OMSITE ACTUAL FINALS QUESTIONS AND ANSWERS
SET A+
✔✔Pt develops Laryngospasm post-op and is broken with positive pressure. In PACU
pt SpO2 drops to 84% with 4 LPM of O2 (baseline: 98% on RA) CXR is taken what do
you do meanwhile: - ✔✔Chest xray, diuretic and intubate
✔✔ARDS happens from? - ✔✔Endogenous cytokines
✔✔Patient gets maxillary lefort. What pre-op condition causes most unacceptable
esthetic
concerns? - ✔✔Obtuse nasolabial angle
✔✔NOE classification of Manson and Markowitz is based on what structures? -
✔✔Status of medial canthal tendon and fracture of lacrimal bone
✔✔Most common reason for skin graft failure? - ✔✔Recipient site defect
✔✔What produces TGF B in fracture healing? - ✔✔Platelets
✔✔Lacrimal Sac is between: - ✔✔Anterior and deep medial canthal ligament
✔✔Patient comes back with anterior open bite after maxillary osteotomy w/ midpalatal
osteotomy for transverse discrepancy. Why? - ✔✔Transverse relapse
✔✔Facial nerve innervate muscles from deep or superficial? - ✔✔Deep
Exceptions are levator angularis superioris, buccinators, mentalis which are from above
(LAMB)
,✔✔How does one prevent arterial bleed during LeFort 1 osteotomy? - ✔✔Limit lateral
nasal osteotomy to 30mm
✔✔The TMJ disc is: - ✔✔Avascular
Aneural
Alymphatic
Virtually acellular
✔✔IVRO with sigmoid notch bleed? How to tx? - ✔✔Embolize masseteric artery
✔✔Which inflammatory mediator is reduced after arthrocentesis? - ✔✔TNF - alpha
✔✔Which of the following is an acceptable way to manage a non-healing/infected angle
fx? - ✔✔I&D with recon plate
✔✔Which of the following has the highest rate of cell survival following graft? -
✔✔Unmilled cancellous graft
✔✔Blood supply to temporalis flap for oronasal communication: - ✔✔Anterior and
posterior deep temporal arteries
✔✔What is the most reliable way to check vitality of free flap? - ✔✔Serial clinical exams
✔✔Wilkes classification of a patient that experiences constant pain, difficulty with
function and crepitus. - ✔✔Wilkes stage 5
✔✔Amount of bone from tibial bone harvest? - ✔✔Old OMSITE (2009) - 10-15cc, so
bilateral ~30cc
Old OMSITE (2005) - 15-20cc
OMS booklet - up to 40cc
Petersons - 20-40cc
OMFS Review - <25cc
✔✔Ketamine mechanism - ✔✔NMDA antagonist
✔✔BRONJ staging where patients has pain, pus, etc limited to alveolar bone. -
✔✔Stage 2
✔✔During upper lid bleph what considerations are needed for incision? - ✔✔Leave at
least 10 mm skin from eyelid for proper closure
,✔✔In a pediatric patient with a nasal fracture, it is important to repair: - ✔✔Naso-
Vomerine (sept-vomerine) Suture (i.e. Nasal Cartilage and Vomer junction)
✔✔In a patient with palatal cleft, which muscle inserts incorrectly into the hard palate -
✔✔Levator Palatini
✔✔When doing coronal approach, dissection needs to be: - ✔✔Deep to superficial layer
of deep temporal fascia
✔✔Xray of kid with distraction and condyle out of fossa on the left. Has mandibular
pain, and
asymmetry upon activation. What is happening? - ✔✔Premature fusion
✔✔What nerves are involved in corneal reflex? - ✔✔the nasociliary branch of the
ophthalmic branch (V1) of the trigeminal nerve (CN V) sensing the stimulus on the
cornea only (afferent fiber).
the temporal and zygomatic branches of the facial nerve (CN VII) initiating the motor
response (efferent fiber).
✔✔Direction of force for extraction maxillary first premolar - ✔✔Buccal
✔✔Patient has episode of bleeding with pulsatile sensation 2 weeks after Orthognathic
Surgery that resolved spontaneously. What step(s) should the surgeon INITIALLY take?
- ✔✔CT angiogram
✔✔The diagnosis is CEOT. How should surgeon treat lesion? - ✔✔1 cm resection listed
in Din Lam and Petersons
resection using 1.0‐ to 1.5‐cm margins in bone and one uninvolved anatomic barrier
margin in Marx
✔✔Patient aspirates a tooth. Which lobe is it most likely to end up in? - ✔✔R lower
Basal segment right lower lobe sitting/standing. Laying down supine superior segment
right lower lobe. Right decubital is posterior segment right upper lobe. Left decubital
goes to lingual.
✔✔What is the definition of capillary ingrowth into soft tissue graft? - ✔✔Inosculation
✔✔What is the treatment of actinomyces israelii? - ✔✔Ampicillin ?
Some form of penicillin whether that be amoxicillin, ampicillin, penicillin
, ✔✔How does one compensate for splaying of the lingual cortex after symphyseal
fracture? - ✔✔Overbend the plate
✔✔What are the fixation principles of edentulous atrophic mandible: - ✔✔Extraoral
approach needed for fixation and bone graft
✔✔Insulin has what DIRECT effect on the cell? - ✔✔Increases glucose uptake by
skeletal muscle
✔✔What is the maximal amount of expiratory volume after full inspiration? - ✔✔Forced
vital capacity
✔✔Which type of VWD requires DDAVP? - ✔✔Type 1
✔✔Ultimate goal of Modified Condylotomy? - ✔✔Increase joint space
✔✔Patient on Dilantin (phenytoin) and Depakote (valproic acid), what blood test do you
need? - ✔✔CBC
✔✔What gives you the best osseointegration at bone to implant surface (or what forces
are
resisted better at implant bone interface) - ✔✔Compressive force
✔✔Woman with long history of headaches gets insidiously worse symptoms over past 3
months. She's been using caffeine, NSAIDs to diminishing effect. What kind of
headache does she
have? - ✔✔Medicine Withdrawal Migraine
Other names...
Transformed rebound headache or medication overuse headache
✔✔Which preoperative lab test for patient with Anorexia? - ✔✔Electrolytes
✔✔What are the signs of increased probability for damage to IAN during Third Molar
extractions? - ✔✔Shading/darkening of the root
(2008 OMSITE says greatest indicator, others include 1. narrowing of root, 2. deflection
of root, 3. Diversion of canal)
(2004 OMSITE says 1. diversion of the inferior alveolar canal, 2. darkening of the third
molar root, and 3. interruption of the cortical white line are only three associated with
increased risk)
SET A+
✔✔Pt develops Laryngospasm post-op and is broken with positive pressure. In PACU
pt SpO2 drops to 84% with 4 LPM of O2 (baseline: 98% on RA) CXR is taken what do
you do meanwhile: - ✔✔Chest xray, diuretic and intubate
✔✔ARDS happens from? - ✔✔Endogenous cytokines
✔✔Patient gets maxillary lefort. What pre-op condition causes most unacceptable
esthetic
concerns? - ✔✔Obtuse nasolabial angle
✔✔NOE classification of Manson and Markowitz is based on what structures? -
✔✔Status of medial canthal tendon and fracture of lacrimal bone
✔✔Most common reason for skin graft failure? - ✔✔Recipient site defect
✔✔What produces TGF B in fracture healing? - ✔✔Platelets
✔✔Lacrimal Sac is between: - ✔✔Anterior and deep medial canthal ligament
✔✔Patient comes back with anterior open bite after maxillary osteotomy w/ midpalatal
osteotomy for transverse discrepancy. Why? - ✔✔Transverse relapse
✔✔Facial nerve innervate muscles from deep or superficial? - ✔✔Deep
Exceptions are levator angularis superioris, buccinators, mentalis which are from above
(LAMB)
,✔✔How does one prevent arterial bleed during LeFort 1 osteotomy? - ✔✔Limit lateral
nasal osteotomy to 30mm
✔✔The TMJ disc is: - ✔✔Avascular
Aneural
Alymphatic
Virtually acellular
✔✔IVRO with sigmoid notch bleed? How to tx? - ✔✔Embolize masseteric artery
✔✔Which inflammatory mediator is reduced after arthrocentesis? - ✔✔TNF - alpha
✔✔Which of the following is an acceptable way to manage a non-healing/infected angle
fx? - ✔✔I&D with recon plate
✔✔Which of the following has the highest rate of cell survival following graft? -
✔✔Unmilled cancellous graft
✔✔Blood supply to temporalis flap for oronasal communication: - ✔✔Anterior and
posterior deep temporal arteries
✔✔What is the most reliable way to check vitality of free flap? - ✔✔Serial clinical exams
✔✔Wilkes classification of a patient that experiences constant pain, difficulty with
function and crepitus. - ✔✔Wilkes stage 5
✔✔Amount of bone from tibial bone harvest? - ✔✔Old OMSITE (2009) - 10-15cc, so
bilateral ~30cc
Old OMSITE (2005) - 15-20cc
OMS booklet - up to 40cc
Petersons - 20-40cc
OMFS Review - <25cc
✔✔Ketamine mechanism - ✔✔NMDA antagonist
✔✔BRONJ staging where patients has pain, pus, etc limited to alveolar bone. -
✔✔Stage 2
✔✔During upper lid bleph what considerations are needed for incision? - ✔✔Leave at
least 10 mm skin from eyelid for proper closure
,✔✔In a pediatric patient with a nasal fracture, it is important to repair: - ✔✔Naso-
Vomerine (sept-vomerine) Suture (i.e. Nasal Cartilage and Vomer junction)
✔✔In a patient with palatal cleft, which muscle inserts incorrectly into the hard palate -
✔✔Levator Palatini
✔✔When doing coronal approach, dissection needs to be: - ✔✔Deep to superficial layer
of deep temporal fascia
✔✔Xray of kid with distraction and condyle out of fossa on the left. Has mandibular
pain, and
asymmetry upon activation. What is happening? - ✔✔Premature fusion
✔✔What nerves are involved in corneal reflex? - ✔✔the nasociliary branch of the
ophthalmic branch (V1) of the trigeminal nerve (CN V) sensing the stimulus on the
cornea only (afferent fiber).
the temporal and zygomatic branches of the facial nerve (CN VII) initiating the motor
response (efferent fiber).
✔✔Direction of force for extraction maxillary first premolar - ✔✔Buccal
✔✔Patient has episode of bleeding with pulsatile sensation 2 weeks after Orthognathic
Surgery that resolved spontaneously. What step(s) should the surgeon INITIALLY take?
- ✔✔CT angiogram
✔✔The diagnosis is CEOT. How should surgeon treat lesion? - ✔✔1 cm resection listed
in Din Lam and Petersons
resection using 1.0‐ to 1.5‐cm margins in bone and one uninvolved anatomic barrier
margin in Marx
✔✔Patient aspirates a tooth. Which lobe is it most likely to end up in? - ✔✔R lower
Basal segment right lower lobe sitting/standing. Laying down supine superior segment
right lower lobe. Right decubital is posterior segment right upper lobe. Left decubital
goes to lingual.
✔✔What is the definition of capillary ingrowth into soft tissue graft? - ✔✔Inosculation
✔✔What is the treatment of actinomyces israelii? - ✔✔Ampicillin ?
Some form of penicillin whether that be amoxicillin, ampicillin, penicillin
, ✔✔How does one compensate for splaying of the lingual cortex after symphyseal
fracture? - ✔✔Overbend the plate
✔✔What are the fixation principles of edentulous atrophic mandible: - ✔✔Extraoral
approach needed for fixation and bone graft
✔✔Insulin has what DIRECT effect on the cell? - ✔✔Increases glucose uptake by
skeletal muscle
✔✔What is the maximal amount of expiratory volume after full inspiration? - ✔✔Forced
vital capacity
✔✔Which type of VWD requires DDAVP? - ✔✔Type 1
✔✔Ultimate goal of Modified Condylotomy? - ✔✔Increase joint space
✔✔Patient on Dilantin (phenytoin) and Depakote (valproic acid), what blood test do you
need? - ✔✔CBC
✔✔What gives you the best osseointegration at bone to implant surface (or what forces
are
resisted better at implant bone interface) - ✔✔Compressive force
✔✔Woman with long history of headaches gets insidiously worse symptoms over past 3
months. She's been using caffeine, NSAIDs to diminishing effect. What kind of
headache does she
have? - ✔✔Medicine Withdrawal Migraine
Other names...
Transformed rebound headache or medication overuse headache
✔✔Which preoperative lab test for patient with Anorexia? - ✔✔Electrolytes
✔✔What are the signs of increased probability for damage to IAN during Third Molar
extractions? - ✔✔Shading/darkening of the root
(2008 OMSITE says greatest indicator, others include 1. narrowing of root, 2. deflection
of root, 3. Diversion of canal)
(2004 OMSITE says 1. diversion of the inferior alveolar canal, 2. darkening of the third
molar root, and 3. interruption of the cortical white line are only three associated with
increased risk)
