plastic& reconstructive surgery mcq: 2013

Monday, November 18, 2013

Question 1 - The difference between a skin graft and skin flap is:

There is no difference

Blood supply

Nerve supply

Epidermal involvement

Question 2 - What are the stages of the graft “take”?

Imbitition, inosculation, neovascular ingrowth

Inosculation, imbitition, neovascular ingrowth

Hemostasis, inflammatory phase, proliferative phase, maturation

Imbition, neovascular ingrowth, inosculation

Question 3 - Which of the following is NOT a local flap?

Transpositional

Rotational

Advancement

Pedicle

Question 4 - A 45-year-old woman undergoes a deep inferior epigastric perforator (DIEP) flap procedure for reconstruction of her right breast after a masectomy for breast cancer. Which of the following is an indication of poor flap health?

Warm to touch and pink in colour

Moderate Doppler strength and increased signal when flap is compressed

Rapid capillary refill

Slow bleeding on needle puncture

Question 5 - Which of the following statements is CORRECT regarding split thickness skin grafts?

They require subsequent closure of the donor site

They have less primary contraction but more secondary contraction compared to FTSG

They have more primary contraction but less secondary contraction compared to FTSG

They are often used to cover facial deficits due to their favorable cosmetic result

Question 6 - The features of a split thickness skin graft include all of the following except:

The graft includes the epidermal layer as well as a portion of the dermis of variable thickness

The graft donor site heals via reepithelialization from the edges of the wound as well as from the epithelium-lined dermal appendages (ie. Hair follicles) that are remaining in the base of the wound

The graft donor site cannot heal via reepithelialization, but rather must be closed by primary intention or be grafted using a split-thicknes skin graft

A thinner split thickness graft is more successful to take than a thicker graft because less vascular ingrowth is required to maintain viability of the graft

The secondary contraction that occurs during the healing phase is greater in a graft that contains a lesser thickness of dermis

Question 7 - Which of the following is NOT a cause of graft loss

Hematoma and/or seroma under the graft

Poorly vascularized recipient site

Plasmatic imbibition

Shearing forces between graft and recipient site

Infection/colonization

Question 8 - The difference between a split-thickness graft (STSG) and a full-thickness skin graft is:

A FTSG covers more surface area than a STSG

A FTSG has its own blood supply whereas a STSG does not

A STSG contains epidermis and part of the dermis whereas a FTSG contains epidermis and all of the dermis

Question 9 - The definition of an allograft is:

Graft from one place to another on same individual

Graft from one individual to another of same species

Graft from one individual to another of a different species

Artificial graft

Question 10 - The difference between a free flap and a graft is:

A free flap has veins and arteries intact

A graft has veins and arteries intact

A graft may consist of bone, but a flap consists only of soft connective tissues

A flap may consist of bone, but a graft consists only of soft connective tissues

Question 11 - Which of the following regarding split-thickness versus full-thickness skin grafts is FALSE?

STSG has the advantage of more sites

There is lower rate of survival with FTSG

There is greater secondary contraction with FTSG

The aesthetic result of STSG is usually poor

12 Full thickness skin graft can be taken from the following sites except ?
a) Elbow b) Back to neck
c) Supraclavicular area d) Upper eyelids

answer a

13Free skin graft is rejected on ?
a) Muscle b) Fat
c) Deep fascia d) Dermis

answer b

14 Skin graft for facial wounds is taken from
a) Medial aspect of thigh b) Cubital fossia
c) Groin d) Post auricular region

15 The best skin graft for open wounds is –
a) Isograft b) Homograft
c) Allograft d) Autograft

16 The organism causing destruction of skin grafts is
a) Streptococcus b) Staphylococcus
c) Pseudomonas d) Clostridium

17 For on open wound of leg with exposure of bone, treatmen of choice
a) Partial skin graft b) Complete skin graft
c) Pedicle graft d) Reverdin graft

18 Graft is not taken up on the following
a) Fat b) Muscle
c) Deep fascia d) Skull bone

19 Man sustained an injury with loss of skin cover exposing bone of 10×10 cms. The best treatment is –
a)Full thickness graft
b)Pedicle graft c)Amnion
d)Split thickness skin graft

20 Skin graft survival in the first 48 hrs is dependent on
a)Random connection between
host & donor capillaries
b)Plasmatic imbibition
c)Saline in dressing
d)Development of new blood vessels

21 Skin grafting is not done in infection with
a)Pseudonmonas aeroginosa
b)Staph. Aureus
c)Beta hemolytic streptococci d)E. coli

22vSplit skin graft can be applied over
a) Muscle b) Bone
c) Cartilage d) Eyelid

23 Best procedure to be done after an injury to leg associated with exposure of underlying bone and skin loss
a) Pedicle flap b) Split skin grafting
c) Full thickness grafting d) Skin flap

24 Dacron vascular graft is
a) Nontextile synthetic b) Textile synthetic c) Nontextile biologic d) Textile biologic

25 Which one of the following statements about Mesh Skin Grafts is not correct?
a)They permit coverage of large areas -True
b)They allow egrees of fluid collections under the graft) -True
c)They contract to the same degree as a grafted sheet of skin
d)They "take" satisfactorily on a granulating bed

26 Split skin grafts in young children should be harvested from
a) Buttocks b) Thigh
c) Trunk d) Upper limb

27 Wolfe grafts is
a)Full thickness -skin grafts b)Partial thickness skin grafts
c)Split-skin grafts
d)Pedicled flap

28 Deep skin burns is treated with
a)Split thickness graft
b)Full thickness graft
c)Amniotic membrane
d)Synthetic skin derivatives

29 Skin flap is used in all except
a) Bone b) Tendon
c) Burn wound d) Cartilage

30 The subdermal plexus forms the vascular basis for –
a)Randomised flaps
b)Axial flaps
c)Mucocutaneous flaps
d)Vasciocutaneous flaps

31 full thickness loss of middle one third of the upper lip is best reconstruted by
a) Naso labial flap b) Cheek flap
c) Abbey flap d) Estlander’s flap

32 In the reconstruction following excision of previously irradiated cheek cancer, the flap will be –
a)Local tongue
b)Cervical
c)Forehead
d)Pectoralis major myocutaneous

33 Reconstruction of the breast following total mastectomy for cancer is done ideally by using –
a)Distant tube pedicvle
b)Opposite breast
c)Trapezius myocutaneous flap
d)Latissmus dorsi myocunaneous flap

34 Flap commonly used in breast reconstruction is

-a) Serratus anterior b) TRAM
c) Flap from arm d) Delto pectoral flap

Skin & Soft Tissue Lesions

Question 1 - Which of the following is NOT a type of melanoma?

Question 2 - What is the primary treatment of melanoma?

Question 3 - Which melanoma is the least common in Caucasians, but makes up the bulk of melanoma in African American, Asians and Hispanics?

Question 4 - Which of the following is NOT a concern of a melanoma skin lesion?

Question 5 - A skin lesion which is ulcerated with rolled, smooth, pearly borders is most likely:

Question 6 - Which of the following is NOT a pre-malignant (or does not have malignant potential) skin condition/ lesion?

Question 7 - Which of the following skin lesions is NOT associated with sun exposure?

Question 8 - Which of the following is TRUE about melanoma?

Question 9 - A 65-year-old male presents to clinic with a small skin lesion (0.5 cm) on his chest which is very suspicious for melanoma. Which of the following is the most appropriate option for this patient?

Question 10 - What is the most common basal cell carcinoma?

Question 11 - You have excised an irregular pigmented lesion from chest of a 50-year-old woman. The pathology report states that the lesion is melanoma, Clark’s level III. This means that the lesion:

Question 12 - A man has a suspected melanoma excised from his back. It appears to be less than 1 mm deep. The smallest margin to plan for excision is:

Question 13 - This subtype of melanoma is the most aggressive, arising in apparently normal skin or in a nevus, and rapidly becoming a firm, elevated nodule of dense black or brown-black colour. The nodule may have bluish hues, and in 5% of cases may be amelanotic (flesh coloured). This subtype, which comprises 15% of all melanoma cases, can arise at any site in the body. The name of this subtype is:

Question 14 - This type of skin lesion is elevated, brown, and has a “stuck on” appearance:

Question 15 - The following are all types of basal cell carcinoma EXCEPT:

Question 16 - What is the most common tumour of the hand?

Question 17 - A 40-year-old woman arrives at her family doctor’s office with concern about a black, bleeding lesion on her left lower leg. She states that it has become enlarged over the past several months and more irregular in appearance. Which of the following is FALSE about melanoma?

Question 18 - The following are true of the skin lesions EXCEPT:

Question 19 - Which of the following is NOT associated with Marjolin’s ulcer?

Question 20 - Risk factors for developing melanoma include all of the following EXCEPT:

Question 21 - A tumour descending into the reticular dermis, but not invading the subcutaneous tissue, would be classified as:

Question 22 - Which of the following regarding melanoma is TRUE?

Question 23 - The best treatment for the removal of actinic keratoses is:

Question 24 - Which nevus would you most likely remove due to its increased malignant potential?

Question 25 - Actinic keratoses are skin lesions that may degenerate into the following skin malignancy:

Lentigo maligna

Basal cell carcinoma

Malignant melanoma

Squamous cell carcinoma

26 Keratoacanthoma is-
a)A type of basal cell carcinoma
b)Infected sebaceous cyst
c)Self healing nodular lesion with central ulceration
d)Pre-malignant disease

27 True about keratoacanthoma –
a)Benign tumor
b)Malignant skin tumor like squamous cell carcinoma
c)Treatment same as for squamous cell carcinoma
d)Easy to differentiate from squamous cell Ca. histologically
e)Treatment is masterly inactivity

28 Which of the following is a regressing
tumour-
a) Portwine stain b) Strawberry angioma
c) Venous angioma d) Plexiform angioma

29 Spontaneous regression is seen in all except –
a)Salmon patch
b)Small Cavernous hemangioma c)Portwine stain d)Strawberry angioma

30 Least likely to regress spontaneously is
a) Osteosarcoma b) Retinoblasoma
c) Choriocarcinoma d) Malignant melanoma

31 Spontaneous Regresssion is seen in all except –
a) Retinoblasoma b) Malignant melanoma
c) Osteosarcoma d) Choriocarcinoma

32Cystic hygroma –
a)Should be left alone
b)Excision of cyst at an early age
c)Spontaneous regression
d)Manifests in 2nd – 3rd decade

33 Salmon patch usually disappears by age- a) One mouth b) One year UPSC 89)
c) Puberty d) None of the above

34 Regarding hemangiomas following are true –
a)Salmon patch disappears after the age of one
b)Port wine stain present throughout life
c)Salmon patch-on forehead midline and over occiput
d)all are correct

35 Eleven month old child presents with erythematous lesion with central clearing which has been decreasing in size
a)Strawberry angioma
b)Nevus
c)Portwine stain
d)Cavernous haemangioma

36 The best cosmetic results for large capillary (port wine) hemangiomas are achieved by
a)Excision and split-thickness skin
b)Laser ablation
c)Cryosurgery
d)Tattooing

37 True about Hemangioma of head & neck a) Are very common b) Sturge Weber synd
c) High output failure d) Thrombocytopenia

38 Hemangioma of the rectum –
a)Common tumour b)Fatal haemorrhage seen
c)Ulcerative colitis like symptoms seen

39 True about lymphangioma –
a)It is a malignant tumour b)It is a congenital sequestration of lymphatic
c)Cystic hygroma is a lymphangioma
d)Laser excision is done
e)Sclerotherapy is commonly done’

40 Earliest tumour to appear after bith is-
a) Sternomastoid tumour b) Cystic hygroma c) Branchial cyst d) Lymphoma

41 Cystic compressible, translucent swelling in the posterior triangle of neck- a) Cystic hygroma
c) Thyroglossal cyst
b) Branchial cyst
d) Dermoid cyst

42 Treatment of cystic hygroma is –
a)Surgical excision
b)Injection of sclerosants
c)Irradiation
d)Masterly inactivity

43 The brilliantly transilluminant tumour in the neck may be- (AI 91)
a) Branchial cyst b) Thyroglossal cyst
c) Sternomastoid tumour d) Cystic hygroma

44 All are true about cystic hygroma except –
a)Pulsatile (AMU 95)
b)May cause respiratory obstruction
c)Common in neck
d)Present at birth

45 All are true about cystic hygroma except a)Aspiration is diagnostic b)50% present at birth
c)Presents as posterior cervical swelling
d)Sequstration of lymphatic tissue

46 True about cystic hygroma –
a)Congenital sequestration of lymphatics
b)Resolves spontaneouly by 5 year of age
c)Common in upper 1/3rd of lateral neck
d)Surgery is the treatment of choice

47 Calcifying epithelioma is also known as —
a)Pilomatrixoma
b)Myoblastoma
c)Calcinosis cutis
d)Dermatofibroma lenticulare

48 True about Marjolins ulcer – a)Develops in long standing scar
b)Sq cell Ca develops
c)Slow growing lesion d)Also know as Baghdad sore
e)Common in Black races

49 True about marjolins ulcer is –
a) Ulcer over scar b) Rapid growth
c) Rodent ulcer d) Painful

50 Chronically lymphoedematous limb is predisposed to all of the following except
a)Thickening of the skin
b)Recurrent soft tissue infections c)Marjolin’s ulcer d)Sarcoma

51 Chronic lymphedema predisposes to all except
a) Lymphangiosarcoma b) Marjolins ulcer
c) Recurrent infections d) Thickening of skin

52 Not a premalignant ulcer
a)Bazin’s ulcer
b)Pagets disease of nipple
c)Marjolins ulcer
d)Lupur vulgaris

53 Commonest cancer in burn scar is
a) Sq. cell Ca b) Fibrosarcoma
c) Adenoa Ca d) Adeno-squamous Ca

54 In pigmented basal cell carcinoma, treatment of choice is –
a) Chemotherapy b) Radiotherapy
c) Cryosurgery d) Excision

55 Diagnostic procedure for basal cell Ca –
a) Wedge biopsy b) Shave
c) Incisional biopsy d) Punch bio

56 Moh’s Micrographic excision for basal cell carcinoma is used for all of the following except –
a)Recurrent Tumour
b)Tumor less than 2 cm in diameter
c)Tumors with aggressive histology
d)Tumors with perineural invasion

57 Basal cell carcinoma spread by –
a) Lymphatics b) Haematogenous
c) Direct spread d) None of the above

58 The commonest clinical pattern of basal cell carcinoma is –
a) Nodular b) Morpheaform
c) Superficial d) Keratotic

59 A 48-year-old sports photographer has noticed a small nodule over the upper lip from four months. The nodule is pearly white with central necrosis, telangiectasia. The most likely diagnosis would be –
a)Basal cell carcinoma
b)Squamous cell carcinoma
c)Atypical melanoma
d)Kaposis sarcoma

60 All are true statement about malignant melanoma except-
a)Clark’s classification used for prognosis
b)Women have better prognosis
c)Acral lentigenous have better prognosis
d)Limb perfusion is used for local treatment

61 Prognosis of malignant melanoma depends on – )
a) Grade of tumor b) Spread of tumor
c) Depth of invasion d) Metastasis

62 Worst prognosis in Melanoma is seen in the subtype-
a)Superficial spreading
b)Nodular Melanoma
c)Lentigo Maligna Melanoma
d)Amelanotic Melanoma

63 Least malignant melanoma is-
a) Lentigo maligna b) Superifcial spreading
c) Nodular d) Amelanotic

64 Prognosis of melanoma depends on –
a)Stage
b)Depth of melanoma on biopsy
c)Duration of growth
d)site

e)brselow thickness

65 Which one of the following is not included in the treatment of malignant melanoma –
a) Radiation b) Surgical excision
c) Chemotherapy d) Immunotherapy

66 In the Clatke’s level of tumor invasion for malignant melanoma level 3 refers to –
a)All tumar cells above basement membrane
b)Invasion into reticular dermis
c)Invasion into loose connective tissue of papillary dermis
d)Tumor cells at junction of papillary and reticular dermis

67 True about melanoma of the anal canal is -
a)Present usually as anal bleeding
b)AP resection gives better result than local excision
c)Local recurrence at the same site after resection
d)Radiosensitive

68 Most common site of Ientigo maligna melanoma is -a) Face b) Legs
c) Trunks d) Soles

69 Most common origin of melanoma is from –
a)Junctional melanocytes b)Epidermal cells c)Basal cells
d)Follicular cells

nerve injury hand 1

Nerve Injury

1-Injury of the hand leads to median nerve injury:

a- claw hand

b- wrist drop

c- sensory defect only

- 20 years old male presented with volar wrist injury with median nerve involvement, what is the clinical picture:

a. Wrist drop.

b. Claw hand.

c. Sensory loss only.

d. Inability to oppose thumb towards fingers.

e. No metacarpophalangeal joint flexion.

- A 20-year-old man sustained a deep laceration on the anterior surface of the wrist. Median nerve injury would result in:

A. A claw hand defect.

B. A wrist drop.

C. A sensory deficit only.

D. An inability to oppose the thumb to other fingers.

E. The inability to flex the metacarpophalangeal joints.

2- a 20 year old patient had deep laceration in his right wrist.which of the following is the result from this injury

a)wrist drop

b)claw hand

c)sensory loss only

d)inability of thumb opponins to other fingers

e)inability of flexion of the interphalangeal joint

Nerve Injury at The Wrist

Radial nerve	Median nerve	Ulnar nerve
Sensory loss on the posterior hand (first dorsal web space).	Loss of function of the thenar muscles and lumbricals 1 and 2; “clawing” of digits 2 and 3. Sensory loss on palmar surface of digits 1, 2, and 3, and one-half of 4. Sign is “ape or simian hand” and “flattening of thenar eminence:’	Loss of abduction and adduction of the digits; loss of the hypothenar muscles and lumbricals 3 and 4. Sensory loss on digits 5 and one half of 4. Sign is “claw hand.”

3- The most important factor in the development of spinal headaches after spinal anesthesia is:

a) the level of the anesthesia

b) the gauge of the needle used

c) the closing pressure after the injection of tetracaine

d) its occurrence in the elderly

e) the selection of male patients

Headache. A characteristic headache may occur following spinal anaesthesia. It begins within a few hours and may last a week or more. It is postural, being made worse by standing or even raising the head and relieved by lying down. It is often occipital and may be associated with a stiff neck. Nausea, vomiting, dizziness and photophobia frequently accompany it. It is more common in the young, in females and especially in obstetric patients. It is thought to be caused by the continuing loss of CSF through the hole made in the dura by the spinal needle. This results in traction on the meninges and pain.

The incidence of headache is related directly to the size of the needle used. A 16 gauge needle will cause headache in about 75% of patients, a 20 gauge needle in about 15% and a 25 gauge needle in 1-3%. It is, therefore, sensible to use the smallest needle available especially in high-risk obstetric patients. As the fibres of the dura run parallel to the long axis of the spine, if the bevel of the needle is parallel to them, it will part rather than cut them and therefore, leave a smaller hole. Make a mental note of which way the bevel lies in relation to the notch on the hub and then align it appropriately. It is widely considered that pencil-point needles (Whiteacre or Sprotte) make a smaller hole in the dura and are associated with a lower incidence of headache (1%) than conventional cutting-edged needles (Quincke) (figure 7).

4- An old man undergoing brain surgery and on asprin. He needs prior to surgery:

a) vitamin K parenterally

b) vitamin K orally

c) delay surgery for 2 days

d) delay surgery for 2 weeks

e) none of the above

Radial nerve Injury

At the Axilla :

Loss of extensors at the elbow, wrist, and digits;
weakened extension at the shoulder;
weakened supination.
Sensory loss on posterior arm, forearm, and hand.
Sign is “wrist drop:’

Shoulder dislocation may injure the radial nerve. Also, pressure on the floor of axilla may injure nerve (Saturday night palsy).

At the Elbow :

Loss of extensors at the wrist and digits.
Sensory loss on the posterior forearm and hand.
Sign is “wrist drop”

Fracture of the shaft of the humerus could lacerate the radial nerve, and the deficits would be the same as if the nerve were damaged at the level of the elbow.

At the Wrist :

Sensory loss on the posterior hand (first dorsal web space).

Median nerve Injury

At the Elbow :

Loss of flexion of the digits, thenar muscles, and lumbricals 1 and 2;
weakened wrist flexion;
ulnar deviation upon flexion of the wrist;
loss of pronation.
Sensory loss on lateral palm and digits 1, 2, and 3, and one half of 4.
Sign is “ape or simian hand” and “flattening of the thenar eminence:’

At the Wrist :

Loss of function of the thenar muscles and lumbricals 1 and 2;
“clawing” of digits 2 and 3.
Sensory loss on palmar surface of digits 1, 2, and 3, and one-half of 4.
Sign is “ape or simian hand” and “flattening of thenar eminence:’

Carpal tunnel compression or wrist laceration.

Ulnar nerve Injury

At the Elbow (medial epicondyle)

Weakened wrist flexion;
radial deviation upon flexion of the wrist;
loss of abduction and adduction of the digits;
loss of hypothenar muscles and lumbricals 3 and 4.
Weakened flexion of digits 4 and 5.
Sensory loss on digits 5 and one half of 4.
Sign is “claw hand:’

At the Wrist

Loss of abduction and adduction of the digits;
loss of the hypothenar muscles and lumbricals 3 and 4.
Sensory loss on digits 5 and one half of 4.
Sign is “claw hand.”

Axillary nerve Injury

Loss of abduction of the arm to the horizontal plane.

The axillary nerve could be damaged with a fracture of the surgical neck of the humerus or dislocation of the shoulder.

Musculocutaneous nerve Injury

Loss of elbow flexion and weakness in supination;
loss of sensation on lateral aspect of the forearm.

plastic& reconstructive surgery mcq

Monday, November 18, 2013

Flaps & Grafts

Flaps & Grafts

Skin & Soft Tissue Lesions

Skin & Soft Tissue Lesions

nerve injury hand 1