1
Q
- A patient with penicillin allergy. What do you give?
A
a. Clindamycin
2
Q
- Wolff-Parkinson-White Syndrome question discussing re-entry.
A
a. Generally due to atrioventricular (AV) reentry
3
Q
- Bulimia patient findings?
A
a. Metabolic alkalosis
Think throwing up all of the acid
4
Q
- Trigeminal neuralgia patient. Which distribution is more common for trigger points?
a. CN V1 and V2
b. CN V2 and V3
A
b. CN V2 and V3
5
Q
- What condition/disease is associated with trigeminal neuralgia in patient under 40?
A
a. Multiple Sclerosis [Rvw p320]
6
Q
- Acetaminophen toxicity can be exacerbated by:
A
a. Phenytoin
7
Q
- Glucose content for CSF vs serum vs nasal
A
a. CSF (2.5 - 4.4 mmol/L) < serum (7.8 mmol/L) < nasal in glucose content
8
Q
- Diabetic ketoacidosis. What do you see in this pt?
( 11 symptoms)
A
b. Tachypnea – my pick
[Rvw p29] Symptoms include:
-ab pain,
-n/v,
-Kussmaul resp,
-ketone breath,
-anion gap metabolic acidosis,
-marked dehydration,
-tachycardia,
-polydpisia,
-polyuria,
-weakness,
-altered consciousness
9
Q
Kussmaul resp
A
Kussmaul respirations are fast, deep breaths that occur in response to metabolic acidosis
10
Q
- Questions on PFT. Which measurement is the same for obstructive vs restrictive lung disease?
A
a. Tidal volume (TV)
11
Q
- Know about FRC, FEV1 and how to tell whether they have restrictive or obstructive disease
A
a. FEV1 is the volume of air expired in 1 second after maximum inspiration.
FVC is the forced vital capacity and is the maximum volume of air forcibly expired after maximum inspiration.
The FEV1:FVC ratio is <80% in obstructive lung disorders (asthma, COPD, etc.). In restrictive disorders (pulmonary fibrosis, sarcoid, etc), the ratio will be normal or >1 since the FVC will be markedly decreased while the FEV1 should be normal. If the ratio is <1, and FEV1 is also decreased, then a mixed disorder is present. In obstructive disease, there is increased FRC and TV
12
Q
- A patient has developed pulmonary hypertension, which is most likely cause?
A
a. Mitral stenosis
13
Q
- A patient with known Aortic Stenosis becomes hypotensive, how do you treat?
A
a. Phenylephrine in small doses
14
Q
- ECG leads is best for monitoring P-wave abnormalities?
A
a. Lead II
15
Q
- What rhythm least likely to show on EKG after unstable paroxysmal supraventricular tachycardia (PSVT)?
a. Persistent PSVT
b. Sinus tachycardia
c. Ventricular tachycardia
d. Sinus bradycardia
A
d. Sinus bradycardia
16
Q
- What is the first line drug for SVT according to ACLS protocol?
A
Adenosine-Confirmed
Adenosine is the first-line medical treatment for the termination of paroxysmal SVT. It is a short-acting agent that alters potassium conductance into cells and results in hyperpolarization of nodal cells
Adenosine has a role in slowing down the heart rate enough to assist in diagnosis.
17
Q
- PE suspected. What’s the most accurate test to confirm?
a. D-dimer
b. CT Angiogram Chest
c. Ultrasound
A
b. CT Angiogram Chest-Confirmed
18
Q
- Hylar lymphadenopathy
A
a. Sarcoidosis
19
Q
- A patient in renal failure needs emergent surgery and anesthesia, what’s the most important lab value?
A
a. Potassium
20
Q
- Cystic Fibrosis (CF) patients overtime develop - understand the disease and what are consequences long term Cystic Fibrosis patients overtime (look up what lung problems this patient will have)
a. Some other lung problems as answer choice
b. Develop pulmonary hypertension
Respiratory (7)
GI (9)
Osteoporosis (3)
A
b. Develop pulmonary hypertension – frequently found in CF
Respiratory: bronchiectasis, chronic lung infection, nasal polyps, hemoptysis, pneumothorax, respiratory failure, acute exacerbations
GI: nutritional deficiencies, diabetes, jaundice, fatty liver disease, cirrhosis, intestinal blockage, intussusception, distal intestinal obstruction syndrome (DIOS)
Reproductive: infertility (men), reduced fertility (women)
Other: osteoporosis, electrolyte imbalances, dehydration, fear
21
Q
- KNOW all different types of fentanyl and their half life, onset time, metabolism rate.
A
a. Fentanyl
b. Remifentanyl – this has the shortest half-life & elimination time
c. Sufentanyl
Coinciding with this trend was the introduction of fentanyl analogues with faster and faster elimination. Fentanyl (8–10 hr elimination half-life) was followed by sufentanil (6–9 hr), alfentanil (2 hr), and remifentanil 0.6 hr.
22
Q
- Question about what pain med to take post-op in someone with GI issues
a. Naproxen
b. Celebrax
c. Diclofenac
d. Ibuprofen
A
They are all NSAIDs so they all has side effect of stomach ulcers, bleeding, holes, etc. Ibuprofen is known to have the least GI side effect amongst all the NSAIDs.
23
Q
- Duration of local anesthesia is related to?
A
a. Degree of protein binding ability
24
Q
- Onset of local anesthetic depends on
A
a. Dissociative constant (pKa)
25
3. What determines the potency of a local anesthetic?
a. Lipid solubility
26
4. One question on possible adverse cardiac affect for marcaine
Bupivacaine produces a concentration-related depression of intra-atrial, A-V nodal, intraventricular conduction and myocardial contractility owing to a fast sodium channel blocking in both nerve and cardiac tissue.
Reports of cardiac arrest
27
5. Marcaine toxicity symptoms
a. Tremors
b. Perioral numbness
(10 symptoms)
b. Perioral numbness – this is what I chose
Anesthetic toxicity: agitation, confusion, dizziness, drowsiness, dysphasia, auditory changes, tinnitus, perioral numbness, metallic taste, dysarthria (difficulty speaking )
28
6. Know local anesthetics with its relationship with PABA
Conventional wisdom holds that, if local anesthetics do indeed produce allergies, esters of PABA would be more likely than amide local anesthetics.
para-aminobenzoic acid (PABA)
this moiety is common to other derivatives of para-aminobenzoic acid (PABA) such as methylparaben and some, but not all, ester local anesthetics. In these cases there may be the potential for cross allergenicity among similar compounds because of a common moiety (eg, sulfa antibiotics, methylparaben, and esters of PABA).
It should be clarified that articaine is classified molecularly as an amide, not an ester of PABA, and does not present any concern for cross-allergy to PABA derivatives.
29
7. Know which local anesthetics will worsen hepatic function
The amide local anesthetics including lidocaine, bupivacaine and ropivacaine are commonly used for pain control during minor surgery or invasive procedures such as biopsies, small excisions or dental work. These local anesthetics have not been linked to serum enzyme elevations, but when given as constant infusions or repeated injections have been occasionally mentioned as possible causes of clinically apparent liver injury.
(bupivacaine): C (probable cause of clinically apparent liver injury).
30
8. Know physiologic changes with patients on clonidine receiving marcaine
during anesthesia mean arterial pressure, heart rate, and FeISO were significantly decreased in Clonidine and Control groups compared with Placebo group
31
9. Pre-operative vitals stable. Patient on propranolol and given 3 carpules of 0.5% Marcaine with 1:100:000 epinephrine. What will happen to vitals?
a. BP 140/80, P 120 –
b. BP 140/80, P 40
c. BP 60/40, P 120
d. BP 60/40, P 40
a. BP 140/80, P 120 – Propranolol with Epi will cause hypertensive crisis
32
4-2-1 rule
The 4 – 2 – 1 rule for maintenance IV fluid therapy (Normal Saline or Ringer's Lactate): 4 ml/kg/hr for the first 10kg of body mass. 2 mg/kg/hr for the next 10 kg of body mass. 1 mg/kg/hr for body mass beyond 20kg.
33
11. How much fluid deficit does a patient that weights 70 kg and has been on NPO from 10 pm to 8 am?
a. Approximately 1L fluid deficit ((40 + 20 + 50)x10 = 1,100 mL)
Remember, 4-2-1 rule x the number of hrs NPO
34
12. What’s true regarding acute bronchitis?
a. Hyperactive for 2-6 weeks (or 3 weeks)
35
13. How long after a URI do you have to delay an elective surgery under general anesthesia?
a. 2 - 6 weeks
36
14. What’s the MOA of dexmedetomidine (Precedex)?
a. α-2 agonist
37
15. Ketorolac (Toradol)
Ketorolac’s anti-inflammatory, antipyretic, & analgesic effects is the inhibition of prostaglandin synthesis by competitive blocking of the enzyme COX
It is a non-selective Cox inhibitor
a. 5 - 6 hours T1/2
b. Will be in the system for 33 hrs
It takes about 5.5 x half life to get back into the system
38
16. If you give a kid both Propofol and Sevoflurane,
a. You don’t have to give as much Sevoflurane
39
17. Kid with no primary heart problem has bradycardia, which drug to give?
a. Epinephrine
40
18. Rash, hypotension with vancomycin, what would be the most appropriate immediate next step to manage?
a. Give oral Benadryl – hmm
b. Give epinephrine
c. Slow infusion – hmm
d. Give fluids
Vancomycin Flushing Syndrome
Vancomycin flushing syndrome (VFS) was previously known as red man syndrome (RMS) is an anaphylactoid reaction caused by the rapid infusion of the glycopeptide antibiotic vancomycin. VFS consists of a pruritic, erythematous rash of the face, neck, and upper torso, which may also involve the extremities, though to a lesser degree. Symptoms may include weakness, angioedema, and chest or back pain. VFS is caused by vancomycin through the direct and non-immune-mediated release of histamine from mast cells and basophils.
Give oral Benadryl would probably be the best
Treatment / Management
When a patient develops VFS, the intravenous antibiotic infusion should be stopped immediately. Supportive care should be provided. H1 (diphenhydramine) and H2 antihistamines (ranitidine or cimetidine) are used in the management of VFS. Future doses of vancomycin may be given at decreased infusion rates in most cases.[1]
Mild cases (mild flushing and mild pruritus) can be managed with antihistamines such as diphenhydramine 50 mg by mouth or intravenously and ranitidine 50 mg intravenously. Most episodes will resolve within 20 minutes, and the vancomycin may be restarted at 50% of the original rate. Future doses should be given at the new, slower rate, typically over two hours.[10]
Moderate to severe cases (severe rash, hypotension, tachycardia, chest pain, back pain, muscle spasms, weakness, angioedema) should be managed according to severity. Patients with severe symptoms should be evaluated for anaphylaxis or other serious cause for their symptoms before assuming vancomycin flushing syndrome (VFS). If, after careful evaluation, the patient is determined to have VFS, antihistamines such as diphenhydramine and ranitidine can both be started intravenously. Normal saline intravenous boluses are used to treat hypotension. After the symptoms resolve, the vancomycin can be restarted and given over four hours. If alternative antibiotics to vancomycin are available, they should be used. If vancomycin must be continued, patients should be premedicated with diphenhydramine 50 mg intravenously and ranitidine 50 mg intravenously 1 hour before each dose, and vancomycin should be administered over four hours under close observation.[11][12]
If the symptoms of anaphylaxis are present, such as altered mental status, hypotension, stridor, difficulty breathing, wheezing, and hives, treatment should be started immediately for anaphylaxis, and the patient needs emergency care. Epinephrine should be given early, and the patient may have an epinephrine auto-injector with them, which can be used. [11][12] Emergency medical services, if available, should be activated immediately to expedite further patient treatment and transport to definitive care.
Patients requiring a rapid infusion of vancomycin may be pre-treated with diphenhydramine and ranitidine. However, the best preventive measure to avoid VFS is maintaining infusion rates below 10 mg/min.[13][14]
41
19. A patient with aortic stenosis develops intra-op hypotension. What’s the most appropriate medication to give?
a. Phenylephrine
b. Ephedrine
Phenylephrine
Oral phenylephrine has a minimal direct effect on heart rate or cardiac output but, as a vasoconstrictor, can increase systolic and diastolic blood pressure at high doses, and thus cause reflex bradycardia.
42
20. What happens to kids when succinylcholine is given
a. Bradycardia
43
21. Obese, asthmatic patient that needs a rapid sequent intubation, use which neuromuscular agent.
a. Succinylcholine (onset in 45 – 60 sec)–
b. Rocuronium (onset in 60 – 90 sec)
c. Atracurium (onset in 120 sec)
Succinylcholine
44
22. Malignant hyperthermia patient, which neuromuscular blocking agent to use?
a. Succinylcholine
b. Rocuronium
c. Atracurium
Rocuronium
45
23. What muscle relaxant is contraindicated in renal failure patients?
a. Vecuronium and pancuronium may result in prolonged relaxation as these drugs are metabolized by the kidneys. Should use Atracurium/cis¬atracurium.
46
24. What drug used to treat laryngospasm in MH patient?
a. Non¬depolarizing muscle relaxant: Rocuronium (onset in 60 – 90 sec), Vecuronium (onset in 90 – 120 sec), Atricurium (onset in 120 sec)
47
25. Which drugs potentiates Versed?
a. Erythromycin & Cimetidine potentiates Versed
48
26. What’s narrowest part of pediatric airway?
a. Below the glottis at the level of the cricoid cartilage
49
27. Evaluating a kid pre-op. What makes difficult airway?
a. Mallampati is a sole accurate indicator
b. 3-2-5 rule
c. Enlarged tonsils
c. Enlarged tonsils
50
28. What do you see with LMA?
a. Arytenoids + vocal cord - this is what I put
51
29. What does a normal Mueller’s maneuver look like?
a. You see arytenoids and vocal cords
52
30. Shown 2 pictures of fiberoptic nasopharyngoscopy with patency and then occlusion. What’s the difference?
a. Mueller’s maneuver
The left picture shows retropalatal level airway collapse during Muller’s maneuver and the right photo shows during induced sleep nasoendoscopy. Note the change in shape of collapse from circular on the left to the coronal airway collapse on the right.
In this maneuver, the patient attempts to inhale with his mouth closed and his nostrils plugged, which leads to a collapse of the airway. Introducing a flexible fiberoptic scope into the hypopharynx to obtain a view, the examiner may witness the collapse and identify weakened sections of the airway.
53
31. What does capnography waveform look like for COPD patients?
54
32. What does this capnography waveform indicates:
Mechanical obstruction
55
Just review
Make sure you pay attention to obese and obstructed patients
56
1. What is the maximum time for a tooth to be out of the mouth for the best prognosis?
a. 120 min
57
2. Pulpitis is most common in:
a. Incisors
b. Premolars
c. Molars
Molars – this is what I picked
58
3. Which nerve is most commonly injured during a ‘block’? (The question didn’t specify what type of block so I assumed IAN block.)
a. Lingual nerve
59
4. When do you do vestibuloplasty?
a. Not enough keratinized tissue
b. High-muscle attachment
High-muscle attachment
Not confirmed
60
5. What effects the long term success of the submucous vestibuloplasty?
a. Long-term use of stint
61
6. Best way to close an oro-antral fistula from a first molar?
a. 1 - 4 mm usually heals on its own, otherwise, buccal advancement flap, palatal finger flap, or buccal fat pad advancement
62
7. Oralantral fistula of 8 mm for site #3 closed best with:
a. Dorsal and ventral tongue flap, not lateral tongue
b. Buccal sliding flap
c. Palatal flap will cause less pain and morbidity
d. Buccal fat pad will cause severe maxillary vestibular shallowing/obliteration
Buccal fat pad will cause severe maxillary vestibular shallowing/obliteration – this is what I chose
63
8. What increases risk for alveolar osteoitis (dry socket)?
a. >25 years of age
64
9. After extraction, foul smell and pus from extraction site. Gram stain shows GNR but no growth after 4hrs. What is most likely cause?
a. Bacteroids
65
10. What happens when you place the tip of a TAD into the root of a tooth?
a. External resorption
66
11. You accidentally injure an adjacent tooth while placing an implant. How long does it take cementum to regrow/heal?
a. 6 – 12 weeks
67
12. What is the minimum measurement of an open apex that is required to support revascularization?
a. 1 mm
68
13. How to maximize success of coronectomy?
a. Remove all enamel
69
14. Most common chronic finding after coronectomy?
a. Periodontal bone loss of adjacent tooth
b. Raiolucency over the remaining root tip
c. Superior migration of the remaining root tip
Superior migration of the remaining root tip
70
a. Osteoinduction:
growth factors stimulate mesenchymal cells to differentiate into osteoblastic lineages
71
b. Osteoconduction
acts as a matrix for bone growth
72
c. Osteogenesis
transplanted osteoblasts and periosteum produce own bone
73
BMP
Pros & Cons
i. Pros: no need for 2nd surgical site, favorable soft tissue response, osteoinductive, similar bone volumes result, allows for eruption to teeth
ii. Cons: requires Autogenous graft in older patients, moderate-to-severe post-op edema associated with use, provides questionable support of all, off-label use in pediatric patients
74
2. How is rhBMP produced/manufactured?
BMPs for clinical use are produced using recombinant DNA technology (recombinant human BMPs; rhBMPs). Recombinant BMP-2 and BMP-7 are currently approved for human use. rhBMPs are used in oral surgeries. BMP-7 has also recently found use in the treatment of chronic kidney disease (CKD).
75
What does rhBMP stand for?
It is recombinant human bone morphogenic protein.
The bone formation process develops from the outside of the implant towards the center until the entire device is replaced by trabecular bone.
76
BMP production, just think about it
Bone morphogenetic protein-2 (rhBMP-2) represents the osteoinductive protein factor which plays a dominant role in growth and regeneration of a bone tissue. In clinical practice the bone grafting materials on the basis of rhBMP-2 are widely applied; the Russian analogues of similar materials are not produced. The fragment of the bmp2gene coding for a mature protein was cloned in Escherichia coli. The effective overproducing strain of rhBMP-2 was created on a basis of the E. coli BL21 (DE3). The rhBMP-2 production was about 25% of total cell protein. The biologically active dimeric form of rhBMP-2 was obtained by isolation and purification of protein from inclusion bodies with subsequent refolding. The rhBMP-2 sample with more than 80% of the dimeric form was obtained, which is able to interact with specific antibodies to BMP-2. Biological activity of the received rhBMP-2 samples was shown in the in vitro experiments by induction of alkaline phosphatase synthesis in C2C12 and C3H10T1/2 cell cultures. On model of the ectopic osteogenesis it was shown that received rhBMP-2 possesses biological activity in vivo, causing tissue calcification in the place of an injection. The protein activity in vivo depends on way of protein introduction and characteristics of protein sample: rhBMP-2 may be introduced in an acid or basic buffer solution, with or without the carrier. The offered method of rhBMP-2 isolation and purification results in increasing common protein yield as well as the maintenance of biologically active dimeric form in comparison with the analogues described in the literature.
77
BMP production, just think about it
Bone morphogenetic protein-2 (rhBMP-2) represents the osteoinductive protein factor which plays a dominant role in growth and regeneration of a bone tissue. In clinical practice the bone grafting materials on the basis of rhBMP-2 are widely applied; the Russian analogues of similar materials are not produced. The fragment of the bmp2gene coding for a mature protein was cloned in Escherichia coli. The effective overproducing strain of rhBMP-2 was created on a basis of the E. coli BL21 (DE3). The rhBMP-2 production was about 25% of total cell protein. The biologically active dimeric form of rhBMP-2 was obtained by isolation and purification of protein from inclusion bodies with subsequent refolding. The rhBMP-2 sample with more than 80% of the dimeric form was obtained, which is able to interact with specific antibodies to BMP-2. Biological activity of the received rhBMP-2 samples was shown in the in vitro experiments by induction of alkaline phosphatase synthesis in C2C12 and C3H10T1/2 cell cultures. On model of the ectopic osteogenesis it was shown that received rhBMP-2 possesses biological activity in vivo, causing tissue calcification in the place of an injection. The protein activity in vivo depends on way of protein introduction and characteristics of protein sample: rhBMP-2 may be introduced in an acid or basic buffer solution, with or without the carrier. The offered method of rhBMP-2 isolation and purification results in increasing common protein yield as well as the maintenance of biologically active dimeric form in comparison with the analogues described in the literature.
78
3. You place an autogenous block graft. What do you intend to achieve by ideally preparing the recipient site?
a. Osteogenesis
b. Osteoinduction
c. Osteoconduction
79
4. What’s the minimum thickness required for attached gingiva from implant? Something like that
a. 1.5 mm
b. 2 mm
c. 2.5 mm
d. 3.0 mm
e. 3.0 mm – this is what I picked
I think 3.0 is correct
80
6. What’s minimum amount of bone needed for simultaneous placement of implant while doing a sinus lift?
a. 3-5 mm review book says 3-8 mm
81
7. You are placing 5 standard 4.0 mm implants into anterior mandible of an edentulous patient between the mental foramina. What is the length of bone between the foramina needed?
a. 4 mm for each implant = 20 mm
3 mm between each implant = 12 mm
5 mm between terminal implant and mental foramina x 2 = 10 mm
Total = 42 mm
82
8. Patient who has worn maxillary and mandibular complete dentures without problems desires a new removable prosthesis with implants. He has 7 mm of bone above the mental nerve and IAN canal. What is the most prudent treatment
a. Two implants in parasymphysis with tissue bar or ERA attachments
83
9. Reasoning for placing immediate implants with restoration
a. Better soft tissue contour
84
12. Platform switch?
a. Reduce bacterial load and therefore reduce recession
85
13. What’s the minimum space for hybrid denture?
15 mm
86
14. What’s the minimum space for an overdenture?
a. 12 mm
87
15. Minimum torque for zygomatic implant
a. 40 NCm (should be within 35-45 Ncm
88
Normal implants have a torque value of
30 Ncm
89
16. In planning for zygomatic implants, you must include?
a. Minimum of 2 additional implants in the anterior maxilla (and 10 mm of zygoma)
90
17. Which one will have better result?
a. 7 mm from bone to contact point – This is what I picked since there’s critical point where the papilla doesn’t grow back if the
I would be suspicious of this, it should be 5 moper some reports. Recent study from Palmer suggested 8.5 mm for full papilla growth.
I think 7 is too high, for 75% of patients to fill the embrasure space, it should be 6 mm, but 5.0 mm is a guarantee.
91
18. Which of the following is the most important factor for success of a cantilevered implant-supported denture?
a. A-P spread of the implants (can be 1.5x AP spread)
92
19. Most likely cause of implant failure within a year
a. Thread exposure at the time of placement
b. Screw loosening after osseointegration
c. Implant not submerged (not subcrestal placement)
a. Thread exposure at the time of placement
93
1. Extrusion of incisor and its relationship to tissue migration.
a. Gingival margin moves but mucogingival junction doesn’t
b. Mucogingival margin migrates coronary
a. Gingival margin moves but mucogingival junction doesn’t
94
2. Infected #32, tonsillar wall bulging medially. Possibly discussing some Horner syndrome symptoms. Which space infection?
a. Lateral pharyngeal
95
3. What is the eye finding if oculomotor nerve (CN III) is injured?
a. Down & out
96
4. CN VI palsy and eye will move in which direction?
a. Down and out
b. In and out
c. Up and out
d. Up and in
d. Up and in
97
5. Loss of supra-tarsal fold (lid crease) after trauma is caused by
a. Levator disinsertion – this is what I picked
it pulls the eyelid skin to form the supratarsal fold when the eyes are open
98
6. Lacrimal duct injury
a. Duct cannulation for 3-4 months
b. DCR
c. Immediate repair
Duct cannulation for 3-4 months
99
7. What causes a hyphema?
a. Ciliary body –
b. Lateral ciliary a.
c. Posterior ciliary a
a. Ciliary body – A tear at the anterior aspect of the ciliary body is the most common site of bleeding (71%)
b. Lateral ciliary a.
c. Posterior ciliary a – Frequently, patients develop hyphema at the time of trauma due to tearing of the anterior and posterior ciliary arteries
100
8. Picture of eye with hyphema. Asking when light show in this eye, no response but response in normal eye.
a. Efferent pupillary defect
b. Afferent pupillary defect
b. Afferent pupillary defect
101
9. Eyelid scar. Pt now has ectropion. What type of ectropion does this pt have?
a. Involutional
b. Cicatrical
c. Spastic
d. Congenital
b. Cicatrical – my pick
Cicatricial ectropion is caused by shortening of the anterior lamella, which is comprised of the skin and orbicularis muscle.
Involutional ectropion is caused by increased horizontal laxity of the lower eyelid and disinsertion of the lower eyelid retractors.
An irritation of the eye caused by dryness or inflammation can lead you to try to relieve the symptoms by rubbing the eyelids or squeezing them shut. This can lead to a spasm of the eyelid muscles and a rolling of the edge of the lid inward against the cornea (spastic entropion).
102
10. What muscle originates from the anterior portion of the orbital rim?
a. Inferior oblique muscle
103
11. Maxillofacial trauma patient suddenly develops hypotension and decreased breath sound. Next step is?
a. Needle chico
b. Needle thoraco
c. Fluids
Needle thoraco
104
12. CentraCentral line of subclavian and suddenly the patient’s breath sound decrease. What’s the next step?
a. Needle decompression
105
13. One question on GCS. Which has the worst prognosis or lowest level of consciousness?
a. Eye opening on deep/painful response
b. Eye opening on deep, painful response
c. Flexor movement on painful response
d. Extensor movement on painful response
d. Extensor movement on painful response
106
14. Head + 1 arm + anterior torso burn
a. 36% (= 9% + 9% + 18%)
107
15. Extensive blood transfusion and what is the effects?
a. Coronary thrombosis
b. Brain hemorrhage
Coronary thrombosis
RBC and platelet transfusions are associated with an increased risk of venous and arterial thrombotic events and mortality in hospitalized ...CONFIRMED
108
16. 1 L of blood loss is equivalent to which hemorrhage classification?
a. Class II: 750 cc – 1,500 cc
109
18. GSW injury and the patient cannot feel anterior 1/3 of tongue and right deviation of tongue is noted. Which nerves are damaged?
a. Lingual, hypoglossal
b. Lingual, glossopharyngeal
c. Hypoglossal, glossopharyngeal
a. Lingual, hypoglossal (CN XII)
the hypoglossal nerve
Damage to the hypoglossal nerve causes paralysis of the tongue. Usually, one side of the tongue is affected, and when the person sticks out his or her tongue, it deviates or points toward the side that is damaged.
110
19. A patient with an ear laceration with small portion of the lacerated ear attached to the ear. No photo shown. It’s asking how to treat.
a. Graft from the other ear to the injured ear
b. Embed the lacerated ear to the post-auricular area or something
Embed the lacerated ear to the post-auricular area or something
111
20. A patient with bite wound to the face. This is best treated by: This is best treated by:
a. High pressure irrigation with PSI >10
b. Hand irrigation with PSI between 5-8
c. Aggressive debridement to remove risk of infection
b. Hand irrigation with PSI between 5-8
112
21. Anterior table comminuted fracture with CSF leak. CT axial view shows. It asks the type of treatment.:
a. Observe and treat if the duct obstructs or CSF leak continues
113
22. Which of these indicates repair of nasolacrimal duct injury not needed or something like that
a. Comminuted anterior and posterior table fractures
b. Observe and if duct obstruction of CSF leak persists then treat
a. Comminuted anterior and posterior table fractures
b. Observe and if duct obstruction of CSF leak persists then treat
114
23. ZMC fracture, binocular diplopiadiploma cause
a. Orbital floor without herniation of contents
b. Inferior displacement of Whitnall’s tubercle
c. Orbital septum displacement
a. Orbital floor without herniation of contents
115
24. ZMC fracture, cannot move upper eyelid. Which nerve is injured?
a. CN III
The oculomotor nerve (CNIII) innervates the main upper eyelid retractor, the levator palpebrae superiorus, via its superior branch. The inferior division of CNIII also innervates the inferior rectus muscle, which by extension via the capsulopalpebral fascia causes lower eyelid retraction in downgaze.
116
25. Bite force in anterior mandible leads to what forces?
a. Tension along superior, compression along inferior
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26. What is the most common complication of rigid fixation for the treatment of jaw fractures?
a. Malocclusion
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27. What type of mandible fracture is most susceptible to infection?
a. Angle
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28. Which type of fracture necessitates rigid fixation?
a. Atrophic mandibular body fracture
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29. Which of the following fractures requires load bearing fixation?
a. Atrophic mandible
b. Angle
c. Symphysis
Atrophic mandible
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30. Most common infection in odontogenic infection
a. Staphylococcus
b. Streptococcus – GPC, aerobe
c. Bactericides – GNR, anaerobe
. Streptococcus – GPC, aerobe
Peptostreptococcus is a genus of anaerobic, Gram-positive, non-spore forming bacteria
The most common species of bacteria isolated in odontogenic infections are the anaerobic gram-positive cocci Streptococcus milleri group and Peptostreptococcus.
In this study the most common aerobic organism isolated was streptococcus viridians (34.49%), most common anaerobe was peptostreptococci, (61.11%)
This is a poorly written question. Most odontogenic infection is mixed (60%) followed by anaerobic only (33%) and aerobic only (7%). Since Streptococcu viridans is the most common GPC that’s aerobic, this could be an answer. However, Bacteroids (causes foul smell) along with Fusobacteriumn is the most common GNR and Bacteroids is anaerobic so this could be an answer as well.
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1. Hemifacial microsomia involves which arches?
a. 1-2 branchial arches
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2. Development of maxilla and mandible
a. 1st arch and mesoderm
(test said ectoderm, but that is incorrect)
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3. Young girl with hemifacial microsomia, which syndrome could she have?
a. Goldenhar syndrome
Goldenhar-Gorlin syndrome is a congenital malformation of the structures derived from the first and second pharyngeal arches. Hemifacial microsomia is a flattening of the face due to underdeveloped mandible (micrognathia), maxilla and zygomatic bones with hypoplastic muscles for mastication and facial expression.
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4. Picture of a child with description of dermis feature
a. Goldenhar syndrome
Ear malformations or microbial, skin tags,
126
5. Tensor veil palatine innervation
a. CN V
b. CN VII
c. CN X
The tensor veli palatini muscle is innervated by the mandibular branch of the trigeminal nerve,
. CN V
Function. The tensor veli palatini tenses the soft palate and by doing so, assists the levator veli palatini in elevating the palate to occlude and prevent entry of food into the nasopharynx during swallowing.
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6. Which muscle pulls soft palate posteriorly?
a. Levator veli palatini
b. Palatopharyngeal
***Levator veli palatini is the elevator muscle of the soft palate in the human body-elevation and backward extension of posterior soft palate
Palatopharyngeal-Its function is to tense the soft palate and pull the pharyngeal walls superiorly, anteriorly, and medially during swallowing, effectively closing off the nasopharynx from the oropharynx.
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7. What palatal muscle is most responsible for speech?
a. Levator veli palatini (this is a primary elevator of palate)
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8. Lateral pterygoid insertion
a. Medial capsule and disc
inserts onto the articular disc and fibrous capsule of the temporomandibular joint.
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9. Fusion of palatal shelves complete by how many weeks
a. 6
c. 8
d. 10
Suggested mechanisms for palatal fusion Fusion between the two palatal shelves occurs during week 9 of embryonic developmen
John would say 8, I would say 10
I would say 10
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10. A cleft patient will have deficient maxillary growth
a. Vertical, A-P, transverse
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11. A patient had cleft palate that was fixed. Later down the road, they did LeFort I advancement.
a. Palatal fistula
b. VPI
VPI
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12. Most likely reason for alveolar cleft failure
a. Alveolar cleft malposition
b. Soft tissue closure under tension
c. Overpacking the site with cancellous graft
Soft tissue closure under tension
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13. What is the most likely malocclusion seen in thalassemia patients?
a. Transverse maxillary excess
b. Posterior maxillary deficiency
c. Class III malocclusion
d. Maxillary hyperplasia
Maxillary hyperplasia
-VME
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14. DiGeorge (velocardiofacial syndrome)
a. Chromosome 22 deletion
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15. Which syndrome presents with mandibular hyperplasia?
a. Apert
b. Pfeiffer
c. Crouzon prognathism
d. Saethre-Chotzen
d. Saethre-Chotzen – mandibular prognathism - my pick'
a. Apert – maxillary hypoplasia
b. Pfeiffer – maxillary hypoplasia
c. Crouzon – maxillary hypoplasia, mandibular prognathism
Intraoral manifestations of SCS include maxillary hypoplasia, mandibular prognathism and high arched palate.
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16. What cleft repair has the highest incidence of maxillary retrusion?
a. 4-point (VWK) flap
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17. SARPE indicated in
a. >7 mm transverse expansion
b. To fix multiocclusal discrepancy
>7 mm transverse expansion
Green book says >10 mm advancemetn
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18. SARPE changes seen on ceph
a. Palatal plane changes
b. Incisor and palatal plane changes
c. ANB angle decrease
d. SNB angle decrease
b. Incisor and palatal plane changes – my pick but not sure
PP-SN, SNA, and ANB angles were increased and U1-SN and U1-PP angles were decreased.
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19. Internal max bleeding during LeFort likely from which osteotomy?
a. Pterygomaxillary junction
b. Lateral maxillary wall
c. Perpendicular plate of maxilla
Pterygomaxillary junction
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20. How to ensure Distraction Osteogenesis (DO) works?
a. Movement in correct vector
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21. Difference between DO vs BSSO
a. Same incidence of nerve
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22. A vascular necrosis prevention. Which blood supply critical?
a. Descending palatine
b. Ascending palatine
c. Internal maxillary?
a. Descending palatine
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23. Septal deviation after LeFort I
a. Go back to OR
b. Fix in clinic or OR ASAP
c. Observe until swelling reduces
Fix in clinic or OR ASAP
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24. During BSSO, fracture of buccal plate of proximal segment. What do you do?
a. MMF for 3 weeks and return to complete BSSO later
b. Plate segment to proximal segment and finish osteotomy
c. Complete osteotomy and mobilize distal segment and then plate fractured segment to proximal segment and then plate that proximal segment to distal segment
Plate segment to proximal segment and finish osteotomy
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25. Most stable fixation for BSSO. Screw pattern for BSSO.
a. Transoral – 3 screw along the superior border
b. Transoral – 3 screw along superior border
c. Transbuccal – 2 superior border screws and 1 inferior
d. Transbuccal – inverted-L formation
d. Transbuccal – inverted-L formation
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26. Patient with severe OSA: SNA 79, SNB 76, PAS 5. What’s the most predictable treatment?
a. MMA of 8 mm with CCW rotation of mandible
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27. A 20-year-old male patient doesn’t know when it started but over the last two year noticed facial asymmetry. No changes in shoe size. Hasn’t seen it get worse over the last two years. When do you think the facial asymmetry started?
a. Started during puberty/growth spurt
b. Started after orthodontic treatment
c. Started recently
d. The patient is still growing
c. Started recently – this is what I picked
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28. What RDI score is associated with significant increase in mortality?
Respiratory disturbance index
I think it may be greater than 15/hr
of disturbances, calculated by number of hours
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2. Trichophytic incision best when
a. Forehead wrinkling
b. Receding hairline
Forehead wrinkling
-Can shorten long foreheads, can excise thinning hair-bearing areas temporally, bony recon touring possible
Possible visible scar at the hairline
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4. 15 mm from the tip of upper eyelid to brow and you do upper bleph. What’s the most common complication?
a. Lagophthalmos
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5. Lagophthalmos due to
a. Removing too much upper eyelid crease
b. Removing levator superioris muscle
c. Removing orbital septum
Removing too much upper eyelid crease
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6. What separates the fat pads in a lower bleph?
a. The inferior oblique muscle separates the medial from the middle fat pad
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7. The ability to distract the lower lid more than ___ indicates the need for lid shortening? (Lid laxity or snap-back test)
a. 8 mm / 2 sec
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8. Lagophthalmos due to
a. Removing too much upper eyelid crease
b. Removing levator superioris muscle
c. Removing orbital septum
Removing too much upper eyelid crease
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9. Eyelid edema and loss of lid crease
Blepharochalasis or blepharochalasis syndrome is a rare condition characterized by episodic inflammation of the eyelids
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10. Degree of canting for lay people to visualize
a. 4 degrees
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11. What do we perform Schirmer’s test before blepharoplasty?
Schirmer's test determines whether the eye produces enough tears to keep it moist. This test is used when a person experiences very dry eyes or excessive watering of the eyes. It poses no risk to the subject.
Schirmer's test is used to determine whether the eye produces enough tears to keep it moist. The test is performed by placing filter paper inside the lower lid of the eye. After 5 minutes, the paper is removed and tested for its moisture content.
urgeons might avoid operating on patients who suffer from dry eye due to concern that blepharoplasty could exacerbate symptoms. Some have proposed that these risks necessitate formal tear production testing or specific ophthalmologic evaluation preoperatively.
The Schirmer’s test is one of the most commonly performed tear production tests and is often regarded as the gold standard. In the Schirmer’s I test, the basal and reflex tear formation is measured using filter paper placed inside the lower eyelid, whereas the Schirmer’s II test measures basal tear formation on the filter paper after an anesthetic is applied to the eye. An abnormal Schirmer’s test occurs when the wetting of the filter paper is less than 10 mm after five minutes, whereas normal wetting ranges from 15mm to 30 mm. Performing the Schirmer’s test could potentially be beneficial in identifying patients who may be at risk for developing dry eye postoperatively as well as those who could benefit from more conservative surgical approaches. However, is a Schirmer’s test necessary prior to a blepharoplasty?
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12. Schirmer’s test. Know normal values and indications.
a. Schrimer’s test determines whether the eye produces enough tears to keep it moist
b. Normal when >10 mm of moisture on the filter paper in 5 minutes
An abnormal Schirmer’s test occurs when the wetting of the filter paper is less than 10 mm after five minutes, whereas normal wetting ranges from 15mm to 30 mm.
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13. Upper/lower nasal cartilage and bone
a. Interlock
b. Overlap
a. Interlock – upper and lower nasal cartilage interlocks
Overlap – nasal cartilage and bone overlaps
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14. What do you perform to decrease nasal tip projection?
a. Complete transfixion incision
Placed near the caudal edge of the cartilagenous septum
-transects the attachments of both medial crura to the septum resulting in loss of tip support
-Connects the right & left nares through the columella
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a. Complete transfixion incision
15. Nasal septal hematoma will cause
a. Binder’s deformity
b. Cartilage necrosis/disruption
Binder's syndrome with nasal deformity-The nasal deformity is characterised by a shortened columella and underdeveloped nasal bridge.
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16. Nerve innervation to nasal tip
a. Anterior ethmoidal
supplies the middle vault and nasal tip
The infraorbital nerve supplies the lateral nose and nasal tip.
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17. Dorsal hump reduction
a. Bone only
b. Cartilage only
c. Dissect above the plane of cartilage and bone
d. Dissect above the plane of cartilage and below the bone
Dissect above the plane of cartilage and bone
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18. What’s the complications if you do too aggressive rhinoplasty?
a. A large hump resection produces an open-roof deformity, which requires lateral osteotomies
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20. Level of depth for medium chemical peel
a. Papillary dermis
b. Reticular dermis
a.Reticular dermis-medium peel "absence of pink sign"
-Light peel-paipillary dermis
Deep peel-mid-reticular dermis-gray color
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21. Resylane (non-animal hyaluronic acid) is replaced by?
a. Cross-linking
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1. What is the source of pain with disc perforation?
a. Subchondral nociceptors
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2. Which fibers/nerve carry taste?
a. Facial n. (VII) via chorda tympani
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3. Gabapentin is useful for
a. Avoids opioid tolerance
b. Sedating and anxiolytic
c. Anti-inflammatory
. Avoids opioid tolerance
Gabapentin is a prescription Painkiller that is less addictive than Opioids. Still, addiction and abuse occur; overdosing is possible.
Gabapentin is also known as nuerontin
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4. What’s the best diagnostic study for assessing active phase of condylar hypertrophy?
a. Technecium-99 scan
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5. A patient with scleroderma comes into your office with mandibular asymmetry. What’s the most likely cause?
a. Muscle fibrosis
b. Condylar resorption
c. ??
d. ??
In scleroderma, structural changes may occur in the osseous tissue and result in mandibular joint restriction (pseudoankylosis) and facial and occlusal disharmonies.
Connective tissue disorders of the skin also show the characteristic activation of fibrosis resulting in excessive production and accumulation of collagen fibers.
PRS, a rare form of scleroderma manifests as progressive shrinking and deformation of one side of the face, thus resulting in unilateral facial atrophy. The deformity effected by PRS is an issue not only of esthetics but also of facial functionality. PRS in fact has been linked with neurologic, ophthalmologic, rheumatologic, maxillofacial, and orthodontic issues
Therefore, we report the rare case of a facial asymmetry patient diagnosed as LS with soft-tissue atrophy.
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6. Scleroderma – know the underlying cause, about this and any oral/facial manifestation
a. Collagen overproduction
Symptoms: skin tightening, GERD, malabsorption, Raynaud disease
Diagnosis: skin biopsy
Treatment: vasodilatory medicine, NSAIDs, steroids, immune suppressants
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7. Idiopathic condylar resorption and how it can be prevented
a. Do ortho in childhood to recent
b. Do orthognathic surgery
Treatment Case Study Treatment requires removing compression by fixing the bite and reducing the influence of whole body inflammation on the TM
Anti-inflammatory medications, which can help slow the condition’s progress.
Bite splints or night guards to protect your teeth from damage due to bruxism (grinding and clenching).
Condylectomy, which is surgery to remove your mandibular condyles. After removing them, your surgeon reshapes and repairs your jaw to restore proper function and improve appearance.
Orthodontics, including braces and retainers, which can correct overbite or teeth alignment problems.
Orthognathic surgery, which repositions your upper and lower jaws. This may be done in combination with TMJ reconstruction.
Splint As with all treatments discussed in this review, splint therapy has limited evidence to support it. It has been proposed that splints may alleviate TMJ loading, and TMJ loading may accelerate ICR. Yet, whether this is in fact the true or not, splints will protect the teeth.
The patients should understand in advance that the night guard will be abnormally thick in all, but the posteriormost section to fill the area of open bite and bring all teeth into occlusion. Hard acrylic should be used because a soft vacuform material cannot be made thick enough for the area of natural open bite. Patients may actually have some difficulty adapting to full occlusion when they have not had it for a long time. The unusual thickness may also be a factor is slower patient acceptance.
Removal of hyperplastic synovium Wolford and Cardenas describe 14 cases that underwent this open-joint surgery, in which the condyles were repositioned, the discs stabilized by attachment to implants, and BSSO and maxillary osteotomies were performed. All reported cases treated in this way in the literature were done by one group, with no relapse after an average follow-up of 33.2 months (range 18–68).[2] No adverse outcomes were reported.
Condylectomy and costochondral graft In a study by Troulis et al., fifteen patients with active ICR underwent a minimum of endoscopic condylectomy and costochondral graft. When indicated, Le Forte I maxillary osteotomy and/or genioplasty was done. Orthodontics was done before the surgery. With a mean follow-up of 34 months (range 12–84), no TMD, neuropathy, or any other adverse outcomes were reported. Furthermore, no significant relapse was observed.[9]
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8. MRI findings in degenerative joint disease
a. Condylar sclerosis
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9. How does damaged articular cartilage heal?
a. By forming fibrocartilage
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10. Wilkes Stages. What is the stage for frequent pain, sometimes reducing disc displacement
a. Stage III
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11. Pain while eating without radiographic perforation. Which Wilkes stage is this?
a. Stage III
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12. How do you describe the following MRI findings?
a. ADD w/o reduction
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13. Something about having about cytokines and TMJ disorders.
a. Cytokines not seen in asymptomatic joints: IL-1β, IL-6, IL-8, TNFα
IL-10 has been shown to be elevated in joints that respond well to arthrocentesis as it is an inhibitor of macrophage activation which in turn inhibits the above pro-inflammatory cytokines
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Which of the following cytokines may predict successful treatment by arthrocentesis when found in TMJ synovial fluid from joints with chronic closed lock?
1. Tumor Necrosis factor alpha (TNF-alpha)
2. Interleukin 1 (IL-1)
3. Interleukin 6 (IL-6)
4. Interleukin 10 (IL-10)
Interleukin 10 (IL-10)
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4- 68. Internal derangement of the TMJ which presents as a chronic closed lock is most effectively managed by what
surgical procedure?
(A) Arthrocentesis
(B) Arthroscopic lysis and lavage
(C) Arthrotomy with disc repositioning
(D) Discectomy and disc replacement with cartilage
(B) Arthroscopic lysis and lavage
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Which of the following is most important in maintaining the nasal valve?
a. medial crus
b. intermediate crus
c. collumellar strut
d. upper lateral cartilages
d. upper lateral cartilages
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Shown pictures of 36yo male patient with painful swelling right maxilla. Pano shows mixed radiopaque/
lucent lesion with cortical perforation right maxillary wall and CT shows orbital encroachment. Histo
shows epithelial cells in uniform background with occasional pink cementum/bone like material. Low
power image looks like could be Liesegang rings but really poor distorted image?
a. CEOT
b. Osteosarcoma
CEOT
Califying Epithelial odontogenic Tumor (Pinborg Tumor)- uncommon lesion that accounts for less than 1%
of all odontogenic tumors. Fewer than 200 cases have been reported to date. Although the tumor is clearly of
odontogenic origin, its histogenesis is uncertain. Tumor cells bear a close resemblance to te cells of the stratum
intermedium. Most often 30-50 yrs. No sex prevalence. About 2/3 are found in the mandible; most often
posterior areas. A painless slow-growing swelling is most common presenting sign.
Radiographically, the tumor shows a unilocular or more often a multilocular radiolucent defect.
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Brow pexy is indicated on what type of patient?
a. patient with complete bilateral brow ptosis
b. moderate lateral brow ptosis
c. lateral lid hooding
d. dermatochalasis
b. moderate lateral brow ptosis
186
4. Bone Morphogenic Protein is correctly classified as which of the following?
a. Interleukin
b. Interferon
c. Transforming growth factor-cytokine
c. Transforming growth factor-cytokine
187
Which of the following correctly describes Beta2-transferrin?
a. Glycoprotein
b. Isoenzyme
c. Cytokine
d. Interleukin
a. Glycoprotein
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32. Patient suffers from chronic temporomandibular joint pain. Which category of medications has been shown
most effective in treated the symptoms?
a. muscle relaxants
b. SSRIs
c. Tricyclic antidepressants
d. steroids
c. Tricyclic antidepressants
TCAs produce significant analgesia independent of their antidepressant effects. TCA induces analgesia is
typically observed prior to antidepressant effects and at doses that are generally believed to be too low for any
significant antidepressant effect. Amitripyline and imipramine, antidepressants with antinocieptive actions, are
potent inhibitors of serotonin uptake. Though these agents have no direct effect on norepinephine reuptake,
their metabolites are also potent norepinephrine reuptake inhibitors.
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43. Shown radiograph, clinical picture, histo, of child with single opacity in the posterior mandible. Which is
the correct diagnosis?
a. Ameloblastic fibroma
b. Ameloblastic fibro-odontoma
c. Calcifying Epithelial Odontogenic Tumor
d. Plexiform Ameloblastoma
b. Ameloblastic fibro-odontoma
Ameloblastic Fibro-odontoma: Tumor with the general characteristics of an ameloblastic firoma but also
contains enamel and dentin. Some investigators believe that the ameloblatic fibro-odontoma is only a stage in
the development of an odontoma and do not consider it a separate entity. However there are documented cases
of progressive growth and causing considerable deformity and bone destruction.
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14. Hyaluronic acid in joint helps with what
a. Reduce pain
b. Improve opening
c. Dose nothing
d. Reduce pain and improve opening
Reduce pain and improve opening
Hyaluronic acid helps in the growth and development of joint's cartilage and bone by promoting the growth of new cells and tissues. Also plays an important role in reducing joint inflammation and pain caused by injury or tissue degeneration.
191
15. Idiopathic condylar resorption and how it can be prevented
a. Do ortho in childhood to recent
b. Do orthognathic surgery
???
192
1. A stupid question on 3D printing asking disadvantages
a. 3D plan sx increases cost?
b. 3D plan sx increases achieving accurate surgical margin precision?
3D plan sx increases cost?
193
2. Sodium alginate, you are trying to use for 3D printing
a. It’s not biodegradable
b. ??
Sodium alginate (SA) is a non-toxic, biocompatible, and biodegradable natural polymer. It had good printability, which is why it is often used in inks for 3D printing in tissue engineering fields
194
3. Also question on what to do in your office to reduce error
a. Talk to your staff about previous errors
b. Stop all procedures and discuss
a. Talk to your staff about previous errors
195
4. A question on computer-assisted resection of ameloblastoma.
a. Not recommended due to increase in cost
b. Not recommended due to increase in operative time
c. Adequate margin is achieved with computer-assisted resection
d. Studies has found 50% of cases with positive margin
c. Adequate margin is achieved with computer-assisted resection
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5. CT-guided OKC resection
a. More predictable
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2. 3 cm SCCa lesion, and 1x1.5cm ipsilateral lymph node without metastasis. What stage is it?
c. Stage III (T2N1M0)
198
3. FOM lesion (T2N1M0) but doesn’t tell your if pt has lump on the neck. What’s the treatment?
a. Resection with margin
b. Resection with margin and ipsilateral neck dissection
c. Resection with margin and bilateral neck dissection
Resection with margin and ipsilateral neck dissection
199
4. Difference between pTMN vs cTMN system
cTMN (before treatment), pTMN (stage assigned by histopathologic examination), yTMN (after chemotherapy and/or radiation therapy)
200
5. At what level of the neck would you find spinal accessory nerve (shrugging motion)
a. Level IIb (or V but they only gave IIb as an option so this is what I picked)
201
6. A question about mechanism of action of a chemotherapy agent
(-mab)
202
7. Inferior border of level II neck (hyoid wasn’t one of the options)
either hyoid bone or carotid bifurcation?
203
8. Most common presentation of Nevoid Basal Cell Carcinoma Syndrome?
a. Hypertelorism-efers to an abnormal decrease in distance between any two organs although some authors use the term synonymously with orbital hypotelorism meaning an abnormal decrease in the distance between the two eyes (the eyes appear too close together).
204
9. Parotitis – most likely cause
a. Dehydration
b. Common in children
Dehydration – this is what I picked
205
10. Most common bacteria in chronic parotitis
a. Staphylococcus aureus
206
11. Complication of Cisplatin chemotherapy
a. Renal issues
207
12. What is Frey’s syndrome
a. Gustatory sweating. Aberrant regeneration of parasympathetics after facial nerve injury. Parasympathetics that went to salivary glands re¬connect with sweat gland sympathetics.
208
13. Melanoma under black guy’s nail
a. Acral lentiginous melanoma (ALM) – a specific type of melanoma that appears on the palms of the hands, the soles of the feet, or under the nails
209
14. Nikolsky’s sign is present in which of the following?
a. Pemphigus vulgaris
Nikolsky’s sign is a skin finding in which the top layers of the skin slip away from the lower layers when rubbed
210
15. Polyostotic fibrous dysplasia is part of what syndrome?
a. McCune-Albright syndrome
211
16. What lesion do you see giant cells in?
a. Aneurysmal bone cyst
212
17. What is the treatment for Aneurysmal Bone Cyst?
a. E&C
50% recurrence) may need more aggressive procedure including resection or cryosurgery for recurrence
Usually occurs in long bones or vertebra of pts under age 30 but may occur in mandible> maxilla.
Unknown cause; seen in younger pts who report rapid development of facial swelling and pain.
May be unilocular or multilocular with expansion and thinning of cortex.
May have significant bleeding of “dark blood” that is difficult to control at time of surgery.
Histo: many spaces containing unclotted blood surrounded by fibroblastic tissue which contains giant cells and osteoid. May resemble giant cell lesion, fibrous dysplasia, or ossifying fibroma.
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18. Which presents as radiopaque lesion?
a. Parosteal osteosarcoma
b. Ewing sarcoma
a. Parosteal osteosarcoma
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19. Shown pathology color plate with large radiopacity left maxilla with mixed radiopaque/radiolucent quality. Biopsy shows lesion contains hair, teeth, bone. Which is the correct diagnosis?
a. Teratoma
215
20. Know immunofluorescence used to diagnose pemphigus vulgaris
a. Indirect immunofluorescence shows “fishnet pattern” suggesting the presence of anti-keratinocyte IgG auto-antibiodies. Intracellular
PF shows a DIF pattern characterized by fluorescent staining around keratinocytes, which is known as the intercellular space (ICS) staining patter
216
Pemphigus vs pemphigoid
Pemphigus on left, phemphioid in middle, lichen planu son right
217
Pemphigus vs Pemphigoid
218
Pemphigus-desmosomes or hemidesmosomes
Disease of Desmosome Dysfunction Caused by Multiple Mechanisms. Pemphigus is a severe autoimmune-blistering disease of the skin and mucous membranes caused by autoantibodies reducing desmosomal adhesion between epithelial cells.
219
Pemphigoid-Desmosomes or hemidemosomes
Bullous pemphigoid is a subepidermal blistering skin disease characterized by an autoimmune response against epidermal/dermal proteins. The major autoantigens in bullous pemphigoid are hemidesmosomal proteins such as BP180 or BP230.
220
22. Rhabdomyosarcoma with positive margin after resection, what do you do?
a. Go back to OR for resection
b. Radiation
c. Chemo
Go back to OR for resection
221
23. Pleomorphic adenomaadenoms of deep lobe, treatment option?
a. Total parotidectomy, sacrifice facial nerve
b. Total parotidectomy, preseve facial nerve
c. Superficial parotidectomy
Total parotidectomy, preseve facial nerve
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24. Ameloblastic fibroma occurs in what age group?
a. 1-25
b. 20-40
c. 35-60
1-25 – Occurs 1st and 2nd decades of life; average age is 14-years [Rvw p200]
1st and 2nd decade of life
223
25. OKC, does it invade soft tissue?
a. Doesn’t invade soft tissue upon perforating cortex
224
26. Actinic cell adenocarcinoma features:
a. Mainly in submandibular minor salivary glands – no, parotid > submandibular gland
b. Mal predilection
225
27. Maxillary myxoma treatment
a. Resection margin 1 cm
b. Resection margin 2 cm
c. E&C
Resection margin 1 cm (recurrence is common
226
28. Epulis in infant similar to what
a. Granular cell tumor
227
29. Acanthoma ameloblastoma similar to
a. SCC
228
30. Where do you find Verocay bodies?
a. Schwannoma
229
31. Melanoma inside the mouth. How do you treat?
230
32. Clinical photo (forehead photo)/histopathology (keratin peral? Schwann cell
a. Ameloblastoma
b. SCC?
Keratin Pearl assocaited with sCC
231
1. Soft tissue grafting most like to fail
a. Large area coverage using small tunnel incision/technique
b. Using palatal connective tissue graft
a. Large area coverage using small tunnel incision/technique
232
2. Which is an advantage of the buccal fat pad graft?
a. Does not require mucosal coverage
233
4. STSG used in specialized tissue.
a. FTSG should be used in special locations such as nose or cheek.
234
a. Short-term shrinkage:
more for FTSG than STSG
235
b. Long-term shrinkage:
more for STSG than FTSG
236
6. How does a STSG receive its nutrition immediately after placement?
a. STSG vary in thickness from .010 to .020 inches (usual is .012 or .014). The donor site is typically the outer thigh region and a dermatome is standardly used. The recipient site is the key to graft survival. The graft survives for the first ¬48 hours or so by diffusion of nutrients from the tissue bed. This is also known as plasmatic imbibition. Between 24 and 72 hours, an ingrowth of capillaries begins which is known as inoscultation
237
7. What is the process called when microvascutures start to form from skin graft to the host?
a. Inoscultation
238
8. Most likely reason for STSG to fail
a. Placement on cranium bone
b. Reconstruction of tongue defect
c. Reconstruction of vestibule after vestibuloplastyvestibuloplastly
my pick
239
10. Full thickness includes what layers:
a. Epidermis and reticular dermis
b. Epidermis and papillary dermis
c. Epidermis and full dermis
d. Epidermis and subcutaneous
c. Epidermis and full dermis - Confirmed
240
11. Cartilage-skin graft relies on
a. Imbibition
241
12. What graft resorbs the fastest?
a.
b. Demineralized cancellous bone
c. Freeze dried cortical bone
Demineralized cortical bone - less graft material remains in histo studies
242
13. Which of the following is a requirement for a successful anteriorly based tongue flap?
a. Leave 35% of tongue width
b. Split in 10-days
c. Thickness to 5 mm to avoid lingual nerve
d. Thickness of 5 mm to avoid lingual nerve
Leave 35% of tongue width
NOT SURE ON THIS ONE
243
14. What’s sutured in a nerve repair?
a. Epineurium
244
15. ¼ pentagonal shape defect of upper lip, how will you reconstruct
a. Karapanzic
b. Abbe
c. Primary closure
Primary closure
245
¼ defect of central lower lip, how will you reconstruct
a. Karapanzic
b. Abbe
c. Primary closure
Primary closure
246
17. 40% lower lip defect at the center in block type. How would you reconstruct?
a. STSG
b. FTSG
c. Karapenzic
Karapenzic – my pick
247
18. Approximately 4 hours after a free flap, the flap appears purplish in color. What is the cause?
a. Venous congestion
248
19. Most likely cause of free flap failure
a. Ischemia
b. Congestion
Congestion – my pick
249
20. What test is performed prior to performing radial forearm flap?
a. Allen’s Test (clench fist multiple times while occluding ulnar and radial arteries, when release ulnar a., should have return of color to thenar eminence and thumb showing adequate communication between superficial (ulnar) and deep(radial) palmar arches
250
21. What is secondary blood supply to pectoralis flap? [Rvw p287]
a. Thoracoacromial artery
b. Long thoracic artery
a. Thoracoacromial artery - dominant
b. Long thoracic artery – secondary
251
22. Blood supply to free fibular flap?
a. Branch of the peroneal artery
252
23. What would preclude from using FFF
a. Dominant peroneal
b. Dominant popliteal
c. No perforators
d. Mild to moderate atherosclerotic disease
No perforators
253
24. Patient with severe atherosclerotic disease of both leg vessels, what are reconstructive options
a. Take FFF from contralateral leg
b. Take iliac and scapula flaps
c. Take pectoralis flap
d. Don't do reconstruction with free flap due to atherosclerotic disease
Take iliac and scapula flaps
254
25. Most common complication after iliac crest harvest
Pelvis instability
b. Ilium fracture
a. Pelvis instability – Sounds like gait disturbances so I picked this
b. Ilium fracture
*Also a risk of paraesthesia at lateral thigh
Chronic harvest site pain is the most frequently reported complication in most studies. In additional to hematoms
ABOMS
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