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General Board Prep Flashcards

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1
Q

What nerve is associated with the first branchial arch?

A

CN V3

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2
Q

What nerve is associated with the second branchial arch?

A

CN VII

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3
Q

What nerve is associated with the third branchial arch?

A

CN IX

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4
Q

What nerve is associated with the fourth branchial arch?

A

Superior laryngeal nerve (CN X)

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5
Q

What artery is associated with the first branchial arch?

A

Maxillary

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6
Q

What artery is associated with the second branchial arch?

A

Stapedial

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7
Q

What artery is associated with the third branchial arch?

A

Common and internal carotid arteries

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8
Q

What artery is associated with the fourth branchial arch?

A

Subclavian on the right

Arch of the aorta on the left

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9
Q

What nerve is associated with the sixth branchial arch?

A

Recurrent laryngeal nerve (CN X)

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10
Q

What artery is associated with the sixth branchial arch?

A

Pulmonary artery on the right

Ductus arteriousus on the left

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11
Q

Are type 1 or 2 first branchial arch anomalies more common?

A

2: ectodermal AND mesodermal elements

Ends inferior to the EAC or into the bony cartilaginous junction

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12
Q

What is the most common type of branchial anomaly?

A

Second: external opening along the ant border of the SCM, internal opening in the tonsillar fossa
**penetrates the platysma

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13
Q

Which branchial anomaly runs between the ICE and the ECA?

A

Second

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14
Q

What is the 10 point grading system for aural atresia?

A

Jahrsdoerfer system: 2 pts for stapes, 1 for mastoid pneumatization, oval windo status, round window status, malleus, incus, facial nerve course, status of middle ear, external appearance

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15
Q

What structure from the nose?

A

Frontonasal process

Bilateral nasal placodes

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16
Q

What is the origin of the inferior turbinate?

A

Maxilloturbinal

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17
Q

What is the origin of the agger nasi cell or uncinate process?

A

First ethmoturbinal

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18
Q

What is the origin of middle turbinate?

A

second ethmoturbinal

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19
Q

What is the origin of superior turbinate?

A

third ethmoturbinal

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20
Q

What is the origin of the supreme turbinate?

A

Fourth ethmoturbinal

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21
Q

What is the Furstenburg test?

A

Expansion of a nasal mass with compression of the IVJs

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22
Q

What is the most common midline nasal mass?

A

Dermoid cyst

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23
Q

Where on the nost is a glimoa usually found?

A

Glabella

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24
Q

What is torticollis post-tonsillectomy concerning for?

A

Grisel’s syndrome: rare cause of torticollis that involves subluxation of atlanto-axial joint from inflammatory ligamentous laxity following an infectious process in the head and neck, usually a retropharyngeal abscess.

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25
Croup like sx in a child <6 mo whould be concerning for possible:
Subglottic hemangioma
26
What are the 2 major criteria for chronic pediatric sinusitis
Nasal obstruction | Purulent nasal discharge
27
Chandler classification
``` I: Pre-septal cellulitis II: Orbital cellulitis III: Sub-periosteal abscess IV: Orbital abscess V: Cavernous sinus thrombosis ```
28
What is the most common pattern of velopharyngeal closure?
Coronal | Followed by sagittal, circular, and circular with Passavant's ridge
29
MCC of croup (laryngotracheitis)?
Parainfluenza
30
What does AP Xray show with Croup?
Steeple sign--subglottic narrowing
31
Rx croup:
Supportive care: humidification, racemic epi, steroids | NO intubation
32
AP xray finding with epiglottitis
Thumbprint sign
33
Rx for epiglottitis
OR intubation, extubate when air leak is present
34
What is the major blood supply of the adenoids?
Pharyngeal branch of the internal maxillary artery
35
What does inflammation do to the histopathological composition of the adenoids?
Increases squamous epithelium and decreases the respiratory proportion
36
What is the rule for tonsillectomy based on number of infections a year
7/yr for 1 yr 5/yr for 2 yr 3/yr for 3 yr
37
What is PFAPA syndrome
``` Periodic high fevers Aphthous stomatitis Pharyngitis Cervical adenitis 3-5 times per week for 6 mo ```
38
What microbe causes cat scratch fever?
Bartonella henselae
39
What is the most common pediatric salivary gland mass?
Hemangioma
40
What is the most common pediatric salivary gland neoplasm?
Pleomorphic adenoma
41
What is the most common pediatric salivary gland malignancy
Mucoepidermoid carcinoma
42
Are parotid gland neoplasms more commonly malignant in children vs adults?
Children 50% | Adults 20%
43
Three basic kinds of small blue cell malignancies of children?
Lymphoma Sarcoma Rhabdomyosarcoma
44
What is the most common site of rhabdomyosarcoma?
Orbit
45
What is the most common histopathology of rhabdomyosarcoma in infants and children?
Embryonal 75%: spindel shaped cells with eosinophilic cytoplasm, best prognosis
46
What is the most common histopathology of rhabdomyosarcoma in adolescents?
Alveolar: small round cells seperated by fibrous septae into alveolar groups
47
What syndrome is characterized by hemangioblastomas of the CNS and retina, renal cysts/carcinoma, pheochromocytoma, pancreatic cysts, and papillary cystadenomas of the epididymis
von Hippel Lindau syndrome
48
Classic triad of retrognathia, glossoptosis, and cleft palate
Pierre robin
49
What causes the cleft palate in Pierre robin sequence?
Retrognathia prevents descent of the tongue into the oral cavity, preventing palate fusion
50
MCC short limb dwarfism
Achondroplasia
51
What mutation causes achondroplasia?
AD mutation in FGFR-3
52
What is VATER syndrome? What is added in VACTERL?
``` Vertebral/vascular anomolies Anal atresia Tracheal anomalies Esophageal anomalies Renal/radial bone anomalies **Cardiac anomalies **Limb anomalies ```
53
What are the AD syndromes?
``` WANTBCS Waardenburg Apert Neurofibromatosis Treacher Collins Branchio-oto-renal Crouzon Stickler ```
54
What presents with pigmentary abnormalities, craniofacial anomalies, and unilateral or bilateral SNHL
Waardenburg
55
What is the key difference in phenotype between type I and type II Waardenburg syndrome?
Type I has dystopia canthorum
56
What is the key feature of type III and type IV Waardenburg syndromes?
III: skeletal dysplasias and muscular hypotonia IV: Hirschsprung megacolon
57
What two syndromes are due to a mutation of the FGFR-2 gene?
Apert | Crouzon
58
What syndrome is similar to Apert's syndrome but has digital broadening rather than syndactyly
Pffeiffer's: associated with tracheal sleeve
59
Cafe au lait spots, Lisch nodules
Neurofibromatosis type I: mutation on chrom 17
60
Bilateral acoustic neuromas
Neurofibromatosis type II: mutation on chrom 22
61
Malformation of the 1st and 2nd branchial arches secondary to TCOF1 gene mutation on chrom 5
Treacher Collins: 50% have hearing impairment from EAC and/or middle ear malformations
62
Mutation in COL2A1 on chrom 12 (type II collagen) leadingto myopia with retinal detachment and cataracts, hypermobility with enlarged joints, early onset arthritis, SHNL in 80%
Stickler
63
Char by branchial cleft anomalies, otologic malformation, and renal dysplasia
Branchio-oto-renal
64
SNHL associated with iodine metabolism defect leading to euthyroid goiter, associated with Mondini's dysplasia and enlarged vestibular aqueduct
Pendred
65
What was Pendred historically diagnose with?
Perchlorate discharge test: now test for the pendrin gene mutation
66
Hearing loss, vestibular deficits, ataxia, retinitis pigmentosa
Usher syndrome
67
What is the most common type of Usher syndrome?
Type I: most common, profound deafness with RP by the age of 10, absent vestibular response
68
Unilateral facial asymmetry, upper lid colobomata, otologic abnormalities, underdevelopment of the mandible
Goldenhar syndrome
69
Profound bilateral SNHL, cardiac defects, syncopal episodes
Jervell-Lange-Nielsen syndrome
70
X linked regressive syndromes
Alport Norrie Otopalatodigital Wildervaank
71
X linked mutations in the NDP gene often leading to blindness, early onset SNHL
Norrie
72
Widely spaced first and second toes, CHL due to ossicular malformation, x linked recessive
Otopalatodigital
73
Klippel-Feil malformation (congenitally fused segment of the cervical spine), SNHL, CN VI paralysis (x linked recessive)
Wildervaank syndrome
74
AD characterized by abnormal facies, VPI, and cardiac anomalies
Velocardiofacial: deletion of 22q11
75
Medial displacement of the ICAs present in 25% of pt with this syndrome
Velocardiofacial
76
Chars of DiGeorge syndrome
``` Cardiac anomolies (ToF) Abnormal facies Thymic aplasia Cleft palate Hypoparathyroidism 22q11 deletion ```
77
Syndrome resulting from improper development of the 3rd and 4th branchial arches
DiGeorge syndrome: CATCH 22
78
Central megaincisor, prosencephaly
Congenital pyriform aperture stenosis
79
CHARGE syndrome
``` Coloboma Heart disease Atresia, choanal Retardation, growth Genital defects Ear anomolies ```
80
Cleft palate results from failure of fusion of:
Bilateral palatine shelves (from maxillary processes) | Developing nasal septum (frontonasal process and bilateral median nasal process
81
Cleft lip results from failure of fusion of:
Maxillary swelling with medial nasal process
82
Signs of a submucous cleft palate
Bifid uvula Zona pellucida Notched hard palate
83
Why do pts with cleft palate almost always have chronic otitis media
Dehiscence of the palatal sling involving the levator veli palatini
84
What % of clefts are unilateral? What side is more common?
80% | More common on the left
85
Formula for ETT size in kids
(age + 16)/4
86
ETT cuff pressures > ___ mmHg will exceed the capillary filling pressure and cause ischemic damage
20 mmHg
87
At what spinal level is the pediatric larynx located at? Where does it descend to?
C2 | C6
88
What kind of stridor do supraglottic and glottic masses cause?
Inspiratory
89
What kind of stridor does a subglottic mass cause?
Biphasic
90
What kind of stridor does a fixed intrathoracic mass cause?
Expiratory
91
Mneumonic for evaluation of stridor?
``` SPECSR Subjective Progression Eating and feeding difficulties Cyanosis Sleep disordered breathing Radiography ```
92
What are 4 pediatric airway abnormalities improved in the prone position?
Laryngomalacia Pierre Robin sequence Vascular compression Mediastinal mass
93
New onset biphasic stridor in an infant under 6 mo with no foreign body hx should raise suspicion for:
Subglottic hemangioma
94
MCC of inspiratory stridor, worse when crying or lying supine
Laryngomalacia
95
How many types of laryngeal clefts are there?
Type 1: supraglottic interarytenoid cleft above VF Type 2: partial cricoid cleft, extends below VF Type 3: total cricoid cleft w/o extension into cervical TE wall Type 4: laryngotracheoesophageal cleft, almost universally fatal
96
What is the grading system for subglottic stenosis?
``` Cotton-Myer I: <50% II: 51-70% III: 71-99% IV: No detectable lumen ```
97
What is the cut-off for requiring trach and laryngotracheal reconstruction for subglottic stenosis?
Cotton-Myer grade III and above (>70%)
98
What are the 4 classes of posterior glottic stenosis?
I: Interarytenoid adhesion: observe or lyse II: Posterior commissure stenosis III: Posterior commissure stenosis w/ unilat cricoarytenoid fixation IV: Posterior commissure stenosis with bilat circoarytenoid fixation
99
What is the most common type of TE fistula?
Esophageal atresia with disteal TEF
100
Acidic ingestion leads to _____ necrosis | Alkaline ingestion leads to _____ necrosis
Acidic: coagulative (superficial) Alkaline: liquefactive (deep)
101
When should esophagoscopy be done following acidic or alkaline ingestion?
24-72 hr (increased risk of iatrogenic perforation after 72 hr)
102
What are 4 structures that compress the esophagus and are likely spots for foreign bodies to get caught?
Cricopharyngeus Aortic arch Left mainstem bronchus Lower esophageal sphincter
103
What is the characteristic sign of ingested button batteries on xray?
Double halo sign
104
How many episodes of recurrent AOM are required prior to replacing tube
>3 in 6 mo | >4 in 12 mo
105
Indications for tube placement in the setting of COME?
Bilateral COME >3 mo Unilateral COME >6 mo Earlier for significant speech delay, severe retraction pocket, disequilibrium, tinnitus
106
What type of auditory testing can be completed from 6 mo to 2 yr?
Visual reinforcement audiometry | Followed by conditioned play
107
When mutation is present in 30% of nonsyndromic congenital hearing loss?
Connexin 26
108
What is the name for complete bony and membranous labyrinthine aplasia?
Michel aplasia
109
What is the most common type of membranous inner ear malformation?
Schiebe (cochleosaccular aplasia)
110
In what malformation is the following seen? 1. only 1.5 turns (instead of the normal 2.5 turns) 2. Enlarged vestibule with normal semicircular canals 3. Enlarged vestibular aqueduct containing a dilated endolymphatic sac 4. Loss of normal partitions
Mondini malformation
111
Which SCC develops last and is most commonly affected in labyrinthine abnormalities
Lateral
112
What classifies an enlarged vestibular aqueduct? | Enlarged cochlear aqueduct?
>1.5 mm in diameter | 3-4 mm in diameter
113
``` Narrowed IAC (<3mm) associated with ____ Widened IAC (>10mm) associated with ____ ```
Absent or hypoplastic CN VIII | Stapes gusher
114
What is the appearance of dried secretions vs polyps on T1 vs T2?
Dried secretions: hyper T1, hypo T2 | Polyps: hypo T1, hyper T2
115
What bacteria causes rhinoscleroma? | What does histopath show?
``` Klebsiella rhinoscleromatis Mikulicz cells (macrophages containing pathogen) and Russel bodies (plasma cells) ```
116
In what meatus is the nasolacrimal duct opening?
``` Inferior meatus (inferior to the inferior turb) Valve of hasner ```
117
Where is the semilunar hiatus located? What does is receive drainage from?
Middle meatus | Ethmoid infundibulum, which receives drainage from the maxillary, anterior ethmoid, and frontal sinuses
118
Where is the opening to the posterior ethomoid sinuses located?
Superior meatus
119
Where is the sphenoethmoidal recess located in relation to the superior turbinate?
Posteriorosuperior to the superior turbinate
120
What plexus is located at the posterior portion of the inferior meatus and nasopharynx, and is the junction of the posterior nasal, sphenopalatine, and ascending pharyngeal veins
Woodruffs
121
What are the two periods of growth of the maxillary sinuses?
3 yo and 7-12 yo | Cooresponds with growth of dentition
122
What separates the anterior and posterior ethmoids?
basal lamella of the middle turbinate
123
What classification system compares the height of the cribriform plate with the fovea ethmoidalis?
Keros classification: I: Cribriform plate 1-3 mm inferior II: 5-7 inferior III: 8-16 inferior
124
What is an agger nasi?
Most anterior ethmoid air cell caused by pneumatization of the lacrimal bone, can block the frontal recess
125
What is a infraorbital ethmoid cell pneumatizating into the maxillary sinus that can block the maxillary sinus osteum?
Haller cell
126
What is a posterior ethmoid cell located superolateral to the sphenoid sinus, may interface with the internal carotid or optic nerve
Onodi cell
127
What is the difference between the semilunar hiatus and the infundibulum?
Semilunar hiatus: 2D gap between the uncinate and the ethmoid bulla Infundibulum: 3D space bounded by the uncinate medially, lamina papyracea laterally, and frontal process of the maxilla anterosuperiorly **route to drainage of the maxillary, anterior ethmoid, and frontal sinuses
128
What is the name of the functional drainage pathway for the maxillary, anterior ethmoid, and frontal sinuses (including middle turbinate, uncinate, semilunar hiatus, ethmoid bulla, and infundibulum)?
Ostiomeatal complex
129
The drainage pattern of the frontal sinus is determined by the position of attachment of the:
Uncinate process
130
What is the most common attachment site of the UP and subsequent drainage pattern of the frontal sinus? Other options?
Attached to the laminal papyracea-> drains medial to the UP | Attaches to skull base or middle turbinate -> lateral to the UP
131
What are the 4 types of frontal cells?
I: Cell above the agger nasi II: Two or more cells above the agger nasi III: Single cell extending from the agger nasi superiorly into the frontal sinus IV: Isolated cells within the frontal sinus
132
Where is olfactory epithelium located?
Upper 1/3 of the septum Medial superior/supreme tubrinates Roof of the nasal cavity
133
Unilateral anosmia, optic atrophy, and papilledema due to a frontal lobe mass
Foster Kennedy Syndrome
134
Hypogonadotropic hypogonadism and anosmia (failure of the hypothalamus to secrete GnRH)
Kallman's syndrome
135
Nasal airflow accounts for __% of the airway resistance
50%
136
What are the limits of the internal nasal valve?
Nasal septum Upper lateral cartilage Head of the inferior turbinate Nasal floor
137
What is the Holman Miller sign?
Anterior bowing of the posterior maxillary sinus wall--seen in JNA
138
What finding in the sinuses shows a ground glass appearance on CT and is hypointense on T2?
Fibrous dysplasia
139
What is a eukaryotic parasitic pathogen that can cause unitlateral nasal obstruction, epistaxis, and friable polyps
Rhinosporidium seeberi (causes Rhinosporidiosis)
140
What are the three stages of Rhinoscleroma?
Catarrhal (nonspecific crusting) Granulomatous (epistaxis, friable mucosa, nodules through the respiratory tract) Sclerotic (sclerosis and fibrosis)
141
Broad based ribbon-like nonseptate hypae with 90 degree branching
Mucor
142
Narrow septate hyphae with branching at 45 degrees
Aspergillus
143
What is the difference in timing between acute, subacute, and chronic rhinosinusitis
Acute: <4 weeks Subacute: 4-12 weeks Chronic: >12 weeks
144
What are the two most common viruses to cause acute rhinosinusitis?
Rhinovirus | Coronavirus
145
Chandler classification for orbital complications of sinusitis
``` Preseptal cellulitis Orbital cellulitis Subperiosteal abscess Orbital abscess Cavernous sinus thrombosis ```
146
What structures pass through the cavernous sinus?
``` O TOM CAT Opthalmic (V1) Oculomotor (III) Trochlear (IV) Maxillary (V2) Carotid (internal) Abducens (VI) ```
147
Osteomyelitis of the anterior table of the frontal sinus
Potts Puffy Tumor: infection transmitted via diploic veins, swelling of forehead soft tissue
148
What is the difference between superior orbital fissue syndrome and orbital apex syndrome?
SOF syndrome: III, IV, V1, VI, opthalmic vien | + CN II
149
What is the defect in primary ciliary dyskinesia
AR defect in the dynein arms of cilia leading to URIs, otitis media, and infertility
150
PCD with situs inversus and bronchiectasis
Kartagener's syndrome
151
What is Samter's triad?
Sinonasal polyps Astma Aspirin sensitivity
152
What is the mechanism of ASA hypersensitivity
ASA inhibits COX metabolism of AA Substrate into 5 lipo-oxygenase and leukotrienes Asthma and allergy
153
What is the MC benign sinonasal lesion
Osteoma
154
Skull osteomas Colonic polyps Soft tissue tumors
Gardner syndrome
155
McCune-Albright syndrome
Polyostotic lesions (fibrous dysplasia) Precocious puberty Pigmented skin lesions
156
Solitary encapsulated slow growing monostotic tumor, CT shows central lucency with an eggshell rim
Ossifying fibroma
157
What are the 4 lamella encountered during FESS anterior to posterior
Uncinate Ethmoid bulla Vertical portion of the middle turbinate basal lamella Vertical portion of the superior turbinate basal lamella
158
Draf I
Removal of anterior ethmoid cells Removal of uncinate Obstructing frontal cells removed **no instrumentation of the frontal sinus ostium
159
Draf IIa:
Draf I with widening of the frontal sinus ostium | Resection of the floor of the frontal sinus from the lamina to the insertion of the middle turbinate
160
Draf IIb:
Draf IIa + resection of the middle turbinate to the skull base Widening of the frontal sinus medially to the septum
161
Draf III (modified lothrop)
Draf II with removal of the intrasinus septum and connecting the bilateral frontal sinuses into one with a common drainage pathway
162
What is the most common site of CSF leak in FESS
Lateral lamella of the ethmoid roof
163
With allergy testing, wheal of greater than __ mm is positive
3
164
Contents of eosinophils
``` Peroxidase Neurotoxin Cationic protein Charcot Leyden crystals Major basic protein ```
165
Which cytokines induce B cells and mast cells to increase IgE production
IL 4 and IL 13
166
Which cytokine is involved in the activation and maturation of eosinophils
IL 5
167
Which complement pathway uses the C1 complex?
Classical pathway | **Lectin pathway similar but uses mannose binding lectin
168
What does major basic protein in eosinophils induce the release of?
Histamine from mast cells, leads to damage to epithelial cells
169
What kind of hypersensitivity reaction is hemolytic anemia, transfusion reactions, Goodpasture, MG
Type II : antibodies directed against cell antigens, destruction via complement interaction
170
Examples of type III hypersensitivity
Serum sickness PSGN Angioedema ***antigen-antibody deposition leading to massive PMN infiltration
171
What is the MC granumolatous disease to affect the upper airway?
Wegener's granulomatosis: necrotizing granulomas, small and medium vessel vasculitis
172
Relapsing and remitting AI disease with a triad of oral or genital ulcers, irititis/uveitis, and progressive SNHL
Behcet's syndrome
173
Which two syndromes display genetic imprinting on chromosome 15?
``` Angelman syndrome (lacks maternal copy) Prader-Willi syndrome (lacks paternal copy) ```
174
What is the function of p53?
Tumor supressor gene involved in cell cycle regulation and apoptosis Binds CDK and arrests cell replication in G1 **mutations in 50-66% of H&N SCC
175
What is the function of p16 and p21?
Tumore suppressor proteins, bind cyclin and CDK
176
What is an oncogene that inhibits apotosis and counteracts p53
bcl-2
177
Cell surface tyrosine kinase receptor proto-oncogene, associated with MEN IIa and IIb
RET
178
What is another name for Osler Weber Rendu syndrome?
Hereditary hemorrhagic telangiectasia
179
What is the diagnostic criteria for Kawasaki disease?
Fever > 5 days and 4-5 of the following: 1) Acute cervical lymphadenopathy > 1.5 cm 2) Desquamative rash of the palms and soles 3) Truncal rash 4) Bilateral painless conjunctivitis 5) Erythema of the tongue (strawberry tongue)
180
What is the tx for Kawasaki disease?
High dose aspirin | Immunoglobulin
181
What arteries does giant cell arteritis typically affect?
Large vessel vasculitis | Temporal and opthalmic arteries
182
Non-syphillitic interstitial keratitis and vestibuloauditory symptoms--Meniere-like hearing loss and vestibular symptoms
Cogan's syndrome

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