Ohns Review

Front 1

A patient has ophthalmoplegia, double vision and suppurative otitis. What is the diagnosis?

Back 1

Gradenigo's syndrome; aka petrous apicitis - complication of otitis media & mastoiditis involving apex of petrous temporal bone.

sxs: retroorbital pain, CN6 paralysis, OM

Front 2

1. A patient has ophthalmoplegia, mydriasis, vision loss, ptosis and cheek numbness. What is the underlying problem?

Back 2

Orbital apex syndrome.

CN3, CN5 ophthalmic br, CN2 out from MC orbital apex tumor. Neoplasm, inflammatory, traumatic etiologies

Front 3

Homer-Wright rosettes; seen in what two tumors?

Back 3

Neuroblastoma & Medulloblastoma

Front 4

"soap bubble" psyalliferous cells seen in what benign tumor?

Back 4

Chordoma

Front 5

Birbeck granules seen on EM in what tumor?

Back 5

Langerhans cell histiocytosis

Front 6

What is Ohngren's line? Used in differentiating prognosis in maxillary sinus cancer

Back 6

Line from medial canthus to angle of jaw. Better prognosis medial to line (nasal cavity, alveolus), than lateral (orbit, ethmoids

Front 7

What is dysphagia lusoria?

What is Ortner's syndrome?

Back 7

aberrant right subclavian artery looping behind esophagus --> dysphagia if dilated.

RLN palsy

Front 8

How long should you wait for the contralateral cochlear implant after a successful first side?

Back 8

6 months

Front 9

Intact OAE but failed ABR, what is dx?

first step in tx?

Back 9

auditory neuropathy

hearing aids (although poor results), then CI

Front 10

A patient has lyme disease with associated SNHL – how should you treat?

Back 10

Doxycycline x4 weeks + high-dose steroid hearing loss protocol

Front 11

In Nasopharyngeal cancer what is the best predictor of treatment response?

Back 11

EBV status: serum IgA against Epstein-Barr virus capsid antigen (EBV-VCA/IgA)

Front 12

Pilomatrixoma; derived from what cells? Benign

Back 12

hair cortex cells

Front 13

Nasal pit with hair protruding in 4yo; dx?

Back 13

Nasal dermoid

Must excise whole tract. Prior to surgery evaluate for intracranial extension

Front 14

Nasal tumor with fibrocytes and histiocytes. +antichymotrypsin; tumor?

Back 14

Malignant fibrous histiocytoma


MFH is part of the nonrhabdomyosarcoma soft tissue sarcomas. This group’s incidence is 2-3/million. Outcomes are determined largely by grade and whether it was totally resected.
In 2002 the WHO changed the nomenclature to undifferentiated pleomorphic sarcoma NOS. There is no clear cell of origin, it is thought to represent a final common de-differentiation pathway. Usual age of presentation is 50-70 years of age. Treatment is surgery followed by XRT.

Front 15

Why is the incus thought to erode in post-stapedectomy?

Back 15

Loose crimp causing resorption osteitis

Correct using malleus attachment or reattachment to short incus.

Front 16

ML site for second primary in patient with glottic cancer?

Back 16

Lung. Makes sense - smokers at risk for both.

Front 17

In rhinoplasty, what is lateral crural steal?

How does this affect nasal projection?
increases nasal tip rotation and nasolabial angle

Back 17

lateral crura advanced onto medial crura, resulting in increased length of medial crura at expense of lateral crura

increases nasal projection & nasofacial angle (bridge of nose with face)

Front 18

In rhinoplasty, what is lateral crural overlay?

How does this affect nasal projection?
increases nasal tip rotation and nasolabial angle

Back 18

lateral crus shortened by vertically transecting and overlapping cut edges

decreases nasal projection & nasofacial angle (bridge of nose with face)

Front 19

What travels through superior orbital fissure?

Back 19

CN III, IV, frontal, lacrimal, nasociliary divisions of V, VI, superior and inferior ophthalmic veins

Front 20

83. A patient suffers an inferior blowout fracture and has diplopia with downward gaze. Forced duction test normal. What is the cause of the diplopia?

Back 20

superior oblique damage; controls the movement in the vertical plane and contributes to downward gaze (innervated by trochlear nerve CN4)

Front 21

What muscle does cranial nerve 6 control?

Back 21

lateral rectus

Front 22

Pilomatrixoma: what is the treatment?

Back 22

Excision with 1-2 cm margin.

A pilomatrixoma is a benign cutaneous tumor with differentiation toward hair cells, with most cases reported in children. Although they are benign, the tumors may be poorly delineated and incomplete resections have been followed by local recurrence

Front 23

Where are vocal cord injections placed?

Back 23

thyroarytenoid muscle

Front 24

Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) Laser; precise or not?

color absorbed?

Back 24

NOT precise

good for control of hemorrhage b/c goes deeper

darkly pigmented

Uses: ablation or palliation of obstructing tracheobronchial lesions, palliation of obstructing esophageal lesions, photocoagulation of vascular lesions of the head and neck, and photocoagulation of lymphatic malformations.

Front 25

CO2 laser; precise or not?

color absorbed?

Back 25

Precise

absorption independent of color

Front 26

KTP (Potassium-Titanyl-Phosphate) laser; precise or not?

color absorbed?

Back 26

precise

Red - strongly absorbed by hemoglobin

selective photoangiolysis of laryngeal lesions such as papilloma and dysplastic lesions

Front 27

PDL, 585-nm Pulsed Dye Laser; precise or not?

color absorbed?

Back 27

precise

oxyhemoglobin: traluminal blood of vascular lesions such as papilloma, vascular polyps, vocal fold ectasias and varices

Unlike CO2 laser ablation effects, the PDL causes involution of the lesion through disruption of the vascular supply rather than immediate removal of the lesion. safer than co2

Front 28

Treatment of necrotizing malignant otitis externa?

Back 28

Aminoglycoside + antipseudomonal PCN & debridement of granulation tissue;

also could use fluoroquinolones & 3rd gen cephs

Front 29

7yo girl with polyposis; next step in treatment?

Back 29

sweat chloride test

finding of nasal polyposis in a child is rare (fever than 0.1% of children) and should prompt an investigation for CF. CF is present up to 60% of children with polyps

Front 30

Most common presenting symptom of nasal sarcoidosis?

Back 30

NASAL OBSTRUCTION

erythema and edema, anosmia, adhesions, granular mucosa, cobblestone mucosa, waxy-yellow mucosal nodules, OSA, hoarseness, dysphagia, laryngeal paralysis, airway obstruction and pulmonary/airway involvement

Front 31

Why is true vocal cord fixed in glottic cancer?

Back 31

Invasion of thyroarytenoid muscle

Front 32

Most common site for granular cell tumor within H&N? 50% head and neck

Back 32

1.tongue. 2.Larynx

squamous pseudoepitheliomatous hyperplasia

Front 33

What is best way to dx esophageal FB in infants: CXR, Esophagoscopy, or by previous history?
c. CXR

Back 33

Esophagoscopy 100%

history alone <5%; CXR 63%;

Front 34

Chondrosarcoma of cricoid: surgical treatment?

MC location in larynx

Back 34

hemicricoidectomy

TL+ND reserved for aggressive forms of dz.

Front 35

What are 3 zones of neck injuries?

Back 35

From bottom up:
Zone 1 is clavical to cricoid – if stable, CT angio, possible DL/esophagoscopy if concern for leak
Zone 2 is cricoid to mandible – usually if penetrates platysma, go to OR for exploration
Zone 3 is mandible to skull base – CT angio

Front 36

Most common salivary gland masses in children?

Back 36

hemangiomas

Front 37

Contact granulomas most likely anterior or posterior?

Back 37

posterior

Front 38

In frontal sinus posterior table fractures, what are the two things important to determine?

Back 38

1.CSF leak - if persistent, then cranialization (removal posterior table)
2.nasofrontal duct obstruction - if yes, then ORIF anterior table & partial oblit. If no, then just ORIF.

Front 39

MC malignancy of lacrimal gland?

Pleomorphic adenoma MC tumor

Back 39

Adenoid cystic carcinoma (50%)

Front 40

What immunologic component activates the classic complement pathway?

Back 40

Immune complexes

LPS-endotoxin -- alternative pathway

Front 41

What is most common immune cell deficiency in child who presents with multiple URIs & AOMs?

Back 41

B-cell deficiency (eg. IgA deficiency)

Front 42

What is frontal sinus cranialization?

Back 42

removal of posterior table and leave brain to fill frontal sinus (or can fill with fat)

Front 43

While doing a mastoid, you get into the sigmoid. You hold direct pressure and stop it – anesthesia says CO2 going up. Why?

Back 43

Venous air embolism

to prevent, flood field with saline & place pt in Tberg (higher venous pressure so less likely suck in air)

to get out of R ventricle (risk CP arrest) place in left lateral decubitus position

Front 44

Otorrhea, hemoptysis, culture negative from ear. See non-caseating granulomas from ear bx and also anti-neutrophil abs. Chronic treatment?

Back 44

Wegener's

Bactrim (prevents flares in upper respiratory tract)

Front 45

Best oral abx for chondritis after ear piercings?

MC pathogen?

Back 45

Pseudomonas
2.staph; 3.GAS

Ciprofloxacin

Front 46

Atypical basaloid cells with peripheral palisade; dx?

Back 46

Basal cell carcinoma

Front 47

What is proper size tube for 1 year old?

Back 47

= age*4 +4 = 4.0 uncuffed ETT or 3-0 cuffed

Front 48

What is most common presentation in paradoxical vocal fold motion?

Back 48

Strain while coughing

Front 49

What is Stenger's test used to detect pseudohypoacusis?

Back 49

a test for detecting simulation of unilateral hearing impairment, in which a tone below the admitted threshold is presented to the test ear and a tone of lesser intensity is presented to the other ear. If the subject is feigning a hearing loss, the lesser tone cannot be appreciated.