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1
Q

When to remove sutures in the HandN

A

Face: 3-7d
Scalp: 7-10d

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2
Q

What are the rungs on the reconstructive ladder?

A 
Secondary intention
Primary closure
Delayed closure
STSG
FTSG
Tissue expansion
Random flap
Local pedicled flap
Free flap
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3
Q

What are the Fitzpatrick skin types?

A 
I: Redhead, blue eyes
II: Redhead/Blonde, blue/green eyes
III: Brunette
IV: Mediterranean
V: Indian
VI: African
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4
Q

Which skin types should get adjunctive therapy when undergoing CO2 resurfacing?

A

Fitzpatrick skin types III and above should get Hydroquinone gel to prevent hyperpigmentation

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5
Q

What two incisions compose an open approach for rhinoplasty?

A

Marginal and transcolumellar

Marginal is at the bottom of the LLC

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6
Q

What is the most common recipient vein in the H&N?

A

EJ

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7
Q

What form the major tip support of the nose?

A

Size and strength of lower lateral cartilage
Medial crura attaching to the septum
Scroll region (attachment of upper & lower lateral)

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8
Q

What is the scroll region of the nose?

A

Where the LLC overlies the ULC

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9
Q

What is the keystone area of the nose?

A

Where the nasal bones overly the ULC

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10
Q

What is a normal nasofrontal angle?

A

~120 degrees

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11
Q

What is a normal collumelar-labial angle?

A

Male 90-105 degrees

Female 5 more degrees

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12
Q

What divides the facial thirds?

A

Trichion (hair peak)
Glabella
Subnasale
Menton

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13
Q

What divides the facial fifths?

A 
Lateral auricle
Lateral canthus
Medial canthus
Medial canthus
Lateral canthus
Lateral auricle
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14
Q

What angle determines tip rotation?

A

Columellar-labial angle

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15
Q

What is the 3-4-5 rule of rhinoplasty?

A

Columella-Base-Dorsum

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16
Q

What is a normal columellar show?

A

2-3mm

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17
Q

What are the rhinoplasty incisions?

A

Intercartilaginous
Marginal
Trans/Intracartilaginous
Transcolumellar

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18
Q

What incisions are made for open septorhinoplasty?

A

Marginal & transcolumellar

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19
Q

What is nasal rotation?

A 
Over-rotated = up
Under-rotated = down
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20
Q

What artery is the pedicle for the supraclavicular island flap?

A

Supraclavicular artery

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21
Q

From where does the supraclavicular artery arise?

A 
Transverse cervical artery (93%)
Suprascapular artery (7%)
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22
Q

Where is the angiosome for the supraclavicular flap?

A

Anterolateral deltoid skin

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23
Q

Submental artery relationship to digastric

A

Deep to it in 70% (lying on the mylohyoid)

Superficial to it in 30%

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24
Q

What defects is the submental island useful for?

A

Intraoral
Lower face
Preauricular

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25
What defects is the FAMM flap useful for?
``` OC & OP Palate defects Floor of mouth Ventral tongue Upper & lower lips ```
26
Which mimetic muscles are innervated on their superficial side?
Buccinator Levator anguli oris Mentalis
27
Where does the facial artery course over the face?
2nd mandibular molar to nasal ala
28
Venous drainage of the FAMM flap
Random | More an arterialized flap than an axial flap
29
What is the dominant artery in a PMMC flap?
Pectoral artery (thoracoacromial trunk)
30
What secondary arteries contribute to the PMMC blood supply?
Lateral thoracic artery | Internal mammary branches
31
Are abx indicated in mandible fractures?
Body/Ramus: Injury through periop period | Isolated condyle: Periop only
32
Are abx indicated in midface fractures?
Periop only
33
What is the difference in outcomes between an oblique ridge Champy plate and a lateral plate?
Lateral plate has lower infection rate. No difference in mechanics.
34
Indications for two fixation plates for mandible ORIF?
Unfavorable fracture line (tension plate) | Symphyseal fracture
35
ORIF or closed reduction and MMF for condylar neck/subcondular fractures?
ORIF Data supports better long-term functional outcomes
36
Indications for orbital fracture repair
Over 50% of the orbital floor EOM entrapment Enophthalmos
37
How long is the gracilis muscle?
25cm
38
What is the arterial supply of the gracilis muscle?
The adductor branch of profunda femoris Also, occasionally the medial circumflex artery
39
Venous supply of the gracilis free flap
Two vena comitantes running with the artery
40
Where does the artery come in for the gracilis FF?
Undersurface of the proximal 1/3 of the muscle Between the adductor longus and adductor brevis 8-10cm inferior to the pubic tubercle
41
What nerve innervates the gracilis FF?
Anterior branch of the obturator nerve
42
Why is a two-stage gracilis preferable?
Better symmetry at rest | allows for axonal regrowth prior to placing gracilis
43
When is a temporary cranial nerve substitution procedure indicated for FN paralysis
Paralysis less than 2y old | prevents mimetic muscle atrophy
44
Where is the incision for a sural nerve harvest
2cm posterior and 2cm superior to lateral malleolus
45
What is the length of a harvested sural nerve?
25-35cm
46
How can you test if a CFNG has undergone axonal regeneration?
Tinel sign | tapping it causes tingling
47
Which side should be harvested for gracilis?
Contralateral to the FN paralysis | for ease of inset
48
How long should a gracilis FF be?
From oral commissure to temple
49
Which muscles of facial expression are innervated on their superficial side?
MLB: Mentalis, Levator anguli oris, Buccinator
50
To what is the gracilis muscle attached in a gracilis FF?
``` Oral commisure/nasolabial fold Temporoparietal fascia (TPF) just above zygoma ```
51
When will a pt begin to see contraction of a gracilis FF?
4-6mo postop Continues to strengthen for 12-24mo
52
What nerve can accompany a RFFF?
Lateral antebrachial cutaneous nerve
53
What are the limiting anatomic factors to bone in RFFF?
Prox: Insertion of pronator teres Dist: Insertion of brachioradialis
54
How long of bone can be harvested with a RFFF?
10-12cm
55
What circumference of the radius can be harvested with a RFFF?
40%
56
Which palmar arches are supplied by which arteries in the arm?
Radial: Deep palmar arch Ulnar: Superficial palmar arch
57
What is the dominant fasciocutaneous branch off of the radial artery in the proximal forearm?
Inferior cubital artery
58
What limits the arterial length of a RFFF?
The takeoff of the radial recurrent artery
59
What marks the course of the lateral antebrachial cutaneous nerve?
It runs with the cephalic vein
60
What pressure for the RFFF tourniquet?
250 mmHg
61
What two muscles border the intermuscular septum?
Brachioradialis | Flexor carpi radialis
62
What is the endpoint when laser treating vascular lesions?
Transient purpura
63
What laser best treats photodamage?
Broad band light
64
What is the limit in defect size for primary closure of the auricular helix?
1.5cm
65
What are the predominant methods to close helical defects too large to close primarily?
Helical chondrocutaneous advancement flaps Pre/postauricular tubed interpolated flaps FTSG
66
What is the ideal defect size for helical chondrocutaneous advancement flaps?
1.5-2.5cm
67
What is the ideal defect for pre/postauricular interpolated tube flaps?
>2.5cm and limited to the helix
68
What is the best method to close a full thickness defect of the superior auricle with an intact helical rim?
Postauricular subcutaneous island flap
69
What are the two general types of skin flaps?
Random cutaneous flaps | Arterial cutaneous flaps (axial flaps)
70
What are the four types of skin flaps?
Random Arterial cutaneous Fasciocutaneous Musculocutaneous
71
What is the blood supply of the ALT flap?
Descending branches of the lateral circumflex femoral artery
72
Indications for ND following parotidectomy
Clinical nodes Tumor over 4cm High grade tumors: SCC, adenoCa, high-grade mucoep)
73
What does the Frankfort horizontal connect?
Porion (superior EAC) to orbitale (inferior orbital rim)
74
What is the most commonly injured motor nerve during facelift surgery?
Frontal branch
75
What is the most commonly injured nerve during facelift surgery?
Great auricular
76
In unilateral cleft lip, tip/columella deviates toward
Normal side
77
In unilateral cleft lip, caudal septum deviates toward
Normal side
78
In unilateral cleft lip, cartilaginous/bony septum deviates toward
Cleft side
79
What is the visual effect of the lateral crural steal technique?
Increases rotation and projection
80
What is the visual effect of the lateral crural overlay technique?
Increases rotation, decreases projection
81
What muscle causes nasal tip ptosis when smiling?
Depressor septi
82
What is seen in the tension nose deformity?
Shortened upper lip (gingival show) Narrowed nostrils Under-rotation Increased collumellar show
83
What is seen in Polybeak deformity?
Supratip fullness | A more pronounced nasal dorsum with relative underprojection of the tip
84
What is seen in inverted V deformity?
Narrow middle vault compared to upper dorsum, shows a true inverted V due to pyriform aperture
85
With 30 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?
Rotate 45 degrees | Lengthen 25%
86
With 45 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?
Rotate 60 degrees | Lengthen 50%
87
With 60 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?
Rotate 90 degrees | Lengthen 75%
88
What eye drop can be used to mask ptosis?
Apraclonidine | Stimulates Muller's muscle & dilates the iris
89
Where is the nasion?
It is at the midline nasofrontal suture
90
Where is the sellion?
It is the deepest point of the nasofrontal angle
91
Where is the radix?
It is the root of the nose.
92
Where is the pogonion?
Most anterior portion of the mandible
93
Where is the gonion?
The most posteroinferior aspect of the mandible
94
Where is the menton?
The most inferior portion of the chin
95
What muscle is responsible for bunny lines?
Transverse nasalis
96
What is the visual effect of the tongue-in-groove stitch?
Increases rotation (MC up on septum) Can decrease projection (MC posterior on septum) Decreases collumellar show
97
What are techniques to increase tip rotation?
columellar strut (increases projection) tip grafting (increases projection) lateral crural steal (increases projection) lateral crural overlay (decreases projection) tongue-in-groove (decreases projection)
98
What is the ideal collumellar show?
2-4mm
99
What kind of toxicity can be seen with a chemical peel?
Phenol toxicity = cardiac arrhythmias
100
When does hair regrow following telogen effluvium?
3mo
101
What are the approaches to the orbital rim?
``` Transconjunctival (pre or post-septal) Subciliary Orbical rim (lower) Brow Lid crease (upper) Bicoronal ```
102
Which chemical peel requires neutralization?
Glycolic acid Can use water or 5% sodium bicarb
103
Where is the rhinion?
Where the ULC and nasal bones meet
104
What types of collagen are formed in a scar?
Type III --> Type I
105
What are the risk factors for hematoma following rhytidectomy?
``` Smoking Aspirin Males HTN Platysmaplasty ```
106
What are the steps of skin graft nutrition during healing?
Days 0-2 = plasmatic imbibition 2-4 = Inosculation 4-7 = Angiogenesis
107
What are the phases of hair follicles?
Anagen (growth) Catagen (involution) Telogen (rest) Exogen (shedding)
108
How long is the anagen phase of hair follicles?
3-4y
109
How long is the telogen phase of hair follicles?
3-4mo
110
What is the landmark for when FN injuries should be repaired via anastomosis?
Lateral to the lateral canthus should be explored and repaired
111
What side is microtia more commonly found on?
Microtia (Mike right)
112
What side is cleft lip more commonly found on?
cLeft
113
What is the Karapandzic flap used for?
Lower lip defects 1/2 to 2/3
114
What is the Abbe flap used for?
Lip defects 1/3-1/2, not involving commisure
115
What is the Gillies fan flap used for?
Lower lip defects over 2/3
116
What is Dedo class I? What is the suggested intervention?
Normal skin | No intervention
117
What is Dedo class II? What is the suggested intervention?
Neck skin laxity | Rhytidectomy
118
What is Dedo class III? What is the suggested intervention?
Submental and submandibular adiposity | Cervical liposuction
119
What is Dedo class IV? What is the suggested intervention?
Platysmal banding | Rhytidectomy and platysmaplasty
120
What is Dedo class V? What is the suggested intervention?
Microgenia or retrognathia | Chin augmentation or mandibular advancement
121
What is Dedo class VI? What is the suggested intervention?
Low hyoid | Division of suprahyoid musculature, chin augmentation
122
What is done if a tissue expander is found to be extruded?
If still early in expansion: abort and remove | If near the end of expansion: continue and monitor for infection
123
Where are split calvarial bone grafts taken from?
2cm lateral to sagittal suture
124
What is suitable for primary closure on the lower eyelid?
Under 25%
125
What is a Tenzel flap used for?
Lower lid reconstruction of 1/3 to 2/3
126
What is a Hughes tarsoconjunctival flap used for?
Lid reconstruction 50-100%
127
What is the blood supply to the temporalis muscle flap?
Deep temporal artery (ant and post)
128
How long does re-epithelialization take following dermabrasion?
5-7d
129
Which injectable fillers are used for deeper injections?
``` Poly-l-lactic acid (Sculptra) Calcium hydroxyapatite (Radiesse) ```
130
What must be administered to pts with a history of herpesvirus infections when undergoing peels or laser resurfacing?
Prophylactic antivirals
131
When are cleft lips repaired?
10, 10, 10
132
What is responsible for a shortened upper lip?
Depressor septi
133
What incisions make up the midfacial degloving approach?
Sublabial Full transfixion Intercartilaginous
134
How wide should the bony nose be compared to alar base width?
75%
135
What is in a Baker-Gordon peel?
Phenol Tap water Liquid soap Croton oil
136
What are the approaches to browlift?
``` Direct Indirect Pretrichial Coronal Endoscopic ```
137
What is a normal MRD1?
3-5mm
138
What is a normal MRD2?
5mm
139
What is the correct plane for an endoscopic browlift?
Subperiosteal
140
What is the correct plane for a coronal browlift?
Subgaleal
141
What is the correct plane for an indirect browlift?
Subcutaneous
142
What is the correct plane for a direct browlift?
Subcutaneous
143
What is Crumley's method?
3-4-5 of nasal triangle
144
What is Goode's method?
Nasal tip to alar-facial crease Nasion to nasal tip Ratio should be 0.55-0.6
145
What is Hering's law?
Law of equal innervation | Repair of ptosis or blepharoptosis may unmask ptosis in the other eye
146
What is the necessary size for a scalp tissue expander?
2.5x the size of the defect
147
What plane are scalp tissue expanders placed in?
Subgaleal
148
When after implantation can tissue expanders begin inflation?
2w postop
149
What are the specific risks to the preseptal vs postseptal approach to lowe lid blepharoplasty?
Preseptal: Can cause scarring of anterior lamella Postseptal: Puts inferior oblique at more risk
150
What type of BCC is the most difficult to excise?
Sclerosing aka Morpheaform It has tentacles and skip lesions
151
What is the treatment for post-inflammatory hyperpigmentation?
It is seen after laser skin rejuvenation. Treatment is hydroquinone, sunblock, and exfoliants.
152
What does the facial plane connect?
The glabella and pogonion
153
What constitutes the nasofrontal angle?
Dorsum of nose to nasion Nasion to glabella It's the angle between the two lines
154
What is the ideal nasofrontal angle?
115-135 degrees
155
Where are the local anesthetics metabolized?
``` Amides = 2 i's, liver Esters = 1 i, plasma ```
156
How quickly is the onset of Botox?
Botox A = 2-5d | Botox B = 24h
157
How long does Botox last?
3-4mo
158
What allergies are a contraindication to Botox?
Albumin | Cow's milk protein allergy
159
What muscle can be denervated with Botox to treat marionette lines?
Depressor anguli oris
160
What bacterium is associated with leech therapy?
Aeromonas hydrophila
161
What is seen in Stickler syndrome?
``` Myopia SNHL Hypermobile joints Cleft palate Flattened midface ```
162
What can EMLA cream cause?
Methemoglobinemia
163
What peel causes perifollicular frosting?
Salicylic acid
164
What is the appropriate length-width ratio for a fusiform excision?
1:3
165
What does the Converse technique treat?
Prominauris Incise on either side of planned antihellix, suture skin together
166
What does the Hatch technique treat?
Prominauris Suture the helical root to the temporalis fascia
167
What does the Furnas technique treat?
Prominauris Suture the conchal cartilage to the mastoid periosteum
168
What are the methods to correct prominauris?
Hatch Converse Furnas Mustarde
169
How long must a pt wait after LASIK before getting a blepharoplasty?
6 months To account for impaired corneal sensation
170
What in Baker's solution changes the depth of peel?
Croton oil
171
What is in Jessner's solution?
Resorcinol Salicylic acid Lactic acid Ethanol
172
How long before dermabrasion can be repeated?
12 months
173
What is the youngest that hair restoration procedures should be attempted?
30-35
174
What is the ideal upper eyelid crease height?
Men: 6-9mm Women: 8-11mm
175
What scores on the Jahrsdorfer scale indicated they are a candidate for surgery?
6-10 Scale to evaluate presence of normal structures in congenital aural atresia.
176
What is the argon laser used for?
Vascular anomalies | Port wine stains, hemangiomas, telangiectasias
177
What is the extinction length of the CO2 laser?
0.03mm It doesn't penetrate very deeply
178
What are the types of YAG lasers and what are they most similar to?
Nd:YAG is similar to Argon (absorbed by Hgb) Ho:YAG is similar to CO2 (absorbed by water)
179
What vessels supply the inferior trapezius island flap?
Occipital Transverse cervical Dorsal scapular
180
What vessels supply the superior trapezius island flap?
Occipital | Paraspinal perforators
181
What vessels supply the lateral trapezius island flap?
Transverse cervical artery branches
182
What is a normal Shirmer's test?
Greater than 10-15mm of tears in 5 minutes
183
What mutation is associated with Alport syndrome?
COL4A5
184
What mutation is associated with the most common type of non-syndromic hearing loss?
GJB2
185
What mutation is associated with non-syndromic HL with intact OAE's?
Otoferlin mutations | DBFN9
186
What mutation is associated with syndromic hearing loss and euthyroid goiter?
PDS gene | Pendred syndrome
187
What is seen in Pendred syndrome
Syndromic HL Euthyroid goiter EVA Mondini deformity
188
What test is used to diagnose Pendred syndrome?
Perchlorate discharge test | Now genetic testing
189
What mutation is associated with Jervell and Lange-Nielsen syndrome?
KVLQT1
190
What is seen in Jervell and Lange-Nielsen syndrome?
Syndromic deafness | QT prolongation
191
How is JLNS inherited?
AR
192
How is Pendred syndrome inherited?
AR
193
What flap is used when the philtrum is involved?
Abbe flap to reconstruct philtrum Can be used in conjunction with perialar crescenteric advancement flaps if the defect is large.
194
What can be changed with the incisions for a PMFF to help with rotation of the flap?
Carry medial incision more inferiorly
195
How are traumatic FN injuries medial to the lateral canthus treated?
Either not explored, or explored and tagged for later elective anastomosis (within 30d)
196
How are Stensen's duct injuries treated?
Proximal: ligation of both ends | In general: re-anastomosed
197
What is the optimal time to dermabrade following surgery?
6-8w postop
198
What incisions describe the delivery approach in rhinoplasty?
Intercartilaginous & marginal
199
What incision is used for the retrograde approach to rhinplasty?
Intercartilaginous
200
What can be approached via the retrograde approach to rhinoplasty?
Upper lateral cartilages | Lateral crus of lower lateral cartilages
201
What lesion is caused by petroleum based ointments in a postoperative nose?
Paraffinoma
202
What is the ideal alar-lobule ratio?
1:1
203
What is the ideal collumellar-lobule ratio?
2:1
204
When is best to fix mandible fractures
Within 1w of injury
205
When is nasal septal growth greatest?
It's bimodal. Age 0-5 then puberty.
206
When is best for closed reduction of nasal fractures?
Kids: within 4 days Adults: within 10 days
207
Flaps based in which direction are more likely to develop trap door deformity?
Superiorly-based flaps Lymphatics drain downward
208
What is a normal auriculocephalic angle?
25-35 degrees
209
How are apart are the medial and lateral limbs of a Mustarde stitch?
16mm
210
What is the position of the superior orbital rim in synostotic frontal plagiocephaly?
Elevated on the affected side
211
What is the position of the superior orbital rim in deformational frontal plagiocephaly?
Normal or depressed
212
What contributes to prominauris?
Unfolded antihelical fold (73% contribution) | Large conchal bowl
213
When must ear molding begin?
Within 3w of life
214
What measurements qualify as prominauris?
Auriculocephalic angle over 40 degrees or Helix-scalp distance over 2.5cm
215
What is the necessary cumulative gain for a tissue expander?
Uninflated width + length needed for defect = cumulative gain
216
Is convexity or concavity better for recipient of a FTSG?
Concavity
217
What is considered early vs. late complications of injectable fillers?
2 weeks is the cutoff
218
What should be done for late complication of injectable fillers?
Triamcinolone injection Can help with granulomas, nodules, and migration
219
What is seen in Binder syndrome?
AKA Maxillo-Nasal dysplasia Absent anterior nasal spine Midface hypoplasia Class III occlusion
220
What inhaled anesthetic is associated with improved flap survival?
Isoflurane
221
What is the starting dose for propranalol for infantile hemangioma?
0.33 mg/kg Q6h Increases based on tolerability and age
222
What negative pressure is required for cervicofacial liposuction?
1 atm
223
What is the ideal nasofacial angle?
30-40 degrees
224
What is a Mathes and Nahai class I musculocutaneous flap?
Single dominant pedicle
225
What is a Mathes and Nahai class II musculocutaneous flap?
One dominant pedicle and multiple minor pedicles that can't support the flap
226
What is a Mathes and Nahai class III musculocutaneous flap?
Dual dominant pedicles
227
What is a Mathes and Nahai class IV musculocutaneous flap?
Multiple segmental pedicles
228
What is a Mathes and Nahai class V musculocutaneous flap?
One dominant and multiple segmental pedicles, any of which can support the flap
229
What component determines the depth of a Baker-Gordon peel?
Croton oil
230
What donor material resist absorption best in rhinoplasty?
Split calvarial bone
231
What portion of people have an incomplete superficial palmar arch?
12%
232
What are the x-rays of choice for assessing mandible fractures?
Panorex and reverse Townes view
233
Progression of local anesthetic toxicity
CNS excitation +/- seizures CNS depression Cardiorespiratory depression
234
Local anesthetic toxicity CNS excitation symptoms
``` Agitation Muscle twitching HTN Lightheadedness Lip tingling Tinnitus Metallic taste ```
235
Treatment of local anesthetic toxicity
Seizures - Benzos (5mg Ativan) Oxygen +/- airway control +/- vasopressor support
236
Lidocaine toxic dosage
4.5 mg/kg plain | 7 mg/kg with Epi
237
Which local anesthetic can cause methemoglobinemia?
Prilocaine
238
Mechanisms of cocaine
Sodium channel inhibitor | NE reuptake inhibitor
239
Contraindications to cocaine
Pseudocholinesterase deficiency HTN Arrhythmias
240
Cocaine toxicity Tx
Oxygen Alpha blockade (phentolamine) Calcium channel blocker Sublingual nitroglycerin
241
V1 blocks
Supraorbital and supratrochlear Nasociliary (superomedial orbital wall) External branch of ant. ethmoidal n. (inferomedial border of nasal bone)
242
V2 blocks
V2 block (sigmoid notch, ant/deep to lateral pter plate, 1.5cm more depth) Sphenopalatine block (greater pal. forament) Infraorbital n. Zygomaticotemporal (posterolateral orb rim) Zygomaticofacial (ant malar eminence
243
V3 blocks
``` V3 block (sigmoid notch, post to lateral pter plate, 6cm depth, 5cc) Inf alveolar intraoral block Mental block (intraoral, btwn 1st and 2nd premolars) ```
244
Cervical plexus block
Erb's point (1/3-1/2 way from mastoid tip to SC joint along post. SCM) 10cc injected 3cm deep
245
Which opiate can cause serotonin syndrome?
Demerol (meperidine) | When given to pts on SSRI or MAOI
246
Serotonin syndrome symptoms
HTN Seizures Coma Pyrexia
247
What receptor do opiates work on?
Opiate receptors (Mu, Sigma, Kappa)
248
What receptor do benzos work on?
Benzodiazepine receptor potentiates GABA
249
Side effects of opiates
``` N/V Constipation Hypotension Respiratory depression Pinpoint pupils ```
250
Four goals of sedation
Anxiolysis Hypnosis Amnesia Anesthesia
251
Ketamine contraindications
``` Patients <3mo Questionable airway Cardiopulmonary disease Head injury or ^ICP Psychosis ```
252
Which sedative can cause laryngospasm?
Ketamine (especially in kids)
253
S/S of malignant hyperthermia
``` Tachycardia Tachypnea ^End-tidal CO2 Masseter spasm Acidosis/Hyperkalemia ```
254
Treatment for malignant hyperthermia
2.5 mg/kg IV dantrolene | Repeat Q5m until stabilized
255
What is the airway fire triad?
Ignition source Fuel Oxygen
256
Treatment of CNS excitation due to lidocaine overdose
Administer benzodiazepine
257
What are the four levels of sedation?
Minimal sedation/Anxiolysis Moderate sedation Deep sedation General anesthesia
258
What four factors define level of sedation?
Responsiveness Airway function Spontaneous ventilation Cardiovascular status
259
Abx for dog/cat bites
Augmentin
260
Three phases of wound healing
Inflammatory Proliferative Maturation
261
Length of inflammatory phase of wound healing
<7d
262
Length of proliferative phase of wound healing
3d-3w
263
Length of maturation phase of wound healing
3w-1y
264
How long is the cycle of a skin cell from generation to shedding?
28 days
265
Layers of the epidermis
"Come Let's Get Sun Burned" ``` Corneum Lucidum Granulosum Spinosum Basale ```
266
What is the predominant collagen type in skin
Type 1
267
Fitzpatrick I description
Always burns | Pale, freckles
268
Fitzpatrick II description
Usually burns, sometimes tans | Fair
269
Fitzpatrick III description
May burn, usually tans | Light brown
270
Fitzpatrick IV description
Rarely burns, always tans | Olive
271
Fitzpatrick V description
Moderate constitutional pigmentation | Brown
272
Fitzpatrick VI description
Marked constitutional pigmentation | Black
273
What are the retaining ligaments of the face?
``` Mandibular Masseteric Zygomatic (McGregor's) Platysmal-auricular Orbicularis ```
274
Where is Pitanguy's line?
0.5cm below tragus to 1.5 cm above lateral brow
275
Tarsal plate heights
Upper 8mm | Lower 4mm
276
Where does medial canthal tendon attach?
Anterior lacrimal crest
277
Where does lateral canthal tendon attach?
Whitnall's tubercle 4mm posterior to lateral orbital rim
278
Where do the labial arteries run?
At vermillion | Between labial mucosa and orbicularis oris
279
Lateral pterygoid origin/insertion
Lateral side of lateral pterygoid plate Coronoid/condyle Opens the jaw
280
Medial pterygoid origin/insertion
Medial side of lateral pterygoid plate Posterior mylohyoid groove Closes the jaw
281
Auricle long axis angle
Posteriorly rotated 15 degrees Roughly parallel to nasal dorsum
282
Ear height/width
Height 6cm | Width 3.5cm
283
Ear projection (angle & linear)
20-30 degrees 2-3cm (Just remember it's 2-3 for both cm and degrees)
284
Layers of the upper eyelid
``` Skin Orbicularis Septum Preaponeurotic fat Levator aponeurosis Muller's muscle Conjunctiva ```
285
Layers of the lower eyelid
``` Skin Orbicularis Pre-CPF fat Lower lid retractors Capsulopalpebral fascia Conjunctiva ```
286
Differences in the Asian upper lid
Levator aponeurosis fuses with septum below the tarsal plate This means no levator-skin insertion and that orbital fat can lie all the way down in front of tarsal plate
287
What does PICO model stand for?
Problem Intervention Comparison Outcomes
288
What does nervus intermedius supply?
GSPN --> lacrimal & nasal mucosa | Chorda --> SMG, sublingual, taste
289
Lacrimation with eating
Bogorad's syndrome Similar to Frey's syndrome but parasympathetics reach lacrimal gland
290
To what LN's does this structure drain? | Above brow
Preauricular | Parotid
291
To what LN's does this structure drain? | Central face
Submandibular
292
To what LN's does this structure drain? | Lateral face
Parotid
293
What does the superficial cervical fascia envelop?
Platysma, mimetic muscles, SMAS, galea
294
What does the superficial layer of the deep cervical fascia envelop?
Salivary glands Masseter SCM AKA investing fascia
295
What does the middle layer of the deep cervical fascia envelop?
Pretracheal fascia Straps Larynx Thyroid
296
What does the deep layer of the deep cervical fascia envelop?
Prevertebral fascia
297
What are the horizontal facial buttresses?
Frontal bar Zygomatic Maxillary Mandibular
298
What are the vertical facial buttresses?
Nasofrontal Zygomaticomaxillary Pterygomaxillary Mandibular ramus

ENT (10 decks)

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