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- 1) autosomal
- 2) mitochondrial
genes' action types?
- 1) dominant
- 2) recessive
- 3) Co-dominant ( semi- dominant)
- 4) X -linked ( can be dominant or recessive)
Where is the action point of radiotherapy on cell cycle?
- 1) M ( mitosis)
- 2) G2 ( prepare to divide)
Where is the action point of chemotherapy on cell cycle?
S ( DNA synthesis)
What gene is responsible for tumor suppression?
Classification of chemotherapy agents?
- 1) Alkalating agents (nytrogen mustard)
- 2) heavy metals (cisplatin)
- 3) antimetabolites (Metotrexate)
- 4) cytotoxic antibiotics (Doxorubicine)
- 5) spindle poisons (Vinca)
- 6) Topoisomerase inhibitors (Etopocide)
What is the main limitng factor for dosing chemotherapy?
Bone marrow suppression
What are the chemotherapy strategies?
- 1) Combination
- 2) Adjuvant
- 3) Neoadjuvant
- 4) Concurrent
- 5) Chemoprevention (retinoids)
What is interpupillary diameter?
What is normal intercanthal diameter?
Branches of ophtalmic nerve?
Marx's Grades of microtia?
- I: slightly small but normal looking ear
- II: partial or hemi-ear
- III: peanut ear
- IV: anotia
Dela Cruz classification of Microtia?
- -Minor malformation (normal mastoid, OW, inner ear, CN VII, footplate)
- -Major malformation
Colman's clasification of canal atresia?
- -Minor aplasia ( incomplete canalization)
- -Moderate: failed canalization of tympanic bone
- - Severe: complete abscence of EAC
Schuknecht's TYPES of canal atresia?
- A: cartilaginous
- B: total canal
- C: Middle ear invlovement
- D: Inner ear, mastoid involvement
Jahrsdoerfer classification for surgery outcome of canal atresia?
- Better outcome if anatomical structures exist:
- stapes: 2
- OW open 1
- middle ear space 1
- FN 1
- Malleus-incus complex 1
- Mastoid pneumatization 1
- Incus- stapes connection 1
- RW 1
- External ear 1
what divides level VA from VB?
the line which passes through the inferior border of cricoid cartilage
what is the safe margin for lip cancer resection?
what is the lasting time for vicryl and PDS sutures?
4 weeks and 60 days respectively
when a drain is removed?
when it drains less than 25ml/day of serous fluid
what is the voltage and advantage of megavoltage RT?
- 4-20million volts
- skin is relatively spared during RT
types of delivery of RT?
- conventional ( 30x2 Gy over 42 days)
- split course
classification of surgical complications?
EARLY : bleeding, airway obstruction, increased intrecranial pressure, carotid sinus syndrome, nerve injury
INTERMEDIATE: pneumothorax, basal pulmonary collapse, bronchopneumonia, DVT, chylous fistula, seroma, skull base syndrome, infection, failure of skin healing, carotid artery rupture, flap failure, fistula
LATE: recurrence, mets, thyroid/parathyroid failure, parotid gland hypertrophy, lymphedema, hypertrophic scars, HIV,
- Autoimmune disease acute nonsyphilitic interstitial keratitis
- sensorineural hearing loss
- Medium- and large-vessel arteritis
- severe vertigonausea/ vomiting
- Transmitted in an autosomal-dominant fashion
- and consists of a constellation of findings, including
- (1) dystopia canthorum
- (lateral displacement of the medial canthi),
- (2) broad nasal root,
- (3) confluence of the medial portions of the eyebrows, (4) partial or total heterochromia iridis,
- (5) a white forelock
- (6) SNHL
- Craniofacial synostosis
Commonest spot of otosclerosis?
Fissula ante fenestram
Other name of papillary cystadenoma lymphomatosum?
- Warthin's tumor
false positive fistula test in congenital syphilis and 25% of Meniere's disease.
- Thrmobosis of PICA (from basilar artery)
- vertigo, diplopia, dysphagia, hoarseness, horner's syn, sensory loss of ipsilat face and contralateral side of body, ataxia.
+ auricular crease
Klippel Feil syndrome?
- synostosis (fusion of cervical vertebrae), brevicollis (short/absent neck) and low posterior hairline with many other associated malformations
acute utriculosaccular dysfunction causing sudden fall with no loss of conciousness. in 2-6 % on Meniere's disease.
Variants of SCC ?
- Verrucous (oral cavity)
- Hybrid verrucous
- Basaloid SCC
posterior cricoarytenoid : videns VCs
- Locally invasive NPC:
- - Ipsilateral headache
- - unilateral soft palate palsy
- - CHL
pain over mastoid due to phlebitis of emissary vein after lateral sinus thrombophlebitis
What is the diagnosis method of choice for paraganglioma?
Gadolinium enhanced MRI
Churg- strauss Syn?
- allergic granulomatous angiitis
- (in Nose: crusting, polyps)
- P-ANCA + in 70%
- phase I: Allergic rhinitis + Asthma
- phase II: Eosinophillic infiltrative + e. pneumonia
- phase III: systemic vasculitisi and granulation
- Atresia of choanna
- Retarded growth
- Genitalia problem
- Ear deformity
What do you know of Mucoepidermoid Ca of salivary gland?
- Comonest ca of major salivary glands and minor ones in oral cavity (34%)
- mainly in parotid
- mage 45
- grading is important
What do you know of adenoid cystic Ca of salivary gland?
- commonest malignant Ca of minor glands
- facial pain/paresis
- nerve spread
- infiltrative growth and slowly progressive behavior with recurrences and spread over a protracted course of many years
Specifications of Acinic cell carcinoma?
- Low grade
- Almost always in parotid
- F>M 30th
- FNAC not very conclusive (similar to normal gland)
- 30% recurrence post op
- Recurrence up to many years later
what is RDI?
AHI + respiratory effort related arousal (RERA)
upper airway resistance syndrome : exessive daylight somnolence without OSA
Fujita classification of pattern of OSA
- Type I: collapse in retropalatal
- Type II: collapse in Retropalatal and retrolingual
- Type III: collapse in retrolingual
- 19-25 normal
- 26-30 overweight
- 30-40 obese
- >40 very obese
Chemotherapy for Hodgkin's disease?
- MOPP ( mustagen, oncovin, procarbazine, prednisolone)
- ABVD (adriamycin, bleomycin, vinblastin, dacarbazine)
Chemotherapy for NHD?
CHOP: (cyclophosphamide, adriamycin [hydroxy doxorubicin], vincristine [Oncovin], Prednisolone)
Causes of nasal polyposis?
- infection by H-influ
- vasomotor changes
- Due to Bernoli's law ( negative pressure increases in narrow areas when air flows through them)
- Plysaccaride changes in ground substance
definition of Apnea?
cessation of airflow for >10sec
Definition of Hypopnea?
- Reduced airflow >30%, >10sec + >4% reduced SPO2
- Reduced airflow >50%, >10sec + >3% reduced SPO2
- ECG arousal
Types of OSA?
- Obstructive: throacoabd effort with reduced airflow
- Central: No throacoabd effort with reduced airflow
- Mixed: Ineffective and weak throacoabd effort
Paragangliomas of H&N?
Related diseases with paragnaglioma?
- MEN IIA
- MEN IIB
- Neurofibromatosis type I
- Chromosome 2
- Living in high altitude ( carotid body tumor)
Risk of malignancy in paraganglioma?
University of Pittsburgh TNM for Neoplasms of the External Auditory Canal?
- Tumor limited to the external auditory canal without bony erosion or evidence of soft tissue extension
- Tumor with limited external auditory canal bony erosion (not full-thickness) or radiographic finding consistent with limited (less than 0.5 cm) soft tissue involvement
- Tumor eroding the osseous external auditory canal (full-thickness) with limited (less than 0.5 cm) soft tissue involvement, or tumor involving middle ear or mastoid, or patients presenting with facial paralysis
- Tumor eroding the cochlea, petrous apex, medial wall of middle ear, carotid
- canal, jugular
- foramen or dura, or with extensive (greater than 0.5 cm) soft tissue involvement
Fisch classification for glomus jugulare?
Type A tumor - Tumor limited to the middle ear cleft (glomus tympanicum)
Type B tumor - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement
Type C tumor - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the petrous apex
Type C1 tumor - Tumor with limited involvement of the vertical portion of the carotid canalType
C2 tumor - Tumor invading the vertical portion of the carotid canal
Type C3 tumor - Tumor invasion of the horizontal portion of the carotid canal
Type D1 tumor - Tumor with an intracranial extension less than 2 cm in diameter
Type D2 tumor - Tumor with an intracranial extension greater than 2 cm in diameter
Glasscock-Jackson classification for Glomus jugular?
Grade I refers to a small tumor involving the jugular bulb, middle ear, and mastoid;
Grade II is a tumor extending under the internal auditory canal;
Grade III is one extending into the petrous apex;
Grade IV is one extending beyond the petrous apex and into the clivus or infratemporal fossa.
Grades II, III, or IV may exhibit intracranial extension.
Glasscock-Jackson classification for glomus tympancum?
- A: small tumor on promontory
- B: Filling middle ear
- C1: from midle ear to mastoid
- C2: from middle ear to EAC
- C3: from middle ear to IAC
types of leukoplakia?
The most common sites of oral cancer?
types of mandibulectomy?
types of cordectomy?
- I: subepithelial
- II: subligamental
- III: Transmuscular
- IV: Total
- V: Extended
- -a: Contralat VC or ant commisure
- -b: arythenoid
- -c: subglottic
- -d: ventricle
symptoms of LPR?
Differential dignosis if symptoms persist >6 months?
- clearing throat
Treatment of LPR?
- general (avoid cofeine, mint, late supper, oily food, keep head up while sleeping)
- medical (metoclopramide, H2 blockers, PPIs)
- surgical ( pull down LES into abd and fix)
paradoxical vocal cord movement
- VCs don't open or close properly while breathing
- Wheezing, SOB ( not responding to bronchodilators)
LPR, cerebral/pontine problems
what are the symptoms and types of labyrinthitis?
- profound SNHL
- Acute vertigo
- Serous: Toxic, viral
- Suppurative: bacterial
- Peri L: labyrinth fistula after mastoid surgery
- Para L: Vertigo/nystagmus in the prescence of CSOM
pain over the mastoid due to phlebitis of emissary veins after lateral sinus thrombophlebitis
Blood supply of facial nerve?
- Superficial petrosal
segments of facial nerve?
- Intracranial: 25mm
- Meatal: 8-10mm
- Labyrithine: 4mm
- Tympanic: 11mm
- Mastoid: 13mm
idiopathic triad of:
- Facial nerve palsy
- Swelling of lips
- Fissured tongue
symptoms/ signs of hypopharynx Ca?
- sore throat
- FB sensation in throat
- Referred otalgia
- for more than 2-4 months, in a heavy smoker/drinker
- Neck mass
Risk of hypothyroidism after
RT for Ca larynx?
Hystopathology of Neck mets with occult primary?
- 50% SCC
- 25% Adeno Ca
- 25% Undiff
Possible origin of primary Ca based on neck node levels?
- Overall: 90% from H&N
- 1,2,3: oral cavity, oropharynx
- 2,3,4: larynx
- 5: NPC
- supraclavicular: esophagus, lung, abdominal, pelvic
Shamblin classification for Carotid body tumor? (paraganglioma)
- I: small, localized, minimally attached to carotid
- II: partially surrounding vessel
- III: Complete encasing carotid
Signs of Glumos jugulare?
- Rising sun (TM)
- Brown's: siegelization: blanching
- Aquino's: Gentle pressure on ICA: blanching
- Audible bruit over mastoid
10% of Paragangliomas secret what?
- Thyrosine (norepinephrine)
- Vasomotor intestinal peptide
Layers of esophagus?
- Meissner (sense)
- Circumferential m.
- Auerbach (peristaltism)
- Longitudinal m.
- Killian dehiscence
- Posteromedial, between Thyropharyngeus and cricopharyngeus m. ( two parts of Inferior Constrictor m.)
- Diverticulum of Zenker due to contacture of Cricopharyngeus and neuologic disturbance of pharynx in old men.
Psoterolateral dehiscence of pharynx?
- Leimer's, dehiscence, between upper pole of vertical esophageal muscles
Natural narrowings of esophagus?
- UES:15cm from incisiors
- LMB: 24cm ( left main bronchus)
- LES: 40cm
What is battle's sign and what does is suggest?
Postauricular ecchymosis due to traumatic temporal bone fracture
What nodes are contained in level VI?
- .From hyoid bone to suprasternal notch
- . pretracheal, paratracheal, precricoid, perithyroid
Where is the association and location of Virchow node?
Yellow spots on buccal mucosa which are cebaceous glands.
Bent & Kuhn criteria for Allergic fungal rhinosinusitis?