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1
Q

What is the microscopic margin of SCC?
2, 5, or 7 mm?

A

5 mm (4 and 6 mm for cutaneous SCC with 6 for high risk). High risk: Grade more than 1, more than 2 cm diameter (low risk site) or 1 cm diameter (high risk site)

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2
Q

What are anesthetic considerations for cardiomyopathy?
1) Diuretics?
2) Digitalis, nitrate, vasodilators?
3) Hypertrophic cardiomyopathy and aortic stenosis?
4) Dilated cardiomyopathy?

A

1) Avoid diuretics (dehydration increases outflow tract pressure gradient from the heart and worsens symptoms)
2) Avoid digitalis, nitrate, vasodilators
3) Run slow (low HR), full (preload) and tight (BP)
4) Fast (high HR), full (preload) and forward (decreased afterload)

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3
Q

What is the benefit of putting PRF in extraction socket?
1) More factors
2) Less bone loss

A

Less bone loss.
Multiple studies show fast healing time and less bone loss with earlier implant placement

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4
Q

PRP Processing technique?
PRP Architecture?
PRP Biologic properties?

A

Processing: Bovine thrombin and calcium chloride, centrifuge twice (labor intensive)
Architecture: Fibrin polymerization, bilateral junctions that allow thickening of fibrin polymers and a rigid network (decrease cytokine enmeshment and cellular migration)
Biologic properties: Immediate release of growth factors but could have a reaction to bovine thrombin factor (coagulopathy)

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5
Q

PRF Processing technique?
PRF Architecture?
PRF Biologic properties?

A

Processing: No anticoag needed, single centrifuge (simple, cost effective)
Architecture: Slow polymerization, equilateral junctions. Flexible architecture to support cytokines and cellular migration
Biologic Properties: Growth factors released slowly, release of TGF-b and PDGF-AB. Expresses alk phos and induces mineralization

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6
Q

What are the advantages of PRF?
Disadvantages of PRF?

A

Advantages: Single step and simplified process, autologous blood sample with minimal manipulation, natural polarization with minimal immunological reaction, release of GF over 7-10 days, can be used with bone grafts.
Disadvantages: Success depends on handling and transference to centrifuge, need glass coated tube to achieve clot polymerization, requires blood from patient

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7
Q

Patient has a subnasal nodule, what could this be indicative of?

A

Basal cell carcinoma, possible Gorlins

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8
Q

What increases tylenol toxicity?
A) Propofol
B) Phenytoin
C) Demerol
D) Hydrocodone

A

B) Phenytoin
Phenytoin decreases levels of acetaminophen by increasing metabolism. Enhanced metabolism increases levels of hepatotoxic metabolites

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9
Q

What are methods to decrease nasal tip projection?
What are ways to increase tip projection?

A

Decrease: Complete transfixion incision, shorten crura (excise strip of lateral or medial crura and reattach), lower septal angle
Increase: Transdomal or interdomal sutures, shield graft, columellar strut graft

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10
Q

What is the depth of a medium chemical peel?

A

Penetrates papillary dermis (treats mild-moderate photoaging)

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11
Q

What great vessels are used for flap in the neck?
A) Thyrocervical trunk
B) External carotid (and branches)
C) Superior Scapular
D) Another

A

B) External Carotid
Midface:
Short pedicle (superficial temporal)
Long pedicle (Facial artery/vein)
Lower face/neck:
Artery: Facial artery, superior thyroid artery, transverse facial artery
Vein: External/internal jugular

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12
Q

Which artery/vein most frequently used in patients with no neck dissection?

A

Superficial temporal artery (branch of external carotid)
Superficial temporal vein

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13
Q

Which artery/vein most frequently used in supraomohyoid neck dissection?

A

Superior thyroid artery
Internal jugular vein

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14
Q

What artery/vein most frequently used in jugular neck dissection?

A

Transverse cervical artery
External jugular vein

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15
Q

What artery/vein most used in modified radical neck dissection?

A

Transverse cervical artery
External jugular vein

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16
Q

What great vessel is most commonly injured in mandibular trauma?
A) External Jugular
B) Internal Carotid
C) External Carotid
D) Common Carotid

A

C) External carotid
Maxillary artery (branch of external carotid) lies in close relation to medial cortex and subcondylar portion of mandible and is at risk during trauma/surgery

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17
Q

What is the position of the pediatric IAN?

A

Mandibular foramen is much lower compared to adults (7 mm above occlusal plane). Position inferior and more posterior

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18
Q

What is the origin/insertion of lateral pterygoid muscle?

A

Origin: On the infratemporal surface and infratemporal crest of the greater wing of sphenoid bone
Insertion: Articular disc/fibrous capsule of the TMJ. Medial capsule/disc

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19
Q

What is the origin/insertion of lower/inferior head?

A

Origin: Lateral surface of lateral pterygoid plate
Insertion: Condyloid process of mandible; superior/upper head

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20
Q

What is the mechanism of a class III relapse at one year after maxilla positioned inferiorly?

A

Maxilla moving superior and mandible autorotates

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21
Q

What is the purpose of a fat graft after parotid surgery?

A

Prevents Freys syndrome
Frey’s Syndrome is a syndrome that includes sweating while eating (gustatory sweating) and facial flushing. It is caused by injury to a nerve, called the auriculotemporal nerve, typically after surgical trauma to the parotid gland.

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22
Q

What are clinical applications of autogenous fat injections?

A

Fat graft to the face, vocal fold augmentation for glottic incompetence, treatment of post-surgical parotidectomy Frey syndrome, velo-pharyngeal insufficiency,

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23
Q

What is the body percentage of a head, arm, trunk burn?

A

36%

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24
Q

What medication is contraindicated in Parkinson’s disease?

A

Droperidol
Antidopaminergic drug used as an antiemetic

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25
What is a complication that can arise from a medial cut that is too high in a BSSO?
Condyle in distal segment
26
What is the process of multiple sclerosis?
Central autoimmune disease Immune-mediated inflammatory disease that attacks myelinated axons in CNS. Activation of myelin-reactive T-cells that adhere and allow entry to the Blood Brain Barrier.
27
What is an anesthesia consideration for Cerebral Palsy?
Aspiration Risk
28
What is the minimal height for an overdenture?
11 mm (12 mm Lam/Laskin)
29
What is minimal height for an all-on-4 (hybrid)
15-17 mm (bar retained prosthesis) 3 mm bone to soft tissue, 1 mm soft tissue to bar, 3-5 bar to attachment, >8 mm for VDO
30
What is the purpose of protein C?
Potent anticoag by inactivating Va and VIIIa
31
Protein C
Zymogen (proenzyme). Anticoagulant protein, vitamin K dependent, when its active it's called APC. APC inactivates V, VIII. Which inactivates factor X, which leads to anticoagulation
32
Factor V Leiden
Inactivates protein C (hypercoagulable, VTE)
33
Substance P
Neuropeptide (neurotransmitter & modulator) 1st responding inflammatory marker with brain and spinal cord associated with inflammation and pain, also a potent vasodilator
34
Malocclusion with unilateral condylar fracture
With unilateral condylar fracture you have a reduction in height in the ramus which leads to: Ipsilateral premature occlusion Contralateral open bite Midline shifts to side of fracture
35
Malocclusion with bilateral condylar fracture
Anterior open bite with minimal deviation
36
Malocclusion with bilateral condyle fracture and fracture of symphysis
Widening of mandible. Very difficult to treat. Failure to recognize and or correct the widening of the body fractures will prevent anatomic reduction of the condylar fracture and subsequent occlusal/functional complication
37
What are complications of succinylcholine in pediatric patients?
Bradycardia, asystole Also rhabdomyolysis with hyperkalemia and ventricular dysrhythmias. More common in Duchenne's muscular dystrophy or other undiagnosed skeletal muscle myopathy
38
What is the most common post-op complication of AICBG
Sensory defect or gait disturbance All will have temporary gait disturbance, percentages overlap between sensory and gait
39
Woman with a lesion?
AML
40
If you only want to advance midface
Subranial Lefort III
41
Superior orbital fissure syndrome
Ophthalmoplegia (CN III, IV, VI) Ptosis (decreased tension in extraocular muscles with loss of innervation) Fixed dilated pupil (loss of parasympathetic supply to pupil by CN III) Lacrimal hyposecretion and forehead anesthesia (CN V1) Loss of corneal reflex (due to loss of afferent input from CN V1
42
Orbital apex syndrome
Loss of vision (CN II), ophthalmoplegia, diplopia, mydriasis, ptosis (CN III, IV, VI)
43
Cavernous sinus syndrome
CN V2 involved (may also present with CN III, IV, VI, V1 issues), internal carotid artery may be involved CN II not involved
44
Absent corneal reflex
Afferent V1 (superior orbital fissure syndrome) Sensory: CN V1 to spinal trigeminal nucleus Motor: Facial nucleus out of the temporal branch of CN VII
45
Explain pupillary light reflex afferent/efferent
Each afferent limb has two efferent limbs (one ipsilateral and one contralateral) The ipsilateral efferent transmits for direct light reflex of ipsilateral pupil, the other efferent limb transmits consensual light reflex to contralateral pupil
46
What is the muscle and nerve pathway of the pupillary constriction?
Iris sphincter muscle Short ciliary nerves via parasympathetic nervous system (muscarinic Ach Receptor M3)
47
What is the muscle and pathway of the pupillary dilation?
Iris dilator muscle Long ciliary nerve via myoepithelial cells via sympathetic nervous system (Nor-epi on alpha-1 receptors)
48
Afferent and efferent oculocardiac reflex pathway
Afferent: Ciliary ganglion to trigeminal sensory nucleus (via long ciliary nerve) Efferent: Motor nucleus of vagus nerv to SA note (via vagus nerve)
49
What is the treatment for anterior and posterior table fracture with CSF Leak
Cranialize and galea flap (pericranial flap, subgaleal fascia is dissected from the flap and used with bone to block off the ofundibulum nasofrontal recess) If anterior wall only with CSF leak, you can observe 5-7 days for resolution with antibiotics and consider sinus obliteration with abdominal fat
50
What are the pathways/management of frontal sinus fracture?
Dislocation 2 mm or less (conservative), more than 2 mm consider obliteraztion, cranialization vs conservative management CSF Leak present (conservative management vs lumbar drain/bedrest vs obliteration) FSOT obstruction (baloon sinuplasty, draf III, endoscopic, obliteration vs cranialization) Need to take all into account
51
What is the MOA of Pradaxa
Reversible, direct thrombin inhibitor
52
What is a late finding of tension pneumothorax? A: Cyanosis B: Tracheal deviation C: Tachycardia
B: Tracheal deviation. (maybe cyanosis), bad question Early signs: Diminished/absent breath sounds, dyspnea, narow pulse pressure, tachycardia, restlessness
53
What is the treatment of tension pneumothorax?
Needle decompression in 2nd intercostal space at mid clavicular line with 18 gauge needle Then do a chest tube
54
What creates a round face? A: Zygoma B: Submalar C: Malar
B: Submalar Zone 5 is the submalar zone includes soft tissues inferior to malar bones. Can created rounder, fuller face/contour
55
In a patient with a zygoma posterior to the orbit with negative vector and you do an inferior bleph, what is the cosmetic result? A: Good B: Malpositioned lower lid C: Hallowing
B: Malpositioned lower lid (negative vector increases risk of lid malpositioning after bleph alone)
56
Who is a good bleph candidate? A: Woman 5 months s/p lasik sx B: Shrimer test of 4 mm C: Recent bleph with asymmetric result
C: Recent bleph with asymmetric result (Ophtho recommends 6 months after lasik, shrimer (eye produces enough tears to keep it moist) test usually >10 mm so this would be a contraindication)
57
What is the alk phhos level in hyperparathyroidism?
Usualy elevated or inappropriately normal
58
What can happen in erosive lichen planus?
Malignant change is possible
59
What is the most common neurologic problem in clover leaf deformity Kleeblattschladel syndrome?
Hydrocephalus
60
What is OSA effect on heart? A: LV hypertrophy B: LF Dilation C: RV hypertrophy D: Right atrial effect
C: RV hypertrophy (due to pulmonary HTN)
61
For an avulsed tooth, how open apex of tooth needs to be for revascularization?
1 mm minimum
62
What is the cause of immediate implant failure?
Occlusal forces
63
How fast does a tooth revascularize in mm/day?
0.5 mm/day
64
What is the treatment for osteosarc with a superior positive margin? A: Go back to surgery B: Interarterial chemo C: Radiation
C: Radiation Most important is wide surgical resection with negative margins
65
What SCC has hhighest risk of metastasis to nodes? A: Anterior FOM B: Tongue C: Lower lip D: Posterior mandibular gingiva
B: Tongue Hypopharynx most common primary site (of distant mets), followed by base of tongue and anterior tongue
66
What is the pattern of inheritance of Duchenes dystrophy? What are anesthesia considerations for it?
X-linked recessive More susceptible to MH, avoid succ Need dystrophin (maintaining muscle integrity)
67
EKG shows a wide QRS and otherwise normal, what is the block?
Left bundle branch block
68
EKG shows large inverted T wave A: Common arrhythmia B: Pacemaker needed C: Needs Class 1a antiarrhythmic med D: Mitral valve prolapse
A Common arrhythmia BLUF (Either totally benign or impending doom). Can be benign from digitalis effect (seen with therapeutic levels), normal abnormalities. Can be morbid such as ACS ischemic events, CNS catastrophe
69
Common complication after distraction osteogenesis and then placing an implant A: Buccal rotate B: Gap
B: Gap You can get bone defects (especially buccal labial). Bone fenestration.
70
Explain classes of hemorrhage
Class I: 15% or 750 mL, pulse 100, normal BP. Class II: 30% or 1500, pulse 100, normal BP, pulse pressure decreased, anxious. Class III: 40% or 2000, pulse 120, BP decreased, pulse pressure decreased, anxious and confused. Class IV: More than 40% more than 2000 mL, pulse 140, BP, pulse pressure decreased, no urine output, confused/lethargic
71
Difference between Wilkes I and II?
Wilkes I: No symptoms, slight ADD Wilkes II: Mild pain, headaches, sublux/locks. Anatomic deformity of disc Wilkes III: Multiple episodes of pain, pain with function, locking. Significant disc deformity, thickening of posterior disc Wilkes IV: Chronic pain. Early/moderate degenerative remodeling of hard tissue Wilkes V: Crepitus, scraping, restricted motion/function. Gross anatomic deformity of disc and hard tissue
72
What is the blood supply to a random pattern flap? A: Vessels in bed of dermis B: Perforators
A: Vessels in bed of dermis. The blood supply to a random cutaneous flap is derived from musculocutaneous or septocutaneous perforator vessel's near the base of the flap in the dermis
73
What type of graft is a buccal fat pad graft?
Axial flap/graft Gets arterial supply from IMAX (buccal/temporal branch), superficial temporal (transverse facial), and facial
74
Platform switch: A: Moves forces to center of implant body B: Reduces bacterial load and reduces recession
B: Reduces bacterial load and reduces recession (Decreases interproximal crestal bone loss, moves microgap associated bacterial 0.5 mm medial and enhances soft tissue around crown
75
Where do you start with an eyelid laceration?
Start at the grey line
76
What are buccal mucosal grafts best used for?
Eyelids, urethroplasty
77
TADs micro screw vs plate, which is better
Plates seem better but with more complications
78
Cytokines seen in symptomatic joint?
IL-1b, IL-6, IL-8, TNF-a. IL 10 seen in joints that respond well to arthrocentesis (inhibitor of macrophage)
79
What is the degree of cant seen with the eye?
4 degrees (3 for male)
80
What do you see if you fiber optic through an LMA? A: Vocal cords B: Posterior wall C: Tip of glottis
A: Vocal cords

GK (1 decks)

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