Top 100 Secrets

Question 1

Aging physiology

Answer 1

The basal function of most organ systems remains unchanged due to the aging process; however, functional reserve and the ability to compensate for physiological stress are reduced.

Question 2

Perioperative beta blocker management

Answer 2

Patients who are on beta blockers should take them on the day of surgery and continue them perioperatively. Abrupt interruption of the regimen can lead to withdrawal symptoms: rebound hypertension, tachycardia, and myocardial ischemia.

Question 3

Blood transfusion decision making

Answer 3

Blood transfusion should not be based solely on hemoglobin or hematocrit levels. The decision should be individualized to the clinical situation and consider the patient’s health status.

Question 4

Most useful spirometry indices

Answer 4

Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), the FEV1/FVC ratio, and the flow between 25% and 75% of the FVC (mean maximal flow [MMF25 to 75]) are the most clinically helpful indices obtained from spirometry.

Question 5

Propofol anesthesia facts

Answer 5

Propofol is the least likely of all induction agents to result in nausea and vomiting. The effects of intravenous anesthetics are terminated by redistribution, not biotransformation and breakdown.

Question 6

Radial vs central aortic systolic pressure

Answer 6

The systolic blood pressure in the radial artery may be as much as 20 to 50 mm Hg higher than the pressure in the central aorta.

Question 7

Cocaine and ketamine interaction

Answer 7

Cocaine sensitizes the cardiovascular system to the effects of endogenous catecholamine. Ketamine potentiates the cardiovascular toxicity of cocaine and should be avoided.

Question 8

Physiologic changes during pregnancy

Answer 8

Physiologic alterations in patients during pregnancy include increases in cardiac output, heart rate, plasma volume, minute ventilation, and oxygen consumption; decreases in SVR; dilutional anemia; loss of functional residual capacity (FRC); and a hypercoagulable state.

Question 9

Pacemaker coding system

Answer 9

In the pacemaker coding system, the first letter refers to the chamber paced, the second letter to the chamber where sensing occurs, the third letter to the responses to sensing in chambers, and the fourth letter to rate responsiveness.

Question 10

Diabetes and coronary artery disease

Answer 10

Patients with diabetes have a high incidence of coronary artery disease with an atypical or silent presentation.

Question 11

Statistical significance p value

Answer 11

When in doubt, remember that a p-value <.05 is generally considered statistically significant, and the finding by chance alone is 1 in 20.

Question 12

WBC count in febrile illness

Answer 12

In febrile patients, a white blood cell or band count is rarely useful in differentiating between bacterial and viral illnesses.

Question 13

Septal hematoma with nasal fracture

Answer 13

A septal hematoma must be ruled out in the setting of nasal bone fracture. Failure to drain a septal hematoma may result in a septal abscess, septal perforation, and/or saddle nose deformity.

Question 14

Common causes acute bacterial sinusitis

Answer 14

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common causes of acute bacterial sinusitis.

Question 15

Facial nerve regeneration

Answer 15

The facial nerve is capable of regeneration. The degree of return to normal mostly depends on the degree of initial injury. The most critical factor is whether the nerve lost function slowly over days or immediately during the trauma.

Question 16

Diagnosis of Sjogren syndrome

Answer 16

A positive antinuclear antibody (ANA), rheumatoid factor (RF), Sjögren syndrome antigen A (SS-a), and SS-b and an elevated erythrocyte sedimentation rate are suggestive of Sjögren syndrome, but the definitive diagnosis is made by a minor salivary gland biopsy in the lower lip showing glandular atrophy with abundant lymphocytes and histiocytes.

Question 17

Parotid infections causes

Answer 17

The most common parotid viral infection is mumps. Less common are cytomegalovirus, coxsackievirus, and Epstein-Barr viruses. Bacterial sialadenitis is commonly associated with coagulase-positive Staphylococcus aureus, but S. pneumoniae, Escherichia coli, H. influenzae, and oral anaerobe infections may also occur.

Question 18

Danger space infection risk

Answer 18

Infection of the danger space between the alar fascia and the prevertebral space can lead to mediastinitis and death if not appropriately treated.

Question 19

Facial nerve landmark parotidectomy

Answer 19

The most common landmark for facial nerve identification during parotidectomy is the tympanomastoid suture line.

Question 20

Unknown primary malignant neck node workup

Answer 20

Biopsies of the possible primary sites, including the nasopharynx, tongue base-valleculae, pyriform sinus, and tonsils, should be obtained during diagnostic work-up in patients with unknown primary with malignant lymph node in the neck.

Question 21

Chemoradiotherapy effectiveness HNSCC

Answer 21

Radiotherapy is more effective when given concomitantly with chemotherapy in the treatment of head and neck squamous cell carcinomas.

Question 22

Phenol skin resurfacing toxicity

Answer 22

When used as a skin-resurfacing chemical agent, phenol can be cardiotoxic, hepatotoxic, and nephrotoxic. Steps must be taken to minimize the risk of these toxicities.

Question 23

CO2 laser skin resurfacing depth indicator

Answer 23

When using carbon dioxide laser in skin resurfacing, a yellow-chamois color indicates that one has reached the reticular dermis.

Question 24

Rhytidectomy correction limits

Answer 24

Rhytidectomy can only correct wrinkling in the lower two-thirds of the face and the neckline.

Question 25

GCS intubation threshold

Answer 25

A patient with a Glasgow coma scale (GCS) score of 8 or less requires intubation.

Question 26

Forced duction test purpose

Answer 26

Forced duction testing is a simple and direct method to detect extraocular muscle entrapment, which may occur with orbital blowout fractures.

Question 27

Amoxicillin rash with mononucleosis

Answer 27

If given in the setting of mononucleosis, amoxicillin or penicillin can cause a salmon-colored rash.

Question 28

Erb's point injury

Answer 28

Erb’s point is on the side of the neck where pressure on roots of C5–C6 causes paralysis of brachial muscles such as deltoid, biceps, and brachialis anterior.

Question 29

Cyanosis hemoglobin threshold

Answer 29

The reduced hemoglobin level at which a patient becomes cyanotic is 5 g/dL.

Question 30

Anisocoria definition

Answer 30

Anisocoria refers to pupil inequality. It is a common normal variation but can also indicate pathology.

Question 31

Local anesthetic metabolism

Answer 31

Amide local anesthetics are metabolized by liver microsomal enzymes; ester anesthetics are metabolized by plasma pseudocholinesterase. Lidocaine is metabolized in the liver.

Question 32

Determinants of local anesthetic properties

Answer 32

Lipid solubility determines potency. Protein binding determines duration. pKa determines onset: the closer the pKa to physiologic pH 7.4, the faster the onset.

Question 33

Opioids causing histamine release

Answer 33

Morphine, codeine, and meperidine cause histamine release causing vasodilation and hypotension. Fentanyl, sufentanil, and alfentanil do not.

Question 34

Plasma cholinesterase function

Answer 34

Plasma cholinesterase produced in the liver metabolizes succinylcholine, ester local anesthetics, and mivacurium. Low levels (liver disease, pregnancy, malignancy, malnutrition, collagen vascular disease, hypothyroidism) prolong succinylcholine blockade.

Question 35

Hypernatremia fluid treatment

Answer 35

Fluid resuscitation with 5% dextrose in water (D5W) is preferable to lactated Ringer for symptomatic hypernatremia, but D5W is rarely indicated otherwise due to risk of osmotic diuresis.

Question 36

Emergency airway pediatric

Answer 36

In children under 10–12 years, tracheostomy is the preferred emergency surgical airway because the cricothyroid membrane is too small and landmarks poorly defined for cricothyrotomy.

Question 37

Malignant hyperthermia

Answer 37

Malignant hyperthermia is a hypermetabolic skeletal muscle state triggered by anesthetics in genetically susceptible individuals. Incidence <0.5%. Key features: acidosis, rigidity, fever, hypermetabolism, myoglobinuria.

Question 38

Creatinine and GFR

Answer 38

Creatinine is a sensitive indirect measurement of GFR because it is filtered by the glomerulus but minimally secreted or reabsorbed.

Question 39

Fetal radiation exposure risks

Answer 39

Fetuses <16 weeks exposed to 0.5 Gy have higher risk of growth restriction, microcephaly, and mental retardation. Diagnostic imaging <0.05–0.1 Gy is not teratogenic. Most radiographs/CT deliver <0.01 Gy.

Question 40

Fresh frozen plasma indications

Answer 40

FFP replaces deficiencies of factors II, V, VII, IX, and XI when component therapy is unavailable. Each unit raises clotting factors 2–3%. Typical dose 10 mL/kg.

Question 41

Cis-atracurium liver disease

Answer 41

Cis-atracurium is ideal in liver dysfunction because it is eliminated by Hofmann elimination independent of liver function.

Question 42

Infected prosthetic joints bacteria

Answer 42

Most infected prosthetic joints involve Staphylococcus aureus or Staphylococcus epidermidis from surgical contamination. Hematogenous spread from oral infections may involve Streptococcus viridans and Streptococcus sanguis.

Question 43

Ludwig angina

Answer 43

Ludwig angina is bilateral boardlike induration of submandibular, sublingual, and submental spaces causing airway obstruction. Infection can extend to epiglottis causing edema.

Question 44

Erysipelas

Answer 44

Erysipelas is superficial cellulitis caused by beta-hemolytic streptococcus or group B streptococcus. Presents with warm erythematous rapidly spreading skin, lymphadenopathy, fever, and abrupt swelling. Treated with parenteral penicillin.

Question 45

IAN deficit after BSSO

Answer 45

Neurosensory deficit of the inferior alveolar nerve after BSSO occurs in 20–85% initially but ~9% at one year. Risk higher in patients >40 and with simultaneous genioplasty.

Question 46

Maxillary expansion stability

Answer 46

Transverse expansion of the maxilla is the least stable orthognathic procedure with ~50% relapse at second molars. Inferior maxillary positioning and mandibular setbacks are also less predictable.

Question 47

Syndromes with prognathism or midface deficiency

Answer 47

Mandibular prognathism: Gorlin syndrome, Klinefelter, Marfan, osteogenesis imperfecta, Waardenburg. Midface deficiency: achondroplasia, Apert, cleidocranial dysplasia, Crouzon, Marshall, Pfeiffer, Stickler.

Question 48

Cleft lip repair timing

Answer 48

Cleft lip repair typically at 10–14 weeks. Rule of Tens: 10 weeks age, hemoglobin 10 g/dL, weight 10 lb.

Question 49

Signs of parotid malignancy

Answer 49

Rapid tumor growth, sudden acceleration, pain, and facial nerve paralysis suggest malignancy, though paralysis can also occur with suppurative parotitis, inflammatory pseudotumor, amyloidosis, or sarcoidosis.

Question 50

Radiolucent sialoliths

Answer 50

Early sialoliths may not be mineralized. 30–50% parotid and 10–20% submandibular stones are radiolucent. They may be seen indirectly on sialography or directly with sialoendoscopy.

Question 51

FNA salivary gland accuracy

Answer 51

Fine needle aspiration biopsy specificity 88–99% and sensitivity 71–93% for salivary gland pathology.

Question 52

Sublingual gland tumors

Answer 52

Sublingual gland tumors are <1% of salivary neoplasms but >80% are malignant, commonly adenoid cystic or mucoepidermoid carcinoma.

Question 53

Salivary gland syndromes

Answer 53

Syndromes affecting salivary glands include primary Sjögren syndrome (parotid and lacrimal enlargement, xerostomia, xerophthalmia); secondary Sjögren syndrome associated with autoimmune diseases such as rheumatoid arthritis, lupus, systemic sclerosis, thyroiditis, primary biliary cirrhosis, and mixed collagen disease; and sarcoidosis involving the parotid gland. Sarcoidosis with fever, lacrimal adenitis, uveitis, and facial nerve paralysis is called Heerfordt syndrome. HIV‑positive children may develop a sicca‑like syndrome with parotid enlargement, xerostomia, and lymphadenopathy.

Question 54

Most common benign salivary tumor

Answer 54

The most common benign tumor of minor and major salivary glands is pleomorphic adenoma.

Question 55

Most common malignant salivary tumors

Answer 55

The most common malignant tumors are mucoepidermoid carcinoma in the parotid gland and adenoid cystic carcinoma in the submandibular, sublingual, and minor salivary glands.

Question 56

Paul‑Elder Critical Thinking Model in ethics

Answer 56

Ethical decision‑making can be difficult when principles conflict. The Paul‑Elder Critical Thinking Model helps clarify ethical dilemmas. Critical thinking is essential for evaluating literature and continuing education. Veracity requires practitioners to stay informed about current knowledge. Not everything published or taught by experts is necessarily correct; P‑ECTM helps analyze literature and apply ethical principles.

Question 57

Cystic lesions around impacted mandibular third molars

Answer 57

The incidence of cystic lesion development around retained asymptomatic impacted mandibular third molars ranges from 0.3% to 37%.

Question 58

Common cysts and tumors in children

Answer 58

The most common soft tissue cysts in children are thyroglossal duct, dermoid, and epidermoid cysts. The most common benign soft tissue tumor is hemangioma. Odontoma is the most common benign odontogenic intraosseous tumor; ossifying fibroma is the most common nonodontogenic tumor.

Question 59

Buccal fat pad flap indications

Answer 59

Buccal fat pad flap can close oroantral fistulae after extraction, repair posterior cleft palate fistulas, reconstruct small (≈4×4 cm) intraoral defects after cancer resection (soft palate, hard palate, retromolar trigone, maxillary defects, cheek mucosa, tonsillar fossa). It can cover defects after release of submucosal fibrosis, skull base defects, improve upper lip augmentation and midface contour, cover intraoral bone grafts, zygomatic implants, act as a membrane in sinus lift surgery, and treat gingival recession.

Question 60

Buccal fat pad contraindications

Answer 60

Contraindications include previously used buccal fat pad, intraoral soft tissue defects >5 cm, prior irradiation, patients with Down syndrome, and malar hypoplasia or thin cheeks.

Question 61

Most common oral cancer sites

Answer 61

The most common sites for oral cancer are the tongue and floor of mouth, though geographic and cultural factors may alter prevalence.

Question 62

Sentinel lymph node definition

Answer 62

The sentinel node is any lymph node receiving direct lymphatic drainage from a primary tumor site.

Question 63

Most common lasers in OMFS

Answer 63

The most common laser in OMFS is the carbon dioxide (CO2) laser. For skin resurfacing, CO2 and Er:YAG lasers are most common because of their high affinity for tissue water.

Question 64

Human vs animal bite infections

Answer 64

Human bites commonly involve Streptococcus and Staphylococcus; severe infections may involve Eikenella. Prophylaxis: penicillin or amoxicillin‑clavulanate. Animal bites commonly involve Pasteurella multocida (50–75%). Amoxicillin‑clavulanate recommended. Tetanus immunization required; rabies prophylaxis may be needed.

Question 65

Bone graft volume rule

Answer 65

Approximately 10 mL of noncompacted corticocancellous bone is required for every 1 cm of bony defect reconstructed.

Question 66

Anterior iliac crest attachments

Answer 66

Structures attaching to the anterior iliac crest: fasciae latae, inguinal ligament, tensor fasciae latae, sartorius, iliacus, and internal and external abdominal oblique muscles.

Question 67

Lip defect closure limits

Answer 67

Defects of about one‑third of the lower lip and one‑quarter of the upper lip can usually be closed primarily without causing significant microstomia.

Question 68

Tongue flap orientation

Answer 68

A posteriorly based tongue flap repairs soft palate, retromolar, and posterior buccal defects. An anteriorly based flap repairs hard palate, anterior buccal mucosa, anterior floor of mouth, and lip defects.

Question 69

Osteoradionecrosis epidemiology

Answer 69

ORN incidence historically 1–44.2% (≈11.8%), more recently 5–15% (≈5.4%). Bimodal peaks at 12 months and 24–60 months but may occur up to 30 years later. Causes include trauma: pre‑irradiation extraction (4.4%), post‑irradiation extraction (5.8%), denture trauma (<1%), or spontaneous disease progression.

Question 70

Hyperbaric oxygen therapy protocol

Answer 70

HBO therapy uses 100% oxygen in a chamber at 2.4 ATA for about 90 minutes per session, once daily, five sessions (dives) per week.

Question 71

Submental liposuction plane and boundaries

Answer 71

Submental liposuction is performed in the supraplatysmal plane beneath the dermis. Treatment area bounded by anterior border of SCM, inferior mandible border, and superior border of thyroid cartilage.

Question 72

Implant osseointegration torque test

Answer 72

Osseointegrated implants tolerate 10–20 N/cm torque without loosening. Additional signs: percussion and immobility with fixture mount. No movement with 5 lb lateral force. Horizontal mobility >1 mm or movement with <500 g force indicates implant failure.

Question 73

Causes of increased ETCO2

Answer 73

Increased ETCO2 may result from increased metabolism or decreased elimination: hypoventilation, hyperthermia, fever/sepsis/malignant hyperthermia, rebreathing, CO2 absorption (laparoscopy/embolism), exhausted CO2 absorbent.

Question 74

MRI/CT safety with titanium implants

Answer 74

MRI and CT are not contraindicated with pure titanium implants. CT scanners can subtract titanium artifacts to reduce scatter.

Question 75

Average maxillary sinus dimensions

Answer 75

Average sinus volume ≈14.75 mL (range 9.5–20 mL). Average width 2.5 cm, height 3.75 cm, depth 3 cm.

Question 76

Split thickness skin graft definition

Answer 76

STSG contains epidermis and part of dermis. Classified as thin, intermediate, or thick. Thickness ranges from 0.010–0.025 inch.

Question 77

Skin graft contraction

Answer 77

Thinner grafts contract more: thin > intermediate > thick. Full‑thickness grafts have minimal contraction. Primary contraction occurs immediately due to elastic fibers; secondary contraction begins around POD 10 and continues up to 6 months.

Question 78

Plasmic imbibition

Answer 78

Plasmic imbibition is initial graft survival phase where graft absorbs plasma‑like fluid from recipient bed via capillary action for about 48 hours.

Question 79

Obstructive sleep apnea definition

Answer 79

OSA involves repeated hypopnea or apnea ≥10 seconds with >2% oxygen desaturation. Occurs during deep sleep stages (III, IV, REM) when pharyngeal muscles relax causing airway collapse.

Question 80

Respiratory disturbance index

Answer 80

RDI equals number of obstructive respiratory events per hour of sleep: RDI = (apnea + hypopnea) / total sleep time × 60. Upper normal limit ≈5.

Question 81

Temperature and heart rate relationship

Answer 81

For every 1°C increase in body temperature, heart rate increases approximately 9–10 beats/min.

Question 82

Postoperative dysuria cause and treatment

Answer 82

Most common cause is anesthetic inhibition of micturition reflex causing bladder distention. Initial management: have patient attempt voiding with running water. If unsuccessful and not hypovolemic, catheterize; if residual >300 mL leave catheter overnight.

Question 83

Surgical site infection timing

Answer 83

SSI typically occurs 12 hours–7 days after surgery and within 30 days unless foreign material present. With implants, infection may be attributed to surgery for up to 1 year.

Question 84

Causes of flat ECG line

Answer 84

Flat ECG tracing may result from fine ventricular fibrillation, loose electrode leads, no power, or signal gain turned down (not only asystole).

Question 85

Endotracheal drug administration

Answer 85

Drugs deliverable via ET tube: lidocaine, epinephrine, atropine, Narcan (L‑E‑A‑N). Dose 2–2.5× IV dose diluted in 10 mL saline or distilled water. Distilled water increases absorption but worsens PaO2.

Question 86

Kiesselbach plexus

Answer 86

Source of ~90% of nosebleeds. Formed by sphenopalatine, anterior ethmoidal, greater palatine, and superior labial arteries with contributions from nasopalatine branch of descending palatine artery.

Question 87

Nasolacrimal duct anatomy

Answer 87

The nasolacrimal duct lies between maxillary sinus and nasal cavity and drains to inferior meatus through valve of Hasner. Located 11–14 mm posterior to piriform aperture and 11–17 mm above nasal floor.

Question 88

Eyelid gland names

Answer 88

Sebaceous glands of eyelid = glands of Zeis. Sweat glands = glands of Moll.

Question 89

Crocodile tears syndrome

Answer 89

After facial nerve injury parasympathetic fibers misdirect to lacrimal gland causing tearing while eating.

Question 90

Facial muscle innervation planes

Answer 90

Most facial muscles receive innervation on their deep surface. Exceptions (mentalis, levator angularis superioris, buccinator) receive superficial innervation because they lie deep to facial nerve plane.

Question 91

Annulus of Zinn

Answer 91

The annulus of Zinn is the fibrous common tendinous ring in the orbit from which rectus muscles originate.

Question 92

Tenon capsule

Answer 92

Tenon capsule divides orbit into anterior (precapsular) and posterior (retrocapsular) compartments. Globe occupies anterior half; posterior half contains fat, muscles, vessels, and nerves.

Question 93

Third molar nerve relationships

Answer 93

IAN commonly lies buccal and slightly apical to mandibular third molar roots. Palatal root of maxillary first molar most commonly displaced into sinus. Radiographic risk signs: canal diversion, canal interruption, root darkening.

Question 94

Tinel sign

Answer 94

Tinel sign occurs when percussion over regenerating nerve produces distal tingling. Indicates small fiber recovery but poorly correlates with functional recovery and may mimic neuroma.

Question 95

Nerve injury after third molar surgery

Answer 95

Injury incidence for IAN, lingual, and long buccal nerves during third molar surgery ranges 0.6–5%. IAN injuries more common than lingual. >96% lingual nerve injuries recover spontaneously.

Question 96

Axonal regeneration rate

Answer 96

Average forward growth of injured axon ≈1–2 mm/day.

Question 97

Sural nerve graft facts

Answer 97

Sural nerve commonly used for IAN grafts (~25 mm defects). Provides up to 30 mm graft. Supplies sensation to posterolateral leg/foot. Has ~50% fewer axons than IAN. Harvested graft should be ~25% longer than defect due to contracture.

Question 98

Mandibular fracture epidemiology

Answer 98

>50% of mandibular fractures are multiple. Associated injuries occur in ~43%, especially in vehicular trauma. Cervical spine fractures occur in ~11%; always rule out cervical spine injury.

Question 99

Aerosol generating procedures

Answer 99

AGPs include any procedure producing infectious aerosols capable of transmitting disease. Healthcare workers must follow guidelines from local health authorities for protection.

Question 100

SSRI opioid interaction

Answer 100

SSRIs inhibit CYP2D6, reducing activation of prodrug opioids like hydrocodone, leading to poorer pain control. Direct‑acting opioids such as oxycodone or morphine may be preferable in patients taking SSRIs.