Pham Randoms Flashcards
the tensor veli palatini muscle is innervated by
the mandibular branch of the trigeminal nerve, and
-the levator veli palatini,
-palatinus, and
-palatopharyngeus muscles are all innervated by the pharyngeal branch of the vagus nerve.
tensor tympani muscle is innervated by
the tensor tympani nerve contains proprioceptive and motor fibers that provide innervation to the
- What is purpose of direct pulp cap
prevent internal resorption, prevent needing rct, prevent external resorption
- Best solution for avulsed tooth: sterile water, cows milk, dextrose
MILK!!!
Milk is a readily
available medium for 1he lay person. and beamse time is
of 1he essence, it is 1he medium of choice in the absence of
Hank’s solution or ViaSpan. Milk will only prevent further
cellular demise; thus, it is used specifically when teeth have
been emaoral for less than 20 minutes. ADy periodontalligammrt
extraom1 exposure greater than 15 min.uCes will deplete
most of the cell metabolites; for this reason, a longer period
of extmora1 time limits milk’s e:lfectivcness to maiiJtain cellular
viability. Unlike Hank’s solution and VmSpan, which
can store avulsed teeth and :replenish cellular metabolite8 for
24 hours and 1 week, respectively, milk as a storage medium
becomes ineffective after approximately 6 hours.
newer physiologically compatible solutions are available that
can maintain 81ld/or replenish PDL cell metabolites. 1.’wo
such solutions are Hank’s balanced salt solution and VlaSpan
- Man with 3 month eye issue and fatigue when chewing:
-ms,
-muscular dystrophy, or
-MG
-Myasthenia gravis is a chronic condition that causes muscles to tire and weaken easily. For example, if you have myasthenia gravis, you may notice that during a meal, your jaw muscles become tired and weak, interfering with your ability to chew food.
-Ocular myasthenia gravis is a form of myasthenia gravis (MG) in which the muscles that move the eyes and control the eyelids are easily fatigued and weakened. What are the common symptoms of ocular myasthenia gravis? People with ocular MG have trouble with sight due to double vision and/or drooping eyelids.
- Patient stops taking their clonidine but keeps taking beta blocker, what happens?
These two medicines are taken together to help lower your blood pressure. In some people, they may increase blood pressure. If you stop taking clonidine and continue taking your beta-blocker, or if you stop taking them both at the same time, your blood pressure may also increase.
- Patient on beta blocker and you give block with local with epi, what vitals can you expect?
Clinical implications: Use of local anesthetic containing a vasoconstrictor should be avoided in patients taking beta-blocker medication because of a possible adverse drug interaction.
Propranolol and other nonselective beta-adrenergic blocking agents can inhibit the vasodilatory effect of epinephrine in dental local anesthetic solutions, leading to hypertensive reactions and a concomitant reflex bradycardia. It is important for clinicians to recognize and avoid these serious drug interactions.
- How many weeks for pdl to form after avulsion: 2-6 weeks, 12-16 weeks, 8 months
2-6 weeks, 12-16 weeks,
Likely 2-6 weeks but not 100% confirmed
- What is needed for maxillary overdenture:
midline implant, 4 implants, 5 mm clearance, a bar
- When do you use a non vascularized bone graft:
child with missing condyle
-composite symphysis defect
-radiated bone
child with missing condyle
- How long does it take for toradol anticoagulant effects to wear off:
It takes about 5.5 x elimination half-life before a drug is totally eliminated from your system. Therefore Ketorolac would in your system for about 33 hours (6 x 5.5 hours)
- What causes respiratory depression from morphine
M6G
M6G has been demonstrated capable of in- ducing naloxone-reversible respiratory depres- sion in animals. In rats receiving M6G, M3G, and morphine by the ICV route, M6G was ap- proximately 10 times more potent than mor- phine in depressing minute ventilation. In awake dogs, ICV administration of M6G also caused profound dose-dependent ventilatory depression.
Studies in rats and dogs have demon- strated that ICV administration of M3G caused stimulation of ventilation. Furthermore ICV administration of M3G functionally antago- nized the ventilatory depression induced by M6G in rats.
- What muscle causes facial elongation in untreated lefort fx:
-medial,
-lateral pterygoid,
-masseter,
-temporalis
Lateral Pterygoids
This treatment prevented the malocclusion; however, it was noted that patients often developed a long face deformity. This may be caused by the effects of gravity or the downward pull of the pterygoid muscles in Le Fort I and II,
and pterygoid and masseter muscles in the case of Le Fort III fractures.
Key fats about the lateral pterygoid muscles
-Origin
-Insertion
-Action
- Why use TCA to treat pin after tjr: Nociceptive, depression, sympathetic, dopaminergic
Nociceptive
The main mechanism of antidepressants that inhibit neuropathic pain is first, to increase noradrenaline in the spinal cord, and second, to act on the LC, thereby directly inhibiting pain and activating the impaired descending noradrenergic inhibitory system. Dopamine and 5-HT also increase in the central nervous system and may enhance the inhibitory effects of noradrenaline in an auxiliary manner.
- How does osseodensification work:
counter clockwise drilling
The recently introduced technique of osseodensification for dental implant involves the use of special drills (Densah) run in a counter-clockwise direction at the osteotomy site. It is claimed that this causes expansion of the osteotomy site, and increases density of the bone in immediate vicinity of the osteotomy.
- What resorbs the fastest:
-mineralized allograft,
-demineralized allograft,
-xenografts,
-HA
demineralized allograft,
Since FDBA is mineralized, it elicits slower resoprtion than DFDBA and provides an osteoconductive scaffold when implanted in mesenchymal tissues. For DFDBA, the demineralization process removes the mineral phase of the graft which can expose the underlying bone collagen and possibly bone growth factors like BMPs. Because of this, DFDBA may have a higher osteoinductivity than FDBA
- best way to preserve gingival tissue with implant : flapless, guided surgery, large flap
flapless
- myasthenia gravis PFT
- dec FEV1, increased RV:FRC ratio
- muscular weakness causes RV to be higher
Goldenhar Gorlin syndrome
Epibulbar dermoid
Epibulbar dermoids are benign tumors. They tend to be firm, white-yellow or pinkish tumors straddling the limbus in the temporal (primarily inferotemporal) quadrants. They are located both over the cornea and sclera
Goldenhar-Gorlin syndrome manifests a number of craniofacial abnormalities that usually involve the face (hemifacial microsomia), eyes (epibulbar dermoid) and ears (microtia). It may also be associated with varying degrees of systemic and vertebral malformations. This syndrome presents at birth and the exact etiology is still unknown. The affections of the neural crest cells may have some role in the multiple malformations of the Goldenhar-Gorlin syndrome.1 The association of cardiac, pulmonary, central nervous system, renal and vertebral abnormalities have been described.2-4 Other skeletal malformations like extra ribs were reported
-local maxes FOR
-Prilo
-Lido/art
-mEpivacaine
- 600-prilo
- 500-lido/arti
- 400-mepi
- 90 mg-Marcaine (bupivacaine)
-cavernous sinus thrombosis
- unliateral periorbital edema, headache, photophobia, proptosis
- CNIII, IV, V1, V2, VI
Nerve fibers
A-Alpha
A-Beta
A-Delta
C
Characteristic & Function
Remember, large myelinated are the last to come back.
Pediatric airway (6 pts)
pediatric airway
1. larynx more ant/sup
2. cricoid more narrow
3. trachea more narrow/rigid
4. tongue larger
5. pharynx smaller
6. epiglottis larger/floppier
Lingual and IAN nerve fibers
- lingual: 10-25, IAN: 12-18 fascicles
inflammatory mediators
- leukotriene B4, PGE2, TNF, NO, IL-1B
Marcus Gunn Pupil
between retina and chiasm, afferent defect
relative afferent pupil defect (RAPD)
Marcus Gunn pupil refers to the unequal pupillary response to light due to damage or disease in the retina or optic nerve. Examples include retinal detachment, retinal ischemia, optic neuritis, severe glaucoma, trauma, and tumor of the optic nerve, among other causes.
What causes a Marcus Gunn Pupil (8 pts)
- retinal detachment
-retinal ischemia
-optic nerve disease, specifically occuring before the optic chiasm
-optic neuritis
-MS
-glaucoma,
-Tumors
-trauma
Marcus Gunn pupil can be caused by diseases of the retina, including retinal detachment (i.e. where the retina at the back of the eye pulls away from its normal position) and retinal ischemia (i.e. a conduction characterized by chronic reduced blood flow to the retina). It may also be due to optic nerve disease, specifically occuring before the optic chiasm (ie. the point where the two optic nerves cross over each other). Examples of optic nerve diseases include optic neuritis, or inflammation of the optic nerve commonly due to multiple sclerosis, which is an autoimmune disease that leads to attack of the coating around the optic nerve.
Another underlying condition that results in Marcus Gunn pupil is severe glaucoma, a condition where fluid build-up in the eye leads to increased pressures in the eye and resultant damage to the optic nerve. Trauma to the eye or head or tumors compressing the optic nerve can likewise result in a non consensual pupillary reflex.
distract lid how much before procedure
6 mm
-facial paralysis
- central
-contralateral lesion in upper motor neuron between cortex and pons (corticobulbar tract)
-only contralateral lower facial muscles affected - peripheral
-lower motor neuron lesion
-ipsilateral upper and lower facial muscles affected
-myxoma
- more common in mandible, more aggressive in maxilla
- anti-apoptotic protein: BCL-2
tooth splinted longest
. subluxation:
2. extrusive luxation:
3. intrusive luxation:
4. avulsion:
- subluxation: 2 weeks
- extrusive luxation: 4 weeks
- intrusive luxation: 4-8 weeks
- avulsion: 2-4 weeks
trichophytic incisions
- coronal, pretricheal, endoscopic
-One such improvement, the trichophytic incision technique, allows for treatment of brow and forehead ptosis while preserving hair follicles along the incision site. The resultant scar is penetrated by the patient’s natural hair affording excellent camouflage and typically is very well tolerated by patients.
-homograft
T cell
-tibial incision
gerdy’s tubercle
ossifying fibroma
- histologically indifferent from fibrous dysplasia
proper lma placement
- tip of epiglottis
T2 tongue no node
- ipsilateral neck
distraction implant time
- 4 weeks
After a 5-day latency period to allow primary callus organization, the distraction device was activated at a rate of 0.5 mm per day until the desired vertical height was achieved. During the initial distraction, a tendency for palatal shifting caused by mucoperiosteal traction was observed. Therefore, a tooth-borne suspension device was mounted to the distractor (Fig 3-1d). A vertical distraction of 12.0 mm proceeded (Fig 3-1e) and was followed by 10 weeks of retention to allow bony maturation and mineralization. The distraction device was removed, and an additional 4 weeks of healing ensued
PALS adenosine
- 0.1mg/kg max 6mg
-melanoma under finger nail
- acral lentiginous
-EtCO2 slope
- COPD- shark fin
-sick sinus syndrome
- treated with pacemaker
-lichen planus
- 0-6% malignancy transformation
-wide complex pediatric tachycarida
- synchronized cardioversion
- 0.5-1 j/kg followed by 2
-SVT
- adenosine 6 then 12
- no cardiac issues: metop, dilt, digoxin,
- cardiac issues: digoxin, amiodarone
-Abbe-estlander flap
- abundance of mucosa
Another technique that has been proven very useful for the reconstruction of lip defects is the use of Abbe-Estlander flap. The conventional Abbe-Estlander flap is composed of skin, muscle, and mucosa with the pedicle containing labial vessels.
jefferson fx
A Jefferson fracture is a bone fracture of the vertebra C1.
-amount of lagopthalmos tolerated
- 2mm
-multiple myeloma severity (based on 4 things)
- amount beta 2
Dependent on the following 4 things
The amount of albumin in the blood
The amount of beta-2-microglobulin in the blood
The amount of LDH in the blood
The specific gene abnormalities (cytogenetics) of the cancer.
retinal detachment
- monocular diplopia
-mono is EBV, DNA
- coxsackie is RNA
-C3 tissue is 7mm
- 6mm at C2, 22mm at C6
-paresthesia after nerve lateralization
- 5%
-initial type of bone contact in implant
- type I
-central: scopolamine, atropine
- peripheral: robinul
NOT SURE what this is getting at
Glycopyrrolate (Robinul) protects against the peripheral muscarinic effects (e.g., bradycardia and excessive secretions) of cholinergic agents such as neostigmine and pyridostigmine given to reverse the neuromuscular blockade due to non-depolarizing muscle relaxants.
isoproteronol, what is it used for?
- used for bradycardia or torsades
-supraorbital rim for facial/orthognathic eval
- 5-8mm in front of cornea
Difference between myfoacial pain and myositis-
myofascial pain: localized reproducible and myositis-Diffuse
-cleft percentages
- 1 parent OR child-4%
- 2 children-9%
- 1 parent AND 1 child-17%
modified Outerbridge grading of chondromalacia is divided into four grades by MRI, typically using fat-saturated proton density sequences, what are the four stages?
- softening
- furrowing
- fibrillation and ulceration
- crater formation and subchondral bone exposure
grade I
focal areas of hyperintensity with normal contour
arthroscopically: softening or swelling of cartilage
grade II
blister-like swelling/fraying of articular cartilage extending to surface
arthroscopically: fragmentation and fissuring within soft areas of articular cartilage
grade III
partial-thickness cartilage loss with focal ulceration
arthroscopically: partial thickness cartilage loss with fibrillation (crab-meat appearance)
grade IV
full-thickness cartilage loss with underlying bone reactive changes
arthroscopically: cartilage destruction with exposed subchondral bone
-langerhans cell
Involves skin, bone, viscrea
Langerhans cell histiocytosis is a rare disorder that can damage tissue or cause lesions to form in one or more places in the body. Langerhans cell histiocytosis (LCH) is a rare disease that begins in LCH cells. LCH cells are a type of dendritic cell that normally helps the body fight infection
Coagulase
- determines pathogenecity
Coagulase is the enzyme which catalyses the conversion of fibrinogen to fibrin. It is most closely associated with pathogenicity, having previously been used in the microbiology laboratory to separate pathogens from non-pathogens. Two types of enzyme are produced: ‘bound’ associated with the cell surface and ‘free’. They are detected by different methods (see below). Strains of S. aureus lacking this enzyme are rare and other staphylococci possessing this enzyme (S. intermedius and S. hyicus) are rarely found in man.
Primary palate
Primary palate is derived from the intermaxillary segment and the secondary palate formed by two palatine processes or palatal shelves from the maxillary prominences.
When does the primary palate form and how?
6 weeks gestation, median nasal prominence fuses with lateral nasal prominent and maxillary prominences to form base of the nose, nostrils, upper lip, and anterior maxillary alveolus.
Lemierre’s syndrome
Lemierre’s syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection.
Frey’s Syndrome
- post ganglionic otic ganglion
Frey syndrome is a common sequela of parotid gland surgery, affecting up to 64% of patients with varying degrees of severity. Frey syndrome is secondary to synkinesis of postganglionic parasympathetic nerve fibers within the transected parotid gland reinnervating the overlying sweat glands
Where do neurofibromas course
They follow peripheral nerves
Where do recurrent cutaneous melanoma’s occur
VEGF infusion-raised VEGF seen in melanoma patient’s
plasmocytomas-treatment
Radiation Therapy provides long-term local control in the solitary bone plasmacytomas and is potentially curative in the extramedullary cases.
What is the treatment for rhabdomyosarcoma/osteosarcoma
Chemotherapy
Psoriatic arthritis? Symmetrical or asymmetrical
Asymmetric
The asymmetric oligoarticular type of psoriatic arthritis involves different joints on each side of the body
Why dochildren have lower MAC
- because of higher alveolar ventilation rate
- lower FRC
-benzocaine, PABA or no PABA
Benzocaine (topical itching treatment) has PABA in it
Contact/photocontact allergy to PABA and benzocaine are not uncommon.
schneiderian membrane
- 0.3-0.8mm
modiolus (9 muscles)
The modiolus (plural: modioli), also known as the modiolus anguli oris or commissural modiolus, is a small fibromuscular structure at the corner of the mouth where fibers from multiple facial muscles converge, and helps coordinate the action of these muscles.
zygomaticus major, orbicularis oris, buccinator, levator anguli oris, mentalis, depressor labii inferioris, depressor anguli oris, platysma and risorius muscles.
-orthodontically extrude tooth, what happen to the MGJ vs the crystal gingiva
- MG junction stays same, crestal gingiva migrates
alveolar crest to intraosseous anastamosis
- 16mm
-wait how long after radiation for implants
6 months after radiation for implants
DFDB
osteoinductive
Staple implant
12 mm
-obesity ventilation
- PaO2 is decreased representing a ventilation/perfusion mismatch
- PaCO2 remains normal
-hageman factor (XII)
- activates complement
type 3 vWF1.
cryoprecipitate
max canine eruption
- 22mm
- 80% palatal
- vertical then buccal
endoscopic brow lift
- 2 parasagittal, 2 temporal, midline
inc APAP (acetaminophen) toxicity
- with phenytoin
fibula perforators
- septocutaneous and myocutaneous (musculocutaneous peforators
Described the position of the IAN -pediatric IAN
- more inferior, lateral, and posterior
inc risk of ankylosis in intracapsular fx
- contralateral ramus
-diazepam
- low hepatic extraction
Diazepam is a typical drug possessing high plasma protein binding (>98%), low hepatic extraction ratio (<0.3), high intrinsic clearance (>36 mL/min/kg) [16], and rapid passive diffusion across cell membranes
-verapamil-what can it help treat?
- vasopastic angina
Verapamil was found to significantly decrease the frequency of angina attacks,
Where is lactate metabolized
the liver
Cardiogenic pulmonary edema
- no pleural effusion of Kerley B
Kerley B lines (arrows) are horizontal lines in the lung periphery that extend to the pleural surface. They denote thickened, edematous interlobular septa often due to pulmonary edema.
Dextran-when is it used in kids?
Often used in a free flap for children
Wien kebach’s also known as
AV Block: 2nd degree, Mobitz I
-peridex reduces what
-peridex
1. reduces nosocomial pneumonia by 52%
Stah’ls ear-What is it
Extra crease, elf ear
A Stahl’s ear deformity consists of an extra cartilage fold in the scapha portion of the ear.
Which NSAID should be avoided if you have an aspirin allergy?
Diclofenac
methemoglobinemia
- oxidized to ferric form
metabolic syndrome and HDL relationship
The metabolic syndrome (MetS) is a constellation of metabolic abnormalities characterized by abdominal obesity, hyperglycemia, high blood pressure, and dyslipidemias including elevated apolipoprotein B (apo-B), high plasma triglycerides (TG), increased numbers of small, dense LDL particles, and
low HDL-cholesterol (HDL …
-xenograft temp for sinus and socket
- medium for sinus
- low for socket, faster resorption
creeping substitution
- resorption of woven bone into lamellar bone
creeping substitution, or the slow, near-complete resorption of the graft with simultaneous deposition of new, viable bone
Ossifying fibroma resection
5 mm
OSA side effects (3)
- pulmoary vasoconstriction
- decreased CO
- bradycardia
massive blood transfusion causes 4 things…what are they?
- dilutional coagulopathy
- met alkalosis
- hypocalcemic hypothermia/hyperkalemia
- cardiogenic pulmonary edema
chondrosarcoma staining
Representative staining patterns of chondrosarcoma tumors with CD4+ and CD8+ mAb are shown
Secondary Hyphema
- more common in stage 3/4 hyphema
What is the configuration in the scroll area
interlocking
-cetuximab
- binds to EGF to inhibit tyrosine kinase
CT graft
- red colored side to recipient bed
- white BM side to abutment
-zygomatic implant 4 point
stabilization: needs 10mm
- crest of alveolus
- sinus floor
- sinus roof
- zygomatic superior border
bone loss around implant? and in first 12-18 months
0.2mm/year
- should not exceed 1.5 in 12-18 mo
For each 0.25-mm increase in diameter, the surface area is increased by____%
5%
0.25 inc diameter inc SA 10%
-thick STSG is 0.01-0.025 in (0.3-.45mm), first 7 day timeline
- 0-48: imbibition
- 48-72: inosculation
- 3-5 days: neovascularization
- 7 days: adequate blood supply
What arteries and nerves are we concerned fo with a posterior hip?
- superior and gluteal a
- superior cluneal nerve L1-3
- middle cluneal nerve S1-3
-AICBH-nerve at risk
iliohypogastric L1-L2
- subcostal T12-L1
- femoral cutaneous L2-L3
Diascopy for VM versus hemangioma
diascopy has blanching in VM but not hemangioma
Diascopy is a test for blanchability performed by applying pressure with a finger or glass slide and observing color changes.
-burkitts, what kind of histologic appearance
- endemic form 2x more freq in maxilla, EBV
- “starry sky”
- chemo gives 90% remission
-desmoplastic fibroma
- fibroblast in collagenous stroma, no atypia or mitotic figures
Stage I/II tongue
- 1-1.5cm margin
- elective neck disseciton unless <2mm invasion
-FOM SCC
- 50% met
- <2mm 7.5% nodal, >2mm 38% nodal
-OSCC
- 85-95% of oral, 3-4% of all
rhabdomyosarcoma tx
- surgical excision followed by chemo
-osteosarcoma
(7 pts)
- chondroblastic MC in jaw
- osteoblastic MC
- small cell worst
- chemo 5x then 3cm resection
- <1% of H&N tumors
- early sign is widening of PDL
- MC in 30-40
-acinic cell adenocarcinoma
- low grade, mostly in parotid
- 18% of malignant, 6.5% of all salivary
- pain and b/l, low recurrence rate, treat with wide local excision
-MMRNA
- bilateral parotitis
- paramyxovirus
osteomyelitis has increased medullary pressure
- can be hematogenous in peds
-what does acanthomatous ameloblastoma resemble
- SCCa
-Immunohistochemical solutions
for
Pemphigoid
Pemphigus
Leukemia/lymphoma
Levasseur-Merrill
- pemphigoid- michels
- pemphigus- indirect immunofluorescence
- leukemia/lymphoma- flow cytometry
-Levasseur-Merrill retractor fro posterior border
-autonomic eye muslces
- levator-PS
- muellers-S
ballistics
- penetration and size are most important factor
Which IV fluid increased ICP
LR
IAN has mechanical allodynia
Not tinnel
Systemic Lupus Erythematous eye symptoms
- keratoconjunctivitis
Where is the V2 block aiming for?
Foramen rotundum
-miliary TB spread occurs through where
pulmonary vein
-argon laser absorbed by
Hgb
-25% inc in diameter increases 10% surface area
I guess this is referring to implants, go with it
Dantrolene MOA
- inhibits Ca release
epresses excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor 1, and decreasing intracellular calcium concentration.
Double humped P wave
Left atrial enlargment
-radiofreuncy ablation
- plasma field radiofrequency
Verapamil
vasoplastic angina is its main use
BMP
colon stimulating factor
Best match for nose
- posterior aurciular skin
-direct thrombin inhibitors
- dabigatran, argatroban, hirudin, bivalirudin
Albumin
- 2 day half life
- decreased shows increased hospital stay
How is remifentanyl metabolized
Plasma esterase
Patient with Hamman’s Sign following MVA, what type of injury?
Tracheo-bronchial tree
Hamman’s Sign
Hamman’s sign (rarely, Hammond’s sign or Hammond’s crunch) is a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium in spontaneous mediastinal emphysema. It is felt to result from the heart beating against air-filled tissues.
Patient has flaccid elbow & wrist reflex, but normal triceps reflex following MVA, what is the
level of C-spine injury?
C 5-6 (triceps is C 6-7)
Primary bone healing requires?
Bone-bone contact & compression across the fracture site
- What type of plate & screw fixation provides the most stable fixation?
a. Neutral zone
What is the thickness of the superior tarsal plate?
a. 10 mm (lower is 5mm)
- What is the position of the upper eyelid, at primary gaze, in relation to the limbus?
a. 2-3mm inferior
- Aniscoria status post trauma, what does it mean?
a. All the following can be the cause s/p trauma
i. Normal
ii. Horner’s
iii. CN III injury
iv. Tonic pupil
Which fracture would you use a compression plate for?
a. Ramus fracture
b. Oblique symphysis fracture (not correct – according to Fonseca’s textbook,
oblique fractures are contraindication to compression plate)
- Best screening test for cardiac contusion?
a. EKG
What is the best way to monitor blood loss & fluid status in a trauma patient?
a. CVP
b. Not HCT/Hbg
A patient presents with an intraoral wound contaminated with wooden debris, what is the
most important aspect of treating this wound?
Thorough debridement
What is the best radiograph to assess displacement of the condyle in a child?
What is the best radiographic study to evaluate orbital floor disruption?
Both are CT
- Which of the following will cause traumatic telecanthus?
a. Type III NOE fracture (not a choice)
b. Periorbital lacerations
c. Lateral displacement of bilateral ZMC fxs ?????
Treatment of a CSF leak, should include?
a. Place patient in head-up, semi-reclining position
i. Semi-Fowler position
- Where do you make the lateral orbital osteotomy for a Lefort III?
a. Frontozygomatic suture extending into the inferior orbital fissure
Why do you need to bone graft in an NOE fracture?
a. To recreate the dorsal-nasal support and correct tip projection
When placing an implant, what temperature results in the destruction of bone?
a. 47 degrees
116 F
Indications for a submucous vestibuloplasty?
When maxillary denture is unstable owing to shallow vestibular depth and/or
high muscle attachments, but the maxilla exhibits good underlying bone height
and contour.
Where is the most stress on an implant?
Crown/implant interface
In a lip-switch vestibuloplasty, where is the mucosal flap sutures?
To the cut periosteal edge at the depth of the vestibule
- What is the difference between a mandibular staple implant and a TMI?
a. Less bone required for TMI
What percentage of disc recapture following arthroscopy?
a. 0-10%
Which form of TMJ noise has the best prognosis?
Early opening & late reciprocal click
When performing a preauricular approach for TMJ surgery, which statement best describes
the position of CN VII?
Between the SMAS & the superficial layer of Deep Temporal Fascia
How is pain felt when you have a disc perforation?
Subchondral nociceptors
If done incorrectly, a high condylotomy may cause damage to what nerve?
a. Auriculotemporal nerve
What is the best treatment for a child with boney TMJ ankylosis?
a. Costochondral graft
A diagnostic aid for Rheumatoid Arthritis is?
a. ANA
Where is the medial cut made in a BSSO?
Immediately above the lingual
What is the best indicator for the amount of impaction necessary for a VME patient?
Maxillary incisor show at rest
- What is the most common site for A-V malformation following LeFort I osteotomy?
Descending palatine artery
What area of the maxilla is most resistant to rapid palatal expansion?
a. Mid palatal suture
Stripping of which muscles causes condylar sag in an IVRO?
Medial pterygoid & masseter
- A patient presents with mandibular alveolar retrognathia, with ideal chin position, how do
you treat?
Total mandibular subapical osteotomy
What causes immediate relapse following BSSO?
Proximal segment distraction during fixation
- Patient with VME have?
Decreased masticatory force (by EMG measurement)
How do you control vermillion show following LeFort I osteotomy?
a. V-Y closure
Which movement of the maxilla causes the greatest widening of the alar base
Anterior (impaction also)
What is the complication of placing the medial cut of a BSSO too high?
a. The medial pole of the condyle remains with the distal segment
SARPE should be considered in which patient?
a. Adults (> 18 years) with greater than 5mm of transverse deficiency
What is the most common “bad split” during a BSSO?
a. Buccal plate fracture
- What is the microscopic anatomy of the lingual nerve?
a. 10-25 fascicles
- What is the position of the lingual nerve in relation to the alveolar crest?
Just below the crest
What is the horizontal relationship of the lingual nerve to the lingual plate?
a. 0-1mm, book says 2.5
Which has a greater amount of long-term shrinkage?
STSG (vs. FTSG) – FTSG has greater immediate shrinkage
What type of nerve injury repair has the worst prognosis?
Gap between severed ends, placed under tension
10-year-old patient who is s/p anterior iliac crest bone harvest, presents with calf pain,
positive popliteal & pedal pulses, pink skin over calf, increased calf pressure, what is the
diagnosis?
a. Compartment syndrome
To avoid damage to CN VII, what layer is elevated during a coronal flap?
Subgaleal
What is the purpose of HA in bone regeneration?
Osteoconduction
Confluence of the maxillary vein & what make up the retromandibular vein?
Superficial temporal vein & Maxillary vein
What length of defect can you repair with a fibula free flap?
25 cm
What type of bond exists between HA & bone?
Chemical
What part of the mandible is most difficult to reconstruct?
Canine to canine
Which would you not use in the treatment of an atrophic mandible fracture?
2.0mm microplate
What treatment for an atrophic mandible fracture has the best prognosis for healing?
a. ORIF w/reconstruction plate (2.4-2.7mm)
b. Closed reduction w/external pin fixation (old study guides give this)
What is an inappropriate material for reconstruction for a severe orbital floor fracture with
enophthalmos?
Gelfilm
You raise an anterior temporalis flap to close a maxillary defect and cannot feel or Doppler a
pulse, what do you do?
Discard flap and use a new posterior temporalis flap
Where does the mentalis muscle insert?
a. Dermis of the skin
How does a split thickness skin graft receive its nutrition for the first 48 hours?
a. Plasmatic imbibition
How does freeze dried bone work?
a. Osteoconduction
b. Provides BMP
What is the primary blood supply to the pectoralis major flap?
Thoracoacromial artery
hat is the primary blood supply to the delto-pectoral flap?
Perforators from internal mammary artery
What muscle, if injured, other than the tensor fascia lata will cause a temporary or
permanent limp?
Psoas major
Best age for hard tissue manipulation in cleft patients is?
a. 9-11 years
What palatal muscle is not involved in speech?
a. Tensor veli palatini
What is the function of the hamulus?
Pully point for the tensor veli palatine
- Patient with congenital micrognathia may also have defects in which bones?
a. Malleus & incus
What is the most common fatal rhythm seen in myocardial infarction?
V-fib
What muscle acts to close the Eustachian tube?
tensor tympani
Describe how you would use a tongue flap to close an alveolar cleft defect?
a. Anterior based
Parents without clefts have a child with a cleft, what is the chance that they will have
another cleft child?
10-20% à NO! it’s 4% for CLP, 2.5% for palate
Ideal time for lip adhesion?
6-8 week of life
- Revision of cleft lip repair in an 18-year-old who is maxillary hypoplastic?
Establish maxillary position first, then revise lip
What palatal muscle is most responsible for speech?
a. Levator veli palatini
- What is the etiology of hemifacial microsomia?
Intrauterine damage of the stapedial artery
What is the blood supply to the free fibula graft?
a. Peroneal artery
Minimum thickness of native bone to allow immediate implant placement during sinus lift
surgery?
4-5mm
What does a minor salivary gland biopsy in Sjogren’s Syndrome show?
Focus of 50 or more lymphocytes, 1 focus per 4mm2 supports diagnosis
Maximum dose of lidocaine?
a. 4 mg/kg
b. 7 mg/kg w/epi
- What is the cause of venoirritation & thrombophlebitis during injection of Diazepam?
a. Propylene glycol
- What shifts oxy-hemoglobin saturation curve to right?
Increases in Temp, CO2, H+ ion, 2-3 dpg
- Criteria for a positive DPL (diagnostic periotoneal lavage)?
a. > 100k RBC/mm3
b. > 500 WBC/mm3
c. + gram stain
d. 10 mL gross blood on inital inspiration.
Late finding in progression of Malignant Hyperthermia?
Increased temperature
Most common arrhythmia in hyperthyroidism?
a. Sinus tachycardia
What is the mechanism of action of metformin?
a. Decrease hepatic glucose production, decreases intestinal absorption, improves
insulin sensitivity
What is the site of action of cyclosporine?
Inhibits T-cell proliferation & activation
Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn’s disease, nephrotic syndrome, and in organ transplants to prevent rejection
- Tinels’ sign?
Tingling or pain, distal to nerve injury
What organism causes cat scratch disease?
a. Gram negative bacillis – Bartonella
What is the most important muscle to close for VP competence?
a. Levator veli palatine
What is the average preferred distance of the upper brow to the pupil center?
25mm
What is the purpose of Guided tissue regeneration?
Prevent migration of epithelium
What is the modified Mueller technique?
a. Inspiratory effort with mouth & nose obstructed during nasoendoscopy
b. For eval of OSA
What muscle relaxant should not be used in a patient with renal failure?
Pancuronium is eliminated primarily by the kidney, and its duration of effect is prolonged in the presence of renal failure
What is Romberg’s syndrome
Progressive hemi-facial atrophy
i. Coup-de-gras defect
Parry-Romberg syndrome is a rare disorder characterized by slowly progressive deterioration (atrophy) of the skin and soft tissues of half of the face (hemifacial atrophy), usually the left side
What is the relationship of the malar eminence to the lateral canthus?
a. 10mm lateral & 15mm inferior
Preoperative dosing of ASA leads to increased incidence of what?
Asthma attack
Likely causes of 100-degree neck-chin angle?
a. Normal
b. Submental fat
c. Loose neck skin
d. Low hyoid
What is the relationship of the medial & lateral canthus?
Lateral is 4mm superior to medial
What is the treatment for a tooth concussion?
Observe
What is the most likely prognostic indicator for OKC recurrence?
a. Type of keratin (parakeratin maybe more aggressive)
Which muscle causes creases between the eyebrows?
Corrugator vertical creases)
Which muscle is not affected by bow lift?
a. Orbicularis
b. Rizorius
Which muscle insert into the nasolabial fold?
a. The LLSAN (
Levator labii superioris alaeque nasalis (LLSAN) inserts into the medial nasolabial fold and alar base, while the
LLS (Levator labii superioris) inserts into the middle third of the nasolabial fold. … A separate muscle
obliquely oriented between the orbicularis oculi and LLSAN was identified and
found to insert into the malar fat pad.
What is the path of the hypoglossal nerve as it relates to the hyoglossus and
mylohyoid muscles?
a. Lateral to hyoglossus, medial to mylohyoid
What joint situation is hyaluronic acid useful in?
a. Rheumatoid arthritis
What is the 3-muscle triangle of a scapular flap?
Teres major, teres minor, triceps (posterior head)
What is the most likely orbital fracture in a child?
a. Roof
What is the blood supply to a genioplasty segment?
Periosteum
What is the cause of diplopia, immediate, with ZMC fracture?
Entrapment
What structures are injured with a deep laceration just anterior to the masseter
muscle?
a. Facial nerve, parotid duct, transverse facial artery
Why is there an increased incidence of TMJ ankylosis in children vs. adults?
a. Thin cortical bone
Which is a contraindication of surgical repair of a nerve injury?
a. Anesthesia
b. Paresthesia
c. Hyperpathia
d. Allodynia
b. Paresthesia
Ramsey Hunt syndrome
Involves auditory canal & nerve, caused by Herpes zoster virus, causes facial
paralysis due to CN VII involvement
Tricyclic antidepressants work by:
a. Blocking norepinephrine reuptake
Tricyclic antidepressants act on approximately five different neurotransmitter pathways to achieve their effects. They block the reuptake of serotonin and norepinephrine in presynaptic terminals, which leads to increased concentration of these neurotransmitters in the synaptic cleft.
Noradrenaline reuptake inhibition enhances analgesic effects, mainly through α2-adrenergic receptors in the dorsal horn of the spinal cor
Ramsay Hunt Syndrome
In a pregnant patient, which pulmonary function tests are altered?
a. Decreased FRC
b. Increased tidal volume
Decreased FRC
The best method to examine the upper airway in OSA is:
Nasal endoscopy
the least predictable area of soft tissue change with mandibular movements is?
a. Lower lip
The wedge pressure of a pulmonary catheter is used to measure?
Left end diastolic pressure (also left atrial pressure)
One of the major limiting factors for the use of a temporalis flap is?
Temporal hallowing
When performing a subgaleal brow lift, which nerve is most likely injured?
a. Supraorbital nerve
The open sky approach in the bleph, the flowing structure is exposed?
Septum
The ability to distract the lower lid more than _____mm indicates the need for a lower
eyelid shortening procedure?
8 mm
The most common reason for impacted wisdom teeth is?
Change in diet with less attrition of the teeth (per knowledge update)
In planning for zygomatic implants, includes?
2 additional implants in anterior maxilla
The extraoral implants with skin around it
a. less than 1mm thick, without hair follicle
when performing a submucosal vestibuloplasty, the most important factor in
determining success is?
Leaving the stent for an extended period of time
What 2 anatomic factors are implicated for their movement having an effect on the soft tissues after LeFort I osteotomies?
ANS & upper incisor
the delay in conduction at the AV node is due to:
sodium & calcium channels
Dental implants in irradiated bone?
Increased success with HBO
An arch length deficiency is most commonly associated with
a. Buccally impacted canines
Question about the resting potential across the nerve membrane and the
sodium/potassium channels
Local anesthesia prevents action potential by preventing inflow of sodium ions
The latency period from the time of radiation of a benign tumor to development of a
sarcoma is?
a. 12 years – per Fonseca
b. 5-10 years per Marx—My Answer
Maximum amount of bone from the tibia is?
40 cc
Maximum amount of bone form the anterior iliac crest?
a. 50 cc
Maximum amount of bone from the posterior iliac?
100-125 cc
When harvesting a dermis graft, which structures survive?
a. Sebaceous glands?
Which of the following is associated with a higher risk of occlusion of anastomoses in a
free flap?
a. Vessel size discrepancy
which of the following has been shown to decrease the risk of failure of revised
anastomoses?
a. Aspirin
What is the most common reason for impaction of the second molar?
a. Arch length discrepancy
In orbital trauma, loss of supraorbital crease is due to:
Enophthalmos
Tennel’s sign is caused by:
Percussion proximal to nerve injury
What tumor occurs most frequently with Sjogren’s syndrome?
Lymphoma
Treatment for cherubism includes?
. Curettage/recontouring
What disease process of bone would have increased alk phos, with normal calcium
and phos.?
Paget’s
What lab test would be elevated in malignant hyperthermia?
CPK, K, myoglobin
Ketamine is contraindicated in which patients?
HTN
Hours after a procedure, the patient is still not breathing, what is the likely cause?
a. Atypical pseudocholinesterase deficiency
What effect does succinylcholine have on potassium?
Increase serum level
How close can an implant be placed to the IAN?
2 mm
How close can an implant be placed to the mental nerve?
5 mm
How much lingual bone do you need around an implant?
1 mm minimum
6 exposed labial threads on an implant after placement?
Graft
In whom is nitrous oxide contraindicated? (4 pts)
a. Repeat otitis media
b. Sinus infection
c. GI obstruction
d. Closed head injury
SLE and eye symptoms?
Iritis
Systemic lupus erythematosus (SLE) can involve many parts of the eye, including the eyelid, ocular adnexa, sclera, cornea, uvea, retina and optic nerve. Ocular manifestations of SLE are common and may lead to permanent blindness from the underlying disease or therapeutic side effects.
What is the possible long term sequelae of hyphema?
Glaucoma
How would you give an intraoral V2 block?
Through greater palatine canal, up to foramen rotundum
Develop a facial nerve palsy s/p IAN block?
Injection too far posterior and lateral
branchial cleft cyst is located where?
Lateral neck
Which STD can cause arthritis?
Gonorrhea
How do you treat temporal arteritis?
a. High dose steroids
How do you treat VPI with poor elevation of soft palate?
Superior based flap
What lesion are Rushton bodies found in?
a. Radicular cysts
What are the primary organisms in acute sinusitis?
a. Strep pneumonia
b. Staph aureus
c. H. influenza
d. M. Catarrhalis
What organism is implicated in nosocomial sinus infections?
a. Pseudomonas
What organisms are responsible for chronic sinusitis?
a. Staph aureus and anaerobic
What is the most classical feature of actinomycosis?
Multiple cutaneous fistulas
Congenital epulis of the newborn is histologically similar to?
a. Granular cell tumor
Sulfur granules are seen in association with what organism?
Actinomycosis
What nerve is affected first in cavernous sinus thrombosis?
CN VI
Ewing sarcoma is most similar to what?
a. Lymphoma?
How is military TB spread?
Hematologically
A craniopharyngioma resembles what other lesion, histologically?
Ameloblastoma
In a patient with intra-osseous AV malformation of the mandible, which of the
following might you see?
a. Spontaneous gingival bleeding
What lesion is associated with Antoni A and Antoni B lines, and Varocay bodies?
Schwannoma
Argon laser is best for vascular lesions because?
It is highly absorbed by hemoglobin
What is the best antibiotic to treat B. Fragilis?
a. Flagyl, then clindamycin
What is the most common location for a Pindborg Tumor (CEOT)?
a. Molar (mandible then maxilla)
Leisegang rings are seen in which lesion?
a. CEOT (Pindborg)
What is the treatment for a recurrent ranula?
Excision of sublingual gland
Pediatric patient with harsh systolic & diastolic murmur?
Patent ductus arteriosus
Which antibiotics interfere with protein synthesis?
a. Clindamycin
b. Tetracycline
c. Erythromycin
d. Aminoglycosides
On an EKG, peaked T waves are associated with?
Hyperkalemia
With restrictive lung disease, which pulmonary function tests are affected?
All are decreased which means FEV1/FVC is normal
With obstructive lung disease, which pulmonary function tests are affected?
a. All are increased, except vital capacity which is decreased
What cranial nerve is involved when you have no consensual or direct reaction in the
affected eye, and normal function in the unaffected eye?
CN III?
Mueller’s muscle is under what type of control?
Sympathetic
What is the initial treatment for SIADH?
Water restriction
What is the effect of aortic stenosis on MAP?
Decrease
What causes clotting of exudates?
Calcium
How many Kcal are in 2400cc of D5LR?
480
- In a patient with MI, what enzyme is elevated?
CK-MB, troponin
What nerve is most often damaged during a bone harvest from the anterior superior
iliac crest?
a. Iliohypogastric
A patient undergoes an IVRO and 2-3 weeks after release of IMF, she begins to
relapse, what is the cause?
a. Not seating condyle
b. Malunion at osteotomy site
Why is it not advisable to use a trapezius flap after a radical neck dissection?
Transverse cervical artery & CN IX may have been sacrificed
Where do you make the lateral orbital osteotomy for a LeFort III?
Through the frontozygomatic suture
What is the location of the nasal portion of the LeFort II osteotomy?
Inferior to the nasofrontal suture
What is the cause of Hamman’s sign?
a. Emphysema due to tracheobronchial tree injury
b. May be due to diaphragmatic puncture
Patient has a hyperplastic pulpitis; which tooth is the most likely cause?
Primary molar
What makes a local anesthetic more potent?
Lipid solubility
There is damage to the articular cartilage in the TMJ, what is the cause of the pain?
a. Prostaglandin E1, leukotriene
How does damaged articular cartilage heal?
By forming fibrocartilage
What happens to the synovial fluid in the TMJ in a patient w/RA?
Decreased viscosity
What is the vascular supply to the inferior turbinate?
Sphenopalatine artery
After a LeFort I osteotomy, a patient has a strange aura and diplopia, what is the
cause?
Cavernous sinus thrombosis
A patient has a ZMC fracture, what happens to the intraocular pressure?
Goes down
A patient has a retro bulbar hematoma that is impairing vision, what is the treatment?
Lateral canthotomy
How does aortic stenosis alter blood pressure?
a. Diastolic pressure goes up
b. MAP decreases
Injection of local into nerve which leads to damage/numbness, where is the damage?
Fascicular from ballooning
What type of occlusal splint will cause more loading on the TMJ?
a. Anterior primary contact
Compression of which part of the brain, or what type of herniation will result in
anisocoria
a. Temporal lobe compression
b. Transtentorial herniation
What type of flap is the temporalis flap?
a. Axial? – My answer
b. Coaxial? Old guide had this as answer
What is the correct pressure setting of CPAP for a patient with OSA?
7-15
What artery does not contribute to the frontal flap to the nose?
Superficial temporal
i. Supratrochlear, supraorbital & dorsal nasal DO
With what disease would you expect to see an increase in uric acid?
a. Renal failure
b. Gout
A patient is receiving 4 implants in the mandible for a removable denture, what is the
best configuration for the implants?
Curvilinear
Which part of the implant is responsible for the best outcome?
Width
Why do skin grafts differ between children & adults?
Child – no redundant skin, more elasticity
What is the most likely cause of a patient in septic shock?
Gram negative endotoxins
What separates the fat pads in the lower lid?
a. Inferior oblique separates medial & central pads
What is the pathway of dissection for an open rhinoplasty?
a. Overperichondrium, under periosteum
What is the relationship of the lateral nasal cartilage to the nasal bones?
Cartilage fits under the bones
Where is the root of a mandibular third molar if displaced through the lingual plate?
a. Submandibular space
Where is the sensation lost after harvesting a sural nerve graft?
a. Dorsal & lateral foot/ankle
What is the major disadvantage of Abbe flap?
Commissure reconstruction
You place an IV catheter into the antecubital fossa and return arterial blood, what
artery is involved?
Brachial
Which is the most potent vasoconstrictor?
Phenylephrine (vs. epi, norepi)
What is minimum that is required on the lower lateral cartilages for tip support?
5-7mm
A patient has a lip lesion that has a 1.5cm diameter, with 2-3-month history. Has
lymphadenopathy & a cheesy center?
a. Keratoacanthoma – My answer??
b. Scca
Where do you place bone grafts for LeFort III?
a. Tuberosity, zygomatic/temporal, orbital
What bacteria are most involved with pericoronitis?
a. Peptostreptococcus
b. Fusobacterium
c. Spirochetes
d. Bacteroides
What is the bacteria responsible for hand-foot-mouth disease?
Cocksackie
What bacteria from the maxillary sinus is the most likely cause for meningitis?
a. H. flu
A patient has medial strabismus, what nerve is damaged?
a. CN VI
What muscle opens the Eustachian tube?
tensor tympani
What is the length of the nares, when compared to the columella?
2:3
You displace a 5 mm portion of the palatal root of a 1st molar into the sinus, what do
you do first?
Xrays in 2 planes, then irrigate & suction
A patient with pulmonary disease is given a bronchodilator and has improvement in
FEV1, what type of disease does he have?
a. Reversible obstructive
What type of coagulopathy does a patient with an elevated PTT & an elevated
bleeding time most likely have?
a. Von Willebrand’s disease
What is the dose of lidocaine to treat multifocal PVC’s?
a. 2-4 mg/min
Why is midazolam the quickest acting benzodiazepine?
a. Lipid solubility
Where should you set the low limit alarm on a pulse oximeter?
94%
pulse oximeter reading of 90% corresponds to a pO2 of?
60 mmHg
What muscle relaxant would you give to a patient in renal failure?
a. Atracurium
Why give supplemental steroids to an adrenally suppressed patient in the
perioperative period?
To prevent hypotension &hypoglycemia
How does epinephrine increase the heart rate?
Stimulates beta-1
How does heparin work?
Inactives Xa and potentiates antithrombin III
Which local anesthetic causes methemoglobinemia?
Prilocaine
Where does the maxillary sinus exit in the nose?
Middle meatus
There is a tooth with a denuded root adjacent to an OAF, what do you do with the
tooth?
Extract
What are the dimensions of a random pattern flap?
1:3, width to length
What is the pollybeak deformity?
a. Convexity of nasal supratip, relative to the rest of the nose.
b. Complication following rhinoplasty – inadequate reduction of the superior septal
angle, a transfixion incision that is not adequately reconstructed and/or
postoperative scarring in the supratip region
c. Also called parrot’s beak deformity
An increase of 25% in the diameter of an implant gives what increase in the surface
area of the implant?
10%
At what level, relative to the CEJ, should the height of an implant be placed?
a. 3-4mm apical to the CEJ of adjacent teeth
What are the risks of total parathyroidectomy?
Osteomalacia
What is another name for Romberg’s Syndrome?
Progressive hemifacial atrophy
Treatment for PSVT?
i. Vagal maneuvers
ii. IV access/oxygen
iii. Adenosine 6mg IV push, may repeat w/12 mg x 2
iv. If good heart:
1. metoprolol 5 mg IV
2. diltiazem 20 mg IV
3. digoxin 0.5 mg IV
4. consider cardioversion
a. procainamide 20mg/min
b. amiodarone 150mg over 10 minutes
v. If poor heart:
1. digoxin
2. amiodarone
How does dantrolene work?
Inhibits Calcium release from sarcoplasmic reticulum
What are some clinical findings of adrenal insufficiency?
a. Hypotension, tachycardia,
b. Hyponatremia, hyperkalemia, hypercalcemia, metabolic acidosis, azotemia
What is the source of bleeding in an epidural hematoma?
Middle meningeal or posterior meningeal arteries
What are the signs & symptoms associated with an epidural hematoma?
Pupil dilation, hemiparesis, decerebration, LOC
What are the most common signs associated with a subdural hematoma?
Anisocoria & motor deficit
Medications used with Class II heart failure
Beta blocker and ACE
Test will have specific drugs (-ol) and (-il)
Severe type III Von Willebrand’s: Pre-operative treatment for removal of one third molar
DDAVP
Parkinson’s patient with nausea/ what not to give
Reglan, Compo, Prochlorperazine, doperidol (Test answer Doperidol)
Hypertrophic cardiomyopathy best med to give that doesn’t change vascular perfusion?
Etomidate
Who will likely die within 30 days of STEMI?
. >75 yo
b. DM
c. HTN
a. >75 yo
Costochondral rib graft on child
a. Left 7th rib
i. (7,8,9 is preferable)
What do you see on arthroscopy of someone with late osteoarthritis?
Subchondral Bone exposure
Late symptoms of bupivacaine overdose?
a. Auditory hallucinations
b. Cardiac changes?
c. Bradycardia
How do you treat bupivacaine toxicity?
Lipid infusion
What med do you give during IV sedation that increases the likelihood of a child having
local anesthetic toxicity?
Fentanyl
Contraindication to submentalplasty
Severe platysmal banding
How does radiofrequency coblation work?
Radiofrequency causing plasma field
What gives motor function to the tongue?
Hypoglossal
Where is the marginal mandibular nerve located related to facial vessels and mandibular
border
Inferior to the mandibular border superficial to vessels
Where is the ideal placement for a TAD
Directly mesial to 2nd premolar (between premolars)
Desmoplastic ameloblastoma
Radiopaque and radiolucent
Relapse after mandibular setback? (didn’t say what type of relapse or open bite or
anything)
a.
Did not strip the muscle of the distal segment enough
Radiograph of 52 yo male with multilocular radiolucency left mandible, histology of
plasma cells
Plasmacytoma
Which cytokine is seen in the TMJ synovium?
a. IL – alpha
b. IL-beta
c. TNF- alpha
d. IL -6
TNF- alpha
What drug is someone with myasthenia gravis more sensitive to?
a. Succinylcholine (less susceptible)
b. Fentanyl
c. Rocuronium
c. Rocuronium
i. Patients with MG are extremely sensitive to nondepolarizing NMBAs
ii. (rocuronium, vecuronium, cisatracurium).
50% upper lip avulsive injury, how to treat?
a. STSG
b. FTSG
c. Abby
d. Karapandzic flap
c. Abby
What do you see initially in Cushing syndrome?
a. Bradycardia
b. Hyperpigmentation
c. Hypotension
b. Hyperpigmentation
Patient with paralysis of lower 2/3 of face?
a. Central
b. peripheral defect
c. ipsilateral
d. contralateral
Central
Treatment CEOT
a. More amyloid less severe
b. Clear cell variant
c. Small: enucleation and curettage
d. Large: Resection with 1cm margin
e. Maxillary treated more aggressively that mandibular
Indications for use of cuffed ET tube in kids
Positive airway pressure
Inferior border of level II neck dissectionf
Region bound by the digastric muscle superiorly and the hyoid bone (clinical
landmark), or the carotid bifurcation (surgical landmark) inferiorly. IIa contains
nodes in the region anterior to the spinal accessory nerve and IIb posterosuperior
to the nerve.
Removal of thyroglossal duct cyst, what do you take a subtotal excision of?
Thyroid gland
Gait disturbance in AICBG
a. IT Band
b. Psoas Major Muscle
Where do osteoprogenitor cells come from 8 days after surgery
Macrophages
Most likely sign of IAN injury with 3rds (Roods criteria)
Darkening of canal around roots
Which fracture is the lowest prognosis
Root fracture with intrusion
CSF leak
a. beta -2 transferrin
b. Glucose test
How do you treat OSA when RDI less than 50
a. Genio
b. MMA greater than 50
Best med to give with cocaine HTN
Labetalol (Beta-blocker)
Muscular dystrophy test
dystrophin gene
Flumazenil dosage
0.2mg, maximum of 3mg
Where are Verocay Bodies found
Schwannoma = Neurilemoma
How does Pradaxa Work?
Direct Thrombin Inhibitor
What level does a moderate chemical peel treat to?
Upper reticular dermis
i. Superficial peel to papillary dermis
ii. Medium depth peel to upper reticular dermis
iii. Deep peels reach mid-reticular dermis
Which branchial arch is the alveolus derived from?
First Branchial Arch Ectoderm
Zofran causes what cardiac changes?
QT prolongation
What flap is used for nasal reconstruction?
a. Melolabial flap
Degrees difference between Frankfurt horizontal and natural head position (Know
percentage)
Male: 3.18
b. Females: 4.416
What happens when HA injected into the TMJ Space
a. Crystal induced arthropathies
What are the fundoscopic signs of HTN?
AV nicking, retinal hemorrhages, exudates, and papilledema (“Gunn’s sign)
What type of drug crosses the BBB (nonionized,
lipophilic,etc) (Atropine vs. robinul)
Substances that are uncharged and lipophilic will readily cross the BBB. Atropine and robinul
both act mostly peripherally but Atropine crosses BBB. Robinul is the most potent sialogogue
while atropine has the most potent cardiac effects.
What is Mobius syndrome and how is it treated?
Mobius syndrome, a rare genetic disorder characterized by facial paralysis, is caused by the
absence or underdevelopment of the 6th and 7th cranial nerves. These nerves control eye
movements and facial expression. In newborns, the first symptom is an inability to suck.
Excessive drooling and strabismus (esotropia) may occur. Other symptoms may include lack of
facial expression; inability to smile; feeding, swallowing, and choking problems; eye sensitivity;
motor delays; high or cleft palate; hearing problems; and speech difficulties. Deformities of the
tongue, jaw, and limbs, such as club foot and missing or webbed fingers, may also occur. Most
patients have low muscle tone, especially in the upper body. Mental retardation may also occur.
As children get older, lack of facial expression and inability to smile become the dominant visible
symptoms.
What is the most potent vasoconstrictor (epi, norepi, phenylephrine,or ephedrine)?
Most Potent to leaset: Epi > Norepi >
Levonordefrin > Phenylephrine (Fonseca p. 40)
Adrenergic receptors can be divided into alpha and beta. Alpha are mainly found on arterioles
in the skin and mucosa. When stimulated, they cause vasoconstriction. Beta 2 receptors are
also found in the vasculature but are primarily located in skeletal muscle. When stimulated,
however, they cause vasodilation. Beta 1 receptors are found in the heart and when stimulated
result in positive chronotropic as well as ionotropic effects. The potency of epi is greater than
norepi which is greater than levonordephrin. The effect on alpha vs beta is as follows epi
(50:50), norepi (90:10), levo (75:25).
Pt with BP 98/78, P 180, already been given 2 doses of adenosine and 5mg of verapamil, and now
with pressure of 70/palp and pulse of 180, what is next step?
Synchronized cardioversion is indicated since the patient is now unstable and has failed to
respond to medical treatment
A patient has PEA on EGK, what is the most efficient way to evaluate for tamponade?
Pericardiocentesis
What is the most likely cause of septic shock (gram neg endotoxin)?
Septic shock is usually due to gram negative rods producing endotoxin (70% of cases).
Endotoxins are lipopolysaccharides (LPS) and are released when cell walls are degraded.
What is most common fungal infection in DM patient?
Mucormycosis is caused by a group of organisms called phycomycotes (Absidia,
Mucor, and Rhizopus species). They are opportunistic fungal infections that occur in patients
with debilitating disease (especially ketoacidotic diabetics) and often in conjunction with the
administration of steroids, other immunosuppressive agents, antibiotics, and antineoplastic
agents. Usually presents as orbital cellulitis and meningoencephalitis (rhinocerebral form) in an
acidotic diabetic. In acidotic patients, the primary site is usually the nose and is caused by
Rhizopus oryzae or arrhizus. These species are more common since they posses the enzyme
ketoreductase
and are able to utilize the ketone bodies these patients have in their blood.
Why is Versed absorbed quicker than other benzos?
Because it is water soluble and then at physiologic pH becomes lipophilic enabling it to easily
cross BBB.
After MI, which enzyme elevates first?
CKMB
elevates 46hrs
after onset of chest pain, peaks at 1220
hrs and returns to normal
with 4872
hrs. Troponins elevate within 312hrs
following MI but the rate of rise for early
infarction is not as dramatic as CKMB.
Troponins remain elevated longer (59
days…therefore good for diagnosing recent MI).
What is the desired skin for extraoral implants?
less than 1mm thick without hair follicles
At what level, relative to the adjacent CEJ should the implant be placed?
34
apical to the CEJ of the adjacent teeth (or 57mm
apical to contact point)
If have trismus after IAN injection, what has happened?
Hematoma in pterygomandibular space (medial pterygoid)
What happened to patients after UPPP?
Elimination in snoring and “subjective improvement” in daytime somnolence in 80100%
RDI decrease by ~50%
UPPP is excellent for snoring but only 40% success rate with OSA at that site
