Aminoglycosides and incidence of HL? which part of the cochlea does it effect? how soon after therapy do pt's start to experience HL?
-10% -basal and inner row of hair cells -3-4 days
Branchial Arches define?
Dermal filler for patients with AIDS
Treatment for anaphylaxis
0.3-0.5mg of 1:1000 epi every 15-20min.
-repeat every 15-20min
Serum markers for anaphylaxis
-histamine have an immediate raise and lasts for 30-60min
-tryptase elevates 30-60min after and stays elevated up to 6 hrs
Innervation of the carotid sinus and/or carotid body tumor?
-Afferent CN IX: info about hypoxia, hypercap, acidosis
-Efferent: superior cervical plexus
Very Finely Proficient At Cell Murder
-Vanco, Fluoroquinolones, Pens, Aminoglycosides, Cephs, Metro
Contributing vessels to Little's area
Growth pattern of hemangioma's of infancy
Rapid growth over first 6 mo's.
50% resolve by 5 yo
70% resolve by 7 yo
Hemangioma of infancy subgottic risks
50% of subglottic will have cutaneous manifestations
60% of hemangiomas in the bearded area will be assc with subglottic ones
2nd most common region for otosclerosis?
Phases of wound healing
Friedman staging for UPPP and success?
What is the definition of surgical success and UPPP?
50% reduction or AHI < 20
Indication for RAI for follicular thyroid CA
-tumor > 4cm
-gross extracapsular extension
-extensive intravascular invasion
-elevated post op TG
-known or suspected metastatic disease.
Only facial muscle not innervated by FN?
levator palpebrae superioris - innervated by CNIII
What kind of hearing loss do you get with quinine?
reversible at 4kHz
Contra-Indications for a partial laryngopharyngectomy?
- involvement of the pyriform
-extension to the post cricoid region
-ipsilateral TVC paralysis
-encroachment into the cricopharyngeus
Sequence of local anesthetic blockage
-Sympathetic fibers -> pain/temp -> touch/motor
Relationship between pH and pKa for local anesthetics
-the closer the pKa is to pH, the more likely the anesthetic will be in unprotonated/hydrophobic state and therefore faster onset of action
Assc with AR
-occur due to spasm of Mueller's muscles in chronic AR
Brow lift and facial nerve anatomy in relation
What is Galactomannan?
Polysaccharide found in aspergillous, elevated in invasive pulmonary aspergillosis. No utliity in mucor.
T staging for supraglottic cancer
T1: Limited to one subsite
T2: Extends to adjacent subsite, still with vocal fold mobility
T3: Vocal cord paresis and/or invading inner cortex of thyroid cartilage, post cric, pre-epiglottic, paraglottic space.
T4a: Invades beyond prior
T4b: Encases carotid, mediastinum or prevertebral invasion.
What is Jessner's solution
salicylic acid, lactic acid, resorcinol, ethanol.
What meds do you give for anaphalyxis of a pt experiencing anaphylaxis
antihistamines, steroid, glucagon (increases cardiac output/HR).
semicircular canal dehiscence, what kind of hearing loss?
How long abx for pott's puffy tumor
When to consider SLNB in melanoma?
-T1b - T4, no gross nodal disease.
Staging for melanoma?
how to treat methemoglobinemia?
1% meth blue 1mg/kilo total slow infusion
2nd MCC OC cancer?
innervation of the ear canal?
MCC presenting sx of NPC?
- 75% neck mass
-73% nasal obstruction
What to do if AOM during CI?
SOM during CI?
- place tubes, implant once clear of infection for min 2 wks
- irrigate, topical gtts, post op ceftriaxone
Meds that increase T4 catabolism?
phenytoin, carbamazepine, phenobarbital, rifampin
Vessels of Woodruff's plexus
SPA, ascending pharyngeal
inhibits DNA polymerase, used in respiratory papillomatosis
What meds are used in respiratory papillomatosis?
organisms in ARS most likely to self resolve?
moraxella catarrhalis, sometimes haemophilus.
S pneumo will not self resolve.
how many dB do you need to double the sound
Sx of Churg Strauss?
-Granulomatis nasal lesions but no epistaxis
-> 10% serum eosinophilia
- allergic rhinosinusitis
-granulomatous lesions of lungs
- vasculitis w extravascular eosinophils
- mononeuritis multiplex
what is the risk for cervical mets in lip SCCa?
most common dental cysts?
Radicular cysts > dentigerous cysts
-mulitiple basal cells
What is the chance for malignancy in a cold nodule in Graves?
they also tend to be more aggressive in Graves patients
Vestibular neuritis typically effects which vestibular nerve?
How to test for laterality?
-fast phase away from the affected side
-symptoms worse with head movements
Class 1: minimal defects, no surgery
Class 2: lax skin, rhitidectomy
3: submental/submandibular adiposity: liposuction and consider anterior platysmoplasty
4: anterior banding of platysmal banding -
6: inferior positioned hyoid: division of suprahyoid muscles, suturing of anterior diagstric muscles, chin augment
Blood supply to the temporalis muscles?
Ant/Posterior branches of the deep temporal artery which are branches from the IMAX
Nerves involved with orbital apex syndrome?
- CN 2, 3, 4, 6, nasociliary/frontal nerves, superior ophthalmic vein.
MCC reason for b/l facial paralysis
Positive hitsilberger sign is what? and what does it signify
- Posterior superior concha numbness
-space occupying lesion of the IAC compressing facial nerve.
Path of foamy histiocytes and bloated plasma cells?
foamy histiocytes -> mikulicz cells
bloated plasma cells -> Russell bodies
sign of rhinoscleroma caused by klebsiella rhinoscleromatis.
Serum Ig changes with immunotherapy?
- 1st: there's a spike in specific IgE: total IgE levels (up to 16)
-2nd: then's it will drop to below pre therapy levels.
-3rd: get a rise in IgA and IgG4
Innervation of taste of the soft palate?
Greater superficial petrosal nerve.
lingual branch of glosspharyngeal n.
Parascusis of Willis?
Diplacusis: subjective perception of more than one pitch when 1 tone is presented. Sign of cochlear dysfunction.
Rollover: Speech reception scores drop with increasing loudness
Paracusis of Willisii: phenomenom where people with CHL can have an enhanced ability to hear in noisy environment.
When to treat with Augmentin/fluoroquinolone in sinusitis?
If failed abx therapy or treated w abx in last 6 wks
Which HPV with RRP?
6, 11 (11 has worse course)
Which HPV for cancer?
16 and 18
Define level III neck radiographically?
inferior cricoid to inferior hyoid.
Most sensitive test for central vestibular dysfunction?
Smooth pursuit tracking.
If impaired, suggests unilateral or posterior fossa lesion.
Head shake test and nystagmus?
horizontal nystagmus will beat away from affected side.
If vertical/rotarary -> suggestive of cns disorder.
MOA of mitomycin C?
DNA crosslinking to prevent cell replication
Criteria for anterior cricoid split?
- failed 2 extubations
-no assisted ventilation for 10 days
What is the definition of sleep hypoventilation?
increase paCo2 to 10mmhg
Treatment of Ramsay Hunt?
-Valcyclovir for 14 days
-or Famcyclovir for 10 days
both w steroids
Describe normal occlusion?
Mesiobuccal cusp of the 1st maxillary molar is aligned with the buccal groove of the mandibular 1st molar.
two MCC viruses that cause rhinitis?
rhinovirus > coronavirus
Proper sequence to treat cleft palate/lip kids?
- determine syndromic, feeding issues, evaluate ears, speech eval
3 mo's: tip rhino, cleft lip, tubes
5yrs: columellar lengthening
10 yrs: alveolar grafts
14 yrs: definitive rhino
Closing eye lid defects?
up to a third: primary
1/3-2/3: lateral canthotomy, semicircular advancement flap
50-100%: Hughes tarsoconj flap
What is in Baker's solution?
phenol, septisol, croton oil, distilled h2o
-croton oil is the key ingredient for depth of chemical peel
Correct auriculocephalic angle?
How far apart should mustarde stitches be placed?
at least 16mm, place at least 3
goiter, enlarged vestibular aqueduct, cochlear hypoplasia, mondini malformation.
-defective pendrid protein affecting chloride and iodide transport
hemifacial microsomia (1/2nd branchial arch defect)
congential FN paralysis
3) superior turb
Early signs of lidocaine tox?
metallic taste, tinnitus, numbness around mouth.
What immunodeficiency cannot surmount a host response to encapsulated bacteria?
Encapsulated bacteria would include H influenzae
MCC immunodeficiency in adults?
-more susceptible to URIs, AR, asthma
How much bone can you harvest for a fib flap?
Histology of schwannoma?
Spindle cells arranged in Antoni type A/B patterns
-A: densely packed spindle cells w aligned or palisading nuclei
-B: loosly arranged myxoid stroma
MOA of 5 fluorouracil?
Binds to thymidylate synthetase
MOA of methotrexate?
binds to dihydrofolate reductase
When do frontal sinuses appear in development?
Nystagmus is worse in the direction of the healthy ear
How is central vertigo different from peripheral?
-does not improve w fixation
-does not improve with repeated stimulation
What congenital condition is assc w endolymphatic sac tumors?
Von hippa lindau
-hemangioblastomas of retina and CNS
-endolymphatic sac tumors
-clear cell renal ca
Pedicle artery for ALT flap?
-Descending branch of lateral circumflex femoral
MCC benign sinonasal tumors?
MCC affected sites for IP?
Lateral nasal wall > max
What anatomically is the greatest predictor OSA?
Man neck circ > 17cm
Woman neck circ > 15cm
Dosing for propanolol for infantile hemangioma?
Propranolol dose for infantile hemangioma
2-3mg/kg per day
Wound tensile strength by time?
3% at 1 wk
20% at 3 wks
80% at 3 mo's
What is the inheritance pattern of Osler Weber Rendu?
Medication and diet stoppage prior to RAI?
Cytomel stoppage 2 wks prior, synthroid 6 wks prior
amiodarone 9 mo's prior
low iodine diet 2 wks prior
For adductor vs abductor dysphonia, which #'s would they have difficulty saying?
adductor -> 80-89
abductor -> 60-69
How to diagnose and monitor malignant OE?
Tc99 scan for dx
then follow w Gallum 67 scan every 4 wks
tx usually 2-4 mos
Inheritance of otosclerosis?
Mean sleep latency of people w OSA?
MCC cardiac arrhythmia of those w OSA?
Inflammatory marker assc w OSA?
Most prominent pharyngeal dilators
Genioglossus and tensor palitini
Esthesio and Kadish staging?
What % of hyperparathyroidism is due to adenoma? hyperplasia? lithium? carcinoma?
- 70% single adenoma
-26% double adenoma
cervical vestibular evoked myogenic potentials pathway?
stimulation of saccule -> inferior vestibular n -> vestibulospinal tract -> SCM
oVEMPs stimulates utricle -> superior nerve.
Markers for B cells? T cells? NK cells? Eosinophils?
B: CD19, 20, 22
Histo for Warthin's?
Cyst surrounded by double epithelium, papillary fronds with lymphoid stroma
How long is re-epithelization after dermaabrasion?
Neutrophil count below what number is ominious in mucor?
Which antithyroid med is ok during 1st trimester?
In the scalp, how large should the tissue expander be? When should inflation occur after placement? How often?
2.5x the size of the defect
2 wks after
Abx treatment for Lemierre's syndrome?
What location is the source?
Nerve contributions to pterygopalatine ganglion
nerve of pterygoid canal
Wiskot Aldrich syndrome?
- X linked
-elevated IgE/A but decreased IgM
-defect in tyrosine kinase therefore B cells cannot mature and have decreased amounts of Ig's across the board
-Infections start at 6mo's once they lose mothers Igs
-Inheritance X linked
IgA deficiency, what do you have to watch out for?
anaphylaxis during blood transfusion
Describe segments of ICA?
Abducens and hypoglossal nerve palsy
Due to tumor of clivus or NPC
Equivalent innervation of matched muscles may cause non physiological overactivity of the normal side while compensating for the weak side.
To pre-op test, manually elevate the ptoticl lid, the opposite normal lid will then become ptotic
Conchal setback: suture technique tacking concha to mastoid periosteum
What % of Downs have atlanto-axial instability?
What do you look for on scan?
>4mm from dens to anterior edge of atlas.
point at the anteror end of the upper border of the zygomatic arch where the masseteric and maxillary edges meet at an angle.
Syndrome: FAP, sinonasal osteomas, supranumery teeth?
Associated features along with pyriform aperture stenosis?
premaxillary dysgenesis, central mega incisor, flat nasal bridge, hypertelorism, holoproencephaly
What deficiency is RLS assc with?
Assc with what medication use?
-Deficient in CNS iron
-SSRIs, SNRIs, TCAs, lithium, antiemetics, dopamine antagonists
-Tx: pramipexole, ropinirole
-loss of dopaminergic cells in substantia nigra
What pyriform apex tumors can you avoid a TL?
< 2cm in size
1.5cm above the pyriform apex
no cord fixation
How does frontal sinusitis track to the cavernous sinus?
superior ophthalmic vein
When to perform Laryngeal EMG in setting of RLN injury?
3-6 mo's after injury
pathphysio for DKA being susceptible to mucor?
-altered transferring binding which leads to increased serum iron which enhances fungal growth
What is Kasabach Merrit phenomenom?
It's a consumptive coagulopathy associated w tufted angiomas
Sturge Weber syndrome
V1 capillary malformation, leptomeningeal angiomas, intellectual instability, glaucoma
What pt features correlate w worse prognosis in PTC?
Males > 41yo; Females > 51yo
nodule > 5cm
How far prior to RAI does levothyroxine have to be stopped? Liotyronine?
Management of sialocele after face lift?
Pressure dressing, glycopyrrolate, botox, transdermal scopalamine
consider drain placement.
Cidofovir MOA? What is it used for?
inhibits DNA polymerasae
used for RRP but off label
How does a vestibular schwannoma appear on MRI?
T1 hypointense, T2 heterogenous, T1 enhancement w gad
What does Ristocetin test test for?
What is the ultimobranchial body and what does it test for?
part of the 4th branchial pouch and gives rise to calcitonin producing parafollicular cells.
For cutaneous squam, level neck dissection per subsite?
anterior scalp: 2-3
posterior scalp: 2-5
Abx tx for nec fasc?
boundaries of pre-epiglottic space?
hyoid, thyrohyoid membrane, epiglottis, thyroepiglottic ligament, hyoepiglottic ligament
avg palpebral fissure diameter?
number of cartilage in larynx?
cric, thyroi, epig, cuneiform, corniculate, arytenoids
Where is the toxicity to the ear in platin medications?
Cisplatin: changes to stria vascularis, spiral ganglion, outer hair cells
Carboplatin: toxic to inner hair cells
What other things should you check for in pts with mumps (specific to ENT)?
check hearing: degeneration to stria vascularis
Innervation of parotid gland parasympathetics?
inferior salivatory nucleus -> CNIX -> Jacobsen's -> tympanic plexus -> lesser petrosal -> otic ganglion -> auricular temporal -> parotid
how do aminoglycosides cause damage?
forms a free radical complex w iron which damages outer hair cells
Most common bug of OE?
How soon prior to skin testing should you stop antihistamies?
72 hrs, loratidine -> 7 days
TCAs ->2-4 days
How long does it take for a FTSG to get a new blood supply?
1-2 days vascular inosculation
2-4 days neovascularization
3-5 days blood supply established.
blood supply to trap?
occipital, dorsal scapular, transvserse scapular
Within what time window should you give IV abx for CI for AOM?
within 2 mo's.
Otherwise oral is ok if uncomplicated.
Indications for primary hyperparathyroid surgery?
- serum ca 1.0mg/dl above upper limit nml
- creatinine clearance reduced by 30%
- < 50 yo
- 24hr urine > 400mg/dL
- bone density <2.5 std
Ideal helix to mastoid measurements?
What is the inheritance of Bruton's agammaglobinemia?
tyrosine kinase deficiency -. B cells cannot mature
What kind of cell deficiency if you get a lot of viral infections/fungual infections?
T cell deficiency
mitogen active protein kinase pathway inhibitor effective for melanoma w BRAF mutation
Staging for anaplastic thyroid ca
Stage IVA: confined to thyroid
IVB: regional mets
IVC: distant mets
Suspicious features of thyroid nodule?
hypoechoic, mostly solid or solid, central vascularity, taller than wide on transverse, microcalfications, cervical adenopathy
What % of hypopharyngeal masses have regional mets at time of diagnosis?
up tp 70%
Innervation of parotid gland?
Parasympathetic: visceral motor fibers -> lesser petrosal n -> exits skull at foramen ovale -> synapse on otic ganglion -> post ganglionic fibers travel w auriculotempora n to parotid gland
MCC symptom of glossopharyngeal cA?
Mid frequency SNHL
Vestibular schwannomas have high frequency
what depth of tumor should a SLND be perform in oral cancer?
4mm or more
Inheritance of pendred syndrome?
Best way to dx?
Genetic testing for SLC264A4 gene
Inheritance of aminoglycoside sensitivity?
Mitochondrial so from mother
When should you get an EMG for traumatic facial paralysis?
What will it show?
What will it show if FN function is returning?
2-3 wks after trauma
Inheritance of connexin 26 hearing loss?
Likelihood of having Group A strep
absence of Cough
Old oR young (+1) if young
What feature on immunohistochemistry do infantile hemangiomas express?
Angle of the laryngeal prominence in men/women?
Orientation of cochlear aqueduct? Endolymphatic sac?
parallel to IAC. IAC is anterior to cochlear aqueduct.
perpendicular to IAC
paresis of 9,10,11,12 and cervical sympathetic chain
indicative of lesion of the retroparotid space
If you have hyphema in an orbital floor fxr, what should you do?
Avoid surgery for 2 weeks min.
How to remember the AD congenital conditions?
Branchio oto renal
Rhinophyma is assc w what bug?
TSH should be what level in order for RAI to be effective?
How long should pt's wait for RAI after receiving contrast for CT?