ENT Surgeon × USMLE Coach 🧠👂👃 25 USMLE concepts that become unforgettable once you see them inside ENT. 1. Poiseuille’s Law → Resistance ∝ 1/r⁴. A few mm of subglottic edema can turn a normal airway into stridor. This is why pediatric airways deteriorate fast. ncbi.nlm.nih.gov/books/NBK47… 2. Bernoulli Principle → Faster airflow lowers intraluminal pressure. In laryngomalacia, inspiratory flow helps suck floppy supraglottic tissue inward. Physics becomes stridor. ncbi.nlm.nih.gov/books/NBK54… 3. Laplace Law → Small radius structures need higher pressure/tension to remain open. Infant airways are unforgiving: small edema, secretions, or collapse create big clinical effects. ncbi.nlm.nih.gov/books/NBK53… 4. Reynolds Number → Narrow airway high velocity = turbulent flow. Turbulence is what you hear as stridor. Wheeze is chest. Stridor is airway until proven otherwise. ncbi.nlm.nih.gov/books/NBK47… 5. Starling Resistor → A collapsible tube between two pressure zones. This explains OSA, tracheomalacia, laryngomalacia, and why airway obstruction worsens during inspiration. ncbi.nlm.nih.gov/books/NBK45… 6. Negative Pressure Pulmonary Edema → Severe upper airway obstruction creates huge inspiratory effort against a closed airway. Classic after laryngospasm or bilateral vocal cord palsy. ncbi.nlm.nih.gov/books/NBK57… 7. V/Q Mismatch → Aspiration after stroke, vocal cord palsy, or dysphagia starts as ventilation-perfusion failure before it becomes obvious pneumonia. ENT sees this in swallowing clinics. ncbi.nlm.nih.gov/books/NBK48… 8. Branchial Arch Embryology → 2nd arch gives CN VII. Suddenly Bell palsy, parotidectomy, facial nerve monitoring, and facial reanimation belong to the same map. ncbi.nlm.nih.gov/books/NBK53… 9. Neural Crest Migration → Treacher Collins, CHARGE, DiGeorge, clefting, craniofacial airway problems. USMLE embryology becomes pediatric ENT and airway planning. ncbi.nlm.nih.gov/books/NBK15… 10. Smoking Warthin Tumor → One of the strongest benign salivary tumor associations. ENT often finds it as a tail-of-parotid mass in a smoker. ncbi.nlm.nih.gov/books/NBK55… 11. Warburg Effect → Cancer cells use glucose avidly even with oxygen present. That is why FDG-PET lights up head-neck SCC. Biochemistry becomes staging. ncbi.nlm.nih.gov/books/NBK55… 12. HPV Oncogenesis → HPV OPSCC is biologically different, often p16 , treatment responsive, and staged separately in AJCC 8. Same neck node, different disease. cancer.gov/types/head-and-ne… 13. p53 Trap → HPV− HNSCC often has mutated p53. HPV tumors may have wild-type p53 functionally degraded by viral E6. This distinction is pure USMLE gold. ncbi.nlm.nih.gov/books/NBK70… 14. EGFR Signaling → Cetuximab targets EGFR in selected advanced/recurrent head-neck cancers. Unlike colorectal cancer, the KRAS testing logic is not the same. cancer.gov/about-cancer/trea… 15. Eustachian Tube Physiology → Poor ventilation creates negative middle ear pressure → retraction pocket → cholesteatoma. A pressure equation becomes mastoid surgery. ncbi.nlm.nih.gov/books/NBK53… 16. Osteoclast Biology → Cholesteatoma does not simply “press” bone away. It drives inflammatory osteoclast-mediated bone resorption. That is why ossicles, canal wall, and tegmen disappear. pmc.ncbi.nlm.nih.gov/article… 17. Weber-Fechner Law → Hearing perception is logarithmic. That is why audiograms use decibels. ENT converts physics into hearing aid, stapes, and cochlear implant decisions. ncbi.nlm.nih.gov/books/NBK10… 1/2 #ENTwithPiyush

兼ねてから仕込んでいたCRVSとCRBP、5～6月にかけてのイベントで爆益の予定が爆損して、一時△60万くらいの評価損出してました(笑) 昨日で40万くらいに回復してましたが、まぁ気分は良くないけど中長期も覚悟しての買いだったので、今年度後半までは様子見する予定。 CRVSに関してはジェフェリーズ＆ゴールドマンサックスカンファレンスも上々、中国の関連会社エンジェルファーマへの追加出資に加えて経営陣のインサイダー買いと、話題に事欠いていません。株価の戻りはあまり良くないですが、主力のソケリチニブの価値が毀損したわけでもないので、期待して保有を続けます。 CRBPもジェフェリーズカンファレンスでの発表後は、 ■CRB-913（肥満症治療薬）のPhase 1b「CANYON-1」トップラインデータ発表 → 240名規模、16週間に及ぶ用量設定試験のデータが、この夏に開示予定 ■CRB-701の承認登録試験「TEMPO-1」開始 →2L（二次治療）の中咽頭がん（OPSCC）を対象とした、FDAとの広範な合意に基づく「承認申請のためのピボタル試験（n=250のランダム化比較試験）」がこの夏に開始予定。すでにFDAからファストトラック（優先審査）指定を受けており、この治験開始によって「一気に商業化（発売）へのカウントダウン」へと突入するか？ 最近はめっきり株の売買をしていない＆もっぱらCRVSとCRBPの情報収集に勤しんでいます(笑)

HPV-DeepSeek improves the detection of residual HPV OPSCC! #mgbpath science.org/doi/10.1126/scit… @MGBpathology

🧵 Neck Masses: high-yield diagnostic scaffold real-world caveat (basic starting point. #ENTwithPiyush) 1/ Midline moves with tongue protrusion 👅 → Thyroglossal duct cyst 2/ Midline moves with swallowing 🦋 → Thyroid swelling 3/ Midline no tongue movement 🚫👅 → Dermoid / submental nodes / thymic-suprasternal lesion 4/ Lateral upper neck, anterior to SCM 📍 → Branchial cyst 5/ Opening along lower/middle anterior SCM 🕳️ → Branchial sinus/fistula 6/ Submandibular swelling, bimanually palpable ✋👄 → Submandibular gland 7/ Submandibular swelling, not bimanually palpable 🔎 → Submandibular lymph node 8/ Pulsatile carotid triangle mass ❤️‍🔥 → Carotid body tumour / carotid aneurysm 9/ Posterior triangle cystic brilliantly transilluminant 💡 → Cystic hygroma / lymphatic malformation 10/ Matted nodes ± cold abscess ± sinus 🧫 → Tuberculous lymphadenitis 11/ Hard fixed node in older adult 🚨 → Metastatic node until proven otherwise 12/ Supraclavicular node ⬇️ → Search infraclavicular primary: lung, breast, GI, kidney, ovary, testis 13/ Newborn SCM mass torticollis 👶 → Sternomastoid tumour of infancy 14/ Modern caveat 🚨 Adult persistent neck mass >2 weeks without clear infection = malignancy until proven otherwise. A cystic lateral neck mass in an adult is not automatically a branchial cyst—exclude HPV-related oropharyngeal SCC/metastatic cystic node first. Article 1: AAO-HNS Clinical Practice Guideline: Evaluation of the Neck Mass in Adults 🔗 entnet.org/quality-practice/… 💎 5 pearls: adult neck mass = malignant until proven otherwise; avoid repeated empiric antibiotics unless clear bacterial infection; persistent mass ≥2 weeks is high risk; use contrast CT/MRI when malignancy risk exists; FNA is preferred over open biopsy. Article 2: RACGP—An approach to neck masses in adults 🔗 racgp.org.au/ajgp/2020/may/a… 💎 5 pearls: all adult neck masses need malignancy thinking; red flags include >2 weeks, voice change, dysphagia, otalgia, weight loss; first-line workup often = FNA contrast CT; HPV-positive cancers may present only as neck mass; cystic nodes are often misdiagnosed as branchial cysts. Article 3: MJA—Dangers of diagnosing cystic neck masses as benign in the HPV era 🔗 mja.com.au/journal/2015/203/… 💎 5 pearls: HPV-related OPSCC often presents as cystic nodal metastasis; these can mimic branchial cysts; adults >40 with cystic neck mass need special caution; CT/FNAC alone may mislead; excision without occult-primary workup risks tumour spillage and delayed cancer care.

$CRBP LIFESCI ASCO takeaways investor event which included a panel of three HNSCC experts who reviewed the epidemiology, unmet need, and CRB-701’s safety profile in this indication. Stepping back, do want to flag that over the past few weeks have focused a significant amount of our work on Corbus' CRB-701 on what we believe is the underserved HPV HNSCC population, including the predominantly HPV oropharyngeal squamous cell carcinoma (OPSCC) subgroup, and this opportunity was clearly reflected in the KOL conversation that took place during Corbus' event early this week. On epidemiology, one KOL cited an incidence of 43,000 to 45,000 HNSCC cases per year in the US (per SEER), with OPSCC at 25,000 to 30,000, the vast majority HPV-positive

75% of patients received 30 Gy with FMISO PET based de-escalation for HPV-associated OPSCC. 30 Gy. Need the randomized data but hard to believe this won’t be the way. Incredible!

Reminder: An abstract featuring updated data from Corbus' Phase 1/2 study CRB-701 in patients with recurrent or metastatic #HNSCC will be presented at #ASCO26 today, May 30th at 4:30 PM CDT (Abstract 6062). For more info: bit.ly/4f9pb0k #OPSCC $CRBP

$CRBP Mizuho PT$44 bottom line. remind that at #ASCO26 $CRBP three presentations: an oral presentation on '701 in cervical cancer/CC Friday (5/29), a poster on '701 in OPSCC Saturday (5/30),&an investor/analyst event featuring three KOLs next Monday (6/1). While acknowledging our need to reassess our model to better reflect '701's opportunity in OPSCC, bigger picture, with CRBP shares now trading just slightly above cash/share levels — thereby implying little-to-no value for CRBP's pipeline (which comprises '701 in HNSCC and in CC, and also CRB-913 in obesity) — believe the current disconnect reflects a buying opportunity. Given this, and ahead of ASCO (where we expect CRBP to be more intensive in providing clarity and confidence in 701's opportunity

Join us on Monday, June 1st for a KOL event to discuss updated data from the Phase 1/2 clinical study of CRB-701 featuring insights from leading #HNSCC experts: @AriRosenbergMD, @HeadNeckMD and @CesarAPerezMD Register here: bit.ly/3QS9MHC #ASCO26 #OPSCC $CRBP

$CRBP lowest analyst price target after yesterday's data is $30. All remain bullish on HPV story in OPSCC

CRBP: How does someone land at 200-250 million? Take Tivdak as a comp, then factor in 1) 2L HPV OPSCC is at least 1.15-1.25x 2L Cervical (probably even more), 2) Tivdak just launching in Europe last year so it hasn't peaked, and 3)Tolerability of 701 should result in higher uptake and less D/C

Yeah. Trading well below 1x peak sales if only indication is 2l opscc. Trading less than 1/5 peak sales if they get 1l.

Thank you @bradloncar of @BiotechTV for speaking with @CEOCorbus about our updated CRB-701 Ph. 1/2 clinical data being presented at #ASCO26 which demonstrated robust activity in 2L oropharyngeal & #cervicalcancers. Watch the interview: bit.ly/3PZP7RQ $CRBP #HNSCC #OPSCC