501-510 MCQ in Facial Plastic and Reconstructive Surgery

501-510

501) The drawing below REPRESENTS a:



A. Vertical mattress closure
B. Horizontal mattress closure
C. Subcutaneous interrupted closure
D. Interrupted intradermal subcuticular closure
E. Horizontal half-buried mattress closure

502) Which of following instruments is RARELY used in soft tissue facial plastic surgery?

A. Double skin hooks
B. Brown-Adson tissue forceps
C. Bishop-Harman tissue forceps
D. No. 10 knife blades
E. Webster needle holder

503) Which of the following statements represents INCORRECT TECHNIQUE for closure of excisions in facial soft tissue surgery?

A. Equalize the sides of the incision by “Halving”.
B. Equalize the sides of the incision with a “Burrow triangle”
C. Sutures must provide eversion and tension relief.
D. Use simple interrupted chromic gut sutures.
E. Use steri strips to reinforce the wound and to relieve further wound tension.

504) Which of the following techniques for scar revision IS CORRECTLY described?

A. Simple Fusiform Excision - ideally the angles should be greater than 60 degrees.
B. Serial Excision - A period of 12 weeks is required between excisions.
C. Z-Plasty - The arms should be 1.5 cm for the face.
D. W-Plasty - This scar revision will produce wound lengthening.
E. Geometric Broken Line Closure - It is easier to perform than W-Plasty.

505) Which of the following wrinkles CANNOT adequately treated with Botox?

A. Horizontal forehead lines
B. Glabellar vertical lines
C. Glabellar horizontal lines
D. Lateral orbital lines (crow’s feet)
E. Actinic damage lines

506) Which of the following dosages is the MEDIAN LETHAL DOSE (LD50) of Botox for an adult person weighing 70 Kg?

A. 500 units
B. 1000 units
C. 2000 units
D. 3000 units
E. 4000 units

507) Which of the following statements is FALSE about Open Rhinoplasty?

A. A high transverse transcolumellar incision is recommended.
B. The Gull Wing Incision heals with a more favorable scar than the V-shaped Incision.
C. It provides better surgical exposure.
D. It is ideal in cases of Revision Rhinoplasty and Cleft Nose Repair.
E. 5-0 prolene sutures are used to close the columellar incision.

508) A 72 year old female is referred to you with a biopsy diagnosis of Merkel Cell carcinoma located in the skin over the left temple area. The lesion is firm, raised and ulcerated, measuring 1. 5 cm. in diameter What is the BEST treatment option for this particular patient?

A. Curettage and electrodessication
B. Wide local excision
C. Wide local excision and prophylactic lymphadenectomy
D. Chemotherapy
E. Radiation therapy

509) Which of the following is the IDEAL medium for storage and transport of an avulsed tooth prior to replantation in its socket?

A. Cold Milk
B. Cool tap water
C. Sterile normal saline
D. Sterile half normal saline
E. Hipertonic solution of glucose

510) Which of the following complications of dermabrasion is the MOST COMMON in dermabrasion?

A. Milia
B. Hyperpigmentation
C. Hypopigmentation
D. Postoperative herpetic infection
E. Scarring


ANSWERS & REFERENCES


501) E     Horizontal half-buried mattress closure

Cook T. A., Guida R. A., Burke A.J.C.: Soft Tissue Techniques, Chapter 3, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 31, 2002

Cook T. A., Guida R. A., Burke A.J.C.: Soft Tissue Techniques, Chapter 3, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 33, 2009

502) D     No. 10 knife blades

Cook T. A., Guida R. A., Burke A.J.C.: Soft Tissue Techniques, Chapter 3, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 31, 2002

Cook T. A., Guida R. A., Burke A.J.C.: Soft Tissue Techniques, Chapter 3, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 28, 2009

503) D     Use simple interrupted chromic gut sutures.

Cook T. A., Guida R. A., Burke A. J.C.: Soft Tissue Techniques, Chapter 3, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 29-33, 2002

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

504) B     Serial Excision - A period of 12 weeks is required between excisions.

Kokoska M. S., Thomas J. R.: Scar Revision, Chapter 5 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 57-59, 2002

Kokoska M. S., Thomas J. R.: Scar Revision, Chapter 5 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 59-65, 2009

505) E     Actinic damage lines

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

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

506) D     3000 units

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

Monhian N., Ahn M.S., Maas C. S.: Injectable and Implantable Materials for Facial Wrinkles, Chapter 22 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 257, 2002

Meyer T. K., Blitzer A.: Botulinium Toxin for Facial Wrinkles, Chapter 30 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 370, 2009

507) A     A high transverse transcolumellar incision is recommended.

Adamson P. A., Huang H.: Open Rhinoplasty, Chapter 33, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 390-400, 2002

Adamson P. A., Litner J. A.: Open Rhinoplasty, Chapter 41, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 390-400, 2009

508) B     Wide local excision

Hendrix J. D., Slingluff C.L.: Cutaneous Malignancies: Diagnosis and Treatment, Chapter 42, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 503-504, 2002

Hendrix J. D., Slingluff C.L.: Cutaneous Malignancies: Diagnosis and Treatment, Chapter 52, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 675-702, 2009

509) A     Cold Milk

Garza J. R.: Mandibular Fractures, Chapter 61 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 781, 2002

Garza J. R.: Mandibular Fractures, Chapter 72 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 1013, 2009

510) A     Milia

http://emedicine.medscape.com/article/1126231-treatment

Mandy S. H., Monheit G. D.: Dermabrasion and Chemical Peels, Chapter 20, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 226-227, 2002

Mandy S. H., Monheit G. D.: Dermabrasion and Chemical Peels, Chapter 25, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 301-320, 2009

-------------------------------------
Updated: June 1, 2017

511-520 MCQ in Facial Plastic and Reconstructive Surgery

511-520

511) The drawing below represents a female brow position. Which of the following anatomical areas occupies A LESS THAN IDEAL POSITION?

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

512) Which of the following chemotherapeutic agents is the MOST active in the treatment of systemic malignant melanoma?

A. Interleukin-2
B. Interferon-alpha
C. Dacarbazine
D. Vincristine
E. Cisplastin

513) Which of the following facial defect shapes is BEST corrected using a Rotation Flap?

A. Circular
B. Square
C. Rectangular
D. Rhomboid
E. Triangular

514) Which of the following indicators is the MOST reproducible prognostic factor in malignant melanoma?

A. Clark level
B. Breslow thickness
C. Growth phase
D. Ulceration
E. Presence of tumor-infiltrating lymphocytes

515) Which of the following nasal areas has the THINNEST skin?

A. Nasion
B. Rhinion
C. Supratip
D. Tip
E. Columella

516) Which of the following statements about Facial Analysis for Rhinoplasty is CORRECT?

A. The nasofrontal angle connects the nasion to the trichion and the nasion to the nasal tip.
B. The ideal nasolabial angle in men is 110 degrees.
C. Adequate projection of the nose is present when 60% of the horizontal nasal projection lies anterior to the upper lip.
D. On lateral view the columella profile should have one or two breaks.
E. Columellar show measures 6 mm in the male patient.

517) Which of the following statements regarding base view analysis in Rhinoplasty is FALSE?

A. The nose should have a base view similar to an isosceles triangle.
B. The lobule is one third of the height of an isosceles triangle and the columella two thirds the height.
C. The width of the nostril should be about the same length as the width of the columella.
D. The nostrils should be symmetrical and pear shaped.
E. The nostrils should have, in the leptorrhine nose, their long axis oriented at a 30 degree-angle to the columella.

518) In the inflammatory phase of the wound healing when the MACROPHAGE is the PREDOMINANT cell in the wound?

A. At 12 hours
B. At 24 hours
C. At 72 hours
D. On the 5th day
E. On the 6th day

519) In the process of wound healing when the FIBROBLASTS appear in the wound?

A. At 12 hours
B. At 72 hours
C. On the 4th day
D. On the 5th day
E. On the 6th day

520) Which of the following percentages is the one corresponding to the tensile strength of scar tissue AFTER adequate wound healing?

A. 50% of the unwounded normal skin
B. 60% of the unwounded normal skin
C. 80% of the unwounded normal skin
D. 90% of the unwounded normal skin
E. 100% of the unwounded normal skin


ANSWERS & REFERENCES


511) E     E

Quatela V. C., Graham III, D. , Sabini P.: Rejuvenation of the Brow and Midface, Chapter 16, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 173, 2002

Graham III, Quatela V. C., D. , Sabini P.: Rejuvenation of the Brow and Midface, Chapter 20, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 227, 2009


512) C     Dacarbazine

Hendrix J. D., Slingluff C. L.: Cutaneous Malignancies: Diagnosis and Treatment, Chapter 42, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel,editor) p. 500, 2002

Hendrix J. D., Slingluff C. L.: Cutaneous Malignancies: Diagnosis and Treatment, Chapter 52, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 692, 2009

513) E     Triangular

Cook T. A., Guida R. A., Burke A. J.C.: Soft Tissue Techniques, Chapter 3, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 34, 2002

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

514) B     Breslow thickness

Hendrix J. D., Slingluff C.L.: Cutaneous Malignancies: Diagnosis and Treatment, Chapter 42, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 496-497, 2002

Hendrix J. D., Slingluff C.L.: Cutaneous Malignancies: Diagnosis and Treatment, Chapter 52, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 675-702, 2009

515) E     Columella

Orten S. S., Hilger P. A.: Facial Analysis of the Rhinoplasty Patient, Chapter 31, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 361-362, 2002

Boahene Kofi D.O., Orten S. S., Hilger P. A.: Facial Analysis of the Rhinoplasty Patient, Chapter 38, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 477-487, 2009

516) C     Adequate projection of the nose is present when 60% of the horizontal nasal projection lies anterior to the upper lip

Orten S. S., Hilger P. A.: Facial Analysis of the Rhinoplasty Patient, Chapter 31, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 364-365, 2002

Boahene Kofi D.O., Orten S. S., Hilger P. A.: Facial Analysis of the Rhinoplasty Patient, Chapter 38, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 477-487, 2009

517) E     The nostrils should have, in the leptorrhine nose, their long axis oriented at a 30 degree-angle to the columella.

Orten S. S., Hilger P. A.: Facial Analysis of the Rhinoplasty Patient, Chapter 31, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 366, 2002

Boahene Kofi D.O., Orten S. S., Hilger P. A.: Facial Analysis of the Rhinoplasty Patient, Chapter 38, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 477-487, 2009

518) C     At 72 hours

Fisher E., Frodel Jr., J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 16-17, 2002

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, 2009

519) B     At 72 hours

Fisher E., Frodel Jr., J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 16-19, 2002

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, 2009

520) C     80% of the unwounded normal skin

Fisher E., Frodel Jr., J. L.: Wound Healing, Chapter 2, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 16-20, 2002

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, 2009

-------------------------------------
Updated: June 1, 2017

521-530 MCQ in Facial Plastic and Reconstructive Surgery

521-530

521) With reference to the drawing below the width of the base of the bony sidewall of the nose is approximately what percent of the width of the alar base?


A. 40 %
B. 50 %
C. 60 %
D. 75%
E. 90 %

522) Which of the following statements is FALSE about the medical treatment of male pattern baldness with finasteride?

A. Systemic therapy can cause reduced libido and sexual potency.
B. Finasteride has no affinity for androgen receptors.
C. Finasteride works by blocking the peripheral conversion of testosterone to dihydrotestosternone (DHT).
D. The recommended oral dose of finasteride is 5 mg/day.
E. Finasteride is a competitive and specific inhibitor of type II 5-α-reductase.

523) Execution of the JURI Flap is accomplished in HOW MANY STAGES?

A. 1
B. 2
C. 3
D. 4
E. 5

524) Which of the following facial areas is MORE PRONE to delayed healing and scarring after the use of Laser Resurfacing or Chemical Peeling Techniques?

A. Forehead
B. Temple
C. Cheek
D. Nasal
E. Neck

525) Which of the following ARE characteristics of unilateral cleft lip and nose?

A. The nasal tip deflects toward the cleft side.
B. The columella deviates to the cleft side.
C. The cleft side alar base is positioned posteriorly, laterally and inferiorly.
D. The caudal septum deflects toward the cleft side.
E. The nasal floor and sill are absent on the noncleft side.

526) Which of the following is INCORRECT about a Rhinoplasty done for correction of a unilateral cleft lip nasal deformity?

A. Open approach is advisable.
B. Modified columellar incision using bilateral forked flaps is advisable.
C. Septoplasty by removing a strip of cartilage inferiorly to allow the “swing” over the nasal spine is advisable.
D. Cartilaginous columellar strut graft to enhance projection is advisable.
E. Lower lateral cartilages are divided lateral to the dome, reconstructed and sutured to the columellar strut.

527) Which of the following facial plating systems is CORRECTLY RELATED to the indication?

A. Miniplates - Le Fort fractures.
B. Microplates - Zygomatic buttress fractures.
C. Dynamic Compression Plates - highly comminuted mandibular fractures.
D. Eccentric Dynamic Compression Plates - glabellar region fractures.
E. Tension Band - inferior border of the mandible.

528) Which of the following indications is INCORRECT for Three-Dimensional Plating?

A. Comminuted calvarial fractures
B. Orbital defects
C. Blow-out factures
D. Midface fractures
E. Angle of the mandible fractures

529) A patient has been diagnosed with PANFACIAL FRACTURES. Which of the following fractures will be repaired LAST?

A. Mandibular fractures
B. Maxillary fractures
C. Malar bones fractures
D. Naso-orbitoehtmoid fractures
E. Frontal Bones fractures

530) Which of the following statements regarding the surgical repair of bilateral cleft lip is FALSE?

A. Single-stage repair is recommended in symmetrical bilateral cleft lips with moderate protruding prolabium and premaxilla.
B. Single-stage repair maximizes symmetry of the lip compared to the two-stage procedure.
C. The orbicularis oris muscle from each lateral lip segment is advanced supero-medially and sutured to the nasal sills.
D. The mid-prolabial flap will form the philtrum.
E. The two lateral prolabial flaps will be sutured to form the nasal sill and the nasal floor on each side of the nose.


ANSWERS & REFERENCES


521) D     75%

Orten S. S., Hilger P. A: Facial Analysis of the Rhinoplasty Patient, Chapter 31, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 363, 2002

Boahene K. D., Orten S. S., Hilger P. A: Facial Analysis of the Rhinoplasty Patient, Chapter 38 in Facial Plastic and Reconstructive Surgery (Papel, I. editor), Thieme, Third Edition, 2009, pp. 477-487

522) D     The recommended oral dose of finasteride is 5 mg/day.

Konior R. J., Kridel R. W. H.: Management of Alopecia, Chapter 188 in Head and Neck Surgery-Otolaryngology (Bailey), Third Edition, Lippincott Williams & Wilkins, p. 2452, 2001

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

Rousso D. E., Sule S., Stough D., Whitworth J. M.: Hair Replacement Techniques, Chapter 33 in Facial Plastic and Reconstructive Surgery (Papel, I. editor), Thieme, Third Edition, 2009, pp. 409-420

523) D     4

Konior R. J., Kridel R. W. H.: Management of Alopecia, Chapter 188 in Head and Neck Surgery-Otolaryngology (Bailey), Third Edition, Lippincott Williams & Wilkins, 2001, p. 2458

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

524) E     Neck

Hecht D. A. , Toriumi D. M.: Laser Skin Resurfacing, Chapter 189 in Head and Neck Surgery-Otolaryngology (Bailey), Third Edition, Lippincott Williams & Wilkins, 2001, p. 2465

Carniol P. J.: Laser Skin Resurfacing, Chapter 182B in Head and Neck Surgery-Otolaryngology (Bailey), Third Edition, Lippincott Williams & Wilkins,2009, pp. 2725-2729

525) C     The cleft side alar base is positioned posteriorly, laterally and inferiorly.

Coleman Jr. J. R., Sykes J. M.: Cleft Lip Rhinoplasty, Chapter 66, in Head and Neck Surgery-Otolaryngology (Bailey), Third Edition, Lippincott Williams & Wilkins, p. 831, 2001

Coleman Jr. J. R., Sykes J. M.: Cleft Lip Rhinoplasty, Chapter 77 in Facial Plastic and Reconstructive Surgery (Papel, I. editor), Thieme, Third Edition, 2009, pp. 1079-1093

526) B     Modified columellar incision using bilateral forked flaps is advisable.

Coleman Jr. J. R., Sykes J. M.: Cleft Lip Rhinoplasty, Chapter 66 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 837-839, 2002

Coleman Jr. J. R., Sykes J. M.: Cleft Lip Rhinoplasty, Chapter 77 in Facial Plastic and Reconstructive Surgery (Papel, I. editor), Thieme, Third Edition, 2009, pp. 1079-1093

527) A     Miniplates - Le Fort fractures.

Costantino P. D., Wolpoe M.: Facial Plating Systems, Chapter 56, in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 707-715, 2002

Costantino P. D., Tadros M., Wolpoe M.: Principles of Facial Plating System, Chapter 67 in Facial Plastic and Reconstructive Surgery (Papel, I. editor), Thieme, Third Edition, 2009, pp. 929-944

528) E     Angle of the mandible fractures

Costantino P. D., Wolpoe M.: Facial Plating Systems, Chapter 56, in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 707-715, 2002

Costantino P. D., Tadros M., Wolpoe M.: Principles of Facial Plating System, Chapter 67 in Facial Plastic and Reconstructive Surgery (Papel, I. editor), Thieme, Third Edition, 2009, pp. 929-944

529) D     Naso-orbitoehtmoid fractures

Strong E. B., Sykes J. M.: Frontal Sinus and Nasoorbitaoehtmoid Complex Fractures, Chapter 59, in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor), 2002, p.756

Strong E. B.: Frontal Sinus and Naso-orbital-oehtmoid Complex Fractures, Chapter 70, in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor), 2009, pp. 977-990

530) C     The orbicularis oris muscle from each lateral lip segment is advanced supero-medially and sutured to the nasal sills.

Dyleski R. A., Crockett D. M., Seibert R. W.: Cleft Lip and Palate: Evaluation and Treatment of the Primary Deformity, Chapter 80 Head and Neck Surgery – Otolaryngology, (Bailey), Volume I, Lippincott Williams & Wilkins, Third Edition, pp. 969-970, 2001

Capone R. B., Sykes J. M.: Evaluation and Management of Cleft Lip and Palate Disorders, Chapter 76 in Facial Plastic and Reconstructive Surgery (Papel, I. editor), Thieme, Third Edition, 2009, pp. 1059-1078

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Updated: June 1, 2017

531-540 MCQ in Facial Plastic and Reconstructive Surgery

531-540

531) Which of the following areas represented in the drawing of the MOUTH below indicates the MESIAL side of the tooth?


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

532) Which of the following treatments is CORRECT for frostbite of the auricle?

A. Rapid rewarming with moist cotton pledgets at a warm-water temperature of 40º C for 20 minutes.
B. Rubbing first with snow then rapid rewarming with moist cotton pledgets at a warm-water temperature of 40º C for 20 minutes.
C. Slow rewarming with moist cotton pledgets, first at a warm-water temperature of 35º C for 20 minutes, then at 40º C for 20 minutes.
D. Slow rewarming with moist cotton pledgets at a warm-water temperature of 35º C for 30 minutes.
E. Exposure to radiant heat until defrosting occurs

533) Which of the following pigmented lesions is the MOST invasive with the POOREST prognosis?

A. Lentigo maligna
B. Superficial spreading melanoma
C. Nodular melanoma
D. Acral lentiginous melanoma
E. Blue nevi

534) A patient has a malignant melanoma in the cheek area with a 3 mm thickness. The current recommended margin for adequate resection is?

A. 0.5 cm
B. 1.0 cm
C. 2.0 cm
D. 2.5 cm
E. 3.0 cm

535) Which of the following facial areas is NOT considered high-risk for aggressive cutaneous malignancies?

A. Preauricular
B. Postauricular
C. Nose
D. Cheek
E. Columella

536) Which of the following facial areas is the MOST common location for recurrence of cutaneous malignancies?

A. Temple
B. Ear
C. Periorbital
D. Nose
E. Scalp

537) Which of the following statements about gold weight implantation used in the upper eyelid for facial paralysis is FALSE?

A. Gold weight implantation is a lid loading and gravity-dependent procedure.
B. Gold weight implantation has a high success rate and low complication rate.
C. Gold weight implantation can be performed under local anesthesia.
D. Gold weight implantation usually leaves a visible bump on the upper eyelid when it is closed.
E. Gold weight implantation is placed in a pocket with the sides of the two fenestrations facing caudally.

538) Which of the following combinations of hair and skin color is the LEAST conducive to hair replacement techniques?

A. Blond hair and pale skin
B. Dark hair and dark skin
C. Salt and pepper hair and dark skin
D. Red hair and light skin
E. Dark hair and light skin

539) Which of the following patients is MOST LIKELY to be discouraged from hair transplantation?

A. 20 year-old male
B. 30 year-old male
C. 40 year-old male
D. 50 year-old male
E. 60 year-old male

540) Which of the following statements about Rhinoplasty complications is FALSE?

A. The incidence of postoperative rhinoplasty complications is around 12%.
B. There are complications related to underresection.
C. There are complications related to overesection, usually associated with scarring.
D. As a general rule, revision rhinoplasty is not recommended until at least 1 year after the original procedure.
E. Complications related to excessive reduction are usually the easiest to correct.


ANSWERS & REFERENCES


531) C     C

Sykes J. M.: Orthognatic Surgery, Chapter 67, Head and Neck Surgery – Otolaryngology, (Bailey), Volume I, Lippincott Williams & Wilkins, Third Edition, p. 844, 2001

532) A     Rapid rewarming with moist cotton pledgets at a warm-water temperature of 40º C for 20 minutes.

Calhoun K. H.: Auricular Trauma, Chapter 62 Head and Neck Surgery – Otolaryngology, (Bailey), Volume I, Lippincott Williams & Wilkins, Third Edition, pp. 738-739, 2001

Jordan J. R., Calhoun K. H.: Management of Soft Tissue and Auricular Trauma, Chapter 67 Head and Neck Surgery – Otolaryngology, (Bailey), Volume I, Lippincott Williams & Wilkins, 4th Edition, pp. 935-948, 2006

533) C     Nodular melanoma

Myers J. N., Nemecheck A. J.: Malignant Melanoma, Chapter 104 Head and Neck Surgery – Otolaryngology, (Bailey), Volume II, Lippincott Williams & Wilkins, Third Edition, pp. 1237-1238,
2001

Myers J. N., Nemecheck A. J.: Malignant Melanoma, Chapter 106 Head and Neck Surgery – Otolaryngology, (Bailey), Volume II, Lippincott Williams & Wilkins, 4th Edition, pp. 1469-1479,
2006

534) C     2.0 cm

Myers J. N., Nemecheck A. J.: Malignant Melanoma, Chapter 104 Head and Neck Surgery – Otolaryngology, (Bailey), Volume II, Lippincott Williams & Wilkins, Third Edition, pp. 1241-1244, 2001

Myers J. N., Nemecheck A. J.: Malignant Melanoma, Chapter 106 Head and Neck Surgery – Otolaryngology, (Bailey), Volume II, Lippincott Williams & Wilkins, 4th Edition, pp. 1469-1479,
2006

Hendrix J. D., Slingluff C.L.: Cutaneous Malignancies: Diagnosis and Treatment, Chapter 42 , Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 497-500, 2002

http://emedicine.medscape.com/article/1100753-treatment

535) D     Cheek

Stucker F. J., Nathan C. O., Lian T. S.: Cutaneous Malignancy Chapter 103 Head and Neck Surgery – Otolaryngology, (Bailey), Volume II, Lippincott Williams & Wilkins, Third Edition, pp. 1228-1229, 2001

Stucker F. J., Nathan C. O., Lian T. S.: Cutaneous Malignancy Chapter 105 Head and Neck Surgery – Otolaryngology, (Bailey), Volume II, Lippincott Williams & Wilkins, 4th Edition, pp. 1455-1468, 2006

536) D     Nose

Stucker F. J., Nathan C. O., Lian T. S.: Cutaneous Malignancy Chapter 103 Head and Neck Surgery – Otolaryngology, (Bailey), Volume II, Lippincott Williams & Wilkins, Third Edition, pp. 1228-1229, 2001

Stucker F. J., Nathan C. O., Lian T. S.: Cutaneous Malignancy Chapter 105 Head and Neck Surgery – Otolaryngology, (Bailey), Volume II, Lippincott Williams & Wilkins, 4th Edition, pp. 1455-1468, 2006

537) E     Gold weight implantation is placed in a pocket with the sides of the two fenestrations facing caudally.

Clark J. M., Shockley W. W.: Management and Reanimation of the Paralyzed Face, Chapter 53 Facial Plastic and Reconstructive Surgery, (Papel, Nachlas), Mosby, p. 666, 1992

Clark J. M., Shockley W. W.: Management of the Paralyzed Face, Chapter 63 Facial Plastic and Reconstructive Surgery, (Papel, Nachlas), Thieme, Third Edition, pp. 869-894, 2009

538) E     Dark hair and light skin

Stough D., Whitworth J. M.: Hair Replacement Techniques, Chapter 26, Facial Plastic and Reconstructive Surgery, (Papel, Nachlas), Mosby, p. 301, 1992

Rousso d. E., Sule S., Stough D., Whitworth J. M.: Hair Replacement Techniques, Chapter 33, Facial Plastic and Reconstructive Surgery, (Papel, I. , editor), Thieme, Third Edition, pp. 409-420, 2009

539) A     20 year-old male

Stough D., Whitworth J. M.: Hair Replacement Techniques, Chapter 26 Facial Plastic and Reconstructive Surgery, (Papel, Nachlas), Mosby, p. 302, 1992

Rousso d. E., Sule S., Stough D., Whitworth J. M.: Hair Replacement Techniques, Chapter 33, Facial Plastic and Reconstructive Surgery, (Papel, I. , editor), Thieme, Third Edition, pp. 409-420, 2009

540) E     Complications related to excessive reduction are usually the easiest to correct.

Becker D. G.: Complications of Rhinoplasty, Chapter 39 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Second edition (Ira Papel, editor) pP. 452-460, 2002

Becker D. G.: Complications of Rhinoplasty, Chapter 49 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 639-648 , 2009

-------------------------------------
Updated: June 1, 2017

541-550 MCQ in Facial Plastic and Reconstructive Surgery

541-550

541) A 20 year old patient has a penetrating injury, stab wound to the right side of his neck. (See drawing below.) The patient arrived at the ER, stable, alert and oriented. He has a huge hematoma in the lower aspect of his neck. The peripheral pulse in his right arm is weak. Which of the following is the MOST APPROPRIATE management for this particular patient?

A. Zone I neck injury, immediate neck exploration
B. Zone I neck injury, angiography prior to neck exploration
C. Zone III neck injury, immediate neck exploration
D. Zone III neck injury, angiography prior to neck exploration
E. Zone I neck injury, immediate midline sternotomy

542) Which of the following statements about a ptotic and overrotated tip is FALSE?

A. Lack of tip support will lead to a tip ptosis with an overly obtuse nasolabial angle.
B. An obtuse nasolabial angle is preferable in females, while an acute nasolabial angle is preferable in males.
C. A lateral crural steal will increase rotation and projection.
D. A full-transfixion incision will decrease rotation and projection.
E. Columellar strut will increase rotation and projection.

543) Which of the following statements about alar retraction is FALSE?

A. Alar retraction is usually a consequence of over-resection of the lateral crus of the lower lateral cartilage.
B. The vestibular mucosa should always be preserved in order to avoid scar contracture.
C. In minor cases of alar retraction, cartilage grafts can be used for the repair.
D. In severe cases of alar retraction, composite auricular grafts are used for repair.
E. The cymba concha of the ipsilateral ear provides the best contour for composite grafting.

544) Which of the following surgical maneuvers will WORSEN a retracted columella?

A. Plumping grafts inserted at the base of the columella
B. Columellar struts
C. Cartilage grafts
D. Composite grafts
E. Excision of the caudal end of the septum

545) Which of the following statements about Rhinoplasty is TRUE?

A. The internal nasal valve is bounded by the cephalic margin of the lower lateral cartilages and the septum.
B. Rocker deformity is due to lateral osteotomy done too low into the thick ascending process of the maxilla.
C. Inadequate support of the lower lateral cartilages after dorsal hump removal can result in an inverted-V deformity.
D. It is standard to resect less hump at the rhinion in order to avoid over-resection at this level.
E. Nasal over-reduction is easier to correct than nasal under-reduction.

546) Which of the following statements about the middle vault in Rhinoplasty is TRUE?

A. At the cephalic end the upper lateral cartilages are fused with the nasal bones, inserting just above the caudal ends of the bones.
B. The angle between the septum and the upper lateral cartilage is one of 30 degrees.
C. The nasal valve represents the site of least resistance to airflow through the nose.
D. The inverted-V deformity of the middle vault is a classic sign of posterior displacement of the nasal bones and upper lateral cartilages.
E. Preservation of the middle-vault mucosa will not help to minimize posterior displacement of the upper lateral cartilages after hump removal.

547) Which of the following statements is TRUE regarding rhinoplastic surgical maneuvers?

A. Lateral crural steal will decrease rotation.
B. Full-transfixion incision will increase rotation.
C. Plumping grafts will increase projection.
D. A radix graft will decrease the nasal length.
E. A deep nasofrontal angle will increase nasal length.

548) Which of the following statements is FALSE about Rhinoplasty done for a Bilateral Cleft Lip-Nasal Deformity?

A. An open approach is advisable.
B. A Columellar approach using an inverted V incision or bilateral forked flaps is advisable.
C. Septoplasty to correct any nasal obstruction and to obtain grafting material is advisable.
D. A Cartilaginous Columellar Strut Graft to enhance projection is advisable.
E. The Lower Lateral Cartilages are divided and inverted but not reconstructed or sutured to the columellar strut.

549) Which of the following is the usual dose (per side) of Botox for treatment of Crow’s Feet?

A. 5 units
B. 10 units
C. 20 units
D. 35 units
E. 40 units

550) Which following degrees represents the LEGAN Facial Convexity Angle?

A. 15º
B. 20º
C. 25º
D. 35º
E. 40º


ANSWERS & REFERENCES


541) B     Zone I neck injury, angiography prior to neck exploration

Stewart M. G.: Penetrating Face and Neck Trauma, Chapter 68 Head and Neck Surgery – Otolaryngology, (Bailey), Lippincott Williams & Wilkins, Third Edition, pp. 817-820, 2001

Stewart M. G.: Penetrating Face and Neck Trauma, Chapter 72 Head and Neck Surgery – Otolaryngology, (Bailey), Lippincott Williams & Wilkins, 4th Edition, pp. 1017-1026, 2006

542) A     Lack of tip support will lead to a tip ptosis with an overly obtuse nasolabial angle.

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

Becker D. G.: Complications of Rhinoplasty, Chapter 49 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 639, 2009

543) E     The cymba concha of the ipsilateral ear provides the best contour for composite grafting.

Becker D. G.: Complications of Rhinoplasty, Chapter 39 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 454, 2002

Becker D. G.: Complications of Rhinoplasty, Chapter 49 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 640, 2009

544) E     Excision of the caudal end of the septum

Becker D. G.: Complications of Rhinoplasty, Chapter 39 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 454, 2002

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

545) D     It is standard to resect less hump at the rhinion in order to avoid over-resection at this level.

Becker D. G.: Complications of Rhinoplasty, Chapter 39 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Second edition (Ira Papel, editor) pp. 457-459, 2002

Becker D. G.: Complications of Rhinoplasty, Chapter 49 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 639-648, 2009

546) D     The inverted-V deformity of the middle vault is a classic sign of posterior displacement of the nasal bones and upper lateral cartilages.

Papel I. D.: Management of the Middle Vault, Chapter 35 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 407-409, 2002

Papel I. D.: Surgery of the Middle Vault, Chapter 43 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 555-561, 2009

547) C     Plumping grafts will increase projection.

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

Becker D. G.: Complications of Rhinoplasty, Chapter 49 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 639-648, 2009

548) E     The Lower Lateral Cartilages are divided and inverted but not reconstructed or sutured to the columellar strut.

Coleman Jr. J. R., Sykes J. M.: Cleft Lip Rhinoplasty, Chapter 66 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 840-841, 2002

Coleman Jr. J. R., Sykes J. M.: Cleft Lip Rhinoplasty, Chapter 77 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 1079-1093, 2009

549) B     10 units

Blitzer A., Binder W. J., Brin M. F.: Botulinum Exotoxin A (Botox) for Facial Wrinkles, Chapter 23 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) p. 265, 2002

Meyer T. K., Blitzer A.: Botulinum Toxin for Facial Wrinkles, Chapter 30 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 373, 2009

550) A     15º

Papel I. D.: Computer Imaging for Facial Plastic Surgery, Chapter 10 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 111-115, 2002

Papel I. D.: Computer Imaging for Facial Plastic Surgery, Chapter 12 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 135-141, 2009

-------------------------------------
Updated: June 1, 2017

551-560 MCQ in Facial Plastic and Reconstructive Surgery

551-560

551) The drawing represents a reconstructive repair of an upper eyelid defect. What is the name of the repair technique?

A. Tensel semicircular flap
B. Mustardé lid repair
C. Cutler-Beard lid repair
D. Hughes flap repair
E. Butterfly flap repair

552) Which of the following areas responds UNPREDICTABLY to CO2 laser resurfacing and may even become scarred?

A. Periocular
B. Forehead
C. Cheek
D. Nasolabial
E. Neck

553) A patient who attempts to murder his physician MOST LIKELY has which of the following disorders?

A. Antisocial personality disorder
B. Obsessive compulsive disorder
C. Narcissistic personality disorder
D. Paranoid personality disorder
E. Maniac-Depressive disorder

554) Which of the following statements related to Rhinoplasty is FALSE?

A. Osteotomies are usually stable by 6 weeks.
B. In the basal view, the tip lobule represents the upper third and the columella represents the lower two thirds.
C. A dorsal hump is usually comprised of cartilage and bone.
D. Older, thick-skinned patients with a widened interdomal distance are prone to bossae.
E. Saddle Nose Deformity is usually associated with obstruction of the internal valve.

555) Which of the following statements is FALSE about the African American nose?

A. The skin is usually thick.
B. The middle third of the nose is usually short.
C. Narrowing of the wide dorsum is best achieved by osteotomies.
D. Nasal base is usually wider than the intercanthal distance.
E. The nasolabial angle is usually acute.

556) Which of the following vitamins, supplements or medications WILL NOT INTERFERE with blood clotting?

A. St. John’s wort
B. Ginko biloba
C. Naproxen
D. Indomethacin
E. Vitamin B

557) What is the maximum recommended dose (mg/Kg) of lidocaine (with 1:100.000 epinephrine) in the adult?

A. 3
B. 6
C. 9
D. 12
E. 15

558) A 72 year old female is referred to you for a suspected dysplastic nevus of 1 cm with irregular pigmentation and indistinct borders. The BEST biopsy technique in this particular situation is:

A. Incisional biopsy
B. Excisional biopsy
C. Punch biopsy
D. Shave biopsy
E. Curettage

559) Which of the following is the MOST UNFAVORABLE characteristic in facelift candidates?

A. Strong forward chin
B. Deep oral commissure grooves
C. Prominent cheek structures
D. Shallow cheek-lip grooves
E. Minimal photoaging

560) Which of the following statements regarding CO2 laser resurfacing is FALSE?

A. It is contraindicated in patients with scleroderma.
B. EMLA cream applied to the facial area treated is sufficient to achieve adequate anesthesia.
C. Infraocular and crow’s feet wrinkles are most responsive to this technique.
D. Visualization of the endpoint maximizes optimum result.
E. Resurfacing should be kept above the skin appendages.


ANSWERS & REFERENCES


551) B     Mustardé lid repair

Sykes J. M., Dugan Jr.M.F.: Evaluation and Management of Eyelid trauma, Thieme Medical Publishers, pp. 157-171, 1994

Iliff W. J., Pacheco E. M.: Flaps, Grafts, and Alloplastic Materials in Lid Reconstruction and Repair, Chapter 88 in Duane's Ophthalmology, CD-ROM, 2006 edition, Lippincott Williams & Wilkins

552) E     Neck

Weinstein C..: Carbon Dioxide Laser Resurfacing, Long-Term Follow-up in 2123 patients in Clinics of Plastic Surgery, Skin Resurfacing, (editor, Baker T. J), Saunders, Baker T. Vo. 25, No. 1, p. 119, 1998

Carniol P. J. , Harmon C. B., Hamilton M. M.: Ablative Laser Facial Skin Rejuvenation, Chapter 26 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 321-330

553) D      Paranoid personality disorder

Powell D., Hobgood T.: Detection and management of the unstable patient in Facial Plastic Surgery Clinics of North America, Aesthetic Analysis, ( Tardy Jr. M. E, editor), Saunders, Vol. 11, No. 3, pp. 307-318, 2003

554) D     Older, thick-skinned patients with a widened interdomal distance are prone to bossae.

Bradley D.T., Park S. S.: Preoperative analysis and diagnosis for rhinoplaty in Aesthetic Analysis , Facial Plastic Surgery Clinic of North America, (Tardy Jr. M. E., editor), Saunders, Vol. 11, No. 3, , pp. 377-390, 2003

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. 640, 2009

555) C     Narrowing of the wide dorsum is best achieved by osteotomies.

Porter J. P.: Non-Caucasian rhinoplasty: preoperative analysis in Aesthetic Analysis, Facial Plastic Surgery Clinic of North America, (Tardy Jr. M. E., editor), Saunders, Vol. 11, No. 3, , pp. 327-333, 2003

556) E     Vitamin B

Cheng E. T., Perkins S. W.: Rhytidectomy analysis: twenty years of experience in Aesthetic Analysis, Facial Plastic Surgery Clinic of North America, (Tardy Jr. M. E., editor), Saunders, Vol. 11, No. 3, , pp. 359-375, 2003

557) B     6

Ehlert T.K., Arnold D.E.: Local anesthesia for soft tissue surgery, Facial Plastic Surgery, Otolaryngologic Clinics of North America, Vol. 23, No. 5, pp. 831-844, 1990

Fletcher M. V.: Anesthesia in Facial Plastic Surgery, Chapter 17 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor), 2009, pp. 189-197

558) B     Excisional biopsy

Smith A. A., Cole A. B., Fosko S. W.: Melanoma from the dermatologist’s perspective in Facial Plastic Surgery Clinics of North America Dermatology for the Facial Plastic Surgeon (Hruza, G.J., editor), Saunders, Vol. 11, No. 2, p. 281, 2003

559) B     Deep oral commissure grooves

Cheng E. T., Perkins S. W.: Rhytidectomy analysis: twenty years of experience in Aesthetic Analysis, Facial Plastic Surgery Clinic of North America, (Tardy Jr. M. E., editor), Saunders, Vol. 11, No. 3, , pp. 359-375, 2003

560) B     EMLA cream applied to the facial area treated is sufficient to achieve adequate anesthesia.

Weinstein C., Roberts T. L.: Aesthetic Skin Resurfacing with the High-Energy Ultrapulsed CO2 Laser, in Clinics in Plastic Surgery, Facial Aesthetic Surgery, (Menick F.J. , editor), Saunders, Vol. 24, No. 2, pp. 379-405, 1997

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Updated: June 1, 2017

561-570 MCQ in Facial Plastic and Reconstructive Surgery

561-570

561) The reconstructive lip repair represented in the drawing UTILIZES which of the following flaps?


A. Karapandzic flap
B. Abbé flap
C. Estlander flap
D. Webster flap
E. Gillies flap

562) Which of the following lasers achieves the GREATEST depth of penetration?

A. CO2
B. Er:YAG
C. Nd:YAG
D. Ruby/Alexandrite
E. Pulsed Dye

563) The term “angle of domal divergence ”signifies a measurement of

A. Rotation
B. Projection
C. Definition
D. Both, rotation and projection
E. Interdomal distance

564) Which of the following is THE RECOMMENDED closing technique in GBLC (Geometric Broken Line Closure) and/or running W-plasty?

A. Gillies sutures
B. Interrupted sutures
C. Running locking sutures
D. Vertical mattress sutures
E. Horizontal mattress sutures

565) Which of the following statements is UNCARACTERISTIC of the African American nose?

A. Acute nasolabial angle
B. Underrotated nasal tip
C. Broad and flattened dorsum
D. Acute alar dome angle
E. Flat and round tip

566) Which of the following statements is TRUE about local anesthetics?.

A. Local anesthetics do not cross the blood-brain barrier.
B. Local anesthetics agents contain a water-soluble benzene aromatic ring connected to a hydrophilic amine by an intermediate chain
C. Amides are degraded by hepatic carboxylesterase
D. Local anesthetics physiologic activity is a function of their water solubility
E. Amides are the most common group involved in allergic reactions.

567) Which of the following statements is TRUE about the local anesthetic, lidocaine?

A. It has a vasocontrictor action.
B. It has a slow onset.
C. It has a duration of action of approximately 120 minutes.
D. The maximum single dose without epinephrine is approximately 600 mg for adults.
E. It is an ester anesthetic agent.

568) Which of the following antibiotics is CONTRAINDICATED with the use of BOTOX?

A. Penicillin
B. Cleocin
C. Aminoglycoside
D. Cephalosporin
E. Erythomicin

569) Which is of the following is the MOST common cause of PROTRUDING EARS?

A. Lack of antihelical fold
B. Prominent concha
C. Prominent cauda helicis and lobule
D. Superior aspect of the helix folded downward
E. Antitragus and tragus abnormalities

570) Which of the following statements is TRUE about the African American nose?

A. The nasolabial angle is usually 90 degrees
B. The ratio of columella to nasal tip lobule is 1:1 or 1.5: 1.
C. The nasal skin is usually thin.
D. The nasal tip projection is usually adequate.
E. Alar hooding is extremely rare.


ANSWERS & REFERENCES


561) E     Gillies flap

Cheney M. L.: Anesthesia for Facial Plastic and Reconstructive Surgery in Facial Surgery Plastic and Reconstructive, Williams and Wilkins, pp. 434-447, 1997

DeFatta R. J., Williams III E. F.: Lip Reconstruction, Chapter 61 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 841-854

562) C     Nd:YAG

Pearlman S.J., Chernoff W. G.: Laser resurfacing of the face: analysis and diagnosis in Aesthetic Analysis, Facial Plastic Surgery Clinic of North America, (Tardy Jr. M. E., editor), Saunders, Vol. 11, No. 3, , pp. 335-347, 2003

563) E     Interdomal distance

Rohrich R.J., Adams WP Jr.: The boxy nasal tip: classification and management based on alar cartilage suturing techniques, Plastic Reconstructive Surgery, 2001 June, 107 (7): 1849-1863; discussion 1864-1868

564) C     Running locking sutures

Thomas R. J.: Geometric-broken line closure, chapter 15 in Facial Scars, Incision, Revision and Camouflage (Thomas J. R., Holt G. R., editors), Mosby, pp. 160-167, 1989

565) D     Acute alar dome angle

Porter J. P.: Non-Caucasian rhinoplasty: preoperative analysis in Aesthetic Analysis, Facial Plastic Surgery Clinic of North America, (Tardy Jr. M. E., editor), Saunders, Vol. 11, No. 3, , pp. 327-333, 2003

http://emedicine.medscape.com/article/840236-overview

566) C     Amides are degraded by hepatic carboxylesterase

Liu S. S., Lin Yi: Local Anesthetics, Chapter 21 in Clinical Anesthesia, Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.; Cahalan, Michael K.; Stock, M. Christine, Lippincott Williams & Wilkins, 6th Edition, 2009, pp. 531-547

http://emedicine.medscape.com/article/873879-overview

567) C     It has a duration of action of approximately 120 minutes.

Ehlert T.K., Arnold D.E.: Local anesthesia for soft tissue surgery, Facial Plastic Surgery, Otolaryngologic Clinics of North America, Vol. 23, No. 5, pp. 831-844, 1990

Liu S. S., Lin Yi: Local Anesthetics, Chapter 21 in Clinical Anesthesia, Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.; Cahalan, Michael K.; Stock, M. Christine, Lippincott Williams & Wilkins, 6th Edition, 2009, pp. 531-547

568) C     Aminoglycoside

Dayan S. H.: Evaluation of the patient for cosmetic Botox injections in Aesthetic Analysis, Facial Plastic Surgery Clinic of North America, (Tardy Jr. M. E., editor), Saunders, Vol. 11, No. 3, , pp. 349-358, 2003

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

569) A     Lack of antihelical fold

Becker D. G., Lai S.S., Schipor I., Becker S. S., Analysis in otoplasty in Facial Plastic Surgery Clinics of North America, Aesthetic Analysis, (Tardy Jr. M. E, editor), Saunders, Vol. 11, No. 3, p. 298, 2003

http://emedicine.medscape.com/article/839886-overview

570) B     The ratio of columella to nasal tip lobule is 1:1 or 1.5: 1.

Porter J. P.: Non-Caucasian rhinoplasty: preoperative analysis in Aesthetic Analysis, Facial Plastic Surgery Clinic of North America, (Tardy Jr. M. E., editor), Saunders, Vol. 11, No. 3, , pp. 327-333, 2003

-------------------------------------
Updated: June 1, 2017

571-580 MCQ in Facial Plastic and Reconstructive Surgery

571-580

571) The mandible fracture represented below is DEFINED as:


A. Type I , favorable
B. Type II, favorable
C. Type II, unfavorable
D. Type III, favorable
E. Type III, unfavorable

572) Which of the following will trigger the MOST “concern” from a surgeon’s point of view?

A. “Doctor, I would like you to remove the wrinkles around my eyes and mouth”.
B. The patient has seen two previous surgeons in order to gather information and make a decision about who he will choose to do his surgery.
C. The patient has internal motivation or personal reasons for surgery.
D. The patient has external motivation or spouse related reasons for surgery
E. The patient has been thinking about cosmetic surgery over a significant period of time.

573) Which of the following medications is NOT BENEFICIAL in the treatment of iatrogenic hyperpigmentation?

A. Tetracycline
B. Hydroquinone
C. Tretinoin
D. Azelaic acid
E. Kojic acid

574) Which of the following skin lesions is BEST treated with 5-fluorouracil (5-FU)?

A. Superficial basal cell carcinoma
B. Actinic keratoses
C. Seborrheic keratosis
D. Dermatosis papulosa nigra
E. Epidermal nevus

575) Which of the following statements is TRUE regarding HYPOPIGMENTATION in Resurfacing or Peeling procedures?

A. Hypopigmentation occurs as frequently as hyperpigmentation.
B. Usually resolves with hydroquinone 4% cream.
C. Usually seen in the first 2 weeks post-resurfacing or post-peeling.
D. It is most likely temporary.
E. It is usually permanent.

576) Which of the following statements is TRUE about the male frontal hairline in hair restoration surgery?

A. The frontal hairline is restored basically with six-hair minigrafts.
B. The frontal hairline is better lower than higher.
C. The frontal hairline should look almost horizontal from the top and oval from the profile view.
D. The frontal hairline should begin 5 cm from the upper aspect of the brow.
E. The frontal hairline is better higher than lower.

577) Which of the following regarding the Baker-Gordon chemical peeling formula is INCORRECT?

A. Should be prepared fresh before each use
B. Phenol 88%, 3 ml
C. Croton oil, 3 drops
D. Septisol, 8 drops
E. Distilled water, 8 ml

578) Your patient , is a 40 year old female who has just had an inferior subciliary blepharoplasty and is complaining of a severe left eye pain immediately after her arrival to the recovery room. Both vision and intraocular pressure are normal. There is mild bruising around both eyes but no evidence of gross hematoma. The next step in the management of this patient is:

A. Close observation with visual checks ups
B. Open the surgical wound
C. Lateral canthotomy
D. Medial canthotomy
E. Fluorescein test

579) Which of the following IONS IS BLOCKED by local anesthetic agents?

A. Potassium
B. Sodium
C. Sodium and potassium
D. Calcium
E. Magnesium

580) Which of the following statement regarding laser principles is FALSE ?

A. The wavelength is the distance between two successive peaks of the wave.
B. The amplitude is the height of the peak and is related to the intensity of the light.
C. Frequency, or the period of the light wave, is the amount of the time require for one full wave cycle.
D. All lasers contain a power source, a laser medium, an optical cavity and a delivery system.
E. Power density increases proportionally with the diameter (spot size) of the laser system.


ANSWERS & REFERENCES


571) C     Type II, unfavorable

Li K. K., Weber A., Cheney M. L.: Mandibular fractures chapter 11 in Facial Surgery Plastic and Reconstructive, (Cheney, M.L.,editor), Williams and Wilkins, pp. 179-192, 1997

572) D     The patient has external motivation or spouse related reasons for surgery.

Powell D., Hobgood T.: Detection and management of the unstable patient in Facial Plastic Surgery Clinics of North America, Aesthetic Analysis, ( Tardy Jr. M. E, editor), Saunders, Vol. 11, No. 3, pp. 307-318, 2003

573) A     Tetracycline

Spenceri E. A.: Disorders of Pigmentation in Facial Plastic Surgery Clinics of North America, Dermatology for the Facial Plastic Surgeon, (Hruza G. J., editor), Vol. 11, No. 2, pp. 209-217, 2003

Sexton C. R., Rubin M.G.: New Concepts in the treatment of Facial Hyperpigmentation, chapter 21 in Facial Plastic Surgery (Willett J. M., editor), Appleton and Lange, pp. 197-206, 1997

574) B     Actinic keratoses

Ammirati C. T., Ioffreda M.D. , Hruza G. J.: Malignant tumors of the keratinocytes and adnexae in Facial Plastic Surgery Clinics of North America, Dermatology for the Facial Plastic Surgeon, (Hruza G. J., editor), Saunders, Vol. 11, No. 2, 141-163, 2003

Hendrix J. D., Slingluff C. L.: Diagnosis and Treatment of Cutaneous Malignancies, Chapter 52 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 675-702

575) E     It is usually permanent.

Weinstein C., Roberts T. L.: Aesthetic Skin Resurfacing with the High-Energy Ultrapulsed CO2 Laser, in Clinics in Plastic Surgery, Facial Aesthetic Surgery, (Menick F.J. , editor), Saunders, Vol. 24, No. 2, pp. 379-405, 1997

Carniol P. J., Harmon C. B., Hamilton M. M.: Ablative Laser Facial Skin Rejuvenation, Chapter 26 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 321-330

576) E     The frontal hairline is better higher than lower.

Kabaker S. S., Macdonald M. R.: Hair Restoration Surgery, Chapter 30 in Otolaryngology Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume One, Third Edition, Mosby, pp. 603-605, 1998

577) E     Distilled water, 8 ml

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

Mandy S. H., Monheit G. D. : Dermabrasion and Chemical Peels, Chapter 25 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 301-320

578) E     Fluorescein test

Colton J. J., Beekhuis G. J..: Blepharoplasty, Chapter 35 in Otolaryngology Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume One, Third Edition, Mosby, p. 696, 1998

579) B     Sodium

Murakami C. S., Khosch M. M.: Local Anesthesia in Facial Plastic Surgery, Chapter 28 in Otolaryngology Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume One, Third Edition, Mosby, p. 561, 1998

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

580) E     Power density increases proportionally with the diameter (spot size) of the laser system.

Russell Ries W., Wittkopf M.: Chapter 10 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 99-118

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Updated: June 1, 2017

581-590 MCQ in Facial Plastic and Reconstructive Surgery

581-590

581) Which of the following anatomic structures represented in the drawing below is the ONE INDICATED BETWEEN THE TWO ARROWS? Click the picture to enlarge image

A. Lavetor palpebrae superioris
B. Müller muscle
C. Orbital septum
D. Orbital rim
E. Superior rectus muscle

582) Which of the following is the single MOST important vital sign to monitor in the ambulatory surgical setting?

A. Blood oxigen
B. Heart rate
C. EKG (electrocardiogram)
D. Temperature
E. Arterial blood pressure

583) Which of the following local anesthetics is an ESTER agent?

A. Procaine
B. Lidocaine
C. Bupivacaine
D. Etidocaine
E. Mepivacaine

584) The toxicity of local anesthetics is MOST COMMONLY RELATED to which of the following systems?

A. Cardiovascular system
B. Central Nervous System
C. Respiratory System
D. Renal System
E. Hepatic System

585) Which of the following questions is NOT APPROPIATE in a facial plastic evaluation?

A. What changes are you hoping to accomplish?
B. How long have you been thinking about the operation?
C. Why do you want the surgery performed?
D. I see that you need a nose job. Don't you agree?
E. Have you had any other cosmetic procedures?

586) Which of the following statements about the Staircase Flap used to reconstruct lower lip defects is FALSE?

A. The unilateral Staircase Flap is useful for lateral lower lip defects of 2 cm or less.
B. The Bilateral Staircase Flap is useful for middle and lower lip defects exceeding 2 cm.
C. This flap demonstrates wide versatility in closing defects comprising 60% of the lower lip
D. 2-4 steps are necessary for adequate closing when employing this flap.
E. Avoidance of microstomia is one of the advantages of this flap.

587) Which of the following IS DESCRIBED as that part of the nose above the nostrils as viewed from the below?

A. Tip of the nose
B. Tip defining point
C. Lobule
D. Scroll
E. Subnasale

588) Which of the following aesthetic complications is related to postsurgical otoplasty and is defined by excessive conchal setback with protrusion of the upper and lower poles of the auricle?

A. Overcorrection
B. Prominent tragus
C. Prominent lobule
D. Telephone
E. Reverse telephone

589) The Frankfort Line is DEFINED by:

A. A line drawn from the inferior aspect of the bony external auditory canal to the inferior most aspect of the infraorbital rim on a lateral radiograph.
B. A line drawn from the superior aspect of the bony external auditory canal to the inferior most aspect of the infraorbital rim on a lateral radiograph.
C. A line drawn from the superior aspect of the bony external auditory canal to the eyelash lines on the lower eyelid.
D. A line drawn from the superior aspect of the helix to the inferior most aspect of the infraorbital rim on a lateral radiograph.
E. A line drawn from the inferior aspect of the tragus to the inferior most aspect of the infraorbital rim on a lateral radiograph.

590) Which of the following is the MOST significant inconvenience of using the costal cartilage for nasal augmentation?

A. Infection
B. Displacement
C. Warping
D. Surface irregularities
E. Resorption


ANSWERS & REFERENCES


581) B     Müller muscle

Graney D. O., Baker S. R.: Anatomy, Chapter 21 in Otolaryngology Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume One, Third Edition, Mosby, pp. 403-412, 1998

582) A     Blood oxigen

Graham III H.D., Duplechain G: Anesthesia in Facial Plastic Surgery, chapter 1 in Facial Plastic Surgery, (Willet J. M., editor), Appleton & Lange, pp. 11-12, 1997

583) A      Procaine

Graham III H.D., Duplechain G: Anesthesia in Facial Plastic Surgery, chapter 1 in Facial Plastic Surgery, (Willet J. M., editor), Appleton & Lange, pp. 12-14, 1997

http://emedicine.medscape.com/article/1127490-overview

584) B      Central Nervous System

Graham III H.D., Duplechain G: Anesthesia in Facial Plastic Surgery, chapter 1 in Facial Plastic Surgery, (Willet J. M., editor), Appleton & Lange, pp. 12-26, 1997

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

585) D     I see that you need a nose job. Don't you agree?

Maloney B. P.: The Plastic Surgery Consultation chapter 3 in Facial Plastic Surgery, (Willet J. M., editor), Appleton & Lange, pp. 27--29, 1997

586) E      Avoidance of microstomia is one of the advantages of this flap.

Ellis D. A.F., Gullane P. J.: Cosmetic and Reconstructive Lip Surgery, chapter 23 in Instructional Courses, American Academy of Otolaryngology Head and Neck Surgery, (Johnson, Blitzer, Ossoff, Thomas, editors) , Volume 1, pp.269-271, 1988

587) C     Lobule

Willet J. M.: Treatment of the Nasal Tip, chapter 8 in Facial Plastic Surgery, (Willet J. M., editor), Appleton & Lange, pp. 67-68, 1997

588) D     Telephone

Adamson P. A., Kraus W. M., Strecker H. D.: Aesthetic Otoplasty, chapter 35 in Facial Plastic Surgery, (Willet J. M., editor), Appleton & Lange, pp.338-339, 1997

Nachlas N. E.: Otoplasty, Chapter 34 in Facial Plastic and Reconstructive Surgery (Papel I. D., editor), Third Edition, 2009, pp. 421-433

589) B     A line drawn from the superior aspect of the bony external auditory canal to the inferior most aspect of the infraorbital rim on a lateral radiograph.

Ridley M. B.: Aesthetic Facial Proportions, chapter 11 in Facial Plastic and Reconstructive Surgery (Papel and Nachlas, editors), first edition, Mosby Year Book, p. 109, 1992

Willett J. M: How to Assess the Nose for Rhinoplasty, chapter 4 in in Facial Plastic Surgery, (Willet J. M., editor), Appleton & Lange, pp. 33-35, 1997

Ridley M. B., VanHook S. M.: Aesthetic Facial Proportions, chapter 9 in Facial Plastic and Reconstructive Surgery (Papel, editor), second edition Thieme, p. 101, 2002

590) C     Warping

Quatela V. C., Goldman N. D.: Nasal Augmentation, chapter 10 in Facial Plastic Surgery, (Willet J. M., editor), Appleton & Lange, pp. 85-90, 1997

http://emedicine.medscape.com/article/881443-overview

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Updated: June 1, 2017