Term
| 1 year old presents with exertional stridor and pulsatile mass against esophageal wall on FFL. What is it? |
|
Definition
| Abberent right subclavian artery due to abnormal aortic arch development |
|
|
Term
50 year old male has tight, strained voice for past 6 months. Voice breaks when counting from 80-89.
What is likely to be most effective therapy? |
|
Definition
Adductor spasmodic dysphonia responds to botox injection in thyroarytenoid. Also speech therapy.
If difficulty was counting from 60-69, think abductor SD. |
|
|
Term
| Where do afferent and efferent nerves in cough reflex synapse? |
|
Definition
| Nucleus tractus solitarus in Medulla |
|
|
Term
What is the embryologic origin of each of the following laryngeal structures?
1) Lesser horn of hyoid
2) Greater horn of hyoid
3) Thyroid cartilage
4) Corniculate cartilate
5) Lower part of hyoid bone |
|
Definition
1) 2nd branchial arch
2) 3rd branchial arch
3) 4th and 6th branchial arch
4) 4th branchial arch
5) 3rd branchial arch |
|
|
Term
| Where should botox injections be directed for adductor vs. abductor spasmodic dysphonia? |
|
Definition
1) Adductor (count 80-89) injections in TA
2) Abductor (count 60-69) injections into PCA |
|
|
Term
| Which drugs are useful in treatment of chronic, idiopathic cough? |
|
Definition
Neuromodulators
1) Amatryptaline
2) Baclofen
3) Gabapentin
4) Pregabalin |
|
|
Term
| Which HPV strains are associated with RRP? |
|
Definition
| 6 and 11. 11 tends to be obstructive earlier in course. |
|
|
Term
| In thyroid surgery, where anatomically do you find the external branch of the superior laryngeal nerve relative to the superior thyroid artery? |
|
Definition
| 1.5cm caudal to carotid bifurcation, the superior laryngeal nerve bifurcates, and the external branch passes dorsally over carotid sheath and superior thyroid artery before passing medial and staying superficial to inferior constrictor muscle |
|
|
Term
| What are the recovery statistics for idiopathic unilateral vocal fold paralysis |
|
Definition
25% of cases are idiopathic. Most commonly present with dysphonia and vocal fatigue
1) 36% recover fully and 39% show some recovery by 1 year. 25% show no recovery.
2) Rarely recover after 1 year |
|
|
Term
| What are the important complications of Zenker's Diverticulum? Which is most common? |
|
Definition
1) Aspiration is most common (30%)
2) Obstruction
3) SCCa
4) Bleeding
5) Fistula |
|
|
Term
| When can laryngeal EMG detect dennervation after laryngeal nerve transection post-operatively? What are the signs? |
|
Definition
1) 3 weeks after surgery
3) positive sharp waves and fibrillation potentials |
|
|
Term
| Describe the T staging for glottic SCCa |
|
Definition
1) T1a- 1 vocal fold (may include ant commisure)
2) T1b- bilateral vocal folds
3) T2- subglottis or supraglottis with impaired mobility
4) T3- immobile cord, paraglottic space invasion, or invasion of inner cortex of thyroid cartilage
5) T4a- strap, trach, esophagus, entire thyroid cartilage
6) T4b- prevertebral, carotid, mediastinal extension |
|
|
Term
| When is risk of post-operative TI fistula greatest? |
|
Definition
| 2-3 weeks after tracheostomy |
|
|
Term
| How is number needed to treat calculated? |
|
Definition
| 1/Absolute risk reduction |
|
|
Term
| What percentage of pediatric vocal cord paralysis is bilateral? How can you manage? |
|
Definition
1) 50%
2) Endoscopic or external arytenoidectomy, cordotomy, reinervation, |
|
|
Term
| what does the triad of progressive hoarseness, stridor and respiratory distress make you think of in children? What do you do? |
|
Definition
RRP- commonly HPV 6, 11
Mainstay of treatment is surgery |
|
|
Term
| You are performing an endoscopic airway procedure with a CO2 laser and suspect an airway fire. What do you do? |
|
Definition
| Simultaneously remove endotracheal tube and stop ventilation |
|
|
Term
| During skeletalization of the hyoid during a total laryngectomy, what nerve is most at risk? |
|
Definition
| Hypoglossal nerve: loops anteriorly around the occipital artery, then crossing the carotid and lingual arteries. |
|
|
Term
| What is the cottom-meyer grading system for SGS? |
|
Definition
1) 0-50%
2) 51-69%
3) 70-99%
4) 100% |
|
|
Term
| How does radiation impair wound healing? |
|
Definition
| Causing endothelial edema and thickening of arterioles and arteries |
|
|
Term
| what is first line therapy for vocal fold granuloma? |
|
Definition
| Reflux control (PPI and dietary) |
|
|
Term
| What is the most common laryngeal subsite inolved in sarcoid? |
|
Definition
| Usually supraglottis, most commonly epiglottis |
|
|
Term
| When should laryngeal EMG be performed in children with suspected post-operative nerve injury? |
|
Definition
| 3-6 months after. Earlier than that and there will be false silence. |
|
|
Term
| What 3 tests are always necessary for a zone 1 penetrating neck injury? |
|
Definition
| CXR, CTA, Gastrograffin swallow |
|
|
Term
| What percentage and severely dysplastic vocal cord lesions become cancer? |
|
Definition
| 20% for severe dysplasia and carcinoma in situs |
|
|
Term
| What is the most common site of RRP in the airway? |
|
Definition
| Vocal folds, usually found in areas where pseudostratified columnar epithelium transition to stratified squamous epithelium |
|
|
Term
What type of voice problem does each symptom make you think of?
1) Worse in morning
2) Worse with use
3) Better with sedating medications
4) Unchanging hoarseness throughout day |
|
Definition
1) LPR
2) Muscle tension dysphonia
3) Spasmodic dysphonia
4) Static lesion |
|
|
Term
| Where are pediatric laryngeal hemangiomas most commonly found? |
|
Definition
| Left posterior lateral subglottis |
|
|
Term
| Small gray mass on left posterior VF with hoarseness. Pseudoepitheliomatous hyperplasia with +S100 and +PAS staning. |
|
Definition
| Arise from Schwann cells, with 3% risk of malignant degeneration. Usually in posterior VF |
|
|
Term
| Where is the RLN found relative to the ligament of berry? Which side is more likely to have non-recurrent? |
|
Definition
Laterally and dorsally
Only Right side, unless Situs invertus, then can have left |
|
|
Term
| What is the GRBAS scale of voice assessment? |
|
Definition
| Grade, Roughness, Breathiness, Asthenia, Strain. Each is graded 0-3. |
|
|
Term
| What is pathophysiology of VF nodules and how should they be managed? |
|
Definition
Recurrent trauma from use or irritation leading to hyalinization of reinke's space in anterior 2/3 (membranous) VF.
Hydration and voice therapy are first line. Surgery considered if >3 months persistent symptoms despite conservative intervention. |
|
|
Term
| What are the contraindications to vertical partial laryngectomy? |
|
Definition
Any large T3-T4 or pre-epiglottic space invasion. Also
1) Fixed VF
2) Posterior commisure involvement
3) Bilateral arytenoid involvement
4) Thyroid cartilage invasion
5) Subglottic extension >10mm anteriorly and >5mm posteriorly |
|
|
Term
| What are the important potential side effects of PPI used in GERD or LPR? |
|
Definition
1) Osteopenia
2) CAP
3) Atrophic gastritis
4) C. dif |
|
|
Term
| What is the primary function of the false vocal folds? |
|
Definition
| Protection via secretion of antimicrobial lubricants |
|
|
Term
| What structures do the superior and inferior laryngeal arteries supply? |
|
Definition
1) Superior (off of superior thyroid) supplies internal surface of larynx
2) Inferior (off of thyrocervical trunk) supplies inferior musculature |
|
|
Term
| What is an "Ogee line" as it applies to facial contours? |
|
Definition
Best seen in 3/4 view. Refers to outline of midface (greek letter "S").
The highest point on the cheek convexity is the "zygomaxillary point" (horizontal line from lateral nasal cartilage and vertical from lateral orbital rim). IN women, the ZM point extends to upper lip, whereas in men it extends to lower nose (relevant for facial rejuvenation). |
|
|
Term
| How should traumatic stenson's duct injuries be managed? |
|
Definition
| Repaired with 8-0 to 10-0 nylon sutures, unless to proximal and not enough length, then ligate duct. |
|
|
Term
| What type of traumatic facial nerve injuries require repair? When should this occur? |
|
Definition
Distal to lateral canthus. These are unlikely to have sufficient redundant innervation. They require exploration and re-anastamosis.
Don't do this immediately in a contaminated field. Instead tag branches in setting of debridement then stage re-innervation. |
|
|
Term
What are three typical static oculoplastics procedures necessary for facial nerve paralysis?
What order should they be performed in? |
|
Definition
1) Upper direct brow lift for ptosis
2) Upper eyelid gold weight
3) Lower lid lateral canthoplasty for ectropion |
|
|
Term
Describe each of the following methods for determining nasal tip projection in rhinoplasty consultation?
1) Crumley
2) Goode
3) Nasofacial angle
4) Frankfort horizontal plane |
|
Definition
1) 3-4-5 triangle defined by alar base, nasal tip and nasion. Ideal nasal angle is 36 degrees
2) Uses Frankfort horizontal plane (FHP)
3) Formed by angle formeed between line drawn from glabella to pogonion and line drawn from nasion to nasal tip (30-40 degrees) |
|
|
Term
Describe % lengthening and angle of scar rotation by Z plasty according to angle of Z plasty.
1: 60 degrees
2: 45 degrees
3: 30 degrees |
|
Definition
1) Rotates scare 90 degrees and elongates by 75%
2) Rotates by 60 degrees, elongates by 50%
3) Rotates by 45 degrees and elongates by 25% |
|
|
Term
| What nerve provides intraoral sensation for RFFF (Think T3 lateral tongue cancer)? What is the artery and vein? |
|
Definition
1) Lateral antebrachial cutaneous, which innervates skin over dorsal and volar aspects of wrist and forearm on radial side
2) Radial artery and either radial venae comitantes or subcutaneous cephalic vein |
|
|
Term
| What differentiates synostotic vs. deformational frontal plagiocephaly? |
|
Definition
Height of the supraorbital rim.
Synostotic frontal plagiocephaly involves elevation of supraorbital rim relative to deformational where their is minor inferior displacement. |
|
|
Term
| What is the active chemical in Baker's solution for the depth of chemical peels? |
|
Definition
Croton oil.
Consists of phenol, croton oil and distilled water. |
|
|
Term
| Which chemical peel causes perifollicular frosting, and what is this? |
|
Definition
Sallicylic acid- lipophilic molecule that concentrates in pilosebaceous apparatus (good for acne and rosacea).
However, lipophilicity causes perifollicular forsting |
|
|
Term
| What are the possible complications of cosmetic blepharhoplasty? |
|
Definition
1) Scleral show
2) Lower lid malposition
3) Lateral canthal dystopia
4) Ectropion
5) Epiphoria |
|
|
Term
| What are the appropriate surgical planes for endoscopic vs. coronal brow lifts? What about direct or mid forehead/indirect? |
|
Definition
1) Subperiosteal
2) Subgaleal
3-4) Subcutaneous |
|
|
Term
| How should ptosis secondary to forehead botox be dealt with? |
|
Definition
| Apraclonidine eye drops, which addresses levator muscle weakness of upper lid by causing conraction of muller muscle below the levator muscle (gets 1-2 mm elevation) |
|
|
Term
| What is the vascular supply of a bilobed flap? |
|
Definition
| This is a random flap supplied by dermal plexus vessels |
|
|
Term
| What lower lid defects can be repaired primarilly? |
|
Definition
1) <=25%
2) IF 1/3-2/3, can use lateral canthotomy and semicircular advancement (Tenzel) as well as other options |
|
|
Term
| How long to wait after initial dermabrasion prior to considering second? |
|
Definition
|
|
Term
| True or False. Botox A is faster onset than Botox B |
|
Definition
|
|
Term
| During injection of calcium hydroxylapatite into nasolabial fold, there is compromise of angular artery. How is this managed? |
|
Definition
1) Gentle massage and warm compresses
2) Injection of hyaluronidase
3) Daily injection of low molecular weight heparin to area daily |
|
|
Term
| What portions of the external ear derive form each of the the 6 auricular hillocks? |
|
Definition
1) Hillocks 1-3 come from first branchial arch and form tragus (1), helical crus (2), and helix (3).
2) Second three hillocks derive from second branchial arch and into antihelix (4), antitragus (5) and lobule (6).
Hillocks fuse at 12 weeks gestation and reach final shape around 20 weeks gestation |
|
|
Term
| What organisms is associated with leech therapy for flap congestion and how should it be prophylactically managed? |
|
Definition
| Leech species used is the Hirudo medicinalis. Organism to look out for is Aeromonas hydrophila (GNR native to leech microbiome) |
|
|
Term
| Which flap is useful for philtrum defects? What about commissure defects? |
|
Definition
1) Abbe
2) Estlander
3) Karapandzic is good for large upper lip defects (>1/2) without philtrum involvement |
|
|
Term
| What nerve is most commonly injured in deep plane face lift? |
|
Definition
|
|
Term
| What is the nasal "tripod"? |
|
Definition
| Conjoined medial crura and bilateral lateral crura. This tripod is fundamental to nasal tip projection |
|
|
Term
| True or false: pediatric nasal fractures should be reduced more rapidly than adult? |
|
Definition
| True. Heal faster. Do within 4 days vs. 10 days for adults |
|
|
Term
| Which chemical peal agent needs to be neutralized? |
|
Definition
| Glycolic acid- 5% sodium bicarbonate |
|
|
Term
| What are the components that make up the INV? How can collapse be addressed? |
|
Definition
1) upper lateral cartilage, septum, head of inferior turbinate.
2) Septoplasty, ITR, spreader grafts, alar battan grafts (structureal support to lateral nasal wall preventing collapse with inspiration) |
|
|
Term
| What order is appropriate for botox and laser resurfacing for addressing facial rhytids? |
|
Definition
| Botox first to relax underlying facial musculature, followed by staged laser 1-2 weeks later |
|
|
Term
| How is the Millard method of unilateral clef lip repair described? |
|
Definition
| Rotational advancement flap of mucucutanous flap from lateral lip element into gap of upper portion of lip leading to inferior downward rotation of medial lip element |
|
|
Term
| What are the major nasal tip support structures? |
|
Definition
1) Attachment of upper and lateral lower cartilages.
2) Medial crura attachment to inferior septal angle
3) Strength and resliance of alar cartilage. |
|
|
Term
| what is width-to-length ratio for fusiform exision of skin lesion in cosmetically sensitive area? |
|
Definition
| 1-3. Avoids coning. 1-4 will make very long scar |
|
|
Term
| When shoudl ENoG be performed for facial nerve paralysis? |
|
Definition
| After 72 hours (time for Wallerian degeneration) but before 2 weeks. If >90% weakness, should perform exploration and decompression |
|
|
Term
| Where is temporal branch of facial nerve located in temporal area? |
|
Definition
| On undersurface of temporoparietal fascia |
|
|
Term
| Describe class III occlusion |
|
Definition
| Buccal groove of mandibular first molar is mesially positioned relative to mesial buccal cusp of first maxillary molar. |
|
|
Term
| When is a direct brow lift particularly useful? |
|
Definition
Brow asymetry and receding hairline.
Can't use endoscopic if hairline is very receeded or if there is excessive forehead curvature. |
|
|
Term
| What symptom might you expect with a longtitudinal temporal bone fracture that crosses just anteriorly to geniculate ganglion? |
|
Definition
| Eye dryness. GSPN comes off CN VII just anterior to geniculate, which contains parasympathetics to lacrimal gland (joins deep petrosal to form vidian and synapses in PP fossa). |
|
|
Term
| When should you avoid immediate repair of a ZMC fracture with orbital complications? |
|
Definition
| Acute Hyphema. Wait 1-2 weeks or risk glaucoma and permanent vision loss from rebleeding. |
|
|
Term
| How long does it take or new blood supply to grow for FTSG? |
|
Definition
| 3-5 days. Initially nutrition is from diffusion of nearby fluids by Plasma Imbibition |
|
|
Term
| What is the sensory innervation of the external ear? |
|
Definition
1) Nervus intermedius of CN VII is conchal bowl
2) Great auricular is mastoid skin, medial pinna and posterior portion of lateral surface of auricle
3) Auriculotemporal (V3) is anterrior bony/cartilagenous EAC
4) Auricular branch of vagus (Arnold) supplies floor of EAC (reason why sore throat from ear infection and cough from cerumen disimpaction). |
|
|
Term
| What nerve innervates taste sensation to soft pallate? What structure does it pass through? |
|
Definition
| GSPN (CN VII), which is given passes through anteriorly the geniculate ganglion into the Pterygoid canal, ultimately forming the vidian nerve (joins with deep petrosal) synapsing in PPF |
|
|
Term
| What is a marginal reflex distance, why is it done and what is a normal range? |
|
Definition
1) Relationship between upper eyelid margin and central cornela light reflex
2) Physical exam for ptosis and levator function
3) 3-4.5 mm is normal (overall average of palpebral fissue is 9mm) |
|
|
Term
| What is the earliest time to use rib grafting for microtia? What about medpore? |
|
Definition
1) 6 years
2) 3 years
Type 1: all major external ear structures are present with mild deformity not requiring tissue transfer
Type II has most major external structures, but there is noticable tissue deficit and surgical repair needs cartilage and skin
Type III has no recognizable auricular landmarks |
|
|
Term
| What are the stages of vascular supply for a STSG? |
|
Definition
1) Imbibition 24-48h
2) Inosculation 48h
3) Angiogenesis days 4-7 |
|
|
Term
| What wrinkles are created by which muscles? |
|
Definition
1) Vertical glabbellar- Corrugator supercilli
2) Horizontal inferior glabellar- Procerus
3) Deep horizontal forehead- Frontalis
4) Crow's feet- Orbicularis |
|
|
Term
What type of INV narrowing is described by inferior displacement of upper lateral cartilages after rhinoplasty?
What about a nasal dorsum step-off? |
|
Definition
1) Inverted-V
2) Rocker
Also remember saddle nose (Cartilagenous dorsal collapse), open roof (gap between dorsal septum and lateral nasal wall), and Pollybeak (relative underprojection of tip with respect to dorsum) |
|
|
Term
| How much bone length can you get from a FFF? What is the blood supply and innervation? |
|
Definition
25cm
Dual supply from Peroneal artery. Vena comitantes for vein. Sural nerve |
|
|
Term
| What is the most common presenting symptom of isolated sphenoid opacification? |
|
Definition
Headache (62%) followed by visual disturbances
Comprises 1-3% of all sinus disease, with 32% harboring underlying neoplastic process (2/3 are IP or SCC and 1/3 are extensions of extrasinus tumors) |
|
|
Term
| What is the most sensitive test for fungal sinusitis? |
|
Definition
CT is 100% sensitive with mottled appearance, bony sclerosis, and calcificaitons
MRI is 21% sensitive but good for extra-sinus extension |
|
|
Term
| How can one identify the likely location of the sphenoid ostium? |
|
Definition
| 30 degree angle from floor of nasal cavity, 7cm from anterior nasal spine. Usually immediately adjacent to posterior nasal septum |
|
|
Term
| What percent of sphenoid carotids are dehiscient? |
|
Definition
|
|
Term
| Describe sensory anatomy of V3 |
|
Definition
| from frontal, lacrimral and nasociliary (gives off anterior ethmoid for nasal alae) |
|
|
Term
| Which nasal spray is safe in pregnancy? |
|
Definition
|
|
Term
| What are the anatomic boundaries of the frontal recess? |
|
Definition
| EB anteriorly, LP laterally and MT medially |
|
|
Term
| 2 year old with bluish soft puslatille mass with nasal dorsum defect. Elarges with compression of IVJ. What is it? |
|
Definition
| encephalocele. They enlarge with compression of the IJV, unlike glioma or dermoid |
|
|
Term
| Which factors are prognostic of poor survival in AFS? |
|
Definition
| ANC<1000, age, renal/liver failure, AMS, intracranial extension |
|
|
Term
| Distinguish between Mucor and Aspergillus in fungal sinusitis |
|
Definition
1) 7) Aspergillus has 45 degree septations (most common isolate in fungal ball). Culture on Sabourad agar.
2) Mucor is non-septate 90 degree broad branching.Usually in IFS, immunosuppressed (worse) or diabetic |
|
|
Term
| Which structures come from the ethmoturbinals 1-5? |
|
Definition
1) Ethmoid bulla and uncinate
2) Middle turbinate
3) Superior turbinate
4-5) Supreme turbinate |
|
|
Term
| What are the 5 criteria for AFS? |
|
Definition
1) Atopy
2) Polyposis
3) Asymetric, heterogenous and expansile filling often with orbital or skull base erosion
4) Eosinophilic mucin without invasion
5) positive fungal stain |
|
|
Term
| What is the histological appearance of Rhinoscleroma? |
|
Definition
| Caused by Klebsiella rhinoscleromatis, shows foamy histiocytes (Mikulicz cell) and bloated plasma cells (Russel bodies) |
|
|
Term
| What differentiates RAST (in vitro) allergy testing from skin testing? |
|
Definition
RAST is more expensive, more specific, less sensitive, takes longer (1-2 weeks).
It avoids risk of allergic response |
|
|
Term
| What is the most common benign mass in sinus cavity? Which sinus is most commonly affected? |
|
Definition
1) Osteoma
2) Frontal (80%) followed by ethmoid, maxillary and more rarely sphenoid |
|
|
Term
| How is Keros measurement made? |
|
Definition
mm from cribriform to fovea ethmoidalis
1) 1-3mm
2) 4-6mm
3) 8-16mm |
|
|
Term
| Where does the uncinate attach most commonly? How does this affect frontal drainage? |
|
Definition
1) LP, drains medially to uncinate and infundibulum
2) in 20% of cases, it attaches to skull base (or even middle turbinate), leading to drainage lateral to uncinate into the infundibulum |
|
|
Term
| How is mucosal melanoma staged? |
|
Definition
Presence starts with T3 (no T1 or T2). T4a invades deep soft tissue, cartilage, bone or overylying skin. T4b is very advanced.
There is N1, no N2-N3. |
|
|
Term
| What percentage of nasal resistance comes from INV? |
|
Definition
50%
Septum medially, inferior turbinate face inferolaterally, upper lateral cartilage superolaterally |
|
|
Term
| What differentiates Gardasil from Cevarix? |
|
Definition
| Gardasil hits more HPV strains (6, 11, 16, 18) and is approved in both men and women |
|
|
Term
| What are the classic elements of AFS diagnosis? |
|
Definition
1) Unilateral sinusitis
2) Allergic musin with eosinophils and Charcot-Leyden crystals (eosinophil degeneration)
3) Demonstrated allergy to fungal species
4) Associated with nasal polyposis
5) CT findings of peripheral hypolencency with central hyerdense material and speckled areas in addition to peripheral bony sclerosis. |
|
|
Term
Cystic mass of petrous apex on CT with evidence of bony erosion/remodeling. The most common benign lesion of the petrous apex.
What is it? What is the histology? How do you treat it? |
|
Definition
1) Cholesterol granuloma
2) Histology will show multinucleated giant cells and histiocytes surrounded by cholesterol deposits.
3) Transphenoidal endonasal if possible, less recurrence compared to transotic |
|
|
Term
| Which bacterial organism in acute sinusitis is most likely to resolve without antibiotics? |
|
Definition
|
|
Term
| Why use total IV sedation for ESS? |
|
Definition
|
|
Term
| What is the mechanism of increased susceptibility to IFS in diabetic patients? |
|
Definition
| Altered transferrin binding lead to increased serum iron concentrations, which facilitates fungal growth (higher serum iron is linked to lower survival) |
|
|
Term
| What membrane does the internal branch of the superior laryngeal nerve pass and what artery accompanies it? |
|
Definition
Thyrohyoid, superior laryngeal artery
Supplies sensation to larynx above glottis. |
|
|
Term
| What is TNM staging for nasopharyngeal carcinoma |
|
Definition
T1: nasopharynx, oropharynx, nasal cavity only
T2: Parapharyngeal space and pterygoid muscle, no bone invation
T3: Bone and/or paranasal sinuses
T4: Intracranial or cranial nerve
N1: unilateral <6 above cricoid
N2: bilateral <6 and/or below cricoid
N3a: >6
N3b: Supraclavicular |
|
|
Term
| What is the only form of primary 4-gland hyperparathyroidism where superior glands are larger than inferior glands? |
|
Definition
Water Cell Hyperplasia. Histologically looks a bit like renal cell carcinoma
Require 4 gland exploration |
|
|
Term
| What is the most prognostic factor for malignant melanoma, stage III? |
|
Definition
Number of metastatic nodes most important for stage III
Tumor thickness is most important for stage 1 or stage 2 disease.
Ulceration is also prgnostic |
|
|
Term
| What orbital site is primary disease site for Graves vision changes? What is the pathophysiology? |
|
Definition
EOM. Muscular enlargement is due to profileration of fibroblasts and lymphocytic infiltration.
Most common site for decompression is endoscopic medial orbital wall. Watch out for strabismus. |
|
|
Term
| What are the main limitations of sestambi scanning for parathyroid pathology? |
|
Definition
| Cannot detect small (<1.5cm) adenomas or hyperplasia. |
|
|
Term
| Why is adjuvent local radiation always a good idea for parotid adenoid cystic? |
|
Definition
| PNI. Local lymphatic spread less likely so elective neck only if neck disease. |
|
|
Term
| What is the main side effect of Octreotide. When is it commonly used in H & N cancer? |
|
Definition
Gallstones
Chyle fistula- Somatostatin analog that reduces splanchnic blood flow and chyle production |
|
|
Term
| Where does adenoid cystic most commonly metastasize to? |
|
Definition
| Lung. Remember, less local lymph nodes and more PNI |
|
|
Term
| How are patterns of pediatric salivary gland masses different in children and adults |
|
Definition
50% of kid pediatric salivary gland masses are malignant, most often MEC.
Most often low grade |
|
|
Term
| Which organism causes jugular vein suppurative thromboplhebitis (Lemierre's) most commonly? |
|
Definition
| Anaeobe Fusobacterium necrophorum. |
|
|
Term
| Which of the 5 soft palate muscles are innervated by V3? |
|
Definition
Tensor veli palatini.
Others innervated by CN X, including palatoglossus, palatopharyngeus, levator veli, uvulae |
|
|
Term
| What percentage of oropharyngeal cancers in US are HPV+ |
|
Definition
|
|
Term
| What is the artery and nerve associated with the first branchial arch? |
|
Definition
|
|
Term
| What is the most common presenting symptom of a glossopharyngeal schwanomma? How do they appear on MRI? |
|
Definition
Mid-frequency SNHL
They enhance brightly with gadolinium |
|
|
Term
| When is post-operative chemoradiation indicated for advanced surgically treated H & N cancer? |
|
Definition
| Positive margins, ENE, distant mets |
|
|
Term
| Which nerve is associated with each branchial arch? |
|
Definition
1- V
2- VII
3- IX
4- Superior laryngeal
6- RLN |
|
|
Term
| True or false: ORN is typically independent of radiation dose |
|
Definition
|
|
Term
| What are the load-sharing solutions to mandibular fractures? |
|
Definition
| Miniplate fixation, compression plates, lag screws. For these to work, significant bone-to-bone contact is needed and the bone must be strong (not atrophic) |
|
|
Term
| What are the load-baring solutions to mandibular fractures? |
|
Definition
Needed when weak bone is present or if there is significant communited fracture or bone loss.
Example is a 2.4mm plate with bicortical screws |
|
|
Term
|
Definition
<55 are stage 1 for no distant mets or stage II for distant mets
>4cm confined to thyroid or microscopic ETE means T3a. T3b refers to thyroid disease with gross ETE or strap involvement. |
|
|
Term
| When is neck dissection indicated in parotid pathology? |
|
Definition
1) Clinically apparent cervical lymphadenopathy
2) Parotid tumor> 4cm (20% risk vs. 4% risk <4cm)
3) High-grade histology |
|
|
Term
| Which division should be performed last in subtotal and total maxillectomy? |
|
Definition
| Pterygomaxillary (risk of Imax bleeding). |
|
|
Term
| What are the useful landmarks for identifying the facial nerve during parotidectomy? |
|
Definition
1) Tragal pointer: nerve is 1cm inferior and 1cm deep
2) Styloid process: nerve is posterolateral (if you find this process, you went too far)
3) TM suture line: nerve 6-8mm deep to suture (most reliable)
4) Posterior belly of digastric: nerve is anterior and medial to insertion |
|
|
Term
| Where do each branchial cleft anamalies (sinuses) typically terminate? |
|
Definition
1st: EAC
2nd: tonsillar fossa
3rd: through thyrohyoid membrane into piriform sinus |
|
|
Term
| Where do each branchial cleft anamalies (sinuses) typically terminate? |
|
Definition
1st: EAC
2nd: tonsillar fossa
3rd: through thyrohyoid membrane into piriform sinus |
|
|
Term
| When is a Bernard-Burow flap useful? |
|
Definition
| Lower lip defects that are large, midline and greater than 2/3. It is a modification of Karapandzic that advances cheek skin and buccal mucosa to close defect. Alternative is free flap. |
|
|
Term
| What are the boundaries of the Paraglottic space? Why is this space relevant? |
|
Definition
Fibro-fatty filled space outside of conus elasticus and quadrangular membrane that allows for transglottic extension of tumor.
1) Superomedial: quadrangular membrane
2) Mid-medial: ventricle
3) Inferiomedial: conus elasticus
4) Posterior: Pyriform sinus mucosa
5) Inferior: space between thyroid and cricoid cartilage
6) Lateral: thyroid cartilage and CT membrane |
|
|
Term
| What are the contents of the IT fossa? |
|
Definition
1) Lateral and medial pterygoids
2) V3
3) Chorda tympani
4) Otic parasympathetic ganglion
5) Maxillary artery
6) Pterygoid venous plexus
7) Deep lobe of parotid. |
|
|
Term
What are the mechanisms of the following chemotherapy agents?
1) 5-FU
2) Mitomycin C
3) MTX
4) Taxane |
|
Definition
1) Antimetabolite that binds thyrmidylate synthetase
2) Alkylating agent (myelosuppression and pulmonary toxicity)
3) Binds DHFR, causes mucositis, renal toxicity and hemorrhagic cystitis
4) Paclitaxel prevents microtubule depolymerization (neutropenia, neurotoxicity, alopecia) |
|
|
Term
| True or False: Any PTC in someone under 55 is stage 1, regardless of T and M stage, if no distant mets |
|
Definition
|
|
Term
| Which branchial arch produces the glottis? What else does this arch produce? |
|
Definition
6 vs. 3-4 which give rise to supraglottic larynx
Six also gives cricoid cartilage, RLN, esophageal musculature, intrinsic laryngeal muscles (except cricothyroid) |
|
|
Term
| Which structures pass between superior and middle pharyngeal constrictors? (muscle and nerve) |
|
Definition
| Stylopharyngeus and CN IX |
|
|
Term
| Which structures pass between superior and middle pharyngeal constrictors? (muscle and nerve) |
|
Definition
| Stylopharyngeus and CN IX |
|
|
Term
| What is Heerfortds syndrome? |
|
Definition
| Uveoparotid fevers associated with Sarcoidosis |
|
|
Term
| When is sentinal node biopsy indicated in melanoma? |
|
Definition
| Depth >0.8mm or <0.8mm with ulceration |
|
|
Term
| What is the treatment of choice for chondrosarcoma of the larynx? |
|
Definition
|
|
Term
| What are the contents of the post-styloid PP space? |
|
Definition
Sympathetic chain, CN IX, X, XII, ICA, IJV, lymph nodes
CN V has small branch to tensor veli through PRE-styloid PP space |
|
|
Term
| What are the contents of the pre-styloid PP space? |
|
Definition
| Deep parotid, lymph nodes, fat |
|
|
Term
| Which malignancy is associated with Sjogren's? |
|
Definition
|
|
Term
| Which tumor has physaliferous cells? What about cell balls of Zellballen? |
|
Definition
1) Chordoma (small round nuclei and abundant cytoplasm)
2) GLomus tumor |
|
|
Term
| Which branchial pouch gives rise to inferior vs. superior PT glands? |
|
Definition
Inferior is 3rd
Superior is 4th |
|
|
Term
| What two veins join to form the IJV vs. the EJV? |
|
Definition
IJ: common facial vein and sigmoid sinus
EJ: posterior facial vein and posterior auricular vein (within the partoid gland join) |
|
|
Term
| Which muscles receive superficial innervation from CNVII? |
|
Definition
Levator anguli oris, buccinator, mentalis
LBM |
|
|
Term
| What criteria is used to determine elective neck or oral tongue SCCa? |
|
Definition
| DOI >3mm. Usually do I-IV |
|
|
Term
| What are the bad anatomic locations for melanoma? |
|
Definition
| BANS: upper Back, posterior Arm, posterior Neck, Scalp (and ear) |
|
|
Term
| When is post-operative radiation therapy indicated for the H & N cancer? When should it be delayed? |
|
Definition
If >20% risk of locoregional metastasis, such as positive margins, >2 nodes, ECE, PNI/LVI.
Start within 6 weeks. ONLY delay if carotid exposure |
|
|
Term
| True or false: Patients with PTC and hashimotos tend to have more advanced cancer stage |
|
Definition
| False. Hashimotos is protective |
|
|
Term
| What are the indications for iodine after thyroidectomy? |
|
Definition
1) Size >4cm
2) Gross ETE
3) Distant mets
4) Increased post-op TG levels
5) Extensive vascular invasion |
|
|
Term
| How is T staging done for Melanoma? |
|
Definition
T1a- <8mm without ulceration
T1b- >8mm < 1mm or <8mm with ulceration
T2- 1-2mm
T3- 2-4mm
T4- >4mm
T2-4 is a vs. b depending upon ulceration |
|
|
Term
| How is T staging done for Melanoma? |
|
Definition
T1a- <8mm without ulceration
T1b- >8mm < 1mm or <8mm with ulceration
T2- 1-2mm
T3- 2-4mm
T4- >4mm
T2-4 is a vs. b depending upon ulceration |
|
|
Term
| Where is osteosarcoma most commonly found in H & N region? |
|
Definition
|
|
Term
| What is the rate of malignancy in a 1.2cm thyroid nodule that is read as follcular neoplasm? |
|
Definition
|
|
Term
| What is the arterial supply of the SCM? |
|
Definition
Upper= occipital
Middle= superior thyroid
Lower= suprascapular |
|
|
Term
| What is the afferent nerve supply of the carotid body? |
|
Definition
| Glossopharyngeal (Carotid sinus nerve branch). It is a chemoreceptor. |
|
|
Term
| When is radiation useful for Mercel cell carcinoma? |
|
Definition
| Stage I-II, adjuvent survival benefit after surgery. Less helpful for advanced, but chemotherapy can be helpful in this situation |
|
|
Term
| True or false: FNA of neck node revealing adenocarcinoma requires thyroglobulin and calcitonin testing |
|
Definition
|
|
Term
| What is malignant transformation rate for inverted papilloma? |
|
Definition
|
|
Term
| What is the most common cochlear malformation? |
|
Definition
Incomplete partition. Only completes 1-1.5 turns instead of 2.5.
The only contraindication for CI is cochlear hypoplasia |
|
|
Term
| Why is stapes surgery contraindicated in MD? |
|
Definition
Risk of profound SNHL
Dilated saccule in endolymphatic hydrops makes injury common.
Other contraindications include TM perforation, active OM, only hearing ear. |
|
|
Term
| How does prognosis for facial paralysis from Ramsey Hunt compare to Idiopathic Bells? |
|
Definition
| Worse. 50% have HB IV-VI. Can affect both motor and sensory. Standard treatment is Valacyclovir (1g TID for 7-10d) and Prednisone |
|
|
Term
| What are the classic features of Pendred Syndrome? |
|
Definition
| Thyroid goiter, Bilateral dilation of vestibular aqueduct +/- cochlear hypoplasia, Mondini malformation, SNHL, all associated with defective ion transport |
|
|
Term
| What situation creates a maximal CHL? |
|
Definition
| 60dB Ossicular discontinuity with intact TM (migrated PORP or trauma) |
|
|
Term
| What are the functions of the nervus intermedius (of Wrisberg)? |
|
Definition
In IAC, the NI runs as separate nerve between facial and superior vestibular nerves.
1) Parasympathetic secretory fibers for lacrimal gland as well as SMG and SLG
2) Afferent taste fibers for anterior 2/3 of tongue
3) Senstory fibers to posterior wall of EAC and post-auricular area |
|
|
Term
| Most common cause of bilateral facial paralysis? |
|
Definition
|
|
Term
| What is Hitzelberger sign? |
|
Definition
| Decreased sensitivity in posterior-superior concha, sensory distribution of CN VII (space occupying lesion in IAC) |
|
|
Term
| What is the most common cause of objective tinnitus? |
|
Definition
Palatal myoclonus (tensor veli palatini)
Also vascular lesions, malformations |
|
|
Term
|
Definition
Rare congenital disorder of hindbrain with CN VI and VII palsies, usually with craniofacial and limb abnormalities and neurological dysfunction.
Type 1: Micrognathia, limb, dysphagia
Type 2: Developmental delay, radiologically detectable neurologic abnormalities |
|
|
Term
| What is Donaldson line useful for? |
|
Definition
Imaginary line drawn posteriorly through plane of horizontal SCC during endolymphatic decompression surgery.
It is posterior to the mastoid facial nerve, anterior to the sigmoid sinus and inferior to the antrum. |
|
|
Term
| What can SP/AP ratio be used for diagnostically? |
|
Definition
| Electrocochleagraphy for endolymphatic hydrops. Ratio >0.4 suggests endolymphatic hydrops. |
|
|
Term
| Where are most congenital cholesteatomas found? |
|
Definition
| Male:Female 3:1. Usually in anterior superior quadrant |
|
|
Term
| What is the most common site of perilymphatic fistula? |
|
Definition
| Anterior to the anterio crus of the stapes |
|
|
Term
| What are the Sunderland nerve injury classifications? |
|
Definition
1) Neuropraxis (compression causing loss of axoplasmic flow)
2) Axonotmesis (axon transection with subsequent wallerian degeneration)
3) Neurotmesis (neural tube is transected).
4) Violation of perineurium.
5) Complete transection |
|
|
Term
Which ototoxic medications affect which parts of the cochlea?
1) Aminoglycoside
2) Cisplatin
3) Carboplatin
4) Diuretics |
|
Definition
1) Basal OHCs in 15% with preceding tinnitus. Spreads apically
2) High frequency SNHL bilateral and symmetric in 20% of patients with damage to stria vascularis and basal OHCs
3) Carboplatin damages IHCs
4) Diuretics cause SNHL via damage to stria vascularis |
|
|
Term
|
Definition
| XLD with high-frequency SNHL and renal failure |
|
|
Term
| How does central vertigo differ from peripheral? |
|
Definition
Central
- Milder intensity
- Nystagmus worse with fixation
- Does not fatigue
- Vertical and bilateral nystagmus
Peripheral
- More intense
- Fatiguable
- Hearing loss, nausea, sweating
- Usually horizontal, unilateral and rotary |
|
|
Term
| What are the Autosomal Dominant congenital hearing loss syndromes? |
|
Definition
WANT BCS
1) Waardenberg
2) Apert
3) NF
4) Treacher Collins
5) BOR syndrome
6) Crouzon
7) Stickler |
|
|
Term
| What is the inheritance of aminoglycoside-sensitivity for hearing? |
|
Definition
|
|
Term
| Describe the origin and course of the nerve of the pterygoid canal. |
|
Definition
1) General visceral efferents originate from superior salivatory nucelus in pons, travel through nervus intermedius to the geniculate ganglion
2) NI give rise to GSPN (parasympathetics), which joins deep petrosal nerve (carries symppathetics) to form the nerve of the pterygoid canal
3) Nerve of pterygoid canal travels to sphenopalatine ganglion
4) From SPG, parasympathetic fibers travel to zygomaticotemporal nerve up to the lacrimal gland |
|
|
Term
| Where do each component of the stapes arise embryologically? |
|
Definition
1) Suprastructure: second branchial arch
2) Footplate: Otic mesenchyme |
|
|
Term
| Where do the ossicles arise from embryologically? |
|
Definition
1) First branchial arch (Meckels)
- Head and neck of malleus
- Body and short process of incus
2) Second branchial arch (Reichert's)
- Manubrium of malleus
- Long process of incus
- Stapes superstructure
3) Otic mesenchyme
- Stapes footplate |
|
|
Term
| What type of repair is the Millar method for unilateral cleft lip repair? |
|
Definition
| Rotation-advancement of mucocutaneous flap from lateral lip element into gap of upper portion of lip resulting from inferior downward rotation of the medial element |
|
|
Term
How can the following lower eyelid lesions be closed after resection of cancer?
1) 25% or less
2) 1/3-2/3
3) 50-100% |
|
Definition
1) primary closure
2) lateral canthotomy and semicircular advancement (Tenzel)
3) Hughes tarsocojunctival flap |
|
|
Term
| How is inadvertent damage to parotid gland parenchyma or ductal drainage system during face lift managed? |
|
Definition
| Can use pressure dressing, drain placement, serial aspiration, anticholinergics (Botox or Scopolamine), parotidectomy |
|
|
Term
| What are the components of Baker's chemical peal? |
|
Definition
1) Croton oil (2-3 drops): main wound forming agent
2) Phenol 88%
3) Septisol (8 drops)
4) Distilled water (2ml) |
|
|
Term
| When is ENOG useful after sudden facial paralysis? |
|
Definition
between 3-14 days. Have to wait 72h for Wallerian degeneration.
Patients who have >90% weakness compared to contralateral need surgical decompression within 2 weeks |
|
|
Term
What are the following distances with regards to nasal analysis?
1) Distance from nasion to subnasale
2) Bony width of nose relative to alar base
3) Nasal tip projection as % of nasal length from nasion to tip-defining point
4) Normal columellar show |
|
Definition
1) 43% of nasion to menton distance
2) 70-80%
3) 60% (3/5)
4) 2-4mm |
|
|
Term
What are the advantages of a RFFF?
What percent of patients have incomplete superficial palmar arch (poor communication between deep and superficial arches)? |
|
Definition
RFFF has long vascular pedicle, favorable vessel caliber, acceptable functional morbidity at donor site.
12% have this issue, precluding safe harvest of radial artery |
|
|
Term
| What cartilage is used as an auto-spreader graft to increase patency of INV during FSRP? |
|
Definition
Upper lateral cartilage.
Remember, INV is formed by septum, caudal border of ULC, anterior face of turbinate, piriform aperture |
|
|
Term
| What can happen as a complication of lateral osteotomies that are superior to medial canthus during a correction of open roof deformity after hump reduction? |
|
Definition
| Rocker deformity (Step off) |
|
|
Term
| What artery is most commonly damaged during injection of the melolabial fold? |
|
Definition
Angular artery. Branch of facial artery providing nasal ala, sidewall and dorsum.
Remember, dorsal nasal artery is one of two terminal branches of opthalmic |
|
|
Term
| What types of collagen are laid down during wound healing and when? |
|
Definition
| Initially type III, even with type I at 3 weeks, by 6 weeks mostly type I. |
|
|
Term
| What are the features of the lower lateral cartilage on the cleft side of a unilateral cleft deformity? |
|
Definition
1) Elongated lateral crus
2) Blunted dome
3) Posteriorly, laterally and inferiorly displaced alar base |
|
|
Term
| What differentiates orbital apex syndrome from superior orbital fissure syndrome? |
|
Definition
1) Orbital apex
- Involvement of optic nerve, commonly with papilledema
- V1, CN III, IV, VI
2) Superior orbital fissure
V1, CN III, IV, VI |
|
|
Term
| What type of tissue is best to receive FTSG? |
|
Definition
| Area with thin kin and concavity, such as the temple. |
|
|
Term
| What are the two major components of prominent ear deformity? |
|
Definition
1) Unfolding of the antihelical fold (73% of prominence)
2) Large conchal bowl (27%)
A prominent ear is defined as a auriculocephalic angle > 40 degrees or a helix to scalp distance of greater than 2.5cm. |
|
|
Term
| What is the appropriate angle to plan a Z plasty for scars that need rotation of 90 degrees, 60 degrees and 45 degrees, respectively? Comment on lengthening? |
|
Definition
1) 90 degree rotation for a 60 degree Z plasty, with 75% lengthening
2) 60 degree rotation for a 45 degree z-plasty for 50% elongation
3) 45 degree rotation for a 30 degree z plasty, with 25% lengthening |
|
|
Term
What is wound strenght at each of the following points post-incision?
1) 1 week
2) 5 weeks
3) 12-18 months |
|
Definition
|
|
Term
What is the innervation of each part of the ear?
1) Mastoid region, medial pinna, posterior portion of lateral surface of auricle
2) Floor of EAC
3) Anterior EAC (osseous and cartilage)
4) Conchal bowl |
|
Definition
1) Great auricular
2) CN XII (Jacobson)
3) V3 (auriculotemporal)
4) CN VII |
|
|
Term
| What muscle do you inject botox in for marionette lines? |
|
Definition
Depressor anguli oris
Originates at mandibular border and inserts at corner of the mouth. Contraction turns corner of mouth with frowning or displeasure. |
|
|
Term
| When should you consider dermabrasion after paramedian forehead flap? |
|
Definition
|
|
Term
| Which incisions are used for mid-face degloving as part of ORIF for lefort II? |
|
Definition
1) Full transfixion
2) Intercartilagenous
3) Sublabial |
|
|
Term
| Describe the Dedo classification of skin laxity |
|
Definition
1) Minimal deformity
2) Skin laxity
3) Adiposity (liposuction and consideration of platysmaplasty)
4) Anterior banding of platysma
5) Chin augmentation for microgenia or mandibular advancement for retrognathia
6) Inferior positioned hyoid (can divite musculature from mandible) |
|
|
Term
| What is the most common location of pediatric mandible fractures? |
|
Definition
|
|
Term
| What is the dissection plane for a Gilles approach to ORIF or zygomatic arch fracture? |
|
Definition
| Deep to deep temporal fascia. The incision in the temporal hair tuft should avoid the facial nerve, which is below the TPF. |
|
|
Term
| What are the stages of wound healing? |
|
Definition
1) Inflammatory: vasodilation, immune cell response (PMN and phage). 3-7days
2) Proliferative: Peaks at 3 weeks
3) Maturation/remodeling: Conversion of type III collagen to type 1, regression of vascularization, increased wound tensile strength |
|
|
Term
| What is the rule of 10s for cleft lip? |
|
Definition
| Repair should be done when the child has hgb of 10, 10 lbs and 10 weeks (3 months) old). |
|
|
Term
| You need to do a brow lift, gold weight and canthoplasty for someone with facial nerve paralysis who has brow ptosis, incomplete eyelid closure and ectropion. What is the correct order? |
|
Definition
1) Brow lift
2) Gold weight
3) Canthoplasty |
|
|
Term
| What structures make up the ENV and the INV? |
|
Definition
1) ENV
- Nasal sill, lower lateral cartilage, columella
2) INV
- Head of inferior turbinate, caudal border of upper lateral cartilage, piriform aperture, caudal septum |
|
|
Term
| What is the arterial/venous supply of the ALT? |
|
Definition
Descending branch of lateral circumflex femoral artery. Lateral femoral cutaneous nerve of thigh.
Pedicle length is up to 7cm
PVD is not a contraindication because of unnafected perforators, which can be a benefit, as well as soft tissue coverage. |
|
|
Term
| How can you manage post-inflammatory hyperpigmentation after skin resurfacing? |
|
Definition
| Hydroquinone and sun block and skin exfoliant. |
|
|
Term
| Which anesthetic has been shown to increase flap survival |
|
Definition
| Isoflurane (sympatholytic vasodilator) better than nitrous oxide |
|
|
Term
| What is the most common type of BCC? What is the most aggressive? |
|
Definition
1) Nodular- rolled border and frequent ulceration
2) Sclerosing (morpheaform) white or pink plaque with unpredictable arms of tumor cells and skip lesions |
|
|
Term
| How does minoxidil topical work for hair loss? |
|
Definition
| Increases diameter of existing fibers and the percentage of anagen follicles |
|
|
Term
| Which incision is necessary for a retrograde approach to nasal tip? |
|
Definition
|
|
Term
| What is the best method for addressing brow asymetry? |
|
Definition
|
|
Term
| What happens to the epidermis, dermis and elasticity of skin with aging? |
|
Definition
| Epidermis and dermis thins. Ground substance of dermis (connective matrix) increases. Elastin decreases. |
|
|
Term
| What is the narrowest portion of the facial nerve and the most commonly injured in Bells? |
|
Definition
| Labrynthine segment (0.7mm in fallopian canal) |
|
|
Term
| How long does it take for BotoxA to produce muscle weakness? |
|
Definition
|
|
Term
| What are the major known risk factors for hematoma after face lift? |
|
Definition
1) Male
2) EDS
3) HTN
4) ASA,NSAIDS other ACs
5) High doses of Vitamin E |
|
|
Term
| When in development can Medpore or Rib grafting be considered for microtia? |
|
Definition
1) Medpore 3 years
2) Rib 6 years (auricle has 95% of adult size) |
|
|
Term
| Hows is the levator palpebrae superioris suspended? |
|
Definition
| Whitnall ligament- hammock stretching between medial and lateral canthal tendons. Encloses the inferior oblique and inferior rectus muscles |
|
|
Term
| Which EOM is most commonly injured in blepharoplasty? |
|
Definition
| Inferior oblique from cauterization of the medial and central fat pads inferiorly |
|
|
Term
| What are the two incisions for an external rhinoplasty? How does this differ from endonasal incisions? |
|
Definition
1) External: Marginal and Transcolumellar
2) Endonasal: Marginal, intercoartilaginous and full transfixion |
|
|
Term
| What are the 4 stages of hair growth? |
|
Definition
1) Anagen (growth): 90% of scalp hairs, lasts 3-4 years
2) Catagen (involution)
3) Telogen (rest phase): 10% in this phase. Lasts 3-4 months without active growth.
4) Exogen (shedding) |
|
|
Term
| Where is the optimal place to harvest a split calvarial bone graft? |
|
Definition
| 2cm inferior to saggital suture on parietal bone. Parietal bone is thickest and need to avoid suture. |
|
|
Term
| What 3 vessels supply the Trapezius? |
|
Definition
1) Occipital
2) Transverse cervical
3) Dorsal scapular |
|
|
Term
| Where should botox injections be placed to maximize brow elevation? |
|
Definition
|
|
Term
| What type of immune reaction is post-streptococcal glomerulonephritis? |
|
Definition
| Type III- Immune complex deposition in glomeruli. Symptoms include HTN, edema and hematuria. |
|
|
Term
| Which cytokines are allergic? |
|
Definition
1) IL-4 (secreted by T cells and mast cells to promote TH2 production)
2) IL-5 secreted by T cells, mast cells and B cells to promote eosinophil differentiation and proliferation
3) IL-13 secreted by activated T cells and stimulates B cell growth and IgE class switching. |
|
|
Term
| What are the classic physical findings of allergic rhinitis? |
|
Definition
1) Allergic shiners (venous congestion)
2) Dennie's lines (fine lower eyelid creases) from spasm of Mueller's muscle
3) Allergic salute from nose wiping
4) Pharyngeal cobblestoning (prominent lymphoid tissue) |
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Term
| How long does intradermal immunotherapy take? |
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Definition
Starts at 12 weeks and increases over 1-2 period after treatment.
Duration of treatment is 3-5 years |
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Term
| Explain the different points of intradermal diluational testing including 1) positive test, 2) endopoint of titration, 3) flash response, 4) plateu response, 5) confirmation wheal |
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Definition
1) Wheal enlarges by 2mm
2) The first dilution which yields a wheal at least 2 mm larger than the preceeding negative wheal and followed by a wheal at the next stronger dilution that is at least 2 mm larger (this is concentration to safely start immunotherapy).
3) Very rigorous positive wheal response (stop testing here)
4) No progressive wheal growth after endopoint.
5) Confirming wheel is next concentration after endpoint that gives a positive wheal |
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Term
| What immunological changes take place with immunotherapy? |
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Definition
1) Th2-->Th1 response
2) Increased IL-10 and IgG4 (blocks IgE activation of mast cells and basophils)
3) Suppress IgE-mediated degranulation, mast cells and memory B cells |
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Term
| Which IG can pass the placenta? |
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Definition
| IgG NOT IgM (which is pentavalent) |
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Term
| What are the most common IgG deficiencies in adults and children? |
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Definition
1) Children: IgG2- encapsulated bacteria such as haemophilus B
2) Adults: IgG3- URIs, allergic rhinitis and asthma |
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Term
| What is Bruton's agammaglobulinemia and how does it present? |
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Definition
1) X-linked defect in TK leading to sinonasal and pulmonary infections due to lack of B cell maturation and IgG deficiency
2) Usually at 6 months, when protecting maternal IGs are gone. |
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Term
| What is Wiskott Aldrich syndrome and how does it present? |
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Definition
1) X-linked disorder with thrombocytopenia, Eczema and bacterial infections
2) Low IgM, and elevated IgE and IgA |
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Term
| Which medications interfere with skin prick allergy testing? |
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Definition
1) TCAs (amatryptaline) reduce activity
2) Diphenhydramine and other anti-histamines blunt reaction for 24-36h
3) Theophylline inhibits testing
4) Topical steroids campen effects
Oral steroids are OK! |
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Term
| What are examples of type IV immune reactions? |
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Definition
Delayed type anti-body independent, T-cell mediated
Poison Ivy, TB test |
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Term
| How does Azelastine work? |
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Definition
| Second-generation H1 receptor antagonist for seasonal allergic rhinitis and vasomotor rhinitis |
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Term
| Why might an infant be born with a cleft palate and tetany? |
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Definition
Di-George q22
CATCH-22
- Cardiac
- Abnormal facies
- Thymic aplasia
- Cleft lip
- Hypoparathyroidism |
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Term
| Allergies to latex have cross-reactivity with which other substances? |
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Definition
| Banannas, Avacados, Kiwis |
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Term
| What are the typical allergens by season? |
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Definition
1) Spring: trees
2) Summer: grass
3) Fall: ragweed |
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Term
| Which changes to IgE predict a positive clinical response to immunotherapy? |
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Definition
1) Low levels of total IgE and blood eosinophils
2) Hihg levels of specific IgE and high specific IgE to total IgE ratio
3) increase IgG4 |
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Term
| What are the clinical benefits of ASA desensitization for AERD? |
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Definition
1) Decreased sinonasal symptoms
2) Decreased asthma symptoms
3) Less need for surgery
4) Fewer sinus infections
DOES NOT CHANGE EXISTING POLYPS |
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Term
| What is the mechanism of action of ASA? |
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Definition
| Inhibits cyclo-oxygenase, decreasing prostaglandin and thromboxane productino and shifting towards leukotriene production via lipoxygenase pathway |
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Term
| What are the 1st generation vs. 2nd generation antihistamines? |
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Definition
1) Lipophilic and cross BBB (Sedating)
- Diphenhydramine, hydroxyzine and clorpeniramine
2) Lipophobic
- Cetirizine and fexofeadine
- Least sedating option is Fexofenadine or Loratidine |
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Term
| True or false: Food allergens are not responsive to immunotherapy |
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Definition
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Term
| Where do thyroid parafollicular cells arise from? |
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Definition
| Ultimobranchial body (Part of fourth branchial pouch). MTC arises from these cells. |
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Term
| What are the criteria for determining parathyroid carcinoma constitutes a malignancy? Where are typical metastasis? |
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Definition
1) Invasion of surrounding structures OR metastasis. Harder to diagnose comparatively
2) Lung |
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Term
| What are the malignancy rates by Bethesda class? |
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Definition
1) II (benign): 0-3%
2) III (Follicular lesion of undetermined): 5-15%
3) IV (Follicular neoplasm): 15-30%
4) V (Suspected): 60-75%
5) VI (Malignant) 97-99% |
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Term
| In 4 gland exploration, if an inferior PT gland is missing, where would you look? |
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Definition
| Thymus (both 3rd branchial pouch) and anterior superior mediastinum |
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Term
| How does hyperparathyroidism manifest in MEN? |
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Definition
1) MEN1 has 4-gland hyperplasia
2) MEN2a usually adenoma |
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Term
| What TSH level is target to increase RAI uptake in tumors? |
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Definition
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Term
| How is BRAF V600E mutational analysis useful? |
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Definition
| Specific for PTC. Increases TMN stage. |
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Term
| Where are the superior parathyroid glands found anatomically? |
|
Definition
Derive from 4th branchial
Typically 1cm above the junction of RLN and inferior thyroid artery |
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Term
| What are the SE of RAI? Who needs it? |
|
Definition
1) Acute sialoadenitis, taste disturbance, nausea, epiphoria
2) T4 disease or >45 with T3 disease |
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Term
| What are the risk factors for worse prognosis in PTC? |
|
Definition
1) Male
2) Large lesion (>5cm)
3) Distant metastasis
4) Gross ETE |
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Term
| What is the intraoperative biochemical confirmation for successful parathyroid surgery for hyperparathyroidism? |
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Definition
| 1) >50% drop in pre-excision level AND
2) |
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Term
| What do you do for thyroid hormone mgmt if a patient is on estrogen? |
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Definition
| Usually needs more because of increased TBG. NOT true or progesterone |
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Term
| What are the indications for surgery for asymptomatic primary hyperparathyroidism? |
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Definition
1) Serum > more than 1.0 mg/dL above normal
2) CrCl reduced by more than 30% for age in absence of another cause
3) <50 years
4) 24h calcium >400
5) BMD more than 2.5 SD reduction by T score |
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Term
| What is the chance that a nodule that is hypofunctional in a patient with graves disease represents thyroid cancer? |
|
Definition
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|
Term
| What is the threshold to institute CPAP therapy for OSA? |
|
Definition
1) Symptomatic moderate AHI 15-30
2) Anyone with severe AHI >30 |
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Term
| What is the definition of CPAP compliance? |
|
Definition
| 4h per night, 5 nights a week |
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Term
| When might intranasal DDAVP be useful in long-term mgmt of epistaxis? |
|
Definition
| Uremia causing platelet inactivation |
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Term
| How long prior to RAI do you need to stop bytomel and synthroid? |
|
Definition
1) Cytomel 2 weeks
2) Synthroid 6 weeks |
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Term
| What frequencies are affected in ototoxicity? Where is the cochlea first damaged? |
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Definition
| High frequencies, Basal turn first (inner row) |
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Term
| How is Friedman's staging applied to mgmt of OSA? |
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Definition
Determines likely success of UPPP, as measured by AHI <20 or greater >50% reduction in AHI.
1) BMI (> or < 40)
2) Tonsil grade (1-4)
3) Palate position (1-4)
Overall stages are 1-3. Stage 1 has 80% success rate with surgery. If Stage 2 or 3, it should NOT be UPPP alone. |
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Term
Which sleep stage is characterized by each?
1) Sleep spindles and K-complexes
2) Alpha waves
3) Slow waves with large amplitudes (delta waves)
4) Low-amplitude waves with sharp waves over vertex with slow eye movents
5) Low EMG tone, rapid eye movements, sawtooth waves |
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Definition
1) Stage II
2) Wakefullness/drowsiness
3) Stage III
4) Stage I
5) REM |
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Term
| What is Kleine-Levin syndrome? |
|
Definition
| Recurrent hypersomnia in early adolescent males (sleep for 18-20h per day, disrupted behavior, aggressive) |
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Term
| How does Mitomycin C work for airway stenosis? What concentration is appropriate for airway? |
|
Definition
| DNA cross-linking (alkylating). 0.4mg/ml |
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Term
| How is Narcolepsy treated? What about Cataplexy? |
|
Definition
Increased stage 1 sleep. MSLIT with 2 or more sleep onset REMS and low sleep latency
1) Stimulants like Modafinil
2) Antidepressants |
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Term
| What is the greatest anatomical predictor of OSA? |
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Definition
1) Neck circumfrence >17 inch (M) or >15 inch (F)
2) Retroglossal space is also good predictor |
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Term
| What medications are useful in mgmt of RRP? |
|
Definition
HPV 6, 11
1) Cidofovir: inhibits DNA polymerase to prevent viral replication (used when frequent surgery is needed)
2) Bevacizumab (Avastin) is VEGF inhibitor that targets vascular supply |
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Term
| What is OK432 and how is it used? |
|
Definition
1) Picibanil comes from S. Pyogenes, sclerosing agent
2) used for large unilocular lymphatic malformations (mainstay is still surgery). Not yet FDA approved. |
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Term
| How are nightmares distinguished from sleep terrors? |
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Definition
1) Nightmares can be recalled
2) Sleep terrors cannot be recalled (1st third of night) |
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Term
| What are the major amide vs. ester anesthestics and how are they metabolized? |
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Definition
Amides have 2 "is", esters have 1 "i"
1) Amide: liver
- Bupivacaine, lidocaine, prilocaine, mepivacaine
2) Ester: Pseudocholinesterase
- cocaine, procaine, novacaine, tetracaine
- more allergic reactions
- benzocaine: methemoglobinuria |
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Term
|
Definition
| Act on parietal cells to inhibit release of gastric acid and intrinsic factor |
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|
Term
| What are the medicines indicated in acute thyroid storm? |
|
Definition
1) Anti-thyroid (PTU, Methimazole or Lithium if can't use others)
2) Anti-pyretic
3) Beta blocker
4) Cooling blanket, iodine solution |
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Term
| What is the feared complication(s) of PTU? |
|
Definition
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Term
| How are infantile hemangiomas differentiated from vascular malformations? |
|
Definition
1) IHs are absent at birth, proliferate rapidly then involute by 7 years of age
2) VMs are present at birth and enlarge proportionally to patient growth |
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Term
| Which portions of the malleus and incus arise from the second branchial arch? |
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Definition
| Manubrium of malleus and long process of incus. Also stapes suprastructure (not footplate, which arises from otic capsule separetly) |
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Term
| What are the major features of CHARGE syndrome? |
|
Definition
1) Coloboma
2) Heart defects
3) Atreasia of choanae
4) Retardation
5) GU abnormality
6) Ear abnormality |
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Term
| What is the most common pediatric vascular ring? How does it present? |
|
Definition
- Double aortic arch
- Recurrent aspiration, dysphagia, stridor
- Barium esophagram showing posterior indentation due to compression (vs. anterior compression from a pulmonary artery sling when left PA arises off of R PA) |
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|
Term
| What is the concerning side effect of CO2 laser for subglottic hemangioma? |
|
Definition
|
|
Term
| What is the anatomy of a pulmonary artery sling? |
|
Definition
| Left PA arises from Right PA in R mediastinum, loops through TEG towards left lung |
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Term
| True or false, all children with T21 need a PSG? |
|
Definition
| True, by age 4. 60% get OSA and symptoms are not reliable |
|
|
Term
| Describe the anatomy of a third branchial cleft anomaly |
|
Definition
| Travel from medial edge of SCM, lateral to common carotid, medial and posterior to ICA, over CN XII, under CN IX, pierce thyrohyoid membrane into piriform sinus. |
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|
Term
| What is the mutation seen in Alport syndrome? |
|
Definition
X-linked SNHL and renal issues such as progressive glomerulonephritis
COL4A5 mutations prevent collagen type IV synthesis |
|
|
Term
Which syndrome is associated with mutations in each gene:
1) COL4A5
2) GJB2
3) Otoferlin
4) PDS
5) KVLQT1 |
|
Definition
1) Alport (kidney and SNHL, X-linked, collagen IV)
2) Connexin 26 (50% of all syndromic deafness)
3) IHC cell-specific loss of glutamate release
4) Pendrin (pendred syndrome), euthyroid goiter
5) K+ channel in Jervell and Lange-Nielsen |
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|
Term
| Which medical factor should be optomized to prevent recurrent SGS after balloon dilation? |
|
Definition
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|
Term
| Describe the anatomy of second branchial cleft anamolies |
|
Definition
| Open in mid-lower neck at anterior border of SCM, penetrate platysma, track superiorly between ICA and ECA, pass over CN IX and CN XII below styloyoid ligament ending in palatine tonsil |
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|
Term
| What is the appropriate management of nasal dermoid? |
|
Definition
| Open rhinoplasty with dissection and extirpation |
|
|
Term
| Distinguish the types of Usher Syndrome |
|
Definition
1) Type 1: AR vision, hearing and vestibular
2) Type 2: Most common, normal vestibular function, visual and hearing changes happen during adolescence
3) Mild version of type 1 |
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|
Term
| What is the most common bacteria in pediatric neck abscesses? |
|
Definition
| S. aureus 66% (71% MSSA, 29% MRSA) |
|
|
Term
| Which is the most common histologic subtype of rhabdomyosarcoma within the H & N? |
|
Definition
| 75% are embryonal (children). Second most are alveolar (20%) |
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|
Term
| What is the most common organism seen in chronic suppurative OM? |
|
Definition
Perforated TM with drainage lasting 6-12 weeks. Most commonly Pseudomonas, 2nd is S. aureus.
Different from chronic serous otitis media where there is no TM perforation and lasts 1-3 months |
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