Term
| How do you differentiate central from obstructive sleep apnea? |
|
Definition
| In central, there is no respiratory effort to compensate. |
|
|
Term
| How is "adequate" CPAP therapy for OSA defined? |
|
Definition
| 4h per night, 5 nights per week |
|
|
Term
| How is nasal surgery useful in the management of OSA? |
|
Definition
Does not change AHI or snoring
1) Improves perceived sleep quality and decrases daytime fatigue
2) Improves CPAP use |
|
|
Term
| How is an "apnea" defined? |
|
Definition
| Cessation of airflow for 10s with an arousal |
|
|
Term
| Which peripheral organs house primary lymphoid system? |
|
Definition
1) Thymus: T cell maturation
2) Bone marrow: B cell maturation, plasma cells
3) Lymph nodes: Cortex (B), paracortex (T), Medulla (phage)
4) Spleen (blood borne)
5) Cutaneous (LHCs)
6) Mucosal
7) Adenoids/Tonsils |
|
|
Term
| What are the principal differentiating factors between Th1 and Th2 immune responses? |
|
Definition
Both mature from naïve CD4 cells
1) Th1: Microbial immunity, produce IL-2 and IFN-y, inhibit B cells, autoimmunity
2) Th2: Allergic response, IL-4,5,6,10, Stimulate B cells, Recruitment of Eosinophils |
|
|
Term
| Differentiate between CD4 and CD8 T cells |
|
Definition
1) CD4: T helper cells, induced cytotoxic/suppressor CD8 cells, Mature into Th1 and Th2 cells
2) CD8: Suppressor/Cytotoxic
- Lyse virus-infected cells
- Lyse tumor cells
- Inhibit B response and other T cells, immune tolerance |
|
|
Term
| What CD markers indicate B cells? What about NK cells? |
|
Definition
1) B cells: CD19, CD21
2) NK cells: CD 16 |
|
|
Term
What are the major functions of each of the follow Cytokines?
1) IL-2
2) IL-3
3) IL-4
4) IL-5
5) IL-10
6) IL-13 |
|
Definition
1) Growth factor for antigen-stimulated T cells, promoting Th1 response
2) From CD4+ T cells, leads to dev of immature bone marrow to promote mast cell and eosinophil activation
3) Stimulate B cell isotype switching to IgE (Th2 cell development)
4) Activates eosinophils and cross-links T-cells for Th2 response
5) Inhibits macrophages and cytokines, homeostatic control
6) Adhesion molecules in allergic inflammation |
|
|
Term
| What are the 4 major hypersensitivity reactions? |
|
Definition
1) Type 1: Anaphylactic/immediate
- Cross--linking IgE molecules on mast cells and release of histamine (vasodilation and capillary permeability)
2) Type II (cytotoxic)
- Antibodies react with antigens on cell surface, activate complement
- Transfusion reactions, hemolytic anemia, Goodpasture, M. gravis
3) Type III (immune-complex)
- IgG complexes deposited in tissues and activate complement
- Angioedema, PSGN, Serum sickness
4) Type IV (Delayed, cell-mediated)
- TB, Sarcoid, Candida, Poison ivy, metals/chemicals |
|
|
Term
What is the mechanism of the following allergic signs and symptoms?
1) Allergic shiners
2) Dennie's lines
3) Supratip horizontal crease |
|
Definition
1) Hemosiderin deposition
2) Horizontal lines in lower lids from Mueller muscle spasms
3) Chronic rubbing |
|
|
Term
| What are the primary phases of the allergic response? |
|
Definition
1) Early Phase
- Histamine mediated within 5-10 minutes of exposure (itching, sneezing, tearing, wheezing)
2) Late phase (delayed)
- Leukotriene and Eosinophil mediated 4-8h after exposure and can last 24h or more
- congestion, rhinorrhea, wheezing |
|
|
Term
| What are the principal inhalant allergens in the Spring, Summer and Fall? |
|
Definition
1) Spring: Tree
2) Summer: Grass
3) Fall: Weed |
|
|
Term
How is intermittent allergic rhinitis distinguished from persistent?
What are the major perennial allergens? |
|
Definition
1) <4d per week and <4 weeks per year
2) Dust, Dust mites (Dermatophagoides, DerP1/DerF1), Animal dander (Cat FelD1, dog CanD1), molds |
|
|
Term
| What are the major In Vivo options for Allergy testing and what are their advantages/disadvantages? |
|
Definition
**Can't do on TCAs or antihistamines, steroids OK**
1) Scratch (epicutaneous)
- Cheep/easy
- Poor specificity, high false positive
2) Prick/puncture
- Safe, consistent
- Less sensitive, false negatives
3) Intradermal
- High sensitive, less specific (false positive)
- Possible delayed reactions
- Intradermal dilutional testing>single dilutional
- First reaction is endpoint, next is confirming |
|
|
Term
| Why might you perform modified quantitative testing for allergy testing? |
|
Definition
Combines epicutaneous and percutaneous testing, which is good for screening and efficiency compared to full IDT.
Disadvantage is endpoint determination is conservative and can involve initiation of immunotherapy with weaker antigens than IDT |
|
|
Term
| How does in vitro RAST allergen testing compare to in vivo approaches? |
|
Definition
1) Less variability and no drug effects. Good specificity
2) More expensive, less sensitive |
|
|
Term
| How do anti-histamines work to fight allergy and how are they differentiated by generation? |
|
Definition
1) H1-receptor antagonists have dose-dependent competitive binding of H1 receptors on target cells
2) Generation 1 (Benadryl, Chlorpheniramine)
- Lipophillic, cross BBB, anticholinergic
3) Second generation
- Laratadine, Fexofenadine, Cetirizline
- Lipophobic, less anti-cholinergic or tachyphylaxis |
|
|
Term
| How does Cromolyn work to fight allergy? |
|
Definition
Stabalizes mast cell membranes by inhibiting calcium-influx
Short half life means frequent dosing. Lipophobic so no systemic effects. Limited effectiveness |
|
|
Term
| What are the immunological effects of immunotherapy? |
|
Definition
1) Shifts toward Tregs
2) Decreases IL4/5 and increases IL10/12
3) Reduces histamine/inflammation |
|
|
Term
| What is the appropriate management of Anaphylaxis? |
|
Definition
1) 0.3-0.5cc of 0.01ml/kg (1:1000) Epinephrine q5min PN (0.1-0.2 cc children)
2) 50 Benadryl IV
3) 8mg Dex IV |
|
|
Term
| How is food allergy treated? |
|
Definition
| Avoidance, elimination and Oral cromolyn therapy. Desensitization still controversial |
|
|
Term
| Which syndrome is associated with allergic rhinitis, renal and pulmonary manifestations with high levels of eosinophils? |
|
Definition
|
|
Term
| What immunodeficiency might you suspect with transfusion anaphylaxis? |
|
Definition
| IgA deficiency. Most common congenital immunodeficiency |
|
|
Term
| What is the X-linked defect in tyrosine kinase function that selectively affects B-cells? |
|
Definition
| Bruton's Agammaglobulinemia |
|
|
Term
| How are the clinical symptoms of B vs. T cell disorders distinguished? |
|
Definition
1) B is primarily sinus and pulmonary, with purulent infections
2) T is primarily viral, fungal and parasitic |
|
|
Term
| Patient has easy bruising and defect in WASP gene. What is syndrome and how is it inherited? |
|
Definition
| Wiskott Aldrich: X-linked, Thrombocytopenia, T-cell defect (virus, parasites, fungus) |
|
|
Term
| Describe how tumor can spread through the cartilaginous vs. bony EAC |
|
Definition
1) Lateral 1/3: Cartilage
- Fissures of Santorini
2) Medial 2/3: Boney
- Foramen of Hushke |
|
|
Term
| Describe the sensory innervation of the auricle |
|
Definition
1) C3 via greater auricular nerve
2) C2,3 via lesser occipital nerve
3) X via auricular branch
4) V3 via Auriculotemporal
5) VII, Sensory twigs |
|
|
Term
| What is the name of the fibrinous ring that holds to the TM to bone? |
|
Definition
|
|
Term
| Patient presents with retro-orbital pain, Diplopia and Aural discharge. What is going on? |
|
Definition
| Gradenigo syndrome, secondary to Petrositis with involvement of the CN VI |
|
|
Term
|
Definition
Ridge of bone between oval window niche and sinus tympani
**Cholesteatoma can hide in sinus tympani, between ponticulum and subiculum)** |
|
|
Term
|
Definition
Ridge of bone between round window niche and sinus tympani
**Cholesteatoma can hide in sinus tympani, between ponticulum and subiculum)** |
|
|
Term
| What is Macewne's triangle and why is it clinically relevant? |
|
Definition
| Space bounded by EAC, inferior temporal line and spine of Henle- identifies Antrum. |
|
|
Term
| Describe the innervation pattern of the inner ear |
|
Definition
7 Up Coke Down
Anterior to Bill's bar, is VII over VIII
Posterior to Bills bar, is SVN over IVN
"IPS"
1) Superior, utricle and horizontal SCC innervated by SVN
2) Posterior SCC and saccule innervated by IVN |
|
|
Term
| Describe the innervation of the middle ear |
|
Definition
| - Tympanic plexus= V3 (Auriculotemporal), IX (Jacobson), X (Auricular) |
|
|
Term
| What are the contents of the vestibular vs. Cochlear aqueducts? |
|
Definition
1) vestibular: endolymphatic sac and duct, runs from vestibule to posterior surface of petrous pyramid
2) cochlear: connects scala tympani to sub-arachnoid space. Carries vein |
|
|
Term
| What is the most common form of ossicular atresia? |
|
Definition
| Fusion of malleus to bony atretic plate, IM joint fusion |
|
|
Term
| What is the blood supply for the incudo-stapedial joint and why is it important? |
|
Definition
| Incudal artery, most susceptible to erosion |
|
|
Term
|
Definition
| Connection between hypotympanum and sub-arachnoid space, where infection can spread from bone to brain causing meningitis |
|
|
Term
| Why might a patient with cleft palate have poor Eustachian tube function? |
|
Definition
ET opens by action of tensor palate (V3) in combination with levator veli palatine (X), but levator function doesn't develop until later in development.
Therefore, child will have poor opening from both muscles and may develop effusions. This is why ear tubes are placed. |
|
|
Term
| Describe the auricle structures that develop from the 1st and 2nd branchial arches. |
|
Definition
1) First: Hillocks 1-3
- Hillock 1: Tragus
- Hillock 2: Helical crus
- Hillock 3: Helix
2) Second: Hillocks 4-6
- Hillock 4: Antihelix
- Hillock 5: Antitragus
- Hillock 6: Lobule and lower helix |
|
|
Term
| What is the origin of a pre-auricular pit/sinus tract? |
|
Definition
| Improper fusion of 1st and 2nd branchial arches |
|
|
Term
| Patient has outward-downward slanted eyes, notched lower lids, short mandible and malformed incus and malleus. What is going on? |
|
Definition
| Treacher Collins- Mandibular facial dysostosis |
|
|
Term
| What are the levels of hearing loss? |
|
Definition
1) Mild 21-40
2) Moderate 41-60
3) Severe 61-80
4) Profound >80 |
|
|
Term
| What is the principal of masking? |
|
Definition
| Distract non-test ear to prevent crossover |
|
|
Term
| What are the principles of "Rollover" and "Recruitment" in audiology? |
|
Definition
Both associated with posterior fossa masses
1) Rollover: louder sounds are harder to understand
2) Recruitment: increased gain |
|
|
Term
What disorder is associated with each tympanogram?
1) Ad
2) As
3) B
4) C |
|
Definition
1) Ossicular disarticulation
2) Otosclerosis
3) Fluid, perforation
4) ETD |
|
|
Term
| What is the neurobiological basis of the stapedius reflex? |
|
Definition
Dampens sound: afferent is CN VIII, efferent is CN VII
Origin; foramen in pyramidal eminence
Insertion; neck of stapes |
|
|
Term
What are the uses/disadvantages of OAEs?
Differentiate between TOAEs and DPOAEs |
|
Definition
1) Screening for organ of cortic function. Somtimes give false positives
2) TE-OAE for hearing screening, sensitive but only 80% specific
DP OAE most sensitive for Ototoxicity |
|
|
Term
| How does speech recognition threshold differ from word recognition score? |
|
Definition
SRT is loudness at which 50% of spondees are perceived.
WRT is suprathreshold stimulation level where subject is acts to repeat sentences (assesses comfortable loudness) |
|
|
Term
What are the age-appropriate forms of audiometry for the following age ranges?
1) Infant
2) Toddler
3) >3 years |
|
Definition
1) Behavioral observation ABR, OAEs
2) Visual reinforcement then by 36 months Conditioned play
3) Pure tone audiometry |
|
|
Term
| How is Stenger test for pseudohypoacusis performed? |
|
Definition
| Play 2 tones of same frequency simultaneously to both ear, then make bad side louder and patient will claim not to hear at all even though it should cross over |
|
|
Term
| What are the audiological parameters that defined Ototoxicity |
|
Definition
High-frequency audiometry typically
1) At least 20dB shift at one frequency
2) 10dB or greater shift at 2 consecutive frequencies
3) Loss of response at 3 consecutive frequencies where thresholds previously obtained
- Should repeat within 24h |
|
|
Term
What are the OSHA Permissible noise exposures?
1) 90 SPL
2) 92 SPL
3) 95 SPL
4) 100 SPL
5) 105 SPL
6) 110 SPL
7) 115 SPL |
|
Definition
2-3-5-5-5-5
1) 8h
2) 6h
3) 4h
4) 2h
5) 1h
6) 0.5h
7) <0.25h |
|
|
Term
| What are the major components of an Electrocochleography (ECoG) reading? |
|
Definition
1) Resting potential (RP): no sound input
2) Summating potential (SP): OHC, organ of corti, IHCs
- Enlarged in Menierres
3) Compound Action potential (CAP): Spiral ganglion, VIII afferent fibers distal
4) Cochlear microphonic (CM)
- OHCs, receptor potentials |
|
|
Term
| How is the summating potential/compound action potential ratio clinically relevant? |
|
Definition
ECoG measurment useful in Menierre's, where SP/AP ratio elevated (Also true in syphilus).
Loss of SP |
|
|
Term
| Differentiate between cervical and ocular VEMPs |
|
Definition
1) cVEMP measures saccule and IVN function by measuring muscle contraction in ipsilateral SCM
- SCDS. neuritis, labrynthitis etc
2) oVEMP measures utricle and SVN |
|
|
Term
| How is Electroneuronography used? |
|
Definition
Monitor CN VII function to predict recovery.
**If affected side is <10% of other side, repair is needed**
80-100% accurate for spontaneous recovery and 50-90% accurate in predicting need of repair.
- Neuropraxia- ENoG normal or reduced, sheath in tact
- Axonotmesis- No response, intact epineurium with inner nerve fiber disruption. Cannot be distinguished from Neurotmesis (no response, total separation) |
|
|
Term
True or False:
Nystagmus is named according to slow phase |
|
Definition
False! Fast phase.
If you look towards lesion on left, will beat fast towards left and it is left-sided nystagmus.
Remembers COWS (cold opposite, warm same) |
|
|
Term
| Desribe how how caloric testing can be easily interpreted? |
|
Definition
COWS: Cold Opposite, Warm Same
Cold water in left ear causes eyes to turn toward left with nystagmus beating to right (opposite) |
|
|
Term
| What does Alexander's law say about Vestibular function? |
|
Definition
The slow-phase velocity of nystagmus increases when eyes look in direction of fast phase (observed in peripheral lesions)
If you look away from lesion, severity of nystagmus gets worse (towards fast phase) |
|
|
Term
| Which SCC most commonly involved in BPPV? What is the mechanism? |
|
Definition
1) posterior
2) Canalolithiasis- liberation of otoconia
- Nystagmus is rotational and geotropic |
|
|
Term
| What syndrome is described by autoimmune disease with interstitial keratitis (corneal inflammation), progressive vestibular loss and bilateral, progressive hearing loss |
|
Definition
| Cogan syndrome: tx high-dose steroids, if no improvement use cyclophosphamide |
|
|
Term
| What do you think of when someone gets disequilibrium following exposure to loud sounds or nose blowing? |
|
Definition
Perilymphatic fistula. Sounds (Tullio) or blowing (Hennebert sign). Increased SP/AP ratios with straining usually.
A form of inner ear fistula is SCDS, communication between middle cranial fossa and superior SCC
Tx with bed rest, head elevation sometimes surgical exploration if hearing loss worsens/vestibular symptoms persist |
|
|
Term
| What is the differential diagnosisfor vertigo associated with positive fistula test (Hennebert or Tullio)? |
|
Definition
1) Meniere disease
2) SCDS
3) Syphilis
4) Perilymphatic fistula |
|
|
Term
| How is bilateral vestibular loss manifested clinically? |
|
Definition
|
|
Term
| Most common environmental cause of prelingual hearing loss in US |
|
Definition
CMV
Also think Rubella if cataracts and mental retardation |
|
|
Term
| What percentage of congenital hearing loss is non-syndromic? What percentage of these are autosomal recessive? |
|
Definition
| 70% non-syndromic, 80% AR |
|
|
Term
Match Autosomal Dominant hearing loss with symptoms
1) Pax 3 gene, white forelock, widening of canthi and SNHL
2) Lobster hands, stapes fixation, CHL
3) Bilateral acoustic neuromas
4) TCOF-1 gene, Mondini malformation (1.5 turns), CHL
5) EYA1 gene on 8Q, mixed HL, pinna deformities, Mondini malformations, renal issues
6) FGRT gene, craniosynostosis and CHL
7) Cleft palate, micrognathia, myiouam narfubiudm, CHL, associated with PRS (mandibular hypoplasia, glossoptosis, cleft palate) |
|
Definition
WANT BCS (SNHL, CHL, except B, mixed)
1) Waardenburg
2) Apert
3) NF
4) Treacher Collins
5) Brancho-oto-renal
6) Crouzon
7) Stickler |
|
|
Term
Match AR syndromic hearing loss with symptoms
1) QT prolongation, KCNQ mutation
2) Thyroid goiter profound SNHL
3) SNHL, RP
4) Hemifacial microsomia, mixed HL |
|
Definition
1) Jervell and Lange-Nielsen syndrome
2) Pendran, tyrosine iodination problem
3) Usher syndrome, need electroretinography to diagnose RP
4) Really multifactorial- Goldenhar |
|
|
Term
| Why is it important to be particularly careful with adenoidectomy in patient with thymic aplasia? |
|
Definition
| Digeorge. Retropharyngeal carotids |
|
|
Term
| What is a Bezold Abscess? |
|
Definition
| Spread of infection through perforation in mastoid to SCM |
|
|
Term
| What are the most commonly involved ossicular sites of cholesteatoma? Where is the most common location? |
|
Definition
1) Distal incus and stapes suprastructure
2) Sinus tympani and Facial recess |
|
|
Term
| What is the most common benign tumor of the temporal bone? What is the classic pathological finding? |
|
Definition
1) Paraganglioma (glomus tumor)
2) Zelballen (ball of cells)
Genetics SDH mutation |
|
|
Term
| Why are you concerned if there is blanching of TM with positive pressure? |
|
Definition
| Brown sign of paraganglioma |
|
|
Term
| What are the 3 approaches to acoustic neuroma surgery and what are the indications for each? |
|
Definition
1) Retrosig: Large tumor, hearing preservation
2) Translab: no hearing preservation, easy complete approach
3) Middle cranial fossa: Small intracanilicular tumors |
|
|
Term
| Why might patient present with otorrhea, retro-orbital pain and double vision? |
|
Definition
Petrous Apicitis
Double vision from CN VI involvement |
|
|
Term
| What is the most common lesion of the Petrous apex? |
|
Definition
Cholesterol Granuloma
Bright on T1/T2 |
|
|
Term
| What is the genetics of Otosclerosis and what is the most common location? |
|
Definition
1) Autosomal dominant, incomplete penetrance
2) Fistula ante-fenestrum |
|
|
Term
| What syndromes characteristically involve Aural atresia? |
|
Definition
Follow Jahrsdoerfer grading for surgical candidacy: MOMMAS FIR (>8 points is good candidate)
1) Treacher colins
2) Goldenhar
3) Branchiootorenal
4) Crouzon |
|
|
Term
| What are the major structures of the 1st branchial arch? |
|
Definition
"You can't see this stuff through TM"
- Innervated by V3, maxillary artery and ECA
1) Cleft:ectoderm (EAC, TM epithelium, 1-3 hillocks of hiss)
2) Arch: mesoderm: Mandible (meckel's, malleus H & N, incus)
3) Pouch: endoderm (middle ear, ET, mastoid, TM) |
|
|
Term
| What are the major structures of the 2nd branchial apparatus |
|
Definition
Innervated by CN VII, stapedial artery from ICA
1) Cleft, ectoderm: Hillocks 4-6
2) Arch, mesoderm: Hyoid, Reichert cartilage, stylohyoid ligament, muscles of facial expression
3) Pouch, endoderm: Mouth and throat |
|
|
Term
| What are the major structures of the 3rd branchial apparatus |
|
Definition
Inferior parathyroids, innervated by CN IX.
Abnormalities are deep to 3rd arch structures and superficial to 4th arch structures (anterior to SCM, ends in pharynx and TH membrane or pyriform sinus, under both carotids. |
|
|
Term
| What are the developmental origins of the parathyroid glands? |
|
Definition
1) Inferior are 3rd branchial and innervated by CN IX
2) Superior are 4th branchial arch and innervated by CN X |
|
|
Term
| How does thyroglossal duct cyst appear on ultrasound? |
|
Definition
| Heterogeneous, Cannot be used to distinguish from teratoma |
|
|
Term
| What is the most common tumor of infancy and premies? |
|
Definition
Infantile hemangioma
Superficial tumors are red, dep are blue.
GLUT1+, grows and then goes away |
|
|
Term
| How does a congenital hemangioma differ from an infantile hemangioma? |
|
Definition
1) Congenital are GLUT1 (-). Can be involuting or non-involuting. Treat with steroids, laser and/or beta blockers
2) Infantile hemangioma are GLUT1+, most common tumor of infancy and premies, grows and then go away after 5 months. |
|
|
Term
| What is the appropriate treatment for AV malformations in children? |
|
Definition
| Surgery is only treatment |
|
|
Term
| What is the most common cause of posterior neck mass in a child? |
|
Definition
Lymphatic malformation
Macrocystic are easier to excise the microcystic (infiltrative) |
|
|
Term
| What are the most common neoplasms in children in the head and neck? |
|
Definition
| 59% are lymphoma. Rhabdomyosarcoma are 2nd (13%, most of which are Alveolar). Thyroid is 3rd at 10% |
|
|
Term
| What are the major characteristics of CHARGE syndrome? |
|
Definition
1) CHD7 gene on chromosome 8
2) Coloboma, Heart disease, Atresia (choanal), Retardation, Genital hypoplasia, Ear abnormalities
**Often see antrochoanal polyp extruding through maxillary sinus into middle meatus** |
|
|
Term
| What is the toxic agent in GAS infection? What are the potential associated conditions? |
|
Definition
1) Endotoxin
2)
- Rheumatic fevers (Aschoff bodies, treat infection, NSAIDS, steroids)
- Scarlet fever
- APGN (not prevented by Abx)
- PANDAS |
|
|
Term
| What are the major complications of tonsillectomy? |
|
Definition
1) Bleeding. Look for VWD platelet dysfunction and give DDAVP (Type 1 not enough, type 2 don't work)
2) Atlanto-axxial Subluxation (Grisels): T21, flex/ex Xray
3) VPI
4) Post-obstructive pulm edema |
|
|
Term
What is the most common cause of:
1) Pediatric hoarseness
2) Congenital tracheal stenosis
3) Stridor improving when lying prone |
|
Definition
1) Nodules
2) Complete tracheal rings
3) Laryngomalacia |
|
|
Term
| What is the pathophysiology of vascular rings (PA sling) in pediatric respiratory restriction? |
|
Definition
| Pulmonary artery sling: L PA comes off of R PA, wraps around R mainstem to get to L lung, causes distal bronchial hypoplasia on R (prevented by complete tracheal rings, which stents open) |
|
|
Term
| Describe the 4 types of laryngeal clefts |
|
Definition
1) Up to cricoid
2) Through cricoid partially
3) Below cricoid
4) Below cricoid |
|
|
Term
| What is the most common type of TEF? |
|
Definition
| Esophageal atresia and distal fistula |
|
|
Term
| What is the most common type of Craniosynostosis |
|
Definition
| Sagittal: Scaphocephaly with narrow head |
|
|
Term
| Describe the structures arising from each of the Ethmoturbinals |
|
Definition
1) Agger Nasi (ascending), Uncinate (descending)
2) Ethmoid bulla (ascending), middle turbinate (descending)
3) Superior turbinate (ascending), middle turb basal lamella (descending)
4) Supreme turbinate
5) Inferior turbinate is from maxilloturbinate, NOT ethmoturubinate |
|
|
Term
| Which sinus is first to develop? Which is MOST developed at birth? Which sinus is last to develop? |
|
Definition
1) Maxillary
2) Ethmoid
3) Frontal |
|
|
Term
| Where does the uncinate most commonly attach and how does this effect frontal sinus drainage? |
|
Definition
| 80% of time to LP. Frontal drainage proceeds medial to uncinate into middle meatus |
|
|
Term
| Which sinus abnormality is most likely to contribute to an orbital hematoma? |
|
Definition
|
|
Term
| Measuring from the lacrimal crest, how far is it to the anterior ethmoid cells? |
|
Definition
| 24mm. Then 12 mm to PEA. Then 6 mm to optic nerve |
|
|
Term
| What is the first CN abnormality you will see in a sphenoid fungus ball? |
|
Definition
| VI: most medial in cavernous sinus |
|
|
Term
| Which nerves are found in the superior vs. inferior orbital fissures? |
|
Definition
1) Superior: III, IV, VI, V1
2) Inferior: V2 |
|
|
Term
| What is the clinical phenomenon described with diplopia, ptosis with normal vision? What if there is also vision loss? Loss of sensation over cheek? |
|
Definition
1) Superior orbital fissure syndrome: III, IV, VI
2) Orbital apex syndrome: SOF + optic nerve
3) Cavernous sinus syndrome
Both have V1 involvement |
|
|
Term
| What type of epithelium line the sinuses? |
|
Definition
| Ciliated, pseudostratified columnar |
|
|
Term
| What are the common neurogenic lesions of the nasal cavity/sinuses and how are they distinguished? |
|
Definition
1) Dermoid: get MRI before repair (biphid crista galli)
2) Encephalocele: change size with straining
3) Glioma: pinched off encephalocele |
|
|
Term
| What are the common neurogenic lesions of the nasal cavity/sinuses and how are they distinguished? |
|
Definition
1) Dermoid: get MRI before repair (biphid crista galli)
2) Encephalocele: change size with straining
3) Glioma: pinched off encephalocele |
|
|
Term
| What is name of the common benign NP cyst? |
|
Definition
|
|
Term
| Which forms of HPV are associated with Inverted Papilloma? What are the classic pathalogical findings? What is the major concern with IP? |
|
Definition
1) 6, 11, 16, 18
2) Crystal-laden synesthent mitochondria
3) 5-10% malignant degeneration |
|
|
Term
| What cell type is abundant in JNA? How do they typically grow? |
|
Definition
1) Mast cells
2) Out of PPF through posterior wall of maxillary sinus |
|
|
Term
| What is the classic stain, pathalogic findings of Esethesioneuroblastoma? |
|
Definition
1) S100+ (like melanoma)
2) Homer Write Pseudorossetes (grade 1), Flexner-Wintersteiner rosettes (grade III) |
|
|
Term
| Why might a patient have sinus hystiocytosis and massive lymphadenopathy? |
|
Definition
|
|
Term
| What is the most common benign tumor of sinuses? Where is it found? What is the associated syndrome? |
|
Definition
1) Osteoma
2) Frontal sinus
3) Gardner |
|
|
Term
| What is the pathologic organism in Rhinoscleroma, what is the pathological finding and how is it treated? |
|
Definition
1) Klebsiella Rhinoscleromatis (Frisch bacillus)
2) Mikulicz cell, Russel bodies, Pseudoepitheliomatous hyperplasia
3) No contagious, give abx |
|
|
Term
| How are Rhinoscleroma and Rhinosporidiosis distinguished? |
|
Definition
1) Scleroma is bacteria Klebsiella Rhinoscleromatis, non-contagious and treated with Abx
2) Sporidiosis is contagious and treated with Dapsone |
|
|
Term
| What type of fungus causes a sphenoid fungus ball and how is it treated? |
|
Definition
1) Aspergillus
2) Surgery
Remember to look for VI palsy, most medial in cavernous sinus |
|
|
Term
| What is the management of allergic fungal sinusitis? How does it occur in? |
|
Definition
1) immunocompetent individuals
2) Surgery with steroids
**Remember fungus can look dark on MRI** |
|
|
Term
| What are the causes of IFS and how are they distinguished? |
|
Definition
1) Aspergillus- narrow hyphae, regular septations, 45 degree
2) Mucor, non-septate, 90 degree turns |
|
|
Term
What are the important markers for the following malignancies?
1) Lymphoma
2) Carcinoma
3) Melanoma
4) Neuroendocrine
5) Sarcoma |
|
Definition
1) CLA
2) Cytokeratin
3) S100, HMB 45
4) Synaptophysin
5) Vimentin and Desmin |
|
|
Term
What are the functions of the following Oncogenes?
1) p53
2) BCL-2
3) P16 and P21 |
|
Definition
1) Arrests G1
2) Inhibits p53
3) Suppresses cyclin-dependent kinase pathways. E6 and E7 make p16 and p21 abnormal |
|
|
Term
| What single factor is the most important determinant of head and neck cancer prognosis? |
|
Definition
|
|
Term
How do each of the following Chemotherapeutics work?
1) Cisplatin/Carboplatin
2) 5-FU
3) MTX
4) Taxane
5) Cetuximab |
|
Definition
1) Alkylating
2) Antimetabolite that binds thymidylate synthetase
3) Binds DHF, can cause interstitial penumonitis and mucositis
4) Prevent microtubular reorganization
5) Anti-EGFT |
|
|
Term
| What are the common complications of head and neck radiation? |
|
Definition
1) Hypothyroidism
2) Xerostoma
3) Transverse myelitis
4) Cancer (Thyroid, Salivary, Leukemia, Sarcoma)
5) ORN |
|
|
Term
| What are the important radiographic signatures of metastatic nodes? |
|
Definition
1) Central necrosis
2) Rim enhancement
3) Spherical isntead of ovoid
4) Extracapsular spread
5) Large size |
|
|
Term
| Where are most lip cancers found and how does it affect prognosis? |
|
Definition
1) SCCa 90% lower lip, 90% of lip cancers on lower lip (bilateral drainage)
2) BCC mostly upper lip (unilateral drainage) |
|
|
Term
| An oral tongue biopsy shows pseudoepithelial metaplasia. What are you thinking? |
|
Definition
| Necrotizing sialometaplasia. Can look like cancer. |
|
|
Term
| What are the most common pathways of tumor spread for laryngeal cancer? |
|
Definition
1) Parglottic space
2) Pre-epiglottic space |
|
|
Term
| How is laryngeal cancer T staging performed? |
|
Definition
1) T1a is one cord, T1b is both cords
2) T2 is supraglottic extension, impaired mobility
3) T3 is fixation |
|
|
Term
| What are the 3 types of nasopharyngeal carcinoma, how are they distinguished? |
|
Definition
1) Keratinizing SCCa
2) Non-keratinizing. Associated with EBV
3) Undifferentiated. In this case better prognosis. Most common blue cell. |
|
|
Term
| What types of cancer to wood and leather workers get? |
|
Definition
| Adenocarcinoma of paranasal sinuses |
|
|
Term
| How is the carotid balloon occlusion test useful in H and N cancer surgery? |
|
Definition
Risk of CVA
15-30% risk without test, 3% with test |
|
|
Term
| True or False: Junctional nevi are pre-malignant cutaneous diseases? |
|
Definition
|
|
Term
| Which syndromes are associated with basal cell carcinoma of head and neck? |
|
Definition
Nodular is most common form of BCC
1) Xeroderma Pigmentosa: AR
2) Gardner syndrome (Osteomas in mandible and frontal sinus)
3) Nevoid basal cell carcinoma syndrome (Gorlins if cysts in mandible) |
|
|
Term
| Which type of melanoma has best and worse prognosis? |
|
Definition
1) Best is superficial spreading
2) Worst is nodular (vs. BCC where nodular is best) |
|
|
Term
| What is the most common cause of pre-styloid parapharyngeal space mass? |
|
Definition
| Salivary gland malignancy |
|
|
Term
| Describe the physiology of thyroid hormone production. |
|
Definition
1) Anterior pituitary releases TSH
2) TSH stimulates iodide uptake by Thyroid
3) MIT/DIT link to form T3/T4 in thyroid colloid
4) Thyroid hormone carried by TBG and converted from T4 to T3 in peripheral organs (T3 is more active and less stable) |
|
|
Term
| How does follicular thyroid cancer spread vs. PTC? |
|
Definition
1) Follicular is hematogenous
2) PTC is regional nodes |
|
|
Term
| What cells are involved in medullary thyroid cancer? What are the MEN syndromes? |
|
Definition
1) Parafollicular C cells
2)
- Type 1 is Pituitary, Pancreas and Parathyroid
- Type 2a is Medullary, Parathyroid hyperplasia and Pheo. ATA-C mutation, needs prophylactic thyroidectomy
- Type 2b is Pheo, medullary and neuromas with marfanoid habitus. Needs prophylactic thyroid by age 1, ATA-D mutation |
|
|
Term
| Who gets tertiary hyperparathyroidism and why? |
|
Definition
| Kidney transplant leads to autonomous PTH production after correction of secondary hyperparathyroidism (4 gland hyperplasia) |
|
|
Term
Match the buzzword with the benign salivary lesion.
1. Acute suppurative siaadenotis
2. Mumps
3) Tree-leaf
4) Chronic sclerosing |
|
Definition
1) Staph
2) Paramyxovirus
3) Chronic inflammation
4) Kuettner turmo- |
|
|
Term
| What is the most common location for sialolithiasis? |
|
Definition
|
|
Term
| Which tongue papillae do NOT participate in taste? |
|
Definition
| Filiform, found throughout tongue |
|
|
Term
| What is associated with median rhomboid glossitis? |
|
Definition
|
|
Term
| What are the respective antibodies for Pemphigus bulgarous vs. Bullous pemphigoid? |
|
Definition
1) Vulgaris: Intraepithelial bridge
2) Bullous: Sub-epithelial bridge |
|
|
Term
| What disease is associated with recurrent painful apthous ulcers? |
|
Definition
|
|
Term
| hamartomas, big head, melanoma. What is the syndrome? |
|
Definition
|
|
Term
| Which sleep findings are found in stage 1, 2 and 3 sleep? |
|
Definition
1) Stage 1 is theta waves
2) Stage 2 is K waves
3) Stage 3 is Delta waves |
|
|
Term
| What kind of margins are needed for mandibular mass appearing as "Soap bubbles" on films? |
|
Definition
|
|
Term
| Larynx lesion in patient from ohio river valley. What stain is necessary? |
|
Definition
| Histoplasmosis: Silver stain |
|
|
Term
| Larynx lesion from patient in LA |
|
Definition
|
|
Term
| Why are you worried if patient clenches jaw on induction of anesthesia? |
|
Definition
| Malignant Hyperthermia: Give Dantrolene |
|
|
Term
| What angle is needed for each percentage of scar in Z plasty? 25%, 50%, 75% |
|
Definition
|
|
Term
Which artery is used in each of the follow flaps?
1) Pec flap
2) Latissimus dorsi
3) Scapular
4) Radial forearm
5) Fibula
6) Juri
7) Paramedian forehead
8) Temporalis |
|
Definition
1) Thoracoacromial
2) Thoracodorsal
3) Circumflex scapular
4) Radial
5) Peroneal
6) Superficial temporal
7) Supratrochlear
8) Deep temporal |
|
|
Term
| What are the major tip support structures for the nasal tip? |
|
Definition
1) Lower lateral cartilage
2) Medial crura attachment to septum
3) Scroll |
|
|
Term
| Describe the rule of thumb for autoimmune lesions of larynx by location |
|
Definition
SAW
1) Supraglottis is sarcoid
2) Glottis is Amyloid
3) Subglottis is wegeners |
|
|
Term
| What are the appropriate sutures for Otoplasty if there is an antihelical fold vs. no fold? |
|
Definition
1) Mustarde makes fold
2) Furna does not if there is allready a fold |
|
|
Term
| What types of cartilage are lost and gained with aging skin? |
|
Definition
|
|
Term
| What muscles are involved in horizontal wrinkes on forehead? What about vertical wrinkes? |
|
Definition
Horizontal: Frontalis, Procerus
Vertical: Corrugator |
|
|
Term
| What muscle do crow's feet arise from? |
|
Definition
|
|
Term
| What are the anatomic layers of the skin? |
|
Definition
1) Epidermis
- Stratum corneum, statum granulosum, stratgum lucidum, stratum spinosum, stratum basale
2) Dermis
3) Subcutis |
|
|
Term
| What are the contents of the Optic canal? |
|
Definition
1) Optic nerve
2) Opthalmic artery
3) Central retinal artery |
|
|
Term
| What is the blood supply of the tonsil? |
|
Definition
1) Facial artery
- tonsillar artery, ascending palatine artery
2) Lingual artery
- Dorsal lingual branch
3) IMAX
- descending palatine
- greater palatine
4) Ascending pharyngeal |
|
|
Term
| Describe the locations of the epitympanum, mesotympanum, hypotympanum and retrotympanum |
|
Definition
1) Epitympanum: Portion of middle ear suprior to TM
- Contains head of malleus, body and short process of incus.
- Superior boundary is tegmen
2) Mesotympanum: middle ear visualized through TM
- Contains manubrium of maleus, long process of incus and stapes
3) Hypotympanum: middle ear inferior to TM
- Contains Hyrtl fissure, connection to SAS
4) Retrotympanum: Facial recess and sinus tympani |
|
|
Term
| How does the tensor tympani insert? What about the stapedius? |
|
Definition
1) tensor tympani arises from cochleaform process and attaches to malleus neck.
2) stapedius arises from pyramidal process and attaches to stapes with innervation from CN VII |
|
|
Term
| Describe the anatomy of the sinus tympani |
|
Definition
Cholesteatoma can hide here
- Medial to CN VII
- Posterior to promontory
- Inferior to facial canal
- Medial to pyramidal eminence (subiculum beneath, ponticulum above) |
|
|
Term
| What structures define the internal nasal valve |
|
Definition
1) Nasal septum
2) Caudal margin of upper lateral cartilage
3) Anterior end of inferior turbinate
4) Floor of nose |
|
|
Term
| Describe the anatomy of pharyngeal musculature |
|
Definition
1) Outer musculature is circular
- superior, middle and inferior constrictors
2) Inner muscle is longitudinal
- Palatopharyngeous, salpingopharyngeous, stylopharyngeus |
|
|
Term
| What anatomical site is most common for Zenker's diverticulum and why? |
|
Definition
1) Killain traignel between inferior constrictor and cricopharyngeus, where there is least resistance
2) Diverticulaum usually emanate form left posterior esophagus |
|
|
Term
| What structures are contained within the pre- and post-styloid compartments of the parapharyngeal space? |
|
Definition
1) Pre-styloid
- Imax, inferior alveolar nerve, lingual nerve, auriculotemporal nerve
2) Post-styloid
- carotid artery, IJ, CN IX-XII, cervical sympathetic chain |
|
|
Term
| What is the only abductor laryngeal muscle? What nerve innervates the cricothyroid? |
|
Definition
1) Posterior CA (recurrent laryngeal)
2) External branch of superior laryngeal |
|
|
Term
| What masses are commonly found in the CPA and what are their imaging characteristics on MRI? |
|
Definition
1) Acoustic Neuroma
- Intermediate on T2/T1 and enhancing after Gadolidium
2) Arachnoid Cyst
- Low T1, High on T2, no enhancement
3) Epidermoid cyst: same as Arachnoid cyst
4) Meningioma: Intermediate on T1/2, "dural tail" on post-contrast T1 |
|
|
Term
What benign cutaneous neoplasm is described by each of the following
1) Small lesion of epidermal proliferation, 1% may evolve into SCC
2) Fast growing tumor that is difficult to disginuish from SCC, but does NOT have epithelial membrane antigen like SCC
3) "pasted on" apperance |
|
Definition
1) Actinic keratosis
2) Keratoacanthoma
3) Seborrheic Keratosis: treat with curettage |
|
|
Term
| True or False: Elective neck dissection is critical to management of mucosal melanoma |
|
Definition
False!
Failure is due to local recurrence. 5 year survival is 10% with 50% recurrence rate |
|
|
Term
| What are the survival estimates for melanoma by clark level? |
|
Definition
1) Clark 1 (epidermis): 100%
2) Clark 2 (papillary dermis): 93%
3) Clark 3 (reticular-papillary junction: 74%
4) Clark 4 (reticular dermis): 39% |
|
|
Term
| What is the treatment of choice for melanoma? |
|
Definition
Typically surgical excision with 1cm margin if <2mm depth, otherwise 2cm margin.
Offer sentinal lymph node biopsy if > 1.0mm Breslow depth
Radiation and IFN can also play a role |
|
|
Term
| Which cranial nerves can be assessed merely through exam of the eye? |
|
Definition
II, III, IV, V, VI, VII
1) Pupillary reflex is II (afferent) and III (efferent)
2) Corneal reflex is V (afferent) and VII (efferent)
3) III, IV, VI is EOMI |
|
|
Term
| Why might a pupil accommodate but not react? |
|
Definition
| Argyle-Robertson pupil- Syphilis |
|
|
Term
| What is interaural attenuation for bone vs. air? |
|
Definition
| 0 for bone. 40-60 for air |
|
|
Term
| What type of CHL gives a maximal CHL? |
|
Definition
50-60dB indicates ossicular discontinuity with intact TM
1) 10-30dB: TM perforation
2) 30-50dB: ossicular discontinuity and TM perforation
3) <50dB: Otosclerosis
4) 50-60dB: Ossicular discontinuity with in tact TM |
|
|
Term
| What age is best for Microtia repair? |
|
Definition
| 6-10 years. External ear is adult by 5 years |
|
|
Term
| What are the most common complications of cholesteatoma? |
|
Definition
1) Erosion of horizontal SCC
2) Ossicular erosion at long process of incus
3) Tympanic portion of CN VII most commonly injured during surgery |
|
|
Term
What are the indications for the following hearing assisted devices?
1) CROS
2) BICROS
3) BAHA |
|
Definition
1) One good ear and one deaf ear
2) One weak ear and one deaf ear
3) Unilateral CHL or mixed HL who cannot wear traditional HA (CSOM, atresia, etc) |
|
|
Term
| What is the differential for an acute facial palsy? |
|
Definition
Give Prednisome 1mg/kg divided TID for 10 days with 10 day taper, Acyclovir 800mg 5 times daily for 10 days
1) Trauma
2) Bells
- rapid onset <48h, associated with HSV
3) Herpes Zoster, Ramsay Hunt
- Cutaneous vesicles of EAC and cochal bowl
- Consider Valacyclovir vs. Acyclovir |
|
|
Term
| What are the options for surgical repair of transected facial nerve? |
|
Definition
Best result will be HB III
1) Before 18 months can do end to end
2) If FN can be mobilized 2cm, use a cable graft
3) If > 2cm needed, use CN XII->VII
4) After 18 months use dynamic muscle sling (temporalis), making sure V3 in tact prior to performing. |
|
|
Term
| Describe pathophysiology of Allergic fungal sinusitis |
|
Definition
| Type I Hypersensitivity to Dematiaceous molds (Pseudallescheria boydii) with Eosinophilic mucin, non-invasive fungal hyphae and nasal polyposis |
|
|
Term
| What is the differential for a congenital nasal mass? |
|
Definition
1) Glioma
2) Dermoid
3) Teratoma
4) Encephalocele |
|
|
Term
| What nerve senses ammonia and hot chili peppers? |
|
Definition
|
|
Term
| What is the appropriate intervention for oral cavity and oropharynx SCC by stage? |
|
Definition
Stage 1-2, Surgery or XRT
Stage 3-4, Surgery and XRT or chemoradiation |
|
|
Term
Patient presents with epistaxis, L serous effusion, restriction of Left lateral gaze and Left level II lymphadenopathy.
How is this condition treated? |
|
Definition
Sounds like Nasopharyngeal carcinoma with CN VI palsy. Give radiation
Remember EBV association. Can follwo treatment success with serial EBC viral capsid.
No neck dissection unless for recurrent disease. |
|
|
Term
| Why order an ACE level in a patient with uveitis, fever, nonsuppurative parotitis and CN paralysis? |
|
Definition
| Uveoparotid fever, or Heerfordt disease is a symptom of Sarcoid |
|
|
Term
| How is post-XRT xerostomia managed? |
|
Definition
1) Chemoprotectant Amifostine
2) Pilocarpine (Salagen)
3) Cevimeline (Evoxac)- originally for Sjogren's, can be used for Xerostomia |
|
|
Term
| How does the percentage of mucoid to epidermoid cells affect prognosis in Mucoepidermoid carcinoma? How does it affect therapy? |
|
Definition
| High grade has increased ratio of epidermoid to mucous cells, and requires wide excision and post-operative XRT |
|
|
Term
| What is the characteristic pattern of spread for Adenoid cystic carcinoma? |
|
Definition
1) 2nd most common salivary gland malignancy- most common in submandibular and minor salivary glands
2)Perineural invasion with "skip lesions"
3) Tubular is best survival, solid is worst
Give wide excision and XRT |
|
|
Term
| How does Acinic cell carcinoma spread? How is it treated? What are the pathalogical findings? |
|
Definition
1) 80-90% in parotid, rare mets, but goes to bone and lungs
2) Treatment is surgery, no radiation
3) Serous acinar cells and cells with clear cytoplasm |
|
|
Term
Name the salivary malignancy by its histologic derivation
1) Acinar and intercalated duct cells
2) Myoepithelial and acinar cells
3) Excretory duct cells |
|
Definition
1) Acinic cell- perineural invasion
2) Mixed malignant
3) Mucoepidermoid or SCCa |
|
|
Term
| What is Frey syndrome and how is it treated? |
|
Definition
Preauricular gustatory sweating from parasympathetic salivary nerves from auriculotemporal nerve innervating sweat glands on skin flap
Diagnose by Minor start iodide test and treat with topical antipersperant, topical glycopyrollate, or topical atropine |
|
|
Term
| What are the layers of the true vocal fold? |
|
Definition
1) Stratified squamous epithelium
2) SLP
3) Vocal ligament: intermediate and deep LP
4) Vocalis muscle |
|
|
Term
| Firm, smooth lesion of posterior cricoid cartilage. How do you treat? |
|
Definition
| Benign chondroma. Treat with surgery |
|
|
Term
| What are the major types of laryngeal cysts? How are they managed? |
|
Definition
1) Ductal
- obstructed mucous duct
2) Saccular
3) Rare thyroid cartilage foraminal cysts |
|
|
Term
| What is the diagnosis of a yellow lesions found on the posterior one-third of vocal fold with histology of pseudoepitheliomatous hyperplasia? How do you manage? |
|
Definition
Granular cell tumor
3% malignant degeneration. Conservative excision is management |
|
|
Term
| Which forms of HPV are associated with RRP?Where are the papillomas most commonly found and how is it treated? |
|
Definition
RRP is common in 2-4 year olds
1) Look undersurface of TVF and in nasopharynx
2) Micro DL with stripping and/or laser ablation, with intralesional injection of Cidofovir
**Don't use Jet ventilation, or you can seed the respiratory tract** |
|
|
Term
| Why might you see a "pale, turban-like" epiglottis? |
|
Definition
| Think Sarcoid. Remember SAW (sarcoid, amyloid, wegeners) |
|
|
Term
| What types of cancers are found in the larynx? |
|
Definition
1) SCC
2) Minor salivary gland (Adenoid cystic or ME)
3) Chondrosarcoma on posterior cricoid |
|
|
Term
What are the management approaches for the following stages of glottic cancer
1) CIS
2) Stage 1 or II
3) Stage III or IV
4) Chondrosarcoma |
|
Definition
1) serial micro DL and stripping until eradication
2) Surgery or XRT
3) Chemoradiation or surgery + XRT
4) narrow excision without radiation |
|
|
Term
| When is a hemilaryngectomy useful? What about a supraglottic laryngectomy? |
|
Definition
1) Hemilaryngectomy is for unilateral T1/T2 disease with < 1cm subglottic extension. may involve anterior commissure or anterior aspect of contralateral true fold
2) Supraglottic laryngectomy: voice-preserving approach for T1-T3 (pre-epiglottic space ONLY) that preserved cricoid and at least one arytenoid carilate. Fifty percent are trach dependent |
|
|
Term
| What is the workup for a patient with headache, palpitations, HTn and concern for a carotid mass? |
|
Definition
1) 24h VMA and serum catecholamines
2) If catecholamines are elevated, get CT to rule out pheo and treat adrenergic symptoms
3) Get Arteriography vs. MRI for salt and pepper |
|
|
Term
| How are paragangliomas typically treated? |
|
Definition
| Surgery with pre-operative embolization |
|
|
Term
| How are chyle leaks managed? |
|
Definition
1) <500-700 cc/day
- Presure, low fat diet, Octreotide
2) >700cc/day
- Exploration and ligation |
|
|
Term
| When should post-op radiation be started? |
|
Definition
| Indicated for advanced stage cancers, close or positive margins, LN involvement, extracapsular spread or PNI, within 6 weeks no matter if wound is healing or not |
|
|
Term
| Why is Thyroglobulin useful in mgmt of thyroid cancer? |
|
Definition
| >10 mg/dL indicates recurrent disease |
|
|
Term
| What antibodies are associated with graves vs. hashimotos thyroid? |
|
Definition
1) Graves is Anti TSH
2) Hashimotos is anti thyroid peroxidase |
|
|
Term
| What is the difference between a macrofollicular and microfollicular thyroid adenoma? |
|
Definition
| macrofollicular are benign, microfollicular that do not exhibit vascular or capsular invasion are benign, but require surgical biopsy to ensure |
|
|
Term
| What is the utility of a Sestambi scan in workup of hyperparathyroidism? |
|
Definition
| If ultrasound fails to diagnose a single adenoma |
|
|
Term
| What is "hungry bone syndrome" as it related to parathyroidectomy? |
|
Definition
| Hypocalcemia after uneventful removal of solitary parathyroid adenoma caused by prior PTH suppression by adenoma |
|
|
Term
| What is the pathophysiology and treatment of Achalasia? |
|
Definition
1) Lack of peristalsis and failure of LES relaxation with birds beak on esophagram
2) Medical includes calcium channel blockers and botox to LES
3) Surgical is dilation and Heller myotomy (gold standard) |
|
|
Term
| What is the appropriate workup strategy for suspected GERD? |
|
Definition
1) OTC antacids or PPI trial
2) Manometry (only 40% sensitive)
3) pH monitoring >90% sensitive and specific |
|
|
Term
| How are the nasal ala and caudal septum displaced in cleft lip? |
|
Definition
1) Nasal ala on affected side is inferolateral
2) Caudal septum displaced to contralateral side |
|
|
Term
| What is the rule of 10s for cleft lip repair? |
|
Definition
| 10 weeks, 10 lbs, Hemoglobin of 10, Millard rotation advancement flap |
|
|
Term
| What are the primary strategies for repair cleft palatte? |
|
Definition
At 10-18 months
1) lengthening: V to Y or Furlow Z-plasty
2) posterior flaps- pharyngeal flap and sphincter pharyngoplasty |
|
|
Term
| What is the most common inner ear abnormality in children with congenital heraingn loss? |
|
Definition
Enlarged vestibular aqueduct (>1.5 mm at midpoint of aqueduct)
Hearing loss is progressive an can be stepwise. Treat with HA or cochlear implantation |
|
|
Term
| What is the timeline of damage from disc battery ingestion and management protocol? |
|
Definition
1) One hour (mucosal), 2-4 hours (muscular), 8-12 hours (potential perforation)
2) If in stomach, send home and monitor stool. repeat X ray in 4-7 days if not passed. |
|
|
Term
| What is the most common branchial cleft cyst? Describe major features of each |
|
Definition
2nd is most common at 90%
1) First branchial cleft
- Type 1 ectodermal duplication of EAC
- Type 2 passes through paroit and opens into anterior neck above hyoid
- Surgery
2) Anterior border of SCM->deep to platysma, superficial to CN IX and XII, exits in tonsillar fossa
3) anterior border of SCM, dep to CN IX, penetrates thyrohyoid membrane and exits piriform sinus |
|
|
Term
| What is the appearance of cat scratch disease on FNA? |
|
Definition
| Warthin-Starry stain showing small pleomorphic gram-negative rods |
|
|
Term
| What is the unique feature regarding Orbital rhabdomyosarcomas? |
|
Definition
Locally aggressive, but rarely metastasize unlike other sites
Chemoradiation is tx mainstay |
|
|
Term
| What is the formula for pediatric endotracheal tube size selection |
|
Definition
(age in years +16) /4
2 year old needs a 4.5 |
|
|
Term
| What is grading for SGS and how is it managed? |
|
Definition
1) 0-50%, 50-70%, 70-99%, >99%
2) 1-2 is observation vs. incision/dilation. 3-4 is anterior split (neonataes), LTR, cricotracheal resection |
|
|
Term
| What are the available agents from chemical peels? |
|
Definition
1) Glycolic acid
- Penetration is time dependent, mild and least complications
2) Trichloracetic acid
- Intermediate to deep peel
- 10%-25% intraepidermal
- 30-40% papillary dermis
- 45-50% reticular dermis |
|
|
Term
| What is the healing time table for skin resurfacing? |
|
Definition
Chemical peels, Dermabrasion, Laser
1) 5d epidermis
2) 7d epidermis loosley attached to dermis
3) 2 weeks- new colalgen deposited, fills out dermis
4) 1 month- pigmentation returns
5) 6 months- epidermis normal thickness
6) 10 moths- dermis normalizes |
|
|
Term
| What type of medication should all patients getting skin resurfacing be on? |
|
Definition
|
|
Term
| Why might a patient undergoing skin resurfacing develop headache, arrythmias and CNS depression |
|
Definition
Phenol toxicity. Used for keratolysis and keratocoagulation
Prevent with aggressive hydration |
|
|
Term
| How does the approach to a brow lift determine the displacement of the hair line? |
|
Definition
Ideal brow position differs by sex. Male rest on superior orbital rim. Remain arc above rim with apex above lateral limbus
1) Endoscopic or coronal approaches cause posterior displacement
2) Pretrichial or direct do not change position |
|
|
Term
| What is the appropriate dissection plane for an endoscopic brow lift? |
|
Definition
1) Subperiosteal in the forehead
2) Supraperiosteal over temporalis
3) Temporal franchise of FN is lateral to plane of dissection, with sensual vein indicating position
4) Corrugator and procures can be partially resected at time of surgery |
|
|
Term
| What are the basic techniques for upper and lower lid Blpharoplasty? |
|
Definition
1) Upper: complication is lagopthalmos (over-resection), ptosis (injury to levator)
- Preserves 1cm of skin, Inferior to lid crease, between brow and superior incision
- Levator aponeurosis inserts into orbiculares and dermis to form upper eyelid crease (10mm form lid margin in caucasians)
2) Lower lid: complications are ectropion, inferior oblique injury
- Skin flap (skin and fat excision)
- Skin-muscle flap (higher risk of ectropion)
- Transconjunctival (dresses fat herniation rather than skin and muscle, decreased risk of ectropion) |
|
|
Term
| What is the relevant surgical anatomy for a rhinoplasty? |
|
Definition
1) Nasion- nasofrontal suture
2) Rhinion- junction of nasal bones and upper lateral cartilages
3) Supratip break- transition between cartilaginous dorm and apex off lower lateral cartilages (ideal is 6mm)
4) Tip- apex of lower lateral cartilages |
|
|
Term
| What is the ideal nasal length of projection? |
|
Definition
Nasal length is 2/3 of mid facial height (glabella to subnasale)
Nasal projection should be 50-60% of nasal length (or sae width as alar base) |
|
|
Term
| What are the ideal nasofrontal and nasolabial angles? |
|
Definition
1) nasofrontal is 115-130 degrees
2) nasolabial is 90-115 degrees |
|
|
Term
| What are the major complications of rhinoplasty apart from bleeding? |
|
Definition
1) Alar notching from overreaction of lower lateral cartilages
2) Inverted V- collapse of upper lateral cartilages
3) Open-roof deformity- inadequate osteotomies following resection of dorsal hump
4) Pollybeak- excessive bony dorm resection with under rescction of cartilaginous septum, loss of tip projection
5) Rocker deformity- medial osteotomy resulting in fracture of frontal bone cephalic to radix
6) Saddle nose deformity- over-resection of dorsum |
|
|
Term
| What is a favorable cervicomental angle for rhytidecotmy? |
|
Definition
| Sharp it high and posterior hyoid bone |
|
|
Term
| What are the major goals of a Rhytidectomy? What nerve is most commonly injured in the procedure? |
|
Definition
1) Reduce jowling, decrease laxity of skin and platysma, submental lipectomy
2) Greater auricular nerve. Most common branch of facial is temporal branch within temporaoparietal fascia |
|
|
Term
| What are the approaches to Lip reconstruction? |
|
Definition
1) <30% use primary closure
2) 30-60% use Abbe-Estlander (flap has width of 50% of defect)
3) Total recon use Karapandzic technique, will cause microstomia |
|
|
Term
| When should scars be revised? What types of collagen are scars composed of? Describe the time course of scar strength. |
|
Definition
1) 1 year
2) Type 1
3) 30% at 1 month, 80% is maximum |
|
|
Term
| What are the therapeutic principles for scar management? |
|
Definition
1) Revise at 1 year
2) Massage, use silicone sheeting/gel, steroids (10mg/ml if routine, 40mg/ml for Keloid)
3) Surgery with simple excision <2cm, Geometric broken line, Z-plasty |
|
|
Term
| What is the best transpositional flap to restore a frontal hair line? |
|
Definition
| Juri, uses superficial temporal artery |
|
|
Term
| What is the most common cause of persistent CHL after temporal bone trauma? |
|
Definition
| Incudostapedial joint dislocation |
|
|
Term
| What are the indications for repair of orbital floor fractures? |
|
Definition
Ideally done at 10-14 days unless entrapment with oculocardiac reflex
1) Rapid onset bleeding or decreased vision
2) Diplopia >7d
3) Entrapment
4) Enopthalmos >2mm or involvement of one third to one half of floor |
|
|
Term
| What are the 3 types of naso-orbital-ethmoid fractures and how are they managed? |
|
Definition
1) Type 1 is single, non-comminuted bone fragment without medial cantonal tendon dysruption. Type 2 is comminution, but no tendon loss. Type 3 is both communion and tendon
2) Goal of surgery is to reconstruct nasal root into which medial cantonal tendon inserts.
- Normal intercanthal distance is 3-3.5 cm |
|
|
Term
| What are the 3 zones of cervical traumatic injury? |
|
Definition
1) Zone 1: sternal notch to cricoid
2) Zone 2: cricoid to angle of mandible
3) Zone 3: angel of mandible to skull base
Angiography first line treatment for Zone 1 and 3, Zone 2 needs surgical exploration if emphysema, hemoptysis, hematoma |
|
|
Term
| How can a minor salivary gland biopsy help distinguish Scleroderma from Lymphoma? |
|
Definition
1) Biopsy will have lymphocytic and histolytic infiltrate with glandular atrophy
2) Sjogrens will have myoepithelial cells, but NOT lymphoma |
|
|
Term
| Why might a patient with OSA present with apnea after tracheostomy? |
|
Definition
CO2 narcosis
Patients rely on hypoxia for respiratory drive. If develop post-obstructive pulmonary edema, give PEEP |
|
|
Term
| What are the maximum doses for Lido with and without Epi? |
|
Definition
1) 4.5 mg/kg without
2) 7 mg/kg with
10mg per cc of 1%. so 10kg kid can have 4.5cc without and 7 with |
|
|
Term
| How is coccidiomycosis diagnosed and treated? |
|
Definition
1) Skin test, complement fixation, CXR "coin lesions"
2) Amphotericin B (also for Cryptococcis) |
|
|
Term
| Differentiate between IgM and IgG |
|
Definition
1) IgM first antibody seen in response to pathogen, on surface of B cells
2) IgG has placental transmission and is majority of antibody-based immunity |
|
|
Term
| What is antibiotic treatment for acute coalescent mastoiditis? What about chronic suppurative otitis media? |
|
Definition
1) Ceftriaxone and Vancomycin
2) Perofrated drum with persistent drainage: given quinolone get and quinolone oral, or cephalosporin vs. anti-pseudomonal PCN for children |
|
|
Term
Match histological finding with disease
1) Charcot-leyden crystals
2) Pseudoepitheliomatous hyperplasia
3) Warthin starry stain showing pleomorphic GNRs
4) Physaliferous cells |
|
Definition
1) Allergic fungal sinusitis
2) Blasto, Necrotizing sialometaplasia, Rhinoscleroma, Granular cell tumor
3) B. hens lea
4) Chordoma |
|
|
Term
Match histological finding with disease
1) Methenamine silver
2) Birbeck granules
3) Psammoma bodies
4) epithelial, myoepithelial and stromal elements |
|
Definition
1) Fungal sinusitis
2) Histiocytosis X
3) Meningioma or PTC
4) Benign mixed tumor, pleomorphic adenoma |
|
|
Term
Match histological finding with disease
1) Russel bodies, Mikulicz cells, Pseudoepitheliomatous hyperplasia
2) Sheets of amyloid rich cells
3) Papillary cyst adenoma lymphomatosum
4) Squamous cells in cords with intercellular bridges and keratin pearls |
|
Definition
1) Rhinoscleroma
2) Medullary thyroid cancer
3) Warthin's tumor
4) Well differentiated SCCa |
|
|
Term
| What is the tip defining point of the nose? |
|
Definition
| Apex of lobular arch of lower lateral cartilage |
|
|
Term
| What are the primary techniques for managing chin deficiencies and what are the important complications of each? |
|
Definition
1) Sliding Genioplasty: horizontal osteotomy of mandibular symphysis and advacement of inferior segments
- Complications of mental nerve injury, poor bony union, damaged tooth roots
2) Chin implants (usually silastic)placed subperiosteally via intraoral or extraoral
3) Orthognathic surgery |
|
|
Term
| What are the advantages and disadvantages of STSGs vs. FTSGs? |
|
Definition
1) Split thickness has better neovascularization, but worse contracture
2) Full thickeness is appropriate for small 1-5cm externally visible facial defects and has poorer neovascularization but less contracture |
|
|
Term
| How large should remaining caudal and dorsal struts of septal cartilage be when preparing septal cartilage grafts? |
|
Definition
| 1.5 cm to avoid loss of tip support |
|
|
Term
Which nerve supplies sensate capabilities for each of the following free flaps?
1) Radial forearm
2) Fibula
3) ALT |
|
Definition
1) Lateral and medial antebrachial cutaneous
2) Lateral sural cutaneous nerve
3) Lateral femoral cutaneous nerve of thigh |
|
|
Term
| Why is a Gracilis free flap useful? |
|
Definition
Primarily in facial reanimation
Motor capability provided by anterior branch of obturator nerve
Bulky, which can be challenging towork with. Good aesthetic outcome at donor site. Based on terminal branch of adductor artery (branch of profunda femoris) |
|
|
Term
| How should oral candida be treated in HIV? |
|
Definition
1) CD4 >200, oral nystatin mouthwash
2) CD4 <200, systemic fluconzazole
**may be fluconazole-resistant |
|
|
Term
| White, corrugated hyperkeratotis lesions of lateral tongue. What does this make you think? |
|
Definition
Oral hairy leukoplakia: Common in HIV
- Associated with EBV, biopsy and show EBV
- Get HIV test
- No malignant potential, but watch out for lichen planus, CIS, etc. No specific treatment except biopsy. |
|
|
Term
| What pathophysiological feature is thought to drive Kaposi sarcoma in HIV? |
|
Definition
HHV-8
Treated by addressing underlying HIV. ANy surgery would be palliative in nature |
|
|
Term
| What organism do you think of in chronic bacterial otitis externa? How is it managed? |
|
Definition
Gram negatives, particularly proteus
Frequent debridement, topical abx, topical steroids, Canaloplasty with STSG for boliterative cases |
|
|
Term
| What is the appropriate workup for suspected malignant OE? |
|
Definition
Skull base osteomyelitis
1) Biopsy tissue
2) T99 scan for osteoplastic activity, to confirm diagnosis
3) G67 studies to follow progression
4) Diabetic control, EAC debridement, correction of immunodeficiency, Oral FQ vs. IV for patients who can't take quinolones. Amphotericin B if fungal suspected. |
|
|
Term
|
Definition
<2 years usually gets them because of increased failure risk. >2 can be observed for improvement first.
Generally, it saves 1d recovery time |
|
|
Term
| Syndrome including hypermobile joints, hearing loss, cleft palate. What is inheritance pattern and associated gene? |
|
Definition
| Stickler, AD inheritance, mutation in collagen genes |
|
|
Term
| Pulsatile tinnitus + elevated SP/AP ratio on ECOG + low-frequency CHL or normal hearing |
|
Definition
|
|
Term
What forms of audiology testing are done at
1) <6 months
2) 6-30 months
3) >30 months |
|
Definition
1) Behavioral observation
2) Visual reinforcement
3) Conditioned play--->Normal audiometry |
|
|
Term
Line that runs parallel to the horizontal SCC and bisects the posterior SCC.
Why is this line important. |
|
Definition
| Donaldson line-->superior boundary of the endolymphatic sac |
|
|
Term
| Which area of the cochlea is most influenced by ototoxocity? |
|
Definition
| OHCs, basal turn or stria vascularis |
|
|
Term
| Where are most congenital chole found? Gender and age most common? |
|
Definition
1) Anterior superior
2) M>F, age 4 |
|
|
Term
| Where is the most common site of a perilymphatic fistula? |
|
Definition
| Anterior to the anterior crus of the stapes |
|
|
Term
| What is the T staging of an EAC neoplasm? |
|
Definition
1) EAC without erosion
2) EAC with erosion partial or limited soft tissue
3) Full thickness EAC with limited (<0.5cm soft tissue). Can involve middle ear or mastoid
4) Extensive erosion |
|
|
Term
| Why not do a stapedectomy on a patient with active meniere's disease? |
|
Definition
| Dilated saccule behind foot plate |
|
|
Term
| What are the contents of the cochlear aqueduct? |
|
Definition
| 1) Periotic (perilymphatic) duct connects the scala tympani at basal turn to subarachnoid space |
|
|
Term
| What are the derivatives of the 6 hillocks of his? |
|
Definition
1) Tragus
2) Helical crus/root
3) Helix
4) Anti-helix
5) Anti-tragus
6) Lobule |
|
|
Term
| What kind of tumors are associated with VHL syndrome? |
|
Definition
|
|
Term
| What are the borders of the sinus tympani? |
|
Definition
1) Superior is ponticulus
2) Inferior by subiculum |
|
|
Term
What are the MRI appearances of the following?
1) Cholesteatoma
2) Meningioma
3) Paraganglioma
4) Schwannnoma
5) Cholesterol granuloma
6) Dermoid |
|
Definition
1) T1 hypo, T2 hyper
2) T1 iso, enhance with contrast on T2
3) T1 iso, T2 iso
4) Iso T1/T2, foci of T2 hyperintensity
5) Hyper T1, Hyper T2
6) Hyper T1, Hyper T2, don't enhance |
|
|
Term
| Which approach to acoustic neuroma surgery has highest risk to facial nerve? |
|
Definition
| Middle cranial fossa, especially if >10mm CPA extension |
|
|
Term
| Where is facial nerve narrowist? |
|
Definition
| Labrynthine in fallopian canal (0.7mm) |
|
|
Term
| How do you avoid blunting with lateral tympanoplasty? |
|
Definition
1) Remove anterior canal wall bone
2) Avoid placing graft over anterior wall
3) Packing gel foam over graft at anterior sulcus |
|
|
Term
| Which are the most vestibulotoxic antibiotics? |
|
Definition
1) Streptomycin (most)
2) Gentamycin
**Amikacin, Kanamycin and Neomycin are cochleatoxic |
|
|
Term
| What are criteria for diagnosis Meniere's disease? |
|
Definition
1) Fluctuating aural symptoms in affected ear
2) Audiometry confirmation of low-mid frequency SNHL in affected ear
3) 2 spontaneous episodes of rotational vertigo lasting 20 min to 24h.
4) Excluding other causes |
|
|
Term
| What are the components of the innate immune system? |
|
Definition
1) Physical barriers (skin, mucous membranes)
2) Phagocytes, NK cells (against cancer and virus-infected cells)
3) Acute phase proteins, complement
4) Innate lymphoid cells |
|
|
Term
| Distinguish between the mediators, cells and immune response associated with Th1, Th2 and Th17 responses. |
|
Definition
1) Th1: Delayed hypersensitivity, cell-mediated vital/bacterial immunity: IFN-y, IL-2
2) Th2: Allergy/Atopy: IL-4, IL-5, IL-13. Cells involve Eosinophils, mast cells, basophils and response is IgE.
3) Th17: Autoimmunity: IL_17, 23
4) TREG: IL-10, TGFb; normal immunity and tolerance |
|
|
Term
| Which sinus diseases are known for a high Th2 response? |
|
Definition
|
|
Term
| What are the available biologics for high Th2 disease states in ENT? |
|
Definition
1) Omalizumab (anti-IgE)
2) Mepolizumab/Reslizumab (anti-IL-5)
3) Benralizumab (anti-IL-5Ra)
4) Dupilumab (anti-IL-4Ra) |
|
|
Term
What is the action of the following atopic interleukins?
1) IL4
2) IL5
3) IL13 |
|
Definition
1) Production of IgE
2) Eosinophilopoeisis
3) Allergic asthma, Nasal polyp remodeling with IL4 receptor |
|
|
Term
| Which IgG deficiency is most common in adults vs. children? |
|
Definition
1) Children: IgG2 (polysaccharide antigens)
2) Adults: IgG3 (protein antigens) |
|
|
Term
Name the immune deficiency syndrome
Sinopulmonary infections with PNAs and sinus infections
Low IgG, low IgA or IgM or IgE
Cant make immuen response to polysaccharide and/or protein vaccines |
|
Definition
|
|
Term
| Which organisms are most likely to affect patients with Bruton's Agammaglobulinemia? |
|
Definition
Encapsulated (S. Pneumo, H. flu, N. meningitiditis)
XLR defect in Bruton TK, critical for B cell maturation, leading to abence lymphoid tissues and lack of germinal centers.
Need IVIG and avoid live vaccines |
|
|
Term
| Child has issues with tetany and a cleft pallate. What do you think? |
|
Definition
DiGeorge
CATCH-22. Cardiac, abnormal facies, thymic aplasia (no T cells), cleft, hypoparathyroidism |
|
|
Term
Bleeding, Eczema and sinopulmonary infections.
Name the congenital immunodeficiency |
|
Definition
WAS. XL severe, mutation in WASP gene.
Microthromobocytopenia, recurrent infections
Rx: stem-cell transplant |
|
|
Term
| Name 3 types of Cytotoxic (type II) hypersensitivity reacitons |
|
Definition
1) Transfusion reactions
2) Graves (anti-TSH receptor Abs)
3) Hashimotos (anti-TPO and anti-thyroglobulin) |
|
|
Term
| Name 4 immune complex hypersensitivity diseases |
|
Definition
1) Hypersensitivity penumonitis
2) Glomerulonephritis
3) RA
4) SLE |
|
|
Term
| Name 3 cell mediated hypersensitivity reactions (type IV) |
|
Definition
Starts days or hours after contact and lasts for days
1) Virus/fungi/parasites/TB
2) Allergic contact dermatitis |
|
|
Term
| What is the management of anaphylaxis: |
|
Definition
1) Epi
- Adult is 0.3-0.5 mg 1:1000 IM in anterior or lateral thigh
- Ped is 0.01 mg/kg 1:1000 IM in thigh
Repeat every 5 min or sooner if needed
Start fluids, H1/H2 antihistamines, Vasopressors, Glucagon, Atropine |
|
|
Term
| Which type of angioedema is mediated by MAST cells vs. Bradykinin? |
|
Definition
1) MAST cells respond to steroids/anti-histamines
- Insects, latex, foods drugs
2) Bradykinin does not respond as well
- ACE-I, HAE |
|
|
Term
| What is the screening test for hereditary angioedema? |
|
Definition
Bradykinin mediated process
- Low C4 level. This is an AD deficiency in C1 inhibitor
Rx: Purified C1INH, Kallikrein inhibitor and Bradykinin receptor antagonists. |
|
|
Term
| What is Dupilumab approved for? |
|
Definition
1) Inadequately controlled CRSwNP is >12
2) Binds IL-4a subunit, inhibits signaling of IL4 and IL13
Cannot interrupt use and effects are not sustained. |
|
|
Term
| True or False. ASA Rx is indicated in AERD. |
|
Definition
| AFTER desensitization, it helps with everything except eliminate existing polyps. |
|
|
Term
| What are the acute phase reactants of allergy? |
|
Definition
within 5-30 minutes of exposure
Histamine and Tryptase
Sneezing, itching, rhinorrohea |
|
|
Term
| How do you distinguish intermittent from persistent allergic rhinitis? |
|
Definition
< 4 days per week OR < 4 weeks
Persistent needs both |
|
|
Term
| Which meds affect allergy skin testing? |
|
Definition
1) Antihistamines
2) TCAs
3) Theophylline
4) Topical steroids applied to testing area
NOT AFFECTED by systemic steroids or LKE modifiers |
|
|
Term
| Describe Skin endpoint titration testing for allergy |
|
Definition
1) Antigen injected intradermally to produce wheel 4-5mm
2) Positive reaction is when wheel of 7mm or greater is followed by larger (confirmatory) positive wheel of >= 9mm.
3) Endpoint is dilution that results in positive response and is directly followed by confirmatory wheal (growth of at least another 2mm). It is the dilution BEFORE the confirmatory wheal. |
|
|
Term
| What are plateau reactions and flash responses in skin endpoint titration for allergy testing? |
|
Definition
1) Plateau: first positive wheal is followed by another positive wheal of same size. If confirming wheal is obtained, then second positive wheal is endpoint.
2) Flash response is when series of negative wheals followed by a very large positive wheal. In this case, STOP testing and resume in 4-7 days. |
|
|
Term
| What is modified quantitative testing? |
|
Definition
Combination of skin prick and IDT.
Use skin prick to screen then confirm with single IDT. |
|
|
Term
| What is Latex-Fruit syndrome? |
|
Definition
IGE to NRL-13 distinct proteins
Latex "plant defense proteins" heat-stable
ABC-KIWI: Avacado, Banana, Chestnut, Kiwi |
|
|
Term
| What are the major cat allergens? |
|
Definition
|
|
Term
| What are the first-generate anti-histamines and how are they matabolized? |
|
Definition
1) Diphenhydramize, Hydroxyzine, Chlorpheniramine
2) Cause sedation and dry mouth
3) Metabolized by Liver. |
|
|
Term
| When are leukotriene-rececept-antagnoists useful in allergic rhinitis? |
|
Definition
Montelukast, Zafirlukast
Co-existing allergic asthma and exercise or cold air-induced asthma.
Otherwise efficacy similar to oral antihistamines and less than nasal steroids |
|
|
Term
| How does immunotherapy for allergy work? |
|
Definition
Conversion of Th2 response to Treg responses. Also increased TH1 response.
Tregs secrete IL-10, which induces T-cell tolerance to specific allergnes. |
|
|
Term
| What are the major components of allergy extracts? |
|
Definition
1) glycerin (50%): preservative
2) phenol (20%): bacteriostatic
3) human serum albumin: stabilizer |
|
|
Term
| What are the useful treatments for vasomotor rhinitis? |
|
Definition
1) Azelastine (likely related to neuropeptide signalling)
2) Ipratropium bromide (for rhinitis alone)
3) Capsaicin
4) Vidian neurectomy or cryo |
|
|
Term
| What are foramen of huschke and fissures of santorini? |
|
Definition
Hushke is medial, bony and abnormal
Santorini is lateral cartilaginous and normal |
|
|
Term
|
Definition
| >10s with associated hypoxia and arousal |
|
|
Term
| What criteria lead to 85% success with UPPP? |
|
Definition
Friedman staging
- Tonsil 2-4 (at least to pillar)
- Palate 1-2 (can at least see uvula) |
|
|
Term
|
Definition
| >5h per night, 4 nights per week |
|
|
Term
| Who can benefit from an expansion sphincteroplasty? |
|
Definition
| Patients with OSA who have narrowing of lateral dimension more than AP, usually from thick palatopharyngeaus muscles. |
|
|
Term
| What is the limitation of transpalatal advancement for OSA? |
|
Definition
Used in excessively long hard palate. Trim and hard palate and advance the soft palate.
high rates of oronasal fistula. |
|
|
Term
| When is radiogrequency ablation of tongue base especially useful in OSA? |
|
Definition
| Tremendously augments success of UPPP in higher freidman stage patients |
|
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Term
|
Definition
Most effective surgery apart from tracheostomy.
1) Lefort 1 osteotoma in maxilla
2) Sagital split in mandible.
Usually good for retrognathic patients without significant soft tissue disease or as salvage |
|
|
Term
| How is treatment success defined in OSA surgery? |
|
Definition
1) >50% reduction
2) AHI <20
3) Clinical improvement |
|
|
Term
| Which sleep study is the most important in diagnosing Narcolepsy? |
|
Definition
Modified sleep latency test.
- Nap 5 times at 2h intervals after full night sleep
- Latency <8 minutes with 2 or more sleep onset REM sleep events.
Given stimulants and antidepressents (cataplexy) |
|
|
Term
| What are respiratory effort related arousals and how to they relate to the RDI and AHI? |
|
Definition
RERAs: cannot be defined as apneas or hypopneas.
RERA + apnea + hypopnea / time (hr) is the RDI.
In upper airway resistance syndrome, there are RERS and not apnea/hypopneas. Still use CPAP. |
|
|
Term
| What are the first and second stage surgical procedures for OSA in the Stanford Program? |
|
Definition
1) Hypoid suspension, UPPP, genioglossus advancement
2) MMA |
|
|
Term
True or False:
UPPP + genioglossus advancement is similarly effective to UPPP + tongue base suspension |
|
Definition
| True: multi-level surgery is better than UPPP alone, but similar effectiveness when in combination. |
|
|
Term
| What is Mueller manuever? |
|
Definition
| FFL while awake during reverse valsalva (breathe in with nose plugged). Look for >50% collapse at retrolingual and retropalatal airway. |
|
|
Term
| What are the most prominent pharyngeal dilators? |
|
Definition
| Genioglossus, Tensor palatini |
|
|
Term
| Most common arrhythmia associated with OSA |
|
Definition
|
|
Term
| What is success rate of oral appliance for OSA (<15 AHI) in CPAP-resistant individuals |
|
Definition
|
|
Term
| What are the characteristics of each stage of sleep? |
|
Definition
1) Wake: alpha waves
2) N1: Theta waves, vertex sharp waves, slow eye movements
3) N2: Sleep spindles and k complexes
4) N3: Delta waves
5) REM: Rapid eye movements |
|
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Term
| What are the findings most predictive of OSA on lateral cephalometry? |
|
Definition
1) Low hyoid bone: increases length of retrolingual airway
2) increased tongue size
3) increased vertical face length
4) increased length and width of soft palate
5) Reduced max/mand projection |
|
|
Term
|
Definition
Central/obstructive/mixed apneas, hypopneas, RERAs over time.
Used to monitor clinical response to therapy |
|
|
Term
| Distinguish between nightmares and sleep terrors. |
|
Definition
1) Nightmare: remembered, last third of night, less autonomic
2) Sleep terror: don't remember, first third of night, more autonomic/behavioral |
|
|
Term
| What sleep disorder is found in PD frequently with lack of atonia during REM sleep? |
|
Definition
| REM sleep behavior disorder: acts out dreams |
|
|
Term
| How is OSAHS score calculated and how can it be predictive of at least moderate sleep apnea? |
|
Definition
1) BMI, tonsil size, friedman tongue size (each 0-4)
2) If >8, 90% chance of moderate OSA |
|
|
Term
| Describe the overall Friedman stage |
|
Definition
1) BMI (> or < 40)
2) Tonsil (1-4)
3) Palate (1-4)
Best candidates for UPPP are thin (<40), large tonsils with low-grade palate (1 or 2).
If BMI >40, < 10% success of UPPP |
|
|
Term
| Can an obese patient benefit from UPPP? |
|
Definition
|
|
Term
| Which portion of MMA for OSA puts mental nerve most at risk? |
|
Definition
| Saggital osteotimes put inferior alveolar nerve at risk. |
|
|
Term
| Which hormones are regulated by sleep and in what direction? |
|
Definition
1) Cortisol, Glucose, Insulin, Prolactin all increase
2) TSH decreases |
|
|
Term
| What are the CSF, PSG and MSLT findings associated with narcolepsy? |
|
Definition
1) CSF: low hypocretin
2) PSG: increased stage 1 sleep
3) MSLT: >2 sleep onset REMs, sleep latency <8 minutes |
|
|
Term
| What are the best predictors of OSA anatomically? |
|
Definition
1) Neck circumfrence > 17 inches for males (15 for remales)
2) Retroglossal space
3) Soft palate length
4) Hypoid position |
|
|
Term
| Define a sleep-related hypoventilation events |
|
Definition
Increase in PaCO2 >10 mmHg compared to baseline, with >50 for at least 10 minutes
Or > 55 for 10 minutes |
|
|
Term
| What is the use of Gamma-hydroxybutyrate in OSA treatment? |
|
Definition
Good for narcolepsy with cataplexy
Also TCA and SSRI |
|
|
Term
| Compare utility of endoscopic compared to coronal brow lift |
|
Definition
Coronal (sub-galeal) has more reduction in scalp sensation and raises frontal hairline.
If you have a high hairline or male pattern baldness, endoscopic (sub-pereosteal) approach is preferred. |
|
|
Term
| Who is an ideal candidate for rhitidectomy? |
|
Definition
- Non-smoker with thicker skin, no sun damage
- Strong bony features
- Sharp cervicomental angle, protruded chin and high hyoid. |
|
|
Term
| Which muscles are responsible for horizontal glabbelar, vertical glabbelar and crow's feet frown lines? |
|
Definition
1) Horizontal glabella- Procerus
2) Vertical glabella- Corrugator
3) Crows feet- Orbicularis oculi
Botox A lasts longer, Botox B acts faster |
|
|
Term
| What are the lateral and inferior extents to be considered when injecting the corrugator for glabellar vertical frown lines? |
|
Definition
1) Don't go lateral to mid-pupillary line
2) Stay 1cm above orbital rim
- otherwise weaken levator muscles and lead to ptosis. |
|
|
Term
| What are the classic nasal features in unilateral cleft lip? |
|
Definition
- Columnella, nasal tip and caudal septum deviate contralateral
- Posterior septum deviates ipsilateral
- Cleft-side ala are inferiorly displaced and horizontally oriented. |
|
|
Term
| Where are full thickness skin grafts on the face most ideal? |
|
Definition
thin skin and concavity. Temple is good.
NOT nose, forehead, cheek (need local flaps) |
|
|
Term
| What is an inverted V deformity? |
|
Definition
| Inferior displacement of upper lateral cartilages during rhinoplasty from overcorrection of nasal dorsum |
|
|
Term
| What is a rocker rhinoplasty deformity? |
|
Definition
| when nasal bone inferior to osteotomy sinks relative to bone superior to osteotomy, causing step off |
|
|
Term
| What is ideal brown position for women (western concept)? |
|
Definition
- medial brow head lies on tangent with medial canthus and nasal ala
- highest point above lateral lumbus or lateral canthus
- end at oblique line drawn through nasal ala and lateral canthus |
|
|
Term
| What is Dedo classification of cervical deformity? |
|
Definition
1) minimal deformity
2) skin laxity
3) fat acummulation
4) platysmal banding
5) retrognathia
6) low hyoi |
|
|
Term
| How should Bell's palsy be treated? |
|
Definition
| Steroids within 72h of symptom onset. Not anti-viral. No usual imaging. |
|
|
Term
| What factors increase risk of hematoma after facelift? |
|
Definition
| Men, BMI>30, smoking, anterior platysmaplasty, blood thinners |
|
|
Term
| What are the benefits of direct and indirect brow lifts as opposed to coronal or endoscopic? |
|
Definition
Direct and indirect are good for brow asymmetry, which is not addressed by coronal or endoscopic.
Indirect is good if there are prominent glabellar rhytids. |
|
|
Term
| What are the incisions for delivery approach of endonasal rhinoplasty? |
|
Definition
| Marginal, intercartilagenous and full transfixion. |
|
|
Term
| How do you manage ptosis from botox injections for racial rhytids? |
|
Definition
|
|
Term
What are the appropriate lower lip recon strategies for
1) <1/3
2) 1/4 to 1/2 without commisure
3) 1/4 to 1/2 with commisure
4) 1/2 to 2/3
5) > 2/3 |
|
Definition
1) Primary
2) Abbe
3) Estlander
4) Karapandzic
5) Burrows, Gilles-Fan or free flap |
|
|
Term
Describe scar elongation and rotation for the following Z plasty angles
1) 30
2) 45
3) 60 |
|
Definition
1) 45 degree rotation, 25% elongation
2) 60 degree rotation, 50 % elongation
3) 90 degree rotation, 75% elongation |
|
|
Term
What are the major cytokines for
1) TREG
2) Autoimmunity
3) Production of Eosinophile
4) Production of IgE |
|
Definition
1) IL-10, TGF-b
2) IL-17, IL-23
3) IL-5
4) IL-4 |
|
|
Term
What do each of the following antibodies do?
1) Omalizumab
2) Mepolizumab/Reslizumab
3) Dupilumab
4) Benralizumab |
|
Definition
1) anti-IgE
2) anti-IL5
3) anti-IL4-receptor
4) anti-IL5-receptor |
|
|
Term
| What are the two major regions of an antibody and what are their functions? |
|
Definition
1) Constant, binds cell surface, determines Ig class
2) Variable, binds antigen, specific binding |
|
|
Term
| Which immunodeficiency is seen in 25% of patients with CRSsNP? |
|
Definition
| Specific polysaccharide antibody deficiency |
|
|
Term
| Name everything you know about Bruton's Agammaglobulinemia |
|
Definition
1) XLR defect in TK
2) B cell maturation defect
3) No germinal centers
4) Sensitive to encapsulated organisms
5) Presents after maternal Abs wear off.
6) Give IVIG and avoid live vaccines |
|
|
Term
| How do you treat wiskott aldrich syndrome? |
|
Definition
Stem cell transplant
XL congenital defect in WASP, eczema, thrombocytopenia and sinopulmonary infections |
|
|
Term
| Which cytokine is low in hereditary angioedema? |
|
Definition
|
|
Term
| Which part of the allergic response initially is blunted by intranasal steroids? |
|
Definition
| Intranasal steroids initially block late allergic response, then will block early after 1 week. Synergistic with intranasal antihistamines |
|
|
Term
| What medications, in addition to avoidance, are useful in rhinitis medicamentosa? |
|
Definition
| Vasodilators: hydralazine, minoxidil, CC blockers, alpha-1 blockers, PDE inhibitors |
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