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BoardVitals Flashcards

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1
Q

Best goal for rhinoplasty in Asian nose that is ptotic, bulbous, underprojected, and broad?

A

Tip projection via columellar strut placement

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2
Q

What do ameleoblastomas arise from?

A

Tooth enamel precursor cells

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3
Q

Linear transposition flaps have a tendency towards what kind of deformity?

A

Trap-door deformity (due to underlying scar formation)

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4
Q

What imaging should be obtained in the setting of a post-op chyle leak?

A

CXR to rule out concurrent chylothorax

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5
Q

What medication should be given when a patient has a moderate output chyle leak?

A

Octreotide (100 mcg subq TID) to reduce splanchnic blood flow and decrease GI chyle production

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6
Q

What % of chyle leaks occur on the right side?

A

25%: inturruption of the right lymphatic duct on its path to the right subclavian vein

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7
Q

What cranial nerves are most often impacted by a jugular paraganglionoma?

A

CN IX-XII

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8
Q

What is Vernet syndrome?

A

Paralysis of CN 9, 10, 11

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9
Q

What is Collet-Sicard syndrome?

A

Paralysis of CN 9, 10, 11, 12

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10
Q

In what direction will the internal and external carotid arteries be displaced by a carotid paraganglionoma?

A

Carotid body tumors splay the internal and external carotids, displacing the external anteriorly and the internal posteriorly

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11
Q

What kind of paraganglionoma would displace the external and internal carotids anterior and medial?

A

Vagal paraganglionoma

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12
Q

What is the basic procedure of an anterior cricoid split?

A

Incision of the anterior cricoid and the first two tracheal rings
Stenting with an ETT for 12-14 days

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13
Q

What are the criteria for performing anterior cricoid split in an infant?

A

Failure to extubate on at least 2 occasions
Infant weight > 1500 g
No assisted ventilation for at least 10 days
Minimal supplemental O2 requirements
Absence of CHF
Absence of URI
No need for antihypertensives

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14
Q

What makes anterior cricoid split superior to balloon dilation for long term extubation in subglottic stenosis?

A

Balloon dilation can provide temporary relief but needs to be repeated frequently

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15
Q

Which site of paraganglionomas has the highest risk of malignancy?

A

Orbital and laryngeal (25%)
Vagal (10%)
Jugular and tympanic (5%)
Carotid body (3-6%)

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16
Q

Is acute mastoiditis associated with smoke exposure?

A

No

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17
Q

What joins to form the internal jugular vein? Where does it form?

A

Sigmoid sinus and common facial vein

Starts in the posterior compartment of the jugular foramen at the base of the skull

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18
Q

What joins to form the external jugular vein? Where does it form?

A

Posterior facial and posterior auricular

Forms in the parotid gland at the level of the angle of the mandible

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19
Q

What degree of subglottic extension is a contraindication to a vertical partial laryngectomy?

A

> 10 mm anteriorly

>5 mm posteriorly

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20
Q

What does electrocochleography measure?

A

Neuroelectric events generated by the cochlea and auditory nerve in response to acoustic stimulation

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21
Q

What does an ABR assess?

A

The auditory pathway function in response to auditory stimuli

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22
Q

What is the level at which a patient is aware of a speech signal 50% of the time?

A

Speech detection threshold

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23
Q

What does directional preponderance express?

A

How the amount of right beating nystagmus compares with left beating nystagmus in caloric testing

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24
Q

What is the Brent and Kuhn criteria for the dx of allergic fungal sinusitis?

A
  1. Eosinophilic mucin (charcot-leyden crystals)
  2. Noninvasive fungal hyphae
  3. Nasal polyposis
  4. Characteristic radiographic findings
  5. Type 1 hypersensitivity by hx, skin test, or serology
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25
What does CT and MRI show in allergic funcal sinusitis?
CT: rim of hypointensity with hyperdense central material (allergic mucin), speckled areas of increased attenuation due to ferromagnetic fungal elements MRI: peripheral hyperintensity with central hypointensity on both T1 and T2, central void on T2
26
What should be done when an acute otitis media is found prior to cochlear implant placement
This is a contraindication to placement of the CI, T tubes should be placed and CI should be deferred until the pt is clear of infection for two weeks
27
What should be done if a serous otitis media is noted before placement of a cochlear implant?
Middle ear irrigation Use of topical antibiotic drops Post-op antibiotic therapy
28
What AHI corresponds to mild, moderate, and severe AHI in adults?
Mild: 5-15/hr Moderate: 15-30/hr Severe: >30/hr
29
What is MEN IIb characterized by?
Medullary thyroid carcinoma Mucosal neuromas Pheochromocytoma Marfinoid habitus
30
What is MEN I characterizes by?
Pituitary tumors Parathyroid hyperplasia Pancreatic tumors
31
What gene is associated with MEN IIa and IIb?
RET protooncogene
32
What is MEN IIa characterized by?
Parathyroid hyperplasia Pheochromocytoma Medullary thyroid carcinoma
33
What air-bone gap cut-offs do the following tuning fork frequencies correspond to?
256 Hz: 15 dB or more 512 Hz: 25 dB or more 1024 Hz: 35 dB or more
34
What is the IM dose of epinephrine that should be given to an adult for anaphylaxis?
0.3-0.5 mL of 1:1000 solution
35
What is the IM dose of epinephrine that should be given to a child for anaphylaxis?
0.01-0.03mg/kg or 0.1-0.3 mL of 1:1000 solution
36
In what percent of cases is tracheomalacia noted in substernal multi-nodular goiters?
3% of cases
37
What is the scutum?
Lateral wall of the epitympanum | Wedge shaped piece of bone
38
What is blunting of the scutum on CT scan indicative of?
Cholesteatoma
39
What is the area between the chorda tympani and the facial nerve?
Facial recess
40
What space is bordered superiorly by the ponticulus and inferiorly by the subiculum?
Sinus tympani
41
What structure takes up the largest portion of the medial wall of the mesotympanum?
Promontory
42
What forms the rounded hollow prominence of the promontory?
first turn of the cochlea
43
Orphan annie eyes after thyroid biopsy suggests:
Papillary thyroid carcinoma
44
What is the treatment modality of choice for thyroid lymphoma?
Chemo and radiation, not surgery
45
Are most thyroid lymphomas Hodgkins or non-Hodgkins?
Non-Hodgkins
46
What is the typical patient for a thyroid lymphoma?
Female >70 yo with a history of Hashimotos thyroiditis | **rapidly enlarging neck mass causing respiratory difficulty
47
What plays a significant role in the formation of recurrnet subglottic stenosis after balloon dilation in children?
Uncontrolled GERD
48
What is the treatment for postinflammatory hyperpigmentation as a complication of skin resurfacing procedures with higher Fitzpatrick grades?
Hydroquinone (tyrosinase inhibitor, inhibits conversion of tyrosine to DOPA in melanocytes) Sun block Exfoliant
49
What is the treatment of adductor vs abductor spasmotic dysphonia?
Botox injection to the: Adductor: vocalis muscle Abductor: posterior cricoarytenoid
50
What are the four kinds of frontal cells as described by Bent and Kuhn
Type 1: single frontal ethmoidal cell above the agger nasi Type 2: multiple cells above the agger nasi Type 3: cells pneumatize into the floor of the frontal sinus Type 4: Isolated frontal ethmoidal cells contained entirely in the frontal sinus
51
What are agger nasi cells?
The most anterior ethmoidal air cells lying anterolateral and inferior to the frontoethmoidal recess and anterior and above the attachment of the middle turbinate Located within the lacrimal bone
52
What is found immidiately behind the poster-medial wall of the agger nasi cell?
Drainage of the frontal sinus
53
What is the most common causative organism of Lemierre syndrome?
Fusobacterium necrophorum
54
What is the best antibiotic for tx of Lemierres syndrome?
Metronidazole (prolonged course up to 6 weeks)
55
What typically proceeds Lemierres syndrome?
Peritonsillar abscess: infection spreads to the adjacent internal jugular vein, creating septic thrombophelbitis
56
What forms the vidian nerve? | What fibers does it contain?
Junction of the greater petrosal and the deep petrosal nerves Parasympathetic and sympathetic fibers, esp parasympathetic fibers supplying the lacrimal gland
57
What is an indication for vidian neurectomy?
Crocodile tears--tearing while eating | Vidian nerve carries parasympathetic fibers to the lacrimal gland
58
What is the most common manifestation of MEN2A?
Medullary thyroid carcinoma Pheo in 70% Hyperparathyroidism in 20-35%
59
What is the key difference between the Abbe and Estlander flaps for lip reconstruction?
Estlander includes the oral commisure
60
What is the indication for a Karapandzic flap?
Reconstruction of a large lower lip defect of more than half and up to 2/3 of the lip
61
What is the indication for a Gilles flap?
Reconstruction of large lower lip defects of greater than 2/3 of the lip tissue
62
What part of a flow volume loop will be altered in the setting of a variable extrathoracic lesion like fixed vocal folds?
Flattening of the inspiratory (bottom) loop
63
1 mg of protamine negates the effects of ___ units of unfractionated heparin
100 units
64
What is a central megaincisor a pathognomic feature of?
Congnital pyriform aperature stenosis
65
What kind of bacterium causes a violacious hue overlying a subacute neck mass in a child
Atypical mycobacterium 56% Mycobacterium acium intracellulare 29% Mycobacterium tuberculosis
66
What layers does blood collect between in an auricular hematoma?
Perichondrium and cartilage
67
In an auricular hematoma, fibroneocartilage begins to form __ days after injury, resulting in a _____ deformity
7-10 | Cauliflower
68
What nerve provides sensory innervation to the superior pinna, helix, and anti-helix
Auriculotemporal nerve
69
When should auricular hematoma pts be seen following bolster placement?
24-48 hr
70
Should a load bearing or load sharing plate be used in an edentulous, atrophic mandible?
Load bearing--load sharing requires significant bone to bone contact and the strength to share the load
71
What is the general MOA of methimazole and propylthiouracil?
Inhibition of TH synthesis by inhibiting oxidation and organification of iodine PTU also disrupts conversion of T4 to T3
72
Which anti-thyroid med is safe in the first semester of pregnancy?
Propylthiourail
73
What is the feared side effect of anti thyroid drugs?
Agranulocytosis (occurs in 0.2% or less of pts)
74
How does TNM staging for mucosa melanoma differ from that of cutaneous melanoma?
No T1 or T2, starts at T3 because mucosal has a worse prognosis N0 is no LN mets, N1 is regional LN mets
75
What is the most common presenting sx of nasopharyngeal carcinoma?
Neck mass 75% Nasal sx (obstruction, epistaxis) 73% Impaired hearing 19%
76
What changes occur with the following with aging? - Epidermis - Dermis - Elastin - Melanocyte count - Dermal connective tissue
- Epidermis thins - Dermis atrophies - Elastin decreases - Fewer melanocytes - Increase in the ground substance component of dermal CT
77
What is the course of parasympathetic innervation to the parotid gland from the inferior salivatory nucleus?
``` Inferior salivatory nucleus (medulla) Glossopharyngeal nerve Jacobson's nerve Tympanic plexus Lesser petrosal nerve Otic ganglion Joins post-ganglionic fibers in the auriculotemporal nerve of V3 division ```
78
What type of antibiotic is a contraindication to botox injection?
Aminoglycosides: potentiation of neuromuscular blockade
79
What are CD 19, 20, and 22 markers of?
B lymphocytes
80
What at CD 2, 3, 4, and 8 markers of
T lymphocytes
81
What are CD 16 and 56 markers of?
NK cells
82
What is CD 69 a marker of?
Eosinophils
83
What is the distance from: - anterior lacrimal crest to the anterior ethmoid artery - anterior lacrimal crest to the posterior ethmoid artery - anterior lacrimal crest of the optic foramen
24 36 42
84
What specific area is more likely to get a subglottic hemangioma?
Posterior left subglottis
85
How often are subglottic hemangiomas associated with skin hemangiomas?
50% of the time
86
Pleomorphic ademomas comprise about __% of all parotid tumors
65%
87
How often are Warthin tumors bilateral?
5-7.5% (more commonly bilateral than pleomorphic adenomas)
88
What is the primary treatment of fungal rhinosinusitis 2/2 aspergillus? Mucormycosis?
IV voriconozole | IV amphotericin
89
What organism causes cat scratch fever?
Bartonella henselae
90
What is the most appropriate treatment for cat scratch fever?
Azithromycin 5 days | **surgical intervention not indicated
91
What can occur as a result of auriculotemporal nerve injury in parotid surgeries?
Frey's syndrome: auriculotemporal carries parasymp fibers to the parotid and symp fibers to the skin Aberrant regerneration an cause gustatory sweating
92
What perfect of thyroid nodules dx as follicular neoplasms on FNA end up being malignant?
20%
93
What is the most common site of iatrogenic CSF leak during sinus sugery?
Lateral lamella of the cribriform plate
94
What mass of the CP angle will be isointense to brain on T1 and T2, strongly enhances with contrast, and has a broad base of dural enhancement?
Meningiomas
95
How do cholesteatomas appear on T1 vs T2?
Hypointense on T1 Hyperintense on T2 Do not enhance with contrast
96
How do cholesterol granulomas appear on T1 and T2?
Hyperintense on T1 and T2 | Do not enhance with contrast
97
How do vestibular schwannomas appear on T1 and T2?
Isointense on T1 and T2 with foci of high density on T2 | Strongly enhance with contrast but do NOT have broad based dural attachment
98
Where is nystagmus directed in patient with vestibular neuritis?
Fast phase away from the the affected side
99
What are risk factors for Hashimoto's thyroiditis?
Female gender Diabetes mellitus Sjogren's syndrome HLA-DR3
100
Where does the right vs left recurrent laryngeal nerve branch off the vagus?
Right: T1-2, anterior to the right subclavian Left: in the thorax
101
What is the clinical significance of recurrent laryngeal dysfunction in the setting of normal pharyngeal sensation?
Lesion must be distal to the pharyngeal branch of the vagus nerve
102
What gives rise to the visceral motor fibers of the vagus nerve (pharyngeal branches and superior and inferior laryngeal nerves)
Nucleus ambiguous
103
What contains the cell bodies of visceral sensory nerves that include cerviccal thoracic, and abdominal fibers, innervate the carotid and aortic bodies, and send branches to the epiglottis and taste buds
Nucleus tractus solitarius
104
What are the main functional secretory cells of the parathyroid glands? What are the less numerous cells that stain more deeply and are rich in mitochondria
Chief cells Oxyphil cells **may also be intermediate cells
105
Is clindamycin bacteriocidal or bacteriostatic?
Bacteriostatic
106
What is the auditory pathway from the cochlea to the brain?
Cochlear nucleus Acoustric stria to the Superior olivary complex and inferior colliculus Auditory cortex
107
Match the inferior colliculus and the superior colliculus to visual and auditory
Inferior: auditory Superior: visual
108
What is a Pott's Puffy tumor?
Non-neoplastic condition occuring as a result of prior frontal sinus trauma, acute/chronic frontal sinusitis, or previous sinus surgery Leads to mucopyocele formation and subperiosteal abscess with underlying osteomyelitis
109
What is general tx of a Pott's Puffy tumor?
Surgical drainage and IV abx for 6-8 weeks
110
What happens to the width and cross sectional area of the choana in congenital nasal pyriform aperture stenosis?
Width reduced | Cross sectional area unchanged
111
What does non-operative treatment of congenital nasal pyriform aperture stenosis include?
Topical nasal vasoconstrictors | Nasal tubes
112
What should you aggressively screen for when you identify a patient with laryngomalacia?
GERD: reported as high as 50-100% of laryngomalacia population
113
What should be done for a child who is noted to have bifid epiglottis?
MRI of the brain--high association between bifid epiglottis and hypothalmic dysfunction
114
What syndrome is associated with polydactyly, pituitary dysfunction, imperforate anus, and hamartoblastomas?
Pallister-Hall syndrome
115
What syndrome encompasses laryngotracheal cleft, hypertelorism, cleft palate, and hypospadias?
Opitz-Frias syndrome
116
What is the medical term for a small chin?
Microgenia
117
What is the definition of class I occlusion?
Mesiobuccal cusp of the maxillary front molar is directly in line with the buccal groove of the permanent mandibular first molar
118
What is the lateral border of the paraglottic space? Medial border? Posterior?
Lateral: thyroid cartilage and cricothyroid membrane Medial: quadrangular membrane, ventricle, conus elasticus Posterior: pyriform sinus mucosa
119
What is the equation for calculating dB based on two intensities?
x dB = 10log(I1/I2)
120
What increase in dB will double sound intensity?
3 dB
121
What approach to CPA tumor is best for a patient with good preoperative hearing and a small, intracanalicular tumor?
Middle fossa approach | **offers exposure to the IAC but not the CPA
122
What population should not have a middle fossa approach to a CPA tumor?
Geriatric population: 2/2 fragility of dura and the need for temporal lobe retraction
123
What CPA tumor approach provides superior exposure to the CPA while preserving hearing, but cannot offer good exposure to intracanalicular tumors?
Retrosigmoid approach
124
What two approaches to CPA tumors injure the otic capsule?
Transcochlear | Translabyrinthine
125
What approach to a CPA tumor requires cerebrellar retraction but offers good exposure of the CPA?
Suboccipital approach
126
What is the optimal time to dermabrade scars post-op?
6-8 weeks
127
In transplant patients or those with hematologic malignancies, what PMN count is linked with the onset of acute invasive fungal sinusitis and reduced survival?
1000 mm3
128
In transplant patients or those with hematologic malignancies, what PMN count is linked with the onset of acute invasive fungal sinusitis and reduced survival?
1000 mm3
129
Which of the ossicle is most commonly eroded by a cholesteatoma?
Incus | Malleus gets displaced with widening of Prussak's space
130
What plane should scalp tissue expanders be placed in?
Subgaleal plane, above the periosteum
131
How long after placement of tissue expander placement can inflation begin?
2 weeks (needs sufficient time to heal)
132
What is a rule of thumb for the base width of a tissue expander for the scalp in relation to the width of the defect?
Expander should be about 2.5x the width of the defect
133
What is the Centor criteria for strep throat?
Fever Tender lymphadenopathy Exudative tonsillitis Absence of cough
134
What is the sensitivity and specificity of the rapid strep test?
90% sensitive | 95% specific
135
A Centor score of 4/4 equates with a __% chance of GABHS infection
60%
136
What is the overall incidence of rheumatic fever in pediatric GABHS pharyngitis patients?
0.3% (1-3% in the adult population)
137
What should be done during a stapedectomy with PORP placement if the incus is found to be dislocated?
Abort the procedure and complete in 4-6 mo when the incus is reattached to the malleus
138
What malignancy is a patient with sjogren's syndrome at higher risk for?
Mucosa-associated lymphoid tissue lymphoma
139
SS-A and SS-B is elevated in what percent of pts with active Sjogren's
50-70%
140
What is the most common salivary gland malignancy?
Mucoepidermoid carcinoma
141
Are males or females more likelyto get mucoepidermoid carcinoma?
Females
142
What types of cells are more prevalent in high grade mucoepidermoid carcinomas?
Higher proportion of epithelial cells, fewer mucoid cells
143
In what week of development does the extratemporal portion of the facial nerve begin development?
6th gestational week, all branches present at the end of the 8th week
144
The nervus intermedius contains preganglionic parasympathetic nerve fibers supplying innervation to what glands:
Lacrimal Submandibular Sublingual Minor salivary glands
145
What is the diameter of the larybrinthine segment of the facial nerve?
0.7 mm
146
What is the name of the bony prominence which projects from the roof of the epitympanum, superior to the facial nerve as it enters the facial cavity?
Cog
147
What is the tullio phenomenon?
Vertigo and nystagmus in response to loud sounds
148
In what situations is the Tullio phenomenon seen?
Superior canal dehiscence | Syphilis
149
What is the most common location of synovial sarcoma in the head and neck?
Hypopharynx--arise from pluripotent mesenchymal cells
150
What are the two types of synovial sarcomas?
Monophasic form composed of spindle cells | Biphasic form composed of epithelial and spindle cells
151
What is the most common location of osteosarcoma in the head and neck?
Mandible and maxilla
152
What is the most common location of liposarcoma in the head and neck?
Neck
153
What is the most common location for chondrosarcomas?
Larynx | Also seen in the petrous temporal bone, clivus, maxilla, and mandible
154
What are the 4 parasympathetic ganglia in the head and neck?
1. Otic 2. Submandibular 3. Pterygopalatine / sphenopalatine 4. Ciliary
155
What is the small parasympathetic ganglion located just inferior to the foramen ovale what carries parasympathetic fibers for salivation of the parotid?
Otic ganglion
156
What ganglion is located near the posterior edge of the mylohyoid mucle just over the hyoglossus muscle
Submandibular ganglion
157
Preganglionic parasympathetic fibers within the chorda tympani never travel along with the lingual and synapse in the ____ ganglion before innervating the sublingual and submandibular glands
Submandibular ganglion
158
Preganglionic parasympathetic fibers carried in the greater superficial petrosal nerve synapse in what ganglion
Pterygopalatine/spehnopalatine
159
Post-ganglionic fibers that synapsed in the ___ ganglion innervate the sphincter pupillae and cause miosis
Ciliary
160
What medication can help prevent epistaxis in a patient with chronic kidney disease who is on coumadin
DDAVP: uremia can cause inactivation of platelets and desmopressin (intranasal or subcutanous), can also be used for Von Willebrand disease
161
What are the boundaries of the frontal recess?
Medial: middle turbinate Lateral: lamina papyracea and uncinate Anterior: posterior wall of the agger nasi Posterior: anterior edge of the ethmoid bulla
162
Abnormality of what embryonic process leads to medial cleft lip?
Abnormal fusion of the medial nasal processes
163
What is the epithelium of the supraglottis? | Glottis?
Pseudostratified columnar | Stratified squamous
164
What is a type IV tympanoplasty
Absent or eroded suprastructure with the graft or TM overlying mobile stapes footplate
165
What is a type V tympanoplasty
Stapes footplate is fixed Va: grafting over a fenestration created in the horizontal semicircular canal Vb: stapedectomy **more common
166
What are the prognostic factors for papillary thyroid carcinoma according to the AMES criteria?
Age: >41 for men, >51 for women Metastasis Extrathyroidal invation Size: >5cm
167
What type of branchial cleft cyst will drain into the pyriform sinus Where will it travel with respect to the internal/external carotid, the hypoglossal and glossopharyngeal
Third branchial cleft cyst | Posterior to the internal carotid artery and between the hypoglossal and glossopharyngeal
168
What type of branchial cleft cyst will pass between the internal and external carotid arteries and superficial to the hypoglossal and glossopharyngeal?
Second branchial cleft cyst
169
Where will a first branchial cleft cyst terminate?
External auditory canal
170
What is the most common finding on laryngoscopy in the setting of laryngomalacia?
Inspiratory collapse of accessory arytenoid cartilages and mucosa into the glottis **will also see posteriorly displaced epiglottis and shortened AE folds
171
What are indications for supraglottoplasty in a child with laryngomalacia
History of apneic events/ALTEs Failure to thrive Cyanosis Cor pulmonale
172
What is the treatment for Stage II lyme?
Doxycycline 100 mg BID for 21 days
173
At what stage of Lyme disease is Bells palsy typically seen?
Stage II (disseminated disease), accompanied by migratory myalgias, generalized rash, fevers, and chills
174
What organism causes Lyme?
Borrelia burgdorferi
175
What is the best treatment for a T2b or T3 melanoma?
Wide local excision with 1-2 cm margins with sentinel lymph node biopsy
176
What is present on pathologic evaluation of a JNA?
Gross: sessile, lobulated, rubbery dark red to tan gray mass Micro: Admixture of vascular tissue and fibrous stroma. Vessel walls have incomplete or absent smooth muscle
177
What arteries supply the trapezius?
Transverse cervical (descending branches) Dorsal scapular Occipital
178
What is the differential blood supply of the following flaps? - Inferior trapezius flap - Lateral island flap - Superior trapezius flap
Dorsal scapular and descending branches of the transverse cervical Superficial branches of the transverse cervical
179
Which of the trapezius flaps provides the longest pedicle?
Inferior trapezius flap
180
The parotid duct exits the parotid parenchyma, passes over the masseter, and turns medially to pierce the ***
Buccinator
181
Where does stenson's duct empty into the oral cavity?
Second maxillary molar
182
What are the subsites of the supraglottis?
``` Aryepiglottic folds Arytenoids Suprahyoid epiglottis Infrahyoid epiglottis Arytenoids ```
183
What branchial pouches are the inferior and superior parathyroid glands derived from?
Inferior: 3rd Superior: 4th
184
What structure do the inferior parathyroid glands migrate with caudally and medially during development?
Thymus
185
Where should you look for superior parathyroid glands if they are not in the expected location during an exploration?
Tracheoesophageal groove Posterior mediastinum Within the carotid cheath
186
Where should epi be injected during anaphylaxis?
Vastus lateralis
187
What is the dosing of epi for anaphylaxis in adults?
Adults: 0.3-0.5 mg of 1:1000
188
A lymph node that demonstrates __% or greater counters per minute compared with the hottest node ex vivo should be considered a sentinel node and be removed
10%
189
Most common location of involvement of otosclerosis?
Bone anterior to the oval window with a small cleft known as the fissula ante fenestrum
190
What is the risk of malignancy per the Bethesda system for a follicular neoplasm?
15-30%
191
What are features of the lower lateral cartilage in a cleft lip?
``` Normal size and width Shortened medial crus Elongated lateral crus Blunted dome Posteriorly, laterally, and inferiorly displaced alar base ```
192
Which strains of HPV do gardasil vs cervarix protect against?
Gardasil: 6, 11, 16, 18 Cervarix: 16, 18
193
Is gardasil or cervarix only indicated for women?
Gardasil
194
What embryological precursor forms the eustachian tube?
First branchial pouch
195
What is the MOA of avastin? | What can injection of avastin be used to control?
VEGF inhibitor | Respiratory papillomatosis
196
What is the autoimmune thyroiditis in which normal parenchyma is replaced by extensive fibrosis
Riedel's thyroiditis
197
What does an UPSIT score less than 5 suggest?
Malingering
198
What scores on the UPSIT test coorespond to anosmia and hyposmia?
Anosmia: 5-18 Hyposmia: 19-33 **total score of 40
199
What is the most common complication following Sistrunk procedure?
Recurrence
200
Primary hyperparathyroidism is caused by one or more adenoma __% of the time and diffuse hyperplasia __% of the time?
75-80% | 20%
201
In MEN 1, hypercalcemia is seen in __% of patients | In MEN 2a, hypercalcemia is seen in __% of patients
95% | 5-20%
202
What artery is the main pedicle of a paramedian forehead flap?
Supratrochlear artery
203
What is the mechanism of action of mitomycin C?
Antitumor antibiotic causing cross linking of DNA
204
What drug binds dihydrofolate reductase and has a rate limiting step of mucositis, with an increased toxicity in patients with kidney failure given renal excretion
Methotrexate
205
Lund-Mackay system for scoring of chronic rhinosinusitis
0: no abnormalities 1: partial opacification 2: complete opacification * *24 points available, 12 pre side
206
What is the effect of using antibiotic drops after tympanostomy tube placement?
Reduce post-tympanostomy tube otorrhea (most common complication following T tube insertion)
207
What is used to calculate the OSAHS score
BMI Tonsillar size Freidman tongue size
208
Which salivary gland has the highest percentage of malignant tumor formation? Middle? Lowest?
Minor salivary glands > submandibular gland > parotid gland
209
What is the most common malignant tumor of the partoid?
Mucoepidermoid carcinoma
210
What is the most common malignant tumor of the submandibular gland?
Adenoid cystic carcinoma
211
Increase in calcitonin is indicative of what kind of thyroid cancer?
Medullary thyroid carcinoma
212
With papillary thyroid carcinoma, are regional and distant metastases more common in children or adults?
Children, though prognosis is favorable
213
What is the University of Pittsburgh Staging System for temporal bone neoplasms?
T1: Tumor limited to the EAC without bonyerosion or evidence of soft tissue extension T2: Tumor with limited EAC bony erosion or soft tissue involvement (less than 0.5cm) T3: Tumor eroding the osseous EAC (full thickness) with limited (less than 0.5 cm) soft tissue involvement, or tumor involving middle ear or mastoid T4: Tumor eroding the
214
What is the ideal position for the highest part of the brow in women?
Above the lateral limbus or lateral canthus
215
What is the ideal shape of a male brow?
No arching, sits at the supraorbital rim
216
What bacteria should you prophylactically treat for when you are using medicinal leeches
Aeromonas hydrophila: gram negative rod in leech gut, sensitive to 3rd generation cephalosporins, ciprofloxacin, aminoglycosides, sulfa drugs, and tetracycline
217
What bacterial infection is classically associated with Lemierre's syndrome?
Fusobacterium necrophorum
218
What are the embryonic sources of the ossicles?
``` First arch: - malleus (minus the manubrium) - incus (minus the long process) Second arch: - manubrium of the malleus - long process of the incus - suprastructure of the stapes ``` **footplate arises from the otic capsule
219
What are two species that are often found in patient with allergic fungal sinusitis?
Curvularia | Bipolaris
220
Are children or adults more likely to present with unilateral allergic fungal sinusitis?
Children (70%)
221
``` What do the following precursors eventually form: 1st ethmoturbinal 2nd ethmoturbinal 3rd ethmoturbinal 4th and 5th ethmoturbinal ```
1st: agger nasi and uncinate 2nd: middle turbinate 3rd: superior turbinate 4th and 5th: supreme turbinate
222
In the porus acousticus, where is the facial nerve in relation to Bills bar and the transverse crest?
The facial nerve is located anterior and superior
223
What is produced by the chief cells in the stomach and is enzymatically active at an acidic pH, but has proteolytic activity at normal pH (ie pharynx and larynx)
Pepsin
224
What is the most common causative organism in cavernous sinus thrombosis?
Staph aureus
225
What is the most common inherited form of congenital facial palsy?
Congenital unilateral lower lip palsy--atrophy of the depressor anguli oris muscle
226
Between what two structures can deep lobe parotid tumors extend to the parapharyngeal space, creating a dumbbell appearance?
Mandible Stylomandibular ligament **through the stylomandibular membrane
227
Prestyloid tumors lie anterior to the carotid artery and usually arise from: Poststyloid tumors lie posterior to the carotid artery and usually arise from:
Salivary | Neurogenic
228
What three studies are mandatory for zone 1 neck injuries (clavicles tot he cricoid)
CXR CT angiography Gastrograffin swallow study
229
What are the most common sites of cervical metastases in base of tongue cancer?
Zones II-IV
230
Cochlear afferents first synapse in what nuclei?
Dorsal and ventral cochlear nuclei
231
What is Donaldson's line?
Hypothetical line that runs parallel to the horizontal semicircular canal and biscets the dome of the posterior semicircular canal Marks the superior boundary of the endolymphatic sac
232
What are the boundaries of the internal nasal valve?
Nasal septum Caudal border of the ULC Head of the inferior turbrinate
233
What cartilage is used for an autograft spreader technique to increase the patency of the the internal nasal valve during functional septorhinoplasty
ULC: medially infolded and suture stabilization, obviates need for free cartilage graft
234
What is a sensitive lab test for Wegners?
C-ANCA
235
What is the footplate of the stapes derived from?
Otic mesenchyme
236
What ossicular structures does the first branchial arch give rise to?
Head and neck of the malleus | Body and short process of the incus
237
What ossicular structures does the second branchial arch give rise to?
Manubrium of the malleus Long process of the incus Stapes superstructure
238
What is the most muscle to reconstruct in cleft palate surgery?
Levator veli palatine: elevates the palate and is responsible for velopharyngeal closure during the swallow mechanism
239
What is Chandler's staging system for JNA?
Stage 1: confined to the nasopharynx Stage 2: extends to the nasal cavity or sphenoid Stage 3: involves the maxillary sinus, ethmoid sinus, infratemporal fossa, orbit, cheeck, cavernous sinus Stage 4: intracranial extension
240
What growth arises from the lateral nasal wall in the region overlying the sphenopalatine canal?
JNA
241
What is the Holman-Miller sign?
Pathognomonic radiologic sign of JNA where growth of JNA pushes the posterior maxillary wall anteriorly
242
What is the most common site of metastasis of ACC?
Lung: indolent but relentless course, seldom metastasizes to regional lymph nodes
243
What are the T1 and T2 imaging findings of cholesterol granuloma?
T1: Hyperintense T2: Hyperintense
244
What is the maximum size upper eyelid defect that can be closed primarily?
25% or less
245
What is the only peeling agent that requires neutralization to end its action (5% sodium bicarbonate)
Glycolic acid
246
What is Ramsay-Hunt syndrome?
Varicella zoster visus infection leading to vesicular eruptiong in the conchal bowl and facial palsy (House-Brackmann IV-VI in 50% of patients)
247
What is standard treatment for Ramsay-Hunt syndrome?
Valacyclovir for 14 days OR | Famciclovir of 10 days with steroids
248
What is Gorlin's syndrome?
AD disorder associated with falx calcifications, multiple cutaneous BCC, odontogenic keratocysts, bifid ribs, scoliosis, and frontal bossing
249
What is PFAPA syndrome?
Periodic fever, aphtous stomatitis, pharyngitis and adenitis: periodic fevers >39 lasting 3-7 days recurring every 21-42 days. Resolution of sx s/p tonsillectomy if abx fail
250
What is the most common cause of temporary diplopia s/p blepharoplasty? Permanent?
Post-operative edema | Injury to the inferior oblique
251
What is the area of weakness that leads to a Zenker's diverticulum?
Killian's triangle: limited superiorly by the inferior constrictor and inferiorly by the cricopharyngeus
252
What type of thyroid carcinoma is the BRAF V600E mutation associated with?
Papillary thyroid carcinoma
253
What is the most common malignancy to arise within the nasal cavity and paranasal sinuses in children?
Rhabdomyosarcoma
254
What is the grading system for the slope of the skull base, and how many types are there?
Keros type I: 1-3 mm Keros type II: 4-7 mm Keros type III: 8-16 mm **measured from the cribriform plate to the fovea ethmoidalis of the frontal bone
255
What is the criteria for drainage of a PTA in a child?
Abscess >2 cm Respiratory distress Failure of IV abx
256
What are the cooresponding structures to hillocks of His 1-6
1: Tragus 2: Helical crux 3: Helix 4: Antihelix 5: Antitragus 6: Lobule
257
What is the most common cause of pediatric facial fractures?
MVCs
258
What condition is often associated with congenital lower lip paralysis (CULLP)?
Cardiac defects (Cayler craniofacial syndrome when combined)
259
What is the source of the majority of hyperparathyroidism?
Single parathyroid adenoma (85%)
260
What % of patients with Downs have atlantoaxial instability (greater than 4mm distance between the dens and the anterior arch of the atlas)?
10-20%
261
What is the name of a painful thyroid following a URI? What is the treatment
DeQuervain's subacute thyroiditis | NSAIDs and corticosteroids
262
The eustachian tube, middle ear, and mastoid cavity are all derived from what embryologic structure?
First pharyngeal pouch
263
What is appropriate therapy for necrotizing fascititis?
Ceftriaxone 2 gm IV q8h Clindamycin 600 mg IV q8h Metronidazole 500 mg IV q6h
264
What mutation underlies Alport syndrome, x-linked form of SNHL associated with progressive glomerulonephritis?
COL4A5, product participates in collagen IV synthesis (present in the basement membrane and the inner ear)
265
Which of the CPA approaches carry the highest risk of facial nerve injury?
Middle cranial fossa
266
What are the primary adductors of the vocal folds?
Lateral crico-arytenoid
267
What is the difference between a subtotal and total temporal bone resection?
Subtotal: removal of the otic capsule and facial nerve but spares the petrous apex and carotid artery **those are removed in a total temporal bone resection
268
What is the term for decrease in speech recognition performance at higher signal intensity?
Rollover | **assoc with RCP
269
What is the term for poor speech recognition out of proportion to that which would be predicted by PTA results?
Phonemic regression | **assoc with RCP
270
What is the term for a test in which a tone is presented continuously to an ear with a hearing loss until it becomes inaudible?
Tone decay | **excessive tone decay associated with RCP
271
What is the term for increases in perceived loudness of a sound in an ear with SNHL?
Recruitment | **assoc with RCP
272
What is Lugol's solution?
Potassium iodine and elemental iodide in water
273
Which direction does the columella and nasal septum deviate in a patient with unilateral cleft lip and palate?
Towards the noncleft side
274
What CD markers are found on NK cells?
CD16 | CD56
275
What CD markers are found on B cells?
CD 19 CD 20 CD 22
276
ORN rarely occurs in pts who have been exposed to less than __ Gy
60
277
Though Crouzon syndrome presents similarly to Apert and Pfeiffer syndromes wih craniosynstosis, midfaial hypoplasia, and ocular proptosis with a parrot-beak nose, what additional findings are seen in Apert and Pfiffer?
Apert: syndactyly Pffiefer: broad thumbs and toes
278
What are characteristics associated with central vertigo?
Doesn't extinguish with repeated stimulation Less severe Nystagmus that doesn't improve with fixation and multidirectional
279
What are the two key types of proteins expressed by HPV?
``` E proteins (1-7): early L proteins (1-2): late ```
280
What is the major capsid protein in Gardasil and Cervarix?
L1: structural protein that encapsulates the viral particle
281
What are the roles of HPV proteins E6 and E7 (early proteins)
E6: inhibits p53 E7: inhibits pRb
282
The levator palpebrae superioris muscle is suspended by what structure?
Whitnall ligament: extends from the fascia of the lacrimal gland laterally to the trochlea attachment medially
283
What is Lockwood ligament?
Thickening of Tenon's capsule, forms a hammoch stretching below the eyeball between the medial and lateral canthal tendons, encloses the inferior rectus and inferior oblique muscles
284
What is the involuntary smooth muscle lid retractor that receives sympathetic innervation located beneath the levator aponeurosis
Muller muscle
285
What is the tx for benzo overdose?
Flumazenil: initially 0.2 mg IV, increased by to 3 mg/hr if there is no response
286
What is the difference between N2a, b, and c laryngeal cancers?
a: single ipsilateral LN 3-6 cm b: multiple ipsilateral LN <6cm c: bilateral or contralateral LN <6cm
287
What two teeth does a cleft lip form between?
Lateral incisors and canines
288
What is the most important factor for the outcome of atresia repair?
Stapes: only element that gets 2 points on the *** scale, implies inner ear pneumatization
289
What nerve provides cutaneous innervation for the radial forearm free flap?
Lateral antebrachial cutaneous nerve
290
What chemokine is secreted by active T helper cells?
IL-2
291
What is the maximum dose of lidocaine that can be safely given with and without epi? (in mg/kg)
WITHOUT 4mg/kg | WITH 7mg/kg
292
How many mg/ml does 1% lidocaine have?
10 mg lidocaine/ml | **4% will have 40 mg/ml
293
What is the best type of audiologic testing for children from 6 to 30 mo
Visual reinforcement audiometry
294
Is nystagmus enhanced or supressed with ocular fixation in central vertigo?
Enhanced
295
What are the limbs of the nasal tripod?
Conjoined medial crura and bilateral lateral crura
296
What subtypes of HPV cause RRP?
6 and 11
297
How high should you stay above the orbital rim to avoid ptosis with botox injections?
1 cm
298
If ptosis is produced w botox injections, how should it be treated and was it the MOA?
Apraclonidine gtts | Alpha 2 agonist which causes Muller muscle contraction
299
What dose of epi should be given for anaphylaxis?
0.01 mg/kg (max 0.5 mg) every 5-15 min if anaphylaxis persists
300
Which incision allows for a retrograde approach in rhinoplasty?
Intercartilaginous: followed by dissection of the vestibular lining retrogrady over the underside of the lateral crus of the lower lateral cartilage
301
Which two incisions allow for an open approach to rhinoplasty?
Marginal | Transcolumellar
302
What is the best tx option initially for presbylaryngis
Voice therapy
303
What differentiates class IV and V Norwood hair loss classes?
IV: Frontal and vertex loss, but still a band of hair separating two areas V: Loss of separation between frontal and vertex areas of hair loss
304
What is the 1st ethmoturbinal the precursor for?
Agger nasi | Uncinate
305
What is the internal nasal valve bounded by?
Upper lateral cartilage Septum Head of the inferior turbinate
306
CRSwNP is defined as the presence of sinonasal mucosal inflammation for more than ___ weeks without symptomatic improvement and with the presence of either endoscopic or CT findings or both
12 weeks
307
What is the most common complication of treatment of a subglottic hemangioma with a CO2 laser?
SGS (occurs in up to 18% of cases)
308
Is pseudomonas sensistive to clindamycin
No
309
What characteristics of a pyriform sinus tumor make it suitable for management w a partial laryngectomy
Smaller than 2 cm At least 1.5 cm above the apex No not cause VF fixation Do not involve adjacent structures
310
What kind of canidiasis infection is an AIDS defining illness?
Tracheal and esophageal candidiasis | **Oral candidiasis is not
311
What is an autoimmune condition leading to SNHL and intersisital keratitis?
Cogan syndrome
312
What is the MC organism that causes Lemierre's?
Fusobacterium necrophorum (anaerobe)
313
What is the MC origin of an acoustic neuroma?
Both the superior and inferior divisions of the vestibular nerve Rarely arise from the facial or cochlear nerves
314
What is the term for the most anterior projection of the mandible at the midline?
Pogonion
315
What is the term for the area with the thinnest skin of the nasal dorsum located at the inferior aspect of the nasal bones at the junction with the upper lateral cartilage?
Rhinion
316
What is the term for the location where the nasal septum intersects with the upper lip
Subnasale
317
What percent of congenital VF paralysis is bilateral?
50%
318
What kind of thyroid mass would stain positive for congo red?
Medullary thyroid carcinoma--contains amyloid deposits
319
What is Hennebert sign?
Pressure-induced vertigo in the setting of a third window--pressure waves taking path of least resistance through vestibular system Pneumatic otoscopy causing vertigo
320
What chromasome carries the gene that is mutated in Neurofibromatosis type 1?
Chromosome 17
321
Why are medium chain triglycerides used in the setting of a chyle leak?
They are absorbed directly into portal circulation after absorption in the gut and do not travel in the lymphatic system or require chylomicron absorption
322
Which type of thyroid carcinoma has psammoma bodies
Papillary thyroid carcinoma
323
Which type of rhabdomyosarcoma reponds the best to primary chemoXRT?
Orbital
324
Do patients with underlying DM vs hematologic malignancy with new fungal sinusitis have a worse prognosis?
Hemaologic malignancy
325
What is the most likely etiology of bilateral parotid swelling in a patient with HIV?
Lymphoepithelial cysts of Goodwin | **also seen in Sjogrens and sarcoidosis
326
Three instances where lymphoepithelial cysts are most commonly seen
Sjogrens Sarcoidosis HIV
327
A total loss of the integrity of the ossicular chain and the TM results in how many dB of hearing loss?
50 dB, sound reaches the oval and round windows at the same time and results in phase cancellation
328
What is there worse hearing loss in the setting of a disrupted ossicular chain WITH an intact TM than without?
An intact TM will reflect sound back into the EAC and will make hearing loss worse (55-60 dB)
329
What are the two most common laryngeal manifestations of rheumatoid arthritis?
Cricoarytenoid joint fixation | Vocal fold nodule formation
330
What is the most common cause of primary hyperparathyroidism?
Solitary parathyroid adenoma 80% | followed by 4 gland hyperplasia 15%
331
What are the two main limitations of sestamibi scanning?
Hyperplasia | Adenomas under 1.5cm
332
What medication will make sestamibi scanning inaccurate?
Thyroid hormone replacement therapy
333
How much time after suspected facial nerve injury must ENoG be performed?
Up to 2 weeks after injury **if ENOG is done within 2 weeks and shows greater than 90% degeneration on the affected side as compared to the normal side, surgery is indicated
334
Which etiology of laryngotracheal stenosis is associated with a higher risk of tracheostomy dependence?
Iatrogenic | **followed by autoimmune, traumatic, and idiopathic
335
A nodule with a uniform halo is __% specific for benign disease
95%
336
A short axis diameter of > __mm in a thyroid nodule is considered to be concerning for malignancy
7 mm
337
What is the MOA of cisplatin?
Cross-links with purine base pairs of DNA, interfering with DNA repair mechanisms
338
Was is the MOA of methotrexate?
Interferes with folid acid metabolism by tightly binding the enzyme dihydrofolate reductase
339
Was is the MOA of mitomycin C?
Alkylating agent that binds DNA and RNA
340
What is the MOA of 5-FU
inhibits DNA synthesis by binding the enzyme thymidylate synthetase
341
What should be used in the setting of ptosis following botox injection?
Apraclonidine gtts (alpha 2 agonist)
342
What is Gradenigo's syndrome?
Triad of symptoms caused by petrous apicitis including 1) Orbital pain 2) 6th nerve palsy 3) Otorrhea
343
Sx of cavernous sinus thrombosis
Fever, lethargy, orbital pain, bilateral proptosis, reduced EOM, bilateral dilated pupils with sluggish pupillary light reflex
344
What is the SRT?
Level at which pt can repeat 50% of speech material
345
What is the SDT?
Level at which pt is aware of a speech signal 50% of the time
346
What kind of tumor is characterized by papillae of eosinophilic ephithlia that project into cystic spaces and lymphoid matrix
Warthin tumor or papillary cystadenoma lymphomatosum | **usually slow growing mass in the superficial lobe of the parotid gland at the angle of the mandible
347
What is the most common site for a minor salivary gland pleomorphic adenoma?
Palate | **second most common is the upper lip
348
What is the most common benign tumor of the lacrimal gland?
Pleomorphic adenoma
349
What are the pathologic findings characteristic of a pleomorphic adenoma
Epithelial and mesenchymal components
350
What represents the majority of salivary gland masses in HIV positive patients?
Benign lymphoepithelial cysts (BLEC) | **persisent nontender enlargement associated with cervical lymphadenopathy
351
What is the best test for narcolepsy?
Multiple sleep latency test: naping at 2 hr intervals after a full nights sleep (min sleep latency <8min char of narcolepsy)
352
What is the earliest age that autologous rib cartilage recon can be considered for microtia?
6 yr (auricle reaches adult size at age 6 yr)
353
What is the most common site of distant disease in adenoid cystic carcinoma of the head and neck?
Lungs
354
What are the two subtypes of HPV responsible for RRP?
Low grade subtypes 6 and 11 | high grade 16 and 18 are involved in SCC
355
What are the common sites of upper and lower airway obstruction in mucopolysaccharidosis (MPS) type 1, 2 and 6?
GAG deposits in the upper or lower airway leading to adenoid hypertrophy, macroglossia, and laryngomalacia
356
What two points determine occlusion?
The mesiobuccal cusp of the first maxillary molar and the mesiobuccal groove of the first maxillary molar
357
What is the orientation of the first maxillary and mandibular molars in class I occlusion?
Mesiobuccal cusp of the first maxillary molar sits in the mesiobuccal groove of the first mandibular molar
358
What are the first and second most common types of jugular foramen schwannomas?
1. Vagal (CNX) | 2. Glossopharyngeal (CNIX)
359
What is the MC presenting symptom of patients with a glossopharyneal Schwannoma?
Mid-frequency hearing loss (80%): due to the posteriorlateral location of CNIX to CNVIII. In contrast, vestibular schwannomas present with high frequency hearing loss
360
EYA1 mutation is found in what syndrome? | What is the inheritance?
Branchio-oto-renal syndrome | AD
361
What is the only statistically significant predicator of success in pediatric tympanoplasty?
Age
362
What is Schwartze sign?
Red hue of the promontory seen in otosclerosis
363
What syndrome is characterized by thyroid goiter and profound SNHL?
Pendred
364
What test should be done when Pendred syndrome is suspected on the basis of goiter and hearing loss
CT to look for associated anomolies such as enlarged vesibular aquaduct or modini malformation
365
What is the best way to treat vasomotor rhinitis associated with contraceptive use (other than changing the contraceptive)
Muscarinic blocker (contraceptives can inhibit anticholinesterase)
366
What are the most common sites of laryngeal involvement of wegners, sarcoidosis, and amyloidosis?
Sarcoidosis: Supraglottis Amyloidoisis: Glottis Wegners: Subglottis **SAW**
367
What is the best anti-thyroid regimen for a pregnant woman with clinically signifiant hyperthyroidism?
PTU first trimester Methimazole for the remainder of pregnancy **methimazole associated with congential malformations in the first trimester, but PTU can cause liver injury later in pregnancy **PMS
368
What nerve carries parasympathetic fibers to the parotid land?
Auriculotemporal (branch of V3)
369
Which nerve provides parasympathetic innervation to the submandibular and sublingual glands?
Chorda tympani
370
Is the position of the superior or inferior parathyroid glands more variable?
Inferior
371
Are most superior parathyroid glands found at the cricothyroid junction cranial or caudal to the juxtaposition of the RLN and inferior thyroid artery?
Cranial
372
Are the superior parathyroid glands superficial or deep relative to the RLN? Inferior?
Superior: deep to RLN Inferior: superficial to RLM
373
What quadrant are the majority of congenital cholesteatomas found in?
2/3 found in the anterior-superior quadrant
374
Elevated TSH levels are necessary to enhance uptake of iodine by thyroid cancer cells. TSH level greater than ___ assocaited with increased RAI uptake in tumors
30 mU/L **this is why patients are taken off thyroid suppression therapy for 2-4 wk prior to RAI therapy and put on a low iodine diet
375
Do patients with upper or lower lip carcinomas have a worse prognosis?
Upper (have a 10-20% worse 5 year survival)
376
Do basal cell carcinomas tend to occur on the upper or lower lips?
Upper (though 95% of all lip caricnomas occur on the lower lip)
377
What is the risk of harboring cervical metastases in individuals with lip carcinomas?
10%
378
What is hte MC location of aberrant parathyroids?
Anterior mediastinum
379
How many mg of epi are in an epi pen?
0.3 mg 1:000 (SC/IM)
380
What is the MCC profound SNHL in a newborn?
Non-syndromic AR connexin 26 mutations
381
What is the MCC of syndromic profound SNHL
Usher syndrome
382
What is a X linked recessive disorder that causes hearing loss and glomerulonephritis
Alport
383
What does Schaefer's classification assess?
Post-operative outcomes of laryngeal injury Group 1: minor hematoma w/o fx Group 2: non-displaced fx with edema, hematoma Group 3: massive edema and exposed cartilage Group 4: massive edema with two of more fx requiring stenting Group 5: Compete laryngotracheal separation
384
What UPSIT score cooresponds to a normal sense of small?
34-40
385
What frequency hearing loss is seen with aminoglycoside toxicity?
High frequency | Via destruction of the outer hair cells at the basal turn of the cochlea
386
Which two structures pass between the superior and middle pharyngeal constrictors?
Stylopharyngeus muscle | Cranial nerve IX
387
Are suprahyoid lesions more likely to be micro or macrocystic?
Microcystic
388
What are the major cytokines involved in allergic inflammation
IL 4 IL 5 IL 13
389
MOA Montelukast
Leukotriene receptor antagonist
390
What does the Bent and Kuhn classification system address?
Allergic fungal rhinosinusitis
391
What are the 5 criteria of Bent and Kuhn criteria?
1. Hx of atopy 2. Nasal polyposis 3. Radiographic findings of a heterogenous and expansile filling of the paranasal sinuses, often with orbital or skull base erosion 4. Eosinophilic mucin without fungal invasion 5. Positive fungal stain for noninvasive disease
392
What is Browns sign on otoscopy?
Blanching of discoloration noted behind the TM
393
What does high grade mucoepidermoid carcinoma resemble pathologically?
Squamous cell carcinoma
394
What are the criteria for recurrent acute sinusitis
At least 4 episodes per year with interfering asymptomatic periods
395
What is the time course to qualify for subacute sinusitis? | Chronic?
4-12 weeks | >12 weeks
396
What is the action of the posterior crico-arytenoid muscle?
Abduction of the vocal folds
397
What is the recommended management of Dedo class II?
Skin laxity--rhytidectomy
398
What is the embryologic source of the inferior parathyroids and thymus?
Inferior parathyroids: superior third branchial pouch | Thymus: inferior third branchial pouch
399
What is the MC presenting symptom of RRP in chidlren?
Hoarseness, progresses to stridor followed by respiratory distress
400
What is the incidence of permanent hypoparathyroidism after total thyroidectomy
1%
401
What pathogen is most likely to self resolve in the setting of acute bacterial sinusitis?
Moraxella catarrhalis
402
Classic triad in Horners syndrome?
Miosis (pupillary construction) Lid ptosis Anhidrosis
403
What part of the aerodigestive tract do second branchial cleft cysts communicate with?
Tonsillar fossae
404
What lab value will confirm a chyle leak?
Triglyceride >100 mg/dL | Amylase supports dx
405
What is first line for acute sinusitis in the setting of a PCN allergy?
Doxy | **macrolide is also an option
406
What is the importance of the reference point of the lateral limbus of the eue in the setting of facial nerve injusy?
Trauma to the facial nerve medial to the lateral limbus of the eye tends to heal spontaneously Lateral to this landmark patients need to be explored and reanastomosed
407
What branchial arch gives rise of the glottic and subglottis?
6th
408
What is the name for muscle spasm of the palate including the tensor veli palatini
Palatal myoclonus
409
What is the most common site for cancer in the oral cavity
Lip
410
Is basal cell more common on the upper or lower lip?
Upper (in contrast to SCC)
411
What muscle creates the vertical rhytids over the glabella
sorrugator supercilliais
412
What is the definitive treatment of esophageal achalasia?
Heller myotomy
413
What is a Zenkers an outpouching through?
Triangle formed by the inferior pharyngeal constrictor and the cricopharyngeus
414
What isa Killian-Jamieson diverticulum an outpouching through?
The oblique and transferse fibers of the cricopharyngeus and the longitudinal fibers of the esophagus
415
What risks injury with repair of a Killiam-Jamieson diverticulum?
RLN
416
Whats the max dose of epi that should be pushed every 5-15 min
0.3 IM
417
What is the risk of malignancy in FDG avid nodules?
33%
418
What % of the semicircular canal is occupied by the semicircular duct?
25%
419
Which two structures pass between the superior and middle pharyngeal constrictors?
Stylopharyngeus muscle | Cranial nerve IX
420
Are suprahyoid lesions more likely to be micro or macrocystic?
Microcystic
421
What nerve is stimulatd tin cVEMPS?
Inferior vesibular nerve (stimulates the saccule)
422
MOA Montelukast
Leukotriene receptor antagonist
423
What does the Bent and Kuhn classification system address?
Allergic fungal rhinosinusitis
424
What are the 5 criteria of Bent and Kuhn criteria?
1. Hx of atopy 2. Nasal polyposis 3. Radiographic findings of a heterogenous and expansile filling of the paranasal sinuses, often with orbital or skull base erosion 4. Eosinophilic mucin without fungal invasion 5. Positive fungal stain for noninvasive disease
425
By the third week after injury, what collagen type predominates?
Tyle I collagen (type III reticulate has been replaced)
426
What does high grade mucoepidermoid carcinoma resemble pathologically?
Squamous cell carcinoma
427
What are the criteria for recurrent acute sinusitis
At least 4 episodes per year with interfering asymptomatic periods
428
What is the time course to qualify for subacute sinusitis? | Chronic?
4-12 weeks | >12 weeks
429
For patients younger than 55 with papillary or follicular thyroid cancer, what will change a patient from Stage I to II?
Metastasis (any T or N is I unless there is metastasis)
430
What is the recommended management of Dedo class II?
Skin laxity--rhytidectomy
431
What is the embryologic source of the inferior parathyroids and thymus?
Inferior parathyroids: superior third branchial pouch | Thymus: inferior third branchial pouch
432
What is the MC presenting symptom of RRP in chidlren?
Hoarseness, progresses to stridor followed by respiratory distress
433
What is the incidence of permanent hypoparathyroidism after total thyroidectomy
1%
434
What pathogen is most likely to self resolve in the setting of acute bacterial sinusitis?
Moraxella catarrhalis
435
What is the inheritance pattern of malignant hyperthermia?
Autosomal dominant
436
What part of the aerodigestive tract do second branchial cleft cysts communicate with?
Tonsillar fossae
437
What lab value will confirm a chyle leak?
Triglyceride >100 mg/dL | Amylase supports dx
438
What is first line for acute sinusitis in the setting of a PCN allergy?
Doxy | **macrolide is also an option
439
What is the importance of the reference point of the lateral limbus of the eue in the setting of facial nerve injusy?
Trauma to the facial nerve medial to the lateral limbus of the eye tends to heal spontaneously Lateral to this landmark patients need to be explored and reanastomosed
440
What is Jessner's solution?
14g resorcinol 14g salicylic acid 14 mL lactic acid 100 mL ethanol
441
What is the name for muscle spasm of the palate including the tensor veli palatini
Palatal myoclonus
442
What is the MCC of facial paralysis in a newborn?
Birth trauma (forcept delivery)
443
Is basal cell more common on the upper or lower lip?
Upper (in contrast to SCC)
444
What is the most likely location of primary nasopharyngeal carcinoma?
Fossa of Rosenmuller
445
What is the definitive treatment of esophageal achalasia?
Heller myotomy
446
What is a Zenkers an outpouching through?
Triangle formed by the inferior pharyngeal constrictor and the cricopharyngeus
447
What isa Killian-Jamieson diverticulum an outpouching through?
The oblique and transferse fibers of the cricopharyngeus and the longitudinal fibers of the esophagus
448
What risks injury with repair of a Killiam-Jamieson diverticulum?
RLN
449
Whats the max dose of epi that should be pushed every 5-15 min
0.3 IM
450
What is the risk of malignancy in FDG avid nodules?
33%
451
What % of the semicircular canal is occupied by the semicircular duct?
25%
452
How long after LASIK should people wait before having a bleph?
6 months -- due to effect on corneal sensation
453
What is the best management of a trap door deformity?
Z plasy to redirect the vectors of contraction
454
What nerve is stimulatd tin cVEMPS?
Inferior vesibular nerve (stimulates the saccule)
455
What is the Mueller maneuver?
Performed with FFL awake in the supine position to assess retropalatal and retrolingual collapse at the end of expiration (abnormal if there is >50% collapse)
456
What is the MOA of cidoforvir?
Antiviral that inhibits FNA polymerase to prevent viral replication
457
What is the youngest that a patient with NF2and hearing los can receive a auditory brainstem implant?
12 yo
458
By the third week after injury, what collagen type predominates?
Tyle I collagen (type III reticulate has been replaced)
459
What kind of flaps are passed over a bridge of tissue and have to be inset with a second procedure?
Interpolated (ex paramedian)
460
What kind of hearing loss is seen in SSCD? Are acoustic reflexes present?
Conductive | Yes
461
What is there a lower threshold on cVEMP in the setting of SSCD?
Third mobile window which increases the sensitivity of the vestibular receptors to sound and pressure stimuli, leading to autophony
462
For patients younger than 55 with papillary or follicular thyroid cance, what will change a patient from Stage I to II?
Metastasis (any T or N is I unless there is metastasis)
463
What cytokines are central to the production of IgE?
IL4 IL5 IL13
464
What is the first line for treatment of a subglottic hemangioma
Propranolol
465
WHat may be seen on imaging in Bells palsy?
Contrast enhancement of the facial nerve on MRI
466
What is the only facial muscle that is NOT innervated by the facial nerve?
Levator palpebra superioris (controlled by the oculomotor nerve)
467
What is the name for hypoesthesia of the EAC 2/2 facial nerve compression by a CPA tumor?
Hitselberger's sign
468
What is the inheritance pattern of malignant hyperthermia?
Autosomal dominant
469
What syndrome is characterized by midfacial hypoplasia and an absent anterior nasal spine? What is required for nasal reconstruction?
Binder syndrome | Premaxillary grafts
470
What is the blood supply of the following? 1) Saccule 2) Utricle, superior and horizontal semicircular canals
1) Posterior vestibular artery | 2) Anterior vestibular artery
471
What is Melkersson-Rosenthal syndrome?
Rare neurologic disorder characterized by recurrent facial paralysis, swelling of the face and lips, and development of folds and fissures in the tongue
472
What provides sensation to the skin of a RFFF?
Lateral antebrachial cutaneous nerve
473
What is Jessner's solution?
14g resorcinol 14g salicylic acid 14 mL lactic acid 100 mL ethanol
474
What syndrome is characterzied by underdevelompent of CN VI and VII leading to facial nerve paralysis and strabismus. Normal inteliigence
Mobius syndrome
475
What is the MCC of facial paralysis in a newborn?
Birth trauma (forcepts delivery)
476
What are the three types of nasopharyngeal carcinoma?
I: SCC II: Non-keritinizing epidermoid III: Non-keritinizing undifferentiated
477
What is the most likely location of primary nasopharyngeal carcinoma?
Fossa of Rosenmuller
478
What phase is approx 90% of hair in?
Anagen (growth), lasts 3-10 years
479
Androgenic alopecia is mediated by what enzymes activity?
5-alpha reductase, converts testosterone to DHT
480
What is the name of a benign lesion presenting as a punched out crater in older men at the rim of the helix or antihelix?
Chondrodermatitis nodularis helicis (Winkler nodule)
481
What is the end point titration of IDT?
Increase in the skin reaction wheal by 2 mm (higher concentration with confirmation of the increase in size at the higher concentration)
482
What nerve branches from CN IX as it passes out of the jugular foramen?
Jacobsen's nerve -- reenters the inferior tympanic canaliculus with nerves from the sympathetic plexus and the interior tympanic artery (branch of the ascending pharyngeal artery)
483
What should be used for thyroid storm if PTU or methimazole are contraindicated?
Lithium
484
What is the best place to harvest calvarial bone grafts from?
Parietal area (where bone is thickest), usually 2cm below the suture line
485
How many afferent neurons supply each inner hair cell?
10
486
Which vessels are responsible for supplying blodo to the brainstem, cerebellum and occipital lobes?
Vertebral arteries
487
What is the only unpaired intrinsic laryngeal muscle and what does it do?
Transverse arytenoid | Assists with adduction of the VFs
488
What is the only vocal fold abductor?
Posterior cricoarytenoid
489
Which laryngeal muscle assists with VF adduction but also adduction of the false VFs and the aryepiglottic folds
Thyroarytenoid
490
What structure is damaged initially by gentamicin leading to ototoxicity?
Inner layer of outer hair cells | **patients my initially have a normal audiogram by abnormal OAEs (tests the function of outer hair cells)
491
What is the best treatment for neonatal rhinitis (MCC nasal obstruction in neonates)
0.1% dexamethasone gtts for 1 week
492
In Frey syndrome, this is injury to post-ganglionic parasympathetic fibers from CN ___ via the ____ nerve of CN V
CN IX | Auriculotemporal
493
What is Gradenigo's syndrome?
Petrous apicitis: pain and drainage from the ear reflecting middle ear/mastoid infx, retrobulbar pain 2/2 irritation of the trigeminal in Meckel's cave, and abducens palsy 2/2 involvement of Dorello's canal which also abuts the petrous apex
494
What is Dorello's canal
Canal that houses the abducens nerve (CN VI) and the inferior petrosal sinus as they emerge from the cavernous sinus, it is found at the apex of the petrous apex and can be irritated in Gradenigo's syndrome (petrous apicitis)
495
What TCA used for tx of tinnitus can lead to torsades?
Nortriptyline
496
What is the MC site of involvement of otosclerosis?
Fissula ante fenestrum--area anterior to the crura of the stapes footplace
497
Which muscle wraps around the cochleariform notch?
Tensor tympani
498
What is the second MC site of involvement of otosclerosis after the fissula ante fenestrum?
Round window
499
Vestibular schwannomas comprise __% of all CPA tumors
90%
500
What is the name for hypoesthesia of the EAC 2/2 facial nerve compression by a CPA tumor?
Hitselberger's sign
501
What species is most commonly seen in invasive fungal sinusitis in diabetic ketoacidosis vs immunocompromise
DKA: Mucor IC: Aspergillus
502
Where do the afferent and efferent nerves of the cough reflex synapse?
Medulla (nucleus tractus solitaries)
503
What is the appropriate starting dose for propranolol for tx of facial infantile hemangioma?
0.33 mg/kg PO q6h for 3-7 days, then 0.5mg/kg q6h if tolerated
504
What is Melkersson-Rosenthal syndrome?
Rare neurologic disorder characterized by recurrent facial paralysis, swelling of the face and lips, and development of folds and fissures in the tongue
505
What is necrotizing sialometaplasia
Uncommon oral lesion in which salivary glandular tissue undergoes infarction and causes an ulcerative lesion, usually presents at the posterior hard palate as a 1-3 cm ulcer with erythematous borders -- no intervention, will heal spontaneously
506
What are the two main drugs used for RRP tx
Cidofovir: inhibition of DNA polymerase Avastin: VEGF inhibitor
507
What is the MC CPA tumor in children?
Brainstem glioma(10-25% of all intracWhat ranial masses in hcildren)
508
What arises from the 1st ethmoturbinal?
Agger nasi and uncinagte
509
What arises from the 2nd ethmoturbinal?
Middle turbinate
510
What arises from the 3rd ethmoturbinal?
Superior turbinate
511
What arises from the 4th and 5th ethmoturbinal?
Supreme turbinate
512
What is the probability of a palpable, hypofunctional thyroid nodule being malignant in a patient with Graves?
45%
513
Severely dysplastic lesions of the true vocal folds have what chance of malignancy transformation?
30%
514
What is the end point titration of IDT?
Increase in the skin reaction wheal by 2 mm (higher concentration with confirmation of the increase in size at the higher concentration)
515
What should be used for tx of thyroid storm?
Anti-thyroid medications like PTU, antipyretic, iodine solution, and cooling blankets with ice packs to lower body temperature
516
What should be used for thyroid storm if PTU or methimazole are contraindicated?
Lithium
517
What is the most commonly fractured subsite of the mandible in children?
Condyle
518
What is a spongiform thyroid nodules?
Nodule with microcystic components comprising more than 50% of the nodule
519
What sleep phase syndrome is characterized by early awakenings and early bedtime?
Advanced sleep phase syndrome
520
After the first genu, the facial nerve runs parallel and superior to _____ and just superior to the ____ before turning at the second genu
Cochleariform process | Oval window
521
What is the N staging system for melanoma
N1a: one clinically occult node N1b: one clinically detected node N1c: no regional nodes, but in-transit or microsatellite mets N2a: 2-3 occult nodes N2b: 2-3 nodes, at least 1 clinically detectable N2c: One node with in-transit, or microsatellite mets N3a: 4+ occult nodes N3b: 4+ nodes at least 1 clinically detected N3c: 2+ nodes, with in-transit or microsatellite mets
522
What is the next step when oral hairy leukoplakia is diagnosed (white patchy mucosal lesion with severe hyperkeratosis with koilocytosis and possible fungal elements)
HIV test
523
What is the found at the N vs C terminus of an antibody?
N: Fab or variable segment which binds antigen C: Fc or constand segment which binds complement or other immune cells
524
What is the path of parasympathetic innervation to the lacrimal gland
``` Superior salivatory nucleus Nervus intermedius Geniculate ganglion GSPN Nerve of the pterygoid canal Zygomaticotemporal nerve ```
525
What should be avoided in patients with a known latex allergy due to cross reactivity?
Bananas Avocados Kiwis
526
What is the syndrome characterized by bilateral SNHL, goiter, ilateral enlarged vesibular aqueducts
Pendred syndrome
527
What syndrome is characterized by hematuria, proteinuria, and progressive renal failure with ocular lesions
Alport syndrome -- x linked
528
What nerve supplies the conchal bowl and the posterior portion of the external meatus?
Facial nerve (nervus intermedius)
529
What nerve supplies the mastoid, medial pinna, and the posterior portion of the lateral surface of the auricle?
Greater auricular nerve
530
What nerve supplies the anterior EAC?
Auriculotemporal nerve (branch of V3)
531
What nerve supplies the floor of the EAC
Auricular branch of the vagus (Arnolds nerve)
532
What is the Abbe flap used for?
Lesions up to 2/3 of the lip NOT involving the oral commissure
533
What is the maximum size lip defect that can be closed primarily
Up to 1/2
534
What is the stratification of lip defects based on size that guides reconstruction?
Less than 1/2: primary Less than 2/3: Abbe or Estlander Greater than 2/3: Bernard-Burow flap Near total: free flap
535
How many days does it take for a full thickness skin graft to have a new blood supply establshed
Imbibition-> inosculation | 3-5 days new blood supply
536
What % of oropharyngeal cancer is HPV +
50-75%
537
What is the name for the superior margin of the forehead at the hairline?
Trichion
538
What does GJB2 encode?
Connexin 26: 6 proteins that bind to form a gap junction through which potassium ions are transmitted from OHC through the supporting cells to the stria vascularis
539
What is the name for the root of the nose including the nasion and the sellion?
Radix
540
What is the name of the most posterior inferior aspect of the mandible?
Gonion
541
Name of the most anterior vs most inferior border of the chin
Anterior: Pogonion Inferior: Menton
542
What is the relationship of a 2nd branchial cleft cyst toe the internal and external carotid arteries? Where does it enter the aerodigestive tract?
Passes between them | Tonsillar bed
543
``` What increase in central scar lengths do the following Z plasty angles coorespond to? 30 degrees 45 degrees 60 degrees 75 degrees 90 degrees ```
``` 30: 25% 45 50% 60: 75% 75: 100% 90: 125% ```
544
What is the name of the flap used for unilateral cleft lip that involves advancement of a myocutaneous flap from the lateral lip into the gap of the upper portion of the lip resulting in inferior downward roation of the medial lip element?
Millard method (rotation advancement flap)
545
How long after admin of contrast do patients need to wait prior to RAI tx
8 weeks
546
What is the AJCC 2017 T staging system for melanoma
``` Tis: in situ T1a: <0.8mm w/o ulceration T1b: 0.8-1mm w/ or w/o ulceration T2: 1-2 mm T3: 2-4 mm T4: >4 mm **stratify T2-4 w/ or w/o ulceration ```
547
What is the MC intracranial complication of otitis media
Meningitis
548
What is the greatest predictor of poor prognosis in mucosal melanomas?
Depth of invasion
549
What is the loss of gain resulting in impedence mismatching between the air in the EAC and the fluid in the cochlear that must be overcome by the TM and ossicules?
30dB (TM accounts for 26 dB of this)
550
What are the 4 most dangerous locations for melanoma?
``` BANS Back (upper) Arm (posterior) Neck (posterior) Scalp (posterior) ```
551
Chandler classification
``` I: Preseptal cellulitis II: Orbital cellulitis III: Subperiosteal abscess IV: Orbital abscess V: Cavernous sinus thrombosis ```
552
What ocular finding helps distinguish types 1 and 2 of Waardenburg's
Dystopia canthorum: lateral displacementof the inner canthi of the eyes giving an appearance of a widened nasal bridge, seen in 95% type 1
553
What is the product of the causitive gene of NF2?
Merlin protein (on chromosome 22q12
554
What is the N staging system for melanoma
N1a: one clinically occult node N1b: one clinically detected node N1c: no regional nodes, but in-transit or microsatellite mets N2a: 2-3 occult nodes N2b: 2-3 nodes, at least 1 clinically detectable N2c: One node with in-transit, or microsatellite mets N3a: 4+ occult nodes N3b: 4+ nodes at least 1 clinically detected N3c: 2+ nodes, with in-transit or microsatellite mets
555
What is the MCC of croup
Parainfluenza I II and II
556
What is the difference between primary and secondary acquired cholesteatoma
Primary: 2/2 ETD leading to retraction Secondary: introduction of epithelial cells into the middle ear
557
What is the path of parasympathetic innervation to the lacrimal gland
``` Superior salivatory nucleus Nervus intermedius Geniculate ganglion GSPN Nerve of the pterygoid canal Zygomaticotemporal nerve ```
558
What is the histologic appearance of Warthin tumors
Papillary cystadenoma lymphamatosum, characterized by cysts lined by double epithelium with papillary fronts and a lymphoid stroma
559
How many times more likely are smokers to develop Warthin tumors?
8 times
560
How often are Warthin tumors found bilaterally
5-7.5%
561
What are the three stages of wound healing
1. Inflammatory 2. Proliferative 3. Maturation
562
By 1 week the wound had what % of its tensile strength
10%
563
What kind of collagen conversion happens in the maturation/remodeling phase of wound healing?
Type III->type I
564
What waves characterize N2 sleep?
Sleep spindles and K complexes
565
What phase of sleep does sleepwalking occur in?
Slow wave sleep
566
What structure is found just deep to the lesser cornu of the hyoid?
Hypoglossal nerve
567
What are the components of Baker's solution/ What ingredient allowe for deep wounding
Phenol Septisol Croton oil *** Water
568
What pathogen is associated with development of rhinophyma
Demodex folliculorum
569
What kind of nasopharyngeal mass will show poorly differentiated cells with Z bands?
Rhabdomyosarcoma--mesenchymal muscle will show Z bands of the sarcomere
570
What is the characteristic cell of chordomas
Physaliferous cells
571
What is PGAPA syndrome and what is the tx
Periodic fevers, aphtous ulcers, pharyngitis, pharyngitis, adenitis (cyclical every 4-6 weeks) Tonsillectomy (may also benefit from short courses of steroids)
572
Which nerve provides taste sensation to the soft palate?
GSPN: travels with the facial nerve and exits at the geniculate ganglion, then travels through the pterygoid canal where is forms the vidian nerve
573
What is the most likely dx of a painless mass of the nose, biopsy shows foamy histiocytes (Mikulicz cells) with a moth eaten cytoplasm as well as large plasma cells (Russell bodies) with birefringent inclusions
Rhinoscleroma, caused by klebsiella rhinoscleromatis
574
What is rhinoscleroma caused by?
Klebsiella rhinoscleromatis
575
How is rhinoscleroma differentiated from rhinosporidiosis?
Both will show chronic granulomatous changes but rhinoscleroma will show Mikulicz cells (foamy histiocytes) and Russel bodies (bloated plasma cells)
576
What will serve to distinguish superior orbital fissure syndrome from orbital apex syndrome?
There will be CN II palsy in orbital apex syndrome leading to decreased visual acuity Also may have papilledema from pressure on the optic nerve
577
What is the MC location for esophageal FB in peds pts
Thoracic inlet, due to narrow diameter and the transition from skeletal to smooth muscle
578
What % of patients with idiopathic VF paralysis recover in 1 yr? Never?
1 yr: 36% | Never: 25%
579
In what case is post-headshake nystagmus considered clinically significant?
If there are at least 3-5 consecutive beats of nystagmus directly following headshak
580
Warm water irrigation to the right EAC should eliicit which kind of nystagmus?
Rightward beating (COWS, cold opposite warm same)
581
What defines grade I, II and III SGS?
I: 0-50% II: 50-70% III: 70-99%
582
What is the Homan Miller sign
Anterior displacement of the posterior wall of the maxillary sinus seen in JNA
583
What is the MC area of injury to the facial nerve following T bone fx
Perigenicular region (geniculate ganglion and tympanic segment)
584
What is the 10 10 10 rule for cleft lip?
Repair should be performed when the child has a hgb of 10, weighs 10 lbs, and is 10 wks old (3 mo)
585
In the setting of bilateral carotid body tumors, what is the recommendation re management of the larger vs smaller tumor?
Smaller--surgery | Large--radiation
586
What is the most vulnerable part of dissection of a carotid body tumor
at the bifurcation
587
What plane should dissection of a carotid body tumor occur in?
Subadventitial plane
588
What is the ocular finding seen in Alport syndrome?
Anterior lenticonus: protrusion of the central portion of the lens into the anterior chamber of the eye, causing myopia
589
What is narcolepsy thought to be caused by?
Loss of hypocretin neurons in the lateral hypothalamus, leading to low hypocretin CSF levels
590
Degradation of the serum PTH of >__% confirms removal of hyperfunctioning tissue
50%
591
What is the N staging for papillary thyroid carcinoma
N1a: level VI mets N1b: any other mets **no N2
592
What is the MCC infectious congenital hearing loss
CMV | Cerebral calcifications, hepatosplenomegaly, jaundice, and intellectual disability
593
In the setting of congenital hearing loss, the presence of cataracts is most commonly associated with ____
Intrauterine rubella infection
594
What are absolute indications for open reduction of a subcondylar mandibular fx
1. Lateral displacement of the condylar head (may preclude spontaneous reduction) 2. Displacement of the condyle into the infratemporal fossa 3. Penetrating FB 4. If normal occlusion cannot be obtained
595
Deficiency of which IgG subclass is most common in children?
IgG2: manifested by recurrent infections to polysaccharide encapsulated bacteria such as haemophilus influenza, strep pneumonia , and klebsiella pneumonia
596
What is the MC IgG subclass deficiency in adults?
IgG3
597
What is seen in CHARGE?
``` Coloboma Heart defects Atresia of the choanae Retardation GU abnormalities Ear abnormalities ```
598
What is the main different between Baker-Gordon peel and the Hetter modification?
Amts of phenol and croton oil | Hetter has a lower concentration of phenol while varying croton oil concentration
599
How long after dermabrasion does reepithelialization occur?
5-7 days
600
What pathogen is associated with development of rhinophyma
Demodex folliculorum
601
What laryngeal framework is made up of __ unpaired and __ paired cartilages
``` 3 unpaired (epiglottis, thyroid, cricoid) 3 paired (arytenoids, cornicular, cuneiform) ```
602
What is the narrowest segment of the adult vs peds airway?
Adult glottis | Peds cricoid
603
What medication in contrast to synthroid decreases the time of hormone withdrawal from 6 weeks to 2 weeks?
Liothyronine
604
What is the filler or choice for deep lines for the melolabial folds and cheek augmentation?
Calcium hydroxyapatite
605
What biologic site in the neuron does lidocaine act on?
Inhibits voltage gated sodium channels
606
What ear structuremust remain for successful prosthetic placement?
Tragus
607
What view is best for assessing the alar lobular ratio
Lateral
608
What is the vascular supply of the ALT flap?
Descending branch of the lateral circumflex femoral
609
What mechanism of injury is most likely to cause a transverse temporal bone fx/
Impact to the occiput | **only accounts for 10-20% of T bone fx
610
What % of patients w transverse T bone fx presents with facial paralysis on examination?
50%
611
What is Bogorad syndrome?
aka crocodile tear syndrome Anomalous reinnervation following facial nerve injury with parasympathetic efferents erroneously innervating the lacrimal gland leading to lacrimation with food intake
612
What are the 3 MCC acute sinusitis
1. Strep pneumonia 2. NTHI 3. Moraxella
613
How does the bacterial profile change in patients with chronic sinusitis?
Most anaerobic species such as bacteroides fragiles and non-anaerobic species like S aureus
614
What is the distance from the midpoint of the lacrimal crest to the foramen of the anterior ethmoid artery?
24 mm
615
What kind of otologic damage is associated with mumps
degeneration of the stria vascularis and organ of corti leading to SNHL
616
What is the preepiglottic space bound by?
``` Hyoid bone Thyrohyoid membrane Hyoepiglottic ligament Thyroepiglottic ligament Epiglottis ```
617
What is Jessner solution?
Resorcinol Salicylic acid Lactic acid Ethanol
618
What kind of scan should be repeated every 4 weeks in the setting of malignant otitis externa to determine the length of treatment course?
Gallium 67 scan
619
What artery usually supplies the superior and inferior parathyroid arteries
Inferior thyroid artery
620
What structure seperates the superifical and deep lobes of the parotid
Retromandibular vein
621
What should any patient presenting with an osteoma of the sinuses be evaluated for?
Gardner's syndrome: FAP, osteomas of the H&N, supranumerary teeth
622
Degradation of the serum PTH of >__% confirms removal of hyperfunctioning tissue
50%
623
What are the parameters on the Jahrdoerfer grading system?
``` Stapes 2 Oval window patent 1 Middle ear patent 1 Facial nerve position 1 Malleus-incus complex 1 Incus-stapes complex 1 Round window status 1 Mastoid pneumatization 1 External ear 1 ```
624
What score on the Jahrsdoerfer grading system indicates a poor outcome for surgical correction of congenital aural atresia?
5/10 or less on the grading scale
625
What are the most common dental cysts?
Radicular cysts
626
What kind of cyst presents as a well-defined radiolucency around an unerupted molar?
Dentigerous (follicular) cysts
627
Dentigerous cysts carry a slight risk of transitioning into _____ therefore tx involving enucleation with dental extraction is idicated
Ameloblastom
628
Multiple basal cell carcinomas are associated with ____ syndrome and odontogenic keratocysts
Gorlin syndrome
629
What is the only muscle that receives bilateral innervation by the RLN and would have normal EMG findings in the setting of unilateral VF paralysis
Interarytenoid
630
What is the inheritance of aminoglycoside sensitivity
Mitochondrial: will only be passed down by females to children
631
What deformity can result from performing lateral osteotomies too high superior to the medial canthus?
Rocker deformity: step off appearance of the nasal dorsum
632
What differentiates N1 from N2 in laryngeal cancer staging?
N1 single ipsilateal node with no ENE | N2 has ENE
633
Midface lift has the greatest effect on which muscle?
Orbicularis oculi
634
Is NF 1 or 2 more common?
NF1 is much more common
635
What thyroid suppressant should be given in the first trimester of pregnancy?
PTU | Then switch to methimazole as there have been reports of liver injury with PTU later in pregnancy
636
Which why is the caudal septum deviated in a unilateral cleft palate?
Away from the celft side
637
Sunderland nerve injury classifciation
Grade 1: Neuropraxia, or nerve compression Grade 2: Axonotmesis, where the axon is transected and there is Wallerian degeneration, but the endoneurial sheath is preserved Grade 3: Neurotmesis where the neural tube is transected Grade 4: Violation of the perineurium Grade 5: Complete transection
638
In what setting can patients develop severe HTN with vagally mediated bradycardia after receiving epinephrine
Beta blocker use
639
How does the apearance of cholesteatoma differ on T1 vs T2?
Hypointnese on T1 | Hyperintense on T2
640
What is the first sinus to begin development in utero? | What sinus is the most deeloped at birth?
Maxillary sinus= first to develop | Ethmoids= most developed at birth
641
What is the Lund Mackay scoring system
``` For severity of sinusitis 0 given for no opacification 1 for partial 2 for full subsites are the maxillary sinus, anterior ethmoid, posterior ethmoid, sphenoid, OMC, frontal ```
642
What is recruitment?
When patients with hearing loss experience a much more rapid increase in subjective loudness of a stimulus
643
What is the rollover phenomenon
Sin of RCP where speech recognition drops with increasing loudness
644
What is the name for an infraorbital ethmoid cell that can lead to maxillary sinus obstruction
Haller cell
645
What is the name for a lateral and posterior extension of the ethmoid cells located superior to the sphenoid sinus? clinical implication?
Onodi cell | Can contain the optic nerve or dehiscent carotid
646
Does medial or lateral grafting have a higher take rate?
Lateral grafting (>90%), but is associated with longer healing times due to more extensive dissection
647
What is the relationship of the supratrochlear nerve to the supraorbital nerve?
Supratrochlear nerve is 1 cm medial to the supraorbital nerve
648
What are the Fisch approaches to the infratemporal fossa
A: anterior facial nerve transposition for access to the jugular foramen, ICA, and infralabyrinthine regions B: removal of the zygomatic arch, temporalis muscle, and dissection of the horizontal ICA C: removal of the pterygoidplates to expose the parasellar region
649
Tx of DeQuervain's (subacute) thyroiditis
NSAIDs and sometimes steroids
650
What is Meckel's cartilage?
Derived from the 1st branchial arch and develops into the mandible and the head of the malleus and body of the incus
651
Which nerve innervates the cornea
Nasociliary (from CN V), afferent limb of the blink relex
652
What phase of sleep do night terroirs occur in
Slow wave sleep (nightmares in REM)
653
What malignancy is Plummer vinson syndrome assocaited with?
(IDA, esohageal webs, atrophic glossitis) | Hypopharyngeal SCC
654
What is Carharts notch
CHL which closes at 20000 Hz indicative of otosclerosis
655
What is Pendred syndrome?
Congenital SNHL with a thyroid goiter, often with enlarged vestibular aqueduct SLC26A4 mutation
656
What vertebral levels is the larynx located at?
C3-C6
657
What syndrome presents with bilateral palsy of CN VI and VII?
Moebius
658
What is the medical treatment for otosclerosis?
Fluoride: conversion of the otosponiotic lesion to n otoclerotic lesion
659
What syndrome results from COL2A1 mutation?
Stickler syndrome: PRS, cleft palate, hearing loss, arthritis AD inheritance
660
How long are hemangiomas (infantile) in proliferative stage?
5 months (will reach 80% of final size at this time)
661
What is the MC organism in malignant OE
Pseudomonas
662
What is the appearance of a congenital chlesteatoma
White mass in the anterior-superior quadrant
663
What is the blood supply of the NSF
Posterior septal branches of the SPA
664
What is the blood supply of the paramedian forehead flap?
Supratrochlear artery
665
The three muscles that receive innervation from the facial nerve on the superior surface
Levator anguli oiris Buccinator Mentalis
666
Why do alkali materials cause more esophageal injury?
Liquifactive necrosis
667
The brachiocephalic (innominate) veins are formed by the union of which veins?
IJ | Subclavian
668
What syndrome can an osteoma of the frontal sinus be indicative of ?
Gardner--colon polyps, skull osteomas, soft tissue tumors
669
What is Furstenberg test?
Pulsation or expansion of a nasal mass with crying, strainings, or compression of the jugular vein
670
What does the lesser palatine artery supply
Soft palate
671
What is the MC site of involvement of sarcoidosis in the larynx?
Supraglottis, specifically the epiglottis | SAW: supraglottis sarcoid, glottis amyloid, subglottis wegners
672
What muscle depresses and protruded the mandible?
Lateral pterygoid
673
What hormone decreases the LES tone
Glucagon
674
What is liothyronine
T3
675
What mandibular fx can be seen on a reverse Townes view
Condylar
676
What is the associated artery and nerve of the first branchial arch?
Trigeminal nerve | Internal maxillar arery
677
What is the artery and nerve of the second branchial arch
Facial nerve | Stapedial artery
678
What cells do PPIs act on?
Parietal cells, which produce gastric acid and IF
679
What are the 5 arteries that supplythe tonsils?
1. Dorsal lingual 2. Lesser palatine (NOT greater) 3. Ascending pharyngeal 4. Tonsillar branch o the facial 5. Ascending palatine
680
What are the exceptions to the rule that most of the nasal cavity blood supply is from the external carotid system?
Anterior and posterior ethmoid arteries which arise from the opthalmic artery off the internal carotid **SPA, decending palatine, and greater palatine all arise from the IMA
681
What does the presence of Hashimotos in a patient with PTC indicated
Protective effect--most likely to have smaller tumor with less advanced TNM stage
682
What is the difference between hyphae of aspergillus vs mucor
Aspergillus: septated hyphae with 45 degree branches Mucor: non-septated hyphae with 90 degree branching
683
What deformities are noted with hyperactivity of the depressor septi muscle
Smiling deformity characterized by descending nasal tip, shortened upper lip, and transverse crease in the mid philtral area
684
What is the difference between growth of infantile hemangiomas and vascular malformations
IHs are absent at birth, appear early in infancy, and grow rapidly VMs are present at birth and grow slowly and proportionally with the child
685
What is a normal Schirmer's test?
Greater than 10-15 mm in 5 min
686
What is the blood supply of the NSF
Posterior septal branches of the SPA
687
What is the blood supply of the paramedian forehead flap?
Supratrochlear artery
688
The three muscles that receive innervation from the facial nerve on the superior surface
Levator anguli oiris Buccinator Mentalis
689
Why do alkali materials cause more esophageal injury?
Liquifactive necrosis
690
The brachiocephalic (innominate) veins are formed by the union of which veins?
IJ | Subclavian
691
What syndrome can an osteoma of the frontal sinus be indicative of ?
Gardner--colon polyps, skull osteomas, soft tissue tumors
692
What nerve pierces the thyrohyoid membrane?
Internal branch of the SLN (sensory innervation to the TVFs, supraglottis, and hypopharynx
693
What is the term of inflection of speech consisting of putting stress on syllabels
Prosody
694
What is the MC site of involvement of sarcoidosis in the larynx?
Supraglottis, specifically the epiglottis | SAW: supraglottis sarcoid, glottis amyloid, subglottis wegners
695
What muscle depresses and protruded the mandible?
Lateral pterygoid
696
What hormone decreases the LES tone
Glucagon
697
What is liothyronine
T3
698
What mandibular fx can be seen on a reverse Townes view
Condylar
699
What is the associated artery and nerve of the first branchial arch?
Trigeminal nerve | Internal maxillar arery
700
What is the artery and nerve of the second branchial arch
Facial nerve | Stapedial artery
701
What cells do PPIs act on?
Parietal cells, which produce gastric acid and IF
702
What are the 5 arteries that supplythe tonsils?
1. Dorsal lingual 2. Lesser palatine (NOT greater) 3. Ascending pharyngeal 4. Tonsillar branch o the facial 5. Ascending palatine
703
What are the exceptions to the rule that most of the nasal cavity blood supply is from the external carotid system?
Anterior and posterior ethmoid arteries which arise from the opthalmic artery off the internal carotid **SPA, decending palatine, and greater palatine all arise from the IMA
704
What does the presence of Hashimotos in a patient with PTC indicated
Protective effect--most likely to have smaller tumor with less advanced TNM stage
705
What is the difference between hyphae of aspergillus vs mucor
Aspergillus: septated hyphae with 45 degree branches Mucor: non-septated hyphae with 90 degree branching
706
What deformities are noted with hyperactivity of the depressor septi muscle
Smiling deformity characterized by descending nasal tip, shortened upper lip, and transverse crease in the mid philtral area
707
What is the MC bacteria found in pediatric neck masses
S aureus
708
What is a normal Schirmer's test?
Greater than 10-15 mm in 5 min
709
What is the most important layer of the TVFs for vocalization
Superficial layer of the lamina propria (Reinkes space)
710
What two layers of the TVF form rthe vocal ligament?
Intermediate and deep layers of the lamina propria
711
What is Broyles ligament?
Anterior commisure ligament: condensation of fibers with ;insertion into the perichondrium of the laryngeal cartilages
712
What is the macula flava?
Thickened lamina propria along the anterior an posterior vocal folds which serves as as transition zone to the tougher anchoring structures
713
What is the only immunoglobulin that crosses the placenta?
IgG
714
What laryngeal muscle lengthens the TVF, increases tension, and changes pitch?
Cricothyroid (innervated by the external branch of the SLN
715
In what disorder at the superior parathyroid glands noted to be larger than the inferior glands?
Water clear cell hyperplasia: proliferation of vacuolated water clear cells of multiple parathryoid glands that leads to severe hypercalcemia
716
What is the term of inflection of speech consisting of putting stress on syllabels
Prosody
717
What is the Kasabach-Merritt phenomenon?
Occurence of profound thrombocytopenia in association with vascular tumors
718
What are binucleated Reed Sternberg cells pathognomonic for?
Hodgkins lymphoma
719
What nutrient deficiency has been shown to contribute to RLS?
Iron
720
What are the three MC organism isolated from otitis media with serous effusion
1. H influenza 2. M catarrhalis 3. S pneumoniae
721
What is the definitive tx for a neck mass caused by non-tuberculum mycobacterial disease
Surgical excision
722
Most effective tx of RLS
Dopamine agmonists like pramipexole and ropinirole
723
% of tensile strength of normal dermis of scar after 1 week 3 weeks 3 months
1 week 3% 2 weeks 20% 3 months 80%
724
How much bone can be harvested with an osseocutaneous fibular free flap?
25 cm bone
725
What is a normal marginal reflex distance/
Disance between the upper eyelid margin and the central corneal light reflex
726
MC site of facial nerve injury after T bone fx
Perigeniculate reion
727
What syndrome is characterized angioma dvelopment in V1 and V2 and a bort wine stain on the face
Sturge-Weber
728
What disease is char by hemanbioblastomas of the retina nad CNS along with renal cysts, clear cell RCC, pehos, and endolymphtic sac tumors
von Hippel Lingau
729
What syndrome is characterized by small vessel vasculitis, asthma, and hypereosinophilia
Churg-Strauss
730
What is the MC bacteria found in pediatric neck masses
S aureus
731
What is the MC benign lesion of the petrous apex
Cholesterol granuloma, hyperintense on T1 and T2 - on histology multinucleated giant cells and histiocytes
732
What is the MC malformation of the cochlea?
Incomplete partition: cochlea only completes 1-1.5 turns as compared to 2.5 turns
733
What staining should be done for an adenocarcinoma of the head and neck?
Thyroglobulin and calcitonin
734
Inheritance of Osler Weber Rendu (epistaxis, telangiectasia, family hx of disorder)
AD
735
What is the periotic duct?
Runs through the cochlear aqueduct which connects the scala tympani at the basal turn of the cochlea to the subarachnoid space
736
What is the only immunoglobulin that crosses the placenta?
IgG
737
How to calculate NNT
1/ARR | ARR= control event rate - experimental event rate
738
In what disorder at the superior parathyroid glands noted to be larger than the inferior glands?
Water clear cell hyperplasia: proliferation of vacuolated water clear cells of multiple parathryoid glands that leads to severe hypercalcemia
739
WHat is the classic inheritance pattern of otosclerosis?
AD
740
What type of HL is seen in otosclerosis?
Low frequency CHL
741
How much time should be allowed between dermabrasions for scars
12 mo
742
What artery suppies the internal surface of the larynx
Superior laryngeal artery
743
What stains are positive in granular cell tumors fo the larynx?
PAS S-100 **arise from Schwann cells
744
WHat is the difference between mechanical and biologic creep?
Mechanical: realignment of collagen fibers but no change in the microanatomy or surface area Biologic: net increase in SA due to permenant tissue changes
745
What is the artery and nerve of the second branchial arech
Facial nerve | Stapedial
746
What are the nerve and artery of the first branchial arch
Trigeminal | I max
747
Inheritance of branchio-oto-renal syndrome
AD
748
In what way does ASA increase leukotriene production?
Inhibits COX, pushing AA down the leukotriene pathway via lipooxygenase
749
What is the time limit for chronic sinusitis?
12 weeks
750
What incisions will allow endonasal rhinoplasty
Marginal Intercartilaginous Full transfixion
751
What artery is most commonly damaged during injection into the melolabial fold?
Angular
752
Treamtnet of a peds neck infection w actinomyces
6 week course of parenteral penicillin
753
What is in Jessners solution
Ethanol Resorcinol Salicylic acid Lactic acid
754
What is Kallman syndrome characterized by?
Hypogonadotropic hypogonadism Absent smell **failure of olfactory axons and GnRH exreting neurons to migrate
755
Which aminoglycoside is the most vestibulotoxic?
Streptomycin followed by gentamicin
756
What staining should be done for an adenocarcinoma of the head and neck?
Thyroglobulin and calcitonina
757
Inheritance of Osler Weber Rendu (epistaxis, telangiectasia, family hx of disorder)
AD
758
What is the mustarde suture technique
Use of three permanent horizontal mattress sutures to secure the auricular cartilage without making cartilage incisions
759
What is the toxic level of lidocaine with an without epi?
5 mg/kg no epi | 7-8 mg/kg with epi
760
What are the most common sites of perilymphatic fistula
1. Anterior to the anterior crus 2. Anteroinferior to the anterior crus 3. Anterosuperior to the anterior crus
761
What is the gold standard for surgical treatment of the larynx
Surgical excision only

Board Review (3 decks)

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