Basic Surgical Concepts Flashcards
(434 cards)
1
Q
What is the esophagotracheal Combitube?
A
A twin-lumen device with upper and lower balloons that is inserted blindly into the hypopharynx.
2
Q
How is the gum bougie introducer for endotracheal intubation used in a patient with difficult airway?
A
Any part of the laryngeal airway, usually the posterior glottis, is visualized with the anterior commissure laryngoscope; the bougie is passed through the scope into the larynx; and the ETT is passed over the bougie.
3
Q
Which laryngoscope blade is especially useful for patients with edematous or redundant tissue obstructing the view of the vocal cords?
A
Bainton blade.
4
Q
What are the two primary disadvantages of the laryngeal mask airway (LMA) compared with endotracheal intubation?
A
Easier to displace than a secured endotracheal tube (ETT) and does not protect from aspiration.
5
Q
Why is jet ventilation contraindicated in patients with tracheal stenosis?
A
Expiration of air is more difficult than inspiration during jet ventilation in patients with tracheal stenosis and can result in air trapping and pneumothoraces.
6
Q
What situations are best for the use of the lightwand during endotracheal intubation?
A
For patients with cervical spine injury, for children with mandibular hypoplasia, or when copious secretions are present.
7
Q
Which laryngoscope blade has a high-resolution digital camera incorporated into it?
A
GlideScope.
8
Q
What is the primary advantage of the fast-track LMA?
A
It allows placement of an ETT without direct laryngoscopy.
9
Q
What is the primary advantage of the ProSeal LMA?
A
It has an extra lumen to allow suctioning of the stomach.
10
Q
What is the Sanders ventilator?
A
Jet ventilator that delivers 02 at
11
Q
What are the best options for the “can’t intubate, can’t ventilate” situations after induction of general anesthesia?
A
LMA, transtracheal needle jet ventilation, Combitube, or surgical airway.
12
Q
What physical features are predictors of difficult intubation in patients with OSAS?
A
Low hyoid (mental protuberance to hyoid distance > 30 em), mandibular deficiency, and large neck circumference (>45 em).
13
Q
What is the primary advantage of the Combitube over an LMA?
A
Prevents aspiration if the patient vomits.
14
Q
What are contraindications to LMA?
A
Upper airway obstruction, preexisting pulmonary aspiration, and conditions that restrict pulmonary compliance.
15
Q
What is the death rate from anesthesia in patients with ar1 ASA class I or II
A
1 in 200,000.
16
Q
Acute renal failure after major ablative head and neck cancer surgery increases the mortality risk by how much
A
10%.
17
Q
How much epinephrine is contained in 1cc of 1:100,000 epinephrine?
A
10mcg.
18
Q
What is the risk of perioperative MI in patients undergoing surgery within 3 to 6 months of an MI
A
16%.
19
Q
What is the best time to begin prophylactic antibiotic therapy for elective surgery?
A
1hour prior to the operation.
20
Q
What is the maximum recommended dose of cocaine
A
2 - 3 mg/kg.
21
Q
What is the maximum recommended dose of bupivacaine
A
2 - 3 mg/kg.
22
Q
Children may have unlimited clear liquids up to how many hours prior to scheduled anesthetic induction
A
2 to 3 hours.
23
Q
What are the daily maintenance fluid requirements of a healthy 60-kg woman?
A
2100 cc.
24
Q
What is the maximum recommended dose ofbupivacaine?
A
2-3 mg/kg.
25
When should oral hypoglycemics be discontinued prior to surgery
24 hours.
26
What is the duration of action of bupivacaine
3 - 10 hours.
27
What is the maximum recommended dose of lidocaine in a 60-kg woman?
300 mg (5mg/Kg) without epinephrine; 420 mg (7mg/Kg) with epinephrine.
28
What is the duration of action ofbupivacaine?
3-10 hours.
29
When is the risk of rebound hypertension from propranolol withdrawal the greatest
4 to 7 days after the drug is discontinued.
30
What is the maximum recommended dose of lidocaine
5 mg/kg without epinephrine; 7 mg/kg with epinephrine.
31
When should a patient quit smoking to have the greatest decrease in perioperative pulmonary complications
8 weeks before the planned procedure.
32
When should warfarin therapy be discontinued prior to surgery
96 to l I 5 hours ( 4 doses).
33
What is the preferred anesthetic technique for bronchoscopy in adults?
A modified endotracheal tube or a jetting system used with a relaxant and controlled ventilation.
34
What is the preferred anesthetic technique for bronchoscopy in adults
A modified endotracheal tube or a jetting system used with a relaxant and controlled ventilation.
35
What is a reliable alternative induction technique in a 5-year-old struggling child who refuses the mask and cannot be managed by intravenous induction because of lack of accessible veins?
A sedating intramuscular injection of ketamine (3 mg/kg).
36
What is a reliable alternative induction technique in a 5-year-old struggling child who refuses the mask and cannot be managed by intravenous induction because of lack of accessible veins
A sedating intramuscular injection of ketamine (3 mg/kg).
37
What is the esophagotracheal Combitube
A twin-lumen device with upper and lower balloons that is inserted blindly into the hypopharynx.
38
What anesthetic considerations must be taken into account in a patient with sickle cell disease
Adequate hydration and oxygenation. Spinal or local anesthesia should be used whenever possible.
39
What factors increase the risk of postoperative pulmonary embolism (PE)
Age \> 40 years, history of lower extremity venous disease, malignancy, CHF, trauma and paraplegia.
40
What factors predispose children with viral URis to airway hyperactivity
Age less than 5 years; family history of allergic disease; infections secondary to respiratory syncytial virus; parainfluenza rhinovirus, influenza or M. pneumonia, coexisting malaise; rhinorrhea and excess mucus production; male sex, and preexisting airway reactivity.
41
What is the standard endocarditis prophylaxis for dental, oral or upper airway procedures in adult patients at risk
Amoxicillin 2 gm orally, I hour before the procedure.
42
What is the appropriate preoperative work-up for a young patient with frequent premature ventricular contractions (PVCs)
An ECG, holter monitor and a cardiac stress test.
43
How is the gum bougie introducer for endotracheal intubation of the "difficult airway" patient used
Any part of the laryngeal airway, usually the posterior glottis, is visualized with the anterior commissure laryngoscope, the bougie is passed through the scope into the larynx, and the ETT is passed over the bougie.
44
What role might oral clonidine play in the preoperative period
As an alpha-2 adrenergic agonist, it can reduce anesthetic requirements and has been used to provide sedation and anxiolysis while maintaining hemodynamic stability.
45
What is the inheritance pattern and incidence of pseudocholinesterase deficiency?
Autosomal recessive with an incidence of about 1in 3000.
46
What is the inheritance pattern and incidence of pseudocholinesterase deficiency
Autosomal recessive with an incidence of about I in 3000.
47
Which hypertensive medications classically cause withdrawal hypertension and, therefore, should not be stopped prior to surgery
Beta-blockers and clonidine.
48
What are the adverse side effects of succinylcholine
Cardiac dysrhythmias, fasciculations, hyperkalemia, myalgia, myoglobinuria, increased pressures (ocular, gastric and cranial), trismus, allergic reactions; it can also trigger malignant hyperthermia.
49
What are the adverse side effects of succinylcholine?
Cardiac dysrhythmias, fasciculations, hyperkalemia, myalgia, myoglobinuria, increased pressures (ocular, gastric, and cranial), trismus, and allergic reactions; it can also trigger malignant hyperthermia and cause prolonged paralysis in patients with pseudocholinesterase deficiency.
50
Why are iodine solutions superior to chlorhexidine as a surgical antiseptic?
Chlorhexidine is not effective against viruses and fungi.
51
Which neuromuscular blocker's metabolism is independent of renal or liver failure?
Cisatracurium.
52
Which antihypertensive medication prolongs the effect of regional anesthesia with amide anesthetics?
Clonidine.
53
Which antihypertensive medication prolongs the effect of regional anesthesia with amide anesthetics
Clonidine.
54
What are the toxic side effects of local anesthetics
CNS excitability or depression, myocardial depression, peripheral vasodilation, methemoglobinemia, allergic reactions.
55
What are the toxic side effects of local anesthetics?
CNS excitability or depression, myocardial depression, peripheral vasodilation, methemoglobinemia, and allergic reactions.
56
Of Goldmann's risk factors, which has been shown to be the most significant
Congestive heart failure (CHF).
57
What comorbid factor provides the greatest risk of perioperative myocardial infarction during major elective noncardiac surgery
Coronary artery disease.
58
Where should local anesthetic be injected to anesthetize the subglottis and preepiglottic space?
Cricothyroid membrane and thyroid notch, respectively.
59
Where should local anesthetic be injected to anesthetize the subglottis and Preepiglottic space
Cricothyroid membrane, thyroid notch, respectively.
60
What are the advantages of propofol over volatile agents in pediatric ambulatory patients
Decreased postoperative nausea and vomiting and decreased incidence of airway obstruction.
61
Which a-agonist is five to ten times more potent than clonidine and is approved for use as a sedative and analgesic in the operating room and ICU?
Dexmedetomidine.
62
What is the primary disadvantage of the laryngeal mask airway (LMA) compared to endotracheal intubation
Easier to displace than a secured endotracheal tube (ETT).
63
T/F: Individuals who take clear liquids close to their time of surgery are at greater risk of aspiration than those who remain NPO
False.
64
T/F: All local anesthetics are weak bases and produce vasodilation
False. Cocaine and ropivacaine are the exceptions.
65
True/False: All local anesthetics are weak bases and produce vasodilation.
False: Cocaine and ropivacaine are the exceptions.
66
True/False: All opioids cause bradycardia.
False: Meperidine is the exception.
67
T/F: All opioids cause bradycardia
False; meperidine is the exception.
68
Which medication has been shown to decrease the catecholamine response during suspension laryngoscopy?
Fentanyl.
69
Which medication has been shown to decrease the catecholamine response during suspension laryngoscopy
Fentanyl.
70
What respiratory symptoms are considered contraindications to elective surgery by most anesthesiologists
Fever, rhinorrhea and productive cough.
71
What is a complication of rapid administration of naloxone?
Flash pulmonary edema.
72
What is a complication of rapid administration of naloxone
Flash pulmonary edema.
73
What medication is used to reverse benzodiazepines
Flumazenil, 200 micrograms IV over 15 seconds, repeated every 15 seconds up to 1 mg.
74
What situations are best for the use of the lightwand during endotracheal intubation
For patients with cervical spine injury, for children with mandibular hypoplasia, or when copious secretions are present.
75
Where should local anesthetic be injected to block the superior laryngeal nerve?
Halfway between the hyoid and thyroid cartilages.
76
Where should local anesthetic be injected to block the superior laryngeal nerve
Half-way between the hyoid and thyroid cartilages.
77
What surgical prep solution is contraindicated for use on the face
Hibiclens as it is caustic to the eyes.
78
What surgical prep solution is contraindicated for use on the face?
Hibiclens, as it is caustic to the eyes.
79
What is the single most important factor predicting postoperative cardiac morbidity
History of congestive heart failure (CHF).
80
Which laryngoscopes are best for visualizing the anterior commissure or the subglottis
Holinger and Benjamin.
81
What is the cause of most anesthetic-related deaths
Human error (50 to 75%).
82
What is the accepted stress dose of corticosteroids for patients undergoing major procedures
Hydrocortisone, I 00 mg, the night before the procedure with repeat administration every 8 hours until the stress has passed.
83
How much epinephrine is contained in 1 cc of 1:100,000 epinephrine
I 0 micrograms.
84
What are the negative side effects of ketamine?
Increased airway secretions, transient increase in intracranial pressure, and auditory/visual hallucinations.
85
What is the mechanism of action behind malignant hyperthermia?
Inhibition of calcium reuptake into the sarcoplasmic reticulum of skeletal muscle.
86
What is the mechanism of action behind malignant hyperthermia
Inhibition of calcium reuptake into the sarcoplasmic reticulum of skeletal muscle.
87
How does the presence of an upper respiratory infection (URI) in an infant influence the perioperative risk of respiratory complications
Intubation results in edema and a greater reduction in cross-sectional area of the trachea.
88
What makes midazolam particularly useful in the outpatient setting
It has a relatively short onset of action and an elimination half-life of 2 to 4 hours.
89
What makes midazolam particularly useful in the outpatient setting?
It has a relatively short onset of action and an elimination half-life of 2-4 hours.
90
What are the advantages of using heliox during laser surgery on the airway
It reduces the amount of inspired oxygen concentration and thus the chance of tube ignition, and it facilitates rapid dissipation of heat.
91
Which laryngoscope exposes the vocal folds best
Kleinsasser.
92
Which local anesthetics are amide compounds?
Lidocaine, ropivacaine, and bupivacaine.
93
Which local anesthetics are amide compounds
Lidocaine, ropivacaine, and bupivacaine.
94
What are the best options for the "can't intubate, can't ventilate" situations after induction of general anesthesia
LMA, transtracheal needle jet ventilation, Combitube, or surgical airway.
95
Which benzodiazepine is preferred in patients with liver disease?
Lorazepam.
96
Shortly after induction of general anesthesia, the patient's body temperature significantly rises, PVCs are noted on the electrocardiogram and his skin becomes flushed. What is the likely diagnosis?
Malignant hyperthermia; other symptoms include masseter spasm, sustained muscle rigidity, and myoglobinuria.
97
What are the signs of malignant hyperthermia
Masseter spasm, sustained muscle rigidity, myoglobinuria, rapid rise in core body temperature, PVCs, and an erythematous flush.
98
What medication is used to reverse opioids
Naloxone, in 20 - 40 microgram increments.
99
A 90-year-old woman is given morphine shortly before beside laryngoscopy. Her respiratory rate drops to 6 and her lips turn blue. She responds only to pain. What medication should be given?
Naloxone, in 20-40 J...Lg increments.
100
What are the most common anesthetic complications seen in the PACU
Nausea, vomiting and airway compromise.
101
All of the inhaled anesthetics are bronchodilators except for which one?
Nitrous oxide.
102
Which anesthetic should be discontinued 15 minutes prior to placing a tympanic membrane graft?
Nitrous oxide.
103
Which anesthetic should be discontinued 15 minutes prior to placing a tympanic membrane graft
Nitrous oxide.
104
Which nasal spray has less cardiac toxicity... oxymetazoline or neosynephrine
Oxymetazol ine.
105
Which nasal spray has less cardiac toxicity: oxymetazoline or neosynephrine?
Oxymetazoline.
106
What patient population might have a decreased amount of pseudocholinesterase
Patients taking anticholinesterase medications for glaucoma or myasthenia gravis, chemotherapeutic drugs and patients with a genetically atypical enzyme.
107
What patient population might have a decreased amount of pseudocholinesterase?
Patients taking anticholinesterase medications for glaucoma or myasthenia gravis, chemotherapeutic drugs, and patients with a genetically atypical enzyme.
108
In which patients should the use of topical cocaine be avoided
Patients with hypertension and those taking adrenergic modifying drugs such as reserpine, tricyclic antidepressants and monoamine oxidase inhibitors.
109
What is the single most important factor that determines title length of stay after general anesthesia in ambulatory patients
Post-anesthesia nausea.
110
What is the mechanism of action of local anesthetics?
Prevent increases in the permeability of nerve membranes to sodium ions.
111
What is the mechanism of action of local anesthetics
Prevent increases in the permeability of nerve membranes to sodium ions.
112
Which topical anesthetics have been shown to induce methemoglobinemia
Prilocaine, benzocaine, lidocaine and procaine.
113
Which local anesthetics have been shown to induce methemoglobinemia?
Prilocaine, benzocaine, lidocaine, and procaine.
114
Patients requiring an emergency tracheostomy for an obstructed airway may develop what postoperative pulmonary complication
Pulmonary edema.
115
What is Poiseuille's law
Resistance to airflow is directly proportional to the density of inhaled gases.
116
How does ropivacaine differ from bupivacaine?
Ropivacaine is also a long-acting amide with equivalent anesthetic properties to bupivacaine but has less potential to cause serious cardiotoxic reactions and has intrinsic vasoconstrictive properties.
117
How does ropivacaine differ from bupivacaine
Ropivacaine is also a long-acting amide with equivalent anesthetic properties to bupivacaine but has less potential to cause serious cardiotoxic reactions and has intrinsic vasoconstrictive properties.
118
What factors are responsible for transfusion-induced immunosuppression?
Serum factors and fragmented debris from white blood cells and platelets.
119
What factors are responsible for transfusion-induced immunosuppression
Serum factors, and fragmented debris from white blood cells and platelets.
120
What is the primary advantage of using remifentanil over fentanyl?
Shorter onset of action (within 30-60 seconds of administration) and offset (within 5-10 minutes after discontinuance).
121
What is the treatment for methemoglobinemia?
Slow intravenous infusion of 1% methylene blue solution (total dose, 1-2 mg/kg).
122
What is the treatment for methemoglobinemia
Slow intravenous infusion of I% methylene blue solution (total dose 1 - 2 mg/kg).
123
Allergy to what substance is a contraindication to the use of propofol?
Soy.
124
Allergy to what substance is a contraindiaction to use of propofol
Soy.
125
What is the preferred anesthetic technique for bronchoscopy in infants and children?
Spontaneous respiration with inhalation anesthesia.
126
What is the preferred anesthetic technique for bronchoscopy in infants and children
Spontaneous respiration with inhalation anesthesia.
127
Which local anesthetic produces toxicity at the lowest dose?
Tetracaine.
128
Which local anesthetic produces toxicity at the lowest dose
Tetracaine.
129
What is the most common site of perforation of the surgeon's glove during surgery
The nondominant index finger.
130
What are the advantages of a thallium stress test over an exercise stress test
The thallium stress test can better identify the location and extent of myocardial ischemia.
131
What are the most common problems associated with adverse anesthetic outcomes
Those related to the airway (i.e., inadequate ventilation, unrecognized esophageal intubation and unrecognized disconnection from the ventilator).
132
What are the two main classes of local anesthetics?
Those with an ester linkage and those with an amide linkage.
133
What are the 2 main classes of local anesthetics
Those with an ester linkage and those with an amide linkage.
134
How do these classes differ in metabolism?
Those with an ester linkage are metabolized in the plasma by cholinesterase; those with an amide linkage are metabolized in the liver by the p-450 system.
135
How do these classes differ in metabolism
Those with an ester linkage are metabolized in the plasma by cholinesterase; those with an amide linkage are metabolized in the liver by the p-450 system.
136
Which patients are more likely to have adverse reactions to succinylcholine
Those with closed-angle glaucoma, space-occupying intracranial lesions, or severe crush injuries of the lower extremity
137
Which patients are more likely to have adverse reactions to succinylcholine?
Those with closed-angle glaucoma, space-occupying intracranial lesions, or severe crush injuries of the lower extremity.
138
What is the treatment for malignant hyperthermia?
Total body cooling, vigorous hydration, dantrolene.
139
What is the treatment for malignant hyperthermia
Total body cooling, vigorous hydration, dantrolene.
140
True/False: Bupivacaine has a depressant effect on cardiac contractility four times that of lidocaine.
True.
141
T /F: Bupivacaine has a depressant effect on cardiac contractility 4 times that of lidocaine.
True.
142
T/F: Beta-blocker eye drops can cause bronchoconstriction in patients under anesthesia
True.
143
What are contraindications to LMA
Upper airway obstruction, preexisting pulmonary aspiration, and conditions that restrict pulmonary compliance.
144
What should be given to cancer patients who need a blood transfusion to minimize the immunosuppression?
Washed RBCs.
145
What should be given to cancer patients who need a blood transfusion to minimize the immunosuppression
Washed RBCs.
146
What medication is used to reverse benzodiazepines?
Flumazenil, 200 11g IV over 15 seconds, repeated every 15 seconds up to 1 mg.
147
What factor best predicts the risk of a major complication following head and neck oncologic surgery?
10% loss of baseline body weight.
148
What is Grillo's rule?
Any patient who develops symptoms of airway obstruction, who has been intubated and ventilated in the recent past, must be considered to have an airway lesion until proven otherwise.
149
What is the drug of choice for bradyarrhythmias and heart block?
Atropine, 0.5-1.0 mg IV every 5 minutes to a maximum of 2-3 mg.
150
What factors increase the risk of postintubation tracheal stenosis?
Difficult intubation, an over inflated cuff, repeated reintubations, and poorly performed tracheostomy.
151
What is the treatment for acute airway obstruction secondary to postintubation tracheal stenosis?
Dilatation with rigid ventilating bronchoscopes; tracheostomy is only performed if a prolonged period is needed prior to definitive treatment of the stenosis.
152
What is the treatment of pneumocephalus?
Emergent drainage with needle aspiration, airway diversion (i.e., tracheostomy), and nasal repacking.
153
In emergency surgery following trauma, which organisms are most likely to cause serious sepsis?
Gram-negative bacteria.
154
In patients with postoperative pneumonia, empiric monotherapy should cover which organisms?
Gram-negative organisms.
155
In which patients is isoproterenol contraindicated?
In those with coronary artery disease.
156
What is the treatment for patients on JJ-blockers who are not responding to initial epinephrine treatment?
Inhalation or IV infusion of a pure -agonist,isoproterenol or low-dose IV dopamine.
157
What precautions should be taken to prevent cardiotoxicity during phenol peel?
IV fluid hydration and treatment of the face in separate units, 30 minutes apart.
158
What is the drug of choice for ventricular ectopy?
Lidocaine, 1.0-1.5 mg/kg IV bolus; repeat every 3-5 minutes to a maximum of 3 mg/kg; then start IV drip at 2-4 mg/min.
159
What are the most common anesthetic complications seen in the PACU?
Nausea, vomiting, and airway compromise.
160
Where are postintubation granulomas typically located?
On the vocal process of the arytenoid.
161
What can cause postoperative pneumocephalus after anterior craniofacial surgery?
Overly aggressive drainage of CSF via a lumbar drain or ball-valve action of the flaps used to reconstruct the skull base.
162
What is the treatment for air embolism?
Pack wound, compress jugular veins, immediately place the patient in the left lateral decubitus and Trendelenburg position, insert needle into right ventricle from under the xiphoid, switch to 100% O2, and stop nitrous.
163
What is the drug of choice of treatment of catecholamine-excess hypertensive crisis?
Phentolamine in 5- to 10-mg IV increments every 5-15 minutes.
164
Patients requiring an emergency tracheostomy for an obstructed airway are more likely to develop what postoperative pulmonary complication?
Pulmonary edema.
165
What is the most common organism identified in patients with pneumonia after major surgical resection of the upper aerodigestive tract?
Staphylococcus aureus.
166
After 2 weeks of intubation for ventilatory support, a 32-week premature infant is extubated and severe upper airway obstruction results. What is the most likely cause?
Subglottic edema.
167
During neck dissection, the patient develops sudden, severe bradycardia while the surgeon is dissecting around the carotid bulb. What should be done?
Surgeon should inject local anesthetic into the carotid bulb or anesthesiologist should give atropine or glycopyrrolate.
168
What are the two important techniques to prevent postoperative fistula formation?
Tension-free closure and perioperative antibiotics.
169
During a neck dissection, large bubbles are noted in the internal jugular vein and the anesthesiologist notes a sudden drop in the patient's blood pressure. What is likely to happen to the end-tidal C0 2?
Will decrease (the patient likely has a central venous air embolism).
170
What is the minimum effective concentration of helium in heliox administration in children with airway obstruction?
6o%.
171
Which laser is primarily used for coagulation of hemangiomas?
Argon laser.
172
What are the three types of infrared lasers with clinical uses?
CO2 laser; Erbium:YAG; and Ho:YAG
173
What is the major complication of laser resurfacing of darker skinned individuals?
Depigmentation (hyper- or hypopigmentation).
174
During surgery to debulk respiratory papillomas using a CO 2 laser, the endotracheal tube cuff is accidentally punctured and a fire starts. What should be done?
Discontinue ventilation and oxygen, remove the endotracheal tube, and if a visible flame is still present, douse the field with normal saline. Once the fire has been extinguished, reintubate the patient with a regular endotracheal tube.
175
Which laser is highly absorbed by water and is used mainly for superficial skin resurfacing?
Erbium:YAG
176
What are the normal side effects of laser skin resurfacing?
Erythema, edema, serous discharge, and crusting.
177
Lasers with wavelengths in the UV range and visible range are minimally absorbed by water but significantly absorbed by what?
Hemoglobin and melanin.
178
What is the significance of this difference?
If the surgeon operating on the left takes the same straight back approach as the right, he or she will contact the lamina papyracea and enter the orbit.
179
Collateral thermal damage is less with infrared or visible lasers?
Infrared.
180
What are the advantages of using heliox during laser surgery on the airway?
It reduces the amount of inspired oxygen concentration and thus the chance of tube ignition, and it facilitates rapid dissipation of heat.
181
Which laser works by passing an Nd:YAG laser through a crystal and is mainly used for vascular lesions and turbinate reduction?
KTP-532 laser.
182
Which laser in clinical use has the deepest penetration?
Nd:YAG (4 mm).
183
Which laser is used for tracheobronchial lesions, hair removal in ethnic patient populations, and nonablative skin resurfacing?
Nd:YAG laser.
184
What factors affect the risk of complications after laser skin resurfacing?
Number of laser passes, energy densities, degree of pulse or scan overlap, preoperative skin condition, anatomic areas.
185
How does the orbital anatomy viewed through the endoscope differ on the right and left sides to the surgeon?
Right nasal meatal anatomy lies visually straight back, whereas on the left, the ethmoids appear to be more medial, especially anteriorly and superiorly.
186
What is plume radiation?
When the laser beam hits the smoke plume, its wavelength may change, often in the visible portion of the spectrum, and cause temporary blindness.
187
What is the maximum length-to-width ratio for local flaps?
0.125694444444444
188
When is the risk of thrombosis highest after microsurgical reconstruction?
15-20 minutes after closure.
189
How long does it take for complete regeneration of the endothelium across a microvascular anastomosis?
2 weeks.
190
What is the most common complication from microsurgical reconstruction?
35% suffer medical complications (pulmonary problems, prolonged ventilatory support, and acute ethanol withdrawal).
191
What organism lives in the gut of leeches and is the most common organism associated with wound infections when leeches are applied?
Aeromonas hydrophila.
192
What are the contraindications to leech use?
Arterial insufficiency, severely immunocompromised, and allergic reaction to previous leech application.
193
How does delaying (elevating the flap in two stages 2-3 weeks apart) improve flap survival?
Conditions tissue to ischemia, closes A-V shunts, and increases blood flow by sympathectomy.
194
When is arterial thrombosis most likely to occur?
First 72 hours.
195
What is the most potent natural inhibitor of thrombin?
Hirudin.
196
What is the significance of time to reexploration and flap survival?
If flaps are reperfused in 1-4 hours, 100% survival is likely. If reperfusion is established by 8 hours, So% survival is likely. If reperfusion is not reestablished by 12 hours, flap survival is unlikely.
197
If a free flap fails, what is the best option for reconstruction?
If medical condition allows, a second free flap should be performed instead of a locoregional flap.
198
What is the initial treatment for any free flap that appears to be failing?
Immediate reexploration.
199
When is using a prosthetic preferable to soft-tissue reconstruction in the head and neck?
In cancer patients who need ongoing monitoring in the area of the face at risk for recurrence and when surgical reconstruction is too complicated.
200
What is the best level for undermining skin flaps?
In the subdermal layer.
201
What is the term for a flap that is raised from a nearby region and moved to a defect across intact skin?
Interpolation flap.
202
What is the most secure way to hold a prosthetic in place in the head and neck region?
Osseointegration.
203
What sort of intraoral prosthetic can be used to help with swallowing in a patient who has lost a significant amount of tongue tissue?
Palatal augmentation device (obturator).
204
What is the typical order of return of sensation in noninnervated flaps?
Pinprick, touch, then temperature.
205
Considering rotation flaps, myocutaneous flaps, and random flaps, which of these has the strongest blood supply?
Rotation flap.
206
Where is this substance found in nature?
Salivary glands of leeches.
207
Most medical prosthetics for the head and neck are made of what material and last how long?
Silicone; 2 years.
208
What is the blood supply of a random flap?
The dermal and subdermal plexuses.
209
What antibiotics is this organism sensitive to?
Third-generation cephalosporins, ciprofloxacin, aminoglycosides, sulfa drugs, and tetracycline.
210
What is the term for a flap that is raised and pivoted into a defect, leaving a secondary defect that must be repaired?
Transposition flap.
211
True/False:Axial flaps are more reliable than random flaps.
True.
212
True/False: The surviving length of an axial pattern flap remains constant regardless of flap width.
True.
213
True/False: Significant return of sensation to a free flap occurs even in the absence of neural anastomosis.
True.
214
What is the most common cause of flap failure?
Venous thrombosis.
215
When is return of sensation after skin grafting considered maximal?
After 2 years.
216
What is the minimum age at which the calvarium can be split?
Age 4 or 5 (layers of the skull are not defined until then).
217
How is the diploic layer of the skull recognized during in situ harvesting?
Color changes from yellow-white to red and increased bleeding occurs.
218
Why do cranial bone grafts have superior resistance to resorption when compared with other bone graft donor sites (e.g., rib or iliac bone)?
Cranial bone originates from membranous bone, whereas the other donor sites originate from endochondral bone; cranial bone revascularizes more quickly.
219
What complications are specific to the cranial bone harvest?
Dural exposure, meningitis, CSF leak, sagittal sinus injury, and brain injury.
220
What are the different types of cranial bone grafts?
Full-thickness calvarium, split-thickness calvarium, bone chips, and bone dust.
221
What factor is most essential to the success of a vascularized bone graft to the mandible?
Good immobilization.
222
What are the advantages of using cranial bone as an autogenous graft compared with other bone grafts for orbital reconstruction?
Harvested from the same surgical field; little postoperative pain; donor site complications are rare; large amounts can be harvested; and less likely to resorb than endochondral grafts.
223
What is the major problem of using Mersilene mesh for genioplasty?
High potential for resorption.
224
What are the three phases of healing for skin grafts?
Imbibition, inosculation, and neovascularization.
225
What complications are specific to the iliac crest donor site?
Injury to abdominal contents or the iliofemoral joint, detachment of the inguinal ligament, interference with tensor fascia lata function, or damage to nearby peripheral nerves.
226
What is the best way to avoid injury to the superior sagittal sinus during harvesting of calvarial bone?
Maintain at least a 2-cm distance from the sagittal suture.
227
What are the advantages of using mesh implants for repair of orbital floor fractures?
No need for a bone or fascial barrier between the orbital contents and the mesh; posterior orbital shape can be simulated more easily than with bone grafts; well tolerated when exposed to open paranasal sinuses; and may facilitate survival of bone grafts in the anterior orbit.
228
What is the preferred site for harvesting calvarial bone?
Parietal bone (anterior for a flat graft; posterior for a curved graft).
229
What is the thickest part of the skull?
Parietal bone.
230
What can be done to minimize the visibility of the bicoronal incision?
Perform a wavy line incision.
231
What process allows survival of skin grafts in the first 48 hours?
Plasmatic imbibition.
232
What complications are specific to the rib donor site?
Pneumothorax, hemothorax, and intercostal nerve injury.
233
Which alloplastic implant material has been reported to cause the least amount of bony resorption deep to the implant?
Porous polyethylene.
234
What is the most important factor in minimizing hyperpigntentation of skin grafts?
Protection from lN light for a full year postoperatively.
235
What are the advantages of using porous polyethylene over other alloplastic materials for orbital reconstruction?
Semirigid; porous allowing fibrous, vascular, and bony ingrowth; minimal inflammatory reaction; and infection and extrusion are rare.
236
Which alloplastic implant material forms a surrounding capsule?
Solid silicone.
237
What is the thinnest part of the skull?
Squamous portion of the temporal bone.
238
What is meant by inosculation with regard to skin grafts?
The process by which vascular buds from the recipient bed make contact with capillaries within the graft.
239
What are the differences between thin and thick split-thickness skin grafts (STSGs)?
Thin grafts take better, but thick grafts have better color match, less contraction, and are more resistant to trauma.
240
True/False: Sagittally oriented scalp incisions tend to cause less scalp sensory disturbance than do coronally oriented incisions.
True.
241
What % of patients with sarcoidosis have laryngeal involvement
0.01
242
What % of patients with relapsing polychondritis have airway involvement
0.6
243
What is the risk of seroconversion following percutaneous exposure to HIV
0.31 %.
244
What % of these patients have involvement of the ophthalmic artery
1/3.
245
What % of patients with sarcoidosis have parotid gland involvement
10%.
246
What are the late manifestations of Lyme disease
15% of untreated patients will develop neurological problems within weeks of the tick bite.... Meningitis, encephalitis, cranial neuropathy, radiculoneuritis, mononeuritis multiplex, cerebellar ataxia, myelitis. 60°/o of untreated patients will develop large joint swelling and pain within months of the tick bite. 5°/o of untreated patients will develop chronic neuroborreliosis with spinal radicular pain or distal paresthesias or acute cardiac problems with A V block, acute myopericarditis or mild LV dysfunction.
247
What % of patients with hilar adenopathy will have histologic findings consistent with sarcoidosis on lower lip minor salivary gland biopsy
2/3.
248
What % of adults with disseminated disease Histoplasma capsulatum present with oropharyngeal involvement
40 - 75%).
249
What is the significance of oral hairy leukoplakia in patients with HIV
50% of patients with HIV and hairy leukoplakia will develop AIDS within 16 months and up to 80°/o will develop HI V within 30 months.
250
What is the 5-year survival rate of patients with Churg-Strauss syndrome
50%.
251
What is the latency period for seroconversion following exposure to the HIV virus
6 to 12 months.
252
What % of patients with sarcoidosis will have an elevated ACE
80 - 90°/o.
253
What are the early manifestations of Lyme disease
80% will have erythema migrans at the site of the tick bite with flu-like symptoms.
254
What % of patients with cat-scratch disease are under 18
90°/o.
255
What is lupus pernio
A cutaneous manifestation of sarcoidosis most commonly occurring on the nose, cheeks, or ears that appears as an indurated blue-purple, shiny, swollen lesion.
256
What is the most common ENT manifestation of actinomycosis
A red, indurated, non-tender, subcutaneous mass in the submandibular triangle with the overlying skin having a purplish discoloration.
257
What infectious diseases can cause chronic thyroiditis
Actinomycosis, TB, and syphilis.
258
Which cardiovascular medication will interfere with radioiodine scanning
Amiodarone.
259
What are the head and neck manifestations of rheumatoid arthritis
Arthritis of the temporomandibular and cricoarytenoid joints, recurrent laryngeal nerve paresis/paralysis, conductive hearing loss, SNHL.
260
Which area is most commonly involved when TB spreads to the larynx
Arytenoids.
261
What disease is characterized by uveitis and oral and genital ulcers
Beh9et's disease.
262
How is Histoplasma capsulatum diagnosed
Biopsy or swab is taken from the center of a lesion and cultured on Sabouraud's medium.
263
What structures are unique to Langerhans cells and are used to diagnose Langerhans cell histiocytosis (LCH)
Birbeck granules, or cytoplasmic inclusion bodies.
264
Which body fluids were involved in all reported HI V seroconversions in health care workers
Blood and sanguinous fluids.
265
How is Sjogren's syndrome distinguished from malignant lymphoma
By the presence of myoepithelial islands.
266
How is amyloidosis diagnosed
Can only be diagnosed by biopsy; amyloid is highly refractile with an affinity for Congo red dye and shows green birefringence with polarized light.
267
What test is most specific for Wegener's
c-ANCA.
268
What is the most common oral manifestation of AIDS
Candidiasis.
269
What is bacillary angiomatosis
Caused by the same organisms of cat-scratch disease with similar manifestations but occurs in immunocompromised patients and is progressive and fatal if left untreated.
270
Patient with Cogan's syndrome usually have elevated titers to what organism
Chlamydia.
271
What vasculitic disease is characterized by a prodromal stage of allergic rhinitis, nasal polyposis, and asthma
Churg-Strauss syndrome.
272
What is the alternate therapy and when should it be initiated
Dapsone should be used when severe reactions (e.g., skin blistering, mucosal involvement, or anaphylaxis) to TMP-SMX occur.
273
How is the risk of seroconversion altered with AZT prophylaxis after percutaneous exposure to HIV
Decreased by 79%.
274
What laboratory test is associated with lymphoproliferative malignancy in patients with Sjogren's syndrome
Decreased level of serum lgM.
275
What are the head and neck manifestations of scleroderma
Dysphagia, hiatal hernia, trismus, thin lips and vertical perioral furrows, gingivitis, xerostomia, hoarseness, Raynaud' s phenomenon of the tongue, trigeminal neuralgia, facial nerve palsy.
276
What are the ENT manifestations of Histoplasma capsulatum
Dysphagia, sore throat, hoarseness, painful mastication, gingival irritation; granulomatous lesions on the lips, gingiva, tongue, pharynx, larynx.
277
What finding is typical of laryngeal involvement of sarcoidosis
Edema of the supraglottis.
278
What are the typical laboratory findings in patients with relapsing polychondritis
Elevated ESR, moderate leukocytosis, mild to moderate anemia.
279
What are the diagnostic criteria for mixed connective tissue disease
Elevated titers of anti-U I RNP (ribonucleoprotein antibody) and three of either hand edema, synovitis, myositis, Raynaud's phenomenon, or acrosclerosis.
280
What is the term for the localized form of LCH
Eosinophilic granuloma.
281
What are the ENT manifestations of Blastomycosis dermatitidis
Erythematous hyperplasia of the mucosa in the larynx and hypopharynx, fibrosis of the vocal cords, pharyngocutaneous fistula.
282
What is the treatment for cat-scratch disease and bacillary angiomatosis
Erythromycin, doxycycline, rifampin; incision and drainage of necrotic lymph nodes if abscess occurs.
283
T/F: FTA-ABS becomes negative once a patient has been adequately treated for syphilis
False.
284
What is the typical appearance of the lesions caused by Histoplasma capsulatum
Firm, painful ulcers with heaped-up margins, often with a verrucous appearance.
285
Where are eosinophilic granulomas most commonly located
Flat bones of the skull.
286
How long should a patient with Kawasaki's disease remain on aspirin
For at least 6-8 weeks; ECHO is then performed, and if negative, can discontinue.
287
What are the systemic manifestations of Sjogren's syndrome
Glomerulonephritis, vasculitis, sensory polyneuropathy, interstitial pneumonitis, thyroid disease resembling Hashimoto's thyroiditis.
288
What are the most common causes of hyperthyroidism
Graves' disease, autonomous toxic nodule, subacute thyroiditis, pituitary tumor.
289
What are the ENT manifestations of tertiary syphilis
Gumma formation can result in septal and hard palate perforations, laryngeal ulcerations, hearing loss, vertigo, osteomyelitis of the temporal bone.
290
What is the chronic, disseminated form of LCH
Hand-Schuller-Christian disease.
291
What are the most common causes of hypothyroidism
Hashimoto's thyroiditis, pituitary tumor, and radioactive I 131 treatment for thyrotoxicosis.
292
What is the most common type of autoimmune thyroiditis
Hashimoto's.
293
Where is gout most commonly located in the head and neck
Helix or antihelix of the ear.
294
What is the treatment for Kawasaki's disease
High-dose aspirin and a single dose of IVIG 2 g/kg.
295
Which fungal infection is endemic to the Mississippi and Ohio River valleys
Histoplasma capsulatum.
296
What antibodies are most commonly seen in patients with rheumatoid arthritis
HLA-DW4 antibodies.
297
What are some common laboratory findings in patients with sarcoidosis
Hypergammaglobulinemia, elevated LFTs, calcium, ESR, and angiotensin converting enzyme (ACE).
298
What are the 4 diagnostic criteria for cat-scratch disease
I. History of contact with a cat or presence of a scratch. 2. Positive skin test or serologic antibody test. 3. Positive gram stain or culture. 4. Characteristic histopathology.
299
What disease is characterized by the presence of black eschar on the middle turbinate
Invasive fungal sinusitis.
300
In which ethnic group is Kawasaki's disease most common
Japanese.
301
Where is necrotizing sialometaplasia most commonly found
Junction of hard and soft palate.
302
What are the 2 most common AIDS-related neoplasms
Kaposi's sarcoma and non-Hodgkin's lymphoma.
303
What disease is characterized by significant painless, posterior triangle cervical lymphadenopathy that typically resolves without treatment within 6 months
Kikuchi's disease.
304
What disease is characterized by Mikulicz's cells and causes stenosis of the nose, larynx, and tracheobronchial tree
Klebsiella rhinoscleromatis (rhinoscleroma).
305
What are the most common laryngeal manifestations of \\-'egener's
Laryngeal ulceration, subglottic stenosis.
306
Which parasitic infection is transmitted to humans by the sandfly
Leishmaniasis.
307
What is an abnormal Schirmer test
Less than 5 mm wetting after 5 minutes; less than 10 mm wetting after stimulation with 1 O% ammonia.
308
What is the acute, disseminated form of LCH
Letterer-Siwe disease.
309
What 2 factors are associated with a higher prevalence of rhinosinusitis in patients with HIV
Low CD4 count and bilateral absence of maxillary infundibular patency.
310
What is the most common vector-borne disease in the US
Lyme disease.
311
What are the ENT manifestations of systemic lupus erythematosus (SLE)
Malar rash, oral ulceration, arthritis of the cricoarytenoid or cricothyroid joints, vocal cord thickening, anterior septal perforations, acute parotid gland enlargement, cranial nerve neuropathy.
312
What is the risk of performing FN A on scrofula
May lead to a chronically draining cutaneous fistula.
313
What is the typical histologic appearance of necrotizing sialometaplasia
Metaplastic epithelial cells lining salivary ducts with preservation of lobular architecture.
314
What is the treatment for insulin-dependent diabetic patients with sarcoidosis
Methotrexate.
315
What tests are use to diagnose Sjogren's syndrome
Minor salivary gland biopsy showing mononuclear cell infiltration, SS-A, SS-8, and ANA, RF.
316
What are Langerhans cells
Mononuclear cells normally found in the skin that play a role in various immune functions.
317
What are the head and neck manifestations of mixed connective tissue disease
Mucocutaneous changes, malar rash, discoid lupus, sclerodermatous skin changes, septal perforations, esophageal dysfunction.
318
What are the ENT manifestations of leprosy
Mucosal nodules at the anterior inferior turbinates, septal perforation, lateral loss of eyebrows, leonine facies.
319
What triad of diseases is commonly seen in patients with Hand-Schuller-Christian disease
Multiple calvarial osteolytic lesions (geographic skull), exophthalmos, and diabetes insipidus.
320
What tumors is amyloidosis associated with
Multiple myeloma and Hodgkin's lymphoma.
321
How does TB involvement of the ear most commonly present
Multiple TM perforations with thin, watery otorrhea.
322
What are the most common ENT complaints of patients with Wegener's
Nasal obstruction, bloody rhinorrhea, nasal crusting, and nasal pain.
323
What are the typical features of Wegener's granulomatosis
Necrotizing granulomas of the upper airway and lungs, focal necrotizing glomerulonephritis, and disseminated vasculitis
324
What histologic finding is the hallmark of sarcoidosis
Noncaseating granulomas.
325
What malignancy is associated with Sjogren's syndrome
Non-Hodgkin's lymphoma.
326
What is the appearance of the rash in patients with Kawasaki's disease
Non-vesicular polymorphous rash starting in the perineal area and spreading to the trunk.
327
What are the most common presenting symptoms in patients with Kawasaki's disease
Oral cavity erythema and cervical lymphadenopathy.
328
What is the treatment for actinomycosis
Oral penicillin or tetracycline for 2 - 4 months or 6 weeks of parental penicillin (for severe cases).
329
What are the ENT manifestations of primary syphilis
Painless ulcer (chancre) of the lips, tongue, or tonsils with reactive lymphadenopathy.
330
What are the ENT manifestations of Rhinosporidium seeberi
Painless, polypoid, friable lesions on the mucous membranes of the nose, conjunctiva, and palate ("strawberry lesions").
331
What is the most appropriate treatment for a patient with AIDS who develops bilateral progressive SNHL secondary to otosyphilis
Penicillin G, 24 million U daily for 3 weeks.
332
What is the most common ENT manifestation of toxoplasmosis
Persistent neck mass.
333
What are the head and neck manifestations of hypersensitivity vasculitis
Petechiae and purpura of oral and nasal mucosa, angioedema, serous otitis media.
334
What disease closely resembles Wegener's granulomatosis and lymphoma clinically but is characterized by angiocentric infiltration of atypical polymorphonuclear cells on histologic exam
Polymorphic reticulosis (a.k.a. lethal midline granuloma, lymphomatoid granulomatosis, angiocentric lymphoma).
335
Where is scrofula most commonly located in adults
Posterior cervical triangle.
336
What factors significantly increase the risk of Staphylococcus aureus infection in patients with HIV
Presence of a vascular catheter, CD4 count \< I 00, nasal carriage of S. aureus, neutropenia.
337
What are the differences between primary and secondary Sjogren's syndrome
Primary (a.k.a. sicca syndrome) is isolated to the lacrimal and salivary glands; secondary (a.k.a. sicca complex) is associated with other connective tissue diseases.
338
Which drugs may precipitate a lupus-like reaction
Procainamide, hydralazine, pencillin, sulfonamides, and hydantoins.
339
What medications are used for the routine treatment of hyperthyroidism
PTU and methimazole.
340
What is the term for a painless, soft lesion found along the gingival mucosa composed of granulation tissue
Pyogenic granuloma.
341
What is the treatment for polymorphic reticulosis
Radiation.
342
What is the treatment of choice for patients over 40 with Graves' disease
Radioactive I131
343
What are the ENT manifestations of polymorphic reticulosis
Rapid necrosis of the external nose, nasal cavity, soft and hard palates, and nasopharynx.
344
What are the diagnostic features of relapsing polychondritis
Recurrent chondritis of the auricles, nonerosive inflammatory polyarthritis, chondritis of the nasal cartilages, inflammation of ocular structures, chondritis of laryngeal or tracheal cartilages, cochlear or vestibular damage.
345
What thyroid disorder is characterized by replacement of the thyroid gland with fibrous tissue
Reidel's struma (invasive fibrous thyroiditis, woody thyroiditis).
346
What is the most common cause of arthritis of the cricoarytenoid joint
Rheumatoid arthritis.
347
Which fungal disease is endemic to Southern India and Sri Lanka
Rhinosporidium seeberi.
348
Which organisms can cause cat-scratch disease
Rochalimaea henselae or Afipia felis.
349
What are the ENT manifestations of congenitally acquired syphilis
Saddle nose deformity, frontal bossing, short maxilla, Hutchinson's incisors, mulberry molars, mental retardation, SNHL.
350
What is the most common ENT manifestation of tuberculosis
Scrofula.
351
What is the appearance of the Aspergillus fumigatus on microscopic exam
Septate, bifurcating hyphae.
352
What are the most common otologic manifestations of Wegener's
Serous otitis media, SNHL.
353
What are the specific otologic manifestations of Cogan's syndrome
Similar to Meniere's (fluctuating hearing loss, vertigo, tinnitus, aural fullness) but bilateral.
354
What are the ENT manifestations of non-invasive Aspergillus fumigatus infection
Single sinus cavity involvement with thick, dark nasal secretions and facial fullness.
355
What diseases are commonly mistaken for necrotizing sialometaplasia
Squamous cell and mucoepidermoid carcinoma.
356
What is the treatment for rhinoscleroma
Streptomycin or tetracycline.
357
Where is scrofula most commonly located in children
Submandibular triangle.
358
What are the head and neck manifestations of polyarteritis nodosa
Sudden bilateral SHNL, and vestibular problems; ulceration of nasal, buccal, or soft palate mucosa; facial nerve palsy.
359
What is the characteristic appearance of actinomycosis on microscopic exam
Sulfur granules.
360
What are the typical histologic findings of biopsied lymph nodes from patients with cat-scratch disease
Suppurative and necrotizing granulomatous lymphadenitis with stellate abscesses.
361
How is temporal arteritis diagnosed
Temporal artery biopsy (ESR for screening).
362
What are the head and neck manifestations of temporal arteritis
Tender and erythematous temporal artery, jaw claudication, lingual claudication, vertigo and hearing loss, blindness, cranial nerve deficits.
363
Where are reparative granulomas most commonly located
The peripheral form is most commonly located on the anterior aspect of the mandible; the central form is most commonly located anterior to the first molar within the bone of the mandible.
364
What is the drug of choice for the prophylaxis of Pneumocystis carinii infections in patients with HIV
TMP-SMX.
365
Which area is most commonly involved when TB spreads to the oral cavity
Tongue.
366
What antibiotic is effective for treatment of Wegener's
Trimethoprim/sulfamethoxazole.
367
T/F: Most lesions of necrotizing sialometaplasia resolve spontaneously within two to three months and do not require excision
True.
368
T/F: Patients with Cogan's syndrome who are not treated promptly with high-dose corticosteroids will have total permanent hearing loss
True.
369
What head and neck malignancies are more common in patients with polymyositis/dermatomyositis
Tumors of the parotid gland and tonsil; nasopharyngeal cancer in endemic areas.
370
What % of patients with Kawasaki's disease will develop coronary aneurysms
Up to 30%.
371
What is the latency period for developing antibodies to hepatitis C
Up to 4 months.
372
What is the significance of a rising c-ANCA titer in a patient with Wegener's
Usually indicates a relapse of active disease.
373
What is the most common site of involvement of amyloidosis in the larynx
Ventricle.
374
What are the characteristics of Cogan's syndrome
Vestibuloauditory dysfunction and interstitial keratitis.
375
What test is used to screen for syphilis
VORL.
376
What are the head and neck manifestations of polymyositis and dermatomyositis
Weakness of neck muscles, dysphagia, skin rash on the eyelids, nose, and cheeks.
377
What is the most specific test for the diagnosis of Cogan's syndrome
Western blot assay for 55 kD inner ear antigen.
378
What is the most specific test for the diagnosis of autoimmune sensorineural hearing loss
Western blot assay for 68 kD inner ear antigen (Otoblot) (95% specific).
379
What are the ENT manifestations of secondary syphilis
Widespread mucocutaneous maculopapular lesions, acute rhinitis, pharyngitis, laryngitis, otitis media, loss of eyelashes, localized alopecia.
380
What are the ENT manifestations of Sjogren's syndrome
Xerostomia, dental caries, oral candidiasis, recurrent salivary gland enlargement, keratoconjunctivitis sicca, nasal crusting/epistaxis.
381
Can patients with total hearing loss secondary to Cogan's syndrome have a cochlear implant
Yes.
382
Children may have unlimited clear liquids up to how many hours prior to scheduled anesthetic induction?
2-3 hours.
383
What is the most effective duration for perioperative antibiotic administration?
24 hours.
384
When should oral hypoglycemics be discontinued prior to surgery?
24 hours.
385
What is the incidence of postoperative hypertension in patients with obstructive sleep apnea syndrome (OSAS) without history of hypertension?
63%.
386
When should warfarin therapy be discontinued prior to surgery?
96-115 hours (4 doses).
387
What anesthetic considerations must be taken into account in a patient with sickle cell disease?
Adequate hydration and oxygenation. Spinal or local anesthesia should be used whenever possible.
388
What factors predispose children with viral URis to airway hyperactivity during surgery?
Age
389
What factors increase the risk of postoperative pulmonary embolism?
Age \>40 years, history of lower extremity venous disease, malignancy, CHF, trauma, and paraplegia.
390
What is the standard endocarditis prophylaxis for dental, oral, or upper airway procedures in adult patients at risk?
Amoxicillin 2 g orally, 1hour before the procedure.
391
What is the appropriate preoperative workup for a young patient with frequent premature ventricular contractions (PVCs)?
An electrocardiogram (ECG), holter monitor, and a cardiac stress test.
392
What role might oral clonidine play in the preoperative period?
As an a2-adrenergic agonist, it can reduce anesthetic requirements and has been used to provide sedation and anxiolysis while maintaining hemodynamic stability.
393
When should a patient quit smoking to have the greatest decrease in perioperative pulmonary complications?
At least 8 weeks before the planned procedure.
394
What is the ideal MAP after surgery for OSAS?
Below 100 mm Hg.
395
How are children with idiopathic thrombocytopenia managed perioperatively?
CBC is drawn 1week prior to the procedure, and if thrombocytopenia is present, IVIG is administered preoperatively (400 mg/kg for 4 days).
396
Of Goldman's risk factors, which has been shown to be the most significant?
Congestive heart failure (CHF).
397
A patient with advanced laryngeal cancer comes in for preoperative evaluation. He currently weighs 130 lbs and reports weighing 149 lbs 3 months ago. His serum albumin level is 2.4 g/dL. What should be done prior to his operation?
He should be hospitalized for 7-10 days prior to surgery for nutritional repletion.
398
What is the accepted stress dose of corticosteroids for patients undergoing major procedures?
Hydrocortisone, 100 mg, the night before the procedure with repeat administration every 8 hours until the stress has passed.
399
What are the primary disadvantages of ketorolac?
Impairs platelet function and can lead to mucosal breakdown in the GI tract.
400
How are children with von Willebrand disease undergoing tonsillectomy managed perioperatively?
IV administration of desmopressin (0.3 11g/kg) preoperatively, 12 hours postoperatively, and every morning until the fossae are completely healed; aminocaproic acid pre- and postoperatively. Alternatively, Factor VIII concentrate can be given perioperatively.
401
Why are children under 3 routinely admitted after adenotonsillectomy?
Less likely to cooperate with oral intake and more likely to have surgery for airway obstruction.
402
Which hypertensive medications classically cause withdrawal hypertension and, therefore, should not be stopped prior to surgery?
P-Blockers and clonidine.
403
What are the guidelines set by the AAO-HNS for 23-hour admission after adenotonsillectomy?
Poor oral intake, vomiting, hemorrhage, age younger than 3, home more than 45 minutes from the nearest hospital, poor socioeconomic situation with possible neglect, and other medical problems.
404
What is the single most important factor that determines the length of stay after general anesthesia in ambulatory patients?
Postanesthesia nausea.
405
How are children with sickle cell disease managed perioperatively?
Preoperative transfusion to decrease the hemoglobin S ratio to
406
The above patient is hospitalized and started on high-calorie tube feeds at 50 ccfh. The next day he becomes confused and goes into cardiac arrest. What has happened?
Refeeding syndrome.
407
What are the advantages of a thallium stress test over an exercise stress test?
The thallium stress test can better identify the location and extent of myocardial ischemia.
408
Which patients are at greatest risk for respiratory problems after adenotonsillectomy?
Those with polysomnogram-proven obstructive sleep apnea, Down syndrome, cerebral palsy, or congenital defects.
409
A patient who is to undergo surgery reports a positive result on a latex-specific RAST test as part of a job screening process but denies any symptoms of latex allergies. Should any precautions be taken during surgery?
Yes, the procedure should be performed under latex-free conditions.
410
How much time does it take for a surgical wound to fully heal?
2 years.
411
What is the absorption rate of chromic catgut sutures?
20 days.
412
What is the tensile strength of a wound after 4 weeks?
30% of normal.
413
How long does epithelialization take to produce a watertight seal?
48 hours.
414
What is the maximum tensile strength of a surgical scar?
8o% of normal uninjured tissue.
415
What is the wound bursting strength?
A direct measure of the force required to separate a healing, linear incision.
416
What is the major event during the proliferative phase?
Accelerated production of collagen.
417
When does the production of collagen peak during wound healing?
Day 7 after wound closure (continues at this pace for 2-3 weeks).
418
Poor wound healing after RT is primarily due to injury to which cell?
Fibroblasts.
419
What are the second most commonly isolated bacteria?
Gram-negative aerobic bacteria.
420
What are the three stages of normal surgical wound healing?
Inflammation (d1-3), proliferation (d3-week 4), maturation (week 4-2 years).
421
Which stage is most sensitive to the effects of chemoradiation?
Inflammatory stage.
422
What is the function of epidermal growth factor (EGF)?
It stimulates DNA synthesis and cell division in a variety of cells, including fibroblasts, keratinocytes, and endothelial cells.
423
What is the tensile strength of a wound during the inflammatory stage?
Less than 5% of normal.
424
What perioperative factors are associated with an increased risk of postoperative wound infection?
Long preoperative hospitalization; no preoperative shower; early shaving of the operative site; hair removal; and prior antibiotic therapy.
425
Deficiency of which white blood cell is most likely to compromise wound healing?
Macrophages.
426
Under what conditions is epithelial migration and replication most facilitated?
Moist wound surfaces under gas-permeable dressings.
427
What are the first inflammatory cells to enter the wound space?
Neutrophils.
428
When should scar revision take place?
Not for at least 1year after injury/surgery.
429
Which suture materials incite the greatest inflammatory response?
Plain catgut and chromic catgut.
430
Which suture material loses its strength within 7 days?
Plain catgut.
431
What are the main events of the maturation stage?
Reduction in the number of fibroblasts and macrophages, increase in collagen content, and gradual increase in tensile wound strength.
432
What effect does radiation therapy (RT) have on the wound bursting strength?
Significantly decreases it-after 18 Gy, it is 52% of normal.
433
What are the most commonly isolated bacteria from wound infections following major contaminated head and neck surgery?
Staphylococcus aureus and beta-hemolytic streptococci.
434
Why do hematomas increase the risk of infection?
They prevent fibroblast migration and capillary formation.
