QBank 1 Flashcards
- 22y/o WF with subtle double tip break in the columella region is due to what?
a. intermediate crua meet medial crua
- What soft tissue movement is the least predictable with mandibular advancement?
a. The lower lip – because of its contact with the upper incisor and upper lip, its movement is often variable and unpredictable
- 80 y/o WF (intra-oral photo and panorex). Care givers notice the patient is unable to eat and the patient refuse to wear denture. (pano shows moth eaten mandible right body and intra-oral picture show rolled borders, speckled white lesion right mandibular alveolar ridge). What is the best immediate tx?
a. Debridement
- What type of patient in the ideal candidate for transconjunctival upper lid blepharoplasty?
a. young patient with no wrinkles
• Reserved for young patients with isolated medial fat pad herniation and minimal or no wrinking of the upper eyelid skin
- A 22 y/o patient is s/p MVA. C/C pain right shoulder, SOB, and positive Hamman’s sign. What is the diagnosis?
a. Diaphramatic injury
• Hamman’s Sign – “mediastinal crunch” produced by the heart beating against air-filled tissues. Associated with pneumomediastinum
- Pt. s/p trauma with a tear in the lacrimal duct. How to repair?
a. Silicone nasolacrimal duct intubation x 3-4 months
Nasolacrimal duct intubation may bypass a disrupted nasolacrimal apparatus and avoid the morbidity associated with a dacryocystorhinostomy. Dacryocystorhinostomy is reserved for a chronic condition. Cannulation should be instituted for both inferior and superior canaliculi.
- Best method for treating a laceration to the inferior cuniculus:
a. Intubation of duct
- 70kg patient loses 5% body weight secondary to hypovolemia. How much fluid must be given to bring him back to equilibrium?
a. 3.5L
• 5% of 70kg = 3.5kg, 110ml/kg x 3.5kg = 3850ml = 3.5L
- Patient s/p cleft lip repair. Tissue appears bunched upper lip and there is a poor philtrum. Why?
a. Poor approximation of the obicularis muscle
• Abnormal thickness of the philtrum is usually caused by placement of the orbicularis oris on the cleft side too far medially
• Lateral bunching caused by improper placement if the medial aspect of the obicularis on the cleft side.
• A wide philtrum is caused by inadequate attachment of the obicularis to the philtrum or lateral placement in relation to the philtral ridges,
• Abnormal thickness maybe caused by excess overlap of the obicularis oris between the cleft and noncleft side
- Which NIDDM med gives rise to lactic acidosis
a. Glucophage (metformin)
- Most common benign child salivary gland neoplasm
a. pleomorphic adenoma
• Malignant: mucoepidermoid carcinoma
- 14y/o patient presents with dentoalveolar fracture and loose maxillary incisiors. How do you manage this patient
a. Acrylic splint
- Pediatric patient with condyle fracture. What is the most likely cause of disturbed growth?
a. Intracapsular injury more likely to cause growth disturbance, along with immobilization as part of the treatment. Intra-articular hemorrhage
- Pt. with pterygomandibular space infection. Where do you drain?
a. Deep to the mandible and superficial to the medial pterygoid
The pterygomandibular space is bounded by the lateral pterygoid muscle superiorly, the pterygomasseteric sling inferiorly, the anterior border of the ramus (where the fascial envelope wraps around the mandible) anteriorly, the posterior border of the ramus posteriorly, the ascending ramus of the mandible laterally, and the anterior layer of the deep cervical fascia medially. The pterygomandibular space contains the inferior alveolar artery and vein, lingual, mylohyoid, and inferior alveolar nerves. Pericororonitis of the lower third molar is the most likely cause of infection in this space. Communicates with the massteric, infratemporal and lateral pharyngeal space.
- What is the most common cause of apertognathia?
a. Vertical maxillary excess - hyperplasia of the maxilla
- Unilateral condylar hyperplasia. What will you see clinically?
a. Chin point to unaffected side, posterior open bite on affected side
- What is the advantage of Versed for use in out patient anesthesia?
a. Lack of active metabolites
• Its active metabolites are not thought to produce significant sedative effects
- Which of the following medications give the most emesis?
a. Ketamine
- The potency of a local anesthetic is due to what?
a. Lipid solubility
• protein binding - duration of action,
• pKa - time of onset
- What is the difference between hemifacial microsomia type 2a and 2b?
a. Muscle Function
- Type I: mini mandible and TMJ. All structures are present, normal in shape and location, but small, Muscle of mastication are consistent with degree of skeletal deformity. Jaw movement (translation, excursions) are present.
- Type IIa - the TMJ, ramus and glenoid fossa are hypoplastic, malformed, and malpositioned, but the deformed joint is adequately positioned for symmetric opening, degree of hypoplasia of mandibular musculature is closer to normal.
- Type IIb - the joint is malpositioned inferiorly, anteriorly and medially and will not function as a TMJ for adequate symmetric opening, degree of hypoplasia of mandibular musculature is considerably greater.
- Type III: Complete absence of the mandibular ramus and TMJ. Lateral pterygoid muscle and articular disk are absent and the temporalis, masseter, and medial pterygoid are moderate to severely hypoplastic. The jaw does not translate on the affected side and does not move medially toward the normal side.
- Blood Brain Barrier – what determines what enters?
a. Freely crosses: high lipid solubility and CO2, non ionized
• Pooly cross: ions, proteins, and large substances
- The syndrome this child is diagnosed with is categorized as what? (picture of a kid with Treacher-Collins)
a. Mandibulofaical dysotosis – autosomal dominant, convexity of the midface and underdevelopment of the mandible (AP deficiency with open bite), downward sloping lateral canthus, flattened cheek prominences due to hypoplastic zygomas
- Aperts, Crouzons, Pfeiffer’s and Saether-Crazeoun are classified as what type of syndrome?
a. Craniosynostosis
• Craniofacial dysostosis (term applied to syndromal forms of craniosynostosis)
- Attachment of medical canthal ligament?
a. The MCT may be subdivided into a superficial portion and a deeper portion with the lacrimal sac between them. The superficial portion has two “legs”. The anterior leg attaches to the posterolateral surface of the nasal bones, and the superior leg inserts at the junction of the frontal process of the maxilla and the angular process of the frontal bone. The deeper portion (also known as Horner’s muscle or the pars lacrimalis) attaches to the posterior lacrimal crest
- Percent of people who go blind after ocular surgery
a. 3/1000
- Beta-2 transferrin is what?
a. Beta-2-transferrin is a carbohydrate free glycoprotein produced by neuraminidase activity in the brain which is uniquely found in the cerebrospinal fluid (CSF) and perilymph.
- Tricep reflex out bicep good, injury at?
a. C7-8 • Upper Extremity Reflexes 1. C4: Pectoral 2. C5: Bicep 3. C6: Brachioradialis tendons 4. C7: Triceps tendon • Lower Extremity Reflexes 1. L1-2: Cremasteric Muscle 2. L2-4: Patellar tendon (Knee) 3. L5: Posterior Tibial jerk 4. S1: Achilles tendon (Ankle) 5. S3-4: Bulbocavernosus 6. S3-5: Anal wink
- Vancomycin (Red Man Syndrome). The cause of this is what?
a. Histamine release
Red man syndrome is an infusion-related reaction peculiar to vancomycin. It typically consists of pruritus, an erythematous rash that involves the face, neck, and upper torso. Intravenous dose of vancomycin should be administered over at least a 60 min interval to minimize the infusion-related adverse effects Discontinuation of the vancomycin infusion and administration of diphenhydramine can abort most of the reactions. Slow intravenous administration of vancomycin should minimize the risk of infusion-related adverse effects.
- The patient is given 1mg of versed and the blood pressure drops. What is the next best course of action?
a. Trendelenburg position
- Pt. elderly male with swelling of the parotid bilaterally at the tail. What condition does he have?
a. Warthins Tumor
- A pt. s/p laser resurfacing breaks out in vesicles. What can prevent this?
a. Antiviral agents prior
- Pansystolic murmur is what type of murmur?
a. TR, MR, VSD - Pansystolic murmurs often occur with regurgitant flow across the atrioventricular valves
• Pansystolic (Holosystolic):
1. Mitral regurgitation – radiates to axilla
2. Tricuspid regurgitation – louder with inspiration
3. VSD – diffuse across precordium
• Midsystolic:
1. Aortic stenosis: crescendo – decrescendo, right 2nd interspace
2. Pulmonic stenosis: left 2nd interspace, EKG shows RVH
• Late systolic:
1. Mitral valve prolapse: apical murmur
2. Hypertrophic subaortic stenosis: gets louder with valsalva
• Early Diastolic
1. Aortic regurgitation: blowing murmur
2. Pulmonic regurgitation: Graham Steel murmur due to pulmonary HTN
• Middiastolic:
1. Mitral stenosis: opening snap
2. Tricuspid stenosis: louder with inspiration
• Continous:
1. Patent ductus: machinery murmur
- Wood splinter in the wound. What is the next measure?
a. Debride and Antibiotics
- A patient on 5 Fluorouracil for beast cancer. What should the doctor be worried about?
a. Drug has myelosuppressive effects which can increase rise of infection and bleeding tendency by causing low WBC and platelets counts
- Patient with leukemia. Why is there so much bleeding?
a. Decreased amount of megakaroctes which is the progenitor cell for platelets
- What is the most common tooth with hyperemic pulp?
a. Molars
- What site will offer the best color match for a full thickness flap?
a. Lateral neck - Any supraclavicular facial graft (from the blush area) matches the facial color better than does any torso or thigh graft.
- What is the advantage of a full thickness flap over a split thickness flap?
a. Less contracture
The FTSG is preferred over the split thickness skin graft (STSG) in areas where a wound contracture may lead to a functional deformity. Full thickness skin graft has better color match
- BMP in freeze dried bone?
a. Osteoinductive
- Inter-arterial injection of diazepam. How to manage next?
a. Leave the needle in place
• Administer 1% procaine (2-10 cc) serves 4 functions {anesthetic to decrease pain, vasodilator to break arterial spasm and intiate return of blood flow, pH about 5 to counterbalance drugs with alkaline pH, and diluent to decrease the concentrations of previously administered IA drug}
• Hospitalization of patient for:
a. Anesthesiologist to perform sympathetic nerve block
b. Vacular surgeon to perform endarterectomy if needed
c. Heparization to prevent further thrombosis
- What medications do you give to treat PSVT?
a. Adenosine – first line choice ACLS
- Foul smelling odor from socket 1 week s/p extraction, what organism most likely?
a. Bacteroides
- What is the dose of Flumazenil?
a. 0.2 mg q1-2min up to 3 mg max
- Sediation reversal: 0.2 mg over 15 seconds, then 0.2 mg q1minute prn up to 1mg total dose.
- Overdose reversal: 0.2mg over 30 seconds, then 0.3mg over 30 seconds, than 0.5mg over 30 seconds to maximum dose of 3 mg.
- What is most common side effect of Flumazenil?
a. Nausea/vomiting
• Others include agitation and myoclonus. May evoke withdraw syndrome including seizures in chronic benzo users and in concurrent tricyclic antidepressant overdose.
- What organisms are found in acute sinusistis?
a. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella (Branhamella) catarrhalis account for more than 70% of cases of acute sinusitis, Staphylococcus aureus, Steptococcus pyrogenes, Alpha and Beta hemolytic streptococci
- Albuterol given to a patient and an improvement in FEV1 is noted. What type of disease does this patient have?
a. Reversible obstructive lung disease
- A trauma patient with an orbital fracture has a decrease in intra-ocular pressure due to what?
a. Increase in intra-orbital volume
- A patient with sympathetic ophthalmia. When do you enucleate the traumatized eye?
a. Enucleation of the affected eye prior to symptoms effecting uninvolved eye
Sympathetic ophthalmia is a potentially blinding, immune-mediated, inflammatory condition, which usually follows severe trauma to one eye
- What labs are associated with a patient diagnoses with Paget’s disease?
a. Normal Ca2+, normal PO4, and elevated alkaline phosphatase
- Bleeding time is increased, PTT increased. What coaguloathy is present?
a. von Willdebrands
- Microvascular anastamosis and thrombus formation?
a. Collagen exposure
- Removal of the parathyroid glands leads to what lab changes?
a. Ca2+ down and PO4 up
Disease Ca Phos Alk Phos Hyperparathyroidism -primary high low normal -secondary low high normal -paraneoplastic high low normal Paget Disease normal normal very high Cherubism normal normal normal Fibrous Dysplasia normal normal normal Ossifying fibroma normal normal normal
- What are the signs of a massive P.E.?
• Massive P.E. – syncope, cardiovascular collapse
- What is the best way to determine the viability of a superficial graft?
a. Observation
- A patient with ESRD preparing for anesthesia, which labs to check?
a. Potassium – hyperkalemia leading to cardiac issues
- What is the best indication for a posterior tongue flap?
a. OA fistula in the molar region, half the tongue can be rotated w/o compromising normal tongue function
• posteriorly based flaps are indicated when treating defects of the soft palate, retromolar region, and posterior buccal mucosa
• Anteriorly based flaps are useful in the treatment of defects of the hard palate, anterior buccal mucosa, lips, and anterior floor of mouth, flap should be 20% wider than defect and 5-7mm thick
• Blood supply for the posterior tongue flap – suprahyoid artery and dorsalis lingual
• Blood supply for anterior tongue flap – deep lingual artery
- OA fistula and closure with buccal fat pad. What are the advantages of closing with the fat pad?
a. Heals by secondary epithelialization, no need for complete coverage, no surgical stents or dressing needed
- You are taking out a lone second molar tooth and you notice that the tooth comes out with the buccal plate attached and the tuberosity fractured. What do you do next?
a. Remove segment and close with palatal flap or buccal fat pad
- Random flap question and blood supply to?
- Random flaps: are supplied by the dermal and subdermal plexus alone and are the most common type of flap used for reconstructing facial defects.
- Axial pattern flaps: are supplied by more dominant superficial vessels that are oriented longitudinally along the flap axis.
- Pedicle flaps: are supplied by large named arteries that supply the skin paddle through muscular perforating vessels.
- Free tissue transfer refers: to flaps that are harvested from a remote region and have the vascular connection reestablished at the recipient site.
- Nasolabial flap blood supply question.
a. Axial flap, blood supply branches of the facial (angular) artery
- Z-Plasty. What type of flap?
a. Rotational (interposition)
• Interposition flaps differ from transposition flaps in that the incomplete bridge of adjacent skin is also elevated and mobilized. An example of an interposition flap is a Z-plasty.
• Transposition flap refers to one that is mobilized toward an adjacent defect over an incomplete bridge of skin. Examples of transposition flaps include rhombic flaps and bilobed flaps
- Loosening of implant crown interface. What type of forces can cause?
a. Eccentric movement
• Abutment and prosthetic screw loosening can be a recurrent problem seen often with single-tooth restorations. Repeated loosening of screws should bring to mind occlusal overload, heavy contact in lateral excursions, or implant mobility
- Abby flap. Based on what blood supply?
a. Labial artery
- Alveolar osteitis. What type of patient most prone?
a. >25 yrs old female smoker taking contraceptives
- EKG strip after starting an IV – rhythm appeared to be regular and roughly 100 beats per minute – next step
a. Titrate midazolam to effect - (Patient anxious getting IV with basic tachycardia and no arrhythmia on EKG)
- Patient with a history of malignant hyperthermia. What muscle relaxant to give?
a. Rocuronium - fast onset and used for rapid sequence induction when succinylcholine contraindicated
- Patient s/p Lefort surgery, c/c periorbital puffiness, visual aura diplopia. What is most likely cause?
a. cavernous sinus thrombosis
- Profuse bleeding noted after tooth pushed into sinus
a. PSA
- Palatal flap based on what artery? what type of flap?
a. Greater palatine – axial flap
- Staging tumor question. Tumor 3 cm with no appreciable nodes and no metastasis. What is TNM?
T Primary tumor size Ts carcinoma in situ T1 Tumor size 0 to 2 cm T2 Tumor size 2 to 4 cm T3 Tumor size > 4 cm T4 massive tumors or tumor invading bone or intrinsic muscles of the tongue, floor of mouth, suprahyoids, or muscles of mastication
N Regional lymph node
N0 No clinically palpable nodes
N1 Clinically palpable ipsilateral node < 3cm
N2A Clinically palpable ipsilateral node 3 to 6 cm
N2B Two or more clinically palpable ipsilateral nodes 3 to 6 cm
N2C Bilateral or contralateral palpable nodes, none > 6 cm
N3 Bilateral or contralateral palpable node OR any clinically palpable node > 6 cm
M Distant metastasis
MX Metastasis not assessed
M0 Metastasis assessed, none found
M1 Metastasis present
- Staging question. T1N2M0. What stage is this?
a. Stage III Stage T N M TS I T1 N0 M0 II T2 N0 M0 III T3 N0 M0 T1 N1 M0 T2 N1 M0 T3 N1 M0 IV T4 N0 M0 T4 N1 M0 Any T N2 M0 Any T N3 M0 Any T Any N M1
- After sagittal split osteotomy, what is the last nerve to come back?
a. Larger myelinated fibers (A-alpha) recovered slower and to a lesser degree at all time intervals up to 2 years when compared with small myelinated and unmyelinated nerve fibers.
- Mandible fracture patient with atrophic mandible (<10mm). How to best treat?
a. splint and circumandibular wire vs ORIF
- Delayed complication of pediatric mandible fracture. What is the most common finding?
a. Growth disturbance (compression fracture of condyle)
- How to best treat an Aneurysmal bone cyst of posterior mandible?
a. Curettage and enucleation
- Forced duction test evaluating?
a. Inferior rectus tendon and potential entrapment
- Harvesting parietal graft. Profuse bleeding from where?
a. Sagittal sinus and arachnoid granulations
- Removal of inferior turbinate can lead to what?
a. Atrophic rhinitis or allergic rhinitis
- The primary early complication of inferior turbinate surgery is hemorrhage. The turbinates are very vascular structures and postoperative bleeding has been reported with a frequency of 3.4-8.6% in various studies.
- Another complication is the formation of adhesions. This is primarily of concern when inferior turbinate surgery is performed in conjunction with septoplasty, creating the possibility of apposed raw surfaces.
- Dryness and crusting may also result. In the early phases of healing, crusting along the inferior turbinate can be observed. This is more common in techniques involving direct mucosal trauma and resolves with healing. A more significant complication is long-term dryness and crusting. This may be the result of an increase in nasal airflow or the turbulence of nasal airflow. The extreme or end stage of this process is atrophic rhinitis.
- Temporal arteritis. Patient with jaw clicking, photophobia, and intense HA. Biopsy temporal artery shows arteritis. What is the best treatment?
a. Methylprednisolone: high doses of corticosteroids may be given at 1-2 mg/kg/d until the disease activity is suppressed adequately
