BoardVitals2 Flashcards
(283 cards)
1
Q
What viral infection are inverted papillomas associated with?
A
HPV 6, 11, 16, 18
**16 and 18 carry higher risk of malignant transformation
2
Q
What are the most common superficial peels?
A
10-25% TCA
Jessner’s (resorcinol, ethanol, salicyclic acid,
40-70% glycolic acid
5-15% salicylic acid
3
Q
How long should patients be off isotretionoin prior to dermabrasion?
A
6 mo
4
Q
What is the MC malignancy of the submandibular and minor salivary glands?
A
Adenoid cystic carincoma
5
Q
What part of the ossicular chain has the most fragile blood supply and is often necrosed in cholesteatomas
A
Long process of the incus
6
Q
What is glucagon useful in anaphylaxis?
A
Increases cardiac output
Increased HR
7
Q
What does the ultimobranchial body give rise to?
A
Part of the 4th branchial pouch and gives rise to calcitonin-producing parafollicular cells
**medullary thyroid carcinoma arises from these cells
8
Q
What is upper airway resistance syndrome?
A
Have the same sx as OSA
Normal AHI <5
Elevated RERAS
CPAP is first line therapy
9
Q
What is the innervation of the diagastric
A
Anterior belly: CN V
Posterior belly: CN VII
10
Q
How many minutes after sleep onset is the first REM cycle?
A
90 min
11
Q
Where do most acoustic neuromas arise?
A
Obersteiner-Redlich zone: zone located within the porus region of the IAC, representing the transition point of central and peripheral myelin
**typically arise here and protrude medially towards the CPA
12
Q
How long should one wait after medialization laryngoplasty before repeat intubation?
A
6 mo
13
Q
What scan is positive in malignant OE and will remain indefinitely positive?
A
Technetium bone scan, as it identifies increased osteogenic bone activity characteristic of MOE
14
Q
What is the MOA of cocaine?
A
Inhibits the reuptake of serotonin, norepinephrine, and dopaime
15
Q
What is the surgical treatment of choice for nonallergic rhinitis that does not respond to medical therapy and in which no anatomic abnormality can be found?
A
Vidian neurectomy: supplies the parasympathetic innervation to much of the nasal mucosa, formed by the greater superficial and deep petrosal nerves
16
Q
What is the MOA of aselastine?
A
Second generation H1 antagonist
17
Q
What are the MRI findings of cholesteatoma on T1 vs T2
A
Hypointense on T1
Hyperintense on T2
18
Q
What syndrome is characterized by episodic vertigo, interstitial keratitis, and bilateral fluctuating SNHL, usually presenting in the 20s-30s
A
Cogan syndrome
Tx with high dose steroids and possibly immunosuppressants
19
Q
What are the Kuhn types of frontal cells?
A
I: Single cell above the agger nasi
II: 2 or more cells superior to the agger nasi
III: single cell extenindg from the agger cell into the frontal sinus
IV: isolated cell within the frontal sinus
20
Q
What is a “marginal” laryngeal tumor
A
Located on the AE fold, marginal as it could be classified as a laryngeal or hypopharyngeal cancer – have a higher rate of basaloid varient of SCC and a more aggressive behavior
21
Q
What is a normal AHI in children?
A
0 events/hr, anything higher is abnormal
22
Q
What is the difference between botox types A and B?
A
Type A is the MC type used
Type B acts more quickly, wears off more quickly, and can be used in patient who develop type A tolerance
23
Q
What is the MC cardiac abnormality seen in OSA?
A
Sinus bradycardia
24
Q
What is seen in orbital apex syndrome
A
Diplopia, proptosis, mydriasis, decreased visual acuity
CN II, III, IV, and VI affected
25
What is Hitselberger's sign
Hypesthesia of the posterior canal wall and concha due to compression of the facial nerve, usually seen with AN
26
What is Gradenigo's triad?
Retroorbital pain
Otorrhea
Abducens palsy
** due to petrous apicitis
27
What is Heerfordt syndrome
Rare manifestation of sarcoidosis involving uveitis, swelling of the parotitis, chronic fever, facial nerve palsy
28
What are the indications for surgical management of hyperparathyroidism?
1. Serum Ca over 1.0 mg/dL above the upper limit of normal
2. Cr clearance reduced by more than 30% for age
3. Patient younger than 50
4. Measurement of 24 hr urinary Ca is over 400 mg/dL
5. Bone mineral density is reduced by more than 2.5 standard deviations
29
What findings suggest acute coalescent mastoiditis?
1. Fluid in the mastoid cavity with bony erosion
2. Subperiosteal abscess
3. Mastoid tenderness or erythema
4. Proptosis of the auricle
5. Retroauricular fluctuance
6. Ear drainage
30
What part of the nasal septum is the ascending pharyngeal artery associated with?
Woodruffs plexus -- common location of posterior bleeds
31
What is associated with low CSF hypocretin?
Narcolepsy
32
The round window represents the end of what structure?
Scala tympani: lower component of the cochlea
33
What test can be used to assess for agreement between two interventions
Chi squared
34
What test can be used to compare continuous date from a single group
T test
35
What patients with rhabdomyosarcoma have a worse prognosis
Children 1-9 yo
| Alveolar subtype
36
Which form of BCC has the worst prognosis?
Morpheaform/sclerosing: appears as a white or pink plaque, associated with unpredictable arms of tumor cells branching from the main lesions
37
What is the only lesions of the temporal bone that will be hyperintense on both T1 and T2
Cholesterol granuloma
38
What are the cut-offs for mild, moderate, and severe OSA?
Mild: AHI 0-15
Moderate: AHI 15-30
Severe: AHI >30
39
What is dysphagia lusoria?
Stridor w exertion and FTT associated with apparent RIGHT subclavian artery
40
At what point to wounds reach 80% of tensile strength?
3 mo
41
How far apart are mustarde sutures placed?
16mm
| **need to place at least 3, permanent horizontal mattress
42
What is a normal MRD
3-4.5 mm (between the lid margin and the light reflex)
43
Difference between MRD 1 and 2
i is measurement from the upper lid
| 2 from lower lid
44
MC lab to be positive in the setting of Wegners
c-ANCA
45
How should laser resurfacing and botox be staged?
Botox first, laser 2 weeks later
| ** relaxation of the underlying facial musculature facilitated by botox allows enhanced results of laser
46
How long prior to RAI do synthroid and cytomel need to be stopped
Cytomel : 2 weeks
| Synthroid : 6 weeks
47
80% of the time, where does the uncinate process attach?
Lamina papyracea--
Frontal sinus will drain medial to the uncinate
The other 20% of the time, the uncinate attaches to the skullbase or the middle turbinate
48
Where should parietal bone grafts be obtained from?
2 cm lateral to the sagital suture over the parietal bone, which avoids the sagittal sinus
49
What pathogen is rhinophyma associated with
Demodex folliculorum
50
Where can the frontal branch of the facial nerve be found on endoscopic brow lift
On the undersurface of the temporoparietal fascia
51
What is the aplasia where the bony labyrinth is well formed but the organ of Corti is poorly differentiated with a poorly formed tectorial membrane and a collpsed Reissner's membrane?
Scheibe aplasia
52
What is the aplasia where there is compete agenesis of the petrous portion of the temporal bone, thought to be 2/2 insult prior to wk 3 of devo
Michel aplasia
53
Which NSAID should not be given for more than 5 consecutive days?
Ketorolac
54
What is the blood supply to the temporalis muscle?
Anterior and posterior branches of the deep temporal artery which are branches off the second portion of the internal maxillary arter
55
What are the OSHA noise exposure regulations?
<8 hr 90dB
<2 hr 100dB
<30min 110dB
**every increase in 5 dB halves the exposure time
56
What % of otosclerosis cases have a hereditary basis?
70% (AD disease)
57
What is paracusis of willis?
Classic finding of otosclerosis where patients can hear better in noisy environments
58
When is chemotherapy recommended in addition to radiation treatment for oropharyngeal cancer?
When there are positive margins, ENE, or distant mets
59
In parathyroidectomy, degradation of the serum PTH that exceeds __% of the preexicion level confirms removal of hyperfunctioning tissue
40%
60
What is the primary parasympathetic neurotransmitter of the nose and leads to vasodilation
ACh
61
In what % of patients is the carotid artery dehiscent in the sphenoid?
23%
62
What is first line tx for keloids
Triamcinolone (kenalog) injection
| Inhibits fibroblast activity and collagen synthesis and increased collagenase production
63
What is the SMAS continuous with on the face?
```
Temporoparietal fascia (frontal branch can be found here)
Galea
```
64
What is the second MC form of hypogammaglobulimemia and results from a failure of B call maturation, leading to recurrent URI
Common variable immunodeficiency
65
What presents with a triad of thrombocytopenia, eczema, and recurrent sinopulmonary infections and is associated with IgM deficiency, affecting B and T cells
Wiskott-Aldrich
66
Where is nasal skin the thinnest?
Rhinion: intersection of the nasal bones and the ULCs
67
What will be seen on CT chest in the setting of RRP
Peripheral nodules that show central cavitation and air-fluid levels
68
What nerve supplies sensation to the nasal tip?
External nasal branch of the anterior ethmoid nerve
69
What lower lid incision has the highest risk for ectropion
Subciliary
70
What syndrome presents with abnormal thyroid hormone metabolism, goiter, congenital SNHL, and positive perchlorate test
Pendred
71
Adenoid cystic carcinoma is associated with deposition of what substance
Amyloid
72
Distance from the lacrimal crest to the anterior ethmoid
24 mm
73
Distance from the lacrimal crest to the posterior ethmoid foramen
36
74
Distance from the lacrimal crest to the midpoint of the optic foramen
42
75
What is the definition of CPAP compliance
CPAP for more than 4 hr a night for 5 nights a week
76
What is Ohngren's line
Angle of the mandible to the medial canthus, delinates tumors in the superior portion of the paranasal sinuses that have increased predisposition to invade the skull base, therefore poor prognosis
77
What are vertical glabellar lines caused by? Horizontal?
Vertical: corrugator
Horizontal: procerus
78
What canal is most commonly eroded by cholesteatoma?
Horizontal SCC
79
What is the characteristic appearance of acoustic neuroma on MRI?
T1: Iso or hypointense
T2: Heterogenously hyperintense
Marked enhancement with contrast
80
What is the only nasal spray that is approved for use in rhinitis of pregnancy
Budesonide
81
What is a cyst that arises from a pharyngeal notochord remnant in the nasopharynx and is surrounded by adenoid tissue
Thornwaldt's cyst
82
Are inferiorly or superiorly based flaps more likely to develop trap door deformities?
Superiorly, 2/2 lymphatic flow
83
What is the malformation limited to the membranous portion of the pars inferior that is the most commonly observed T bone dysplasia in cases of congenital profound SNHL
Scheibe aplasia
84
Blood supply to the SCM (3 parts)
Upper: Occipital
Middle: Superior thyroid
Lower: Suprascapular
85
What is the most consistent laboratory finding in vestibular neuritis?
Reduction or caloric response
86
What is the treatment of vestibular neuritis?
Methylprednisolone
| **no indication for valacyclovir
87
Roll of the false vocal folds or vestibular folds
Airway protection
88
Expected functional limitation of donor site after free flap reconstruction
Limitation of eversion
89
The anterior ethmoid artery is always seen between what two lamellae?
2nd: bulla
3rd: basal lamella
90
What is OK-432 and what is it used to treat?
Picibanil, comes from strep pyogenes treated with benzylpenicillin
Used as a sclerosing agent for lymphatic malformations (macrocystic has the best response)
91
Lid elevation via botox injection is best achieved via injection of what structure
Crows feet--lateral orbicularis
92
Which petrous apex lesion is hyper intense on both T1 and T2?
Cholesterol granulomas
93
How can a petrous apex lesion can be diagnosed as a cholesterol granuloma vs cholesteatoma?
CG: T1 and T2 hyperintense
Ctoma: Hypointense T1, hyperintense T2
94
What are the most notable allergens in spring, summer, and fall?
Spring: Trees
Summer: Grasses
Fall: Weeds
95
What is the only instance you'd see a non-recurrent left laryngeal nerve?
Situs inversus
96
What is the most likely cause of a nonrecurrent R laryngeal nerve
Retroesophageal R subclavian artery--usually RLN pulled by the R subclavian artery during development
97
Where is the Killian triangle?
Between the inferior constrictor and the cricopharyngeus
98
What are the two less common sites of diverticula aside from the Killian triangle?
Inferiorly: Larimer triangle, between the cricopharyngeus and the superior esophageal circular muscle
Laterally: Killian Jamieson, between the oblique and transverse fibers of the CPM
99
Hillocks of his derivatives:
1: Tragus
2: Helical crus
3: Helix
4: Antihelix
5: Antitragus
6: Lobule
100
Triad of Gradenigo's syndrome
Abducens palsy (CN VI), retroorbital pain, and otorrhea
101
What is the role of E6 in HPV?
Binds and leads to degradation of p53 tumor suppressor gene product
102
What is mitomycin derived from and what is the MOA?
Streptomyces caespitosus
| Alkylating agent to inhibit DNA synthesis
103
What voice condition often improves with benzos or other sedatives
Spasmotic dysphonia
104
Timeframe for imbibition, inosculation, and angiogenesis
Imbibition: first 24-48 hr
Inosculation: 48 hr - 4 days
Angiogenesis: 4-7 dars
105
What type of HSV is associated with kaposi sarcoma?
HSV8
106
What complication is most likely to be seen in a fracture o the T bone running through the geniculate ganglion of the facial nerve
Dry eye
| Geniculate ganglion gives of the GSPN which contains parasympathetic innervation to the lacrimal gland
107
T staging for nasopharyneal carcinoma
T1: nasopharynx, can extend to oropharynx
T2: Extension into parapharyngeal space and pterygoid musculature
T3: Invasion of bony structures and/or paranasal sinuses
T4: Intracranial extension, IT fossa, hypopharynx, or orbit
108
Tumor that is HMB 45 and S-100 positive is most consistent with
Melanoma
109
What marker is esthesioneuroblastoma often positive for?
Neuron specific enolase
110
What is the black box warning for PTU? When should PTU be used instead of methimazole?
Liver failure
| SHould be used in the first trimester of pregnancy given risk of congenital defects with methimazole
111
What pressure is needed for cervicofacial liposuction?
1 atm (higher perssures are needed for body)
112
'Motor oil fluid' inside a parotid lesion is pathnomic for:
Warthin tumor
113
What happens to collagen and elastin levels in presbylaryngis?
Collagen (types I and III) increase
| Elastin decreases
114
MC complication of caldwell luc procedure
Nasal obstruction
115
What age can play audiometry be used for?
3-5 yo
116
What is the etiologic agent of oral hairy leukoplakia
| MC location
EBV
| Lateral tongue
117
How many hours NPO after ingestion of fatty meal prior to anesthesia?
Light meal?
Breast milk?
Clears?
Fatty meal: 8 hr
Light meal: 6 hr
Breast milk: 4 hr
Clears: 2 hr
118
When is ENog useful in facial nerve palsy?
Patients with full nerve loss after 3 days
| Greater than 90% degeneration would support exploration
119
What modulators are upregulated with intradermal immunotherapy?
IL 10
IFG beta
**leads to deviation towards Treg response
120
How can types 1 and 2 Waardenburg syndrome be distinguished
Dystopia canthorum: displacement of the inner canthi and lacrimal puncti
121
Majorty of epistaxis occurs at the anastomosis of which 4 arteries
Anterior ethmoid
SPA
Superior labial
Greater palatine
122
What is the drainage pathway of the frontal sinus in 80% and 20% of cases
80% uncinate attaches to the lamina--drainage medial to the uncinate and infundibulum
20% uncinate attaches to the SB and drainage is lateral to the uncinate into the infundibulum
123
What are the results of the following Z pasty angles on scar rotation and scar elongation?
30 deg
45 deg
60 deg
30 deg -> 45 deg scar rot -> 25% elongation
45 deg -> 60 deg scar rot -> 50% elongation
60 deg -> 90 deg scar rot -> 75% elongation
124
MOA of meclizine
H1 receptor antagonist w anticholinergic properties
125
Masking should be used on the contralateral ear whenever there is >__ dB air-bone gap
10 dB
126
MOA of botox
Inhibits presynaptic release of ACTh, preventing conduction of nerve signals
127
When is the highest risk for TI fistula?
2-3 weeks after surgery
128
What is the MC type of rhabdomyosarcoma?
| What is the MC type in rhabdomyosarcoma in adolescents?
Embryonal
| Alveolar
129
Based on Freidman staging,, who would benefit most from UPPP
```
Large tonsils (3-4+)
BMI <40
Grade 1-2 palate
80% success w Stage I
40% success w Stage II
10% success w Stage III (BMI>40)
```
130
What do the superior and inferior vestibular nerves innervate
Superior: Superior SCC, lateral SCC, utricle
Inferior: Posterior SCC, saccule
131
What kind of a flap its a rhomboid?
Translational: adjacent tissue is rotated to fill a defect resulting in a secondary defect
132
What malignancy does caustic ingestion put patient at risk for?
SCC
133
Superior laryngeal nerve passes through which membrane and travels with which artery
Thyrohyoid artery
| Superior laryngeal artery
134
What numbers would people with adductor and abductor dysphonia have counting between?
Adductor: 80-89, difficulty with vowels
Abductor: 60-69
135
What is the most common midine developmental nasal mass?
Dermoid: does not transilluminate, negative Furstenbery test. Fluctuating cyst with a sinus tract. May have intracranial component
136
MC causative agent of croup?
Parainfluenza
137
Major blood supply to the adenoids
Pharyngeal branch of the imax
138
What is the pathophysiology of postoperative pulmonary edema after tonsillectomy?
Loss of auto-PEEP from chronic obstruction and decreased intrathoracic pressure
tx: diuretics, fluid restriction, and CPAP
139
What is PFAPA characterized by and what is the management?
Periodic (every 3-5 wk for 6 mo) fevers, aphthous stomatitis, pharyngitis, and cervical lymphadenopathy
Tx w T&A
140
Which syndrome leads to malformation of the 1st and 2nd branchial arches?
What gene?
Treacher Collins
TCOF 1
Presents with malformed ossicles, auricular deformity, aural atresia, CHL, preauriclar fistulas, coloboma of the lower lids, mandibular hypoplasia
141
Mutation seen in Stickler syndrome
COL2A1 on chrom 12, responsible for collagen II synthesis
| PRS, myopia with retinal detachment, joint hypermobiity, SNHL
142
Gene in branch-oto-renal syndrome
| Presentation
EYA1
Brachial cleft cysts or fistulas
Otologic issues -- HL, pre auricular pits (CHL)
Renal dysplasia (genesis, polycystic, duplicated ureters)
143
What syndrome is characterized by SNHL and iodine metabolism defect leading to euthyroid goiter
What structural otologic malformations are associated?
```
Pendrend syndrome
Modini malformation (1.5 turns) and enlarged vestibular aqueduct
```
144
What syndrome is characterized by progressive hearing loss and retinitis pigmentosa
MC type of the syndrome
Usher syndrome
| Type I: profound HL, RP by age 10, absent vestibular response
145
What syndrome is characterized by progressive SNHL and renal disease characterized by defective basement membrane
Alport syndrome
146
X linked recessive syndrome characterized by blindness and early onset SNHL
Norrie syndrome -- NDP gene
147
What X linked recessive syndrome is characterized by Klippel Feil malformation (fusion of the cervical spine), SNHL or mixed HL, and CN VI paralysis
Wildervaank syndrome
148
Syndrome characterized by abnormal facies (almond shaped eyes, deficient alas, malar flatness), VPI, and cardiac anomalies (VSD)
Velocardiocacial syndrome
149
What are the components of DiGeorge syndrome
CATCH-22
- Cardiac anomalies (TOF)
- Abnormal facies
- Thymic aplasia
- Cleft palate
- Hypocalcemia, hypoparathyroidism
* *some present initially with hoarseness associated with anterior glottic web
150
What presents with central megaincisor and cerebral malformations
Congenita pyriform aperture stenosis
151
What is the developmental source of choanal atresia
Persistent buccopharyngeal membrane
152
What causes cleft palate?
| Cleft lip?
Palate: failure of bilateral palatine shelves (from maxillary processes) to fuse at the midline with developing nasal septum (from frontonasal processes and bilateral medial nasal processes)
Lip: Failure of fusion of the maxillary swelling with the medial nasal processes
153
What is the rule of 10s for cleft lip repair
10 wk old
10 kg
hgb 10
154
New onset biphasic stridor in a patient w no FB history
Subglottic hemangioma
155
Stridor in patient with hx of intuition, NICU admission ,or prematurity, consider
SGS or subglottic cyst
156
What type of HPV causes RRP?
HPV 6 and 11
157
Cotton myer grading system for SGS
I: <50%
II: 51-70%
III: 71-99%
IV: complete obliteration
158
MC type of TE fistula
Type C: esophageal atresia with distal TE fistula
159
What kind of necrosis does acidic vs alkaline ingestion result in?
Acidic: Coagulative (superficial)
Alkaline: Liquidative (deep)
160
What conditions can a pediatric aural polyp be associated with?
Chronic OM, w or w/o cholesteatoma
Necrotizing OE: DM or immunosuppression
Rhabdomyosarcoma
Langerhans cell histiocytosis: eosiniophilic granuloma
Hand-Schuller Christian disease: DI, proptosis, lytic lesions
Letterer-Siwe disease: acute disseminated disease
161
Risk factors for OM
```
Male gender
Bottle feeding
Older siblings with OM
Daycare attendance
Low SE status
Maternal smoking
Craniofacial anomalies
Immunosuppression
```
162
What mutation is present in 30% of nonsyndromic congenital HL patients
Connexin 26
163
Defective development of the otic placed leading to absence of the cochlea, SCC, and vestibule
Michel aplasia
164
What are the types of membranous inner ear malformations?
Schiebe (MC)
Bing-Siebenmann
Alexander
165
What is Scheibe malformation
MC type of congenital inner ear aplasia
Involves the cochlea and the saccule (membranous)
No abnormalities on imaging
Profound SNHL, but amplification may be helpful
166
What is Alexander malformation?
Least severe form
Partial aplasia of the cochlear duct (basal turn)
High frequency HL, amplification helpful
167
Which inner ear aplasia presents with a normal bony labyrinth but a malformed membranous labyrinth almost in its entirety, but radiologically normal
Bing-Siebenmann
168
What is the SCC that is most commonly affected by developmental issues
Lateral SCC, develops last
169
Enlarged vestibular aqueduct loosely defined as >__ in diameter
1. 5 mm
| * * HL associated with this disorder brought on by head trauma
170
What is a narrow (<3mm) vs enlarged (>10mm) IAC associated with
Narrow: absent or hypoplastic CN VIII
Enlarged: stapes gusher
171
Causitive agent to rhinoscleroma?
| Path will show:
```
Klebsiella rhinosclertomatis
Mikulicz cells (macrophages with pathogen)
Russel bodies (plasma cells)
```
172
Contributors to kiesselbach's plexus
SPA
Greater palatine
Anterior ethmoid
Superior labial
173
Keros classification
Distance from the cribriform plate to the fovea ethmoidalis
I: 1-3 mm
II: 4-7 mm
III: 8-16 mm
174
Foramina of Breschet
Venous perforators connecting intracranial and extracranial vascular supply, most commonly convey infection from the frontal sinuses
175
How can superior orbital fissure syndrome be differentiated from orbital apex syndrome
SOFS: ophthalmoplegia, ptosis, proptosis, ipsilateral forehead paresthesia, and fixed dilated pupil
OAS: SOFS + CN II involvement (vision changes or blindness)
176
What is Foster Kennedy Syndrome?
Unilateral anosmia, optic atrophy, and papilledema due to frontal lobe mass
177
AR defect in the dyne arms of cilia and of respiratory tract and reproductive system
Primary ciliary dyskinesia (PCD)
178
Primary ciliary dyskinesia with situs inverses and bronchiectasis
Kartageners syndrome
179
What is the MOA of ASA sensitivity in Sampters triad
ASA ingestion -> inhibition of metabolism of arachidonic acid -> stimulation of 5 lipo-oxygenase and production of leukotrienes -> asthma and allergy effects
180
Distance from the anterior lacrimal crest to the AEA
AEA to the PEA
PEA to the optic nerve
8-12 mm
10-12 mm
4-6 mm
181
What is a cystic remnant of caudal notochord that can be seen in the midline nasopharynx
Tornwaldt cyst
182
Syndrome with polyosteotic fibrous dysplasia, precocious puberty, and cafe-au-lait lesions
McCune-Albright syndrome
183
How do Draf I, IIa, and IIb differ
I: Removal of anterior ethmoid cells, uncinate, and obstructive frontal cells but no instrumentation of the frontal recess
IIa: I + widening of the frontal recess, w resection of the frontal sinus floor from the lamina to the insertion of the middle turbinate
IIb: IIa + resection of the middle turbinate to widen from the lamina to the septum
184
Hows is a Draf IIb advanced to a Draf III?
Removal of the intrasinus septum to connect the bilateral frontal sinuses into ta horseshoe shaped sinus with a common drainage pathway
185
What size wheal would represent a massive rxn that necessitates cessation of intradermal testing?
13 mm
186
Clinical diagnostic criteria for Kawasaki disease?
Fever >5 days and 4-5 of the following
1. Cervical lymphadenopathy
2. Rash of the palms and soles
3. Truncal rash
4. Painless conjunctivitis
5. Tongue erythema
187
What is a late CV risk of Kawasaki disease?
Coronary artery dilation and aneurysms (7-20%), can lead to MI 2-12 wk after disease onset
188
Tx of Kawasaki disease
IVIg and high dose ASA
189
Jaw pain, flow grade fever, and sometimes visual disturbance
Giant cell arthritis/temporal arteritis
190
Dx and tx of temporal arteritis
Dx: Elevated ESR, multinucleated giant cells seen on artery bx
Tx: Oral steroids if no vision loss, otherwise IV
191
Interstitial keratitis, vestibular sx, meniere-like HL, all preceded by viral prodrome
Tx?
Cogan's syndrome
| Systemic steroids, topical ophthalmic steroids, and cyclophosphamide
192
What virus is found in the lesions of Kaposi sarcoma?
HHV-8
193
What is a variant of sarcoidosis that presents with a prodrome of fever, malaise, nausea and night sweats and progresses to parotitis, uveitis, CN VII paralysis, diagnosed with elevated ACE level
Heerfordt's disease
194
What is the key features that will differentiate Churg Struss from Wegners
Asthma -- Churg strauss presents with eosinophilic infiltrative stage and asthma
195
What is the MC site of amyloid deposition in the H&N region?
Larynx--true and false VF, ventricles
| Light chain Ig type
196
What kind of hypersensitivity is SLE?
Type III: immune complex deposition in the BM of dermal-epidermal junctions
197
What is the difference between acute and chronic laryngeal involvement of rheumatoid arthritis?
Acute: tender, erythematous, and edematous arytenoids
Chronic: CA joint involvement with ankylosis, can lead to bilateral VF fixation, can see sublimed CA join. Submucosal nodules
198
What is the triad of symptoms seen in Behcet's syndrome?
1. Oral aphthous ulceration and genital ulcers
2. Iritis and uveitis
3. Progressive SNHL
199
What disease is caused by antibodies against postsynaptic ACh nicotinic receptors leading to insufficient Na entry into myocytes?
Myasthenia gravis
200
What is the tx for MG?
Acetylcholinesterase inhibitors to increase ACh levels acting on post-synaptic receptors to overcome inhibitory antibiodies
201
What is the difference in where antibiodies are directed in pemphigus vulgaris vs (bullous) pemphigoid?
PV: Desmoglein 3, separation of the superficial epithelium from the parabasal epithelium--no separation at the level of the basement membrane, + acantholysis
BP: Multiple antigens at the level of the basement membrane (BP antigen 2, BP hemidesmosomal antigen 180, laminin 5), separation of the epithelium from the LP
202
Palpable firm mass of the neck after dental procedure with a sinus tract
Actinomyces: multifilamented anaerobic gram + rod, forms sulfur granules
203
Treatment of actinomyces infection of the neck
PCN G IV 2-6 wk (tetracycline or erythro if PCN allergic)
| I&D
204
What stain does Bartonella show up on?
Intracellular pleomorphic gram negative bacillus, visible on Warthin starry silver stain
205
What cardiologic concern should you have in the setting of tonsillar pseudomembrane with dyshagia and dysphonia
20% of myocarditis with diphtheria
206
What pathogen causes Lemierre syndrome
Fusobacterium necrophorum -- bacterial endotoxin causes platelet aggregation
207
What are Griesinger's sign and Queckenstadt (Toby-Ayer) test for Lemierres
Griesinger: edema and erythema of the mastoid process
Queckenstadt: measuring CSF pressure change w LP with compression of IJ--if no change likely thrombus
208
What kind of virus is EBV
ds DNA herpes virus
209
What virus is seen in oral hairy leukoplakia, which is a AID defining infection
EBV
210
Though secondary bacterial infection can be seen in the setting of infectious mononucleosis, what abx should be avoided?
Ampicillin/Augmentin--can cause maculopapular rash
211
What titer can be used for prognostication in WHO II and III NPC?
antibody dependent cellular cytotoxicity titers
212
What non-Hodgkins lymphoma is associated with EBV and what is the translocation seen?
What histology is characteristic
Tx
Burkitts
mic gene from chromosome 8 to 14
Starry sky -- small non-cleaved cells with minimal variability
ara-c, MTX. Do not give steroids 2/2 risk of tumor lysis syndrome
213
Viral causative agents of RRP vs H&N SCC
RRP: HPV 6 and 11
SCC: HPV 16 and 18
214
How can fibrous dysphasia be differentiated from an ossifying fibroma?
Ossifying fibroma is encapsulated
215
What mutation is seen in Pagets disease
| Diagnosis?
Sequestome 1 -- AD inheritance
| Elevated alkaline phosphatase, lytic lesions of the calvarium
216
What is the name of the vertically oriented fissures in the anteroinferior EAC cartilage that allow spread of infection and tumor to the parotid?
Fissures of Santorini
217
Hypogonadotropic hypogonadism and anosmia due to failure of the hypothalamus to secrete GnRH (can be X linked or AD)
Kallman syndrome
218
What lesion will be hypointense on T1/T2 with thickening of the maxillary sinus wall
Mycetoma
219
What sinonasal lesion will have a ground glass appearance on CT and will be hypointense on T2 MRI?
Fibrous dysplasia
220
What is Holman-Miller sign?
Anterior bowing of the posterior maxillary wall seen with JNA
221
Which population is more likely to have the following pathogen cause invasive fungal sinusitis?
Mucor: DM in DKA
Aspergillus: Immunocompromise
222
Bent and Kuhn classification (6) for AFS
1. Nasal polyps
2. Allergic mucin (w Charcot Leyden)
3. Fungal elements
4. CT findings w heterogenous density, sinus wall expansion
5. Lack of invasion
6. Hx of type I hypersensitivity
223
What is Heerfordt's syndrome?
Uveoparotid fever--extrapulmonary form of sarcoidosis, characterized by uveitis, parotid enlargement, and facial palsy
224
What is the name of an autoimmune condition leading to firm enlargement of the SMG, path showing chronic inflammation with cirrhotic changes
Kuttner's tumor (chronic sclerosis siladenitis)
| tx: SMG excision for dx and tx
225
What is the best flap for reconstruction of large upper lip defects of more than half up to 2/3 of the lip in which the philtrum is not involved
Karapandzic
| **Abbe better for defects that involve the philtrum
226
What % of the total nasal resistance is provided by the internal nasal valve
50%
227
What is the name of the vertically oriented fissures in the anteroinferior EAC cartilage that allow spread of infection and tumor to the parotid?
Fissures of Santorini
228
What is the clinical significance of a persistent foramen tympanum (foramen of Huschke)?
Occurs in 5% of the population
| Provides a potential communication for spread of infection or tumor into the IT fossa
229
Innervation of tensor veli palatine
| Innervation of elevator veli palatini
TVP: CN V3
LVP: CN X
230
What nerve crosses over the promontory?
| What does it innervate?
Jacobson's nerve (CN IX)
| Parotid gland
231
What is the most common site of primary acquired cholesteatoma?
Prussak's space (epitympanum): bordered laterally by the pars flaccida
232
What structure courses from the medial wall of the vestibule to a region of thickened posterior fossa dura?
What structure is continuous with the subarachnoid space of the posterior fossa and courses inferior and parallel to the IAC, opening at the base of the Scala tympani
Vestibular aquaduct
| Cochlear aquaduct
233
Cochlea and saccule are joined by a segment of membranous labyrinth called the ______
ductus reuniens
234
Which components of the cochlea contain perilymph? Endolymph?
Perilymph: Scala vestibuli and tympani
Endolymph: Media **contains the organ of corti
235
What separates the scala media from the Scala vestibuli?
Reissner's membrane
236
What supports the organ of corti and separates the Scala media from the Scala tympani?
Basilar membrane
237
Which hair cell provides the majority of the afferent stimulation? Receives the effected from superior olivary nucleus?
Inner: 90% afferent
Outer: 10% afferent, receives efferent
238
Which otolithic organ senses horizontal vs vertical acceleration?
Horizontal: utricle
Vertical: saccule
239
What parts of the labyrinth do the superior and inferior vestibular nerves innervate?
Superior: utricle, superior SCC, lateral SCC
Inferior: saccule, posterior SCC
240
Avg of hearing sensitivity at 500, 1000, and 2000 dL
PTA
241
Lowest level at which a given word can be repeated 50% of the time
SRT
* *assessed via spondee testing
* **should estimate PTA within 10 dB
242
What volume should WRS testing be performed at?
40 dB greater than SRT
243
What dB reduction is seen in bone and air conduction thresholds in the setting of intraaural attenuation?
Bone: none
Air: 40 dB
**crossover is when intramural attenuation is exceeded to stimulate the test ear
244
When should mask be using in air conduction testing?
If the signal presented to the tested ear is 40 dB greater than the BC threshold of the non-test ear
245
When should masking be used in bone conduction testing?
If there is a suspected difference in bone conduction between test and contest ears
246
When can the following forms of testing be used in children?
1. Behavioral observation audiometry
2. Visual reinforcement audiometry
3. Conditioned play audiometry
1. birth - 6mo
2. 6 mo - 3 yr
3. 3 yr to 5 yr
247
How does tympanometry evaluate ear drum mobility?
Ear canal volume
248
What are the three kinds of tymaograms?
Type A: normal
Type B: flat -- low volume (effusion) or high volume (perf)
Type C: negative middle ear pressure, ETD
249
What are the two subsets of type A typanogram
Type As: shallow or stiff, normal pressure but decreased compliance--otosclerosis, tympanosclerosis
Type Ad: deep, normal pressure but increased compliance--ossicular discontinuity, flaccid TM
250
What are three general reasons for an absent stapedial reflex?
1. Severe SNHL (over 65 dB), cannot stimulate CN VIII
2. Any CHL
3. Facial nerve pathology, defect in efferent pathway to tensor tympani
251
What does a positive stapedial reflex decay test indicate
Retrocochlear pathology
252
What does OTE test?
| What kind of HL can it pick up?
Low energy sounds produced by cochlea in response to clicks, from outer hair cells
SNHL or CHL > 20-40 dB -- absent response
253
What are the waveforms assessed by ABR
```
Wave I: Proximal CN VIII
Wave II: Distal CN VIII
Wave III: Cochlear nuclei
Wave IV: Superior olivary nucleus
Wave V: Lateral lemniscus
Wave VI: Inferior colliculus
```
254
What is the most important predictor of success with CI?
Shorter duration of deafness
255
What study is recommended in all patients with Down syndrome before age 4?
PSG
| 60% risk of OSA by age 4
256
Why is gentamicin the preferred injection of the aminoglycosides for Menderes disease
Aminoglycosides are both ototoxic and vestibulotoxic, but gent is the most vestibulotoxic
257
How far out should dermabrasions be spaced for tx of scars?
12 mo
258
1. Broad based osseous lesions of the EAC that are often multiple and bilateral
2. Solitary pedunculated lesions of the EAC that often occur at the tympanosquamous or tympanomastoid suture lines
Exostoses
| Osteomata
259
Tx of lesion of cat scratch disease?
Azithromycin--no I&D indicated
260
What are the following lines:
1. Ohngrens
2. Frankforts
1. Ohngrens: angle of the mandible to the medial canthus, above the line in the sinuses, tumors have increased propensity to invade the skull base
2. Frankforts: superior EAC to the inferior orbital wall, used in facial analysis
261
What is the only chemical peeling agent that requires neutralization to end its activity?
How is it neutralized?
Glycolic acid
| Rinsing with water or 5% sodium bicarbonate solution
262
MC quadrant for congenital cholesteatoma
anterosuperior quadrant
263
In HPV + BOT SCC, what is the rate of clinically significant cervical mets at the time of dx?
Rate of bilateral cervical mets at the time of dx?
60%
| 20%
264
MC sites of LN mets in BOT cancer
Levels II-IV
265
AJCC 8 clinical vs pathological N staging in HPV+ OP SCC
```
CLINICAL:
cN0: No LN
cN1: One or more ipsilateral nodes <6cm
cN2: Contralateral or bilateral nodes <6cm
cN3: Nodes > 6cm
```
PATHOLOGIC:
pN0: No mets
pN1: <4 LN
pN2: >4 LN
266
AJCC 8 T staging for HPV+ OP SCC
T0: No primary
T1: <2 cm
T2: 2-4 cm
T3: >4 cm or extends to lingual surface epiglottis
T4: Invades larynx, extrinsic muscle of the tongue, medial pterygoid, hard palate, or mandible
267
Wound strength as compared to normal dermis at the following time points after injury
1 wk
3 wk
3 mo
1 wk--3%
3 wk--20%
3 mo--80%
268
What is Alexander's law with regard to nystagmus?
Intensity of nystagmus increases when looking toward the direction of the fast phase
269
In what canals is ampullopetal flow excitatory? Ampullofugal?
Ampullopetal (towards ampulla): excitatory in lateral SCC
| Ampullofugal: excitatory ins superior and posterior SCC
270
What type of nystagmus indicates brainstem disease?
Pure vertical
271
Hennebert's sign
Pressure induced nystagmus or dizziness
272
What do VEMPs measure and what is the pathway?
Vesticulocollic reflex
Sound -> stapes -> saccule (sound perception) -> inferior vestibular nerve -> medial/lateral vestibulospinal tract ->ipsilateral SCM
273
MC canal affected by BPPV
Posterior, less commonly horizontal, rarely superior
274
What kind of nystagmus will a patient with posterior canal BPPV have?
Vertical torsional
275
Classic audiogram during Menieres episode?
Low frequency SNHL
276
What is a vasodilator shown to decrease dizziness in Menieres in 2 randomized controlled trials
Betahistine
277
How can auditory testing be used to distinguish hearing loss in otosclerosis from superior SCC dehiscence
Reflexes will be absent in otoslerosis and present in dehiscence
278
Where is a notch typically seen with noise induced hearing loss?
4000 Hz
279
What diuretics can be used to decrease calcium? Which ones increase calcium?
Decrease: Loop
Increase: Thiazides
280
What is the only immunoglobulin that crosses the placenta
IgG
281
What approach to the CPA carries highest risk to the facial nerve
Middle cranial fossa
282
What is the maximal HL see with ossicular chain disruption without TM perforation? With TM perforation?
Without: min 35 to max 60 dB, unable to conduct sound to oval window with intact drum
With: 50 dB, conduction via TM perf to oval window
283
What is a syndrome of recurrent facial paralysis, facial edema, fissured tongue
Melkerson-Rosenthal syndrome
