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163 Cards in this Set
- Front
- Back
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What stain is used to diagnose cat scratch dx? |
Warthin-Starry stain
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What is organism of cat scratch disease? |
Bartonella henselae |
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What disease is associated with psammoma bodies? |
papillary thyroid ca (meningioma, ovarian ca, colon ca) |
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What is the origin of the superior parathyroid glands? |
4th pharyngeal pouch
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What is the origin of the inferior parathyroid glands? |
3rd pharyngeal pouch |
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What is the route of 2nd branchial anomaly? |
-anterior border of scm -between ICA and ECA -deep to 9, 12 -exit tonsillar fossa
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What is the route of the 3rd branchial anomaly? |
-posterior to eca, ica -superificial to 12, deep to 9 -opens to pyriform sinuses
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What muscles cause soft palate elevation? |
-tensor veli palatini -levator veli palatini
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What is the most common type of midline encephalocele? |
nasofrontal |
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What is the most common cause of bacterial resistance to cephalosporins? |
plasmid-mediated B-lactamases |
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Most common side effect of ondasetron? |
headache |
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What is the first treatment of SIADH? |
hypertonic saline (3%) |
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What is a contraindication to cetirizine? |
renal failure |
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What is the best treatment of a large clot on the tonsillar fossa 8 days post TNA? |
observe |
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What is the work-up of a stable level III neck injury |
angiography |
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Patient has blurry vision after trauma. What is most likely site of injury? |
orbital apex |
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What is best airway management after laryngeal fracture? |
trach |
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What dx's other than Wegener's can cause high c-ANCA? |
microscopic polyangiitis idiopathic glomerulonephritis Churg Strauss ulcerative coliitis |
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What are the features of CHARGE? |
coloboma heart disease atresia choanal retardation genital hypoplasia ear anomalies and deafness |
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What are the features of pendred? |
-profound SNHL -goiter: 50% euthyroid, 50% hypothyroid -ear anomalies |
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What are ear anomalies of pendred? |
mondini aplasia dilated vestibular aquaduct |
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What are features of Usher: |
-SNHL -retinitis pigmentosa -3 types |
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What is the first diagnostic step 4hr after caustic injection? |
CXR and neck radiograph to eval for mediastinitis or subQair -endoscopy 24-48hr after injury |
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Patient with VonWillebrand dx needs TNA. What is best treatment? |
DDAVP |
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How does DDAVP work? |
stimulates release of VWF and factor VIII |
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What is the treatment when patient goes into a-fib and has increased temp after induction of anesthesia? |
malignant hyperthermia |
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what anesthetics trigger malignant hyperthermia? |
-inhalation agents -succinycholine |
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How to treat malignant hyperthermia? |
-d/c anesthetic -call for help -dantrolene -cool patient -treat arrhythymia -treat hyperkalemia with glucose and insulin |
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What are ways to decrease cerebral edema and blood flow? |
-mannitol (1g/kg) -hyperventilation (PCO2 25-30)
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What is best treatment for child with fever, rash on palms an soles? |
Kawasaki disease -treat with IVIG and ASA |
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Patient with sinusitis and orbital cellulitis has been treated with amok for 2 days. What is the best treatment? |
-IV abx, decongestants, mucolytics, ophtho consult. surgery if: -progression over 24hr -failed response to IV abx in 48-72hr |
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what is best diagnostic test for patient with blurry vision and bruit over eye after orbital trauma? |
-carotid cavernous fistula -CT with contrast? -angio not first-line but allows for embolization |
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what nerve is injured in a pt that cannot smell ammonia after trauma? |
trigeminal |
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what is treatment for congenital torticollis |
-conservative: PT, passive stretching |
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what is difference between scleroderma and achalasia? |
-scleroderma: dilated esophagus, patent LES -achalasia: dilated esophagus, bird-beak narrowing of LES |
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what is the diagnosis of a patient with chest pain and dyspnea after being diagnosed with necrotizing fasciitis |
mediastinitis |
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what is the treatment of necrotizing fasciitis |
-immediate surgical debridement -broad abx -HBO |
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what is treatment of hoarseness with bilateral VC nodules and a posterior glottic chink? |
voice therapy |
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why do CI early in a child who is deaf from meningitis |
avoid ossification of the cochlea |
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what is treatment if, during mastoidectomy, facial nerve is cut |
immediate re-anastamosis if >50% of nerve is transected and anastomosis can be completed tension free. otherwise cable graft |
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What is the House-Brakman score for facial movement? |
I. Normal II. Normal symmetry, slight weakness of forehead III. Asymetric, mod weakness of forehead, full eye closure with effort, slight weakness of mouth IV. Asymmetric, forehead weakness, incomplete eye closure, weakness of mouth V. Total asymmetry. barely perceptable movement VI. No movement |
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what nerve provides sensation to EAC floor? |
auricular branch of X |
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what is treatment for ramsey hunt? |
steroids/antivirals |
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What is treatment of Meniere's disease after failure of medical treatment? |
Good hearing: endolymphatic shunt, MCF with VNS, gentamycin Poor Hearing: labrinthectomy, transmastoid VNS |
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what is the characteristics of nystagmus caused by central pathology? |
-negative fixation suppression -vertical nystagmus |
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What is the location of the nucleus of CN VII |
Middle pons, exiting at pontomedullary junction |
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What is the best audiogram for an 8-month old child? |
Condition-oriented response audiometry |
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When a child has an autosomal recessive inherited hearing loss with two normal parents and a sibling with normal hearing, what is the chance that the normal hearing child is a carrier? |
67%. 75% offspring with normal hearing, 2/3 will be carriers. |
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what is the most common complication of revision tympanomastoidectomy |
persistent perforation/otorrhea (FN injury, CSF leak, fistula are rare) |
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What is the decibel change when sound pressure level changes by 100x |
20 Increasing sound pressure by 100 results in bel change of 2 (log 100=2). 2 bels=20dB |
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What are the OSHA guidelines for initiation of a hearing preservation program? |
85dB: 95db for 4 hr 100db for 2hr 105db for 1hr 110db for 30min Noise exposure greater than 115 cannot be longer than 1sec duration. No noise greater than 140dB allowed |
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What is the ototoxic effect of ahminoglycosides? |
OHCs. Starts at the base (high frequency) |
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What aminoglycosides are most vestibulotoxic? |
gentomycin and streptomycin |
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What aminoglycosides are more cochleotoxic? |
Kanamycin and neomycin |
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How is lasix ototoxic? |
damages stria vascularis |
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How is cisplatin ototoxic? |
damages OHCs at basal turn |
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How is quinine ototoxic? |
atrophy of stria vascularis |
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What diseases are associated with S-100 stain? |
Melanoma (also many tumors of neural origin) Granular cell tumors Paragangliomas myoepithelial cells in pleomorphic adenoma adenoid cystic ca skin langerhan's cells |
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What diseases are NEGATIVE for S-100 stain? |
SCC BCC Lymphoma |
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What is the most specific stain for melanoma? |
HMB-45 (but poor sensitivity) S-100 sensitive but not specific |
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What is the histologic appearance of basal cell carcinoma? |
-Nuclei large and oval with little cytoplasm -peripheral palisades of baseloid cells |
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What is the histologic appearance of SCC? |
-irregular masses of epidermal cells -keratin pearls |
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What is the histologic appearance of melanoma? |
malignant nests of cell with large nucleoli and clear cytoplasm |
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A patient has serous drainage from the chest tube 8hr after bilateral ND, TL and gastric pull-up. What is most likely cause? |
anastomotic leak |
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Most cost effective antibiotics after TL? |
Ancef x24hr |
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What is treatment for a patient with increased JP output after starting TF? |
-closed wound drainage -pressure dressing -low fat diet -avoidance of long chain triglyceride |
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What is treatment if, during superficial parotidectomy, the FN is cut? |
immediate direct anastamosis |
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Patient with leukoplakia. What is best treatment to prevent malignant degeneration |
13-cis retinoid acid and etretinate |
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What is biochemical effect of leukovorin |
-downstream metabolite in the folate pathway -used as a rescue after high dose methotrexate -decreases mucositis and myelosuppression |
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What are the prognostic indicators for well-differentiated thyroid cancer? |
AGES age M>50, F>40 gender extracapsular spread size >4cm |
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What is the effect of mutation in the p53 gene? |
p53 acts as a tumor suppressor gene, induces either arrest of cell cycle or apoptosis |
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What is the inheritance of MEN2 syndrome? |
RET proto-oncogene Autosomal dominant inheritance |
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What is the most common complication of I-131 therapy? |
Transient bone marrow suppression |
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Acute complications of I-131 thyroid ablation therapy? |
-sialoadenitis -loss of taste -bone marrow suppression -thyroid storm -decreased fertility -conjunctivitis |
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What is the treatment of soft palate SCCA without LAD |
XRT or bilateral selective neck dissection necks should include II, III, IV |
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What muscle causes vertical lines on lower forehead? |
corrugator supercili |
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What muscle causes horizontal lines on lower forehead? |
procerus |
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What is the most commonly injured nerve in a facelift? |
great auricular |
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what is best treatment of a mature superior nasal septal defect? |
silastic button or medical mgmt consider surgery if less than 3cm |
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what is the advantage pericardial flap? |
highly vascularized tissue capable of a watertight separation between the nasal and intracranial cavities |
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What nerve is harvested with a RFFF |
lateral antebrachial cutaneous |
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What causes a rocker deformity in rhinoplasty? |
medial osteotomy carried too far superiorly into thicker bone of the frontal bone beyond the nasofrontal suture line |
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What is the best treatment for pain and swelling s/p rhytidectomy? |
Think hematoma. Incision and drainage. |
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What effect does increasing nasal tip projection have on other facial features? |
can worsen retronagthism |
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What muscle is missing in a submucosal cleft? |
levator palatini |
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What is the best treatment of insufficient posterior closure of the pharynx? |
pharyngeal flap |
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What is best treatment for a patient who undergoes subconjunctival incision with subconjunctival swelling and pain? |
treat for corneal abrasion |
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When is the best time to do dermabrasion for scarring s/p rhitidectomy? |
3-6 months |
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What is the best age to do otoplasty in a child? |
5-8yo |
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What is the advantage of TCA over phenol in a chemical peel? |
No systemic toxity (phenol is cardio and renal toxic) |
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What is the treatment of a patient with a red scar 4 months after rhytidectomy? |
kenalog injection q2 weeks |
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What is the mechanism of negative effects of smoking on wound healing? |
vasoconstriction |
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what is the best therapy when a male presents for cosmetic surgery and states he desires cosmetic surgery because the improvement in his looks will improve his job |
proceed with procedure if patient has reasonable expectations of outcome |
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Male presents after cosmetic surgery by another doctor and states he wants you to note that the prior doctor made a mistake. What do you do? |
Do not document "mistakes" by other doctors |
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What is the treatment of lower lid lag? |
horizontal eyelid shortening by lateral canthotomy, tarsal strip, canthal tendon plication |
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What is the mechanism of botox? |
Inhibits Ach presynaptic release |
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What is the most aesthetic location of the apex of the lateral brow? |
above the lateral limbus |
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what does flumazenil counteract? |
benzodiazepine receptor antagonist -alaprazolam (xanax) -chlordiazepoxide (librium) -clonazepam (klonopin) -diazepam (valium) -midazolam (versed) -triazolam (halcion) |
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what is the mechanism of action of finasteride |
5-alpha-reductase inhibitor |
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what type of medication is Vistaril? |
antihistamine |
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what is the best med to give a patient who is nervous 15min before an operation? |
-versed (fast acting, short duration benzodiazepine) -versed is shorter acting than valium with fewer side effects |
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what is the mechanism of cold-temperature induced rhinorrhea? |
parasympathetic system by way of vidian nerve |
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What is the best antibiotic for multi-drug resistant strep pneumonia? |
Vanc |
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which of these muscles does the trigeminal nerve innervate? |
tensor tympani digastric |
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You think another MD plans to operate on a patient is the wrong thing. What do you do? |
Address with physician directly |
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what is a student's t-test used for? |
evaluates if two groups are statistically different according to their means |
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A patient's family doesn't want him to know about a new diagnosis. What do you do. |
Tell the patient |
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Wha tis the effect of capitation |
incentive to withhold care to save money |
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Why does a Jehovah's witness refuse blood |
religious beliefs |
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What is the location of the SLN branching off of the vagus |
At carotid bifurcation |
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What does adenoid cystic cancer look like pathologically? |
-small nuclei, bland appearance -tubular, solid or cribiform pattern (swiss cheese) -cells arranged in nests around a cylindrical space that may contain hylanized material |
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What does acidic cell carcinoma look like pathologically? |
granular or honeycomb cytoplasm dark staining tumor cells |
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what does adenocarcinoma look like pathologically? |
-formation of glandular structures |
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What does clear cell carcinoma look like pathologically? |
uniform pattern of round or polygonal cells with peripherally displaced dark nuclei and clear cytoplasm |
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what pH level in a fluid would cause the most damage to the esophagus? |
high pH: causes liquefaction necrosis (low pH causes coagulation necrosis=more superficial injury) |
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Patient gets sub-q injection of phynylepherine and has severe hypertension and heart rate of 30. Treatment? |
Phenylepherine is an alpha agonist Phentolamine is an alpha antagonist--treat with this |
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Patient has a chronic sore throat and on FFL has a clean ulcer on one of the vocal processes and a granuloma on the other. In addition to antireflux therapy, what is the best treatment? |
high rate of relapse with surgery or laser |
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what ENT problem do antidepressants treat best? |
headaches |
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what is the appearance of cutaneous anthrax? |
begins as a red/brown papule that enlarges with peripheral erythema, vesiculation, induration and ulceration |
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What is the most common cause of persistent sinus disease after ESS? |
restenosis of maxillary sinus ostia |
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What is the treatment of an ethmoid sinus esteem causing obstructive sinusitis. |
Radiographic exam unless obstructive symptoms--then conservative surgery |
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what is the most common cause of failure of a medicalization thyroplasty? |
no closure of posterior glottic gap |
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what is the most significant prognostic indicator for a person with a port wine stain? |
location |
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what is a skin discoloration that increases in size with the patient? |
vascular malformation |
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what is the cause of blurry vision, chemosis, bruit over the eye 10 days after facial trauma? |
carotid cavernous fistuls |
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what is the best study to diagnose a carotid cavernous fistula? |
CT scan with contrast |
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Which tastebuds are non-gustatory |
filiform papillae |
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A 14yo girl s/p renal transplant has tonsil asymmetry. What is diagnosis? |
post-transplant lymphoproliferative disorder |
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Post-transplant lymphoproliferative disorder is related to what infection? |
EBV |
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What are the pathologic features of PTLD? |
Homogeneous population of large transformed B cells with prominent nucleioli |
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What is the treatment of pediatric airway hemangioma? |
-monitor -b-blocker -systemic corticosteroid -intralesional injection of steroid -laser -open excision |
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After a tracheal surgery for subglottic hemangioma with jet ventilation, a child has respiratory distress and sub! emphysema. What is the best treatment? |
chest tube |
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A 3yo with hyperkalemia after succinylcholine likely has what problem? |
pseudocholinesterase deficiency |
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What is the most common type of hearing loss with Treacher-Collins? |
CHL, malformed ossicles auricular deformity atresia of EAC (AD) |
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What are the findings of Pierre-Robin Sequence? |
-cleft palate -retrognathia -glossoptosis |
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What is the best audio for an 8 month child? |
-less 6 month--behavioral observation audio -6-30mo--visual reinforcement audiometry -greater than 3yo--play audio |
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What % of deaf children have parents of normal hearing? |
90% |
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What is the mechanism of ototoxicity of gentamicin? |
OHC damage |
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Where does noise-induced SNHL damage occur? |
OHC |
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A cochlear implant stimulates what? |
auditory spiral ganglion |
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Where is a cochlear implant electrode placed? |
scala tympani |
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what is treatment for patient with otorrhea, dizziness, hearing loss after stapedectomy? |
-likely granuloma -explore, remove prosthesis |
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While doing a mastoidectomy, you make a 4mm opening in the tegmen and a CSF leak is seen |
-bone graft vs fibrin glue vs pack mastoid side |
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What is most common injury to labyrinthine structure during mastoidectomy? |
lateral scc |
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what is the most common complication of cholesteatoma? |
-ossicular chain disruption (30%) -labyrinthine fistula (10%--lateral canal most common) |
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what is the most common location of CSF leak after a longitudinal temporal bone fx? |
tegmen tympani |
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What is the most likely diagnosis in a patient with unilateral decrease in discrimination with symmetric PTAs and no dizziness? |
retrocochlear pathology (acoustic neuroma) affects discrim without distorting pure tone average |
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what it the most common cause of peripheral vertigo? |
BPPV |
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where does wallerian degeneration occur? |
distal axon |
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auditory brainstem implants are FDA approved for what disease? |
NF2 patients older than 12 |
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A patient with severe HA at night and rhinorrhea has what? |
cluster headache |
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What is Cogan's syndrome? |
-non-syphilitic interstitial keratitis associated with audiovestibular involvement similar to Meniere's disease -symptoms of SNHL, vertigo, keratitis |
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What is most common adult cancer of temporal bone? |
SCCA |
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What is most common pediatric cancer of temporal bone? |
rhabdomyosarcoma |
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Patient s/p total laryngectomy with abdominal pain, fatigue, constipation. What to check? |
-Ca -Mg -Ph |
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what is treatment of grade I chondrosarcoma of thyroid cartilage? |
TL |
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what is TNM stage of supraglottic sc. with pre-epiglottic space invasion and contralateral 3cm LN? |
T3N2C |
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What is the most likely cause of upstaging from a T1B scc glottis to a T4 scc glottis |
invasion of broil's ligament |
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what is most likely cause of TVC fixation in a patient with ca? |
thyroarytenoid muscle invasion |
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what is best closure for a patient s/p total laryngectomy with cervical esophagectomy down to thoracic inlet? |
gastric pullup (cummings bc no free flap and only one neck anastomosis) |
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what is best way to avoid aspiration in supraglottic laryngectomy |
spare SLN |
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how can a person decrease or prevent aspiration after hemilaryngectomy |
cough and swallow 2nd time after each swallow |
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EBV viral capsid antigen titers in NPC are useful how? |
favorable prognostic indicator |
