Others are ototoxicity and neurotoxicity.

179
Q

Derivative of cisplatin. Dose limiting toxicity is myelosuppresion (primary leukopenia), thrombocytopenia. May be administered at the opd.

A

Carboplatin.

180
Q

Inhibit microtubule polymerization, resulting in cell arrest at G2? Major toxicity is neutropenia.

A

Taxanes (ex. Paclitaxel).

181
Q

Causes dna inter and intrastrand crosslinking. Dose limiting toxicity is hemorrhagic cystitis, thus administered with sodium mercaptothane sulfonate (mesna).

A

Ifosfamide.

182
Q

Generates O2 radicals to break dna strands. Serious complication of pulmonary toxicity.

A

Bleomycin.

183
Q

Inhibits formation of thymidine. Toxic reactions are myelosuppression.

A

5-fluororacil

184
Q

Crosslinks DNA strands. Causes permanent infertility, fibrotic bladder.

A

Cyclophosphamide.

185
Q

Interferes with nucleic acid synthesis. Cause limiting effect is cardiac toxicity.

A

Adriamycin.

186
Q

Moa of vinca alkaloids?

A

Disrupt microtubular spindle formation.

187
Q

Major side effects of vinblastine?

A

Myelosuppresion, alopecia, myalgia

188
Q

Major side effect of vincristine?

A

Constipation (almost no myelosuppressive effect).

189
Q

Inhibits dna synthesis. Major toxic response is neutropenia and thrombocytopenia.

A

Hydroxyurea

190
Q

Most effective combinations for npca?

A

Cisplatin based regimens

191
Q

Gold standard to which all new combinations should be compared?

A

Cisplatin + 5-FU

192
Q

Another name for induction therapy (chemo before surgery or radiation?)

A

Neoadjuvant therapy

193
Q

Standard of treatment in npca?

A

Cisplastin + radiotherapy then cisplatin + 5 FU.

194
Q

In intraarterial chemotherapy, factors to consider in choosing the drug?

A
  1. Drug concentration
  2. Drug should be deactivated in the systemic circulation
  3. Should be a high tissue extraction
  4. Should not require deactivation in the liver
195
Q

Best chemotherapeutic agents for adenoid cystic carcinoma?

A

Cisplatin, 5-FU, doxorubicin

196
Q

Have been used to prevent malignant transformation of dysplastic leukoplakia lesions.

A

Retinoids and carotenoids

197
Q

Thermoregulation is via?

A

Precapillary sphincters

198
Q

What is a tissue supplied by a named artery?

A

Angiosome

199
Q

What communicates adjacent angiosomes?

A

Choke vessels

200
Q

Blood flow needed for nutritional support?

A

9ml/mg/100g of tissue

201
Q

In maximal vasodilation, what is the blood flow?

A

20x normal

202
Q

Theories of zone 2 (capillary circulation) autoregulation?

A

Myogenic theory-stretching of arteriolar muscle results in reflex contraction

Metabolic theory-excess of oxygen and nutrients results in arteriolar constriction

203
Q

Loss of nutritive blood flow occurs in the prescence of an adequate vascular supply?

A

No reflow phenomenon

204
Q

Dermis is ____ thicker than epidermis. Maximum ___ at back.

A

15-40x, 4mm

205
Q

How nutrients are passed in zone 3?

A

Diffusion (passive) and convection (active).

206
Q

Ultimate determinant of flap survival.

A

Zone 4 (cellular systems)

207
Q

Loss of energy substrate in cells (oxygen and subsequently atp) produces reversible swelling in ____ of insult, after which cell lysis and flap necrosis develop?

A

10 mins.

208
Q

Mucosal Kaposi’s sarcoma usually occurs?

A

Oral cavity

209
Q

3 histologic forms of ks?

A

Spindle cell
Anaplastic
Mixed cell (most common in aids-ks)

210
Q

Most common type of non aids defining tumor?

A

Hodgkin’s lymphoma

211
Q

30% occur in the head and neck in hiv infected persons compared to 85% in the general population?

A

Basal cell carcinoma

212
Q

Three mechanisms that contribute to the high incidence of sinusitis in HIV infected persons?

A

Impaired systemic and local immunity
Decreased mucociliary clearance
Increased atopy

213
Q

What are the principle components of the cell cycle?

A 
G1 phase
S phase
G2
M phase
G0
214
Q

Cell cycle state of rest?

A

G0

215
Q

Cell cycle actual distribution of the duplicated DNA and physical division into daughter cells?

A

M phase

216
Q

Cell cycle cell growth and duplication of cellular proteins and structures?

A

G2 phase

217
Q

Cell cycle dna replication or synthesis?

A

S phase

218
Q

Cell cycle enzymes, nucleic acids and other factors are produced?

A

G1 phase

219
Q

What are the 3 basic tenets of tumor progression?

A
  1. Cancer arises as a result of inactivation of tumor suppressor genes
  2. There is a defined order of genetic events that lead to development of a malignant phenotype
  3. Variations in the order of events can occur, and it is ultimately the net accumulation of genetic events that determines the phenotypic expression of malignancy.
220
Q

Tobacco smoke contains how many mutagenic compounds?

A

55

221
Q

Inactivation of both parenteral alleles of TSG leads to a malignant phenotype.

A

Knudson’s hypothesis

222
Q

What is the largest neuronal center outside the cranial cavity, for facial pain, headaches ang migraine?

A

Sphenopalatine ganglion.

223
Q

Formed by the fusion of the inferior cervical ganglion to the first thoracic ganglion?

A

Stellate ganglion.

224
Q

What are the 4 phases of migraine progression?

A

1st phase: prodromal phase, depressiom, irritability, and anorexia
2nd: aura phase, visual somatosensory, or motor/language deficit of neurologic origin
3rd: headache phase marked by unilateral throbbing pain of moderate to severe intensity that lasts for 4-72hours, sometimes with nausea
4th phase: resolution phase marked by fatigue

225
Q

Only anticonvulsant approved for prophylaxis of migraine headache?

A

Sodium valproate

226
Q

What is effective for acute therapy for migraine?

A

12.5 to 37.5mg of IV chlorpromazine, or 10mg IV prochlorpromazine

227
Q

Cluster headache more common M>F?

A

6:1

228
Q

Presentation of cluster headache?

A

Excruciating unilateral pain involving the eye, temple, or upper jaw, lasting 15mins to 2hrs, 1-4x/day.

229
Q

Treatment of cluster headaches?

A

240-480mg

230
Q

Acute therapy of cluster headache in the ER?

A 
O2 8-10lpm for 10mins
Ergotamine
DHE-45
Triptans
Lidocaine
Sphenopalatine block
231
Q

Maximal rate of salivary production?

A

1ml/min/gm of glandular tissue

232
Q

Pathway for stimulation of parotid gland.

A 
Pans 
Inferior salivary nucleus
Cn 9
Jacobsons nerve
Otic ganglion
Cn 5
Auriculotemporal branch
Parotid gland
233
Q

Pathway for stimulation of smg

A 
Pans
Superior salivary nucleus
Nervus intermedius
Chorda tympani
Submandibular ganglion
Submandibular gland
234
Q

Salivary gland sans stimulation?

A

Sans
Superior cervical ganglion
Smg and parotid gland

235
Q

Salivary flow rate stabilizes at what age?

A

15yo

236
Q

Unstimulated salivary flow?

A

0.1ml/min

237
Q

Stimulated saliva flow?

A

0.2 ml/min

238
Q

Maximum salivary flow rate

A

7 ml/min

239
Q

Ave daily saliva secretion?

A

1000-1500 ml

240
Q

Most stimulating taste?

A

Acid

241
Q

Least stimulating taste

A

Sweet

242
Q

Diurnal variation of salivary flow

A

Highest late afternoon

Minimal night

243
Q

What is referred to by salivary highways and byways?

A

Highest flow mandibular lingual area and lowest maxillary incisors and interproximals

244
Q

Amylase present in parotid? Smg?

A

60-120 mg/100ml

25mg/100ml

Diplomate exam (7 decks)

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