QBank 2 Flashcards
<p>202. Urine output of a 70kg man over 24 hrs?</p>
<p>a. 840 to 1890 cc • 0.5cc/kg/hr x 70kg x 24hrs = 840cc minimum • 1.0cc/kg/hr x 70kg x 24hrs = 1890cc Adults: 0.5 – 1.0 cc/hr Children: 1.0 – 1.5 cc/hr Infants: 1.5 – 2.0 cc/hr</p>
<p>203. Minimum blood loss in a 70kg male to alter systolic blood pressure?</p>
<p>a. 1500-2000ml Class III shock
Class I Class II Class III Class IV
Blood loss (mL) Up to 750 750–1,500 1,500–2,000 > 2,000
Blood loss (% vol) Up to 15 15–30 30–40 > 40
Pulse rate < 100 > 100 > 120 > 140
Blood pressure Normal Normal Decreased Decreased
Pulse pressure Normal or Decreased Decreased Decreased
increased
Respiratory rate 14–20 20–30 30–40 > 35
Urine output (mL/h) > 30 20–30 5–15 Negligible
Mental status Slightly Mildly Anxious, Confused,
anxious anxious confused lethargic
Fluid replacement Crystalloid Crystalloid Crystalloid Crystalloid
and blood and blood</p>
<p>205. A 21-year-old female is an unrestrained driver involved in a MVA. She suffers a scalp laceration and is noted to have lost 1000mL of blood at the scene. You would expect her vital signs to be consistent with:</p>
<p>a. Pulse rate >100, normal systolic blood pressure, decreased pulse pressure, respiratory rate of 20-30, urinary output of 20-30mL/hr.
These findings are consistent with a Class II hemorrhage, 750-1500ml, The vitals signs or such a blood loss are consistent with those in response A. Response D reflects the vital signs of a Type IV blood loss, Response C a Type III and Response B a Type I.</p>
<p>206. Primary (direct)- callus free- bone healing involves what?</p>
<p>a. Direct contact between the bony segements</p>
<p>207. Which drug causes burning sensation on injection?</p>
<p>a. Propofol</p>
<p>208. When do you not use propofol?</p>
<p>a. White soybean oil-egg yolk lecithin emulsion
A history of egg allergy does not necessarily preclude the use of propofol, as the egg protein contained in the suspension is lecithin, whereas most egg allergies consist of a reaction to egg albumin</p>
<p>209. Uprighting an impacted 2nd molar is best done when?</p>
<p>a. The optimal time for uprighting a molar tooth is when 2/3 of the root has formed
When impaction of a second molar is identified, consideration should be given to correcting the impaction before the roots are fully formed. The optimal time for uprighting a molar tooth is when two-thirds of the root has formed; molars with fully formed roots have a poor prognosis.</p>
<p>210. You are uprighting an impacted 2nd molar, you need to do what?</p>
<p>a. Stabilize to 1st molar, avoid occlusal forces
An extremely important part of this surgical procedureIs ensuring that there are no occlusal forces on the repositioned second molar. This generally does not require equilibration on the opposing tooth, but an occlusal adjustment can be performed if necessary.</p>
<p>211. Long term consequence of third molars?</p>
<p>a. Periodontal defect</p>
<p>212. Removal of third molars for?</p>
<p>a. Periodontal concerns</p>
<p>213. How to distinguish between one or two fractures on panorex?</p>
<p>a. One fracture – lines converge at inferior border
| Two fractures –lines diverge and separate at inferior border</p>
<p>214. Osteoprogenitor cells?</p>
<p>a. Mesenchymal cells</p>
<p>215. What is synonomous with an allograft?</p>
<p>a. Homologous graft
• Allograft – transplant from one individual to a genetically non-identical individual of the same species
• Autograft – from on region to another in the same individual
• Xenograft (heterogenous graft) – transplant from one species to another</p>
<p>216. What causes rejection of a facial implant rejection of homograft?</p>
<p>a. Cell mediated – cellular immunity
The major source of antigenicity in allografts is the cellular elements of bone.</p>
<p>217. Which repositioning has the greatest increase in alar flare in a Lefort I?</p>
<p>a. a) superior repositioning of the maxilla causes elevation of the nasal tip, widening the alar bases and decrease the nasolabial angle.</p>
<p>218. Loss of articular cartilage most likely causes pain in the joint?</p>
<p>a. Subchondral nociceptive fibers</p>
<p>219. Property of drugs that cross thee BBB?</p>
<p>a. Lipophilic and nonionized
* Freely crosses: high lipid solubility and CO2, non ionized
* Pooly cross: ions, proteins, and large substances</p>
<p>220. Osteoinduction vs. Osteoconduction</p>
<p>Osteoinduction – new bone formation from the differentiation of osteoprogenitor cells, derived from the primitive mesenchymal cells, into secretory osteblasts. Under the influence of BMP,
Osteoconduction – new bone from host-derived or transplanted osteoprogenitor cells along a biologic or alloplastic framework. Provided a passive framework or scaffolding.</p>
<p>221. What are the papillary signs seen in severe HTN?</p>
<p>a. AV nicking arteries</p>
<p>222. What is the plane of elevation of the facial nerve during a preauricular dissection below the zygomatic arch?</p>
<p>a. Deep to the superficial layer of the temporalis fascia</p>
<p>223. Relationship of frontal branch of the facial nerve?</p>
<p>a. Between the SMAS and temporal fascia</p>
<p>224. A lab report indicates coagulase positive. This refers to what?</p>
<p>a. Coagulase is an enzyme that coats the bacteria with fibrin and reduces the ability of the host cell to phagocytize it. S. aureus is the only coagulase-positive staphylococci</p>
<p>225. Sural nerve harvest. Where is the sensory deficit?</p>
<p>a. Posterior lower extremity and the dorsolateral foot - The sural nerve, or medial sural cutaneous nerve, is a branch of the sacral plexus (S1, S2) and supplies sensory information to the posterior lower extremity and the dorsolateral foot.</p>
<p>226. Synovial membrane that is redundant, hyperemic, capillary proliferation?</p>
<p>a. Synovitis
• Synovitis occurs when the level of cellular debris and the concentration of chemical mediators of inflammation and pain produce levels that the synovial membrane is unable to ingest, absorb, or process
• Acute synovitis – aute inflammation with dilated superficial capillaries – initially without hyperemia, but progressively increasing to hyperemia until it obliterates the superficial vascularity
• Chronic synovitis – characterized by synovial hyperplasia with an increased proliferation of tissue folds, particularly in the retrodiskal area. Synovitis with fibrous adhesions present is most marked after previous arthrotomy or arthroscopic surgery</p>
<p>227. Pt has trismus after injection. Injury to what muscle?</p>
<p>a. Medial ptyerygoid</p>
<p>228. Best management non surgical of OSA patient?</p>
<p>a. Weight loss and CPAP are the initial modes of therapy that should be initiated in obese patients with moderate obstructive sleep apnea.</p>
<p>230. Which of the following patients will benefit from PEEP?</p>
<p>a. ARDS</p>
<p>231. Effects of ketamine?</p>
<p>a. Sympathomimetic – increases heart rate, BP</p>
<p>232. Mandibular 2rd molar root pushed through lingual plate and non palpable in floor of mouth. What is most likely space involved?</p>
<p>a. Submandibular –
• inferior alveolar canal
• cancellous bone space
• submandibular space</p>
<p>234. Make medial osteotomy too high. What can happen?</p>
<p>a. Condyle may stay in the distal segment</p>
<p>235. Chora Typani is a branch off of what nerve?</p>
<p>a. Cranial nerve VII</p>
<p>236. Complications of massive transfusion.</p>
<p>a. Dilutional thrombocytopenia
Complications of massive blood transfusion: thrombocytopenia, coagulation factor depletion, oxygen affinity changes, hypocalcemia, hyperkalemia, acid/base disturbances, hypothermia, and ARDS</p>
<p>237. Where are Headaches in a typical TMJ internal derangement?</p>
<p>a. Temporal</p>
<p>238. A crushing injury to the NOE region results in detachment of the medial canthal ligament leading to?</p>
<p>a. Traumatic telecathus</p>
<p>239. Where are verocay bodies found?</p>
<p>a. Neurilemoma (Schwannoma)</p>
<p>240. Tzank test used for what?</p>
<p>a. Tzank smear is used in the diagnosis of herpesvirus infections (Tzank cells also seen in pemphigus vulgaris)</p>
<p>241. Aortic stenosis.</p>
<p>a. syncope and sudden cardiac death</p>
<p>242. Female patientt, pano left body of mandible with impacted premolar with radiolucent lesion completely surrounding impacted premolar displace to inferior mandible. What is diagnosis?</p>
<p>a. Adenomatoid Odontogentic Tumor (AOT) - usually associated with anterior maxilla but not always</p>
<p>244. Orbital apex syndrome vs. superior orbital fissure syndrome. What is the difference?</p>
<p>a. Decreased visual acuity
Symptoms of superior orbital fissure syndrome include:
1. Pupillary dilation via alteration in cranial nerve III function in it's innervation of the pupillary constrictors.
2. Paresis of cranial nerves III, IV, and IV causing ophthalmoplegia.
3. Cranial nerve III involvement causes paresis of the levator palpebrae superiorus muscle, leading to ptosis and loss of the superior palpebral fold.
4. Neurosensory disturbance to the first division of cranial nerve V with hypesthesia of the supraorbital and supratrochlear nerves and loss of the corneal reflex.
5. Proptosis from engorgement of the ophthalmic vein and lymphatics.
The orbital apex syndrome includes all of the above plus optic nerve involvement, leading to changes in visual acuity.</p>
<p>245. Loss of taste sentation after 3rd molar removal. What impaired cranial nerve?</p>
<p>a. Cranial nerve V (Chorda tympani traveling on CNV)</p>
<p>246. Easiest way to assess cardiac trauma on table?</p>
<p>a. EKG</p>
<p>247. A patient seen in the emergency department presents with: elevated venous pressure, muffled heart sounds, and decreased arterial pressure. What is the most likely diagnosis?</p>
<p>a. Cardiac tamponade</p>
<p>248. Ketamine contraindicated in:</p>
<p>a. Hypertensive patients, also avoid in head trauma (increases ICP)</p>
<p>249. What anesthetic gas to avoid with history of atrial fibrillation?</p>
<p>a. Halothane</p>
<p>250. Widen mediastinum on CXR indicates what?</p>
<p>a. Aortic dissection</p>
<p>251. Antibiotics most effective when MIC is what?</p>
<p>a. 2-4x
• The usual recommended dose of an antibiotic is usually sufficient to provide threefold MIC concentration against the common susceptible organism</p>
<p>252. Maintain lip length s/p orthognathic surgery. How?</p>
<p>a. V-Y closure</p>
<p>253. Resuscitation of kids. What technique?</p>
<p>a. Head Tilt</p>
<p>254. What nerve mediates temperature and pain?</p>
<p>a. A delta and C</p>
<p>What side effect of flumazenil?</p>
<p>a. May unmask seizure disorder and Nausea and Vomiting</p>
<p>256. What is associated with Plummer Vinson syndrome?</p>
<p>higher incidence of esophageal cancer</p>
<p>257. What is a poor prognosis sign of patient with squamous cell carcinoma of maxillary sinus?</p>
<p>a. Pain is often a late, therefore ominous sign</p>
<p>258. Neurogenic shock is due to what?</p>
<p>a. Neurogenic shock is shock caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls.
This can result from severe central nervous system (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure. Classic picture hypotension without tachycardia or cutaneous vasoconstriction. Narrow pulse pressure is NOT seen.</p>
<p>259. What is the best way to determine proper faical projection with reduction of panfacial fracture?</p>
<p>a. Zygomaticoshenoid junction
The sphenozygomatic suture area has been previously analyzed and shown to be an area for confirmation of alignment of the zygomatic arch and the zygomatic complex (ZMC). This has also been shown to key point for fixation thru biomechanical studies.
The sphenozygomatic suture is a broad area along the greater wing of the sphenoid and can be approached along the internal aspect of the lateral orbit. Even in severe midface fractures the greater wing of the sphenoid is intact thus acting as a key landmark for proper reduction of the ZMC fracture.
Reduction of the frontozygomatic suture or the infraorbital rim alone can result in errors due to the small surface area. The medial orbit is generally not involved in a ZMC fracture.</p>
<p>260. Vestibuloplasty procedure. Where is mucosa sutured at depth of vestibule?</p>
<p>a. Mucosa is sutured to the vestibular depth at the area of the periosteal attachment</p>
<p>261. What is the most common cause of impacted second molar?</p>
<p>a. Impacted 3rd molar</p>
<p>262. Mandibular osteotomy vs. placement of a medpor implant to augment chin. What is the advantage of the osteotomy?</p>
<p>a. Less resorption</p>
<p>263. What post operative complication is the most difficult to correct after laser skin resurfacing?</p>
<p>a. hypopigmentation</p>
<p>264. What type of speech is most common after Lefort surgery?</p>
<p>a. Hypernasal</p>
<p>265. Clinical case 17 y/o female Hispanic patient. Ceph shows apertognathia, posterior VME, class I molar occlusion, gingival show at repose. How to tx?</p>
<p>a. Segmental Lefort</p>
<p>266. What subnucleus of the trigeminal brainstem nucleus is primarily involved in the receiving and processing of facial pain?</p>
<p>a. Subnucleus caudalis of CN 5</p>
<p>267. What is the most common type of condyle fracture in children?</p>
<p>a. Compressive</p>
<p>268. Where is the most common source of infection in mandible fracture?</p>
<p>a. Angle</p>
<p>269. What concerns the anesthesiologist about a patient with rheumatoid arthritis?</p>
<p>a. Restricted neck mobility and the possibility of dislocation of cervical vertebrae</p>
<p>270. Most common complication associated with compression osteosynthesis?</p>
<p>a. Necrosis at bone interface</p>
<p>271. When does the blood supply to the STSG begin:</p>
<p>a. Survives 48 hours by plasmatic imbibition, Revascularization complete in 4-7 days.</p>
<p>272. Most difficult mandibular defect to reconstruct?</p>
<p>a. Symphysis – Cainine to canine region due to curvature of anterior mandible</p>
<p>273. What percentage of lingual nerve rises above the level of the alveolar crest in the area of the third molar?</p>
<p>a. 10-15%
| 15% (Pogrel), 17.9% (Kisselbach and Chamberlain)</p>
<p>274. What is the best solution for a dislodged tooth?</p>
<p>a. Hank’s balanced salt solution</p>
<p>275. What is the conventional wisdom regarding the maximum time that the tooth has before reimplantation to have a shot at viability?</p>
<p>a. 120 minutes, periodontal ligament fibers become irreversibly necrotic after this time frame</p>
<p>276. Treatment of avulsed tooth, out 3 hrs, but patient kept in mouth. Do you treat it with:</p>
<p>a. Root canal first before reimplantation</p>
<p>277. You are extracting a maxillary third molar &amp; you displace it into the sinus &amp; get profuse bleeding. Where is the bleeding coming from?</p>
<p>a. Posterior Superior Alveolar Artery</p>
<p>278. Best way to close an oro-antral fistula from a 1st molar of 8 mm?</p>
<p>a. Openings greater than 6 mm require primary closure
Openings less than 2mm, nosurgical treatment is necessary providing adequate hemostasis. Openings 2-6 mm conservative treatment is indicated including placement of figure of eight suture over the socket, gelfoam and sinus precautions.</p>
<p>279. Indications for Buccal Fat pad closure of O-A fistula?.</p>
<p>a. Defects greater than 6 mm</p>
<p>280. A pediatric patient presents to our office 2 weeks following trauma to a primary central incisor. The tooth is now discolored, but otherwise asymptomatic. What is your treatment?</p>
<p>a. Observation</p>
<p>281. What type of mandibular fracture poses the greatest risk of airway obstruction?</p>
<p>a. Bilateral angle fracture</p>
<p>282. Child bitten by a dog 3 days ago, now infected, what is the most likely organism?</p>
<p>a. Pasturella multicedins
Augmentin is the antibiotic choice because it is bacteriocidal for the range and spectrum of human and animal bite pathogens including Staphylococcus species and Pasteurella multocida.</p>
<p>283. When you bite on your anterior teeth describe the forces applied over an angle fracture?</p>
<p>a. Tension at the alveolus, compression at the inferior border</p>
<p>284. Patient has flaccid elbow &amp; wrist reflex, but normal triceps reflex following MVA, what is the level of C-spine injury?</p>
<p>a. C 5-6 (triceps is C 7)</p>
<p>285. Primary bone healing requires?</p>
<p>a. Bone-bone contact &amp; compression across the fracture site</p>
<p>286. What type of plate &amp; screw fixation provides the most stable fixation?</p>
<p>a. Neutral zone
| However, this is not possible in the mandible, since the neutral zone is in direct line w/ the IAN</p>
<p>287. What is the thickness of the superior tarsal plate</p>
<p>a. 1 mm, (length 25mm, height upper 10mm, height lower 4mm)</p>
<p>288. What is the position of the upper eyelid, at primary gaze, in relation to the limbus?</p>
<p>a. 2-3mm inferior</p>
<p>289. Aniscoria status post trauma, where is injury in brain?</p>
<p>a. Compression of midbrain
~~~
All the following can be the cause s/p trauma
• Normal-physiologic
• Horner’s syndrome
• CN III injury
• Tonic pupil</p>
~~~
<p>290. Which fracture would you NOT use a compression plate for?</p>
<p>a. Oblique fractures are contraindication to compression plate</p>
<p>291. Best screening test for cardiac contusion?</p>
<p>a. EKG</p>
<p>292. What is the best way to monitor blood loss &amp; fluid status in a trauma patient?</p>
<p>a. CVP and urine output</p>
<p>293. What is the best radiograph to assess displacement of the condyle in a child?</p>
<p>a. CT</p>
<p>294. What is the best radiographic study to evaluate orbital floor disruption?</p>
<p>a. Coronal CT</p>
<p>295. Which of the following will cause traumatic telecanthus?</p>
<p>a. Periorbital lacerations and Type III NOE fracture</p>
<p>296. How to plate &amp; wire a Type III NOE fracture?</p>
<p>a. ORIF, transnasal wiring of canthus – posterior &amp; superior to the lacrimal fossa</p>
<p>297. What is the primary complication for RIF of a mandible fracture?</p>
<p>a. Malocclusion</p>
<p>298. Treatment of a CSF leak, should include?</p>
<p>a. Place patient in head-up, semi-reclining position
| • Semi-Fowler position</p>
<p>299. Where do you make the lateral orbital osteotomy for a Lefort III?</p>
<p>a. Frontozygomatic suture extending into the inferior orbital fissure</p>
<p>300. Why do you need to bone graft in an NOE fracture?</p>
<p>a. To recreate the dorsal-nasal support and correct tip projection</p>
<p>301. When placing an implant, what temperature results in the destruction of bone?</p>
<p>a. 47 degrees Centigrade</p>
<p>302. Indications for a submucous vestibuloplasty?</p>
<p>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.</p>
<p>303. You are placing 5 standard (4.0mm) implants into the anterior mandible of an edentulous patient, between the mental foramina. What is the length of bone, between the foramina needed?</p>
<p>a. 44 mm • 4mm each implant • 3mm between each implant • 5mm between terminal implants and mental foramina • Adds up to: 42 mm</p>
<p>304. Patient who has worn maxillary &amp; mandibular complete dentures without problems, desires a new removable prosthesis with implants. He has 7mm of bone above the mental nerve and IAN canal. What is the most prudent treatment?</p>
<p>a. 2-4 implants in parasymphysis with tissue bar</p>
<p>305. Where is the most stress on an implant?</p>
<p>a. Crown/implant interface</p>
<p>306. In a lip-switch vestibuloplasty, where is the mucosal flap sutures?</p>
<p>a. To the cut periosteal edge at the depth of the vestibule</p>
<p>307. What is the difference between a mandibular staple implant and a TMI?</p>
<p>a. Less bone required for TMI (transmandibular implant)</p>
<p>308. What is the most common long-term complication of costochondral grafts?</p>
<p>a. Asymmetric growth</p>
<p>309. Minimum clearances needed fora bar-attached overdenture?</p>
<p>a. 11 mm
The vertical height needed for a bar attachment can approach 11 mm. This measurement is taken from the occlusal plane to the highest point of the alveolar process. This distance will provide for the height of the bar (2 to 4 mm), 2 mm under the bar for maintenance of hygiene, and at least 7 to 8 mm of restorative material in the overdenture (usually acrylic resin)</p>
<p>310. What percentage of disc recapture following arthroscopy?</p>
<p>a. 0-10%</p>
<p>311. Which form of TMJ noise has the best prognosis?</p>
<p>a. Early opening &amp; late reciprocal click</p>
<p>312. When performing a preauricular approach for TMJ surgery, which statement best describes the position of CN VII?</p>
<p>a. Between the SMAS &amp; the superficial layer of Deep Temporal Fascia</p>
<p>313. How is pain felt when you have a disc perforation?</p>
<p>a. Subchondral nociceptors</p>
<p>314. If done incorrectly, a high condylotomy may cause damage to what nerve?</p>
<p>a. Auriculotemporal nerve</p>