101-110 MCQ in Facial Plastic and Reconstructive Surgery

101-110

101) The use of W-plasty scar revision is CONTRAINDICATED in which of the following facial areas? Click the picture to enlarge image.

A. A
B. B
C. C
D. D
E. E

102) Which of the following antibiotics is CONTRAINDICATED with the use of Botox?

A. Penicillin
B. Cephalosporin
C. Tetracycline
D. Aminoglycoside
E. Clindamycin

103) Which of the following anatomic sites will heal by Second-Intention with the BEST cosmetic result?

A. Temple
B. Forehead
C. Cheek
D. Chin
E. Helix

104) Which of the following statements is FALSE regarding the “O-T” Flap?

A. The flap converts a circular defect to a T-shaped scar.
B. It is useful in the temple area close to the hairline.
C. The disadvantage is that it leaves an unfavorable scar with two perpendicular limbs.
D. The advantage is that there is no need for excision of normal tissue.
E. The flap has advancement and rotational components.

105) Which of the following is the “PRIMARY CHROMOPHORE” for resurfacing lasers (CO2 & Er:YAG lasers)?

A. Oxyhemoglobin
B. Carboxyhemoglobin
C. Melanin
D. Hemoglobin
E. Water

106) Which of the following would benefit the LEAST by using Botulinum Exotoxin A (Botox) injections?

A. Glabellar lines
B. Horizontal forehead lines
C. Lateral orbital lines “crow’s feet”
D. Nasal flare
E. Nasolabial folds

107) In which layer of the epidermis are the LANGERHANS’ CELLS, for the most part, located?

A. The basal cell layer
B. The stratum spinosum
C. The stratum granulosum
D. The stratum lucidum
E. The stratum corneum

108) Which of the following statements defines the POGONION?

A. Anterior hairline at the midline
B. Lowest contour point of the chin
C. Anterior most point of the chin
D. Most inferior, posterior, and lateral point on the external angle of the mandible
E. Point of deepest depression at the root of the nose

109) Which of the following statements is FALSE regarding Z-Plasty?

A. No angles are greater than 90 degrees.
B. No angles are less than 30 degrees.
C. Arms are no greater than 1 cm on the face.
D. Arms have a 2 cm length on the neck.
E. An angle of 60 degrees is the most versatile.

110) Which of the following is THE MOST common complication of tissue expanders?

A. Early infection
B. Late infection
C. Early exposure
D. Late exposure
E. Necrosis of the flaps


ANSWERS & REFERENCES



101) E     E


Borges A. F.: W-Plasty, Chapter 14, Facial Scars, Incision, Revision and Camouflage (Thomas and Holt, editors), 1989, pp. 152-153

102) D     Aminoglycoside

Blitzer A., Binder W.J. Brin M.F.: Botulinum Exotoxin A (Botox) for Facial Wrinkles, Chapter 23 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 262-263, 2002

Meyer T. K., Blitzer A.: Botulinum Toxin for Facial Wrinkles, Chapter 30 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third Edition, (Ira Papel, editor) pp. 369-377, 2009

 http://emedicine.medscape.com/article/1271380-overview#aw2aab6b6

103) A     Temple

Hom D. B., Tope W. D.: Minimally Invasive Options and Skin Grafts for Cutaneous Reconstruction, Chapter 43 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 513-522, 2002

Hom D. B., Tope W. D.: Minimally Invasive Options and Skin Grafts for Cutaneous Reconstruction, Chapter 53 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 513-522, 2009

104) D     The advantage is that there is no need for excision of normal tissue.

Park S.S., Local and Regional Cutaneous Flaps, Chapter 44 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 535-536, 2002

Park S.S., Local and Regional Cutaneous Flaps, Chapter 54 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 721-743, 2009

105) E     Water

Carniol P.J., Harmon C.B.: Laser Facial Resurfacing, Chapter 21 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 242, 2002

Carniol P.J., Harmon C.B., Hamilton M.M.: Ablative Laser Facial Resurfacing, Chapter 26 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 321, 2009

106) E     Nasolabial folds

Blitzer A., Binder W. J., Brin M. F.: Botulinum Exotoxin A (Botox) for Facial Wrinkles, Chapter 23 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 262-267, 2002

Meyer T. K., Blitzer A.: Botulinum Toxin for Facial Wrinkles, Chapter 30 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third Edition, (Ira Papel, editor) pp. 369-377, 2009

 http://emedicine.medscape.com/article/1271380-overview#aw2aab6b4

107) B     The stratum spinosum

Bennett R.G.: Anatomy and Physiology of the skin in chapter 1, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp.5-6, 2002

Bennett R.G.: Anatomy and Physiology of the skin in chapter 1, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp.3-14, 2009

108) C     Anterior most point of the chin

Ridley M.B., Vanhook S.M.: Aesthetic Facial Proportions in chapter 9, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 108, 2002

Ridley M.B., Vanhook S.M.: Aesthetic Facial Proportions in chapter 11, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 132, 2009

109) D     Arms have a 2 cm length on the neck.

Cook T.A., Guida R.A., Burke A.J.C.: Soft Tissue Techniques in chapter 3, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 35-36, 2002

Cook T.A., Guida R.A., Burke A.J.C.: Soft Tissue Techniques in chapter 3, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 27-39, 2009

110) D     Late exposure

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck in Chapter 45, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 556-557, 2002

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck in Chapter 55, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 745-756, 2009

-------------------------------------
Updated:  May 1, 2017

111-120 MCQ in Facial Plastic and Reconstructive Surgery

111-120

111) Which of the following statements regarding the Palatoplaty technique shown in the drawing below is TRUE?


A. It is used to repair complete palate clefts.
B. The created flaps are bipedicled.
C. The soft palate can be lengthed using a V-to-Y technique.
D. The repositioning of the velopharyngeal muscular sling can not be accomplished.
E. The medial and lateral incisions are connected anteriorly at the level of the incisor teeth

112) Which of the following statements about lip aesthetics is FALSE?

A. The distance from the menton to the subnasale should be one third of the distance from the menton to the hairline.
B. The distance from the subnasale to the stomion is one third of the distance comprising the lower third of the face.
C. The lower lip and chin constitute one half of the distance comprising the lower third of the face
D. The upper lip should lie 3.5 mm anterior to the line formed by the subnasale to the pogonion
E. The lower lip should lie 2.2 mm anterior to the line from the subnasale to the pogonion

113) Which of the following cells have THE MOST important ROLE in the inflammatory phase of wound healing?

A. Macrophages
B. Lymphocytes
C. Monocytes
D. Neutrophils
E. Platelets

114) Which of the following cells are FIRST TO APPEAR in the wound healing process?

A. Polymorphonuclear leukocytes
B. Macrophages
C. Lymphocytes
D. Endothelial cells
E. Fibroblasts

115) Which of the following statements regarding actinic keratosis is TRUE?

A. Actinic keratosis are common skin lesions with no malignant potential.
B. Actinic keratosis result from solar damage and chronic skin trauma.
C. Actinic keratosis can be removed or watched.
D. Diffuse actinic keratosis can be treated with topical 5-fluorouracil.
E. The lack of hyperkeratosis is a clinical feature of these skin lesions.

116) Which of the following anatomic areas will produce the LEAST intraoperative expansion?

A. Forehead
B. Scalp
C. Upper half of the nose
D. Neck
E. Nasal tip

117) Which of the following metals is THE BEST choice for long-term facial implantation?

A. Stainless steel
B. Vitallium
C. Titanium
D. Cobalt
E. Chromium

118) Which of the following tissue adhesives is the LEAST histotoxic?

A. Butyl-2-cyanoacrylate
B. Octyl-2-cyanoacrylate
C. Methyl-α-cyanoacrylate
D. Octyl-8-cyanoacrylate
E. Fibrin glues

119) Which of the following statements is FALSE using the trichloroacetic acid as a chemical peeling agent?

A. Has no systemic toxicity.
B. Depth of peel is predicted by concentration of solution.
C. Is unstable and therefore must be mixed fresh before each use.
D. Cost is low
E. Neutralization is not needed.

120) Which of the following cells synthesizes COLLAGEN?

A. Keratinocytes
B. Melanocytes
C. Langerhans’ Cells
D. Fibrocytes
E. Merkel’s Cells


ANSWERS & REFERENCES



111) C     The soft palate can be lengthed using a V-to-Y technique.

Bardach J., Salyer K., Noordhoff M. S.: Bilateral Cleft Lip Repair, Chapter 4, Surgical Techniques in Cleft Lip and Palate (Bardach and Salyer, editors), Mosby, Second Edition, 1991, pp. 119-121

112) C     The lower lip and chin constitute one half of the distance comprising the lower third of the face

Sherris D.A., Kern E.B.: Computed-Assisted Facial Analysis, Chapter 43 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume Two, Mosby, Third Edition, 1998, p. 840

Maloney B. P.: Aesthetic Surgery of the Lip, in chapter 36, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 460, 2009

Zimbler M. S.: Aesthetic Facial Analysis, chapter 19 in Cummings Otolaryngology-Head and Neck Surgery, Fifth Edition, Volume one, Mosby Elsevier, 2010, pp. 269-280

113) A     Macrophages

Fisher E., Frodel Jr. J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 18, 2002

Fisher E., Frodel Jr. J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 18, 2009

114) A     Polymorphonuclear leukocytes

Fisher E., Frodel Jr. J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 16-18, 2002

Fisher E., Frodel Jr. J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 16-18, 2009

115) D     Diffuse actinic keratosis can be treated with topical 5-fluorouracil.

Swanson N.A.: Grekin R. C.: Recognition and Treatment of Skin Lesions, Chapter 22 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume One, Mosby, Third Edition, 1998, pp. 415-416

Willey A., Swanson N. A., Lee K.K.: Recognition and Treatment of Skin Lesions, Chapter 20 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 281-294

116) E     Nasal tip

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 45, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 555, 2002

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 55, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 753, 2009

117) C     Titanium

Binder W. J., Moelleken B., Tobias G. W.: Aesthetic Facial Implants, Chapter 25, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 278, 2002

Binder W. J., Azizzadeh Babak, Tobias G. W.: Aesthetic Facial Implants, Chapter 32, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 391, 2009

Fuleihan N. S.: Facial Implants, Chapter 38 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume One, Mosby, Third Edition, 1998, pp. 720-721

118) E     Fibrin glues

Quatela V.C., Sabini P.: Synthetic Implants, Chapter 6, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp.68-69, 2002

Mobley S. R., Hillinski J., Toriumi D. M.: Surgical Tissue Adhesives, Facial Plastic Surgery Clinics of North America, New Horizons in Facial Plastic Surgery, (Sclafani, editor), Vol. 10., No. 2, , pp. 147-154, 2002

119) C     Is unstable and therefore must be mixed fresh before each use.

Alford E. L., Porter J. P.: Chemical Peel, Chapter 32, in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Mosby, Vol. 1, p. 644-645, 1998

http://emedicine.medscape.com/article/842768-overview#aw2aab6b6

120) D     Fibrocytes

Bennett R.G.: Anatomy and Physiology of the skin in chapter 1, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp.5-6, 2002

-------------------------------------
Updated:  May 1, 2017

121-130 MCQ in Facial Plastic and Reconstructive Surgery

121-130

121) Which of the following areas in a congenital bilateral complete cleft lip represents the PROLABIUM? Click the picture to enlarge image.


A. A
B. B
C. C
D. D
E. E

122) Which of the following statements is TRUE regarding the Tricophytic Approach to brow and forehead elevation?

A. There is increased risk of brow malposition.
B. There is limited access to the corrugator musculature.
C. There is limited access to the procerus musculature.
D. It is indicated in patients who have a high frontal hairline.
E. The incision should be beveled with a curvilinear regular line pattern.

123) Which of the following statements related to lower eyelid blepharoplasty is TRUE?

A. Hematoma is the most common complication.
B. Eyelid malposition is the least common complication.
C. Failure to remove enough fat occurs most commonly in the lateral pocket.
D. The ocular muscle most commonly injured is the inferior rectus.
E. Blindness has been reported with an incidence of 0.1%.

124) A 57 year old man has asymmetric brow ptosis, deep static forehead rhytids and a high frontal hairline. Which of the following surgical managements is the MOST appropriate in this case?

A. Mid-Forehead Rhytidectomy
B. Mid-Forehead Browplasty
C. Prethichial Forehead Lift
D. Coronal Forehead Lift
E. Endoscopic Forehead Lift

125) Which of the following areas of the auricle will be anesthetized by the injection of local anesthesia into the LESSER OCCIPITAL NERVE?

A. Posterior surface of the auricle
B. Inferior auricle and skin over the mastoid
C. Anterior limb of the helix and tragus
D. Superior half of the auricle
E. Inferior half of the auricle

126) Which of the following statements is TRUE regarding wound healing?

A. The phases of the wound healing are: hemostasis, proliferation and maturation.
B. Wound healing is better in a cool, dry and sterile environment.
C. Polymorphonuclear leukocytes are the most important component in the maturation phase.
D. Fibroblasts appear in the wound on day 7.
E. In the maturation phase collagen type III is replaced by type I collagen.

127) Which of the following statements regarding the Temporo-Parietal-Occipital (TPO) Flap is FALSE?

A. The TPO flap’s blood supply is based on the superficial temporal artery.
B. The TPO flap requires two delay procedures.
C. The TPO flap is 25 cm long.
D. The TPO flap is 4 cm wide.
E. The TPO flap is used for the treatment of frontal male-pattern alopecia.

128) Which of the following statements regarding hair transplantation is TRUE?

A. The hairline design should be low and wide, rather than high and narrow
B. Patients with ages between 20 to 25 are better candidates that those with ages between 50 to 55
C. The patient’s hair color is the most critical parameter to assess before hair transplantation
D. Micrografts are usually used at the crown.
E. Minigrafts are usually used at the vertex.

129) Which of the following statements regarding CO2 laser facial resurfacing is TRUE?

A. Neck skin is well suited for CO2 laser resurfacing.
B. Deep “ice-pick” acne responds very well to CO2 laser resurfacing.
C. The initial layer of desiccated white debris has to be left in place.
D. The reticular dermis level is recognized by its “yellow chamois cloth” appearance.
E. The CO2 laser settings and passes remain the same for the entire face.

130) Which of the following statements regarding Endoscopic Forehead Lift is FALSE?

A. There is usually less bleeding and a faster recovery period.
B. Subgaleal plane dissection is most commonly used.
C. Three small vertical incisions of 2 cm each just behind the hairline are commonly used.
D. Is indicated in patients with asymmetric brow ptosis, horizontal and vertical forehead and glabellar rhytids.
E. There is no scalp excision but there is fixation with screws or sutures.


ANSWERS & REFERENCES



121) C     C

Bardach J., Salyer K., Noordhoff M. S.: Bilateral Cleft Lip Repair, Chapter 4, Surgical Techniques in Cleft Lip and Palate (Bardach and Salyer, editors), Mosby, Second Edition, 1991, pp. 119-121

122) D     It is indicated in patients who have a high frontal hairline.

Becker F.F., Johnson, Jr, C.M., Mandel L. M.: Surgical Management of the Upper Third of the Aging Face, Chapter 34, in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Mosby, Vol. 1, pp. 668-671, 1998

Adamson P. A., Dahiya R.: The Aging Forehead, Chapter 179, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins) 4th Edition, 2006, pp. 2663-2683

Nassif P. S.: Rejuvenation of the Aging Brow and Forehead, chapter 25 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition,  Volume one, Mosby Elsevier, 2010, pp. 428-438

123) C     Failure to remove enough fat occurs most commonly in the lateral pocket.

Rankin B. S., Arden R. L., Crumley R.L.: Lower Eyelid Blepharoplasty, Chapter 18, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp.5-6, 2002

Crumley R.L., Torkian B. A., Karam A. M.: Lower Eyelid Blepharoplasty, Chapter 23, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp.271-285, 2009

http://emedicine.medscape.com/article/838696-treatment

124) B     Mid-Forehead Browplasty

Becker F.F., Johnson, Jr, C.M., Mandel L. M.: Surgical Management of the Upper Third of the Aging Face, Chapter 34, in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Mosby, Vol. 1, pp. 660-675, 1998

Henderson J. L., Larrabee, Jr.: Analysis of the Upper Face and Selection of Rejuvenation Techniques, Facial Plastic Surgery Clinics of Noth America, Upper Face Rejuvenation, Adamson P.A., Guest Editor), Vol. 14, No. 3, August 2006, pp. 153-158

Adamson P. A., Dahiya R.: The Aging Forehead, Chapter 179, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins) 4th Edition, 2006, pp. 2663-2683

125) A     Posterior surface of the auricle

Nachlas N.E.: Otoplasty, Chapter 27, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 310-311, 2002

Nachlas N.E.: Otoplasty, Chapter 34, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 421-433, 2009

126) E      In the maturation phase collagen type III is replaced by type I collagen..

Fisher E., Frodel Jr. J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 15-25, 2002

Fisher E., Frodel Jr. J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 15-25, 2009

127) D     The TPO flap is 4 cm wide.

Rousso D. E.: The Use of Scalp Flaps for Frontal Alopecia, Hair Replacement Surgery, Facial Plastic Surgery Clinics of North America, Saunders, Vol. 2 Number 2, May 1994, pp. 183-193

128) E     Minigrafts are usually used at the vertex.

Buchwach K.A.: Standard Grafts, Minigrafts and Micrografts. Their Use in Hair Transplantation, Hair Replacement Surgery, Facial Plastic Surgery Clinics of North America, Saunders, Vol. 2, Number 2, May 1994, pp. 149-161

129) D     The reticular dermis level is recognized by its “yellow chamois cloth” appearance.

Hecht D.A., Toriumi D.M.: Laser Skin Resurfacing, Chapter 189 in Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins, Third Edition, 2001, pp. 2461-2469

130) B     Subgaleal plane dissection is most commonly used.

Graham III H.D., Endoscopic Rhytidectomy, Chapter 36 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume Two, Mosby, Third Edition, 1998, pp. 699-708

--------------------------------------
Updated:  May 1, 2017

131-140 MCQ in Facial Plastic and Reconstructive Surgery

131-140

131) The IDEAL obtuse angle represented in the rhombic flap (Limberg flap design) shown in the drawing below should be?

A. 70 degrees
B. 80 degrees
C. 100 degrees
D. 120 degrees
E. 140 degrees

132) Which of the following side effects is MOST commonly seen in laser skin resurfacing?

A. Erythema
B. Edema
C. Pruritus
D. Hypopigmentation
E. Scarring in overlapping areas

133) Which of the following represents THE ONSET of a herpes simplex infection after a carbon laser skin resurfacing procedure?

A. Erythema
B. Edema
C. Pruritus
D. Vesicles
E. Pain

134) Which of the following regarding the diagnosis of flap venous congestion is FALSE?

A. The flap is warm.
B. The flap has an edematous appearance.
C. The flap has a purplish blue color.
D. The flap’s color blanches with pressure but does not refill.
E. A pinprick demonstrates dark venous blood.

135) Which of the following statements regarding cosmetic surgery of the Asian Face is TRUE?

A. 90% of Asian faces exhibit a “single eyelid”.
B. In the Asian eye, filaments of the levator penetrate the orbital septum and the orbicularis muscle and attach to the overlying dermis
C. Most Asian patients are requesting eye westernization.
D. Hypertrophic scarring of the face is more common in Asians than Caucasians.
E. Skin malignancies are more common among Asians than Caucasians

136) Which of the following operative maneuvers will DECREASE projection in rhinoplastic surgery?

A. Lateral crural steal
B. Plumping grafts
C. Premaxillary grafts
D. Nasal spine reduction
E. Tip Grafts

137) Which of the following is the recommended wait time prior TO STARTING sequential inflation after insertion of a scalp tissue expanders?

A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks
E. 6 weeks

138) Which of the following statements regarding hair transplantation is TRUE?

A. Minigrafts are used at the most anterior portion of the hairline.
B. Minigrafts comprise from 3-8 hair follicles.
C. Micrografts are used at the crown and vertex.
D. Micrografts have a success rate of approximately 75%
E. Plan the hairline in a lower and wider position.

139) Which of the folllowing IMPLANTABLE MATERIALS is an injectable autologous soft tissue material derived from cultured human fibroblasts?

A. Autologen
B. Alloderm
C. Autologous dermal grafting
D. Dermalogen
E. Isolagen

140) Which of the following statements comparing the Erbium Laser to the CO2 Laser in Skin Resurfacing is FALSE?

A. Erbium Laser energy absorption remains very superficial.
B. The depth of vaporization after one pass is 25 μm.
C. Erbium Laser has a faster healing time.
D. Erbium Laser has less postoperative erythema and pigmentation problems.
E. Erbium Laser is useful in treating deeper wrinkles and severe photo-damage.


ANSWERS & REFERENCES



131) D     120 degrees

Park S. S.: Local and Regional Cutaneous Flaps, Chapter 44, Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, pp. 538-539, 2002

Park S. S.: Local and Regional Cutaneous Flaps, Chapter 54, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, pp. 721-743, 2009

 http://emedicine.medscape.com/article/879923-treatment#a1133

132) A     Erythema

Hecht D.A., Toriumi D.M.: Laser Skin Resurfacing, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins) Third Edition, Chapter 189, 2001, p. 2467-2468

Carniol P. J., Harmon C.B., Hamilton M. M.: Ablative Laser Facial Skin Rejuvenation, Chapter 26, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, pp. 321-330, 2009

133) E     Pain


Hecht D.A., Toriumi D.M.: Laser Skin Resurfacing, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins) Third Edition, Chapter 189, 2001, p. 2467-2468

Carniol P. J., Harmon C.B., Hamilton M. M.: Ablative Laser Facial Skin Rejuvenation, Chapter 26, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, pp. 321-330, 2009

134) D     The flap’s color blanches with pressure but does not refill.

Park S.S.: Local and Regional Cutaneous Flaps, Chapter 44, Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, pp. 546-547, 2002

Park S. S.: Local and Regional Cutaneous Flaps, Chapter 54, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, pp. 741-742, 2009

135) D     Hypertrophic scarring of the face is more common in Asians than Caucasians.

McCurdy Jr., J.A.: Cosmetic Surgery of the Asian Face, Chapter 28, Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, pp. 322-323, 2002

McCurdy Jr., J.A.: Cosmetic Surgery of the Asian Face, Chapter 35, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, pp. 435-458, 2009

136) D     Nasal spine reduction

Becker D.G.: Complications of Rhinoplasty, Chapter 39, Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, p. 453, 2002

Becker D.G.: Complications of Rhinoplasty, Chapter 49, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, p. 641, 2009

137) B     2 weeks

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 45, Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, p. 555, 2002

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 55, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, p. 751, 2009

Konior J. R., Kridel R.W.H.: Tissue Expansion in Scalp Surgery, Hair Replacement Surgery, Facial Plastic Surgery Clinics of North America, Vol. 2, No. 2, May 1994, p. 208

138) B     Minigrafts comprise from 3-8 hair follicles.

Buchwach K.A.: Standard Grafts, Minigrafts and Micrografts, Their use in Hair Transplantation, Facial Plastic Clinics of North America, Vol. 2, No. 2, May 1994, pp. 149-161

139) E     Isolagen

Monhian N., Ahn M. S., Maas C. S.:Injectable and Implantable Materials for Facial Wrinkles, Chapter 22 in Facial Plastic and Reconstructive Surgery, (Papel I.D. , edittor), Second Edition, 2002, pp.248-252

Maas C. S., Yu K.C. Y., Egan K. K.:Neuromodulators and Injectable Soft Tissue Substitutes, Chapter 28 in Facial Plastic and Reconstructive Surgery, (Papel I.D. , edittor), Third Edition, 2009, pp. 337-353

140) E     Erbium Laser is useful in treating deeper wrinkles and severe photo-damage.

Hecht D.A., Toriumi D.M.: Laser Skin Resurfacing, Chapter 189, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins) Third Edition, 2001, p. 2468

-------------------------------------

Updated:  May 1, 2017

141-150 MCQ in Facial Plastic and Reconstructive Surgery

141-150

141) Which of the following lines represents THE VECTOR OF MAXIMUN TENSION in the rhombic flap below? Click the picture to enlarge image.

A. A
B. B
C. C
D. D
E. E

142) Which of the following statements regarding the Juri Flap is TRUE?

A. The Juri flap's blood supply is based on the deep temporal artery.
B. The Juri flap has a 4 cm width.
C. The Juri flap seldom needs a dog-ear revision.
D. The Juri flap is transposed after one delay procedure.
E. The Juri flap is undermined in the subperiosteal plane.

143) The timing for the SECOND DELAY in the temporo-parietal-occipital (TPO) flap is:

A. 3 days
B. 7 days
C. 2 weeks
D. 3 weeks
E. 4 weeks

144) Which of the following anatomic areas is THE IDEAL LOCATION for tissue expansion?

A. Scalp
B. Nose
C. Ear
D. Cheek
E. Neck

145) Which of the following organisms is MOST commonly associated with infection produced by medical leeches?

A. Pseudomonas aeruginosa
B. Aeromona hydrophila
C. Bacteroides fragilis
D. Staphylococcus aureus
E. Aspergillus

146) Which of the following cells are implicated in the production of TROPOCOLLAGEN UNITS?

A. Macrophages
B. Fibroblasts
C. Lymphocytes
D. Endothelial cells
E. Smooth-muscle cells

147) Which of the following statements is FALSE regarding tissue expanders?

A. The forehead is an ideal location for tissue expansion.
B. In the scalp expanders are placed deep to the galea and superficial to the periosteum.
C. Nerve tissue tolerates expansion poorly.
D. Adipose tissue is intolerant of tissue expansion.
E. After tissue expander insertion 14 days is usually allowed before inflation is initiated.

148) Which of the following cell types have been RELATED to the mediation of immunologic responses within the skin?

A. Keratinocytes
B. Langerhans’ Cells
C. Merkel’s Cells
D. Melanocytes
E. Cuboidal cells of the basal layer

149) Which of the following anatomic sites will heal by Second-Intention with the WORST cosmetic result?

A. Temple
B. Concave surface of the eye
C. Antihelix
D. Forehead
E. Chin

150) Which of the following antibiotics is NOT a contraindication for the use of Botulinum Exotoxin A (Botox)?

A. Kanamycin
B. Amikacin
C. Tobramycin
D. Gentamicin
E. Clindamycin


ANSWERS & REFERENCES



141) A     A

Park S. S.: Local and Regional Cutaneous Flaps, Chapter 44, Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, pp. 538-539, 2002

Park S. S.: Local and Regional Cutaneous Flaps, Chapter 54, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, pp. 721-743, 2009

142) B     The Juri flap has a 4 cm width.

Konior R.J., Kridel R.W.H.: Management of Alopecia, Chapter 188, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor), Lippincott Williams & Wilkins, Third Edition, Volume Two, 2001, pp. 2458-2459

Bassichis B. A., Konior R.J.: Management of Alopecia, Chapter 184, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor), Lippincott Williams & Wilkins, 4th Edition, Volume Two, 2006, pp. 2749-2759

143) B     7 days

Rousso D.E.: The Use of Scalp Flaps for Frontal Alopecia Facial Plastic Surgery Clinics of North America, Hair Replacement Surgery, Saunders, Vol. 2, Number 2, May 1994, pp. 183-193

Bassichis B. A., Konior R.J.: Management of Alopecia, Chapter 184, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor), Lippincott Williams & Wilkins, 4th Edition, Volume Two, 2006, pp. 2749-2759

Ende K. H., Kabaker S. S.: Hair Restoration: Medical and Surgical Techniques, Chapter 26 in Cummings Otolaryngology-Head and Neck Surgery,  Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 373-389

144) A     Scalp

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 45, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 551-552, 2002

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 55, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 745-755, 2009

Baker S. R.: Reconstruction of Facial Defects, chapter 24 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 342-363

145) B     Aeromona hydrophila

Utley D.S., Koch R.J., Goode R.L.: The Failing Flap in Facial Plastic and Reconstructive Surgery: Role of the Medicinal Leech, Laryngoscope 108, August 1998, pp 1129-1135

http://emedicine.medscape.com/article/1284841-overview

146) B     Fibroblasts

Fisher E., Frodel Jr. J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 18-19, 2002

Fisher E., Frodel Jr. J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 15-25, 2009

147) C     Nerve tissue tolerates expansion poorly.

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck in Chapter 45, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 549-559, 2002

Hoffmann J.F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 55, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 745-755, 2009

148) B     Langerhans’ Cells

Bennett R.G.: Anatomy and Physiology of the skin in chapter 1, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp.5-6, 2002

Bennett R.G.: Anatomy and Physiology of the skin in chapter 1, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 3-14, 2009

149) E     Chin

Hom D. B., Tope W. D.: Minimally Invasive Options and Skin Grafts for Cutaneous Reconstruction, Chapter 43 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 513-522, 2002

Hom D. B., Tope W. D.: Minimally Invasive Options and Skin Grafts for Cutaneous Reconstruction, Chapter 53 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 703-719, 2009

150) E     Clindamycin

Blitzer A., Binder W.J. Brin M.F.: Botulinum Exotoxin A (Botox) for Facial Wrinkles, Chapter 23 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 262-263, 2002

Meyer T. K., Blitzer A.: Botulinum Toxin for Facial Wrinkles, Chapter 30 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Thhird edition (Ira Papel, editor) pp. 369-377, 2009

--------------------------------------
Updated:  May 1, 2017

151-160 MCQ in Facial Plastic and Reconstructive Surgery

151-160

151) The angle for an M-plasty, indicated in the drawing, SHOULD BE approximately?


A. 30 degrees
B. 40 degrees
C. 50 degrees
D. 60 degrees
E. 70 degrees

152) Which of the following methods involves the measure of TIP PROJECTION in relation to the length of the upper lip?

A. Simons
B. Gonzalez-Ulloa
C. Byrd
D. Crumley
E. Goode

153) Which of the following chemical peels is MOST commonly used for the treatment of fine lower eyelid rhytids during the Transcutaneous Blepharoplasty Skin Flap Techniques?

A. 35% trichloroacetic acid
B. 50% trichloroacetic acid
C. 89% Phenol
D. Baker-Gordon Phenol Formula
E. Chemical Peeling is not indicated.

154) Which of the following operative maneuvers will DECREASE ROTATION?

A. Full-transfixion incision
B. Plumping grafts
C. Columellar strut
D. Lateral crura steal
E. Cephalic resection

155) Which of the following statements regarding the indications for rhytidectomy is FALSE?

A. Rhytidectomy will correct ptosis of the jowl.
B. Rhytidectomy will correct blunting of the cervicomental angle.
C. Rhytidectomy will correct the wrinkles and creases of facial skin.
D. Rhytidectomy will be most helpful in patients with a high posterior hyoid bone.
E. Rhytidectomy will be helpful in patients with strong facial bone structures and prominent cheek bones.

156) In which of the following medical conditions is the use of synthetic tissue adhesives for wound closure INDICATED?

A. Patients with insulin-dependent diabetes
B. Patients with collagen vascular disease
C. Patients with tendency to form hypertrophic scars or keloids
D. Patients with a known history of an allergic response to formaldehyde
E. Wound depth beyond the depth of the dermis with tendency toward skin-edge inversion

157) Which of the following combination of incisions is USED in the Delivery Approach in Rhinoplasty?

A. Intercartilaginous and Transcolumellar
B. Intercartilaginous and Rim
C. Intercartilaginous and Marginal
D. Transcartilaginous and marginal
E. Transcartilaginous and Transcolumellar

158) Which of the following statements about the Open Approach in Rhinoplasty is FALSE?

A. Combines bilateral marginal incisions and a transcolumellar incision
B. Compromises a major support mechanism for the tip of the nose
C. Compromises a minor support mechanism for the tip of the nose
D. Provides excellent visualization for diagnosis, exposure and academic teaching
E. Fosters prolonged nasal tip postoperative edema

159) Which of the following muscles OPENS the eustachian tube?

A. Tensor Veli Palatine
B. Levator Veli Palatine
C. Musculus Uvulae
D. Glossopalatine
E. Palatopharyngeous

160) Which of the following potential complications in Lower Transconjuntival Blepharoplasty is THE LEAST possible to occur?

A. Overcorrection
B. Undercorrection
C. Increased skin wrinkles
D. Increased skin redundancy
E. Lower eyelid retraction


ANSWERS & REFERENCES



151) A     30 degrees

Davidson T.M.: Lacerations and Scar Revision, Chapter 23 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Mosby, Vol. 1, pp. 439-452, 1998

 http://emedicine.medscape.com/article/838297-treatment

152) A     Simons

Ridley M.B., VanHook S. M.: Aesthetic Facial Proportions, Chapter 9, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 104, 2002

Ridley M.B., VanHook S. M.: Aesthetic Facial Proportions, Chapter 11, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 128, 2009

Zimbler M. S.: Aesthetic Facial Analysis, chapter 19 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp.269-280

153) E     Chemical Peeling is not indicated.

http://emedicine.medscape.com/article/838696-treatment

154) A     Full-transfixion incision

Becker D.G.: Complications of Rhinoplasty, Chapter 39 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 453, 2002

Becker D.G.: Complications of Rhinoplasty, Chapter 49 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 641, 2009

155) C     Rhytidectomy will correct the wrinkles and creases of facial skin.

Kridel R.W.H., Covello L.V.: The Aging Face (Rhytidectomy), Chapter 180 in Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins, Third Edition, 2001, pp. 2317-2324

Kridel R.W.H., Soliemanzadeh P.: The Aging Face (Rhytidectomy), Chapter 177 in Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins, 4th Edition, 2006, pp. 2627-2649

156) E     Wound depth beyond the depth of the dermis with tendency toward skin-edge inversion

Toriumi D.M., Bagal A.A.: Cyanocrylate Tissue Adhesives for Skin Closure in the Outpatient Setting, Otolaryngology Clinics of North America, Volume 35, Number 1, February 2002, pp.103-107

157) C     Intercartilaginous and Marginal

Tardy ME., Toriumi DAM., Hecht D.A.: Philosophy and Principles of Rhinoplasty, chapter 32, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp.378-381, 2002

Tardy ME., Toriumi DAM., Hecht D.A.: Philosophy and Principles of Rhinoplasty, chapter 40, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) 507-528, 2009

Tardy Jr., M. E., Thomas J. R.: Rhinoplasty, chapter 36 in Cummings Otolaryngology-Head and Neck Surgery, Fifth Edition, Volume one, Mosby Elsevier, 2010, pp.508-544

158) B     Compromises a major support mechanism for the tip of the nose

Tardy ME., Toriumi DAM., Hecht D.A.: Philosophy and Principles of Rhinoplasty, chapter 32, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp.378-381, 2002

Tardy ME., Toriumi DAM., Hecht D.A.: Philosophy and Principles of Rhinoplasty, chapter 40, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) 507-528, 2009

159) A     Tensor Veli Palatine

Pasha R, Areden R.L. Facial Plastic and Reconstructive, Chapter 7 in Otolaryngology-Head and Neck Surgery, Clinical Reference Guide, (Pasha R., Editor), Singular Thomson Learning, 2001, p. 436

160) E     Lower eyelid retraction

Groth M.J.: Transconjuntival Lower Blepharoplasty in Facial Plastic Surgery Clinics of North America, Volume 6 Number 1, Saunders, pp. 63-65, 1998

---------------------------------------
 Updated:  May 1, 2017

161-170 MCQ in Facial Plastic and Reconstructive Surgery

161-170

161) The angle in a fusiform excision as indicated in the drawing SHOULD BE approximately?






A. 30 degrees
B. 40 degrees
C. 50 degrees
D. 60 degrees
E. 70 degrees

162) Which of the following statements regarding the palpebral spring is TRUE?

A. It is a passive animation method used in the management of lagophtalmos due to facial paralysis.
B. It is easily placed in proper position in the upper lid.
C. The lower end should be wrapped in a sheet of Gelfilm.
D. Both gravity and pressure are factors that help to restore eyelid function.
E. The distance between the spring arms should be 1.5 times the palpebral aperture.

163) The maximal muscle weakness response after the use of botulinum A Toxin injection is:

A. 2 weeks
B. 1 week
C. 36 hours
D. 24 hours
E. 12 hours

164) Which of the following is NOT CONSIDERED a “danger zone” in the use of dermabrasion?

A. Maxillary area
B. Zygomatic arch area
C. Malar eminence area
D. Chin area
E. Forehead area

165) Which of the following statements regarding injectable collagen materials is TRUE?

A. Zyderm I is used in a 25 mg/ml concentration.
B. Zyderm II is used in a 50 mg/ml concentration.
C. Zyplast is a collagen cross-link with gluteraldehyde.
D. Bovine collagen allergic sensitivity is about 5%.
E. Correction will remain for approximately 18 months.

166) Which of the following techniques is the MOST useful in the treatment of Deep-Pitted Acne Scars located around the oral commisure?

A. CO2 laser resurfacing
B. Erbium laser resurfacing
C. Dermabrasion
D. Punch excision with primary closure
E. Chemical Peeling

167) Which of the following statements regarding eyelid anatomy is FALSE?

A. The posterior lamella is composed by the tarsus, the lower lid retractors and the conjuntiva.
B. The cosmetically appealing eye has an “almond” shape.
C. The lower lid margin should be tangential to the inferior limbus of the iris.
D. The lateral canthus is approximately 2 mm higher than the medial canthus.
E. The shape and the position of the upper eyelid is the primary determinant of the general eye shape.

168) Which of the following clinical conditions will benefit THE MOST by the Transconjuntival Blepharoplasty?

A. Minimal orbital fat pseudoherniation with marked eyelid laxity and no orbicularis muscle hypertrophy
B. Marked orbital fat pseudoherniation, with minimal eyelid laxity and no orbicularis muscle hypertrophy
C. Minimal orbital fat pseudoherniation, no eyelid laxity and no orbicularis muscle hypertrophy
D. Marked orbital fat pseudoherniation, severe eyelid laxity and marked orbicularis muscle hypertrophy
E. Marked orbital fat pseudoherniation without eyelid laxity and marked orbicularis muscle hypertrophy

169) Which of the following conditions is BEST improved by Subciliary Blepharoplasty?

A. Fine wrinkles of the lower eyelids
B. Crow’s feet
C. Changes in coloration of the eyelid
D. Malar bags
E. Hypertrophied orbicularis muscle

170) Which of the following statements is THE MOST common presentation of cleft lip and palate disorders?

A. Combined cleft lip and palate
B. Isolated cleft palate
C. Isolated cleft lip
D. Isolated cleft lip and alveolus
E. Isolated unilateral imcomplete cleft lip


ANSWERS & REFERENCES



161) A     30 degrees

Davidson T.M.: Lacerations and Scar Revision, Chapter 23 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Mosby, Vol. 1, pp. 439-452, 1998

http://emedicine.medscape.com/article/884692-overview

162) E      The distance between the spring arms should be 1.5 times the palpebral aperture.

Seiff S. R., Carter S. R.: Reanimation of the Paretic Eyelid Complex in Facial Plastic Surgery Clinics of North America, Volume 6 Number 1, Saunders, pp. 25-27, 1998

163) B     1 week

Foster J.A., Wulc A.E.: Cosmetic Use of Botulinum A Toxin in Facial Plastic Surgery Clinics of North America, Volume 6 Number 1, Saunders, pp. 63-65, 1998

Lovice D.: Botulinum Toxin Use in Facial Plastic Surgery, Office-Based Procedures in Facial Plastic Surgery, Otolaryngologic Clinics of North America, Volume 35, Number 1, Saunders, pp. 171-172, February 2002

164) A     Maxillary area

Alt T.H.: Dermabrasion in Facial Plastic Surgery Clinics of North America, Volume 6 Number 1, Saunders, p. 51, 1998

165) C     Zyplast is a collagen cross-link with gluteraldehyde.

Cheng J. T., Perkins S. W., Hamilton M.M.: Collagen and Injectable Fillers, Office-Based Procedures in Facial Plastic Surgery, Otolaryngologic Clinics of North America, Volume 35, Number 1, Saunders, pp.73-77, February 2002

Maas C. S., Yu K. C. Y., Egan K. K.: Neuromodulators and Injectables Soft Tissue Substitutes, Chapter 28, Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), pp. 337-353, 2009

Skouge J. W., Diwan R. V.: Soft Tissue Augmentation with Injectable Collagen, Chapter 24, Facial Plastic and Reconstructive Surgery, (Papel & Nachlas, editors), pp. 208-214, 1992

166) D     Punch excision with primary closure

Mangat D.S., Robinson B.P.: Adjuntive Treatment of Deep-Pitted Acne Scars in Facial Plastic Surgery Clinics of North America, Volume 2 Number 1, Saunders, p. 69-75, 1994

167) E     The shape and the position of the upper eyelid is the primary determinant of the general eye shape.

http://emedicine.medscape.com/article/839264-overview

Friedman O., Zaldivar R. A., Wang T. D.: Blepharoplasty, chapter 30 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 439-451 

168) B     Marked orbital fat pseudoherniation, with minimal eyelid laxity and no orbicularis muscle hypertrophy

http://emedicine.medscape.com/article/838605-overview

Friedman O., Zaldivar R. A., Wang T. D.: Blepharoplasty, chapter 30 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 439-451 

169) E     Hypertrophied orbicularis muscle

http://emedicine.medscape.com/article/838696-overview

Friedman O., Zaldivar R. A., Wang T. D.: Blepharoplasty, chapter 30 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 439-451 

170) A     Combined cleft lip and palate

http://emedicine.medscape.com/article/877970-overview

Pasha R, Areden R.L.: Facial Plastic and Reconstructive, Chapter 7 in Otolaryngology-Head and Neck Surgery, Clinical Reference Guide, (Pasha R., Editor), Singular Thomson Learning, 2001, p. 437

--------------------------------------
Updated:  May 1, 2017

171-180 MCQ in Facial Plastic and Reconstructive Surgery

171-180

171) The drawing below represents a local flap used to close a facial defect. Which of the following statements BEST describes this reconstructive flap?


A. Rotation
B. Transposition
C. Advancement
D. Interpolation
E. Hinge

172) Which of the following statement is TRUE regarding normal adult anatomy and position of the ear?

A. The ear width is normally about 70% of its height.
B. The ear is normally about 75 mm in height.
C. The ear sits at a distance of about one ear length from the lateral orbital rim.
D. The auricle should be about 10 degrees displaced anteriorly from the vertical axis.
E. The angle formed by the auricle and the head is 40 degrees.

173) Which of the following statements regarding the use of Tretinoin (Retin A) is TRUE?

A. The liquid preparation is the most commonly used in the treatment of photoaging.
B. Dryness of the face is a very uncommon side effect of Tretinoin use.
C. Tretinoin therapy is a short-term maintenance therapy, no more than 6 months.
D. Moisturizers are seldom used with the Tretinoin therapy.
E. Desquamation will begin approximately 2 weeks after starting the medication.

174) Which of the following systems is related to the selective toxicity of Bupivacaine?

A. Cardiac
B. Renal
C. Hepatic
D. Lymphatic
E. Pulmonar

175) Which of the following medications is COMPATIBLE with the use of Botulinum Toxin?

A. Aminoglycosides
B. Penicillamine
C. Quinine
D. Calcium channel blockers
E. Statins

176) Which of the following statements about the running W-plasty technique use in scar revision is FALSE?

A. Each limb of the triangle should be 5 mm in length.
B. The apex of the triangle should be a 60 degree angle.
C. The final triangle at the terminal corners of a running W-plasty should be 60 degree angles.
D. Use for scars oriented perpendicular to the RSTL (relaxed skin tension lines).
E. Use for unsightly scars of the cheek area.

177) Which of the following surgical techniques is the BEST for reconstruction of a full-thickness defect comprising 50% of the upper lip and NOT INVOLVING the oral commisure?

A. Abbé flap
B. Estlander flap
C. Primary closure
D. Rhomboid flap
E. Nasolabial flap

178) Which of the following surgical techniques is the MOST useful in the repair of a “whistle” deformity after bilateral clef lip repair?

A. Unilateral Z-Plasty
B. V-Y advancement
C. Elliptic excision
D. O-T Flap
E. O-Z Flap

179) Which of the following statements regarding M-Plasty is TRUE?

A. It is commonly used to lengthen a contracting scar.
B. It is commonly used to camouflage an unsightly scar.
C. It is commonly used to decrease the volume of healthy skin excised.
D. It is commonly used to break a scar into multiple irregular small segments.
E. It is commonly used to excise a scar (bilateral M-Plasty technique).

180) Which of the following blepharoplastic surgical techniques is the MOST appropriate for a 53-year-old male patient with severe skin abundance of the lower eyelid, almost no fat pocket redundancy and no evidence of lower eyelid laxity?

A. Transcutaneous blepharoplasty with skin-muscle flap
B. Transcutaneous blepharoplasty with skin flap
C. Transconjuntival blepharoplasty
D. Transconjuntival blepharoplasty with repositioning of orbital fat
E. No surgical blepharoplastic operation is indicated.


ANSWERS & REFERENCES



171) C     Advancement

Park S. S.: Local and Regional Cutaneous Flaps, in chapter 44, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp.533-534, 2002

Park S. S.: Local and Regional Cutaneous Flaps, in chapter 54, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp.721-743, 2009

Baker S. R.: Reconstruction of Facial Defects, Chapter 27 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume 1, Mosby, Third Edition, 1998, pp. 527-533

172) C      The ear sits at a distance of about one ear length from the lateral orbital rim.

Ruder R. O.: Microtia Reconstruction, Chapter 57 Facial Plastic and Reconstructive Surgery (Papel and Nachlas), First Edition, Mosby, p. 536, 1992

Ruder R. O.: Congenital Auricular Deformities, Chapter 75 Facial Plastic and Reconstructive Surgery (Papel I.D., editor), Third Edition, Thieme, pp. 1043-1057, 2009

173) E     Desquamation will begin approximately 2 weeks after starting the medication.

Bark J.P.: A Systematic Approach to Retin-A in Facial Plastic Surgery Clinics of North America, Volume 6 Number 1, Saunders, pp. 11-14, 1998

174) A     Cardiac

Ahlstrom K.K., Frodel J. L.: Local Anesthetics for Facial Plastic Procedures, Office-Based Procedures in Facial Plastic Surgery, Otolaryngologic Clinics of North America, Volume 35, Number 1, pp. 45-50, February 2002

Fletcher M. V.: Anesthesia in Facial Plastic Surgery, Chapter 17 Facial Plastic and Reconstructive Surgery (Papel I.D., editor), Third Edition, Thieme, pp. 189-197, 2009

175) E     Statins

Lovice D.: Botulinum Toxin Use in Facial Plastic Surgery, Office-Based Procedures in Facial Plastic Surgery, Otolaryngologic Clinics of North America, Volume 35, Number 1, Saunders, pp. 183-185, February 2002

http://emedicine.medscape.com/article/1271380-overview

176) C     The final triangle at the terminal corners of a running W-plasty should be 60 degree angles.

Park S.: Scar Revision through W-Plasty in Facial Plastic Surgery Clinics of North America, Saunders, Vol. 6 Number 2, May 1998, p. 158

 http://emedicine.medscape.com/article/838297-treatment

177) A     Abbé flap

Baker S. R.: Reconstruction of Facial Defects, Chapter 27 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Mosby, Vol. 1, pp. 544-548, 1998

http://emedicine.medscape.com/article/876634-treatment

178) B      V-Y advancement

Bardach J., Noordhoff M. S.: Correction of Secondary Bilateral Cleft Lip Deformities, Chapter 5, in Surgical Techniques in Cleft Lip and Palate, (Bardach, Salyer), Mosby, 1991, pp. 174-183

179) C     It is commonly used to decrease the volume of healthy skin excised.

Cook T.A., Guida R.A., Burke A.J.C.: Soft Tissue Techniques, Chapter 3 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 29, 2002

Cook T.A., Guida R.A., Burke A.J.C.: Soft Tissue Techniques, Chapter 3 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 30, 2009

 http://emedicine.medscape.com/article/838297-treatment

180) B     Transcutaneous blepharoplasty with skin flap

http://emedicine.medscape.com/article/838696-overview


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Updated:  May 1, 2017

181-190 MCQ in Facial Plastic and Reconstructive Surgery

181-190

181) Which of the following surgical techniques have been USED in the reconstruction of the lower lip defect seen in the drawing below? Click the picture to enlarge image.

A. Abbé Flap
B. Eslander Flap
C. Karapandzic Flap
D. Bernard-Burrow Flap
E. Gillies Flap

182) Which of the following is the ADEQUATE INTERVAL between scalp reductions?

A. 1 month
B. 1 ½ months
C. 2 months
D. 2 ½ months
E. 3 months

183) The distance from the nasal tip to the alar line measures 0.55 - 0.60 of the distance from the nasion to the tip of the nose. To WHOM do we attribute this rule?

A. Goode
B. Crumley
C. Byrd
D. Simmons
E. Gonzalez-Ulloa

184) Which of the following with reference to Rhinoplasty is NOT considered an incision?

A. Intercartilaginous
B. Transcartilaginous
C. Transcolumellar
D. Marginal
E. Cartilage-splitting

185) Which of the following surgical techniques used to treat a long curvilinear scar - not parallel to RSTL- in the cheek is the BEST related to camouflage?

A. Running W-Plasty
B. Single M-Plasty
C. Multiple M-Plasty
D. Multiple Z-Plasty
E. Geometric Broken Line Closure

186) Which of the following with reference to Rhinoplasty is NOT considered an approach?

A. Cartilage-splitting
B. Retrograde
C. Delivery
D. External
E. Complete strip

187) Which of the following relationships of the lips to the nasomental line is CORRECT?

A. Upper lip is 4 mm anterior; lower lip 2 mm anterior.
B. Upper lip is 4 mm posterior, lower lip 2 mm posterior.
C. Upper lip is 2 mm anterior, lower lip 4 mm posterior.
D. Upper and lower lips are tangential to the nasomental line.
E. Upper lip is 4 mm posterior, lower lip 4 mm posterior.

188) Which of the following anatomic REGIONS is bounded by the nasal septum, the caudal margin of the upper lateral cartilage and the floor of the nose?

A. Scroll region
B. Rhinion
C. Sellion
D. Nasal valve
E. Internasal suture line

189) Which of the following infections is the MOST common in the postoperative period after Laser Skin Resurfacing?

A. Herpes simplex virus
B. Herpes zoster virus
C. Staphylococcus aureus
D. Pseudomonas aeruginosa
E. Candida

190) Which of the following statements about scalp reduction is TRUE?

A. It is adequate for frontal hair loss.
B. It is adequate for Norwood alopecia class I and II.
C. It is adequate for Norwood alopecia class V.
D. The “Stretch-Back” phenomenon is insignificant.
E. It is usually carried out under general anesthesia.


ANSWERS & REFERENCES



181) C     Karapandzic Flap

Williams III E.F., Hove C.: Lip Reconstruction, Chapter 51, Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, pp. 634-645, 2002

DeFatta R. J., Williams III E. F.: Lip Reconstruction, Chapter 61, Facial Plastic and Reconstructive Surgery, Third edition (Ira Papel, editor), Thieme Medical Publishers, pp. 841-854, 2009

182) E      3 months

Unger M.G.: Scalp Reduction, Hair Replacement Surgery, Facial Plastic Surgery Clinics of North America, Volume 2, Number 2, pp. 166, May 1994

183) A     Goode

Ridley M.B., VanHook S. M.: Aesthetic Facial Proportions, Chapter 11, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 128, 2009

Papel I. D., Mabrie, D. C.: Deprojecting the Nasal Profile, Rhinoplasty and Septoplasty, Part I ( Park S.S., Holt G. R., editors) The Otolaryngologic Clinics of North America, Vol. 32, No. 1, February 1999, pp.71-73

Zimbler M. S.: Aesthetic Facial Analysis, chapter 19 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 269-280

184) E     Cartilage-splitting

Toriumi D.M., Becker D.G.: Rhinoplasty: Dissection Manual, Lippincott Williams & Wilkins, pp.160, 1999

Tardy Jr. M. E., Toriumi D. M., Hecht D. A.: Philosophy and Principles of Rhinoplasty, Chapter 40, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 507-528, 2009

Tardy Jr. M. E., Thomas J. R.: Rhinoplasty, chapter 36 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 508-544

185) E     Geometric Broken Line Closure

Cook T.A., Guida R.A., Burke A.J.C.: Soft Tissue Techniques, Chapter 3 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 35-36, 2002

Cook T.A., Guida R.A., Burke A.J.C.: Soft Tissue Techniques, Chapter 3 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 27-39, 2009

186) E     Complete strip

Tardy M.E., Toriumi D.M., Hecht D.A.: Philosophy and Principles of Rhinoplasty, Chapter 32 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 378, 2002

Tardy Jr. M.E., Toriumi D.M., Hecht D.A.: Philosophy and Principles of Rhinoplasty, Chapter 40 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 516, 2009

187) B

Ridley M.B., VanHook S. M.: Aesthetic Facial Proportions, Chapter 9, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 106, 2002

Ridley M.B., VanHook S. M.: Aesthetic Facial Proportions, Chapter11, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 130, 2009

Zimbler M.S.: Aesthetic Facial Analysis, chapter 19 in Cummings Otolaryngology- Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 269-280

188) D     Nasal valve

Toriumi D.M., Becker D.G.: Rhinoplasty: Dissection Manual, Lippincott Williams & Wilkins, pp.5-6, 1999

Becker D. G.: Complications of Rhinoplasty, chapter 39 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 458, 2002

Becker D. G.: Complications of Rhinoplasty, chapter 49 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 645, 2009

189) A     Herpes simplex virus

Hecht D.A., Toriumi D.M.: Laser Skin Resurfacing, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins) Third Edition, Chapter 189, 2001, p. 2467-2468

190) C     It is adequate for Norwood alopecia class V.

Unger M.G.: Scalp Reduction, Hair Replacement Surgery, Facial Plastic Surgery Clinics of North America, Volume 2, Number 2, pp. 163-180, May 1994

Bassichis B. A., Konior R. J.: Management of Alopecia, Head and Neck Surgery-Otolaryngology, (Bailey B.J., editor) Lippincott Williams & Wilkins) 4th Edition, Chapter 184, 2006, p. 2749-2759

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 Updated:  May 1, 2017