QBank 3 Flashcards
- Sedated patient unresponsive to stimulation with regular breathing; tears from her eyes:
a. Light plane of general anesthetic
- Ellis classification tooth fractures when enamel, dentin, and pulp involved:
a. Class III
Ellis classification I–fracture within enamel; II–fracture of enamel-dentin; III–fracture involving pulp; IV–fractures involving the roots
- Obstructive vs Restrictive lung disease.
- Obstructive lung disease – a decrease in the exhaled air flow caused by a narrowing or blockage of the airways, which can occur with asthma, emphysema, and chronic bronchitis.
- Restrictive lung disease – a decrease in the total volume of air that the lungs are able to hold. Often, this is due to a decrease in the elasticity of the lungs themselves or caused by a problem related to the expansion of the chest wall during inhalation.
- Effect of Aortic stenosis in MAP?
a. Decrease
At very beginning, aortic stenosis will cause decrease in MAP. this wil lead to compensatory overactivity of heart in short term via sympathetics, while in the long term there will be hypertrophy of left ventricle. these will lead to increase force generation whixch will lead to increased pressure in left ventricle and bringing the MAP towards normal. but as always, compensation is never complete
- Why is Versed the quickest acting benzo?
Most lipid soluble
Because Versed is water soluble it does NOT need Propyl Glycol as carrier (as Diazepam does) and is therefore less irritating to the vein, but its lipid solubility accounts for quick onset)
- Muscle relaxant used in renal pts?
a. Atracurium
Atracurium is a widely-used non-depolarising neuromuscular blocker causing muscular relaxation. It has a short duration of action (20 minutes) because of stability only in cold, acidic environments. It degrades rapidly in the body and so is independent of liver and renal elimination. This is of value in patients with dysfunction of these systems.
- Lethal rhythm most commonly seen in cardiac arrest pts?
a. V-fib
- Drugs that cause Methemoglobinemia?
a. Prilocaine >600mg
• Tx-Methylene Blue 1-2mg/Kg IV
The blood supply to the inferior turbinates:
a. Segment supplied by ethmoidal artery off ophthalmic artery
- What could be damaged during an inferior meatus antrostomy?
a. Nasolacrimal duct
- The most common rhythm seen in cardiac arrest?
a. V fib
- Which form of TMJ noise has the best prognosis?
a. Early opening, late reciprocal click
- What happens to serum Ca, PO4 levels s/p removal of parathyroid glands?
a. Remove glands then calcium (down) and PO4(up)
- Disruption of the BBB?
a. Disrupted by severe HTN, tumors, trauma, strokes, infection, marked hypercapnia, hypoxia, and sustained seizures.
- Cerebral Perfusion Pressure is the difference between?
a. MAP and ICP.
CPP less than 50 mm Hg shows cerebral slowing
CPP between 25-40 mm Hg flat EEG
CPP less than 25 mm Hg will result in irreversible brain function
- Diazepam exerts a synergistic effect when administered concurrently with
a. cimetidin, eerythromycin, diltiazem, verapamil, ketoconazole and itraconazole
Caution is advised when midazolam is administered concomitantly with drugs that are known to inhibit the P450 3A4 enzyme system such as cimetidine (not ranitidine), erythromycin, diltiazem, verapamil, ketoconazole and itraconazole. These drug interactions may result in prolonged sedation due to a decrease in plasma clearance of midazolam.
- Tooth in the infratemporal fossa after cautious attempt at removal what next?
a. close, ABX, Wait 4-6 weeks and attempt again after triangulating with radiographs
- Moebius Syndrome.
a. Moebius Syndrome is a rare disorder characterized by lifetime facial paralysis. People with Moebius Syndrome can’t smile or frown, and they often can’t blink or move their eyes from side to side. In some instances, the syndrome is also associated with physical problems in other parts of the body. Two important nerves - the sixth and seventh cranial nerves - are not fully developed, causing eye muscle and facial paralysis. The movements of the face - blinking, lateral eye movements, and facial expressions are controlled by these nerves. Many of the other 12 cranial nerves may also be affected, including the 3rd, 5th, 8th, 9th, 11th and 12th.
- Fixed unilateral pupil LEAST likely cause:
a. CN II injury
- What joins the maxillary vein to from the retomandibular vein?
a. Sup temp V.
- Between what two fat pads does the inferior oblique muscle run?
a. The IO muscle runs between the nasal and middle fat pad
• There are two upper and three lower fat pads
- Which pharyngeal flap is indicated when there is good lateral wall movement?
a. Superior base pharyngeal flap
- What is the most common postop problem assoc with tracheostomy?
a. Tracheal stensosis
- What is the primary elevator of the palate?
a. levator veli palatini
- Which muscle protrudes the tongue?
a. Genioglossus
- A patient with a bleeding disorder is given desmopressin, what will this cause?
a. Decreased urine volume and increased urine osmolality
- The blood supply for a free ilum is:
- The blood supply for a free ilum is:
a. deep circumflex because of the diameter of the vessel and its predictability
- Radial forearm- radial a and v
- Fibula- peroneal
- Scapular- circumflex scapular a.
- Pec- thoracoacromial a. (primary), lat and sup thoracic (secondary)
- Lat. Dorsi- thoracodorsal a and v
- Trapezius- transverse cervical a
- Deltopectoral skin flap- random pattern cutaneous flap with peforators from internal mammary a
- SCM- occipital a (primary), sup thyroid (secondary)
- Median forehead- supratrochlear (primary), supraorbital and dorsal nasal (secondary)
- Temporalis- deep temporal a
- Temporoparietal fascia- superficial temporal a
- Platysma- subdermal plexus (random pattern flap mainly), also supplied by submental a (some people will claim this to be an axial flap-based on the submental artery, but this is debatable)and superior cervical a (less predictable)
- Which bones comprise the external nasal vault?
frontal process of maxilla
Bones of external nose: paired nasal bones, frontal bone, frontal process the maxilla or nasal process of the maxilla.
The external nasal valve is defined laterally by the nasal ala and medially by the septum, whereas the internal valve is defined by the attachment of the upper lateral cartilage to the septum, which forms an angle of approximately 15°
- Which muscle is not dealt with by a brow lift?
a. orbicularis oculi
- What is the treatment of dry socket/alveolar osteitis?
a. irrigation and placement of topical ointment/eugenol
- What are the most common bacteria involved with human bites?
a. staph and strep
- What is the blood supply of a pedicled buccal fat graft for closing an OA fistula?
a. blood supply from branches of Imax
- A patient has 2 previous attempts to close an OA fistula, what should be done to improve the chances of success?
a. clear any infection
- What is the first line drug of choice for treating PSVT?
a. adenosine
Stable patient treatment:
• Vagal stimulation (carotid message, valsalva)
• Adenosine
• Calcium channel blockers: verapamil, diltiazem
• Beta blockers: metoprolol or esmolol
- A middle aged male pt has diffuse muscle pain and has no jaw dysfunction, what is the diagnosis?
a. fibromyalgia
- Which is the antibiotic treatment for mucormycosis infections?
a. amphotericin B
Treatment includes: radical debridement and high dose amphotericin B.
- The difference between a thermal burn and an electrical burn in a child is which of the following?
a. deep underlying tissue destruction with possibility of late bleeding
Electrical burns have may cause distant organ damage and necrosis due to conduction of current and density; bones>skin>muscle; electrical burns occur more commonly in early childhood due to exploration and adulthood due to work
- What is the best medical treatment for post-herpetic neuralgia?
a. tricyclic antidepressants
- What is the best medical treatment for trigeminal neuralgia?
a. Anticonvulsants- carbamazepine (Tegretol) and muscle relaxants Lioresal (Baclofen)
- What is the most common complication from arthroscopy?
a. scuffing of disk
- Pt with a vitek implant and bony changes on MRI, what is best treatment?
a. remove prosthesis and reconstruct with total joint
- Which patient is best to have hylauronate injected into the TMJ?
a. patients with large MIO, acute closed lock and steep posterior slope of eminence
- What are the indications for arthrocentesis?
a. Persistant closed lock, previous invasive procedure, point tenderness, internal derangement associated with hypomobility due to adhesions, disk immobility and disk displacements, degenerative disease, synovial disease and hypermobility
- 21 y.o. patient with bilateral TMJ pain and a progressive open bite, what is diagnosis?
a. Rheumatoid Arthritis
Chronic inflammatory synovium- B lymphocytes infiltration and expansion, macrophages and T cell invasion release cytokines which lead to synoviocyte proliferation; diagnosis: atleast 1 joint with arthritis > 6 wks, age <16 yrs excluding other causes; labs reveal increased ESR, possible lymphopenia, thrombocytopenia, anemia; articular- girls>boys, systemic- girls=boys, polyarticular- >5 joints, pauciarticular- arthritis affecting 4 or fewer joints
- A kid presents with what sounds like post-septal cellulitis after a tooth extraction involving the maxillary sinsus, he has decreased visual acuity, how do you treat?
a. admit and give IV Abx
- A patient has sympathetically mediated pain what is best treatment?
a. clonidine and phentolamine
- Why are more impacted 3rd molars seen today than previously?
a. change in diet resulting in less attrition of fewer permanent teeth
- What is the test performed before doing a free radial forearm flap?
a. Allen’s Test
- One child is born with a cleft to normal parents, what is the chance of having a second child with a cleft?
a. 4%
- Normal parents with 1 cleft child= 4%
- 1cleft parent with 1 cleft child= 13%
- 1 cleft parent and no children= 2-7%
- Normal parents with 2 cleft children=19%
- 1 cleft parent and 2 normal children=3.5%
- Frey’s syndrome is?
a. para and sympathetic innervation of sweat glands
Cross innervation of auriculotemporal nerve (branch of V3) with otic ganglion and glossopharyngeal nerve (parasympathetic) causing gustatory sweating; aka auriculotemporal syndrome
- What is the most common side effect of romazicon?
a. >10% nausea and vomiting,
• 1-10% palpitations, seizures with long term benzodiazapam use
- Which drug is most likely to cause an arrhythmia?
a. terbutaline
- A patient is s/p ORIF of a mandible fx, which of the following would be a good reason to remove the hardware?
a. infected hardware that is not providing any fixation
- During submental liposuction, which direction should the opening of the cannula face?
a. towards the platysma
- What happens to the level of potassium in a patient in DKA who is given insulin?
a. extracellular level decreases
- A patient with rheumatoid arthritis may have which of the following respiratory problems?
a. restrictive lung disease
- How would you treat a patient that had an alveolar ridge augmentation with HA 3 months ago and now has infraorbital dysesthesia?
a. remove the HA
- OSA can lead to which long term problem?
a. Right sided CHF