Plastic Surgery

·      Basic Surgical Techniques 

1.    Sutures and Suturing.

***) Twenty milliliters of 2% Lidocaine contains:

A.    20 mgs

B.     40 mgs

C.     200 mgs

D.    400 mgs

E.     800 mgs

Answer: D* 400mgs

·      Wounds 

1.    Wounds.

???) Wound healing is enhanced by the administration of all the following, except:

A.    High protein diet

B.     Vitamin C

C.     Cortisol

D.    Oxygen

E.     Zinc

Answer: C* Cortisol

???) The major cause of impaired wound healing is:

A.    Anemia

B.     Diabetes mellitus

C.     Local tissue infection

D.    Malnutrition

E.     Steroid therapy

Answer: C* Local tissue infection

???) Wound healing is affected by all the following except:

Black skin

Oxygen

Blood supply

Nutrition

Vitamin C

Answer: 1* Black skin

???) The most common source of bacteria in wound infection after groin hernia repair is:

The patient's skin

The patient's nasopharynx

Operating room air

Surgical instruments

Operating room staff

Answer: 1* The patient's skin

???) Management of contaminated contused wound is best by:

Primary suturing

Dressing and antibiotics

Wound debridement, dressing daily, antibiotics and suturing later on

Primary excision and grafting

Tetanus toxoid and primary suturing

Answer: 3* Wound debridement, dressing daily, antibiotics and suturing later on

???) Regarding crushed (war) wounds all of the following should be done, except:

Good debridement

Washing the inside of the wound with normal saline

Giving good doses of broad spectrum antibiotics

Giving tetanus immunoglobulin

Primary wound closure

Answer: 5* Primary wound closure

???) The most dangerous type of wounds is the:

Incised

Lacerated

Penetrating

Crushed

Abrasion

Answer: 4* Crushed

???) The immediate treatment of a sucking wound in the chest should be:

Thoracoscopy

Tracheostomy

Under water seal drainage

Immediate closure of the wound by any maneuver irrespective of bacterial contamination

Give good dose of morphine and antibiotics

Answer: 4* Immediate closure of the wound by any maneuver irrespective of bacterial contamination

???) Factors which contribute to wound dehiscence include all except:

Vit C deficiency

Local radiation

Hypoproteinemia

Anemia

Malignancy

Answer: 4* Anemia

???) In wound dehiscence all are considered to be causes, except:

Anemia

Hypoalbuminemia

Ascites

Chronic pulmonary disease

Chronic cough

Answer: 5* Chronic cough

·      Ulcers 

1.    Lower Limb Ulcers.

???) A chronic leg ulcer just above the medial malleolus and surrounded by brownish skin pigmentation is usually:

Ischemic ulcer

Venous ulcer

Tuberculous ulcer

Chronic non-specific ulcer

Malignant ulcer

Answer: 2* Venous ulcer

???) All of the following are causes of leg ulceration, except:

Venous insufficiency

Arterial insufficiency

Sickle cell disease

Erythema nodosum

Post-cellulitis

Answer: 4* Erythema nodosum

???) All of the following are causes of leg ulceration, except:

Beta-thalassemia trait

Ulcerative colitis

Syphilis

Polyarteritis nodosa

Diabetes mellitus

Answer: 2* Ulcerative colitis

???) Regarding diabetic foot all of the following are true, except:

Correction of an associated anemia or pulmonary disease improves the condition of the foot

Diabetes has to be controlled by insulin therapy

Amputation is required once bone is infected

Sympathectomy has a major role in the management

Antibiotics against aerobes and anaerobes are to be given

Answer: 3* Amputation is required once bone is infected

???) Patients with diabetic foot, all are causes for the condition, except:

Unnoticed trauma

High blood sugar

Altered immunity of the patient

Infection

Ischemia of the lower limb

Answer: 3* Altered immunity of the patient

???) As regard diabetic foot all of the following are correct, except:

Infection, neuropathy and angiopathy share in its development

Pockets of pus must be opened widely

Sympathectomy is of great benefit

Angiography may be needed

In infected type diabetes must be controlled by insulin

Answer: 3* Sympathectomy is of great benefit

???) In the management of infected diabetic foot all of the following are correct, except:

Diabetes is controlled by one of the hypoglycemic drugs

The limb has to be elevated on one or two pillows

Antibiotics against aerobes and anaerobes should be given

Any associated blood, chest or heart disease causing tissue hypoxia should be managed

If amputation is required conservative one is usually adopted

Answer: 1* Diabetes is controlled by one of the hypoglycemic drugs

???) The most important predisposing cause to diabetic foot is:

Hyperglycemia

Ischemia

Neuropathy

Infection

Unnoticed injury

Answer: 1* Hyperglycemia

???) The least important factor in developing diabetic foot ulcers is:

Atherosclerosis

Peripheral neuropathy

Microangiopathy

Obesity

Decreased immunity

Answer: 4* Obesity

???) Regarding diabetic foot ulcers all are true except:

It is the most common cause of amputation in adults

Diabetic foot with cellulites should be treated with IV antibiotics

Patients with severe infections and high serum glucose should be given oral hypoglycemic drugs

Prevention of diabetic foot ulcers is better than treatment

30% of patients with amputation will need another amputation in 5 years

Answer: 3* Patients with severe infections and high serum glucose should be given oral hypoglycemic drugs

2.    Pressure Ulcers.

???) The most important factor in the development of ulcers in a spinal cord injury patient is:

Malnutrition

Septic episodes

Anemia

Local pressure

Diminished sensation

Answer: 4*Local pressure

·      Burns 

1.    Burns.

???) All of the following are signs of burn inhalation Injury except:

Erythema of oral mucosa

Coughing

Black sputum

Red colored burn

Burn of nasal hair

Answer: 4* Red colored burn

???) All of the following are true regarding second degree burn except:

It involves the epidermis and part of the dermis

Red to white

Wet

Painless

Blisters

Answer: 4* Painless

???) The burn that is difficult to estimate in percentage is the:

Electrical burn

Sun burn

Scald burn

Direct flame burn

Chemical bum

Answer: 1* Electrical burn

???) The best dressing for an excised burn wound is:

Silver sulfadiazine (Flamazine)

Nitrofurazone (Furacine)

Mafenide acetate (Sulfamylon).

Autograft

Allograft

Answer: 4* Autograft

???) Immediate shock in the burn patient is caused by:

Fluid loss through the burn wound

Fluid shift to the extravascular compartment

Edema of burned tissues

Edema of unburned tissues

Other injury

Answer: 5* Other injury

???) The most important step in the early management of extensive burns is:

Prevention of burn shock by giving i.v. fluids and analgesics

Giving tetanus toxoid

Antibiotics administration

Immediate split thickness grafting

Dressing of the burn area

Answer: 1* Prevention of burn shock by giving i.v. fluids and analgesics

???) 40 years old patient presented to ER with 10% thickness burns, is best treated by:

Admission to hospital + 2 liters i.v. R/L daily

Admission to hospital + i.v. fluids + antibiotics

Dressing + outpatient follow up

Immediate excision + grafting

Admission to hospital + i.v. fluid + blood transfusion

Answer: 2* Admission to hospital + i.v. fluids + antibiotics

???) All of the following features are common in the early period after severe burns, except:

Hypotension

Tachycardia

Oliguria

Low hematocrit value

Confusion

Answer: 2* Tachycardia

???) A 20 years old patient arrived at the accident and emergency department with a burn involving the whole right lower extremity. The surface area involved will be:

10%

7%

18%

9%

36%

Answer: 3* 18%

???) If the whole skin of one of the lower extremities is burnt the, percentage of burn is:

9%

18%

27%

36%

50%

Answer: 2* 18%

·      Hand 

1.    Hand Infections.

***) In hand infections all of the following are true, except:

A.    Early antibiotic therapy is essential and may abort the inflammation

B.     Early recognition of the presence of pus is necessary

C.     Incision, evacuation of the pus and debridement of the wall of the abscess must be done

D.    Physiotherapy and exercises form an important part of the late after-treatment

E.     Lowering of the affected limb is essential to reduce pain, edema and spread of the inflammation

Answer: E* Lowering of the affected limb is essential to reduce pain, edema and spread of the inflammation

2.    Fractures and Dislocations.

???) Bennet’s fracture occurs at:

A.    Distal end of radius

B.     Base of the first metacarpal bone

C.     Neck of femur

D.    Ankle joint

E.     Surgical neck of the humerus

Answer: 2* Base of the first metacarpal bone

·      Craniofacial Injuries 

1.    Fractures.

???) Concerning base skull fracture involving the anterior fossa all of the following are true except:

Epistaxis

Battle sign

Blindness

Raccoon eyes

CSF Rhinorhea

Answer: 2* Battle sign

???) The absolute indication for surgical repair of depressed skull fracture Is:

Overlying the saggital sinus

Over an eloquent area with no neurological deficits

Compound dirty fractures

Sharp angle of fracture

Underlying thin noncompressing sub dural hematoma

Answer: 3* Compound dirty fractures

???) In basal skull fracture all are correct except:

Rhinorrhea : cerebrospinal fluid is leaking from the nose

Otorrhea : cerebrospinal fluid is leaking from the ears

Raccoon eyes : periorbital ecchymosis

Battle's sign : retroauricular ecchymosis

Treatment is often surgical

Answer: 5* Most basal skull fractures do not require treatment. These fractures tend to heal themselves.

???) Which one of the following needs urgent surgical treatment:

Brain concussion

Brain stem laceration

Compound fracture of the vault of the skull

Linear fracture of the vault of the skull

Compound fracture of the skull base

Answer: 5* Compound fracture of the skull base

·      Pediatric Plastic Surgery 

1.    Craniofacial Anomalies.

???) Surgical repair of cleft lip is usually undertaken at the age of:

One week after birth

At the age of 3 months

At the age of one year

At the age of two years

At the age of five years

Answer: 2* At the age of 3 months