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1
Q

What scale is used to grade facial nerve function?

A

House-Brackmann scale

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2
Q

What are the grades in grading facial nerve function?

A

House Brackmann scale

Grade 1: Normal
Grade 4: Incomplete eye closure
Grade 6: No movement

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3
Q

Symptoms of Ramsay-Hunt Syndrome

A

AKA Herpes Zoster Oticus

1) Acute peripheral facial neuropathy
2) Herpetic vesicular rash on the EAC or auricle

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4
Q

Where is the most likely site (on the TM) for cholesteatomas?

A

Congenital: Anterior superior
Acquired: Posterior superior

Congenital - intact TM
Acquired - normally retraction pocket seen

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5
Q

Where to make myringotomy incision

A

Anterior inferior quadrant

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6
Q

What type of skin cancer is more likely found on which lip?

A 
BCCa = upper lip
SCCa = lower lip
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7
Q

What should you check for if bifid uvuala is present?

A

Submucosal cleft palate

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8
Q

Cause of a Thornwaldt cyst

A

Cystic formation during notocord obliteration

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9
Q

What is bright vs. dark on T1?

A

Fat: Bright
Fluid: Dark
Bone: Dark

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10
Q

What is bright vs. dark on T2?

A

Fat: Intermediate
Fluid: Bright
Bone: Dark

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11
Q

Shiley adult cuffless trach tubes offered in what sizes?

A

4, 6, 8, 10

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12
Q

Shiley pediatric cuffless trach tubes offered in what sizes?

A

3.0-6.5

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13
Q

Indications for a cuffed trach

A

1) Aspiration

2) Need for positive pressure ventilation

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14
Q

Shiley laryngectomy tube sizes

A

6, 8, 10

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15
Q

Types of laryngocele

A

Primary: No underlying disease
Secondary: Caused by obstruction of the ventricle (usually by SCC)

*Can be external/internal/mixed and fluid or air filled

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16
Q

What are the absorbable sutures?

A

Vicryl
PDS
Monocryl
Maxon

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17
Q

What are the non-absorbable sutures?

A

Prolene
Ethibond
Dacron
Silk (absorbed after a long time)

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18
Q

How long until absorbable sutures are absorbed?

A

60 days

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19
Q

Where does the RLN run?

A

In the tracheo-esophageal groove

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20
Q

What must be looked for if thyroglossal duct cyst is diagnosed?

A

Where the thyroid is so you don’t excise it

Can be a lingual thyroid

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21
Q

Contents of the carotid sheath

A 
Carotids
Internal jugular
Vagus n.
Sympathetic plexus
LN levels II-IV
Remnants of 2nd branchial cleft (pathologic)
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22
Q

What can the pattern of stridor tell us about location of obstruction?

A

INspiratory stridor = EXtrathoracic

EXpiratory stridor = INtrathoracic

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23
Q

What is included in the VOTE evaluation?

A

Evaluation for DISE

Velum
Oropharyngeal (lateral) walls
Tongue
Epiglottis

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24
Q

What surgery can help patients with OSA due to the palate/velum?

A

UPPP

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25
What is the grading for the modified Malampati?
Class 0: Ability to see any part of the epiglottis upon mouth opening and tongue protrusion Class I: Soft palate, fauces, uvula, pillars visible Class II: Soft palate, fauces, uvula visible Class III: Soft palate, base of uvula visible Class IV: Soft palate not visible at all
26
Which V cell deficiency syndrome affect T cells too?
Common variable immunodeficiency does | X linked Agammaglobulinemia (Brutton's) does not
27
What is seen clinically with selective IgA deficiency?
Allergies Transfusion anaphylaxis Autoimmune disorders
28
What is seen with Wiskott-Aldrich syndrome?
TIE: Thrombocyopenia IgM deficiency (and infections) Eczema
29
By CD4 counts, what is considered aids?
CD4 < 200 | CD4 < 14%
30
Causes of xerostomia
Radiation Systemic disease (Sjogrens) Medications & anesthesia
31
Most common pathogen seen in sialadenitis
Staph aureus
32
Risk factors for sialadenitis
Dehydration Post-surgical Radiation/chemo Sjogrens
33
Complications of acute sialadenitis
Ducto-cutaneous fistula Abscess Ludwig's angina
34
Treatment for sialadenitis
Antibiotics Warm compresses Sialogogues Massage
35
Symptoms of sialolithiasis
Recurrent pain swelling, | Salivary colic
36
What is the role of plain films in sialolithiasis?
Submandibular calculi are radiopaque | Parotid calculi are radiolucent
37
Diagnostic modality of choice in sialolithiasis
High-resolution CT
38
What is seen with Heerfordt's syndrome?
``` AKA Uveoparotid syndrome (a form of sarcoid) Anterior uveitis Parotid gland enlargement Facial nerve palsy (50%) Fever ```
39
What is seen with Kuttner's tumor?
Firm, tender enlargement of the submandibular gland | autoimmune "cirrhosis" of the gland
40
What dose of radiation may produce permanent radiation sialadenitis?
>40-50 Gy
41
What malignancy can be caused by Sjogren's syndrome?
Non-Hodgkin's Lymphoma
42
Diagnosis of Sjogren's
``` Shirmer test (tissue paper on eye) Saxon test (chew on sponge) SS-A & SS-B ```
43
What is seen with Mikulicz syndrome?
Recurrent lyphocytic parotid gland swelling | Secondary to amyloid, TB, bulimia, lymphadenitis, lead/mercury, EtOH
44
What can cause sialadenosis?
``` DM Cirrhosis Malnutrition Endocrine insuff (ovaria, thyroid, pancreatic) Medications ```
45
What salivary gland lesion is seen in HIV patients?
Benign lymphoepithelial cysts | pseudolymphoma, multiple parotid cysts
46
What is a ranula?
Mucous retention cyst of the floor of mouth. May "plunge" into cervical tissues & present as a neck mass.
47
What is seen in necrotizing sialometaplasia?
Ulceration of the hard palate
48
What causes necrotizing sialometaplasia?
Ischemia resulting in necrosis and infection of the minor salivary glands
49
What is the treatment for necrotizing sialometaplasia?
It is self-limited **Important bc it can clinically and histologically mimic SCCa and mucoepidermoid Ca
50
What proportion of parotid tumors are benign?
80%
51
Where are the majority of salvary neoplasms found?
80% in the parotid
52
What salivary glands have higher rate of malignancy?
The smaller the gland, the more likely it is malignant
53
What are the benign salivary gland malignancies?
``` Pleomorphic adenoma Warthin's tumor Oncocytoma Monomorphic adenoma Hemangioma ```
54
What are the malignant salivary gland tumors?
``` Mucoepidermoid carcinoma Adenoid cystic carcinoma Acinic cell carcinoma Malignant mixed tumors (CEPA) SCCa Lymphoma Adenocarcinoma Clear cell carcinoma Malignant Oncocytoma Epithelial-Myoepithelial carcinoma Salivary duct carcinoma ```
55
What is the most common salivary gland tumor?
Benign mixed tumor | pleomorphic adenoma
56
What are the histologic components of a Pleomorphic adenoma?
Myoepithelial component Epithelial component Stromal component Fibrous pseudocapsule
57
What parotid tumor is seen in middle-aged smoking men?
Warthin's
58
What salivary parotid tumor can be bilateral?
Warthin's
59
What are the histologic components of Warthin's tumor?
Epithelial component Lymphoid component Mucous-secreting cells Oncocytic cells
60
What is the difference between monomorphic and pleomorphic adenoma on histology?
Monomorphic is predominantly an epithelial component
61
What blood test can be abnormal in patients with large hemanigomas?
Thrombocytopenia
62
What does a violaceous hue overlying a lymph node indicate?
Possible mycobacterium infection
63
What is the most likely cause of a non-recurrent RLN?
Retroesophageal subclavian | arteria lusoria
64
What are the indications for CPAP?
``` Moderate OSA (AHI 15-30) with symptoms Severe OSA (AHI >30) ```
65
What is the medical treatment for acute invasive fungal rhinosinusitis?
Aspergillus: Voriconazole Mucor: Amphotericin B
66
What do the hillocks of His develop into?
``` I: Tragus II: Crus of helix III: Helix IV: Antihelix V: Antitragus VI: Lobule ```
67
What is the most common site of facial nerve injury following temporal bone fracture?
Near the geniculate
68
What are the stages of papillary thyroid cancer for patients under age 45?
No distant mets: Stage 1 | Distant mets: Stage 2
69
Melanoma T staging
T1: <1mm deep T2: 1mm-2mm deep T3: 2-4mm deep T4 >4mm deep a: no ulceration b: ulceration
70
Melanoma N staging
N1: 1 node N2: 2-3 nodes N3: 4+ nodes a: micromets b: macromets
71
When should a cleft lip be repaired?
10, 10, 10 rule Hgb of 10 10 pounds 10 weeks
72
When should NOACs be held prior to surgery?
2d prior to surgery
73
When should Coumadin be held prior to surgery?
5d prior to surgery
74
When should a Heparin gtt. be held prior to surgery?
6h prior to surgery
75
When should NOACs be restarted after surgery?
Usually on POD1
76
When should Coumadin be restarted after surgery?
12-24h postop
77
What diet should be used if a chyle leak is present?
Medium chain triglycerides
78
Types of malocclusion
Type I: Molars normally placed, subjective malocclusion Type II: Overbite Type III: Underbite
79
What is seen with Cogan's syndrome?
Episodic vertigo Interstitial keratitis Bilateral fluctuating SNHL
80
Treatment for Cogan's syndrome
High dose steroids It is an autoimmune disease
81
What is the treatment for congenital torticollis?
Physical therapy | SCM section if refractory
82
What medical treatment can be offered to slow the progression of otosclerosis?
Fluoride
83
What tests should be performed following a Zone 1 injury?
CTA CXR Gastrografin swallow
84
What are the trauma neck zones?
Zone 1: Clavicles to cricoid Zone 2: Cricoid to angle of mandible Zone 3: Angle of mandible to skull base
85
What paraganglioma site has the highest rate of malignancy?
Orbital and laryngeal paragangliomas (25%)
86
What is the treatment for neonatal rhinitis?
0.1% dexamethasone drops
87
What is ECOG?
Electrocochleography Testing of cochlear potentials in response to sound
88
What is a VEMP?
Vestibular evoked myogenic potential
89
What parts of the ossicles are formed by the first branchial arch?
Malleus (except manubrium) | Incus (except long process)
90
What parts of the ossicles are formed by the second branchial arch?
Manubrium of malleus Long process of incus Stapes superstructure
91
What is the most common cause of stridor in infants?
Laryngomalacia
92
What are the indications for supraglottoplasty in children with laryngomalacia?
Apneic events Cyanosis Failure to thrive Cor pulmonale
93
What is the treatment for laryngomalacia?
Observation Anti-reflux medication Supraglottoplasty
94
What nerve is most commonly injured during a facelift?
Great auricular nerve
95
What is a normal SP/AP ratio on ECOG?
Less than 0.4 More than that suggests Meniere's or SSCD
96
What physical exam finding is most specific for OSA?
Next Males over 17" Females over 15"
97
What's nerves are responsible for taste innervation of the tongue and soft palate?
Anterior 2/3 tongue: Chorda tympani (CNVII) Posterior 1/3 tongue: Lingual n. (CNIX) Soft palate: Vidian n. (GSPN)
98
What should be done if a dehiscent ICA in the sphenoid is lacerated?
Pack the sinus Permissive hypotension Emergent IR and NSGY consult
99
What is the narrowest point of the pediatric airway?
Cricoid
100
What is the narrowest point of the adult airway?
Glottis
101
Where is the RLN found relative to the ligament of Berry?
Lateral and dorsal
102
Symptoms of lidocaine toxicity
``` Metallic taste Tinnitus Perioral numbness Vomiting Tremors Convulsions ```
103
What is the most common site for an esophageal foreign body to lodge in a child?
Thoracic inlet
104
What lymph node levels should electively be taken for cutaneous SCCa?
Face: I-III Anterior scalp/Ear: II-III Posterior scalp: II-V
105
How is a vocal cord granuloma treated?
PPI's Resection only if suspicious for malignancy or failure to resolve with medical therapy
106
What protein is abnormal in neurofibromatosis type II?
Merlin
107
What protein is abnormal in Treacher-Collins?
Treacle
108
What is seen with Godtfredson's syndrome?
CNVI & CN XII palsies
109
What causes Godtfredson's syndrome?
Clival tumors Usually metastatic to clivus, can also be from nasopharyngeal cancer
110
What is seen with Mobius syndrome?
Congenital CNVI and CNVII dysfunction
111
What is seen with Vernet's syndrome?
AKA Jugular foramen syndrome CN 9, 10, 11 dysfunction
112
What is seen with Gardner syndrome?
Familial adenomatous polyposis Multiple osteomas Soft tissue tumors
113
What is the first sinus to develop in utero?
Maxillary sinus
114
What is the most developed sinus at birth?
Ethmoids
115
In what stage of sleep our confusional arousals, night terrors, and sleepwalking found?
Sleep stage III (Slow wave sleep; NREM)
116
At what drain output should a chyle leak be surgically repaired?
Over 600-1000 cc/day
117
What is Brown's sign?
Blanching of a middle ear mass when pneumatic otoscopy is performed. Indicates a middle ear glomus tumor.
118
What is the lyre sign?
Splaying of the ICA and ECA by a carotid body tumor
119
What are the four phases of the hair growth cycle?
Anagen (growth) Catagen (involution) Telogen (rest) Exogen (shedding)
120
What is the best time postoperatively to dermabrade a scar?
6w postop
121
What parotid tumor metastasizes to solid organs instead of LN's?
Adenoid cystic carcinoma Goes to lungs & liver
122
What part of the ear is important to preserve if a prosthesis is to be used?
Tragus
123
Scala ________ abuts the oval window | Scala ________ abuts the round window
Scala vestibuli abuts the oval window | Scala tympani abuts the round window
124
What does the GSPN carry?
Parasympathetics to the lacrimal gland
125
What is classically seen on otoscopy for a congenital cholesteatoma?
White mass behind the anterosuperior TM
126
What Jahrsdoerfer score qualifies a patient as a surgical candidate?
Jahrsdoerfer score for aural atresia Score >6 makes a patient a surgical candidate
127
What is the pathogenesis of Pierre-Robin sequence?
Mandibular hypoplasia causes in-utero displacement of the tongue anterosuperiorly, which blocks the fusion of the palatine shelves. Results in micrognathia, glossoptosis, and cleft palate.
128
What is the cutoff for facial weakness on nerve excitability testing?
A difference of >3.5 mA between the two facial nerves to get gross facial movement
129
What is the Stanford protocol?
1st Phase: UPPP + Genioglossus Advancement and/or Hyoid Suspension 2nd Phase: Maxillomandibular advancement.
130
What subtype of BCC is more aggressive?
Sclerosing aka Morpheaform
131
What muscle is responsible for horizontal rhytids?
Procerus (HP-VC)
132
What muscle is responsible for vertical rhytids?
Corrugator (HP-VC)
133
What muscle is responsible for bunny lines?
Transverse nasalis muscle
134
What is associated with an absent foramen spinosum?
Persistent stapedial artery Courses between crura of stapes
135
What disease can cause the superior parathyroids to be larger than the inferior parathyroids?
Water clear cell hyperplasia Water clear cell proliferation leads to hypercalcemia.
136
What is the most common cardiac defect in DiGeorge syndrome?
ToF
137
What disease can cause the superior parathyroids to be larger than the inferior parathyroids?
Water clear cell hyperplasia Water clear cell proliferation leads to hypercalcemia.
138
What is the most common cardiac defect in DiGeorge syndrome?
ToF
139
What can be used to sclerose lymphatic malformations?
OK-432 Bleomycin EtOH
140
What type of lymphatic malformation responds to sclerosis?
Macrocystic
141
What percentage of congenital VC paralysis is bilateral?
50% bilateral
142
What viruses carry risk of H&N cancer?
EBV: Nasopharyngeal HPV: Oropharyngeal
143
What industrial exposures can increase risk of paranasal sinus and nasal cavity cancer?
Wood dust Nickel dust Formaldehyde
144
What percent of chronic leukoplakic lesions will become malignant?
14% Median of 5y
145
How is otosclerosis inherited? | Typical patient?
It is autosomal dominant with variable penetrance | White women
146
Where are the vessels found that supply a random flap?
Subdermal plexus
147
COL4A5 mutation
Alport syndrome
148
GJB2
SNHL Codes for Connexin 26. Responsible for half of all non-syndromic HL.
149
PDS gene
Pendred syndrome
150
What is seen with Pendred syndrome?
SNHL Euthyroid goiter +/- EVA & Mondini's aplasia
151
KVLQT1
Jervell and Lange-Nielsen syndrome
152
What is the most common feeding vessel for a carotid body tumor?
Ascending pharyngeal
153
How is tissue expander width determined?
It should be 2.5x the size of the defect
154
What plane are tissue expanders placed within?
Subgaleal
155
When does postop tracheoinominate fistula occur most commonly?
2-3w postop
156
How long before dermabrasion can be repeated?
1y
157
What is ASA's mechanism?
COX inhibitor Increases Leukotrienes, decreases TXA2 & prostaglandins
158
What sensory nerves supply the auricle?
Auriculotemporal (V3; anteriosuperior) Vagus (conchal bowl) Lesser occipital (C2; posteroinferior) Great auricular (C2-3; Lobule)
159
DiGeorge patient with stridor
Anterior laryngeal web
160
What is the nodal staging in thyroid cancer?
N1a: Level VI nodes N1b: Nodes at any other levels
161
What is the T staging for thyroid cancer
T1: under 2cm T2: 2-4cm T3: over 4cm or limited extrathyroidal extension T4a: subQ soft tissues, larynx, trachea, esophagus, or RLN T4b: prevertebral fascia or encases carotid artery or mediastinal vessel
162
What is the most commonly injured EOM during blepharoplasty?
Inferior oblique
163
How are bilateral carotid body tumors managed?
Surgery for the smaller tumor | Radiation for the larger tumor
164
What is the only reason to delay RT after resection of a cancer?
Exposed carotid
165
What are the Bent & Kuhn major criteria?
Used for diagnosis of allergic fungal rhinosinusitis 1) Hx of type I hypersensitivity 2) Nasal polyps 3) Characteristic CT findings 4) Eosinophilic mucin without invasion 5) Positive fungal stain
166
What are the risks of Phenol peels?
Cardiac arrhythmia Laryngeal edema in smokers Should minimize the surface area exposed at one time.
167
What are the fall allergies?
Ragweed | Tumbleweed
168
What is the most common spring allergy?
Tree pollen
169
What are the most common perennial allergies?
Pet dander | Mold
170
What is the most common summer allergy?
Grasses
171
What are the side effects of RAI?
Sialadenitis Taste disturbance Nausea Epiphora
172
What does cVEMP test?
Saccule and inferior vestibular nerve
173
What does oVEMP test?
Utricle and superior vestibular nerve
174
Where should the medial brow end?
Along a line drawn between the medial canthus and the nasal ala
175
Where should the lateral brow end?
Along a line drawn between the lateral canthus and the nasal ala
176
What are the most common causes of primary hyperparathyroidism?
``` One adenoma (75%) 2 adenomas (26%) Parathyroid hyperplasia (1.5%) Carcinoma (1%) ```
177
What mutation is associated with papillary thyroid carcinoma?
BRAF in 40%
178
What cytokines are upregulated in the long run with immunotherapy?
IL-10 TGF-beta These are the Treg cytokines
179
What is it called if the maxillary sinus is seen to be pushed forward by a mass?
Holman-Miller sign It is pathognomonic for JNA
180
What is the preferred method of resection of a JNA?
Embolization followed by Endoscopic resection Endoscopic resection has been shown to have less blood loss.
181
What special scans are used in the evaluation of malignant otitis externa?
Technetium: To diagnose (osteoblastic activity) Gallium: To monitor (inflammation)
182
What is the treatment for Ramsay-Hunt syndrome?
Valacyclovir for 14d | Steroids
183
What is the toxic dose of lidocaine in children?
4.5 mg/kg of lidocaine | 7 mg/kg of Lidocaine with Epi
184
What does 1% lidocaine indicate?
10mg in 1cc
185
How much rotation will you get from a Z-plasty with angles of: 30 degrees? 45 degrees? 60 degrees?
30: rotates 45 degrees 45: rotates 60 degrees 60: rotates 90 degrees
186
How much increase in length will occur with a Z-plasty with angles of: 30 degrees? 45 degrees? 60 degrees?
30: 25% 45: 50% 60: 75%
187
What can be used for truly idiopathic cough?
TCA's Gabapentin/Lyrica Baclofen
188
What condition(s) is/are associated with increased VEMP amplitude?
Superior SCC dehiscence
189
What condition(s) is/are associated with decreased VEMP amplitude?
Meniere's Otosclerosis Acoustic neuromas Vestibular neuronitis
190
What bacteria can cause an ABRS that is often self-resolving
Moraxella | H. flu
191
What is the most common organism in chronic suppurative otitis media?
Pseudomonas
192
What is the most effective surgery to increase compliance with CPAP?
Nasal surgery (septoplasty) More effective than any OP surgery to reduce pressures required and increase compliance.
193
What level should TSH ideally be at prior to initiating RAI?
TSH > 30 mU/L
194
What is the most important muscle to reconstruct in cleft palate surgery?
Levator veli palatini It closes off the nasopharynx with swallowing and helps in phonation.
195
What are the major tip support mechanisms for the nose?
1) Lower lateral cartilage strength 2) Scroll area (overlap of upper & lower lateral cartilages) 3) Attachment of the medial crura to the caudal septum
196
At what age is microtia repair performed?
Age 5y At 5y, the child's ear size is 95% of the adult's size.
197
What is the normal nystagmus response to caloric testing?
COWS Cold opposite, Warm same Indicates which way the nysagmus should beat
198
What do the supraclavicular nodes drain?
Esophagus Abdomen Lung
199
What is seen on histology in mucoepidermoid carcinoma?
Cords, sheets and clusters of mucous, squamous, intermediate and clear cells. Look for mucous. Can be low grade (glandular) or high grade (squamous)
200
What is the T staging for mucosal melanoma?
There is no T1 or T2! T3: Just mucosal & soft tissue involvement T4a: Involvement of cartilage, bone, or skin T4b: Involvement of vital structures or spaces
201
What is the N staging for mucosal melanoma?
N0: No regional nodes N1: Regional nodes involved
202
What physical exam finding is used to test for vestibular neuritis?
Reduced or absent caloric testing on the affected side is the most reliable PE finding
203
How is vestibular neuritis treated?
Steroids! Also vestibular therapy & meclizine
204
What causes vestibular neuritis?
Reactivation of HSV
205
What is the difference in pharmacologic treatment of Bell's palsy vs. vestibular neuritis?
Bell's palsy: Steroids and valacyclovir | Vestibular neuritis: Just steroids
206
What drug can be used for RSV prophylaxis in susceptible children?
Palivizumab
207
What is the mechanism of Avastin?
VEGF inhibitor
208
What chemo drug can be used in RRP?
Avastin | VEGF inhibitor
209
What is the ideal nasolabial angle?
Men: 90-95 degrees Women: 95-115 degrees
210
What are the most common primary mandibular tumors?
1) Odontoma | 2) Ameloblastoma
211
What is seen on histology with ameloblastoma?
Central triangular-shaped cystic cells | Border of palisading columnar cells with nuclei pushed away from basement membrane.
212
What is the typical duration of intradermal immunotherapy?
3-5y
213
What level should TSH be suppressed to in PTC?
Low risk: 0.1-0.5 mU/L | Moderate/High risk: Less than 0.1 mU/L
214
What are the autosomal dominant SNHL syndromes?
``` WANT CBS Waardenburg Apert NF2 Treacher-Collins Crouzon Branchio-Oto-Renal Stickler ```
215
How many aesthetic subunits of the nose are there?
9
216
What cranial nerve innervates the carotid body?
CNIX
217
Which aminoglycosides are vestibulotoxic? | Cochleotoxic?
Vestibulotoxic: Streptomycin Cochleotoxic: Amikacin, Kanamycin, Neomycin
218
What branch of the FN is most vulnerable to injury during sclerotherapy for a venous malformation?
Zygomatic branch (up to 40% of the time)
219
What supplements can increase bleeding rates?
``` Garlic Ginseng Gingko Ginger Glucosamine Green tea ```
220
What is considered compliance with CPAP?
4h per night | 5 days per week
221
What is considered positive on the ESS?
Score >10
222
What is the dosage of epi for anaphylaxis in an adult?
0.3-0.5mg
223
What is the dosage of epi for anaphylaxis in a child?
0.01 mg/kg
224
What embryologic structure is responsible for a nasal dermoid cyst?
Foramen cecum
225
Types of allergic reactions
Type I: Anaphylactic Type II: Cell-mediated Type III: Immune complex Type IV: Delayed hypersensitivity
226
What embryologic precursor is responsible for parafollicular cells?
C-cells come from ultimobrachial body
227
What are the 2 most common benign masses in the nose?
Osteoma | Iverted papilloma
228
What is the criteria for AFRS?
1) Atopy 2) Nasal polyposis 3) Asymmetric filling of sinuses 4) Eosinophilic mucin without invasion 5) Positive fungal stain for noninvasie disease
229
What is the mean sleep latency for a normal patient? | OSA patient?
Normal: 10-15 minutes OSA: Under 5 minutes
230
What are the most common pharyngeal dilator muscles?
Genioglossus | Tensor veli palatini
231
What defines a hypopnea event?
30% decrease in airflow 10 seconds 4% desaturation
232
What audiometry is used for kids 0-6mo old?
Behavioral audiometry
233
What audiometry is used for kids 6mo-3y
Visual reinforcement audiometry
234
What audiometry is used for kids 3-5y?
Conditioned play audiometry
235
What is the blood supply to the parathyroid glands?
In most cases, both inf and sup parathyroids are supplied by the inferior thyroid artery
236
What is the nodal staging for NP cancer?
N1: Under 6cm, ipsi, above cricoid N2: Under 6cm, contra/bilat, above cricoid N3a: Over 6cm N3b: Extends to supraclavical fossa
237
What are the UPSIT categories?
0-4: Malingering 5-18: Anosmia 19-33: Hyposmia
238
What is the most common inhalant allergy associated with spring?
Trees
239
What is the most common inhalant allergy associated with summer?
Grasses
240
What is the most common inhalant allergy associated with fall?
Ragweed
241
What is considered positive in intradermal allergy testing?
2mm or larger wheal
242
What are the causes of recurrence of hearing loss following stapedectomy?
Displacement of the prosthesis Necrosis of the long process of the incus Middle ear adhesions
243
What can cause failure to improve following stapes surgery?
Obliterative otosclerosis of the round window
244
What causes oral hairy leukoplakia?
EBV in the setting of immunosuppression
245
What causes oral lichen planus?
T-cell mediated reaction against the epithelium
246
What is the most common CPA tumor in children?
Glioma
247
How long does each stage in skin graft healing last?
Plasmatic imbibition: 24-48h Inosculation: 24h-72h Vascular ingrowth: 3-5d
248
Where is the Frankfort plane drawn?
Superior EAC to inferior orbital rim
249
T-staging for temporal bone carcinoma
``` Pittsburgh staging: T1: EAC skin only T2: Partial thickness bone erosion T3: Full thickness bone erosion T4: Into adjacent structures, or over 0.5cm soft tissue involvement or FN paralysis ```
250
Orientation of cochlear aqueduct and endolymphatic duct
Cochlear aqueduct = parallel to IAC | Endolymphatic duct = perpendicular to IAC
251
Which petrosal nerves innervate what
GSPN = lacrimal | Lesser petrosal n. = Parotid
252
What nerves constitute the Vidian?
``` GSPN (parasymp) Deep petrosal (symp) ``` This then runs to the pterygopalatine fossa
253
Which muscles cause which glabellar rhytids?
Procerus = horizontal Corrugator supercilii = vertical Plastics Hates Crappy Views
254
What is the dosage for epi in peds (for anaphylaxis)?
0.01 mg/kg IM
255
What kind of hypersensitivity reaction is contact dermatitis?
Delayed (Type IV)
256
Where are the most common sites for a dermoid cyst in the H&N?
Periorbital Nasal Suprasternal Submental
257
What is telogen effluvium?
Alopecia at a surgical site due to the trauma of surgery. Occurs at donor and recipient site & lasts 3mo.
258
What Hillocks of His develop into what?
1: Tragus 2: Helical crus 3: Helix 4: Antihelix 5: Antitragus 6: Lobule ``` 1-3 = 1st branchial arch 4-6 = 2nd branchial archd ```
259
What is the other name for Warthin's tumor?
Papillary cystadenoma lymphomatosum
260
Where do the parathyroids lie relative to the depth of the RLN?
Superior parathyroids are deep to RLN | Inferior parathyroids are superficial to RLN
261
When do fibrillation potentials and sharp waves appear on laryngeal EMG?
3w Indicates a poor prognosis for recovery
262
What is rocker deformity?
Bone inferior to an osteotomy sinks down, creating a stepoff
263
What is inverted-V deformity?
Upper lateral cartilages are not sufficiently reattached to nasal bones or septum, causing them to slide down. Can cause internal nasal valve collapse.
264
What nerve is at risk during tonsillectomy?
Lingual branch of the glossopharyngeal nerve (IX) | Sensory to the posterior 1/3 of the tongue
265
What is class I-III occlusion?
Class I: MAxillary 1st molar overlies the mandibular groove of mandibular 1st molar Class II: Overbite Class III: Underbite
266
What is a possible systemic adverse effect of chemical peels?
Phenol can cause cardiotoxicity and arrhythmia
267
What types of collagen are observed in wound healing?
Type III --> Type I
268
Which type of chemical peel requires neutralization?
Glycolic acid
269
What is the most common fungus causing malignant OE?
Aspergillus
270
What can be seen on CT chest in RRP?
Cavitary nodules with air-fluid levels Poor prognostic sign
271
What sites on the H&N has poor prognosis for Merkel cell carcinoma?
Scalp (distant mets) Lip (bone invasion) Neck
272
When and how does abx-induced hearing loss present?
After 3-4d of therapy | High frequency, bilateral SNHL
273
What antiviral can be used in RRP?
Cidofivir (DNA polymerase inhibitor)
274
What is seen in CULLP?
Congenital Unilateral Lower Lip Paralysis Depressor anguli oris fails to develop. EMG will show no response.
275
What muscle is responsible for the smiling deformity?
Depressor septi nasi
276
What is seen in the smiling deformity?
Depressed nasal tip Shortened upper lip Transverse crease along the philtrum
277
What are the last paranasal sinuses to develop?
Frontal sinuses
278
Where relative to the TM are congenital cholesteatomas observed?
Anterior superior (in 2/3)
279
Liothyronine vs. Levothyroxine?
Liothyronine can be continued up until 2w prior to RAI therapy, whereas Levothyroxine must be stopped 6w prior
280
When do hemangiomas grow most on children?
Majority of the growth is complete by 5mo
281
Alpha waves | What sleep cycle?
Wakefulness
282
Vertex sharp waves | What sleep cycle?
Stage I
283
Slow eye movements | What sleep cycle?
Stage I
284
K complexes | What sleep cycle?
Stage II
285
Sleep spindles | What sleep cycle?
Stage II
286
Delta waves | What sleep cycle?
Stage III
287
What defects can be closed primary following lower eyelid resection?
Up to 25% defects can be closed primarily
288
What nerves are affected in Vernet syndrome?
Aka jugular foramen syndrome, so IX, X, XI
289
What nerves are affected in Villaret syndrome?
Aka retroparotid syndrome | So IX, X, XI, XII, cervical sympathetic chain
290
Where is calvarium harvested from?
2cm lateral to the sagittal suture
291
What incisions comprise the delivery method of endonasal rhinoplasty?
Full transfixion Marginal Intercartilaginous
292
What are the indications for urgent drainage of a peds RPA?
Abscess greater than 2cm Respiratory distress Failed IV abx
293
Treatment for rhinitis of pregnancy
Budesonide | only nasal steroid proven safe in pregnancy
294
How large should margins be for cutaneous melanoma?
It mirrors the thickness 1cm thickness = 1cm margins 2cm or greater depth = 2cm margins
295
What is the most common tumor in the pediatric parotid?
Mucoepidermoid carcinoma 50% of peds parotid tumors are malignant
296
What is the SMAS contiguous with?
TPF | Platysma
297
When is the earliest that microtia reconstruction can occur?
6y Ear growth has reached 95% by age 6.
298
Durations of the stages of skin graft take
Day 0-2 = plasmatic imbibition Day 2-3 = inosculation Day 3-5 = angiogenesis
299
How long does re-epihelialization take following dermabrasion?
A week
300
What abx is indicated for Bartonella lymphadenitis?
Azithromycin
301
Where is Donaldson's line?
It is a line running posteriorly through the horizontal semicircular canal. Aids in locating the endolymphatic sac (along line or just inferior).
302
When is the optimal time to perform laryngeal EMG for a vocal cord paralysis?
3-6 months post-injury
303
What is the most common cause of congenital hearing loss?
Prenatal infections (CMV most common)
304
What is seen in Usher syndrome?
``` Profound SNHL Retinitis pigmentosa (poor vision) Vestibular dysfunction ```
305
Air-Bone gap patterns in TM perf
More severe in lower frequencies
306
Air-Bone gap patterns in partial ossicular discontinuity
More in higher frequencies
307
Air-Bone gap patterns in otosclerosis
Carhart notch (2k)
308
Air-Bone gap patterns in complete ossicular discontinuity
Maximal CHL across all frequencies (60dB)
309
What nerve is available with the RFFF?
Lateral antebrachial cutaneous
310
What nerve is available with the ALT free flap?
Lateral femoral cutaneous Also used if doing a PLT flap
311
What nerve is available with the lateral arm flap?
Posterior cutaneous nerve
312
What are the 4 parasympathetic ganglia in the Head and Neck?
Otic Submandibular Pterygopalatine Ciliary
313
Where does the GSPN synapse?
Pterygopalatine ganglion Carries parasympathetics to lacrimal gland and nasal mucosa
314
What laryngeal muscle receives bilateral innervation?
Interarytenoid
315
What is the significance of BRAF?
Seen in PTC | Portends a more aggressive cancer
316
What approach is best for treating petrous apex cholesterol granulomas?
If possible, transphenoidal approaches have lower recurrence rates than transotic ones
317
What are the T1 and T2 MRI characteristics of cholesteatoma?
T1 hypointense | T2 hyperintense
318
What are the T1 and T2 MRI characteristics of schwannomas?
T1: Hypointense T2: Heterogenous hyperintense Enhances with contrast
319
What is seen on histology with hairy cell leukoplakia?
Hyperkeratosis Acanthosis Koilocytosis Fungal elements
320
What subtype of IgG is most commoly deficient?
IgG2
321
What determines if a penetrating injury to the FN is likely to heal spontaneously?
If it is medial to the lateral limbus of the eye, it is likely to heal spontaneously
322
What is the main blood supply to the temporalis flap?
Deep temporal artery (off of maxillary artery)
323
What is considered compliance with CPAP?
4+ hours per night | 5+ days per week
324
What is seen anatomically with a pulmonary artery sling?
Left PA comes off of right PA and runs through tracheo-esophageal groove
325
How does the FN relate to layers of the temporal area?
On the undersurface of the TPF
326
Treatment of a central air embolus
Left lateral decubitus Trendelenburg 100% O2
327
What molecular markers are specific for PTC?
BRAF RAF (RAS less specific ~85%)
328
What is more difficult to treat, microcystic or macrocystic lymphatic malformations?
Microcystic. More infiltrative and have higher recurrence.
329
Where in the neck is a lymphatic malformation more likely to be microcystic?
Suprahyoid
330
How to manage persistent stapedial artery in stapes surgery
If small - laser coagulate and proceed | If over 50% of obturator foramen - abort and amplify
331
What borders the pre-epiglottic space?
``` Hyoid bone Thyrohyoid membrane Hyoepiglottic ligament Thyroepiglottic ligament Epiglottis ```
332
What is the effect of Minoxidil on hair?
Makes hairs thicker but not greater in number
333
Where is the most common site of PLF?
Anterior to the anterior crus
334
What incisions are used in the midface degloving approach?
Sublabial Full transfixion Intercartilaginous
335
What testing should be performed following a mumps infection?
Audiogram to assess for SNHL
336
What is in the Baker-Gordon peel?
Phenol Tap water Liquid soap Croton oil
337
Define rollover
Decrease in speech recognition at higher signal intensity
338
Recruitment is specific for pathology where in the hearing apparatus?
The cochlea
339
What is the treatment for post-resurfacing hyperpigmentation?
Hydroxyquinone Sunblock Exfoliation
340
What is a normal MRD1?
3-4.5mm
341
What is a normal palpebral fissure measurement?
9mm
342
What is seen in Usher syndrome?
Hearing loss Vestibular dysfunction Retinitis pigmentosa
343
What is seen in Apert syndrome?
Stapes fixation | Lobster hands
344
What is seen in goldenhaar syndrome?
Hemifacial microsomia FN abnormalities Colobomas
345
What is seen in Pendred syndrome?
Goiter | SNHL
346
How is Pendred syndrome confirmed?
Perchlorate test
347
Plane for an endoscopic brow lift
Subperiosteal
348
Plane for a coronal brow lift
Subgaleal
349
What depth of invasion for melanoma requires evaluation of the LN's?
0.75 cm or greater
350
Most common site fot pyogenic granuloma in the mouth
Gingiva
351
What is seen in Melkersson-Rosenthal syndrome?
Recurrent facial edema Facial paresis Chelelitis and fissured tongue
352
What is the order in which to address cleft lip and palate defects?
``` Cleft lip, ear tubes Palate repair Collumellar lengthening Orthodontics Definitive reconstruction ```
353
What is Hering's law?
Equivalent innervation of matched muscles means that correcting ptosis may cause unmasking of contralateral subclinical ptosis
354
What is the treatment for thyroid storm?
PTU Steroids (inhibits T4 to T3 conversion) Iodine solution +/- lithium
355
What do the utricle an saccule sense?
Linear acceleration Utricle = Horizontal Saccule = Vertical
356
Where is the site of injury for aminoglycoside ototoxicity?
Basal outer hair cells
357
Where is the site of injury for cisplatin ototoxicity?
Stria vascularis | Basal outer hair cells
358
Where is the site of injury for carboplatin ototoxicity?
Inner hair cells
359
Where is the site of injury for diuretic ototoxicity?
Stria vascularis
360
What nasal masses are Furstenburg test positive?
Encephaloceles
361
If hereditary hemorrhagic telangiectasia is diagnosed, what should be looked for?
Pulmonary AVM
362
What gene is associated with Stickler syndrome?
COL2A1
363
What are the most common inner ear malformations?
Incomplete partition, common cavity, cochlear hypoplasia
364
What causes dysphagia lusora?
Retro-esophageal right subclavian
365
Contraindications to supraglottic laryngectomy
1. Involvement of TVC's 2. Immobile TVC 3. Extension into tongue base (within 1cm of circumvalate papilla) 4. Poor pulmonary status
366
Who gets Kleine-Levine syndrome?
Adolescent males
367
Recurrent hypersomnia with behavioral disturbance a few times per year is known as what?
Kleine-Levine syndrome
368
Margin of the midline hairline is called the:
Trichion
369
The lowest/anterior point of the nasal bones is called the:
Rhinion
370
The soft tissue point at the inferior aspect of the chin is the:
Pogonion
371
What is seen on histology of neuroblastomas?
Small blue cells | Homer-Wright pseudorosettes
372
What is seen on histology of chordomas?
Physaliferous cells | small round nuclei with vacuolated cytoplasm
373
What are the terminal branches of the IJV?
Sigmoid sinus | Common facial vein
374
What are the terminal branches of the EJV?
Posteior facial vein/retromandibular vein | Posterior auricular vein
375
What is the risk of malignancy associated with oral hairy leukoplakia?
None
376
What is the risk of malignancy associated with oral erythroplakia?
15-50%
377
What is the risk of malignancy associated with oral lichen planus?
1%
378
What is the risk of malignancy associated with oral leukoplakia?
5%
379
What is the risk of malignancy associated with white sponge nevus?
None
380
What parotid tumor has a femal predominance?
Mucoep
381
What antibiotic is a contraindication to Botox?
Aminoglycosides
382
What are the indications for postop RAI?
``` Tumor over 4cm Suspected metastatic disease Extrathyroidal extension Elevated postop thyroglobulin levels Vascular invasion ``` True for follicular, well-differentiated PTC, Hurthle cell.
383
What is the upper limit for primary closure of midline lower lip defects?
Up to 50%
384
What is the Abbe flap used for?
Up to 2/3 of the lip, no oral commisure involvement
385
What is the Estlander flap used for?
Up to 2/3 of the lip, with oral commisure involvement
386
What is the Bernard-Burrow flap used for?
Midline lower lip defects over 2/3 of the lip | (similar to Karapandzic
387
What is the histology of glomus tumors?
Zellballen (cell balls surrounded by stroma)
388
What is the histology of pericytoma?
Pericytes of Zimmerman
389
What is the histology of glomus tumors?
Pseudoepitheliomatous hyperplasia
390
What is the histology of necrotizing silometaplasia?
Pseudoepitheliomatous hyperplasia
391
What is the imgaing modality of choice in 1st branchial clefts?
MRI to evaluate its relationship to the facial nerve
392
Where do osteomata in the EAC typically arise?
At the tympanosquamous or tympanomastoid suture line
393
Which contains marrow, osteomata or exostoses?
Osteomata
394
What is the stapedial artery derived from?
2nd branchial arch
395
W/hat is the most common site for labyrinthine fistula?
Lateral SCC
396
CHD7 mutation
CHARGE syndrome
397
What inner ear deformity is associated with CHARGE?
Mondini deformity

ENT (10 decks)

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