Random Facts

Question 1

Neuropraxia

Answer 1

Compression and ischemia. Comes back in hours to weeks, and no wallerian degeneration occurs.

Question 2

Axonotmesis

Answer 2

Has disruption of the neuronal axon, but with maintenance of the myelin sheath. Wallerian degeneration occurs, but regeneration occurs over weeks to years.

Question 3

Neurotmesis

Answer 3

Not only the axon, but the encapsulating connective tissue lose their continuity. Has wallerian degeneration, with permanent loss.

Question 4

Charcot Leyden crystals

Answer 4

allergic fungal rhinosinusitis

Question 5

Furstenburg test

Answer 5

encephalocele expands with compression of IJ

Question 6

Potts puffy tumor

Answer 6

fonticulus nasofrontalis subperiostial abscess

Question 7

Local anesthetic allergy - which are amides?

Answer 7

contain 2 “i”s

Question 8

Local anesthetic allergy - which are esters?

Answer 8

contain 1 “i”

Question 9

Rapid Sequence medications

Answer 9

100mg Succinylcholine, 20mg Etomidate

Question 10

Sunderland’s Classification

Answer 10

Nerve Injury

First-degree (Class I)

Seddon’s neurapraxia and first-degree are the same.

                                                                                       Second-degree (Class II)

Seddon’s axonotmesis and second-degree are the same.

                                                                                       Third-degree (Class II)

Sunderland’s third-degree is a nerve fiber interruption. In third-degree injury, there is a lesion of the endoneurium, but the epineurium and perineurium remain intact. Recovery from a third-degree injury is possible, but surgical intervention may be required.

                                                                                       Fourth-degree (Class II)

In fourth-degree injury, only the epineurium remain intact. In this case, surgical repair is required.

                                                                                       Fifth-degree (Class III)

Fifth-degree lesion is a complete transection of the nerve. Recovery is not possible without an appropriate surgical treatment.

Question 11

Nerve layers

Answer 11

Epineurium

Perineurium

Endoneurium

Question 12

How much blood is in a human?

Answer 12

Obese Female: 60cc/kg
Adult Female: 65cc/kg
Obese Male: 70cc/kg
Adult Male: 75cc/kg
Infant: 80cc/kg
Term Neonate: 85cc/kg
Premature Neonate: 95cc/kg

Question 13

List the cranial nerves

Answer 13

I - Olfactory nerve
II - Optic nerve
III - Oculomotor nerve
IV - Trochlear nerve
V - Trigeminal nerve/dentist nerve
VI - Abducens nerve
VII - Facial nerve
VIII - Vestibulocochlear nerve/Auditory nerve
IX - Glossopharyngeal nerve
X - Vagus nerve
XI - Accessory nerve/Spinal accessory nerve
XII - Hypoglossal nerve

Question 14

What is Frey’s syndrome?

Answer 14

(Gustatory Sweating)

Pathophysiology

injury to the auriculotemporal nerve (sympathetic
fibers) results in aberrant innervation of cutaneous sweat glands (which share the same neurotransmitter) by postganglionic
parasympathetic fibers

• may occur up to 5 years postoperatively
• less incidence with the use of “thick” skin flaps

Symptoms

sweating and reddening of skin during meals

Treatment

1. Medical Management: antiperspirant and anticholenergic preparations (scopolamine, glycopyrrolate, diphemanil methylsulfate)
2. Surgical Management: tympanic neuronectomy (chorda tympani nerve section via tympanotomy approach), interpose a sheet of fascia lata or dermis between skin and parotid gland
3. Radiation Therapy: reserved for failed management with severe symptoms

Question 15

What is the only cranial nerve to both enter and exit the skull?

Answer 15

CN XI (spinal accessory)

This nerve derives from the brainstem, enters through the foramen magnum, then exits the skull via the jugular foramen

Question 16

What are the Paradise Criteria for Tonsillectomy?

Answer 16

7/1 5/2 3/3

• 7 episodes in previous year
• 5 episodes in each of the previous 2 years
• 3 episodes in each of the previous 3 years

Clinical features

• Sore throat plus at least one of the following features qualifies as a counting episode:
• Temperature of greater than 100.9°F (38.3°C)
• Cervical adenopathy (tender lymph nodes or lymph node size greater than 2 cm)
• Tonsillar exudate
• Culture positive for group A β-hemolytic streptococcus

Question 17

What are the criteria for placement of pressure-equalizing tubes?

Answer 17

>3 episodes in 6 months, > 4 episodes in 12 months (3/6, 4/12)

• Severe acute otitis media
• Hearing loss > 30 dB in patient with otitis media with effusion
• Poor response to antibiotic for otitis media
• Impending mastoiditis or intra-
• cranial complication due to otitis media
• Otitis media with effusion > 3 months
• Recurrent episodes of acute otitis media (more than 3 episodes in 6 months or more than 4 episodes in 12 months)
• Chronic retraction of tympanic membrane or pars flaccida
• Barotitis media control.
• Autophony due to patulous eustachian tube.
• Craniofacial anomalies that predispose to middle ear dysfunction (e.g., cleft palate)
• Middle ear dysfunction due to head and neck radiation and skull base surgery

Question 18

How many cells are there in the human body?

Answer 18

10^14, or 100,000,000,000,000

Question 19

How many bacteria are there in the human body?

Answer 19

10^15, or 10 times more than there are human cells

Question 20

What hormones are secreted from the anterior pituitary?

Answer 20

FLATT-PMG

• Follicle-Stimulating hormone
• Luteinizing hormone
• Adrenocorticotropic hormone
• Thyroid-stimulating hormone
• Tropic hormone
• Prolactin
• Melanocyte-stimulating hormone
• Growth hormone

Question 21

What hormones are secreted from the posterior pituitary?

Answer 21

• Oxytocin
• Vasopressin (ADH)

Question 22

What is Klumpke Paralysis?

Answer 22

Palsy of the lower roots of the brachial plexus

Usually C8 and T1 involved

Caused by shoulder dystocia leading to a pulled arm

Leads to “claw hand”

“Klumpke the monkey hung from a tree”

Question 23

Osteoclasts vs Osteoblasts

Answer 23

Osteoclasts

Removes bone tissue by breaking mineralized matrix down (bone resporption)

Osteoblasts

Responsible for bone formation

Specialized fibroblasts that produce a matrix of osteoid (type 1 collagen)

Question 24

What are the 5 types of collagen?

Answer 24

1. Collagen I: skin, tendon, vascular ligature, organs, bone (main component of the organic part of bone)
2. Collagen II: cartilage (main component of cartilage)
3. Collagen III: reticulate (main component of reticular fibers), commonly found alongside type I.
4. Collagen IV: forms bases of cell basement membrane
5. Collagen V: cell surfaces, hair and placenta

Question 25

What is **Scrofula**?

Answer 25

_Tuberculous cervical lymphadenitis_ Lymphadenitis of the cervical lymph nodes associated with **TB** (95%) as well as atypical mycobacterium (more common in **immunocompetent children**)

Question 26

What are the indications for hemodialysis?

Answer 26

**AEIOU** 1. Acidosis 2. Electrolyte abnormalities-hyperkalemia 3. Ingestion of substances like barbiturates, salicylates, lithium, methanlo, etc 4. Overload fluid (unresponsive to diuretics) 5. Uremia symptoms (pericarditis, encephalopathy)

Question 27

What is another name for the tubal tonsil?

Answer 27

**Tonsil of Gerlach**

Question 41

What is the Torus Tuberius?

Answer 41

Question 42

What is Torus Palatinus?

Answer 42

Bony protrusion on the palate Can also occur on the mandible (**torus mandibularis**) Multifactorial

Question 43

What is the maximum dose of Lidocaine **with** epi?

Answer 43

**_7mg/kg_** ex: 70kg male: 70kg\*(7mg/kg) = 490mg 490mg/(10mg/mL) = 49mL max dose Can give more due to the decrease blood flow from the epinephrine, and therefore the decreased systemic concentrations reached

Question 44

What is the maximum dose of Lidocaine **without** epi?

Answer 44

**_4.5mg/kg_** ex: 70kg male: 70kg\*(4.5mg/kg) = 315mg 315mg/(10mg/mL) = 31.5mL max dose

Question 45

On MRI, T1 vs T2?

Answer 45

**_World War 2_** **water** looks **white** in **T2** T1 weighted: enhances fat, water is DARK T2 weighted: enhances water, fat appears DARK

Question 46

What does an amalgam tattoo look like?

Answer 46

Question 47

What are otowicks composed of?

Answer 47

sea sponge

Question 48

What is the confluence of sinuses?

Answer 48

**torcular herophili** * connecting point of the superior sagittal sinus, straight sinus, and occipital sinus.

Question 49

What is the vomeronasal organ?

Answer 49

**Jacobson's organ** * Auxiliary olfactory sense organ that is found in many animals * Discovered by Frederik Ruysch and later by Ludwig Jacobson in 1813 * Sense organ involved in the **_flehmen response_** in mammals * Seen as a vestigial line in the septum in humans during sinus surgery

Question 50

What is the Flehmen Response?

Answer 50

* Animal curls back its upper lips exposing its front teeth, inhales with the nostrils usually closed and then often holds this position for several seconds * Facilitates the transfer of pheromones and other scents into the vomeronasal organ located above the roof of the mouth via a duct which exits just behind the front teeth of the animal

Question 51

What is dysphagia lusoria?

Answer 51

* abnormal condition characterized by difficulty in swallowing caused by aberrant right subclavian artery * lusus naturæ means sports of nature or natural anomaly * During development of aortic arch, if the proximal portion of the right fourth arch disappears instead of distal portion, the right subclavian artery will arise as the last branch of aortic arch. * It then courses behind the esophagus (or rarely in front of esophagus, or even in front of trachea) to supply blood to right arm. This causes pressure on esophagus and results in dysphagia. It can sometimes result in upper gastrointestinal tract bleeding

Question 52

What is the opposite of the Valsalva maneuver?

Answer 52

**Toynbee maneuver** Pinch nose, and swallow Pulls eustachian tube open

Question 53

Anatomy of the Carpals

Answer 53

Question 54

What are the steps of skin graft healing?

Answer 54

1. **Plasmatic Imbibition** - 0 - 48 hours, passive absorption 2. **Inosculation** - day 3-5, vascular network forms from capillary buds 3. **Revascularization** - day 5 and on, new blood vessels grow into graft

Question 55

What are the steps of the reconstructive ladder?

Answer 55

Question 56

What is Von Hippel–Lindau disease?

Answer 56

* Rare, autosomal dominant genetic condition that predisposes individuals to benign and malignant tumours * The most common tumours found in VHL are central nervous system and _retinal hemangioblastomas, clear cell renal carcinomas, pheochromocytomas, pancreatic neuroendocrine tumours, pancreatic cysts, endolymphatic sac tumors and epididymal papillary cystadenomas_ * VHL results from a mutation in the von Hippel–Lindau tumor suppressor gene on **chromosome 3p25**

Question 57

What is the frequency of post tonsillectomy bleeding?

Answer 57

2-4% bleed rate 1/15,000-30,000 mortality rate

Question 58

What bacteria is commonly seen in human bites?

Answer 58

**_Eikenella corrodens_** Gram negative bacillus Infections most commonly occur in patients with cancers of the head and neck It is also common in human bite infections, especially "reverse bite" or "fight bite", or "clenched fist injuries" It also causes infections in insulin-dependent diabetics and intravenous drug users who lick their needles ("needle-licker's osteomyelitis") It is one of the HACEK group of infections which are a cause of culture-negative endocarditis.

Question 59

Mucocele vs mucous retention cyst

Answer 59

Mucoceles do not have a true lining/wall Mucous retention cysts are true cysts, and have a cyst wall (dont grow, invade, erode)

Question 60

What is sternberg's canal?

Answer 60

Lateral craniopharyngeal canal Medial to foramen rotundum Thought to be the cause of spontaneous CSF leaks

Question 61

What is Ondine's Curse?

Answer 61

**Congenital Central Hypoventilation Syndrome** Disorder of autonomic nervous system Must think about breathing, otherwise go apneic Often fatal, particularly in sleep Require tracheostomy, ventilator

Question 62

Describe the features of Plummer-Vinson Syndrome

Answer 62

Triad of **dysphagia**, **esophageal webs**, and **iron** **deficiency anemia**. It most usually occurs in postmenopausal women. Genetic factors and nutritional deficiencies may play a role. In these patients, esophageal squamous cell carcinoma risk is increased; therefore, it is considered a premalignant process. Dysphagia Pain Weakness Odynophagia Atrophic glossitis Angular stomatitis Increased risk of carcinoma

Question 63

Pathology from Granular Cell Tumor

Answer 63

**Pseudo-epitheliomatous hyperplasia** very important, as it may mimic or look very similar to SCC

Question 64

Only cranial nerve thats not part of the peripheral nervous system?

Answer 64

The **optic nerve** is derived from the diancephalon, and is therefore a direct extension of the CNS.

Question 65

Describe features of "Acute calcific tendinitis of the longus colli muscle"

Answer 65

Retropharyngeal inflammatory process Typically present with neck pain, stiffness, headache CT w/ constrast shows calcification in the longus colli muscle, small RP effusion Treat with NSAIDS and PT

Question 66

Are Aminoglycosides more *cochleotoxic* or *vestibulotoxic*?

Answer 66

**Vestibulotoxic** * Streptomycin * Gentamicin * Neomycin * Kanamycin * Amikacin * Tobramycin

Question 67

How many muscles are there in the human face?

Answer 67

42