CHAPTER 4: History, Physical Examination and the Preoperative Evaluation

Question 1

Indicative of temporal bone fracture

Answer 1

Battle sign (ecchymosis overlying the mastoid)

Question 2

To straighten the canal and allow atraumatic insertion of the otoscopic speculum

Answer 2

Gently grasp the pinna and elevate it superiorly and posteriorly

Question 3

TRUE or FALSE

The lateral process of the malleus is readily seen in the superior TM and will be quite prominent in retracted membrane

Answer 3

TRUE

Question 4

TM lacks the radial and circular fibers

Answer 4

Pars flaccida

Question 5

Most common location for retraction pockets, debris, and cholesteatoma

Answer 5

Pars flaccida

Question 6

TRUE or FALSE

The normal TM should be pearly gray and translucent

Answer 6

TRUE

Question 7

A thickened, erythematous membrane, occasionally with bullae

Answer 7

Myringitis

Question 8

A thin atelectatic membrane draped closely over the underlying middle ear structure

Answer 8

Adhesive otitis media

Question 9

Prominent radial blood vessels

Answer 9

Chronic middle ear effusion

Question 10

Often appear as amber fluid, sometimes with air-fluid levels or air bubbles

Answer 10

Serous effusions

Question 11

Appear dull gray to white in color, with loss of the typically visualized middle ear landmarks, and the TM will often be retracted

Answer 11

Mucoid effusions

Question 12

Mass blanches with pneumatic otoscopy

Answer 12

Brown sign

Question 13

Tuning fork tests is done to distinguish between a sensorineural and conductive hearing loss with a

Answer 13

512-Hz fork

Question 14

Performed by placing the vibrating 512-Hz tuning fork in the center of the patient’s forehead, at the bridge of the nose, or on the central incisors with the patient’s teeth tightly clenched

Answer 14

Weber test

Question 15

The 512-Hz tuning fork is placed firmly on the mastoid process, and the patients are instructed to tell the examiner when they are no longer able to hear the sound. The fork is then quickly transferred in front of the ear canal, and patients are asked if they can hear the sound

Answer 15

Rinne test

Question 16

NPCA most commonly presents in the

Answer 16

Fossa of Rosenmuller

Question 17

Boundaries of the oral cavity

Answer 17

1. Skin-vermillion junction of the lips
2. Hard palate
3. Anterior 2/3 of the tongue
4. Buccal membranes
5. Upper and lower alveolar ridge
6. Retromolar trigone
7. Floor of the mouth

Question 18

Parotid duct or Stenson duct opens near the

Answer 18

2nd upper molar

Question 19

Small yellow spots in the buccal mucosa are sebaceous glands

Answer 19

Fordyce spots

Question 20

Oropharynx area

Answer 20

1. Posterior 3rd of the tongue
2. Anterior and posterior tonsillar pillars
3. Soft palate
4. Lateral and posterior pharyngeal wall
5. Vallecula

Question 21

Tonsil size/scale

Answer 21

Brodsky scale

Question 22

Indicates the tonsils are entirely within the tonsillar fossa

Answer 22

0

Question 23

Indicates the tonsils are located just outside the fossa and occupy <25% of the total width of the oropharynx

Answer 23

1+

Question 24

Tonsils occupy 26%-50%

Answer 24

2+

Question 25

Tonsils are 51%-75% of the oropharyngeal width

Answer 25

3+

Question 26

Tonsils occupy >75% of the oropharyngeal width

Answer 26

4+

Question 27

Larynx is subdivide into

Answer 27

1. Supraglottis 2. Glottis 3. Subglottis

Question 28

Area of supraglottis

Answer 28

1. Epiglottis 2. Aryepiglottic folds 3. False vocal cords 4. Ventricles

Question 29

Area of glottis

Answer 29

1. Inferior floor of the ventricle 2. True vocal folds 3. Arytenoids

Question 30

Area of subglottis

Answer 30

Begin 5-10mm below the free edge of the true vocal fold And to extend to the inferior margin of the cricoid cartilage

Question 31

Extends from the superior edge of the hyoid bone to the inferior aspect of the cricoid cartilage

Answer 31

Hypopharynx

Question 32

Subsites of hypopharynx

Answer 32

1. Piriform sinuses 2. Posterior hypopharyngeal wall 3. Postcricoid area

Question 33

Correct positioning in indirect laryngoscopy

Answer 33

1. Patient’s legs should be uncrossed and placed firmly on the footrest 2. The back should be straight with the hips planted firmly against the chair 3. While leaning slightly forward from the waist, the patient should place the chin slightly upward in a sniffing position 4. The patient’s tongue is pulled forward by the examiner 5. The examiner’s middle finger is extended to retract the patient’s upper lip superiorly, and a dental mirror is warmed to prevent fogging and is placed in the oropharynx to elevate the uvula and soft palate to view the larynx

Question 34

Divides the neck into a posterior triangle and anterior triangle

Answer 34

SCM

Question 35

Posterior triangle comprises of

Answer 35

Supraclavicular and occipital triangles

Question 36

Anterior triangle comprises of

Answer 36

1. Submandibular 2. Carotid 3. Muscular

Question 37

Defined by the body of the mandible, the anterior belly of the contralateral digastric muscle, and the stylohyoid muscle

Answer 37

Level I

Question 38

Contains submental nodes

Answer 38

Level IA

Question 39

Consists of the submandibular nodes

Answer 39

Level IB

Question 40

Levels IA and IB are separated by the

Answer 40

Ipisilateral anterior belly of the digastric muscle

Question 41

Upper third of the jugulodigastric chain is known as

Answer 41

Level II

Question 42

Middle jugulodigastric chain

Answer 42

Level III

Question 43

Lower jugulodigastric chain

Answer 43

Level IV

Question 44

Located medial to the plane defined by the spinal accessory nerve

Answer 44

Sublevel IIA

Question 45

Lateral to the spinal accessory nerve

Answer 45

Sublevel IIB

Question 46

Extends from the inferior border of the hyoid bone to the inferior border of the cricoid catilage

Answer 46

Level III

Question 47

Located from the inferior border of the cricoid to the superior border of the clavicle

Answer 47

Level IV

Question 48

Anterior and posterior boundary of levels II and IV

Answer 48

Anterior: lateral border of the sternohyoid muscles Posterior: lateral border of the SCM

Question 49

Encompasses the posterior triangle (spinal accessory and supraclavicular nodes)

Answer 49

Level V

Question 50

Encompasses the nodes from the lateral border of the SCM to the anterior border of the trapezius muscle

Answer 50

Level V

Question 51

TRUE or FALSE | Virchow node is not in the VB region but is located in level IV

Answer 51

TRUE

Question 52

Pretracheal, paratracheal, precricoid (delphian), and perithyroid nodes

Answer 52

Level VI

Question 53

Most common cause of perioperative mortality

Answer 53

Cardiovascular complications

Question 54

Second most common cause of perioperative mortality

Answer 54

Pulmonary complications

Question 55

Inhibits both thyroid hormone synthesis and the peripheral conversion of T4 to T3

Answer 55

Propylthiouracil

Question 56

Inhibits iodide organification

Answer 56

Potassium iodide (Lugol solution)

Question 57

Inhibits abnormal bone resorption

Answer 57

Etidronate

Question 58

Inhibits parathyroid hormone induced osteoclastic activity

Answer 58

Mithramycin

Question 59

Direct inhibition of osteoclast activity

Answer 59

Calcitonin

Question 60

Most common cause of hypoparathyroidism

Answer 60

Iatrogenic

Question 61

Facial nerve hyperactivity elicited by tapping over the common trunk of the nerve as it passes through the parotid gland)

Answer 61

Chvostek sign

Question 62

Finger and wrist spasm after inflation of a blood pressure cuff for several minutes

Answer 62

Trousseau sign

Question 63

Primary aldosteronism

Answer 63

Conn syndrome

Question 64

Aldosterone antagonist

Answer 64

Spironolactone

Question 65

Idiopathic primary adrenal insufficiency

Answer 65

Addison disease

Question 66

,substitution of valine for glutamic acid in the 6th position of the beta-chain of the hemoglobin molecule

Answer 66

Sickle cell disease