1
Q
Aminoglycosides and incidence of HL? which part of the cochlea does it effect? how soon after therapy do pt’s start to experience HL?
A
-10% -basal and inner row of hair cells -3-4 days
2
Q
Branchial Arches define?
A
3
Q
Dermal filler for patients with AIDS
A
4
Q
Treatment for anaphylaxis
A
- 3-0.5mg of 1:1000 epi every 15-20min.
- repeat every 15-20min
- parenteral anti-histamine
5
Q
Serum markers for anaphylaxis
A
- histamine have an immediate raise and lasts for 30-60min
- tryptase elevates 30-60min after and stays elevated up to 6 hrs
6
Q
Innervation of the carotid sinus and/or carotid body tumor?
A
- Afferent CN IX: info about hypoxia, hypercap, acidosis
- Efferent: superior cervical plexus
7
Q
Bacteriocidal antibiotics?
Bacteriostatic?
A
Very Finely Proficient At Cell Murder
-Vanco, Fluoroquinolones, Pens, Aminoglycosides, Cephs, Metro
ECSTaToC
- Erythro (macrolides)
- Clinda
- Sulfa
- Tetra
- Trimethoprim
- Chloramphenicol
8
Q
PTC staging
A
9
Q
Sunderland Classifications
A
10
Q
Contributing vessels to Little’s area
A
11
Q
Growth pattern of hemangioma’s of infancy
A
Rapid growth over first 6 mo’s.
50% resolve by 5 yo
70% resolve by 7 yo
12
Q
Hemangioma of infancy subgottic risks
A
50% of subglottic will have cutaneous manifestations
60% of hemangiomas in the bearded area will be assc with subglottic ones
13
Q
2nd most common region for otosclerosis?
A
Round window
14
Q
Phases of wound healing
A
15
Q
Friedman staging for UPPP and success?
A
16
Q
What is the definition of surgical success and UPPP?
A
50% reduction or AHI < 20
17
Q
Indication for RAI for follicular thyroid CA
A
- tumor > 4cm
- gross extracapsular extension
- extensive intravascular invasion
- elevated post op TG
- known or suspected metastatic disease.
18
Q
Only facial muscle not innervated by FN?
A
levator palpebrae superioris - innervated by CNIII
19
Q
What kind of hearing loss do you get with quinine?
A
reversible at 4kHz
20
Q
Contra-Indications for a partial laryngopharyngectomy?
A
- involvement of the pyriform
- extension to the post cricoid region
- ipsilateral TVC paralysis
- encroachment into the cricopharyngeus
21
Q
Sequence of local anesthetic blockage
A
-Sympathetic fibers -> pain/temp -> touch/motor
22
Q
Relationship between pH and pKa for local anesthetics
A
-the closer the pKa is to pH, the more likely the anesthetic will be in unprotonated/hydrophobic state and therefore faster onset of action
23
Q
Dennie Lines
A
Assc with AR
-occur due to spasm of Mueller’s muscles in chronic AR
24
Q
Brow lift and facial nerve anatomy in relation
A
25
What is Galactomannan?
Polysaccharide found in aspergillous, elevated in invasive pulmonary aspergillosis. No utliity in mucor.
26
T staging for supraglottic cancer
T1: Limited to one subsite
T2: Extends to adjacent subsite, still with vocal fold mobility
T3: Vocal cord paresis and/or invading inner cortex of thyroid cartilage, post cric, pre-epiglottic, paraglottic space.
T4a: Invades beyond prior
T4b: Encases carotid, mediastinum or prevertebral invasion.
27
What is Jessner's solution
salicylic acid, lactic acid, resorcinol, ethanol.
28
What meds do you give for anaphalyxis of a pt experiencing anaphylaxis
antihistamines, steroid, glucagon (increases cardiac output/HR).
29
semicircular canal dehiscence, what kind of hearing loss?
- CHL
30
How long abx for pott's puffy tumor
6-8 wks
31
When to consider SLNB in melanoma?
-T1b - T4, no gross nodal disease.
32
Staging for melanoma?
33
how to treat methemoglobinemia?
1% meth blue 1mg/kilo total slow infusion
34
2nd MCC OC cancer?
adenocarcinoma
35
innervation of the ear canal?
36
MCC presenting sx of NPC?
- 75% neck mass
- 73% nasal obstruction
37
What to do if AOM during CI?
SOM during CI?
- place tubes, implant once clear of infection for min 2 wks
- irrigate, topical gtts, post op ceftriaxone
38
Meds that increase T4 catabolism?
phenytoin, carbamazepine, phenobarbital, rifampin
39
Vessels of Woodruff's plexus
SPA, ascending pharyngeal
40
Cidofovir?
inhibits DNA polymerase, used in respiratory papillomatosis
41
What meds are used in respiratory papillomatosis?
Cidofovir, avastin
42
43
organisms in ARS most likely to self resolve?
moraxella catarrhalis, sometimes haemophilus.
S pneumo will not self resolve.
44
how many dB do you need to double the sound
3 dB
45
Sx of Churg Strauss?
- Granulomatis nasal lesions but no epistaxis
- \> 10% serum eosinophilia
- allergic rhinosinusitis
- granulomatous lesions of lungs
- asthma
- vasculitis w extravascular eosinophils
- mononeuritis multiplex
46
what is the risk for cervical mets in lip SCCa?
10%
47
most common dental cysts?
Radicular cysts \> dentigerous cysts
48
Gorlin syndrome?
- mulitiple basal cells
- odontogenic keratocysts
49
What is the chance for malignancy in a cold nodule in Graves?
45%
they also tend to be more aggressive in Graves patients
50
Vestibular neuritis typically effects which vestibular nerve?
How to test for laterality?
Superior
- fast phase away from the affected side
- symptoms worse with head movements
51
Dedo classifications
Class 1: minimal defects, no surgery
Class 2: lax skin, rhitidectomy
3: submental/submandibular adiposity: liposuction and consider anterior platysmoplasty
4: anterior banding of platysmal banding -
5: microgenia/micrognathia
6: inferior positioned hyoid: division of suprahyoid muscles, suturing of anterior diagstric muscles, chin augment
52
Blood supply to the temporalis muscles?
Ant/Posterior branches of the deep temporal artery which are branches from the IMAX
53
Nerves involved with orbital apex syndrome?
- CN 2, 3, 4, 6, nasociliary/frontal nerves, superior ophthalmic vein.
54
MCC reason for b/l facial paralysis
Lymes
55
Positive hitsilberger sign is what? and what does it signify
- Posterior superior concha numbness
- space occupying lesion of the IAC compressing facial nerve.
56
Path of foamy histiocytes and bloated plasma cells?
foamy histiocytes -\> mikulicz cells
bloated plasma cells -\> Russell bodies
sign of rhinoscleroma caused by klebsiella rhinoscleromatis.
57
Serum Ig changes with immunotherapy?
- 1st: there's a spike in specific IgE: total IgE levels (up to 16)
- 2nd: then's it will drop to below pre therapy levels.
- 3rd: get a rise in IgA and IgG4
58
Innervation of taste of the soft palate?
Posterior tongue?
Greater superficial petrosal nerve.
lingual branch of glosspharyngeal n.
59
Diplacusis?
Rollover?
Parascusis of Willis?
Diplacusis: subjective perception of more than one pitch when 1 tone is presented. Sign of cochlear dysfunction.
Rollover: Speech reception scores drop with increasing loudness
Paracusis of Willisii: phenomenom where people with CHL can have an enhanced ability to hear in noisy environment.
60
When to treat with Augmentin/fluoroquinolone in sinusitis?
If failed abx therapy or treated w abx in last 6 wks
61
Which HPV with RRP?
6, 11 (11 has worse course)
62
Which HPV for cancer?
16 and 18
63
64
# Define level III neck radiographically?
inferior cricoid to inferior hyoid.
65
Most sensitive test for central vestibular dysfunction?
Smooth pursuit tracking.
If impaired, suggests unilateral or posterior fossa lesion.
66
Head shake test and nystagmus?
horizontal nystagmus will beat away from affected side.
If vertical/rotarary -\> suggestive of cns disorder.
67
MOA of mitomycin C?
DNA crosslinking to prevent cell replication
68
Criteria for anterior cricoid split?
- failed 2 extubations
- \>1500g weight
- no assisted ventilation for 10 days
- otherwise healthy
69
What is the definition of sleep hypoventilation?
increase paCo2 to 10mmhg
70
Treatment of Ramsay Hunt?
- Valcyclovir for 14 days
- or Famcyclovir for 10 days
both w steroids
71
Describe normal occlusion?
Mesiobuccal cusp of the 1st maxillary molar is aligned with the buccal groove of the mandibular 1st molar.
72
two MCC viruses that cause rhinitis?
rhinovirus \> coronavirus
73
Proper sequence to treat cleft palate/lip kids?
- determine syndromic, feeding issues, evaluate ears, speech eval
3 mo's: tip rhino, cleft lip, tubes
1yr: palate
5yrs: columellar lengthening
8-16: orthodontics
10 yrs: alveolar grafts
14 yrs: definitive rhino
74
Closing eye lid defects?
up to a third: primary
1/3-2/3: lateral canthotomy, semicircular advancement flap
50-100%: Hughes tarsoconj flap
75
What is in Baker's solution?
phenol, septisol, croton oil, distilled h2o
-croton oil is the key ingredient for depth of chemical peel
76
Correct auriculocephalic angle?
How far apart should mustarde stitches be placed?
25-35 degrees.
at least 16mm, place at least 3
77
Pendred Syndrome?
AR
goiter, enlarged vestibular aqueduct, cochlear hypoplasia, mondini malformation.
-defective pendrid protein affecting chloride and iodide transport
78
Appropriate MRD-1/2?
4-5mm
5-5.5mm respectively
79
Goldenhar Syndrome?
AD
hemifacial microsomia (1/2nd branchial arch defect)
80
Mobius Syndrome?
congential FN paralysis
81
5 ethmoturbinals?
1) agger/uncinate
2) MT
3) superior turb
4/5) supreme
82
Early signs of lidocaine tox?
metallic taste, tinnitus, numbness around mouth.
83
What immunodeficiency cannot surmount a host response to encapsulated bacteria?
IgG2 defiency.
Encapsulated bacteria would include H influenzae
84
MCC immunodeficiency in adults?
IgG3
-more susceptible to URIs, AR, asthma
85
How much bone can you harvest for a fib flap?
25cm
86
Histology of schwannoma?
Spindle cells arranged in Antoni type A/B patterns
- A: densely packed spindle cells w aligned or palisading nuclei
- B: loosly arranged myxoid stroma
87
MOA of 5 fluorouracil?
Binds to thymidylate synthetase
88
MOA of methotrexate?
binds to dihydrofolate reductase
89
When do frontal sinuses appear in development?
5-6 yrs
90
Alexander's law
Nystagmus is worse in the direction of the healthy ear
91
How is central vertigo different from peripheral?
- does not improve w fixation
- does not improve with repeated stimulation
- multidirectional nystagmus
92
What congenital condition is assc w endolymphatic sac tumors?
Von hippa lindau
- hemangioblastomas of retina and CNS
- endolymphatic sac tumors
- clear cell renal ca
- pheochromocytoma
93
Pedicle artery for ALT flap?
-Descending branch of lateral circumflex femoral
94
MCC benign sinonasal tumors?
1. osteoma
2. IP
95
MCC affected sites for IP?
Lateral nasal wall \> max
96
What anatomically is the greatest predictor OSA?
Man neck circ \> 17cm
Woman neck circ \> 15cm
97
Dosing for propanolol for infantile hemangioma?
Propranolol dose for infantile hemangioma
2-3mg/kg per day
98
Wound tensile strength by time?
3% at 1 wk
20% at 3 wks
80% at 3 mo's
99
What is the inheritance pattern of Osler Weber Rendu?
AD
100
Medication and diet stoppage prior to RAI?
Cytomel stoppage 2 wks prior, synthroid 6 wks prior
amiodarone 9 mo's prior
low iodine diet 2 wks prior
101
For adductor vs abductor dysphonia, which #'s would they have difficulty saying?
adductor -\> 80-89
abductor -\> 60-69
102
How to diagnose and monitor malignant OE?
Tc99 scan for dx
then follow w Gallum 67 scan every 4 wks
tx usually 2-4 mos
103
Inheritance of otosclerosis?
AD
104
Mean sleep latency of people w OSA?
5 min
105
MCC cardiac arrhythmia of those w OSA?
sinus brady
106
Inflammatory marker assc w OSA?
CRP
107
Most prominent pharyngeal dilators
Genioglossus and tensor palitini
108
Esthesio and Kadish staging?
109
What % of hyperparathyroidism is due to adenoma? hyperplasia? lithium? carcinoma?
- 70% single adenoma
- 26% double adenoma
- 1.5% hyperplasia
- 1.5% lithium
- 1% carcinoma
110
cervical vestibular evoked myogenic potentials pathway?
stimulation of saccule -\> inferior vestibular n -\> vestibulospinal tract -\> SCM
oVEMPs stimulates utricle -\> superior nerve.
111
Markers for B cells? T cells? NK cells? Eosinophils?
B: CD19, 20, 22
T: CD2,3,4,8
NK: CD56,16
Eosinophils: CD69
112
Histo for Warthin's?
Cyst surrounded by double epithelium, papillary fronds with lymphoid stroma
113
How long is re-epithelization after dermaabrasion?
5-7 days
114
Neutrophil count below what number is ominious in mucor?
below 1000
115
Which antithyroid med is ok during 1st trimester?
PTU
116
In the scalp, how large should the tissue expander be? When should inflation occur after placement? How often?
2.5x the size of the defect
2 wks after
1-2 times/wk
117
Abx treatment for Lemierre's syndrome?
What bug?
What location is the source?
Metronidozole
Fusobacterium necrophorum
Peritonsillar region
118
Nerve contributions to pterygopalatine ganglion
deep petrosal
GSPN
Max nerve
nerve of pterygoid canal
119
Wiskot Aldrich syndrome?
- X linked
- Eczema
- elevated IgE/A but decreased IgM
- thrombocytopenia
120
Bruton's agammaglobinemia?
- defect in tyrosine kinase therefore B cells cannot mature and have decreased amounts of Ig's across the board
- Infections start at 6mo's once they lose mothers Igs
- Inheritance X linked
121
IgA deficiency, what do you have to watch out for?
anaphylaxis during blood transfusion
122
Describe segments of ICA?
123
Godtfredson's syndrome?
Abducens and hypoglossal nerve palsy
Due to tumor of clivus or NPC
124
Hering's Law
Equivalent innervation of matched muscles may cause non physiological overactivity of the normal side while compensating for the weak side.
To pre-op test, manually elevate the ptoticl lid, the opposite normal lid will then become ptotic
125
Furnas technique?
Conchal setback: suture technique tacking concha to mastoid periosteum
126
What % of Downs have atlanto-axial instability?
What do you look for on scan?
10-20%
\>4mm from dens to anterior edge of atlas.
127
Jugal point?
point at the anteror end of the upper border of the zygomatic arch where the masseteric and maxillary edges meet at an angle.
128
Syndrome: FAP, sinonasal osteomas, supranumery teeth?
Gardner syndrome
129
Associated features along with pyriform aperture stenosis?
premaxillary dysgenesis, central mega incisor, flat nasal bridge, hypertelorism, holoproencephaly
130
What deficiency is RLS assc with?
Assc with what medication use?
Tx?
Associated pathology?
- Deficient in CNS iron
- SSRIs, SNRIs, TCAs, lithium, antiemetics, dopamine antagonists
- Tx: pramipexole, ropinirole
- loss of dopaminergic cells in substantia nigra
131
What pyriform apex tumors can you avoid a TL?
\< 2cm in size
1.5cm above the pyriform apex
no cord fixation
no invasion
appropriate PFTs
132
How does frontal sinusitis track to the cavernous sinus?
superior ophthalmic vein
133
When to perform Laryngeal EMG in setting of RLN injury?
3-6 mo's after injury
134
pathphysio for DKA being susceptible to mucor?
-altered transferring binding which leads to increased serum iron which enhances fungal growth
135
What is Kasabach Merrit phenomenom?
It's a consumptive coagulopathy associated w tufted angiomas
136
Sturge Weber syndrome
V1 capillary malformation, leptomeningeal angiomas, intellectual instability, glaucoma
137
What pt features correlate w worse prognosis in PTC?
Males \> 41yo; Females \> 51yo
nodule \> 5cm
138
How far prior to RAI does levothyroxine have to be stopped? Liotyronine?
6 wks
2 wks
139
Management of sialocele after face lift?
Pressure dressing, glycopyrrolate, botox, transdermal scopalamine
consider drain placement.
140
Cidofovir MOA? What is it used for?
inhibits DNA polymerasae
used for RRP but off label
141
How does a vestibular schwannoma appear on MRI?
T1 hypointense, T2 heterogenous, T1 enhancement w gad
142
What does Ristocetin test test for?
vWF deficiency
143
What is the ultimobranchial body and what does it test for?
part of the 4th branchial pouch and gives rise to calcitonin producing parafollicular cells.
144
For cutaneous squam, level neck dissection per subsite?
face: 1-3
anterior scalp: 2-3
ear: 2-3
posterior scalp: 2-5
145
Abx tx for nec fasc?
146
boundaries of pre-epiglottic space?
hyoid, thyrohyoid membrane, epiglottis, thyroepiglottic ligament, hyoepiglottic ligament
147
avg palpebral fissure diameter?
9mm
148
number of cartilage in larynx?
9
cric, thyroi, epig, cuneiform, corniculate, arytenoids
149
Where is the toxicity to the ear in platin medications?
Cisplatin: changes to stria vascularis, spiral ganglion, outer hair cells
Carboplatin: toxic to inner hair cells
150
What other things should you check for in pts with mumps (specific to ENT)?
check hearing: degeneration to stria vascularis
151
Innervation of parotid gland parasympathetics?
inferior salivatory nucleus -\> CNIX -\> Jacobsen's -\> tympanic plexus -\> lesser petrosal -\> otic ganglion -\> auricular temporal -\> parotid
152
how do aminoglycosides cause damage?
forms a free radical complex w iron which damages outer hair cells
153
Most common bug of OE?
Pseudonomas
154
How soon prior to skin testing should you stop antihistamies?
TCAs?
72 hrs, loratidine -\> 7 days
TCAs -\>2-4 days
155
How long does it take for a FTSG to get a new blood supply?
Diffusion
1-2 days vascular inosculation
2-4 days neovascularization
3-5 days blood supply established.
156
blood supply to trap?
occipital, dorsal scapular, transvserse scapular
157
Within what time window should you give IV abx for CI for AOM?
within 2 mo's.
Otherwise oral is ok if uncomplicated.
158
Indications for primary hyperparathyroid surgery?
- serum ca 1.0mg/dl above upper limit nml
- creatinine clearance reduced by 30%
- \< 50 yo
- 24hr urine \> 400mg/dL
- bone density \<2.5 std
159
Ideal helix to mastoid measurements?
Upper: 10-12mm
Middle: 16-18mm
Lower: 20-22mm
160
What is the inheritance of Bruton's agammaglobinemia?
Defect?
X linked
tyrosine kinase deficiency -. B cells cannot mature
161
What kind of cell deficiency if you get a lot of viral infections/fungual infections?
T cell deficiency
162
Vemurafinib?
mitogen active protein kinase pathway inhibitor effective for melanoma w BRAF mutation
163
Staging for anaplastic thyroid ca
Stage IVA: confined to thyroid
IVB: regional mets
IVC: distant mets
164
Suspicious features of thyroid nodule?
hypoechoic, mostly solid or solid, central vascularity, taller than wide on transverse, microcalfications, cervical adenopathy
165
What % of hypopharyngeal masses have regional mets at time of diagnosis?
5yr survival?
up tp 70%
\< 25%
166
Innervation of parotid gland?
Parasympathetic: visceral motor fibers -\> lesser petrosal n -\> exits skull at foramen ovale -\> synapse on otic ganglion -\> post ganglionic fibers travel w auriculotempora n to parotid gland
167
MCC symptom of glossopharyngeal cA?
Mid frequency SNHL
Vestibular schwannomas have high frequency
168
what depth of tumor should a SLND be perform in oral cancer?
4mm or more
169
Inheritance of pendred syndrome?
Best way to dx?
AR
Genetic testing for SLC264A4 gene
170
Inheritance of aminoglycoside sensitivity?
Mitochondrial so from mother
171
When should you get an EMG for traumatic facial paralysis?
What will it show?
What will it show if FN function is returning?
2-3 wks after trauma
fibrillations
polyphasic potentials
172
Inheritance of connexin 26 hearing loss?
AR
173
CENTOR criteria?
Likelihood of having Group A strep
absence of Cough
tonsil Exudates
+ Nodes
Temp
Old oR young (+1) if young
Score -1-5
174
What feature on immunohistochemistry do infantile hemangiomas express?
Glut-1 transporter
175
Angle of the laryngeal prominence in men/women?
90/120
176
Orientation of cochlear aqueduct? Endolymphatic sac?
parallel to IAC. IAC is anterior to cochlear aqueduct.
perpendicular to IAC
177
Villaret Syndrome?
paresis of 9,10,11,12 and cervical sympathetic chain
indicative of lesion of the retroparotid space
178
If you have hyphema in an orbital floor fxr, what should you do?
Avoid surgery for 2 weeks min.
179
How to remember the AD congenital conditions?
WANT CBS
Waardenberg
Aperts
Neurofibromatosis
Treacher Collins
Crouzon
Branchio oto renal
Stickler
180
Rhinophyma is assc w what bug?
Demodex folliculorum
181
TSH should be what level in order for RAI to be effective?
\> 30
182
How long should pt's wait for RAI after receiving contrast for CT?
8 wks
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