QBank 2 Flashcards
(273 cards)
<p>202. Urine output of a 70kg man over 24 hrs?</p>
<p>a. 840 to 1890 cc • 0.5cc/kg/hr x 70kg x 24hrs = 840cc minimum • 1.0cc/kg/hr x 70kg x 24hrs = 1890cc Adults: 0.5 – 1.0 cc/hr Children: 1.0 – 1.5 cc/hr Infants: 1.5 – 2.0 cc/hr</p>
<p>203. Minimum blood loss in a 70kg male to alter systolic blood pressure?</p>
<p>a. 1500-2000ml Class III shock
Class I Class II Class III Class IV
Blood loss (mL) Up to 750 750–1,500 1,500–2,000 > 2,000
Blood loss (% vol) Up to 15 15–30 30–40 > 40
Pulse rate < 100 > 100 > 120 > 140
Blood pressure Normal Normal Decreased Decreased
Pulse pressure Normal or Decreased Decreased Decreased
increased
Respiratory rate 14–20 20–30 30–40 > 35
Urine output (mL/h) > 30 20–30 5–15 Negligible
Mental status Slightly Mildly Anxious, Confused,
anxious anxious confused lethargic
Fluid replacement Crystalloid Crystalloid Crystalloid Crystalloid
and blood and blood</p>
<p>205. A 21-year-old female is an unrestrained driver involved in a MVA. She suffers a scalp laceration and is noted to have lost 1000mL of blood at the scene. You would expect her vital signs to be consistent with:</p>
<p>a. Pulse rate >100, normal systolic blood pressure, decreased pulse pressure, respiratory rate of 20-30, urinary output of 20-30mL/hr.
These findings are consistent with a Class II hemorrhage, 750-1500ml, The vitals signs or such a blood loss are consistent with those in response A. Response D reflects the vital signs of a Type IV blood loss, Response C a Type III and Response B a Type I.</p>
<p>206. Primary (direct)- callus free- bone healing involves what?</p>
<p>a. Direct contact between the bony segements</p>
<p>207. Which drug causes burning sensation on injection?</p>
<p>a. Propofol</p>
<p>208. When do you not use propofol?</p>
<p>a. White soybean oil-egg yolk lecithin emulsion
A history of egg allergy does not necessarily preclude the use of propofol, as the egg protein contained in the suspension is lecithin, whereas most egg allergies consist of a reaction to egg albumin</p>
<p>209. Uprighting an impacted 2nd molar is best done when?</p>
<p>a. The optimal time for uprighting a molar tooth is when 2/3 of the root has formed
When impaction of a second molar is identified, consideration should be given to correcting the impaction before the roots are fully formed. The optimal time for uprighting a molar tooth is when two-thirds of the root has formed; molars with fully formed roots have a poor prognosis.</p>
<p>210. You are uprighting an impacted 2nd molar, you need to do what?</p>
<p>a. Stabilize to 1st molar, avoid occlusal forces
An extremely important part of this surgical procedureIs ensuring that there are no occlusal forces on the repositioned second molar. This generally does not require equilibration on the opposing tooth, but an occlusal adjustment can be performed if necessary.</p>
<p>211. Long term consequence of third molars?</p>
<p>a. Periodontal defect</p>
<p>212. Removal of third molars for?</p>
<p>a. Periodontal concerns</p>
<p>213. How to distinguish between one or two fractures on panorex?</p>
<p>a. One fracture – lines converge at inferior border
| Two fractures –lines diverge and separate at inferior border</p>
<p>214. Osteoprogenitor cells?</p>
<p>a. Mesenchymal cells</p>
<p>215. What is synonomous with an allograft?</p>
<p>a. Homologous graft
• Allograft – transplant from one individual to a genetically non-identical individual of the same species
• Autograft – from on region to another in the same individual
• Xenograft (heterogenous graft) – transplant from one species to another</p>
<p>216. What causes rejection of a facial implant rejection of homograft?</p>
<p>a. Cell mediated – cellular immunity
The major source of antigenicity in allografts is the cellular elements of bone.</p>
<p>217. Which repositioning has the greatest increase in alar flare in a Lefort I?</p>
<p>a. a) superior repositioning of the maxilla causes elevation of the nasal tip, widening the alar bases and decrease the nasolabial angle.</p>
<p>218. Loss of articular cartilage most likely causes pain in the joint?</p>
<p>a. Subchondral nociceptive fibers</p>
<p>219. Property of drugs that cross thee BBB?</p>
<p>a. Lipophilic and nonionized
* Freely crosses: high lipid solubility and CO2, non ionized
* Pooly cross: ions, proteins, and large substances</p>
<p>220. Osteoinduction vs. Osteoconduction</p>
<p>Osteoinduction – new bone formation from the differentiation of osteoprogenitor cells, derived from the primitive mesenchymal cells, into secretory osteblasts. Under the influence of BMP,
Osteoconduction – new bone from host-derived or transplanted osteoprogenitor cells along a biologic or alloplastic framework. Provided a passive framework or scaffolding.</p>
<p>221. What are the papillary signs seen in severe HTN?</p>
<p>a. AV nicking arteries</p>
<p>222. What is the plane of elevation of the facial nerve during a preauricular dissection below the zygomatic arch?</p>
<p>a. Deep to the superficial layer of the temporalis fascia</p>
<p>223. Relationship of frontal branch of the facial nerve?</p>
<p>a. Between the SMAS and temporal fascia</p>
<p>224. A lab report indicates coagulase positive. This refers to what?</p>
<p>a. Coagulase is an enzyme that coats the bacteria with fibrin and reduces the ability of the host cell to phagocytize it. S. aureus is the only coagulase-positive staphylococci</p>
<p>225. Sural nerve harvest. Where is the sensory deficit?</p>
<p>a. Posterior lower extremity and the dorsolateral foot - The sural nerve, or medial sural cutaneous nerve, is a branch of the sacral plexus (S1, S2) and supplies sensory information to the posterior lower extremity and the dorsolateral foot.</p>
<p>226. Synovial membrane that is redundant, hyperemic, capillary proliferation?</p>
<p>a. Synovitis
• Synovitis occurs when the level of cellular debris and the concentration of chemical mediators of inflammation and pain produce levels that the synovial membrane is unable to ingest, absorb, or process
• Acute synovitis – aute inflammation with dilated superficial capillaries – initially without hyperemia, but progressively increasing to hyperemia until it obliterates the superficial vascularity
• Chronic synovitis – characterized by synovial hyperplasia with an increased proliferation of tissue folds, particularly in the retrodiskal area. Synovitis with fibrous adhesions present is most marked after previous arthrotomy or arthroscopic surgery</p>
227. Pt has trismus after injection. Injury to what muscle?
a. Medial ptyerygoid
228. Best management non surgical of OSA patient?
a. Weight loss and CPAP are the initial modes of therapy that should be initiated in obese patients with moderate obstructive sleep apnea.
230. Which of the following patients will benefit from PEEP?
a. ARDS
231. Effects of ketamine?
a. Sympathomimetic – increases heart rate, BP
232. Mandibular 2rd molar root pushed through lingual plate and non palpable in floor of mouth. What is most likely space involved?
a. Submandibular – • inferior alveolar canal • cancellous bone space • submandibular space
234. Make medial osteotomy too high. What can happen?
a. Condyle may stay in the distal segment
235. Chora Typani is a branch off of what nerve?
a. Cranial nerve VII
236. Complications of massive transfusion.
a. Dilutional thrombocytopenia Complications of massive blood transfusion: thrombocytopenia, coagulation factor depletion, oxygen affinity changes, hypocalcemia, hyperkalemia, acid/base disturbances, hypothermia, and ARDS
237. Where are Headaches in a typical TMJ internal derangement?
a. Temporal
238. A crushing injury to the NOE region results in detachment of the medial canthal ligament leading to?
a. Traumatic telecathus
239. Where are verocay bodies found?
a. Neurilemoma (Schwannoma)
240. Tzank test used for what?
a. Tzank smear is used in the diagnosis of herpesvirus infections (Tzank cells also seen in pemphigus vulgaris)
241. Aortic stenosis.
a. syncope and sudden cardiac death
242. Female patientt, pano left body of mandible with impacted premolar with radiolucent lesion completely surrounding impacted premolar displace to inferior mandible. What is diagnosis?
a. Adenomatoid Odontogentic Tumor (AOT) - usually associated with anterior maxilla but not always
244. Orbital apex syndrome vs. superior orbital fissure syndrome. What is the difference?
a. Decreased visual acuity Symptoms of superior orbital fissure syndrome include: 1. Pupillary dilation via alteration in cranial nerve III function in it's innervation of the pupillary constrictors. 2. Paresis of cranial nerves III, IV, and IV causing ophthalmoplegia. 3. Cranial nerve III involvement causes paresis of the levator palpebrae superiorus muscle, leading to ptosis and loss of the superior palpebral fold. 4. Neurosensory disturbance to the first division of cranial nerve V with hypesthesia of the supraorbital and supratrochlear nerves and loss of the corneal reflex. 5. Proptosis from engorgement of the ophthalmic vein and lymphatics. The orbital apex syndrome includes all of the above plus optic nerve involvement, leading to changes in visual acuity.
245. Loss of taste sentation after 3rd molar removal. What impaired cranial nerve?
a. Cranial nerve V (Chorda tympani traveling on CNV)
246. Easiest way to assess cardiac trauma on table?
a. EKG
247. A patient seen in the emergency department presents with: elevated venous pressure, muffled heart sounds, and decreased arterial pressure. What is the most likely diagnosis?
a. Cardiac tamponade
248. Ketamine contraindicated in:
a. Hypertensive patients, also avoid in head trauma (increases ICP)
249. What anesthetic gas to avoid with history of atrial fibrillation?
a. Halothane
250. Widen mediastinum on CXR indicates what?
a. Aortic dissection
251. Antibiotics most effective when MIC is what?
a. 2-4x • The usual recommended dose of an antibiotic is usually sufficient to provide threefold MIC concentration against the common susceptible organism
252. Maintain lip length s/p orthognathic surgery. How?
a. V-Y closure
253. Resuscitation of kids. What technique?
a. Head Tilt
254. What nerve mediates temperature and pain?
a. A delta and C
What side effect of flumazenil?
a. May unmask seizure disorder and Nausea and Vomiting
256. What is associated with Plummer Vinson syndrome?
higher incidence of esophageal cancer
257. What is a poor prognosis sign of patient with squamous cell carcinoma of maxillary sinus?
a. Pain is often a late, therefore ominous sign
258. Neurogenic shock is due to what?
a. Neurogenic shock is shock caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls. This can result from severe central nervous system (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure. Classic picture hypotension without tachycardia or cutaneous vasoconstriction. Narrow pulse pressure is NOT seen.
259. What is the best way to determine proper faical projection with reduction of panfacial fracture?
a. Zygomaticoshenoid junction The sphenozygomatic suture area has been previously analyzed and shown to be an area for confirmation of alignment of the zygomatic arch and the zygomatic complex (ZMC). This has also been shown to key point for fixation thru biomechanical studies. The sphenozygomatic suture is a broad area along the greater wing of the sphenoid and can be approached along the internal aspect of the lateral orbit. Even in severe midface fractures the greater wing of the sphenoid is intact thus acting as a key landmark for proper reduction of the ZMC fracture. Reduction of the frontozygomatic suture or the infraorbital rim alone can result in errors due to the small surface area. The medial orbit is generally not involved in a ZMC fracture.
260. Vestibuloplasty procedure. Where is mucosa sutured at depth of vestibule?
a. Mucosa is sutured to the vestibular depth at the area of the periosteal attachment
261. What is the most common cause of impacted second molar?
a. Impacted 3rd molar
262. Mandibular osteotomy vs. placement of a medpor implant to augment chin. What is the advantage of the osteotomy?
a. Less resorption
263. What post operative complication is the most difficult to correct after laser skin resurfacing?
a. hypopigmentation
264. What type of speech is most common after Lefort surgery?
a. Hypernasal
265. Clinical case 17 y/o female Hispanic patient. Ceph shows apertognathia, posterior VME, class I molar occlusion, gingival show at repose. How to tx?
a. Segmental Lefort
266. What subnucleus of the trigeminal brainstem nucleus is primarily involved in the receiving and processing of facial pain?
a. Subnucleus caudalis of CN 5
267. What is the most common type of condyle fracture in children?
a. Compressive
268. Where is the most common source of infection in mandible fracture?
a. Angle
269. What concerns the anesthesiologist about a patient with rheumatoid arthritis?
a. Restricted neck mobility and the possibility of dislocation of cervical vertebrae
270. Most common complication associated with compression osteosynthesis?
a. Necrosis at bone interface
271. When does the blood supply to the STSG begin:
a. Survives 48 hours by plasmatic imbibition, Revascularization complete in 4-7 days.
272. Most difficult mandibular defect to reconstruct?
a. Symphysis – Cainine to canine region due to curvature of anterior mandible
273. What percentage of lingual nerve rises above the level of the alveolar crest in the area of the third molar?
a. 10-15% | 15% (Pogrel), 17.9% (Kisselbach and Chamberlain)
274. What is the best solution for a dislodged tooth?
a. Hank’s balanced salt solution
275. What is the conventional wisdom regarding the maximum time that the tooth has before reimplantation to have a shot at viability?
a. 120 minutes, periodontal ligament fibers become irreversibly necrotic after this time frame
276. Treatment of avulsed tooth, out 3 hrs, but patient kept in mouth. Do you treat it with:
a. Root canal first before reimplantation
277. You are extracting a maxillary third molar & you displace it into the sinus & get profuse bleeding. Where is the bleeding coming from?
a. Posterior Superior Alveolar Artery
278. Best way to close an oro-antral fistula from a 1st molar of 8 mm?
a. Openings greater than 6 mm require primary closure Openings less than 2mm, nosurgical treatment is necessary providing adequate hemostasis. Openings 2-6 mm conservative treatment is indicated including placement of figure of eight suture over the socket, gelfoam and sinus precautions.
279. Indications for Buccal Fat pad closure of O-A fistula?.
a. Defects greater than 6 mm
280. A pediatric patient presents to our office 2 weeks following trauma to a primary central incisor. The tooth is now discolored, but otherwise asymptomatic. What is your treatment?
a. Observation
281. What type of mandibular fracture poses the greatest risk of airway obstruction?
a. Bilateral angle fracture
282. Child bitten by a dog 3 days ago, now infected, what is the most likely organism?
a. Pasturella multicedins Augmentin is the antibiotic choice because it is bacteriocidal for the range and spectrum of human and animal bite pathogens including Staphylococcus species and Pasteurella multocida.
283. When you bite on your anterior teeth describe the forces applied over an angle fracture?
a. Tension at the alveolus, compression at the inferior border
284. Patient has flaccid elbow & wrist reflex, but normal triceps reflex following MVA, what is the level of C-spine injury?
a. C 5-6 (triceps is C 7)
285. Primary bone healing requires?
a. Bone-bone contact & compression across the fracture site
286. What type of plate & screw fixation provides the most stable fixation?
a. Neutral zone | However, this is not possible in the mandible, since the neutral zone is in direct line w/ the IAN
287. What is the thickness of the superior tarsal plate
a. 1 mm, (length 25mm, height upper 10mm, height lower 4mm)
288. What is the position of the upper eyelid, at primary gaze, in relation to the limbus?
a. 2-3mm inferior
289. Aniscoria status post trauma, where is injury in brain?
a. Compression of midbrain ``` All the following can be the cause s/p trauma • Normal-physiologic • Horner’s syndrome • CN III injury • Tonic pupil
```290. Which fracture would you NOT use a compression plate for?
a. Oblique fractures are contraindication to compression plate
291. Best screening test for cardiac contusion?
a. EKG
292. What is the best way to monitor blood loss & fluid status in a trauma patient?
a. CVP and urine output
293. What is the best radiograph to assess displacement of the condyle in a child?
a. CT
294. What is the best radiographic study to evaluate orbital floor disruption?
a. Coronal CT
295. Which of the following will cause traumatic telecanthus?
a. Periorbital lacerations and Type III NOE fracture
296. How to plate & wire a Type III NOE fracture?
a. ORIF, transnasal wiring of canthus – posterior & superior to the lacrimal fossa
297. What is the primary complication for RIF of a mandible fracture?
a. Malocclusion
298. Treatment of a CSF leak, should include?
a. Place patient in head-up, semi-reclining position | • Semi-Fowler position
299. Where do you make the lateral orbital osteotomy for a Lefort III?
a. Frontozygomatic suture extending into the inferior orbital fissure
300. Why do you need to bone graft in an NOE fracture?
a. To recreate the dorsal-nasal support and correct tip projection
301. When placing an implant, what temperature results in the destruction of bone?
a. 47 degrees Centigrade
302. Indications for a submucous vestibuloplasty?
a. When maxillary denture is unstable owing to shallow vestibular depth and/or high muscle attachments, but the maxilla exhibits good underlying bone height and contour.
303. You are placing 5 standard (4.0mm) implants into the anterior mandible of an edentulous patient, between the mental foramina. What is the length of bone, between the foramina needed?
a. 44 mm • 4mm each implant • 3mm between each implant • 5mm between terminal implants and mental foramina • Adds up to: 42 mm
```304. Patient who has worn maxillary & mandibular complete dentures without problems, desires a new removable prosthesis with implants. He has 7mm of bone above the mental nerve and IAN canal. What is the most prudent treatment?
a. 2-4 implants in parasymphysis with tissue bar
305. Where is the most stress on an implant?
a. Crown/implant interface
306. In a lip-switch vestibuloplasty, where is the mucosal flap sutures?
a. To the cut periosteal edge at the depth of the vestibule
307. What is the difference between a mandibular staple implant and a TMI?
a. Less bone required for TMI (transmandibular implant)
308. What is the most common long-term complication of costochondral grafts?
a. Asymmetric growth
309. Minimum clearances needed fora bar-attached overdenture?
a. 11 mm The vertical height needed for a bar attachment can approach 11 mm. This measurement is taken from the occlusal plane to the highest point of the alveolar process. This distance will provide for the height of the bar (2 to 4 mm), 2 mm under the bar for maintenance of hygiene, and at least 7 to 8 mm of restorative material in the overdenture (usually acrylic resin)
310. What percentage of disc recapture following arthroscopy?
a. 0-10%
311. Which form of TMJ noise has the best prognosis?
a. Early opening & late reciprocal click
312. When performing a preauricular approach for TMJ surgery, which statement best describes the position of CN VII?
a. Between the SMAS & the superficial layer of Deep Temporal Fascia
313. How is pain felt when you have a disc perforation?
a. Subchondral nociceptors
314. If done incorrectly, a high condylotomy may cause damage to what nerve?
a. Auriculotemporal nerve
315. What is the best treatment for a child with boney TMJ ankylosis?
a. Costochondral graft
316. A diagnostic aid for Rheumatoid Arthitis is?
a. ANA
317. What is the best indicator for the amount of impaction necessary for a VME patient?
a. Maxillary incisor show at rest
318. What is the most common site for A-V malformation following Lefort I osteotomy?
a. Descending palatine artery
319. Stripping of which muscles causes condylar sag in an IVRO?
a. Medial pterygoid
320. A patient presents with mandibular alveolar retrognathia, with ideal chin position, how do you treat?
a. Total mandibular subapical osteotomy
321. What causes immediate relapse following BSSO?
a. Proximal segment distraction during fixation
322. Patient with VME have?
a. Decreased masticatory force (by EMG measurement)
323. How do you control vermillion show following Lefort I osteotomy?
a. V-Y closure
324. What is the complication of placing the medial cut of a BSSO too high?
a. The medial pole of the condyle remains with the distal segment
325. SARPE should be considered in which patient?
a. Adults (> 18 years) with greater than 5mm of transverse deficiency
326. What is the most common “bad split” during a BSSO?
a. Buccal plate fracture
327. What is the microscopic anatomy of the lingual nerve?
a. 10-25 fascicles
328. What is the position of the lingual nerve in relation to the alveolar crest?
a. 2.5mm medial to the lingual plate and 2.5mm inferior to the crest, • Direct contact 25% of time, 10-15% lie above lingual crest
329. What is the horizontal relationship of the lingual nerve to the lingual plate?
a. 2.5mm
330. Which has a greater amount of long-term shrinkage? (skin grafts)
a. STSG | • FTSG has greater immediate shrinkage due to elastin
331. What artery supplies the composite iliac crest flap?
a. Deep iliac circumflex artery
332. What type of nerve injury repair has the worst prognosis?
a. Gap between severed ends, placed under tension
333. 10 year old patient who is s/p anterior iliac crest bone harvest, presents with calf pain, positive popliteal & pedal pulses, pink skin over calf, increased calf pressure, what is the diagnosis?
a. Compartment syndrome - pallor, paresthesias, pulseless (late and rare), paralysis (late), and pain (early) on passive extension of the compartment
334. To avoid damage to CN VII, what layer is elevated during a coronal flap?
a. Subgaleal
335. What is the purpose of HA in bone regeneration
a. Osteoconduction
336. What length of defect can you repair with a fibula free flap?
a. 25 cm
338. What type of bond exists between HA & bone?
a. Ionic bonding
339. Which would you NOT use in the treatment of an atrophic mandible fracture?
a. 2.0mm microplate
340. What treatment for an atrophic mandible fracture has the best prognosis for healing?
a. ORIF w/reconstruction plate (2.4-2.7mm)
341. What is an inappropriate material for reconstruction for a severe orbital floor fracture with enophthalmous?
a. Gelfilm
342. You raise an anterior temporalis flap to close a maxillary defect and cannot feel or Doppler a pulse, what do you do?
a. Discard flap and raise a posterior temporalis flap
343. Where does the mentalis muscle insert?
a. Dermis of the skin
344. How does a split thickness skin graft receive its nutrition for the first 48 hours?
a. Plasmatic imbibitions After graft placement, an initial adherence to the wound bed via a thin fibrin network temporarily anchors the graft until definitive circulation and connective-tissue connections are established. This adherence begins immediately and is probably maximized by 8 hours postgrafting. The period of time between grafting and revascularization of the graft is referred to as the phase of plasmatic imbibition. The graft imbibes wound exudate by capillary action through the spongelike structure of the graft dermis and through the dermal blood vessels. This prevents graft desiccation, maintains graft vessel patency, and provides nourishment for the graft. This process is entirely responsible for graft survival for 2-3 days until circulation is reestablished. During this time, the graft typically becomes edematous and increases in weight by 30-50%. Revascularization of the graft begins at 2-3 days postgrafting. full circulation to the graft is restored by 6 or 7 days postgrafting. Without initial adherence, plasmatic imbibition, and revascularization, the graft will not survive.
345. How does freeze dried bone work?
a. Osteoconduction – may provide BMP
346. How does corticocancellous particulate graft work?
a. Cortical bone has higher concentration of BMP, cortical chips incorporated into corticocancellous grafts enhance osteoinductive potential
347. What is the primary blood supply to the pectoralis major flap?
a. Thoracoacromial artery - Pectoral Branch
348. What is the primary blood supply to the delto-pectoral flap
a. Perforators from internal mammary artery
349. What muscle, if injured, other than the tensor fascia lata may cause a temporary or permanent limp?
a. Psoas major
350. Best age for hard tissue manipulation in cleft patients is?
a. 6-9 years of age Bone graft reconstruction is performed in the mixed dentition prior to the eruption of the permanent canine and/or permanent lateral incisor.
351. What palatal muscle is not involved in speech?
a. Tensor veli palatini
352. What is the function of the hamulus?
a. Pully or support point for the tensor veli palatine
353. Patient with congenital micrognathia may also have defects in which bones?
a. Malleus & incus
354. What is the most common fatal rhythm seen in myocardial infarction
a. V-fib
355. What muscle acts to open the eustacian tube?
a. Tensor veli palatini
356. Revision of cleft lip repair in an 18 year old who is maxillary hypoplastic? (order of surgery?)
a. Establish maxillary position first, then revise lip
357. What palatal muscle is most responsible for speech?
a. Levator veli palatini
358. What is the etiology of hemifacial microsomia?
a. Intrauterine damage of the stapedial artery or a disturbance in neural crest cell development and migration
359. What is the blood supply to the free fibula graft?
a. Peroneal artery
360. What does a biopsy of minor salivary gland lower lip/parotid in Sjogren’s Syndrome show?
a. Focus of 50 or more lymphocytes and plasma cells, finding of one focus of 50 or more cells within a 4mm squared area of glandular tissue supports diagnosis. Greater number of foci greater correlation.
361. Scattered inflammation with ductal dilation and fibrosis?
a. Chronic sclerosing sailadenitis
362. Maximum dose of lidocaine?
a. 4 mg/kg (plain) and 7 mg/kg w/epi
363. What is the cause of venous irritation & thrombophlebitis during injection of Diazepam?
a. Propylene glycol
364. What shifts oxy-hemoglobin saturation curve to right?
a. Increases in Temp, CO2, H+ ion, 2-3 dpg
365. Criteria for a positive DPL?
a. > 100k RBC/mm3, > 500 WBC/mm3, + gram stain
366. Late finding in progression of Malignant Hyperthermia?
a. Increased temperature
367. Most common arrhythmia in hyperthyroidism?
a. Sinus tachycardia
368. What is the mechanism of action of metformin?
a. decreases hepatic glucose production and intestinal glucose absorption; increases insulin sensitivity
369. What is the site of action of cyclosporine?
a. inhibits activation of T-cells without causing myelosuppression
370. What organism causes cat scratch disease?
a. Bartonella henselae, a curved, pleomorphic, gram-negative bacillus
371. What is the average preferred distance of the upper brow to the pupil center?
a. 25mm
372. What is the purpose of Guided tissue regeneration
a. Prevent migration of epithelium
373. What is the modified Mueller technique?
a. maneuver to simulate maximum airway collapse. Inspiratory effort with mouth & nose obstructed during nasoendoscopy, level of collapse is assessed using the Muller maneuver noted with the fiberoptic flexible nasopharyngoscopy. The Muller maneuver is usually graded on a 5-point scale, from 0 to 4. For eval of OSA
374. What is Romberg’s syndrome
a. Progressive facial atrophy
375. What is the relationship of the malar eminence to the lateral canthus?
a. 10mm lateral & 15mm inferior | Inferior has more syllables (so number is higher), face is longer than wide so inferior number is larger
376. Preoperative dosing of ASA leads to increased incidence of what?
a. Asthma
377. What is the normal dimension for the palpebral fissure?
a. 8-12mm women, appox 30mm horizontally | 7-10mm men, appox 30mm horizontally
378. Likely causes of 100 degree cervical-mental angle?
a. Submental skin and platysmal laxity
379. What is the relationship of the medial & lateral canthus?
a. Lateral is 3-4mm superior to medial, forms a 2 degree angle
380. What is the treatment for a tooth concussion?
a. Observe | Concussion results in mild injury to the periodontal ligament without tooth mobility or displacement
381. What is the most likely prognostic indicator for OKC recurrence?
a. The histopathologic presence of one or more daughter cysts
382. Which muscle causes creases between the eyebrows?
a. Corrugator/Depressor supercilli complex
383. Which muscle insert into the nasolabial fold?
a. levator alae muscle (levator labii superioris alaeque nasi) as the primary facial muscle responsible for creating the medial nasolabial fold. The levator labii superioris muscle was found to define the middle nasolabial fold
384. What is the path of the hypoglossal nerve as it relates to the hyoglossus and mylohyoid muscles?
a. Lateral to hyoglossus, medial to mylohyoid
385. What joint situation is hyaluronic acid useful in?
a. Acute closed lock
386. What is the 3 muscle triangle of a scapular flap?
a. Teres major, teres minor, triceps long head (posterior head)
387. What is the most likely orbital fracture in a child?
a. Roof
388. What is the blood supply to a genioplasty segment?
a. Lingual periosteum
389. What is the cause of acute diplopia with ZMC fracture?
a. Edema and hematoma Monocular diplopia is usually due to lens dislocation or opacification, or another disturbance in the clear media along the visual axis. Acute binocular diplopia, secondary to trauma, derives from one of three basic mechanisms: edema or hematoma, restricted motility or neurogenic injury. The most common cause of binocular diplopia following trauma is orbital edema and hematoma. In the trauma setting, diplopia may be due to restricted ocular motility from a prolapse of the periorbital contents into the medially fractured ethmoid air cells or underlying maxillary sinus. Such diplopia may also be due to entrapment or direct impingement on the fine suspensory ligamentous system of the orbit or, less frequently, of the extraocular muscles. Restricted motility or entrapment is commonly found with orbital floor and medial wall fractures, less frequently with roof fractures, and rarely with lateral wall fractures.
390. What structures are injured with a deep laceration just anterior to the masseter muscle?
a. Facial nerve, parotid duct, transverse facial artery
391. Why is there an increased incidence of TMJ ankylosis in children vs. adults?
a. Thin cortical bone
392. Which is a contraindication of surgical repair of a nerve injury?
• Indications: 1. Observed nerve severance 2. Total anesthesia beyond 3 months 3. Dysesthesia beyond 4 months 4. Severehypoesthesia without improvement beyond 4 months • Contraindications: 1. Central neuropathic pain 2. Dysethesia not abolished by local anesthesic nerve blocks 3. Improving sensation 4. sensory decficit acceptable by patient 5. Metabolic neuropathy 6. Medically compromised patient 7. “Excessive” delay after injury
```393. Ramsey Hunt syndrome is caused by what virus?
a. Varicella-zoster virus
394. Tricyclic antidepressants work by:
a. inhibiting the re-uptake of the neurotransmitters norepinephrine, dopamine, or serotonin by nerve cells. also increase the effects H1 histamine
395. The best method to examine the upper airway in OSA is:
a. Nasal endoscopy
396. The wedge pressure of a pulmonary catheter is used to measure?
a. Left end diastolic pressure
397. One of the major limiting factors for the use of a temporalis flap is?
a. Temporal hallowing
399. When performing a subgaleal brow lift, which nerve is most likely injured?
a. Supraorbital nerve
400. The open sky approach in an upper blephroplasty, what structure is exposed?
a. Orbital septum
401. The ability to distract the lower lid more than _____mm indicates the need for a lower eyelid shortening procedure?
a. 8-10 mm
402. The extraoral craniofacial implants with skin around it
a. less than 1mm thick, without hair follicle
403. What 2 anatomic factors are implicated for their movement having an effect on the soft tissues after Lefort I osteotomies?
a. ANS & upper incisor
404. The delay in conduction at the AV node is due to:
a. Calcium channels
405. Dental implants in irradiated bone?
a. Increased success with HBO
406. An arch length deficiency is most commonly associated with
a. Buccally impacted canines
407. What are the most common ectopically erupting permanent teeth?
a. maxillary first molars, the maxillary canines and the mandibular lateral incisors
408. The resting potential across the nerve membrane and the sodium/potassium channels. How does LA affect this?
a. Local anesthesia prevents action potential by preventing inflow of sodium ions
409. 45-year-old female with lesion on forehead, for roughly 2 months painless but bleeds with probing histology shows invasive epithelium in coonective tissue.
a. Basal cell carcinoma Basal cell carcinoma (BCC) is the most common form of skin cancer. The risk of developing BCC is increased for individuals with a family history of the disease and with a high cumulative exposure to UV light via sunlight[1] or, in the past, were exposed to carcinogenic chemicals, especially arsenic. Basal cell carcinomas develop in the basal cell layer of the skin. Sunlight exposure leads to the formation of thymine dimers, a form of DNA damage. While DNA repair removes most UV-induced damage, not all crosslinks are excised. There is, therefore, cumulative DNA damage leading to mutations. Apart from the mutagenesis, sunlight depresses the local immune system, possibly decreasing immune surveillance for new tumor cells.
410. Sinus lifting with perforation of membrane – best method to assure success
a. PTFE membrane to cover perforation and then continue with the graft
411. Immediate release of IMF with malocclusion:
a. Proximal segment distraction
412. Proximal segment rotation
a. Late relapse with encroachment on pterygomasseteric sling
413. Paget disease with elevated alkaline phosphatase; calcium and phosphorus: Normal or abnormal?
a. Normal
414. Electrical activity associated with pulselessness:
a. Wolff-Parkinson-White
415. Lancing pain behind eye in a male:
a. Cluster headache
416. Masticatory dysfunction related to
a. Parafunctional habits
417. Reconstruction of bony ankylosis in a child:
a. Costochondral graft
1. Which dental fracture has the worse prognosis?
a. Intrusion with middle root fracture
419. 45-year-old male with indiscreet, diffuse swelling in bilateral tail of the parotids
a. Papillary lymphadenomatosum (Warthin’s)
420. Lady with marble-like swelling in upper lip - freely movable – Histo: canalicular pattern:
a. Canalicular adenoma
421. Pulmonary capillary wedge pressure best to evaluate:
a. Left heart failure
422. Diastolic murmur:
a. Mitral stenosis
423. Pansystolic murmur:
a. Mitral regurgitation
424. Monostotic fibrous dysplasia: what age group?
a. Found in children
425. Positioning of incision to harvest cranial bone graft in child:
a. Parietal
426. Pus coming out of an extraction site, foul smelling – gram negative rod - no culture results p 48 hours:
a. Bacteroides
427. Bacteria associated with chronic and acute sinusitis:
a. Haemophilus influenzae and diplococcus pneumoniae
428. Apertognathia resulting from:
a. Nasal obstruction
429. Sodium bicarbonate used for what cardiac situation:
a. hyperkalemia
430. Finding in Langerhans cell disease:
a. Diabetes insipidus
431. Closure of an alveolar cleft at posterior junction of premaxilla with tongue flap
a. Posteriorly based flap (Most preferred in the region is anteriorly-based flap)
432. Pulmonary wedge pressure valuable for:
a. Left ventricular function
433. Retromandibular approach through parotid for treatment of mandible fracture – most likely postoperative issue 1 week out:
a. Nerve injury
434. Unilateral disruption of medial canthus should be reattached via wire fixation
a. Opposite orbital wall
435. Delayed finding with pediatric mandible fractures:
a. TMJ problems
436. Most important with autogenous corticocancellous graft:
a. Fixation
437. Female pregnant in her third trimester has decreased (which lung measurements?)
a. Functional vital capacity due to developing baby impinging on diaphragm
438. Arterial injury most often in antecubital fossa:
a. Brachial
439. Elderly man with acute onset of right facial weakness - remainder of body is intact with good strength - hyperacusis and loss of taste on the right:
a. Bell’s palsy
440. Peripheral nerve injury causing central trigeminal pathosis
a. Central deafferentiation with loss of primary brain ganglion cells
441. Avoid with seizure history: (medication)
a. Ketamine
442. Radiograph showing an impacted second molar with divergent roots - what is surgical management:
a. Section the tooth
443. Female with VME and steep mandibular angle – treatment:
a. Lefort I and sliding genioplasty expecting the autorotation
444. Anterior mandibular osteotomy versus alloplastic augmentation
a. Advancement of suprahyoid musculature
445. Lateral ceph with posterior vertical maxillary excess – treatment
a. LeFort osteotomy
446. Bimaxillary protrusive without skeletal excess (dental origin) – management:
a. Anterior segmental osteotomies of the dentition
447. Relapse following mandibular setback:
a. Proximal segment overrotation (aligning superior border)
448. Complications with completion of IAN lateralization for implants:
a. Incising the incisive branch
449. Older female with pain in right mandible with no history of past radiation – generalized exposure of alveolar crest with necrotic bone - best initial treatment:
a. Debridement
450. Female with large lesion in posterior mandible - radiograph showed a localized lesion – CT scan illustrated an oval shape lesion with an intact cortical border:
a. Ossifying fibroma
451. Surgically assisted palatal expansion:
a. Individuals older than 18 years old requiring expansion greater than 5 mm
452. HSV following laser skin resurfacing:
a. Common with past history of recurrent labialis
453. Integrity of osteointegration:
a. Bone interface
454. Random flap for closure of facial defects:
a. Rotational flaps
455. Width to Length ratio for a flap:
a. 1:3
456. Murmur of mitral stenosis best heard:
a. Fifth rib at midclavicular line
457. Sign of right heart failure:
a. JVD Signs – elevated jugular venous pressure, abnormal hepatojugular reflux, ascites, peripheral edema, enlarged liver, pleural effusion, hepatomegaly. Symptoms: fatigue, edema, weight gain due to retained salt and water, loss of muscle mass
a. Dyspnea Left sided: Signs – S3 (third heart sound), rales, wheezes, tachypnea, renal hypoperfusion causing increased aldosterone which leads to sodium retention increased total body fluid. Symptoms: dyspnea on exertion, nocturnal cough, orthopnea, paroxysmal nocturnal dyspnea, hemoptysis
459. Patient hospitalized for 5 days with diffuse bilateral infiltrates on 6 liters of O2 with PaO2 of only 80:
a. ARDS
460. Displacement of the condyle in a child alters the functional extracellular matrix via loss of
a. Lateral capsular ligament
461. Separating junction between the upper and lower lateral cartilages results in change of nasal tip:
a. Decreased projection and rotation
462. Nasal tip changes with maxillary advancement:
a. Increased tip projection and rotation
463. Potential limitation regarding the utilization of a temporalis flap:
a. Trismus and contour defect
464. Cranial bone graft verses autogenous hip graft:
a. Less chance of resorption
465. Initial orbital pressure following ZMC fracture:
a. Decreased from increased orbital volume
466. Blindness with orbital trauma:
a. Venous stasis associated with ophthalmic vein
467. Incidence of osteoradionecrosis following extraction of teeth in individuals with radiation:
a. Literature supports 2-6% 22% to 27% (Marx)
468. Percentage of time lingual nerve found in tissues distal to second molar above impacted third molar:
a. 10% to 15%
469. Etiology of apertognathia:
a. Nasal obstruction
470. Relapse following correction of open bite:
a. Maxillary constriction - (Most unstable movement is maxillary expansion)
471. Development of an open bite most likely related to:
a. Posterior vertical maxillary excess
472. Adult with condylar hyperplasia and vertical growth
a. Posterior open bite on the affected side
473. Best means for ensuring success of revised microvascular free flap:
a. Aspirin
474. Which medicine in combination with midazolam is going to lengthen the sedative effects:
a. Cimetidine
475. Temperature of bone necrosis when drilling an implant:
a. 47 degrees Celsius
476. Indications for a brow lift:
a. Severe total brow ptosis
477. Lesion with giant cells discovered on histology:
a. Aneurysmal bone cyst
478. Refractory AV node transmission is based on:
a. Potassium conductance
479. Distal root from mandibular second molar lost from socket – located:
a. Submandibular space, cancellous canal, inferior alveolar canal
480. Trauma to lingual nerve when taking out the third molar with loss of taste – fibers from which nerve injured:
a. Cranial nerve V traumatized carrying fibers for VII
