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Flashcards in Head and Neck Deck (91):
1

What % of lentigo meligna (melanoma in situ) progresses to invasive LMM? LMM should be excised with what margin?

5%
0.5-1.0 cm margins

2

What is the MC form of melanoma?

Superficial spreading (65-75% of cases)

3

What is the MC form of melanoma in the African American population

Acral lentiginous

4

What is the most invasive of the cutaneous melanomas and therefor affected patients have the worst prognosis?

Nodular melanoma

5

What type of melanoma requires wider excision than others given tendency for perineural invasion leading to recurrence rates of 23-48%

Desmoplastic melanoma (rare overall, but of this subset 75% occurs in the H&N)

6

What is the most common tumor of each type of salivary gland?

Pleomorphic adenoma

7

What is the second most common benign salivary gland neoplasm?

Warthin tumor/papillary cystadenoma lymphomatosum

8

What is the clearest etiologic factor of warthin tumors?

Smoking

9

Oncocytoma occurs almost exclusively in which of the salivary glands?

Parotid

10

What Fitzpatrick skin type is the most ideal candidate for a pulsed dye laser resurfacing of a port wine stain?

Type 1: much less PDL energy is absorbed by the epidermal pigements

11

What nerve passes through the foramen ovale?

Mandibular nerve (1S2R3O)

12

What structure passes through the foramen spinosum

Middle meningeal artery

13

What is hyphema?

A collection of blood in the anterior chamber of the eye, can be a sign of a major intraocular trauma

14

What physical exam finding should lead to deal of orbital surgery for a minimum for two weeks?

Hyphema: sign of major intraocular trauma

15

What syndrome presents with hearing loss, decreased vestibular function, and retinitis pigmentosa?

Usher syndrome

16

What is the most common cause of hearing loss after stapes surgery?

Displaced prosthesis

17

Which type of medication should be held one week before intradermal dilutional allery testing?

Antihistamines

18

What is the GRBAS scale

Grade
Roughness
Breathiness
Asthenia
Strain

19

What is the most common presenting symptom of esthesioneuroblastoma?

Nasal obstruction

20

What is esthesioneuroblastoma thought to arise from?

Basal neural cells of the olfactory mucosa

21

What is the life threatening condition that can be found in 40% of patients with HHT?

Pulmonary AVM, can result in life threatening bleeding

22

What test can be used to diagnose superior semicircular canal dehiscence (SSCD)

Cervical vestibular evoked myogenic potential (cVEMP) -- tests the function of the saccule and the inferior vestibular nerve

23

What is the name of the point at the lower end of the median suture joining the nasal bones?

Rhinion

24

What is the name of the most anterior portion of the chin?

Pogonion

25

What is the MOA of cocaine?

Blocks the reuptake of norepinephrine and epineprhine, both in the CNS and systemically

26

What is the MCC bilateral facial paralysis

Lyme

27

ENoG value lasts how many days after complete paralysis of the facial nerve?

3-14 days

28

What is the most common malignant neoplasm of salivary glands?

Mucoepidermoid carcinoma
**MC in parotid

29

Do low grade mucoepidermoid carcinomas have a high proportion of mucous or epidermoid cells?

Mucous
**high grade have a higher proportion of epidermoid and can be difficult to distinguish from squamous cell carcinoma

30

Management of low grade mucoepidermoid carinoma of the salivary gland?

Surgical excision
No neck dissection indicated for the N0 neck (risk of occult nodal involvement only 20%)
If margins are clear, no radiation recommended

31

What is the most common malignancy of the submandibular and minor salivary glands?

Adenoid cystic carcinoma

32

What allows patients to stay on thyroid replacement therapy throughout RAI?

Thyrogen (rhTSHalpha)

33

What stain are cells of acinic cell carcinoma characteristically positive for?

Periodic acid-Schiff staining

34

What salivary clinic is the most common site of adenocarcinoma?

1. Minor salivary glands
2. Parotid
**behave aggressively

35

What can be used to pathologically identify adenocarinoma of the salivary gland

Mucicarmaine positivity (mucous production)
Lack of keratin in comparison to mucoepidermoid carcinoma
**degree of glandular formation used to grade

36

Where does polymorphous low-grade adenocarcinoma (PLGA) most commonly occur?

Minor salivary glands, notably the palate, buccal mucosa, and upper lip
**Typical presentation is a long-standing asymptomatic mass of the palate

37

What is the treatment of polymophous low-grade adenocarcinoma (PLGA)?

Wilde local excision **cervical mets very uncommon, only perform neck dissection with clinically positive nodes, dont typically need

38

Primary SCC of the salivary gland constitutes less than __% of salivary gland malignancies
Occurs most commonly in which salivary gland?

1%
Submandibular

39

A defect of __% or less or the lower eyelid can be closed primarily

25%

40

What is the recommended tx for salivary duct carcinoma?

Wide surgical resection with neck dissection and radiotherapy
**very aggressive cancer

41

What is the MC type of lymphoma to affect the salivary glands

Mucosa-associated lymphoid tissue lymphomas (MALT)

42

WHat is the only salivary gland tumor that is assocaited with smoking?

Warthin tumor

43

What is the MC malignant radiation related tumors of the salivary glands?

Mucoepidermoid carcinoma
Adenocarcinoma

44

What does the periparotid fat strip separate the deep lobe of the parotid from?

The parapharyngeal space

45

What are solitary pedunculated osseous lesions that are smooth and round and originate at the tympanosquamous or tympanomastoid suture line?

Osteoma

46

What are broad based osseous lesions that occur around the circumference of the medial aspect of the EAC, occur as multiple lesions and are often bilateral

Exostoses

47

Is surgical removal of osteomas or exostoses more challenging?

Exostoses

48

What is the MOA of botox?

Binds to the receptor sites on motor nerve terminals and inhibits the release of acetylcholine by interfering with SNAP proteins

49

What kind of flap/graft should be used in areas with concavity and thin skin?

Full thickness skin graft

50

What do waves I-V in an ABR coorelate with?

I: Distal CN VIII
II: Proximal CN VIII
III: Cochlear nucleus
IV: Superior olivary nucleus/lateral lemniscus
VI: Inferior colliculus/lateral lemniscus

51

What is the most commonly injured nerve during a rhytidectomy?

Greater auricular nerve

52

What is the source of the nerve to the mylohyoid?

Mandibular nerve (V3)--> Inferior alveolar nerve

53

What nerve can be damaged during an extracapsular tonsillectomy?

Lingual branch of the glossopharyngeal nerve **runs between the superior and middle pharygneal constrictor muscles

54

What are beta blockers contraindicated in patients undergoing intradermal allergy testing?

Patients on beta blockers are resistant to the effects of systemic epinephrine because of the beta adrenergic blockade

55

What nerves regenerate in to cause Frey syndrome?

Parasympathetic fibers from the glossopharyngeal nerve (CN IX) regenerate into sympathetic pathways of the auriclotemporal nerve (mandibular branch of CN V)

56

What is the only intrinsic muscle of the larynx that is not innervated by the RLN?

Cricothyroid: innervated by the external branch of the superior laryngeal nerve

57

What are the only muscles to abduct the vocal folds?

Posterior cricoarytenoid

58

What is the MC complication of a cholesteatoma?

Labyrinthine fistula: erosion into the LATERAL SCC

59

What syndrome has an autoimmune etiology and presents with interstitial keratitis, bilateral fluctuating SNHL, and vertigo?

Cogan syndrome

60

What presents with serum eosinophlia, allergic rhinosinusitis, granumolatous lesions of the lungs and nasal septum?

Churg-Strauss syndrome

61

What are the anterior and posterior borders of the frontal recess?

Anterior: agger nasi
Posterior: ethmoid bulla

62

What type of hearing loss is seen in Cogan syndrome?

Unilateral or bilateral SNHL

63

What are H1 antagonists metabolized by?

the liver

64

What is the MC type of branchial cleft cyst?

Second branchial cleft cysts

65

What is the relationship of second branchial cleft cysts to the internal and external carotids?

Passes between them

66

What is the vascular supply of random flaps like a bilobed?

Subdermal plexus, therefor the plane of dissection needs to be through subcutaneous fat

67

What are amides (lidocaine, bupivacaine) and esters (cocaine, benzocaine) metabolized by?

Amides (two is): Liver
Esters (one 1): Pseudocholinesterase

68

What type of mass characteristically has physaliferous cells? (vacuolated cytoplasm)

Chordoma

69

Which ear is more commonly affected in microtia?

Right
**males are more commonly affected, unilateral more common, highest incidence in Latin and Native Americans

70

What is the classic appearance of a carotid body tumor on MRI?

Salt and pepper appearance with flow voids

71

What is the MC feeder vessel of carotid body tumors which may be embolized preoperatively?

Ascending pharyngeal artery

72

What is the MOA of mitomycin?

DNA crosslinker (alkalating agent)
Use 0.4 mg/ml for topical airway management

73

Does medial or lateral graft tympanoplasty have a higher risk of iatrogenic cholesteatoma?

Risk is higher with lateral graft due to possible incomplete squamous epithelium removal

74

What is the narrowest and shortest segment of the fallopian canal

Labyrinthine, contains the geniculate ganglion
**vulnerable to the effects of edema and nerve compression in causes of trauma or inflammation

75

What are absolute indications for post-thyroidectomy radioactive iodine therapy?

Primary >4 cm
Gross extrathyroidal extension
Known or suspected distant metastases
Extensive vascular invasion
Presence of post-operative elevated thyroglobulin levels

76

Are oral antihistamines or intranasal steroids more effective in treating congestion associated with allergic rhinitis?

Intranasal steroids

77

What syndrome is associated with deficient outer dynein arm within cilia causing abnormal ciliary motion and leading to bronchiectasis, otitis media, and male infertility

Kartagener's syndrome

78

What is the recommended NPO time after the following?
Clear liquids
Breast milk
Light meal
Fatty meal

Clears 2 hr
Breast milk 4 hr
Light meal 6 hr
Fatty meal 8 hr

79

Where are superior parathyroid glands located with respect to the RLN and inferior thyroid artery?

1 cm above the intersection

80

What imaging should be completed to evaluate for intraorbital, intracranial and infratemporal spread of a JNA?

MRI w contrast

81

What do glomus tympanicum arise from?

Jacobsons nerve: tympanic branch of the glossopharyngeal nerve

82

What allows patients to stay on thyroid replacement therapy throughout RAI?

Thyrogen (rhTSHalpha)

83

What nerve controls the ability of vocal folds to lengthen?

External branch of the superior laryngeal nerve (EBSLN) which powers the cricothyroid

84

What is the triad of Pierre Robin sequence

1. Micrognathia
2. Glossoptosis
3. Cleft palate

85

What is Donaldson's line?

Imaginary line drawn posteriorly through the plane of the horizontal SCC, endolymphatic sac is generally found along this line or just inferior to it

86

What is the MC indiation for endolymphatic sac decompression?

Persistent ongoing vertigo in Meniere despite medical therapy

87

What are the following stages of sleep characterized by?

Wakefullness: alpha waves
Stage 1: Vertex sharp waves and slow eye movements
Stage 2: K complexes and sleep spindles
Stage 3: delta waves
REM: Low EMG tone and REM

88

What structure lies just medial to the tip of the cochleariform process?

The geniculate ganglion

89

A defect of __% or less or the lower eyelid can be closed primarily

25%

90

What dedo classification cooresponds with a low hyoid in evaluating cervicomental angle?

VI (highest class), I is minimal deformity with an acute cervicomental angle, good platysmal tone, and little accumulation of fat

91

Which component of gastric refluxate causes laryngeal epithelial cell damage and explains why patients have refractory sx on maximal PPI therapy?

Pepsin: released by chief cells in the stomach, causes direct damage to laryngeal cells