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ABOMS > Pham Randoms > Flashcards

Pham Randoms Flashcards

1
Q

the tensor veli palatini muscle is innervated by

A

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.

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2
Q

tensor tympani muscle is innervated by

A

the tensor tympani nerve contains proprioceptive and motor fibers that provide innervation to the

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3
Q
  1. What is purpose of direct pulp cap
A

prevent internal resorption, prevent needing rct, prevent external resorption

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4
Q
  1. Best solution for avulsed tooth: sterile water, cows milk, dextrose
A

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

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5
Q
  1. Man with 3 month eye issue and fatigue when chewing:
    -ms,
    -muscular dystrophy, or
    -MG
A

-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.

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6
Q
  1. Patient stops taking their clonidine but keeps taking beta blocker, what happens?
A

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.

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7
Q
  1. Patient on beta blocker and you give block with local with epi, what vitals can you expect?
A

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.

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8
Q
  1. How many weeks for pdl to form after avulsion: 2-6 weeks, 12-16 weeks, 8 months
A

2-6 weeks, 12-16 weeks,

Likely 2-6 weeks but not 100% confirmed

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9
Q
  1. What is needed for maxillary overdenture:
A

midline implant, 4 implants, 5 mm clearance, a bar

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10
Q
  1. When do you use a non vascularized bone graft:
    child with missing condyle
    -composite symphysis defect
    -radiated bone
A

child with missing condyle

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11
Q
  1. How long does it take for toradol anticoagulant effects to wear off:
A

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)

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12
Q
  1. What causes respiratory depression from morphine
A

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.

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13
Q
  1. What muscle causes facial elongation in untreated lefort fx:
    -medial,
    -lateral pterygoid,
    -masseter,
    -temporalis
A

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.

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14
Q

Key fats about the lateral pterygoid muscles
-Origin
-Insertion
-Action

A
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15
Q
  1. Why use TCA to treat pin after tjr: Nociceptive, depression, sympathetic, dopaminergic
A

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.

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16
Q
  1. How does osseodensification work:
A

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.

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17
Q
  1. What resorbs the fastest:
    -mineralized allograft,
    -demineralized allograft,
    -xenografts,
    -HA
A

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

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18
Q
  1. best way to preserve gingival tissue with implant : flapless, guided surgery, large flap
A

flapless

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19
Q
  1. myasthenia gravis PFT
A
  1. dec FEV1, increased RV:FRC ratio
  2. muscular weakness causes RV to be higher
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20
Q

Goldenhar Gorlin syndrome

A

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

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21
Q

-local maxes FOR
-Prilo
-Lido/art
-mEpivacaine

A
  1. 600-prilo
  2. 500-lido/arti
  3. 400-mepi
  4. 90 mg-Marcaine (bupivacaine)
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22
Q

-cavernous sinus thrombosis

A
  1. unliateral periorbital edema, headache, photophobia, proptosis
  2. CNIII, IV, V1, V2, VI
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23
Q

Nerve fibers
A-Alpha
A-Beta
A-Delta
C

Characteristic & Function

A

Remember, large myelinated are the last to come back.

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24
Q

Pediatric airway (6 pts)

A

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

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25
Q

Lingual and IAN nerve fibers

A
  1. lingual: 10-25, IAN: 12-18 fascicles
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26
Q

inflammatory mediators

A
  1. leukotriene B4, PGE2, TNF, NO, IL-1B
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27
Q

Marcus Gunn Pupil

A

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.

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28
Q

What causes a Marcus Gunn Pupil (8 pts)

A
  • 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.

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29
Q

distract lid how much before procedure

A

6 mm

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30
Q

-facial paralysis

A
  1. central
    -contralateral lesion in upper motor neuron between cortex and pons (corticobulbar tract)
    -only contralateral lower facial muscles affected
  2. peripheral
    -lower motor neuron lesion
    -ipsilateral upper and lower facial muscles affected
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31
Q

-myxoma

A
  1. more common in mandible, more aggressive in maxilla
  2. anti-apoptotic protein: BCL-2
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32
Q

tooth splinted longest
. subluxation:
2. extrusive luxation:
3. intrusive luxation:
4. avulsion:

A
  1. subluxation: 2 weeks
  2. extrusive luxation: 4 weeks
  3. intrusive luxation: 4-8 weeks
  4. avulsion: 2-4 weeks
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33
Q

trichophytic incisions

A
  1. 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.

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34
Q

-homograft

A

T cell

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35
Q

-tibial incision

A

gerdy’s tubercle

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36
Q

ossifying fibroma

A
  1. histologically indifferent from fibrous dysplasia
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37
Q

proper lma placement

A
  1. tip of epiglottis
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38
Q

T2 tongue no node

A
  1. ipsilateral neck
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39
Q

distraction implant time

A
  1. 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

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40
Q

PALS adenosine

A
  1. 0.1mg/kg max 6mg
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41
Q

-melanoma under finger nail

A
  1. acral lentiginous
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42
Q

-EtCO2 slope

A
  1. COPD- shark fin
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43
Q

-sick sinus syndrome

A
  1. treated with pacemaker
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44
Q

-lichen planus

A
  1. 0-6% malignancy transformation
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45
Q

-wide complex pediatric tachycarida

A
  1. synchronized cardioversion
  2. 0.5-1 j/kg followed by 2
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46
Q

-SVT

A
  1. adenosine 6 then 12
  2. no cardiac issues: metop, dilt, digoxin,
  3. cardiac issues: digoxin, amiodarone
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47
Q

-Abbe-estlander flap

A
  1. 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.

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48
Q

jefferson fx

A

A Jefferson fracture is a bone fracture of the vertebra C1.

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49
Q

-amount of lagopthalmos tolerated

A
  1. 2mm
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50
Q

-multiple myeloma severity (based on 4 things)

A
  1. 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.

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51
Q

retinal detachment

A
  1. monocular diplopia
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52
Q

-mono is EBV, DNA

A
  1. coxsackie is RNA
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53
Q

-C3 tissue is 7mm

A
  1. 6mm at C2, 22mm at C6
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54
Q

-paresthesia after nerve lateralization

A
  1. 5%
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55
Q

-initial type of bone contact in implant

A
  1. type I
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56
Q

-central: scopolamine, atropine

A
  1. 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.

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57
Q

isoproteronol, what is it used for?

A
  1. used for bradycardia or torsades
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58
Q

-supraorbital rim for facial/orthognathic eval

A
  1. 5-8mm in front of cornea
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59
Q

Difference between myfoacial pain and myositis-

A

myofascial pain: localized reproducible and myositis-Diffuse

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60
Q

-cleft percentages

A
  1. 1 parent OR child-4%
  2. 2 children-9%
  3. 1 parent AND 1 child-17%
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61
Q

modified Outerbridge grading of chondromalacia is divided into four grades by MRI, typically using fat-saturated proton density sequences, what are the four stages?

A
  1. softening
  2. furrowing
  3. fibrillation and ulceration
  4. 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

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62
Q

-langerhans cell

A

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

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63
Q

Coagulase

A
  1. 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.

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64
Q

Primary palate

A

Primary palate is derived from the intermaxillary segment and the secondary palate formed by two palatine processes or palatal shelves from the maxillary prominences.

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65
Q

When does the primary palate form and how?

A

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.

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66
Q

Lemierre’s syndrome

A

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.

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67
Q

Frey’s Syndrome

A
  1. 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

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68
Q

Where do neurofibromas course

A

They follow peripheral nerves

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69
Q

Where do recurrent cutaneous melanoma’s occur

A

VEGF infusion-raised VEGF seen in melanoma patient’s

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70
Q

plasmocytomas-treatment

A

Radiation Therapy provides long-term local control in the solitary bone plasmacytomas and is potentially curative in the extramedullary cases.

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71
Q

What is the treatment for rhabdomyosarcoma/osteosarcoma

A

Chemotherapy

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72
Q

Psoriatic arthritis? Symmetrical or asymmetrical

A

Asymmetric

The asymmetric oligoarticular type of psoriatic arthritis involves different joints on each side of the body

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73
Q

Why dochildren have lower MAC

A
  1. because of higher alveolar ventilation rate
  2. lower FRC
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74
Q

-benzocaine, PABA or no PABA

A

Benzocaine (topical itching treatment) has PABA in it

Contact/photocontact allergy to PABA and benzocaine are not uncommon.

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75
Q

schneiderian membrane

A
  1. 0.3-0.8mm
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76
Q

modiolus (9 muscles)

A

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.

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77
Q

-orthodontically extrude tooth, what happen to the MGJ vs the crystal gingiva

A
  1. MG junction stays same, crestal gingiva migrates
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78
Q

alveolar crest to intraosseous anastamosis

A
  1. 16mm
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79
Q

-wait how long after radiation for implants

A

6 months after radiation for implants

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80
Q

DFDB

A

osteoinductive

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81
Q

Staple implant

A

12 mm

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82
Q

-obesity ventilation

A
  1. PaO2 is decreased representing a ventilation/perfusion mismatch
  2. PaCO2 remains normal
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83
Q

-hageman factor (XII)

A
  1. activates complement
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84
Q

type 3 vWF1.

A

cryoprecipitate

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85
Q

max canine eruption

A
  1. 22mm
  2. 80% palatal
  3. vertical then buccal
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86
Q

endoscopic brow lift

A
  1. 2 parasagittal, 2 temporal, midline
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87
Q

inc APAP (acetaminophen) toxicity

A
  1. with phenytoin
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88
Q

fibula perforators

A
  1. septocutaneous and myocutaneous (musculocutaneous peforators
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89
Q

Described the position of the IAN -pediatric IAN

A
  1. more inferior, lateral, and posterior
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90
Q

inc risk of ankylosis in intracapsular fx

A
  1. contralateral ramus
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91
Q

-diazepam

A
  1. 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

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92
Q

-verapamil-what can it help treat?

A
  1. vasopastic angina

Verapamil was found to significantly decrease the frequency of angina attacks,

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93
Q

Where is lactate metabolized

A

the liver

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94
Q

Cardiogenic pulmonary edema

A
  1. 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.

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95
Q

Dextran-when is it used in kids?

A

Often used in a free flap for children

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96
Q

Wien kebach’s also known as

A

AV Block: 2nd degree, Mobitz I

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97
Q

-peridex reduces what

A

-peridex
1. reduces nosocomial pneumonia by 52%

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98
Q

Stah’ls ear-What is it

A

Extra crease, elf ear

A Stahl’s ear deformity consists of an extra cartilage fold in the scapha portion of the ear.

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99
Q

Which NSAID should be avoided if you have an aspirin allergy?

A

Diclofenac

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100
Q

methemoglobinemia

A
  1. oxidized to ferric form
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101
Q

metabolic syndrome and HDL relationship

A

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 …

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102
Q

-xenograft temp for sinus and socket

A
  1. medium for sinus
  2. low for socket, faster resorption
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103
Q

creeping substitution

A
  1. 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

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104
Q

Ossifying fibroma resection

A

5 mm

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105
Q

OSA side effects (3)

A
  1. pulmoary vasoconstriction
  2. decreased CO
  3. bradycardia
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106
Q

massive blood transfusion causes 4 things…what are they?

A
  1. dilutional coagulopathy
  2. met alkalosis
  3. hypocalcemic hypothermia/hyperkalemia
  4. cardiogenic pulmonary edema
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107
Q

chondrosarcoma staining

A

Representative staining patterns of chondrosarcoma tumors with CD4+ and CD8+ mAb are shown

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108
Q

Secondary Hyphema

A
  1. more common in stage 3/4 hyphema
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109
Q

What is the configuration in the scroll area

A

interlocking

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110
Q

-cetuximab

A
  1. binds to EGF to inhibit tyrosine kinase
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111
Q

CT graft

A
  1. red colored side to recipient bed
  2. white BM side to abutment
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112
Q

-zygomatic implant 4 point

A

stabilization: needs 10mm

  1. crest of alveolus
  2. sinus floor
  3. sinus roof
  4. zygomatic superior border
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113
Q

bone loss around implant? and in first 12-18 months

A

0.2mm/year

  1. should not exceed 1.5 in 12-18 mo
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114
Q

For each 0.25-mm increase in diameter, the surface area is increased by____%

A

5%

0.25 inc diameter inc SA 10%

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115
Q

-thick STSG is 0.01-0.025 in (0.3-.45mm), first 7 day timeline

A
  1. 0-48: imbibition
  2. 48-72: inosculation
  3. 3-5 days: neovascularization
  4. 7 days: adequate blood supply
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116
Q

What arteries and nerves are we concerned fo with a posterior hip?

A
  1. superior and gluteal a
  2. superior cluneal nerve L1-3
  3. middle cluneal nerve S1-3
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117
Q

-AICBH-nerve at risk

A

iliohypogastric L1-L2

  1. subcostal T12-L1
  2. femoral cutaneous L2-L3
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118
Q

Diascopy for VM versus hemangioma

A

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.

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119
Q

-burkitts, what kind of histologic appearance

A
  1. endemic form 2x more freq in maxilla, EBV
  2. “starry sky”
  3. chemo gives 90% remission
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120
Q

-desmoplastic fibroma

A
  1. fibroblast in collagenous stroma, no atypia or mitotic figures
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121
Q

Stage I/II tongue

A
  1. 1-1.5cm margin
  2. elective neck disseciton unless <2mm invasion
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122
Q

-FOM SCC

A
  1. 50% met
  2. <2mm 7.5% nodal, >2mm 38% nodal
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123
Q

-OSCC

A
  1. 85-95% of oral, 3-4% of all
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124
Q

rhabdomyosarcoma tx

A
  1. surgical excision followed by chemo
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125
Q

-osteosarcoma

(7 pts)

A
  1. chondroblastic MC in jaw
  2. osteoblastic MC
  3. small cell worst
  4. chemo 5x then 3cm resection
  5. <1% of H&N tumors
  6. early sign is widening of PDL
  7. MC in 30-40
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126
Q

-acinic cell adenocarcinoma

A
  1. low grade, mostly in parotid
  2. 18% of malignant, 6.5% of all salivary
  3. pain and b/l, low recurrence rate, treat with wide local excision
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127
Q

-MMRNA

A
  1. bilateral parotitis
  2. paramyxovirus
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128
Q

osteomyelitis has increased medullary pressure

A
  1. can be hematogenous in peds
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129
Q

-what does acanthomatous ameloblastoma resemble

A
  1. SCCa
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130
Q

-Immunohistochemical solutions
for
Pemphigoid
Pemphigus
Leukemia/lymphoma
Levasseur-Merrill

A
  1. pemphigoid- michels
  2. pemphigus- indirect immunofluorescence
  3. leukemia/lymphoma- flow cytometry
    -Levasseur-Merrill retractor fro posterior border
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131
Q

-autonomic eye muslces

A
  1. levator-PS
  2. muellers-S
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132
Q

ballistics

A
  1. penetration and size are most important factor
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133
Q

Which IV fluid increased ICP

A

LR

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134
Q

IAN has mechanical allodynia

A

Not tinnel

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135
Q

Systemic Lupus Erythematous eye symptoms

A
  1. keratoconjunctivitis
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136
Q

Where is the V2 block aiming for?

A

Foramen rotundum

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137
Q

-miliary TB spread occurs through where

A

pulmonary vein

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138
Q

-argon laser absorbed by

A

Hgb

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139
Q

-25% inc in diameter increases 10% surface area

A

I guess this is referring to implants, go with it

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140
Q

Dantrolene MOA

A
  1. inhibits Ca release

epresses excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor 1, and decreasing intracellular calcium concentration.

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141
Q

Double humped P wave

A

Left atrial enlargment

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142
Q

-radiofreuncy ablation

A
  1. plasma field radiofrequency
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143
Q

Verapamil

A

vasoplastic angina is its main use

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144
Q

BMP

A

colon stimulating factor

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145
Q

Best match for nose

A
  1. posterior aurciular skin
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146
Q

-direct thrombin inhibitors

A
  1. dabigatran, argatroban, hirudin, bivalirudin
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147
Q

Albumin

A
  1. 2 day half life
  2. decreased shows increased hospital stay
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148
Q

How is remifentanyl metabolized

A

Plasma esterase

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149
Q

Patient with Hamman’s Sign following MVA, what type of injury?

A

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.

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150
Q

Patient has flaccid elbow & wrist reflex, but normal triceps reflex following MVA, what is the
level of C-spine injury?

A

C 5-6 (triceps is C 6-7)

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151
Q

Primary bone healing requires?

A

Bone-bone contact & compression across the fracture site

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152
Q
  1. What type of plate & screw fixation provides the most stable fixation?
A

a. Neutral zone

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153
Q

What is the thickness of the superior tarsal plate?

A

a. 10 mm (lower is 5mm)

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154
Q
  1. What is the position of the upper eyelid, at primary gaze, in relation to the limbus?
A

a. 2-3mm inferior

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155
Q
  1. Aniscoria status post trauma, what does it mean?
A

a. All the following can be the cause s/p trauma
i. Normal
ii. Horner’s
iii. CN III injury
iv. Tonic pupil

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156
Q

Which fracture would you use a compression plate for?

A

a. Ramus fracture
b. Oblique symphysis fracture (not correct – according to Fonseca’s textbook,
oblique fractures are contraindication to compression plate)

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157
Q
  1. Best screening test for cardiac contusion?
A

a. EKG

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158
Q

What is the best way to monitor blood loss & fluid status in a trauma patient?

A

a. CVP
b. Not HCT/Hbg

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159
Q

A patient presents with an intraoral wound contaminated with wooden debris, what is the
most important aspect of treating this wound?

A

Thorough debridement

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160
Q

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?

A

Both are CT

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161
Q
  1. Which of the following will cause traumatic telecanthus?
A

a. Type III NOE fracture (not a choice)
b. Periorbital lacerations
c. Lateral displacement of bilateral ZMC fxs ?????

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162
Q

Treatment of a CSF leak, should include?

A

a. Place patient in head-up, semi-reclining position
i. Semi-Fowler position

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163
Q
  1. Where do you make the lateral orbital osteotomy for a Lefort III?
A

a. Frontozygomatic suture extending into the inferior orbital fissure

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164
Q

Why do you need to bone graft in an NOE fracture?

A

a. To recreate the dorsal-nasal support and correct tip projection

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165
Q

When placing an implant, what temperature results in the destruction of bone?

A

a. 47 degrees

116 F

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166
Q

Indications for a submucous vestibuloplasty?

A

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.

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167
Q

Where is the most stress on an implant?

A

Crown/implant interface

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168
Q

In a lip-switch vestibuloplasty, where is the mucosal flap sutures?

A

To the cut periosteal edge at the depth of the vestibule

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169
Q
  1. What is the difference between a mandibular staple implant and a TMI?
A

a. Less bone required for TMI

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170
Q

What percentage of disc recapture following arthroscopy?

A

a. 0-10%

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171
Q

Which form of TMJ noise has the best prognosis?

A

Early opening & late reciprocal click

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172
Q

When performing a preauricular approach for TMJ surgery, which statement best describes
the position of CN VII?

A

Between the SMAS & the superficial layer of Deep Temporal Fascia

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173
Q

How is pain felt when you have a disc perforation?

A

Subchondral nociceptors

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174
Q

If done incorrectly, a high condylotomy may cause damage to what nerve?

A

a. Auriculotemporal nerve

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175
Q

What is the best treatment for a child with boney TMJ ankylosis?

A

a. Costochondral graft

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176
Q

A diagnostic aid for Rheumatoid Arthritis is?

A

a. ANA

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177
Q

Where is the medial cut made in a BSSO?

A

Immediately above the lingual

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178
Q

What is the best indicator for the amount of impaction necessary for a VME patient?

A

Maxillary incisor show at rest

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179
Q
  1. What is the most common site for A-V malformation following LeFort I osteotomy?
A

Descending palatine artery

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180
Q

What area of the maxilla is most resistant to rapid palatal expansion?

A

a. Mid palatal suture

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181
Q

Stripping of which muscles causes condylar sag in an IVRO?

A

Medial pterygoid & masseter

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182
Q
  1. A patient presents with mandibular alveolar retrognathia, with ideal chin position, how do
    you treat?
A

Total mandibular subapical osteotomy

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183
Q

What causes immediate relapse following BSSO?

A

Proximal segment distraction during fixation

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184
Q
  1. Patient with VME have?
A

Decreased masticatory force (by EMG measurement)

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185
Q

How do you control vermillion show following LeFort I osteotomy?

A

a. V-Y closure

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186
Q

Which movement of the maxilla causes the greatest widening of the alar base

A

Anterior (impaction also)

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187
Q

What is the complication of placing the medial cut of a BSSO too high?

A

a. The medial pole of the condyle remains with the distal segment

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188
Q

SARPE should be considered in which patient?

A

a. Adults (> 18 years) with greater than 5mm of transverse deficiency

189
Q

What is the most common “bad split” during a BSSO?

A

a. Buccal plate fracture

190
Q
  1. What is the microscopic anatomy of the lingual nerve?
A

a. 10-25 fascicles

191
Q
  1. What is the position of the lingual nerve in relation to the alveolar crest?
A

Just below the crest

192
Q

What is the horizontal relationship of the lingual nerve to the lingual plate?

A

a. 0-1mm, book says 2.5

193
Q

Which has a greater amount of long-term shrinkage?

A

STSG (vs. FTSG) – FTSG has greater immediate shrinkage

194
Q

What type of nerve injury repair has the worst prognosis?

A

Gap between severed ends, placed under tension

195
Q

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

a. Compartment syndrome

196
Q

To avoid damage to CN VII, what layer is elevated during a coronal flap?

A

Subgaleal

197
Q

What is the purpose of HA in bone regeneration?

A

Osteoconduction

198
Q

Confluence of the maxillary vein & what make up the retromandibular vein?

A

Superficial temporal vein & Maxillary vein

199
Q

What length of defect can you repair with a fibula free flap?

A

25 cm

200
Q

What type of bond exists between HA & bone?

A

Chemical

201
Q

What part of the mandible is most difficult to reconstruct?

A

Canine to canine

202
Q

Which would you not use in the treatment of an atrophic mandible fracture?

A

2.0mm microplate

203
Q

What treatment for an atrophic mandible fracture has the best prognosis for healing?

A

a. ORIF w/reconstruction plate (2.4-2.7mm)
b. Closed reduction w/external pin fixation (old study guides give this)

204
Q

What is an inappropriate material for reconstruction for a severe orbital floor fracture with
enophthalmos?

A

Gelfilm

205
Q

You raise an anterior temporalis flap to close a maxillary defect and cannot feel or Doppler a
pulse, what do you do?

A

Discard flap and use a new posterior temporalis flap

206
Q

Where does the mentalis muscle insert?

A

a. Dermis of the skin

207
Q

How does a split thickness skin graft receive its nutrition for the first 48 hours?

A

a. Plasmatic imbibition

208
Q

How does freeze dried bone work?

A

a. Osteoconduction
b. Provides BMP

209
Q

What is the primary blood supply to the pectoralis major flap?

A

Thoracoacromial artery

210
Q

hat is the primary blood supply to the delto-pectoral flap?

A

Perforators from internal mammary artery

211
Q

What muscle, if injured, other than the tensor fascia lata will cause a temporary or
permanent limp?

A

Psoas major

212
Q

Best age for hard tissue manipulation in cleft patients is?

A

a. 9-11 years

213
Q

What palatal muscle is not involved in speech?

A

a. Tensor veli palatini

214
Q

What is the function of the hamulus?

A

Pully point for the tensor veli palatine

215
Q
  1. Patient with congenital micrognathia may also have defects in which bones?
A

a. Malleus & incus

216
Q

What is the most common fatal rhythm seen in myocardial infarction?

A

V-fib

217
Q

What muscle acts to close the Eustachian tube?

A

tensor tympani

218
Q

Describe how you would use a tongue flap to close an alveolar cleft defect?

A

a. Anterior based

219
Q

Parents without clefts have a child with a cleft, what is the chance that they will have
another cleft child?

A

10-20% à NO! it’s 4% for CLP, 2.5% for palate

220
Q

Ideal time for lip adhesion?

A

6-8 week of life

221
Q
  1. Revision of cleft lip repair in an 18-year-old who is maxillary hypoplastic?
A

Establish maxillary position first, then revise lip

222
Q

What palatal muscle is most responsible for speech?

A

a. Levator veli palatini

223
Q
  1. What is the etiology of hemifacial microsomia?
A

Intrauterine damage of the stapedial artery

224
Q

What is the blood supply to the free fibula graft?

A

a. Peroneal artery

225
Q

Minimum thickness of native bone to allow immediate implant placement during sinus lift
surgery?

A

4-5mm

226
Q

What does a minor salivary gland biopsy in Sjogren’s Syndrome show?

A

Focus of 50 or more lymphocytes, 1 focus per 4mm2 supports diagnosis

227
Q

Maximum dose of lidocaine?

A

a. 4 mg/kg
b. 7 mg/kg w/epi

228
Q
  1. What is the cause of venoirritation & thrombophlebitis during injection of Diazepam?
A

a. Propylene glycol

229
Q
  1. What shifts oxy-hemoglobin saturation curve to right?
A

Increases in Temp, CO2, H+ ion, 2-3 dpg

230
Q
  1. Criteria for a positive DPL (diagnostic periotoneal lavage)?
A

a. > 100k RBC/mm3
b. > 500 WBC/mm3
c. + gram stain
d. 10 mL gross blood on inital inspiration.

231
Q

Late finding in progression of Malignant Hyperthermia?

A

Increased temperature

232
Q

Most common arrhythmia in hyperthyroidism?

A

a. Sinus tachycardia

233
Q

What is the mechanism of action of metformin?

A

a. Decrease hepatic glucose production, decreases intestinal absorption, improves
insulin sensitivity

234
Q

What is the site of action of cyclosporine?

A

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

235
Q
  1. Tinels’ sign?
A

Tingling or pain, distal to nerve injury

236
Q

What organism causes cat scratch disease?

A

a. Gram negative bacillis – Bartonella

237
Q

What is the most important muscle to close for VP competence?

A

a. Levator veli palatine

238
Q

What is the average preferred distance of the upper brow to the pupil center?

A

25mm

239
Q

What is the purpose of Guided tissue regeneration?

A

Prevent migration of epithelium

240
Q

What is the modified Mueller technique?

A

a. Inspiratory effort with mouth & nose obstructed during nasoendoscopy
b. For eval of OSA

241
Q

What muscle relaxant should not be used in a patient with renal failure?

A

Pancuronium is eliminated primarily by the kidney, and its duration of effect is prolonged in the presence of renal failure

242
Q

What is Romberg’s syndrome

A

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

243
Q

What is the relationship of the malar eminence to the lateral canthus?

A

a. 10mm lateral & 15mm inferior

244
Q

Preoperative dosing of ASA leads to increased incidence of what?

A

Asthma attack

245
Q

Likely causes of 100-degree neck-chin angle?

A

a. Normal
b. Submental fat
c. Loose neck skin
d. Low hyoid

246
Q

What is the relationship of the medial & lateral canthus?

A

Lateral is 4mm superior to medial

247
Q

What is the treatment for a tooth concussion?

A

Observe

248
Q

What is the most likely prognostic indicator for OKC recurrence?

A

a. Type of keratin (parakeratin maybe more aggressive)

249
Q

Which muscle causes creases between the eyebrows?

A

Corrugator vertical creases)

250
Q

Which muscle is not affected by bow lift?

A

a. Orbicularis
b. Rizorius

251
Q

Which muscle insert into the nasolabial fold?

A

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.

252
Q

What is the path of the hypoglossal nerve as it relates to the hyoglossus and
mylohyoid muscles?

A

a. Lateral to hyoglossus, medial to mylohyoid

253
Q

What joint situation is hyaluronic acid useful in?

A

a. Rheumatoid arthritis

254
Q

What is the 3-muscle triangle of a scapular flap?

A

Teres major, teres minor, triceps (posterior head)

255
Q

What is the most likely orbital fracture in a child?

A

a. Roof

256
Q

What is the blood supply to a genioplasty segment?

A

Periosteum

257
Q

What is the cause of diplopia, immediate, with ZMC fracture?

A

Entrapment

258
Q

What structures are injured with a deep laceration just anterior to the masseter
muscle?

A

a. Facial nerve, parotid duct, transverse facial artery

259
Q

Why is there an increased incidence of TMJ ankylosis in children vs. adults?

A

a. Thin cortical bone

260
Q

Which is a contraindication of surgical repair of a nerve injury?

a. Anesthesia
b. Paresthesia
c. Hyperpathia
d. Allodynia

A

b. Paresthesia

261
Q

Ramsey Hunt syndrome

A

Involves auditory canal & nerve, caused by Herpes zoster virus, causes facial
paralysis due to CN VII involvement

262
Q

Tricyclic antidepressants work by:

A

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

263
Q

Ramsay Hunt Syndrome

A
264
Q

In a pregnant patient, which pulmonary function tests are altered?

a. Decreased FRC
b. Increased tidal volume

A

Decreased FRC

265
Q

The best method to examine the upper airway in OSA is:

A

Nasal endoscopy

266
Q

the least predictable area of soft tissue change with mandibular movements is?

A

a. Lower lip

267
Q

The wedge pressure of a pulmonary catheter is used to measure?

A

Left end diastolic pressure (also left atrial pressure)

268
Q

One of the major limiting factors for the use of a temporalis flap is?

A

Temporal hallowing

269
Q

When performing a subgaleal brow lift, which nerve is most likely injured?

A

a. Supraorbital nerve

270
Q

The open sky approach in the bleph, the flowing structure is exposed?

A

Septum

271
Q

The ability to distract the lower lid more than _____mm indicates the need for a lower
eyelid shortening procedure?

A

8 mm

272
Q

The most common reason for impacted wisdom teeth is?

A

Change in diet with less attrition of the teeth (per knowledge update)

273
Q

In planning for zygomatic implants, includes?

A

2 additional implants in anterior maxilla

274
Q

The extraoral implants with skin around it

A

a. less than 1mm thick, without hair follicle

275
Q

when performing a submucosal vestibuloplasty, the most important factor in
determining success is?

A

Leaving the stent for an extended period of time

276
Q

What 2 anatomic factors are implicated for their movement having an effect on the soft tissues after LeFort I osteotomies?

A

ANS & upper incisor

277
Q

the delay in conduction at the AV node is due to:

A

sodium & calcium channels

278
Q

Dental implants in irradiated bone?

A

Increased success with HBO

279
Q

An arch length deficiency is most commonly associated with

A

a. Buccally impacted canines

280
Q

Question about the resting potential across the nerve membrane and the
sodium/potassium channels

A

Local anesthesia prevents action potential by preventing inflow of sodium ions

281
Q

The latency period from the time of radiation of a benign tumor to development of a
sarcoma is?

A

a. 12 years – per Fonseca
b. 5-10 years per Marx—My Answer

282
Q

Maximum amount of bone from the tibia is?

A

40 cc

283
Q

Maximum amount of bone form the anterior iliac crest?

A

a. 50 cc

284
Q

Maximum amount of bone from the posterior iliac?

A

100-125 cc

285
Q

When harvesting a dermis graft, which structures survive?

A

a. Sebaceous glands?

286
Q

Which of the following is associated with a higher risk of occlusion of anastomoses in a
free flap?

A

a. Vessel size discrepancy

287
Q

which of the following has been shown to decrease the risk of failure of revised
anastomoses?

A

a. Aspirin

288
Q

What is the most common reason for impaction of the second molar?

A

a. Arch length discrepancy

289
Q

In orbital trauma, loss of supraorbital crease is due to:

A

Enophthalmos

290
Q

Tennel’s sign is caused by:

A

Percussion proximal to nerve injury

291
Q

What tumor occurs most frequently with Sjogren’s syndrome?

A

Lymphoma

292
Q

Treatment for cherubism includes?

A

. Curettage/recontouring

293
Q

What disease process of bone would have increased alk phos, with normal calcium
and phos.?

A

Paget’s

294
Q

What lab test would be elevated in malignant hyperthermia?

A

CPK, K, myoglobin

295
Q

Ketamine is contraindicated in which patients?

A

HTN

296
Q

Hours after a procedure, the patient is still not breathing, what is the likely cause?

A

a. Atypical pseudocholinesterase deficiency

297
Q

What effect does succinylcholine have on potassium?

A

Increase serum level

298
Q

How close can an implant be placed to the IAN?

A

2 mm

299
Q

How close can an implant be placed to the mental nerve?

A

5 mm

300
Q

How much lingual bone do you need around an implant?

A

1 mm minimum

301
Q

6 exposed labial threads on an implant after placement?

A

Graft

302
Q

In whom is nitrous oxide contraindicated? (4 pts)

A

a. Repeat otitis media
b. Sinus infection
c. GI obstruction
d. Closed head injury

303
Q

SLE and eye symptoms?

A

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.

304
Q

What is the possible long term sequelae of hyphema?

A

Glaucoma

305
Q

How would you give an intraoral V2 block?

A

Through greater palatine canal, up to foramen rotundum

306
Q

Develop a facial nerve palsy s/p IAN block?

A

Injection too far posterior and lateral

307
Q

branchial cleft cyst is located where?

A

Lateral neck

308
Q

Which STD can cause arthritis?

A

Gonorrhea

309
Q

How do you treat temporal arteritis?

A

a. High dose steroids

310
Q

How do you treat VPI with poor elevation of soft palate?

A

Superior based flap

311
Q

What lesion are Rushton bodies found in?

A

a. Radicular cysts

312
Q

What are the primary organisms in acute sinusitis?

A

a. Strep pneumonia
b. Staph aureus
c. H. influenza
d. M. Catarrhalis

313
Q

What organism is implicated in nosocomial sinus infections?

A

a. Pseudomonas

314
Q

What organisms are responsible for chronic sinusitis?

A

a. Staph aureus and anaerobic

315
Q

What is the most classical feature of actinomycosis?

A

Multiple cutaneous fistulas

316
Q

Congenital epulis of the newborn is histologically similar to?

A

a. Granular cell tumor

317
Q

Sulfur granules are seen in association with what organism?

A

Actinomycosis

318
Q

What nerve is affected first in cavernous sinus thrombosis?

A

CN VI

319
Q

Ewing sarcoma is most similar to what?

A

a. Lymphoma?

320
Q

How is military TB spread?

A

Hematologically

321
Q

A craniopharyngioma resembles what other lesion, histologically?

A

Ameloblastoma

322
Q

In a patient with intra-osseous AV malformation of the mandible, which of the
following might you see?

A

a. Spontaneous gingival bleeding

323
Q

What lesion is associated with Antoni A and Antoni B lines, and Varocay bodies?

A

Schwannoma

324
Q

Argon laser is best for vascular lesions because?

A

It is highly absorbed by hemoglobin

325
Q

What is the best antibiotic to treat B. Fragilis?

A

a. Flagyl, then clindamycin

326
Q

What is the most common location for a Pindborg Tumor (CEOT)?

A

a. Molar (mandible then maxilla)

327
Q

Leisegang rings are seen in which lesion?

A

a. CEOT (Pindborg)

328
Q

What is the treatment for a recurrent ranula?

A

Excision of sublingual gland

329
Q

Pediatric patient with harsh systolic & diastolic murmur?

A

Patent ductus arteriosus

330
Q

Which antibiotics interfere with protein synthesis?

A

a. Clindamycin
b. Tetracycline
c. Erythromycin
d. Aminoglycosides

331
Q

On an EKG, peaked T waves are associated with?

A

Hyperkalemia

332
Q

With restrictive lung disease, which pulmonary function tests are affected?

A

All are decreased which means FEV1/FVC is normal

333
Q

With obstructive lung disease, which pulmonary function tests are affected?

A

a. All are increased, except vital capacity which is decreased

334
Q

What cranial nerve is involved when you have no consensual or direct reaction in the
affected eye, and normal function in the unaffected eye?

A

CN III?

335
Q

Mueller’s muscle is under what type of control?

A

Sympathetic

336
Q

What is the initial treatment for SIADH?

A

Water restriction

337
Q

What is the effect of aortic stenosis on MAP?

A

Decrease

338
Q

What causes clotting of exudates?

A

Calcium

339
Q

How many Kcal are in 2400cc of D5LR?

A

480

340
Q
  1. In a patient with MI, what enzyme is elevated?
A

CK-MB, troponin

341
Q

What nerve is most often damaged during a bone harvest from the anterior superior
iliac crest?

A

a. Iliohypogastric

342
Q

A patient undergoes an IVRO and 2-3 weeks after release of IMF, she begins to
relapse, what is the cause?

A

a. Not seating condyle
b. Malunion at osteotomy site

343
Q

Why is it not advisable to use a trapezius flap after a radical neck dissection?

A

Transverse cervical artery & CN IX may have been sacrificed

344
Q

Where do you make the lateral orbital osteotomy for a LeFort III?

A

Through the frontozygomatic suture

345
Q

What is the location of the nasal portion of the LeFort II osteotomy?

A

Inferior to the nasofrontal suture

346
Q

What is the cause of Hamman’s sign?

A

a. Emphysema due to tracheobronchial tree injury
b. May be due to diaphragmatic puncture

347
Q

Patient has a hyperplastic pulpitis; which tooth is the most likely cause?

A

Primary molar

348
Q

What makes a local anesthetic more potent?

A

Lipid solubility

349
Q

There is damage to the articular cartilage in the TMJ, what is the cause of the pain?

A

a. Prostaglandin E1, leukotriene

350
Q

How does damaged articular cartilage heal?

A

By forming fibrocartilage

351
Q

What happens to the synovial fluid in the TMJ in a patient w/RA?

A

Decreased viscosity

352
Q

What is the vascular supply to the inferior turbinate?

A

Sphenopalatine artery

353
Q

After a LeFort I osteotomy, a patient has a strange aura and diplopia, what is the
cause?

A

Cavernous sinus thrombosis

354
Q

A patient has a ZMC fracture, what happens to the intraocular pressure?

A

Goes down

355
Q

A patient has a retro bulbar hematoma that is impairing vision, what is the treatment?

A

Lateral canthotomy

356
Q

How does aortic stenosis alter blood pressure?

A

a. Diastolic pressure goes up
b. MAP decreases

357
Q

Injection of local into nerve which leads to damage/numbness, where is the damage?

A

Fascicular from ballooning

358
Q

What type of occlusal splint will cause more loading on the TMJ?

A

a. Anterior primary contact

359
Q

Compression of which part of the brain, or what type of herniation will result in
anisocoria

A

a. Temporal lobe compression
b. Transtentorial herniation

360
Q

What type of flap is the temporalis flap?

A

a. Axial? – My answer
b. Coaxial? Old guide had this as answer

361
Q

What is the correct pressure setting of CPAP for a patient with OSA?

A

7-15

362
Q

What artery does not contribute to the frontal flap to the nose?

A

Superficial temporal
i. Supratrochlear, supraorbital & dorsal nasal DO

363
Q

With what disease would you expect to see an increase in uric acid?

A

a. Renal failure
b. Gout

364
Q

A patient is receiving 4 implants in the mandible for a removable denture, what is the
best configuration for the implants?

A

Curvilinear

365
Q

Which part of the implant is responsible for the best outcome?

A

Width

366
Q

Why do skin grafts differ between children & adults?

A

Child – no redundant skin, more elasticity

367
Q

What is the most likely cause of a patient in septic shock?

A

Gram negative endotoxins

368
Q

What separates the fat pads in the lower lid?

A

a. Inferior oblique separates medial & central pads

369
Q

What is the pathway of dissection for an open rhinoplasty?

A

a. Overperichondrium, under periosteum

370
Q

What is the relationship of the lateral nasal cartilage to the nasal bones?

A

Cartilage fits under the bones

371
Q

Where is the root of a mandibular third molar if displaced through the lingual plate?

A

a. Submandibular space

372
Q

Where is the sensation lost after harvesting a sural nerve graft?

A

a. Dorsal & lateral foot/ankle

373
Q

What is the major disadvantage of Abbe flap?

A

Commissure reconstruction

374
Q

You place an IV catheter into the antecubital fossa and return arterial blood, what
artery is involved?

A

Brachial

375
Q

Which is the most potent vasoconstrictor?

A

Phenylephrine (vs. epi, norepi)

376
Q

What is minimum that is required on the lower lateral cartilages for tip support?

A

5-7mm

377
Q

A patient has a lip lesion that has a 1.5cm diameter, with 2-3-month history. Has
lymphadenopathy & a cheesy center?

A

a. Keratoacanthoma – My answer??
b. Scca

378
Q

Where do you place bone grafts for LeFort III?

A

a. Tuberosity, zygomatic/temporal, orbital

379
Q

What bacteria are most involved with pericoronitis?

A

a. Peptostreptococcus
b. Fusobacterium
c. Spirochetes
d. Bacteroides

380
Q

What is the bacteria responsible for hand-foot-mouth disease?

A

Cocksackie

381
Q

What bacteria from the maxillary sinus is the most likely cause for meningitis?

A

a. H. flu

382
Q

A patient has medial strabismus, what nerve is damaged?

A

a. CN VI

383
Q

What muscle opens the Eustachian tube?

A

tensor tympani

384
Q

What is the length of the nares, when compared to the columella?

A

2:3

385
Q

You displace a 5 mm portion of the palatal root of a 1st molar into the sinus, what do
you do first?

A

Xrays in 2 planes, then irrigate & suction

386
Q

A patient with pulmonary disease is given a bronchodilator and has improvement in
FEV1, what type of disease does he have?

A

a. Reversible obstructive

387
Q

What type of coagulopathy does a patient with an elevated PTT & an elevated
bleeding time most likely have?

A

a. Von Willebrand’s disease

388
Q

What is the dose of lidocaine to treat multifocal PVC’s?

A

a. 2-4 mg/min

389
Q

Why is midazolam the quickest acting benzodiazepine?

A

a. Lipid solubility

390
Q

Where should you set the low limit alarm on a pulse oximeter?

A

94%

391
Q

pulse oximeter reading of 90% corresponds to a pO2 of?

A

60 mmHg

392
Q

What muscle relaxant would you give to a patient in renal failure?

A

a. Atracurium

393
Q

Why give supplemental steroids to an adrenally suppressed patient in the
perioperative period?

A

To prevent hypotension &hypoglycemia

394
Q

How does epinephrine increase the heart rate?

A

Stimulates beta-1

395
Q

How does heparin work?

A

Inactives Xa and potentiates antithrombin III

396
Q

Which local anesthetic causes methemoglobinemia?

A

Prilocaine

397
Q

Where does the maxillary sinus exit in the nose?

A

Middle meatus

398
Q

There is a tooth with a denuded root adjacent to an OAF, what do you do with the
tooth?

A

Extract

399
Q

What are the dimensions of a random pattern flap?

A

1:3, width to length

400
Q

What is the pollybeak deformity?

A

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

401
Q

An increase of 25% in the diameter of an implant gives what increase in the surface
area of the implant?

A

10%

402
Q

At what level, relative to the CEJ, should the height of an implant be placed?

A

a. 3-4mm apical to the CEJ of adjacent teeth

403
Q

What are the risks of total parathyroidectomy?

A

Osteomalacia

404
Q

What is another name for Romberg’s Syndrome?

A

Progressive hemifacial atrophy

405
Q

Treatment for PSVT?

A

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

406
Q

How does dantrolene work?

A

Inhibits Calcium release from sarcoplasmic reticulum

407
Q

What are some clinical findings of adrenal insufficiency?

A

a. Hypotension, tachycardia,
b. Hyponatremia, hyperkalemia, hypercalcemia, metabolic acidosis, azotemia

408
Q

What is the source of bleeding in an epidural hematoma?

A

Middle meningeal or posterior meningeal arteries

409
Q

What are the signs & symptoms associated with an epidural hematoma?

A

Pupil dilation, hemiparesis, decerebration, LOC

410
Q

What are the most common signs associated with a subdural hematoma?

A

Anisocoria & motor deficit

411
Q

Medications used with Class II heart failure

A

Beta blocker and ACE
Test will have specific drugs (-ol) and (-il)

412
Q

Severe type III Von Willebrand’s: Pre-operative treatment for removal of one third molar

A

DDAVP

413
Q

Parkinson’s patient with nausea/ what not to give

A

Reglan, Compo, Prochlorperazine, doperidol (Test answer Doperidol)

414
Q

Hypertrophic cardiomyopathy best med to give that doesn’t change vascular perfusion?

A

Etomidate

415
Q

Who will likely die within 30 days of STEMI?
. >75 yo
b. DM
c. HTN

A

a. >75 yo

416
Q

Costochondral rib graft on child

A

a. Left 7th rib
i. (7,8,9 is preferable)

417
Q

What do you see on arthroscopy of someone with late osteoarthritis?

A

Subchondral Bone exposure

418
Q

Late symptoms of bupivacaine overdose?

A

a. Auditory hallucinations
b. Cardiac changes?
c. Bradycardia

419
Q

How do you treat bupivacaine toxicity?

A

Lipid infusion

420
Q

What med do you give during IV sedation that increases the likelihood of a child having
local anesthetic toxicity?

A

Fentanyl

421
Q

Contraindication to submentalplasty

A

Severe platysmal banding

422
Q

How does radiofrequency coblation work?

A

Radiofrequency causing plasma field

423
Q

What gives motor function to the tongue?

A

Hypoglossal

424
Q

Where is the marginal mandibular nerve located related to facial vessels and mandibular
border

A

Inferior to the mandibular border superficial to vessels

425
Q

Where is the ideal placement for a TAD

A

Directly mesial to 2nd premolar (between premolars)

426
Q

Desmoplastic ameloblastoma

A

Radiopaque and radiolucent

427
Q

Relapse after mandibular setback? (didn’t say what type of relapse or open bite or
anything)
a.

A

Did not strip the muscle of the distal segment enough

428
Q

Radiograph of 52 yo male with multilocular radiolucency left mandible, histology of
plasma cells

A

Plasmacytoma

429
Q

Which cytokine is seen in the TMJ synovium?
a. IL – alpha
b. IL-beta
c. TNF- alpha
d. IL -6

A

TNF- alpha

430
Q

What drug is someone with myasthenia gravis more sensitive to?

a. Succinylcholine (less susceptible)
b. Fentanyl
c. Rocuronium

A

c. Rocuronium
i. Patients with MG are extremely sensitive to nondepolarizing NMBAs
ii. (rocuronium, vecuronium, cisatracurium).

431
Q

50% upper lip avulsive injury, how to treat?
a. STSG
b. FTSG
c. Abby
d. Karapandzic flap

A

c. Abby

432
Q

What do you see initially in Cushing syndrome?
a. Bradycardia
b. Hyperpigmentation
c. Hypotension

A

b. Hyperpigmentation

433
Q

Patient with paralysis of lower 2/3 of face?
a. Central
b. peripheral defect
c. ipsilateral
d. contralateral

A

Central

434
Q

Treatment CEOT

A

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

435
Q

Indications for use of cuffed ET tube in kids

A

Positive airway pressure

436
Q

Inferior border of level II neck dissectionf

A

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.

437
Q

Removal of thyroglossal duct cyst, what do you take a subtotal excision of?

A

Thyroid gland

438
Q

Gait disturbance in AICBG

A

a. IT Band
b. Psoas Major Muscle

439
Q

Where do osteoprogenitor cells come from 8 days after surgery

A

Macrophages

440
Q

Most likely sign of IAN injury with 3rds (Roods criteria)

A

Darkening of canal around roots

441
Q

Which fracture is the lowest prognosis

A

Root fracture with intrusion

442
Q

CSF leak

A

a. beta -2 transferrin
b. Glucose test

443
Q

How do you treat OSA when RDI less than 50

A

a. Genio
b. MMA greater than 50

444
Q

Best med to give with cocaine HTN

A

Labetalol (Beta-blocker)

445
Q

Muscular dystrophy test

A

dystrophin gene

446
Q

Flumazenil dosage

A

0.2mg, maximum of 3mg

447
Q

Where are Verocay Bodies found

A

Schwannoma = Neurilemoma

448
Q

How does Pradaxa Work?

A

Direct Thrombin Inhibitor

449
Q

What level does a moderate chemical peel treat to?

A

Upper reticular dermis
i. Superficial peel to papillary dermis
ii. Medium depth peel to upper reticular dermis
iii. Deep peels reach mid-reticular dermis

450
Q

Which branchial arch is the alveolus derived from?

A

First Branchial Arch Ectoderm

451
Q

Zofran causes what cardiac changes?

A

QT prolongation

452
Q

What flap is used for nasal reconstruction?

A

a. Melolabial flap

453
Q

Degrees difference between Frankfurt horizontal and natural head position (Know
percentage)

A

Male: 3.18
b. Females: 4.416

454
Q

What happens when HA injected into the TMJ Space

A

a. Crystal induced arthropathies

455
Q

What are the fundoscopic signs of HTN?

A

AV nicking, retinal hemorrhages, exudates, and papilledema (“Gunn’s sign)

456
Q

What type of drug crosses the BBB (nonionized,
lipophilic,etc) (Atropine vs. robinul)

A

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.

457
Q

What is Mobius syndrome and how is it treated?

A

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.

458
Q

What is the most potent vasoconstrictor (epi, norepi, phenylephrine,or ephedrine)?

A

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).

459
Q

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?

A

Synchronized cardioversion is indicated since the patient is now unstable and has failed to
respond to medical treatment

460
Q

A patient has PEA on EGK, what is the most efficient way to evaluate for tamponade?

A

Pericardiocentesis

461
Q

What is the most likely cause of septic shock (gram neg endotoxin)?

A

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.

462
Q

What is most common fungal infection in DM patient?

A

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.

463
Q

Why is Versed absorbed quicker than other benzos?

A

Because it is water soluble and then at physiologic pH becomes lipophilic enabling it to easily
cross BBB.

464
Q

After MI, which enzyme elevates first?

A

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).

465
Q

What is the desired skin for extraoral implants?

A

less than 1mm thick without hair follicles

466
Q

At what level, relative to the adjacent CEJ should the implant be placed?

A

34
apical to the CEJ of the adjacent teeth (or 57mm
apical to contact point)

467
Q

If have trismus after IAN injection, what has happened?

A

Hematoma in pterygomandibular space (medial pterygoid)

468
Q

What happened to patients after UPPP?

A

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

ABOMS (9 decks)

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