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
- What is the most common infection associated with diabetes mellitus?
a. Mucormycosis
• Mucormycosis form nonspetate, irregular wide fungal hypae with frequent right angle branching. Spread is from nasal sinuses to the orbit and brain-giving rise to rhinocerebral mucormycosis.
- 5 yo w/ URI develops buccal cellulites w/ blue hue, what is cause?
a. H. influenza
- Why is a cranial bone graft for midface reconstruction used in place of an AICBG?
a. Less resorption
- What is the most probable cause of gait disturbance following AICBG harvest?
a. Tensor fascia lata srtipping – lateral approach
- What determines the amount of cantilever possible for an implant supported prosthesis?
A-P Spread of implants
- Zygomaticus implants. What improves the success?
a. At least two regular implants placed in the anterior
• In addition to two to four conventional fixtures in the anterior
maxilla, initial stability of this elongated fixture is assured by its contact with four osseous cortices 1.At the ridge crest, 2. The sinus floor, 3. The roof of the maxillary sinus, 4. The superior border of the zygoma.
- How long does it take for sarcoma to develop after radiation?
a. 14 years - may develop as early as 3 years, but average 14 years
- Osteoradionecrosis. What percentage of patients develop this condition?
a. 2-6% - Current prevalence rate is less than 4%
- A 15mm implant with an immediate sinus lift requires a minimum bone height?
a. 3.5-5mm
- Mandible fracture in a patient. Where is the most common site of infection?
a. Angle
- Placement of cortical ramus graft for small alveolar defect?
a. Resorb before remodeling
- Cat scratch disease. What organism responsible?
a. Gram negative rods, Bartonella henselae
- Where is the most resistance to transverse expansion of the maxilla?
a. Zygomaticomaxillary Buttress
• increased facial skeletal resistance to expansion was at the zygomaticotemporal, zygomaticofrontal, and sutures
- What eye muscle is not attached to the Annulus of Zinn?
a. Inferior oblique muscles originate separately from the posterior orbital wall
- Congenital epulus of the newborn. Mosty resembles what lesion?
a. Granular cell tumor (Granular Cell Myoblastoma) - The granular cell tumor (myoblastoma) has cells which are histopathologically identical to those of the granular cell epulis, but the early onset, unique location and pedunculated appearance make the epulis easily differentiated from the tumor.
- Congenital epulus of the newborn (additional question). How do you treat?
a. Surgical excision
- Deficiency with bilateral cleft lip, cleft palate patient?
a. Anterior/posterior and vertical due to the reflectionof tissue from the palate
- Patient with impacted supernumerary teeth and multiple osteoma?
a. Gardner syndrome - sebaceous cysts, osteomas, desmoids tumors, gastrointestinal polyps, multiple teeth,
- 35 y/o male large lesion right maxilla, right facial swelling, c/c pain, CT shows obliteration of right sinus with sunburst pattern. What is your diagnosis?
a. Osteosarcoma
• Malignant neoplasm from mesenchymal stem cells, occur in jaws at average age 37, bimodal age distribution, may present with expansion of bone, widened PDL (Garrington sign), mobile tooth, numb lip, pain, M=F, Mand>Max (60% vs. 40%), Sun-ray/sunb-burst appearance on x-rays, max tumors more frequently grow into sinuses and don’t show sun-ray appearance as often,
- Chest x ray. Pt s/p MVA, c/c SOB, hypotension and trachea deviation. CXR shows right tension pneumothorax. How would you manage?
a. Needle decompression
- Chest x-ray with description of trauma and pulmonary findings of tachypnea, increased resonance, absence of breath sounds?
a. Pneumothorax
- Young patient with well circumscribed mixed lesion right mandible. Photo shows mass with multiple tooth like structures. What is diagnosis?
a. Ameloblastic fibro-odomtoma - treatment includes enucleation and curettage being curative
- Radiographic appearance of what tumor is identical to that of unicystic ameloblastoma?
a. Ameloblastic fibroma
- When performing a sternocleidomastoid rotational flap what nerve needs to be preserved?
a. Spinal accessory nerve
• The spinal accessory nerve enters the deep portion of the muscle approximately at the carotid bifurcation and should be preserved to prevent denervation atrophy of the muscle The dominant vessel is the occipital artery, which enters the muscle below the mastoid tip and supplies the superior portion of the muscle. The superior thyroid artery supplies the middle portion, and the thyrocervical trunk supplies the inferior third of the muscle.
- Most important with reconstruction of mandibular segmental/continuity defect?
a. soft tissue coverage at site
- Composite graft with the best morphology for implants.
a. Iliac - limit of 10mm implants with fibula and scapula, 18mm implants can be placed in iliac composite graft
- Lesion posterior mandible, expanding, no pain. Fistula noted intraoral leaking straw colored cheesy fluid. Young patient. What is your diagnosis?
a. OKC
- Mandibular anterior lesion. 22 y/o female. CT scan shows radiolucent lesion that crosses midline. 2 yrs growing. What is diagnosis?
a. Ameloblastoma
- Pleomorphic adenoma. Lesion well circumscribed in the buccal mucosa. Not fixed but movable, no facial nerve weakness, slow growing. What is you diagnosis?
a. Pleomorphic adenoma
- Picture red, beefy tongue. Pseudomembranous film wipes off tongue, painful lesion. What is your diagnosis?
a. Erosive lichen planus
- Nikolsky sign is NOT associated with which of the following?
a. bullous pemphigoid
• Neg. Nikolsky – bullous pemphigoid
• Pos. Nikolsky – Positive: Pemphigoid, pemphigus, scalding skin syndrome(staph infection), toxic epidermal necrolysis(a severe drug reaction).
Older male, with history of Non-hodgkins lymphoma bluish palatal lesion right palate, molar region. Diffuse borders. What is your diagnosis?
a. Kaposi Sarcoma - Associated with HIV. Oral lesion may be first sign of disease. Usually palate.
- Child sustained kicked in the face and the traumatized tissue turned blue hue. What is oraganism?
a. H. influenza
- Mechanism of action of cyclosporine?
a. Inhibits the production of interleukin IL-2 by helper T-cells thereby blocking T cell activation and proliferation
- Punched out bony lesions refer to what?
a. Multiple myeloma - Increased calcium, serum electrophoresis “M” spike, Bence Jones proteins, bone pain
- Female with punched out lesions, increased calcium, pathologic fracture of mandible. What disease process?
a. Multiple myloma
- Older female patient, brown papillary, exophytic lesions on mucosa. History of snuff tobacco. What is your diagnosis?
a. Verrucous Carcinoma
- Tinel’s sign is due to what?
a. Tingling or electric sensations in a nerve upon percussion – Distal tingling to percussion (DTP) usually assoc w/ carpal tunnel synd
- Pt presents with severe pain on swallowing which radiates to the angle of mandible and ear ? Diagnosed with what?
a. Glossopharyngeal neuralgia
• Glossopharyngeal neuralgia (GN) is described as sharp, jabbing, electric, or shock like pain located deep in the throat on one side. Generally located near the tonsil although the pain may extend deep into the ear. It is usually triggered by swallowing or chewing. Treatment: carbamazepine (Tegretol®) and gabapentin (Neurontin®)
- How is glossopharyngeal neuralgia distinguished from trigeminal neuralgia?
• Distinguished from trigeminal neuralgia based on the pain’s location or results of a specific test. Touch the back of the throat with a cotton-tipped applicator. If an attack results, apply a local anesthetic to the back of the throat and repeats the test. If the anesthetic prevents an attack, the diagnosis is glossopharyngeal neuralgia.
- What is NOT completed with craniofacial abnormalities of the frontal and frontonasal region?
a. Lefort III advancement of mid-face region
- 5 y/o with increased fullness on the left side, cant and left eye missing, pano shows malformed short ramus . What syndrome is shown?
a. Goldenhar (Romberg is hemifacial atrophy)
- Clinical photos. Basal Cell Nevus Syndrome. What else would kids show?
a. Hypertelorism - seen in 40% of patients
- CT scan. Pt s/p MVA, NOE frx. Large fragment displaced, still attached to medial canthal tendon. Fracture site is comminuted. How do you classify? Markowitz
a. II
• Type I fractures involve a single, noncomminuted, central fragment without medial canthal tendon disruption (left-unilateral, right-bilateral).
• Type II fractures involve comminution of the central fragment without medial canthal tendon disruption (left-unilateral, right-bilateral).
• Type III fractures result in severe central fragment comminution with medial canthal tendon disruption (left-unilateral, right-bilateral).
- Separation of the upper lateral cartilage from the lower lateral cartilage. What does that do to the tip?
a. Cephalic tip rotation, projection - interrupt the ligamentous connections of the upper and lower lateral cartilages. This can result in cephalic tip rotation
What muscles not affected when performing a Browpexy?
a. Procerus
• Incision is through the orbicularis oculi, frontalis is elevated and well as lateral aspect of corregator.
- What are the indications for browpexy?
a. Pt not undergoing formal brow lift or who have relapsed following brow-lifting and still require brow elevation
- What muscle opens the Eustacian tube?
a. Tensor veli palatini
• The eustachian tube opens upon swallowing or yawning by contraction of the tensor veli palatini muscle. Defective tensor veli palatini muscle function in cleft palate results in eustachian tube dysfunction.
- What muscle tenses or closes the soft palate?
a. Levator veli palatini
- What are the indications to repair VPI?
a. good movement of lateral pharyngeal wall
- Flap for VPI with proper functioning lateral pharyngeal walls?
a. Superior pharyngeal based flap
- Monostotic fibro-osseous dysplasia is associated with what?
a. Found in children
- What field of vision is the last to improves with a resolving hyphema?
a. Downward gaze due to gravity
- What is hyphema caused from?
a. Caused by rupture of an iris or ciliary body vessel, usually results from blunt trauma
- Blunt trauma to the eye causing ciliary injection?
a. Synonym for hyphema
- Patient with cherubism. How to manage his osseous lesions?
a. Treatment of cherubism is usually conservative and expectant and into the
teenage years is devoted to trying to aid eruption of the teeth, which is often abnormal. Later it is directed toward cosmetic recontouring of the affected bones. The lesions normally become less active And less vascular toward the end of the second decade and into the third decade, and it is at this time that most cosmetic remodeling is carried out.
Radiation NOT indicated due to risk of radiation sarcoma
- Genetic defect of cherubism?
a. autosomal dominant - chromosome 4p16.3
- Histologically cherubism most similar to?
a. Central giant cell granuloma –
• Perivascular cuffing is often present in cherubism, and in some cases can be used to differentiate the two lesions
Which of the following medicines can lead to lactic acidosis in the NIDDM patient?
a. Metformin (glucophage
- Which of the following injectables help to improve dynamic rhytids?
a. Botox – inhibits the release of acetalcholine
- Inferior oblique muscle originates from where?
a. The inferior oblique muscle arises from a small depression on the orbital plate of the maxilla just behind the margin and slightly lateral to the bony nasolacrimal canal
- Innervation of the extraocular muscles?
a. LR6(SO4)3.
- Elderly man with rapidly growing lesion on sun exposed lower lip. Clinical photo - Sun exposed skin, Histology - central keratin plug.
a. Keratoacanthoma
- 45 y/o male with pain in mandible and lytic lesion radiograph. Histology slide illustrated plasma cells. Diagnosis?
a. Plasmacytoma
- Blood supply for the deltopectoral flap?
a. Internal mammary artery
- Blood supply for the platysma flap?
a. Submental branch of the facial artery, superior thyroid, transverse cervical, occipital
- Blood supply of the iliac free flap?
a. Deep circumflex iliac artery and vein
- Blood supply for the nasolabial flap?
a. Angular artery
- Success of submucosous vestibuloplasty based on?
a. Maintenance or prolonged use of a splint
- Melanoma is measured in mm from the top of the granular cell layer to the deepest identifiable point but what classification?
a. Breslow Breslow’s microstages evals tumor thickness in melanoma. Evaluatess the thickest part of the tumor and measures distance between granular layer of the epidermis and the deepest identified tumor cell Stage Depth 5 yr Survival (%) 1 <0.76 mm >98 2 0.76-1.49 mm 87-94 3 1.50-4.00 mm 66-83 4 >4.00 mm <50
Clark’s levels indicate tumor invasion by relating the most deeply invading tumor cells to surrounding structures Levels 5 yr Survival (%) 1 Intraepidermal 99 2 Invasion of papillary dermis 95 3 Fill the papillary dermis 82 4 Invasion of reticular dermis 71 5 Invasion of fat 49
- Male patient with elevated acid phosphatase.
a. prostate cancer
- Clinical slide of a 27 y/o male with large hyperplastic gingival growth in maxilla and mandible. Histology slide – showed thickened epithelial layer. What is the condition (gingival hyperplasia) due to?
a. Calcium channel blocker (verapamil), phenytoin (dilantin)
- What is the best radiograph for localizing salivary gland tumors?
a. T2 weighted MRI
Both T1 and T2 images show the margins of the lesion with equal clarity the tumor composition is better defined with T2 sequences and the detection of subtle areas of disease by short inversion tau inversion recovery (STIR) sequences.
- Contraindications for flumazenil?
a. Mixed drug OD and chronic benzodiazepine use
- Anisocoria is unequal pupils. What situation is this clinical condition associated with?
a. Uncal herniation
Uncus pushed over tentorial edge by hematoma. The uncus can squeeze the third cranial nerve, which controls parasympathetic input to the eye on the side of the affected nerve. This interrupts the parasympathetic neural transmission, causing the pupil of the affected eye to dilate and fail to constrict in response to light as it should, so a dilated unresponsive pupil is an important sign of increased intracranial pressure
- Uncal herniation can manifest with what findings?
a. Ipsilateral fixed dilated pupil with contralateral hemiparesis
- Most common complication of ORIF of mandible.
a. Malocclusion
- Most common bleeding in Le Fort surgery that is difficult to control?
a. Internal maxillary artery -
Vessels most at risk are the internal maxillary artery, the PSA, and the greater palatine.
- Most common bleeding following LeFort surgery?
a. Descending palatine arteries
- What contributes most to relapse of the inferior positioned Le Fort I?
a. Occlusion
- Dorsal hump removal. What plane of dissection to be in?
a. superior to the lateral cartilages (suprachondrial) and inferior to the nasal bones peristeum (subperiosteum)
- What layer do you suture in an inferior alveolar nerve repair?
a. Outer epineurium
Neurorrhaphy is the act of nerve suturing for both direct and gap repairs. The trigemina lnerve is repaired using epineurial sutures, not perineurial sutures.
- How many sutures are placed in a anastamosis of a nerve?
a. 2-4 placed in the epineurium
At least two sutures are used per anastomosis site to prevent rotation, but not more than three or four sutures should be used per anastomosis.
- A transected nerve is classified under Seddon system as what?
a. Neurotmesis
Seddon
Neuropraxia (1st degree),
Axonotmesis (2nd, 3rd and 4th degree),
Neurotmesis (5th degree)
Sunderland
Degree of Injury Recovery Pattern Rate of Rec. Tx
1st complete fast (days to weeks) None
2nd complete Slow (weeks) None
3rd Slow (wks to mth) Nerve exploration Variable
4th Unlikely Microneurosurg None
5th No recovery Microneuro None
- Intial sign of cavernous sinus thrombosis?
a. Abducens paresis - Loss of lateral gaze – CN VI
- Open bite at the end of a LeFort case. Due to what?
a. Distraction of condyles, unrecognized posterior interferences
- Most common complication to TMJ arthroscopy?
a. Joint surface scuffing
- Young girl with TMJ and progressive open bite. What is diagnosis?
a. rheumatoid arthritis
- Injury to neurovascular bundle with TOVRO?
a. Excessive medial dissection
- What is the stability of a BSSO advancement mainly due to?
a. fixation
- Where is the needle position during a Gow-Gates block?
a. Condylar neck
Extra-oral landmarks - tragus, intertragal notch
Intra-oral landmarks - medial aspect of condyle
- Missed IAN block. Where is the needle placed?
a. below mandibular foramen
- Medial cut on BSSO too high, what complication can happen?
a. Condyle remains on distal segment
- Most important factor with a cortical bone (onlay) graft to the alveolus for future implant is?
a. fixation to stabilize
- When to treat retrobulbar hematoma?
a. Pain, increase intraocular pressure, decreased visual acuity
- Modified and Classic Le Fort III cuts
Septal Cut: Nasal bones through the perpendicular plate of the ethmoid and vomer at posterior palate
Lateral Cut: Positioning of cut into the orbital floor and inferior orbital fissure
- Where do you separate the nasal septum in LeFort III
a. Through the perpendicular plate of the ethmoid and the vomer at the posterior plate
- Disinsertion of the levator palpebrae superioris causes what?
a. Loss of tarsal fold and upper lid ptosis
- Main etiology of periorbital cellulites?
a. Preseptal infection
- Proptosis involving orbital cellulitis
a. Post-septal
- Von Willebrand disease. What happens to BT, PT and PTT
a. Prolonged bleeding time, decreased ristocetin cofactor activity, and a variable decrease in factor VIII activity that may be associated with prolongation of the aPTT. PT should be within the reference range.
- What process involves the perihilar nodes?
a. Sarcoidosis –
MAO inhibitors. Do not use with what medication?
a. Meperidine
- Pt with JVD and right ventricle and left atrial hypertophy has what?
a. Mitral stenosis
- Best monitor for P waves in office anesthesia?
a. Lead II
- Aortic Stenosis predisposes to what?
a. Syncope and sudden death
- Sudden cardiac death’s etiology usually is of cardiovascular in origin. What rhythm is most seen?
a. ventricular tachycardia or chaotic ventricular fibrillation or both
- Patient with angina. What is most ominous sign?
a. Hypotension with bradycardia
- Patient with MI, what is the most ominous sign?
a. Diaphoresis and tachycardia
- Malignant hyperthermia. What enzyme is elevated?
a. Creatine Kinase
- Advantage of costochondral graft for TMJ reconstruction.
a. Adaptive
Costochondral grafts contain both bony and cartilaginous tissue. The cartilaginous component is useful for providing an articular surface for the TMJ and for providing a growth center in growing patients.
- Characteristic of pt w. OSA?
a. Look at position of hyoid bone, posterior airway space, soft palate length
- Earliest age to perform lip adhesion procedure?
a. 3 months
Lip adhesion is usually completed at 3 months of age. In most cases this will convert a wide complete cleft into a wide incomplete cleft as the scar will eventually be excised from the cleft site recreating a similar wide deformity. The definitive lip repair is then completed 3 to 9 months later by excising the scar and reapproximating the remaining lip structures.
- Location of most nasal airway resistance?
a. Internal nasal valve
- Internal nasal valve is formed from?
a. Upper lateral cartilage and septum
- Length of screw in ZF region to reach brain?
a. 8mm
- Layers encountered with retroseptal transconjuntival dissection of the lower eyelid
a. Post-septal approach - Conj, retractors, periosteum
• Pre-septal approach – Conjunctiva, retractors, septum, periosteum
- What is the fluid deficit of a 70kg man NPO for 10 hrs.?
110cc/hr x 10 hrs = 1100cc
- At rest the cell membrane is least permeable to?
a. Na. At rest membrane is more permeable to K than Na
