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2022 Flashcards

1
Q

Normal MRD1 and MRD2

A

Distance from lid margin to light reflex

MRD1 (upper lid) - 4-5mm
MRD2 (lower lid) 5-5.5mm

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2
Q

Grettfredsons syndrome

A

CN VI and XII palsies

Cause: Clivus tumor or nasopharyngeal carcinoma

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3
Q

tensile strength of a scar at:

  • 1 wk
  • 1-3wks
  • 3 wks
  • 12-18 months
A
  • 3%
  • 30%
  • 50-60%
  • 80%
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4
Q

Jessner’s Solution

A

14g risorcinol
14g salicylic acis
14mL lactic acid + 100mL Ethanol

superficial peel

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5
Q

what is the most common site of involvement in inverted papilloma?

A

lateral nasal wall

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6
Q

causes for bilateral facial paralysis

A
  1. stage II Lyme dx

2. Heerfordt dx; uveoparotid fever - acute sarcoidosis

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7
Q

what is compressed in the following vascular anomalies?

  1. double aortic arch/ vascular ring
  2. abnormal innomonant artery
  3. pulmonary sling
A
  1. both esophagus and trachea
  2. anterior trachea
  3. right trachea and right main stem bronchus
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8
Q

Sleep EEG patterns

A

Awake - alpha
N1 (non-REM) - theta wave
N2 (non-REM) - sleep spindles and K-complexes (low freq and high amp)
N3 (non-REM) - delta waves
REM - similar to awake EEG with rapid eye movement

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9
Q

maneuvers that increase nasal tip projection

A
  • interdomal sutures
  • columellar strut
  • shield grafting
  • lateral crural steal
  • tongue-in-groove
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10
Q

when to use image-guidance FESS

A
  1. revision
  2. anatomic changes due to congenital, trauma, post-op
  3. nasal polyps
  4. pathologies in the frontal, post ethmoid, and sphenoid sinuses
  5. pathologies involving the ICA, skull base, optic nerve, and orbit
  6. neoplasms
  7. CSF leak 2/2 skull base defect
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11
Q

contraindications for gamma knife

A
  • > 3cm; swelling can cause hydrocephalus

- inferior spread of tumor; does not fit into collimator helmet

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12
Q

lidocaine dosing

A

4mg/kg
6mg/kg - with epi

1% lido contains 10mg/1mL
2% - 20 mg/1mL

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13
Q

Blood supply for ALT graft

A

lateral descending femoral branch of profunda femoral

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14
Q

apnea

A

> 90% reduction in airflow for >10 seconds

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15
Q

hypopnea

A

> 30% reduction in airflow + 4% reduction in saturation

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16
Q

AHI

A

total sleep time

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17
Q

RDI

A

AHI + RERA

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18
Q

RERA

A

sleep events leading to arousal that does not meet criteria for apnea or hypopnea

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19
Q

what is impedance matching?

A

how loss of sound is prevented as it goes from air to fluid

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20
Q

mechanisms of impedance matching and dB for each

A
  1. TM surface area to oval window ratio (20:1) - 26dB
  2. Ossicles - 2dB
  3. TM bucking - 6dB
  4. stiffness of ossicles
  5. resonance of ME
  6. phase difference of round and oval windows
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21
Q

list the intrinsic muscles of the larynx and their functions

A

vocalis/thyroidarytenoid - adduct and relax
transverse and oblique cricothyroid (interarytenoid) - adduct and close laryngeal inlet
cricothyroid - lengthen and tense
posterior cricoarytenoid - abduct
lateral cricoarytenoid - adduct

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22
Q

nasal features of cleft lip

A
  1. nasal tip - contralateral
  2. lateral cruz - caudal and horizontal
  3. medial cruz - shortened on cleft side
  4. columella - base is pointed contralateral
  5. caudal septum - towards contralateral
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23
Q

OSA risk factors

A 
male 
neck circumference (15 & 17 cm)
soft palate length
retropalatal space 
hyoid position
age
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24
Q

virus responsible for recurrent Respiratory Papillomatosis

A

HPV 6 and 11

- 11 is more aggressive

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25
Q

Bethesda Classification

A
  1. non-diagnostic - repeat FNA with US
  2. benign - observe
  3. atypia or follicular of undetermined significance - repeat FNA/ molecular testing/ lobectomy
  4. (suspicious) follicular neoplasm - molecular testing/ lobectomy
  5. suspicious for malignancy - near total/ lobectomy
  6. malignant - near total/ lobectomy
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26
Q

ages of sinus development

A

sinus - start - end

  1. maxillary - utero - 3 years and again at 7-18 years
    * first to develop
  2. ethmoids - utero - 12-15 yo
    * most developed at birth
  3. sphenoid - 4 yo - 12-18 yo
  4. frontal - starts at 5-6 yo - 20 yo
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27
Q

phases of hair growth

A
  1. anagen
    • 90%
    • active growth
    • male pattern hair loss
  2. catagen
    • transition
  3. telogen
    • 10%
    • terminated
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28
Q

fillers appropriate for lipodystrophy 2/2 antiviral use

A

calcium hydroxyapetite

poly-L-lactic acid

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29
Q

malignancy rate of inverted papilloma

A

10%

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30
Q

embryonic derivatives of ear bones

A

manubrium of malleus - 2nd branchial arch
long process of incus - 2nd branchial arch
stapes suprastructure - 2nd branchial arch
stapes foot place - separate; from otic capsule
rest of malleus and incus - 1st branchial arch

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31
Q

Eyelid Defect Repair

  1. <25%
  2. <60%
  3. > 50% upper lid
  4. > 50% lower lid
A
  1. primary closure
  2. tenzel semicircular advancement flap
  3. cutler-beard flap
  4. Huge’s tarsoconjunctival flap
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32
Q

risk factors for tracheo-innominate fistula

A
  • low placement
  • steroids
  • radiation
  • malnutrition
  • hyperextension of neck
  • 3-4 weeks
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33
Q

what % of congenital VC paralysis is bilateral?

A

50%

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34
Q

features of central vertigo

A
  • does not diminish with repeated stimulation
  • nystagmus is in multiple direction and not relieved with fixation
  • symptoms are not as bad
  • no hearing loss
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35
Q

what is the most anterior structure of tympanic cavity?

A

cochleariform process

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36
Q

1st branchial fold

A

EAC

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37
Q

1st branchial arch

A

A. maxillary a.
N. CN V
M. mastication
S. malleus, incus, sphenomandibular ligament, Meckle’s cartilage

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38
Q

1st branchial pouch

A

middle ear cavity

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39
Q

2nd, 3rd, and 4th branchial fold

A

neck

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40
Q

2nd branchial arch

A

A. stapedial a, hyoid a.
N. CN VII
M. facial expression
S. long process of incus, manubrium of malleus, stapedial superstructure, styloid, stylohyoid ligamemt, lesser horn and upper hyoid, Reikerts cartilage

41
Q

2nd branchial pouch

A

supratonsillar fossa

42
Q

3rd branchial arch

A

A. ICA
N. CN IX
M. stylopharyngeal
S. greater horn and lower hyoid

43
Q

3rd branchial pouch

A

thymus & inferior parathyroids

44
Q

4th branchial arch

A

A. R subclavian and aorta
N. CN X (superior laryngeal)
M. laryngeal & parapharyngeal
S. laryngeal cartilage

45
Q

4th branchial pouch

A

superior parathyroids, thymus, and ultimobranchial body (parafollicular cells)

46
Q

mucoepidermoid carcinoma

A

MC malignant ca of salivary glands
affects middle-age females
grades: low vs high based on cellular differentiation and presence of mucinous cyst

47
Q

Superficial Peels

A

epidermis to superficial dermis

  • AHA: glycolic acid, lactic acid, and citric acid
  • salicylic acid
  • Jessner’s solution
48
Q

Medium depth peels

A

papillary dermis to superficial reticular layer

tricholoroacetic acid (TCA)

  • up o 50%
  • weight to VOLUME concentration
  • risk of scarring
  • can be used with glycolic acid or Jessner’s solution (these are applied first)
49
Q

Deep peels

A

penetration into the reticular dermis

Baker-Gordon solution

50
Q

baker gordon solution

A

phenol 88% - 3cc
distilled water - 2cc
croton oil - 3 drops
septisol - 8 drops

51
Q

Hyperthyroidism treatment for pregnancy

A

PTU - 1st trimester

Methimazole - 2-3 trimesters

52
Q

E6 + E7

A

suppresses p53 (E6) and pRB (E7)

53
Q

Gilles approach - what is the plane of dissection?

A

deep to deep layer of temporals fascia

54
Q

risk factors for developing ex-pleomorphic carcinoma

A
  • fast growth
  • facial nerve paralysis
  • malignant cells on histological slide
  • pain
55
Q

how does non-recurrent RNL from on the right?

A

RLN comes from 6th arch
subclavian artery comes from 4th arch and pulls RLN down as heart descends
if it regresses, the subclavian artery arises from left aorta and takes a retroesophageal course

occurs 0.5-5% of the time

56
Q

how does left non-recurrent RLN form?

A

situs inversus

57
Q

acidic vs. alkali ingestion

A

acidic

  • causes coagulation necrosis
  • low depth of penetration

alkali

  • cause liquefaction necrosis
  • high depth of penetration
  • higher risk of perf
58
Q

orbital apex syndrome vs. superior orbital fissure syndrome vs. cavernous sinus syndrome

A

OAS - CN II, III, IV, VI, V2
SOFS - CN III, IV, VI, V2
CSS - CN III, IV, VI

59
Q

histopath stain positivity

  • melanoma
  • sinonasal undifferentiated carcinoma
  • Ewing
  • rhabdomyosarcoma
  • esthesioblastoma
A
  • melanoma: HMG 45, s-100, melanin-A
  • SUC: cytokeratin
  • Ewing - neuron specific enolase
  • rhabdomyosarcoma - design
  • esthesioblastoma - neuron specific enloase
60
Q

Factors that improve overall survival in IFS

A

diabetes
liposomal amphotericin B
surgery

61
Q

Describe each type of Dedo Classification

A 
I: Youthful
II: jowling and skin laxity
III: submental fat
IV: platysmal banding
V: micro or retrognathia
VI: low hyoid bone
62
Q

treatment options for T1 and 2 glottic cancers

A

radiation or partial laryngectomy (CI in with poor lung function)

63
Q

US findings suspicious for thyroid malignancy

A
  1. hypo echoic
  2. taller than wide
  3. calcifications
  4. central vascularity
  5. solid
  6. extension
  7. CLAD
64
Q

US nodal findings suspicious for metastasis

A
  1. round
  2. microcalcifications
  3. loss of fatty hilum
  4. central vascularity
  5. hypo echoic
65
Q

Path of cochlear afferent

A

ECOLI-MA

Inner hair (90%)/ outer hair (5-10%) cells

eighth nerve
cochlear nuclei
olivary complex (superior)
lateral lemniscus 
inferior colliculus
-
medial geniculate body
auditory cortex
66
Q

disadvantage of lateral graft tympanoplasty

A
  • blunting
  • cholesteatoma
  • more intensive technique
  • longer healing time
  • laeralization
67
Q

Hitselberger sign

A

numbness of the conchal bowl and posterior EAC due to compression of facial nerve from schwannoma

68
Q

Hennebert’s sign

A

pressure induced nystagmus

perilymphatic leak

69
Q

what are the 3 stages of skin graft take

A
  1. imibition - first 24-48 hours - nutrients from tissue beneath
  2. inosculation - starts at 48 hours - small vessels from the tissue beneath and the graft start to grow toward each other
  3. angiogenesis - days 4-7 - new, permanent blood vessels are formed from recipient to graft
70
Q

what is lyer sign?

A

splaying of the ICA posteriorly and ECA anteriorly due to presence of carotid body tumor

71
Q

what are the phases of wound healing?

A
  1. inflammatory - duration: 3-7 days - PMN/macrophage, vasodilation, phagocytosis
  2. proliferative - peaks at 3 weeks
    2a. superficial reepithelialization
    2b. fibroblast and collagen synthesis
  3. remodeling - ends: 18 months - replacement of type III to type I collagen
72
Q

ototoxic characteristic of the following:

  • aspirin
  • carboplatin
  • cisplatin
A

many affect outer hair cells of the base

  • aspirin: mild-moderate reversible hearing loss in 24-72 hrs
  • carboplatin: affect inner hair cells
  • cisplatin: stria vascularis, outer hair cells, spiral ganglion cells
73
Q

what does mitomycin C do?

A

it alkylates DNA leading to crosslinking

74
Q

distance from lacrimal crest - ant eth - post eth - optic canal

A

24-12-6

75
Q

how is prominaris measured?

A

mastoid to lateral helical rim >2-2.5cm

auriculocephalic angle >25-35º

76
Q

what are the main features of prominaris

A

unfolded antihelix
large conchal bowl
distal insertion of anti-tragicus muscles (pulls helix laterally)

77
Q

what is the most common sinus of involvement in inverted papilloma?

A

maxillary sinus

78
Q

what is the most commonly injured sensory nerve during a face lift?

A

greater auricular nerve

79
Q

what are the most commonly injured motor nerve during a face lift?

A

marginal and temporal CN VII

80
Q

contents of the infra temporal fossa

A
  1. medial and lateral Pterygoid muscles
  2. mandibular branch of V
  3. chorda tympani
  4. deep lobe of pterygoid
  5. otic parasympathetic ganglion
  6. maxillary artery and branches
81
Q

Kadish staging system

A

esthesioblastoma

A: limited to nasal cavity
B: limited to nasal cavity and paranasal sinuses
C: extends beyond nasal cavity and paranasal sinuses
D: involved nodes/mets

82
Q

Gradenigo Syndrome

A

petrous apecitis

  • retrorbital pain (trigeminal nerve, ophthalmic division)
  • abducens palsy (Derello canal)
  • otorrhea
83
Q

z-plasty angles, scar rotation and elogation

A

angles rotation elongation
30 45 25%
45 60 50%
60 90 75%

84
Q

ototoxicity of aminoglycosides

A
  • irreversible
  • high frequency (starts at the base)
  • affects the outer hair cells
  • dose-dependent
  • streptomycin and gentamicin are vestibulotoxic
  • sensitivity is passed through mtDNA (maternal)
85
Q

how many dB increase will double the sound intensity

A

3dB

86
Q

what is recruitment?

A

outer cell hair damage causes recruitment of normal functioning cells
outcome: there is a lower threshold for louder sounds because the gap between soft and loud sounds become smaller
if recruitment is absent in SNHL, indicates retrocochlear lesion

87
Q

asymptomatic vs symptomatic pt with caustic ingestion

A

(-) sx: observe

(+) sx: esophagoscopy in 12-24 hrs

88
Q

Lund Mckay score

A

for each sinus 0-2 on sinus opacification

for OMC blockage 2

89
Q

vernet syndrome

A

Jugular foramen
CN IX, X, XI involvement
cause: lesion involvement jug foramen (tumor, trauma, thrombophlebitis, LAD of nodes of Krause)

90
Q

Villaret Syndrome

A

retroparotid space

CN IX, X, XI, and XII involved

91
Q

Treatment for botox

A

Apraclonidine

Alpha 2 agonist to activate muller muscle

92
Q

OHSA noise exposure limits

A

90dB over 8 hours

for additional 5dB, half the allowable hours of exposure
e.g. 95 dB over 4 hrs
100 dB over 2 hrs
…

93
Q

incisions of mid-face degloving approach

A

full transfixion
bilateral intercartilagenous incisions
sublabial incision from molar to moalar

94
Q

boundaries of the frontal recess

A

anterior: aggar nassi cell
posterior: anterior ethmoid cell/basal lamella
medial: middle turb
lateral: lamina papyracea

95
Q

ohngren’s line

A

line from angle of mandible to the medial canthus

sinus cancer above this line = poor prognosis

96
Q

when to repair a clef lip

A

10-10-10

hgb-weight-weeks

97
Q

laryngeal dysplasia - malignant potential

A

10-30% from ild to severe/CIS

will occur ~5yrs after dysplasia diagnosed

98
Q

protein targeted in HPV vaccine

A

L1 (structural surface proteins)

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