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A Plastics Written Board Review > Board Review > Flashcards

Board Review Flashcards

My total review for PRS boards 2016

1
Q

Blepharophimosis syndrome triad

A

ptosis, telecanthus, phimosis of lid fissure

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2
Q

Marcus Gunn jaw-winking syndrome

A

synkinesis of upper lid with chewing

aberrant innervation from fifth cranial nerve, seen in 2-6% of congenital ptosis

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3
Q

Marcus Gunn pupil

A

during the swinging flashlight test,
- when the light is flashed on the unaffected eye, the pupils constrict normally
- when the light is swung to the affected eye, the pupils dilate
= afferent pupillary defect from optic nerve injury

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4
Q

McCune-Albright Syndrome

A

Fibrous dysplasia, precocious puberty, cafe au lait spots

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5
Q

Klippel-Feil syndrome

A

congenital fusion of any two of the sever cervical vertebrae; short neck, low occipital hairline, restricted mobility of the upper spine

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6
Q

Paget disease of the bone

A

enlarged deformed bones

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7
Q

Proteus syndrome

A

atypical bone development and skin overgrowth

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8
Q

Renal osteodystrophy

A

bone mineralization deficiency resulting from electrolyte and endocrine abnormalities associated with chronic kidney disease

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9
Q

difference between hypertelorism and telecanthus

A

telecanthus = the intercanthal distance is increased, but the interorbital distance is normal; hypertelorism = both the intercanthal and interorbital distances are increased

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10
Q

coup de sabre deformity is pathognomic for…

A

Romberg disease AKA progressive hemifacial atrophy

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11
Q

Medial nasal prominences form

A

primary palate, midmaxilla, midlip, philtrum, central nose, and septum

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12
Q

Lateral nasal prominences form…

A

nasal alae

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13
Q

Maxillary prominences form…

A

secondary palate, lateral maxilla, and lateral lip

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14
Q

Muscles of mastication

A

4 muscles;

Masseter, medial pterygoid, lateral pterygoid, temporalis

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15
Q

Romberg disease

A

progressive facial atrophy

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16
Q

Lateral arm flap - vascular supply

A
  • posterior radial collateral artery (terminal branch of deep brachial artery)
  • for reverse flap: radial recurrent
    2012 2.22
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17
Q

Posterior interosseous artery flap

A

based on communication between the AIA and PIA just proximal to the distal radioulnar joint. Can be based distally 2012 2.22

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18
Q

ALT flap pedicle

A

Pedicle is descending branch of the lateral femoral circumflex artery off the profunda 2012 2.23

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19
Q

TFL flap pedicle

A

Ascending branch of the lateral femoral circumflex artery 2012 2.23

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20
Q

Gracilis pedicle

A

Ascending branch of the medial femoral circumflex artery 2012 2.23

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21
Q

Critical size bone defect of the hand

A

6-8 cm

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22
Q

Definition of osteogenesis

A

Provides the cells needed for bone growth (vascularized bone graft, bone graft)

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23
Q

Definition of osteoconductive

A

Some thing that promotes bone ingrowth but doesn’t provide growth factors or stimulant (ex/ inert scaffolding, calcium phosphate cement)

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24
Q

Definition of osteoinductive

A

Promotes bone formation - BMP2, demineralized bone

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25
Q

Gustilo fracture classification

A

3 components: wound size, contamination, bony injury
I: 1cm, contaminated, moderate communition
ii: wound >1cm, soft tissue isn’t extensive
IIIa: >10cm, highly contaminated, severe communition, can be addressed with local flaps, grafting
IIIb: >10cm, ,Involves extensive soft tissue damage with high-energy fracture pattern; soft tissue requires free tissue transfer or regional tissue transfer for coverage, periosteal stripping and bone exposed
IIIc: Major vascular injury requiring repair for salvage

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26
Q

mass with foamy histiocytes and hemosiderin deposits on the hand

A

giant cell tumor of the tendon sheath

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27
Q

Most common tumor of the hand

A

Ganglion cysts - cystic in character

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28
Q

second most common tumor of the hand

A

Giant cell tumor (AKA localized nodular synovitis, fibrous xanthoma, pigmented villonodular tenosynovitis)

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29
Q

Elson test for central slip disruption

A

central slip disruption = PIP joint is flexed and DIP can extend independently

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30
Q

Pathophys of swan neck deformity

A

Terminal extensor tendon disruption

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31
Q

Risks of free fibula flap

A

damage to peroneal nerve, destabilization of the ankle, damage to the posterior tibial nerve

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32
Q

Interval to approach the median nerve in the forearm

A

between FCR and pronator teres

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33
Q

Interval to approach the radial nerve in the forearm

A

Between the EDC and ECRB

2014 #59

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34
Q

Interval to approach the radial nerve in the upper arm

A

Between the brachialis and triceps

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35
Q

Inability to flex the elbow with the forearm supinated = injury to ____ nerve

A

Musculocutaneous (Brachialis)

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36
Q

Inability to flex the elbow with the forearm pronated = injury to the _____

A

radial nerve (brachioradialis)

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37
Q

7 requirements for tendon transfers

A
  1. functional
  2. expendable
  3. Excursion
  4. Strength
  5. travels in a straight line
  6. Performs 1 function
  7. supple joints
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38
Q

Which tendons have the greatest excursion/amplitude for tendon transfer? The least?

A

Greatest: FDP > FDS > FPL> digital extensors
Least: Wrist flexors and extensors
(This is proportional to how distal they are)

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39
Q

Options for opponensplasty

A 
Camitz: PL + palmar fascia to APB
Bunnel: FDS ring through FCU pulley to APB
Burkhalter: EIP to ADQ or APB
Huber: ADM to APB
BR to FPL
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40
Q

Nerve compression syndromes:
Median (3):
Ulnar (2):
Radial (3):

A

Median: CTS, AIN syndrome, pronator syndrome
Ulnar: Cubital, guyon’s
Radial: radial tunnel, PIN, wartenberg

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41
Q

Innervated by the median nerve (not AIN)

A 
LOAF muscles:
Lumbricals 2/3
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
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42
Q

Innervated by AIN

A

FPL, 2/3 FDP, FDS, FCR (Think of everything near the carpal tunnel)

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43
Q

Options for tendon transfer for high median nerve palsy

A
  1. EIP to APB (EIP is PIN innervated)
  2. BR to FPL (BR is PIN innervated)
  3. ADM to APB (ADM is ulnar innervated)
  4. for IF/LF DIP flexion - tenorrhaphy betwen IF/LF FDP and RF/SF FDP (ulnar innervated)
    (thumb opposition, thumb flexsion, dip flexion)
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44
Q

Tendon transfers for claw hand

A

Low injury will have more clawing than high ulnar due to muscle imbalance

  1. ECRB or ECRL to radial lateral bands
  2. Lasso FDS over A1 or A2
  3. Split FDS to lateral bands or proximal phalanx
    * in high ulnar nerve injury cannot use FDS of RF and SF due to palsy of FDP in RF and SF
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45
Q

Common tendon rupture in RA

A

EPL

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46
Q

Common tendon rupture in distal radius fx

A

EPL

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47
Q

Tendon transfer for radial nerve palsy

A 
wrist = PT to ECRB
Fingers = FCU, FCR, or FDS to EDC
Thumb = PL or EIP to EPL
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48
Q

Approach to dissect the radial nerve (PIN) in the forearm

A

between the ECRB and EDC

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49
Q

Approach to dissect the radial nerve in the upper arm

A

between brachialis and triceps

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50
Q

Approach to dissect the median nerve in the forearm

A

between the pronator teres and the FCR

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51
Q

What are superficial vs. medium vs. deep peels?

AHA, BHA, Jessner, 20%TCA, Phenol-croton oil

A

Superficial: AHA, BHA, Jessner
Medium: 20% TCA
Deep: Phenol-croton

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52
Q

Characteristics of a tuberous breast

A

constricted breast and high inframammary crease, herniation of breast parenchyma into NAC, large diametere areola

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53
Q

Layers of tears

A
  1. precorneal - mucin secreting goblet cells in conjuctiva - promotes dispersion of aqueous layer
  2. middle = tear layer from lacrimal gland - promotes osmotic regulation and control of infectious agents
  3. meibomian glands - prevents evaporation of tear film
    2014 #168, 2015#184
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54
Q

Role of estrogen and progesterone in breast function

A

Estrogen = ductal proliferation
Progesterone = glandular proliferation, periductal stromal development
2014 #169

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55
Q

Symptoms of lidocaine toxicity

A

– dizziness, agitation, lethargy, slurred speech, euphoria,
– tinnitus, metallic taste, perioral paresthesia,
– hypotension, bradycardia, asystole
- hypotension may be refractory to ACLS resus
- treat with lipid emulsion
2014 #174, 2013 #181 2016

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56
Q

Layers of the epidermis

A

Stratum corneum, stratum lucidem, stratum granulosum, stratum spinosum, stratum basale

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57
Q 
Epidermal response to tissue expansion
Dermal response to tissue expansion
Muscle response to TE
Fat response to TE
Capsule response to TE
Vascular response to TE
A

epidermis - thickens, normalizes after 6 months
dermis - thins 30-50%, increase fibroblasts and myofibroblasts, sweat glands and hair further apart
Muscle - decreased thickness and mass, function unchanged
Fat - decreased thickness and mass
Capsule - forms within days 4 layers, thick layer of collagen parallel to the surface of the expander
Vascular - angiogenesis occurs, highest density at junction of capsul and host tissue

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58
Q

4 layers of a capsule

A
  1. inner layer - synovial -like lining
  2. central layer - elongated fibroblasts and myofibroblasts
  3. transitional layer - loose collagen
  4. outer layer - vasculature and collagen
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59
Q

What is the amount of surface area gained with a

  1. round expander
  2. crescent expander
  3. rectangular expander
A 
round = 25%
Crescent = 32%
Rectangular = 38%
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60
Q

Absolute contraindications to tissue expansion

A
  • near malignancy
  • under skin graft
  • open infection
  • already tight tissue
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61
Q

Rule for Tissue Expander base diameter size

A

2-2.5 times the diameter of the defect to be covered

- the tissue available for expansion is = circumference minus the base width

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62
Q

Placement of tissue expander and incision

A

Incision is perpendicular of the direction of expansion

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63
Q

Frankfort plane

A

Orbitale - tragion horizontal like (notch above tragus along infraorbital rim)

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64
Q

Treatment of chemotherapy IV infiltrate

A

“A” drugs (anthracycline “rubicins”, Abx, Alkylating agents) = dry cold compress, neutralize with DMSO topical or IV dexrazoxane
“Vinka, taxanes, platins” = dry warm compress to disperse, dilute with hyaluronidase

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65
Q

At ___ weeks of embryologic life, male or female differentiation begins

A

6 weeks

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66
Q

Paramesonephric ducts (mullerian) regression

  • influenced by
  • produced by
  • develop into
A
  • influenced by mullerian inhibiting substance
  • produced by sertoli cells
  • develop into fallopian tubes, uterus, and upper part of vagina in the absence of mullerian inhibiting substance
    = female is the default and occurs in the absence of mullerian inhibiting substance
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67
Q

Masculine development of mesonephric (wolffian) ducts

  • influenced by
  • produced by
  • develops into
A
  • influenced by testosterone analog
  • produced by the interstitial cells of Leydig
  • develops into the epididymis, vas deferens, and seminal vesicles
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68
Q

innervation in the genital region

A

Pudendal nerve, perineal nerve, dorsal nerve of the penis/clitoris, posterior scrotal/labial nerves, inferior anal nerves; ilioinguinal nerve, anterior scrotal/labial nerve

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69
Q

What is Mayer-Rokitansky-Kuster-Hauser Syndrome?

A

Congenital Vaginal Agenesis;

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70
Q

Flap options for vaginal reconstruction

A

Singapore flaps, vertical rectus flap, bilateral gracilis flaps, colon transfer,

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71
Q

Techniques for scrotal reconstruction

A 
superiomedial thigh flaps
skin grafts
pedicled ALT flaps
Gracilis flap with STSG
tissue expansion of perineal skin or remaining scrotal tissue
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72
Q

Techniques for penile reconstruction

A

Most popular; radial forearm flap
Free sensate osteocutaneous fibular flap
Scapula flap +/- latissimus dorsi
abdominal flaps (VRAM or DIEP flaps)

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73
Q

Treatment of hypospadias

A
  • treat between 6-9 months
  • release chordee
    -meatal advancement and glanuloplasty
    -Urethral advancement
    -tubularized incised plate (TIP) urethroplasty for distal defects
    -Flip flap technique (distal)
    Proximal: FTSG, Preputial flap urethroplasty
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74
Q

Hypospadia repair complications

A

fistula, glands dehiscence, urethral stenosis

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75
Q

Epispadia repair techniques

A
  • young (penile skin makes neourethra)
  • cantwell-ransley (shaft degloved, lateral incision of urethra and tubularized)
  • W-flap (bilateral superiorly based groin flaps)
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76
Q

Epispadias are commonly seen with _____

A

bladder exstrophy

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77
Q

Excision margins for melanoma

A 
insitu: 0.5mm
<1mm = 1cm
1-4mm = 2cm
>4mm = 2cm
don't include fascial layer
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78
Q

SCIP protocol

A

Do not use razors
Abx 30-59 minutes before incision
Postop abx for 24 hours
HgA1c

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79
Q

Mustarde sutures for correction of

A
  • conchoscaphoid permanent sutures to CREATE ANTIHELICAL FOLD
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80
Q

How to create an antihelical fold

A

Mustarde conchoscaphoid sutures

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81
Q

How to correct moderate prominence of posterior wall of concha

A

Furnas Conchomastoid sutures

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82
Q

Reduce conchal projection

A

resection of conchal cartilage

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83
Q

causes of prominent ears

A
  1. Conchal hypertrophy
  2. Effaced antihelix
  3. Conchoscaphal angle >90degrees
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84
Q

Spinal accessory nerve innervates

A

SCM, trapezius

- may presend as drooping of the shoulder with scapular winging

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85
Q

wavelength and laser good for treating vascular lesions

A

wavelength = 585 nm

Pulsed-dye laser

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86
Q

Lasers that are absorbed by water

A

CO2, Er:YAG

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87
Q

Lasers to treat acne scarring

A

Nd:YAG, diode, erbium lasers

- wavelengths 1064-1540

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88
Q

Tattoo lasers

A

Q-switched ruby laser at 694nm (blk, blu, grn)
Q alexandrite 755 (black, blue, green)
KTP: red

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89
Q

Measurements for ptosis and levator function

A

Degree of Ptosis
1-2 mm = mild
3mm = moderate
4mm or more = severe

Levator Function
>10mm = Good
5-10mm = Fair

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90
Q

Seven indications for head and neck cancer adjuvant radiation

A
  1. high grade malignancies
  2. residual disease
  3. recurrent disease
  4. invasion of adjacent structures/extraglandular extension
  5. close or positive margins
  6. perineural invasion
  7. T3 or T4 parotid malignancies
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91
Q

Indications for a neck dissection

A
  • Failed XRT
  • Recurrent tumors
  • clinically or radiologically positive nodes
  • large or rapidly growing tumors
  • extraglandular extension, facial nerve palsy
  • Involvement of spinal accesory n. or SCM
  • aggressive tumors (SCC, adenoid cystic, malignant mixed, high-grade mucoepidermoid, adenocarcinoma)
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92
Q

What are high grade Head and Neck malignancies?

A
  • high-grade mucoepidermoid carcinoma
  • adenoid cystic carcinoma
  • SCC
  • Adenocarcinoma
  • Carcinoma ex-pleomorphic adenoma
  • undifferentiated
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93
Q

Branches of the external carotid artery?

A 
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
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94
Q

Prelaminated versus prefabricated flaps

A 
prelaminated = adding additional tissue to a flap still attached to its axial blood supply;
Prefabricated = introduction of a vascular pedicle to a desired donor tissue that on its own does not possess an axial blood supply
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95
Q

How does aproclonidine work to relieve post-botox ptosis?

A

stimulation of alpha-andrenergic receptors in Muller muscle

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96
Q

most common benign tumor of the nasopharynx?

A

juvenile angiofibroma

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97
Q

MC malignant tumor of the nasopharynx?

A

Nasopharyngeal carcinoma, ass’d with Asian, diet, EPV; most present with nodal mets

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98
Q

MC cancer of the oropharynx?

A

SCC

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99
Q

MC cancer of the hypopharynx?

A

SCC - has the worst outcome of the head and neck cnacers

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100
Q

4 stages of swallowing

A
  1. oral preparatory
  2. oral (CN IX triggers pharyngeal swallowing)
  3. pharyngeal - airway protection too; most important part
  4. esophageal
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101
Q

Superior orbital fissure syndrome

A

SOF runs between greater and lesser wings of sphenoid (CN III, IV, VI, V1 ophtho)

  • paresthesia of upper forehead, brow, lid, cornea
  • pupil fixed and dilated
  • ptosis
  • proptosis
  • paralysis of III, IV, VI
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102
Q

Orbital apex syndrome

A

5P’s of SOFS + blindness

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103
Q

Limits of primary closure for lip defects?

A

Upper lip 25%

Lower lip 40%

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104
Q

methods of closure for lip defect 25-80%

A

Estlander, Abbe, karapandzic, Bernard/nasolabial

central: abbe
commissure: estlander

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105
Q

method of closure for lip defect > 80%

A

bilateral bernard/NL flaps, or free flap (radial forearm)

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106
Q

Indications for replantation

A
  1. child
  2. thumb
  3. multiple digits
  4. distal amp (zone 1), simple and straight
  5. hand amputation
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107
Q

Contraindications for replantation

A
  1. patient cannot undergo surgery
  2. Multiple levels
  3. Zone 2 to a single digit
  4. severe crush/mangle
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108
Q

Order of repair for a replant

A
  1. bone
  2. tendon
  3. nerve
  4. artery or vein
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109
Q

Indications for pharyngeal flap for VPI treatment?

A
  1. good lateral wall movement

2. circular or sagittal port on nasoendoscopy

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110
Q

Indications for sphincter pharyngoplasty for VPI treatment?

A

large posterior gap with coronal, circular or bowtie patterns with poor lateral wall movement

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111
Q

Age at which pollicization is performed for thumb hypoplasia

A

3months to 3 years

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112
Q

Management of RA swan neck

  1. flexible PIP joint
  2. PIPJ limited due to intrinsic tightness
  3. PIPJ limited in all MCP positions
  4. PIPJ destruction
A
  1. figure of 8 splinting
  2. Intrinsic release
  3. translocation of lateral bands, PIPJ capsulectomy and collateral ligament release
  4. Arthrodesis or arthroplasty
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113
Q

Responsible for lateral leg sensation and eversion of the foot

A

Superficial peroneal nerve

- lateral compartment with peroneus brevis and longus

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114
Q

Responsible for dorsiflexion and sensation at the 1st dorsal webspace

A

Deep peroneal nerve

- anterior compartment with TA, EHL, EDL/B, peroneus tertius

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115
Q

Responsible for innervation of the anterior thigh and leg extension

A

Femoral nerve

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116
Q

Transfers for radial nerve palsy

A 
Wrist extension (to ECRB): PT
Finger extension (to EDC): FCUor FCR or FDS
Thumb extension/abduction (to EPL): PL
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117
Q

Transfer for chronic EPL rupture

A

EIP or EDQ or ECRL

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118
Q

Things that can cause radial nerve compression

A
  • Leash of Henry
  • Arcade of Frohse (fibrous edge of supinator)
  • Radial tunnel (fibrous edge of ECRB)
  • Distal edge of supinator
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119
Q

Areas of ulnar nerve compression in cubital tunnel

A
  • arcade of struthers
  • heads of FCU
  • Osborne ligament
  • Medial epicondyle
  • Medial intermuscular septum
  • Anconeus
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120
Q

Rate of cure of arteriovenous malformations:

Stage i, ii, iii

A

Schobinger stages
I: quiescent (75%)
II: enlarging (67%)
iii: ulcerating (48%)

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121
Q

Most common malignancy of parotid?

2nd most common?

A
  1. mucoepidermoid carcinoma

2. Warthin tumor

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122
Q

Mechanism of action for aproclonidine?

A

alpha-2 adrenergic stimulation of the Muller muscle

123
Q

Cyanosis that improves with crying

A

choanal atresia

124
Q

CD4 counts for HIV

A

> 200 cells/mm3 = risk same as general population
AIDS when CD <200 cells/mm3
high viral loads = therapy no longer effective, Increases risks

125
Q

Keloids vs. hypertrophic scars

  1. fibroblast density
  2. ratio of collagen III:I
  3. collagen fibers
A

Keloids have:

  1. both have increased fibroblast density but keloids have increased fibroblast proliferation rates
  2. more collagen I than HTS
  3. thicker, large, and more randomly oriented collagen fibers
126
Q

Review the rule of 9’s for burns

127
Q

In electrical injuries, what areas are the most affected?

A

Areas of less cross-sectional area. Tissue resistance is lowest in nerves, highest in bone. Deeper tissues will be more injured than superficial tissues.

128
Q

When is rigid stabilization needed in chest reconstruction?

A
  1. without rads: >3 ribs
  2. with rads: >5 ribs
  3. worse with loss of lateral ribs
  4. diameter is >5cm
129
Q

What is the tensile strength of wounds at

  1. 2 weeks
  2. 3 weeks
  3. 4 weeks
  4. 6 weeks
  5. 12 weeks
A
  1. 10%
  2. 20%
  3. 40%
  4. 80%
  5. full strength
130
Q

Signs of involutional ptosis

A

high skin crease (>7mm), thinned upper eyelid, lid drop on downward gaze

131
Q

Causes of neurogenic ptosis

A

oculomotor nerve palsy, horner syndrome, marcus gunn jaw-winking syndrome

132
Q

Causes of myogenic ptosis

A

myasthenia gravis, myotonic dystrophy, mitochondriopathy

133
Q

Where do the abdominal intercostals run?

A

BELOW THE INTERNAL OBLIQUE

  • Between the transversus abdominis and internal oblique muscles. They enter the internal oblique fascia, divide into two branches and enter the posterior rectus sheath.
  • abdominoplasty block using a TAP block
134
Q

Where do the iliohypogastric and ilioinguinal branch?

A

Between the oblique muscles

135
Q

Where is the arcuate line found?

A

At the level of the ASIS

136
Q

Where do the intercostal neurovascular bundles run?

A

Between the internal and innermost intercostals. There are 3: external, internal, and innermost

137
Q

Indications for chest wall reconstruction

A

> 4 ribs, >5cm, flail chest

138
Q

Mesonephric duct develops into…

A

epididymus, vas deferens, seminal vescicles

139
Q

Paramesonephric ducts develop into…

A

fallopian tubes, uterus, and upper portion of the vagina

140
Q

Methods for female to male surgery

A

fibula osteocutaneous free flap, ALT with prosthetic

141
Q

Options for coverage of Sacral ulcers

A 
Lumbosacral flap (requires backgrafting)
These can be re-rotated:
-Gluteal FC flap
-Gluteal musculocuatenous flap
-Uni- or bi-lateral V-Y flap
142
Q

Options for coverage of ischial ulcers

A

Gluteal flaps
Posterior hamstring myocutaneous V-Y advancement flaps
posterior FC thigh flap
TFL flap

143
Q

Options for coverage of trochanteric ulcers

A

TFL +/- vastus lateralis

Girdlestone procedure

144
Q

Symptoms of lidocaine toxicity

A

neuro and cardiac toxicity
Early: neuro - slurred speech, restlessness, tinnitus, and a metallic taste, numbness in the mouth;
Late: muscle twitching, seizures, and cardiac arrest

145
Q

Symptoms of Fat embolism

A

petechial rash, respiratory dysfunction, cerebral dysfunction that appears 24-48 hours after surgery

146
Q

If a transaxillary aug is done, what is the worst new pedicle you could do for a revision aug?

A

Inferior because the inferior pole gets stretched out ….

147
Q

Innervation to the orbicularis oculi

A

Orbic has three parts: pretarsal, preseptal, orbital

2 functional parts: extracanthal (zygomatic) and medial inner canthal (buccal)

148
Q

What does the extracanthal orbic control?

A

eyelid closure, voluntary squinting, animation *(zygomatic br)

149
Q

What does the medial inner canthal orbic control?

A

blinking, lower lid tone, pumping mechanism of the lacrimal system (buccal br)

150
Q

Criteria for nipple sparing mastectomy

A
  1. tumor 2cm from nipple
  2. <2cm
  3. not multicentric
  4. clinically negative nodes
  5. no nipple discharge, no inflammatory breast cancer, no Paget’s
151
Q

What causes the tear trough deformity?

A

osteocutaneous ligament betwen the palpebral and orbital portion of the muscle. It extends from the medial canthus and connects with the bilayered orbicularis retaining ligament mid-pupil

152
Q

Most common inherited thrombophilia

A

factor V Leiden

153
Q

Risks for breast cancer

A

Early menarche, late first pregnancy, late menopause, no breast-feeding, recent oral contraceptive use

154
Q

Treatment of biopsy papilloma in the breast

A

excision - difficult for distinguishing between benign and malignant on biopsy only. Malignant features include >1cm, peripherally located,

155
Q

Components of bleph/ptosis examination

A

Palpebral fissue height, marginal reflex distance, levator function or excursion, scleral show, lid crease height and contour, superior sulcus depth and contour, lagophthalmos, Bell phenomenon, ocular deominance, and eyelid laxity

156
Q

MRD1 values - normal?

A

Normal is between 3.5-4.5

Ptosis is

157
Q

Tensilon test for ptosis

A

used when myasthenia gravis is suspected. mg neostigmine injected IM and ptosis should improve if MG is the cause

158
Q

Phenylephrine test for ptosis

A
  • phenylephrin 2.5% drops stimulate Muller muscle and results in 2-3mm of lid elevation
159
Q

Treatment of phyllodes tumor

A

wide local excision with 1cm margins

160
Q

Evaluation of gynecomastia

A

always check the scrot and testicles for testicular tumors.

can be related to obesity, drugs, Klinefelter

161
Q

Structures that affect nasal airflow

A

internal and external nasal valves, inferior turbinates, nasal septum

162
Q

What cancers are also associated with BRCA?

A

BRCA - pancreatic and prostate

- NOT thryoid, lung, esophageal, or colon

163
Q

Tear layers

A
  1. precorneal - mucin secreting goblet cells in conjuctiva - promotes dispersion of aqueous layer
  2. middle = tear layer from lacrimal gland - promotes osmotic regulation and control of infectious agents
  3. meibomian glands - prevents evaporation of tear film
    2014 #168, 2015#184
164
Q

Depth of peels from superficial to deep

A

Salicyclic 20-30%; jessner/Glycolic acid; TCA 35 to 50%

165
Q

Tuberous breast deformity treatments

A

constricted IMF - radial scoring

short IMF to nipple distance - lower the IMF

166
Q

Risk of breast cancer

A

all: 8%
mother/sister: 15%
premenopausal/bilateral 1st degree: 45%
BRAC1: 50-80%

167
Q

Difference in asian eyelids

A

absent or low lid crease, shorter tarsus, descending pre-aponeurotic fat, minimal or absent connection between the levator and upper lid dermis

168
Q

Quadrangular space - boundaries and contents

A

Boundaries: teres minor, teres major, long head of triceps, surgical neck of humerus (and lateral head of triceps)
Contains: Axillary nerve, posterior circumflex humeral artery

169
Q

Triangular space

A
  1. teres minor, teres major, long head of triceps - contains the circumflex scapular artery
170
Q 
Pharyngeal pouches
1:
2:
3:
4:
A 
Pharyngeal pouches
1 - eustachian, mastoid, tympanic cavity
2 - tonsil
3 - thymus, lower parathyroids
4 - upper parathyroids
171
Q

Branchial arches: nerves, bones, muscles, vessels,

A

1 (mandibular): CN5; maxilla & mandible; muscles of mastication, mylohyoid, tensors, TENSOR VELI PALATINI, anterior belly digastric; maxillary artery, anterior 3 hillocks of his
2 (hyoid): CN7; hyoid, stapes; platysma, stylohyoid, facial muscles, POSTERIOR belly of the digastric; stapedial artery; posterior 3 hillocks of his
3: CN9; lower part of hyoid; stylopharyngeus; common carotid, ICA;
IV/VI: CN10; laryngeal cartilage, pharyngeal constrictors, levator veli palatini; palate muscles; aortic arch, right subclavian, ductus arteriosus

172
Q

Most common parotid malignancy?

A

Mucoepidermoid carcinoma

173
Q

Parotid malignancy most likely to present with distant mets?

A

Adenoid cystic carcinoma

174
Q

Most common minor salivary gland maligancy

A

Adenoid cystic carcinoma

175
Q

Most common parotid tumor in children

A

Hemangiomas

176
Q

Treatment for parotid tumors with cervical mets

A
  1. resect tumor
  2. parotidectomy
  3. post-op XRT vs MRND
  4. Radical neck when extracapsular disease
177
Q

Bilateral parotid masses

A

Warthin’s tumor AKA papillary cystadenoma lymphomatosum

178
Q

Treatment of nasopharyngeal carcinoma

179
Q

Indications for adjuvant XRT in head and neck cancers

A
  1. any stage III or IV (III = >3cm or with a node) (IV = growing into other structures and/or large nodes)
  2. single node >3cm
  3. multiple nodes
  4. extracapsular disease
180
Q

taste and Sensation to the anterior 2/3 of the tongue

A

sensation via lingual nerve V3, taste via chorda tympani (VII)

181
Q

taste and sensation to the posterior 1/3 of the tongue

A

glossopharyngeal (IX) for both taste and sensation

182
Q

Treatment of SCC of the lip

A

SCC of the lip is RADIOSENSITIVE. most will regress with XRT only, if >6cm, shrink with XRT first
- consider surgical excision if it looks like you will have an easily cosmetic resection

183
Q

Palisading odontogenic epithelial cells

A

Ameloblastoma of the mandible

184
Q

Cystic fluid containing keratin in mandible

A

Odontogenic keratocyst

185
Q

Treatment of odontogenic keratocyst

A

enucleation, curettage, peripheral ostectomy - need to rule out Gorlin’s syndrome

186
Q

Treatment of unicystic ameloblastoma

A

Enucleation and curettage only

187
Q

Treatment of “soap bubble” ameloblastoma

A

marginal mandibular resection with immediate recon. If cortical spread, 1cm margins

188
Q

Treatment of peripheral or extraosseous ameloblastomas

A

Radial resection and/or hemimandibulectomy, 20% recurence rate

189
Q

Treatment of cyst at the apex of a non-vital tooth

A

Radicular cyst: treat with root canal

190
Q

Treatment of giant cell tumor of the mandible

A

benign (as opposed to malignant in long bones); curettage if small, excision and recon if large

191
Q

Approaches to reducing a zygomatic arch fracture

A

Gilles - elevate immediately beneath DEEP temporal fascia (superficial to temporalis muscle)
Keen - intraoral incision - lateral maxillary vestibular incision

192
Q

Cranial nerves

193
Q

What are the structure continuous with the SMAS?

A

Galea–> superficial temporal fascia –> SMAS –> platysma –> superficial cervical fascia

194
Q

Was is the continuous structure with the parotidomasseteric fascia?

A

deep cervical fascia

195
Q

What facial muscles are innervated on their superficial surface?

A

mentalis, levator anguli oris (LAO), buccinator = the deepest layer of muscles

196
Q

Most superficial facial muscles?

A

DAO, zyomaticus minor, orbicularis oris

197
Q

2nd layers of facial muscles?

A

Depressor labii inferioris, risorius, platysma

198
Q

3rd layer of facial muscles?

A

Zyomaticus major, levator labii superioris alaeque nasi

199
Q

Buccal branch of the facial nerve innervates all mid and lower facial muscles except?

A

DAO, DLI, mentalis –> marginal mandibular

Orbic oculi –> zygomatic part (lateral), deep buccal branch innervates the medial aspect

200
Q

7 orbital bones

A

zygoma, maxilla
ethmoid
lacrimal, palatine, frontal, sphenoid

201
Q

Lateral orbital wall bones

A

Zygoma, greater wing of the sphenoid

202
Q

Inferior orbital bones

A

maxilla, zygoma,

203
Q

Medial orbital bones

A

ethmoid, palatine, lacrimal

204
Q

Superior orbital bones

A

frontal, greater wing of the sphenoid

205
Q

How does a CN III present?

A

eyeball is “down and out”. All EOM are innervated by CN 3 except lateral rectus (CN6) and superior oblique (CN4)

206
Q

Trauma to the lower eyelid with epiphora - jones testing and tx?

A

Jones testing - for checking for obstruction of lacrimal system. Positive = it is open (no obstruction)

  • I = fluorescein into eye, check for fluor in inferior meatus in nose,
  • II = saline into ducts, check for saline in noseTx: Dacryocystorhinostomy = makes a connection between the lacrimal sac and nose
207
Q

Structures that lie superficial to posterior belly of the digastric

A
  1. facial nerve

2. external jugular vein

208
Q

Structures that lie deep to the posterior belly of the digastric

A

vagus, spinal accessory, hypoglossal, sympathetic trunk, IJ, ICA, ECA, facial artery, lingual artery

209
Q

First permanent tooth to erupt

A

Mandibular first molar = start of mixed dentition phase

210
Q

Arcade of Frohse

A

radial tunnel syndrome, PIN palsy

211
Q

Leash of Henry

A

radial tunnel syndrome/PIN

212
Q

lacertus fibrosis

A

pronator syndrome

213
Q

ligament of struthers

A

pronator syndrome

214
Q

arcade of struthers

A

cubital tunnel

215
Q

Osborne’s ligament

A

cubital tunnel

216
Q

MOA of aspirin

A

Cyclooxygenase inhibitor which then inhibits thromboxane which is a platelet aggregator and vasoconstrictor

217
Q

MOA of Dextran

A

decreases platelet aggregation via altering electric charge of platelets and decreases blood viscosity

218
Q

MOA of Heparin

A

binds to antithrombin III to inhibit thrombin and factors 9, 10, 11, 12

219
Q

MOA of Hirudin

A

directly inhibits thrombin

220
Q

MOA Streptokinase

A

thrombolytic agent the activates plasminogen

221
Q

EMG normal motor finding

A

no sharp waves, no fasciculations
latency <4.0ms
amplitude 15-25 uV

222
Q

EMG normal sensory findings

A

latency <3.5 ms

amplitude 15-25uV (abnormal is <15 uV)

223
Q

Presentation of volkmann’s contracture

A

pseudo-claw position with intact ulnar nerve function

224
Q

Cause of boutonniere deformity

A

central slip disruption resulting in volar subluxation of lateral bands

225
Q

Causes of swan-neck deformity

A

Dorsal subluxation of lateral bands, laxity of volar plate at the PIP joint, MCP volar dislocations, DIP extensor injury, Rheumatoid arthritis

226
Q

What are the strongest donor tendons?

A

Brachioradialis and Flexor carpi ulnaris = 2
FCR, wrist extensors, finger flexors, and PT = 1
finger extensors = 0.5
palmaris longus, thumb extensors and abductors = 0.1

227
Q

Radial nerve palsy effects on UE function

A

loss of wrist extension, finger MCP extension, thumb abduction, thumb extension and thumb retropulsion, decrease in grip strength

228
Q

Tendon transfer for radial nerve palsy

A

Wrist: PT to ECRB
MCP: FCR, FDS, or FCU to EDC
Thumb: EIP or PL to EPL

229
Q

How to distinguish between high and low median nerve palsy

A 
low = loss of thenar function and opposition
high = loss of thenar function PLUS loss of FDS to all fingers, loss of FPL, and index FDP (AIN innervated)
230
Q

What is innervated by the AIN?

A

think carpal tunnel

FDS, FDP (2/3), FPL + FCR

231
Q

Tendon transfer for low median nerve palsy

A

Restore thumb opposition (opponensplasty to APB)

  • Camitz (PL)
  • Huber (ADM)
  • EIP
  • FDS
232
Q

Tendon transfer for high median nerve palsy

A

Restore thumb opposition, +FPL, and index FDP

  • Thumb: EIP or ADM to APB
  • FPL: brachioradialis
  • FDP 4/5 side to side with FDP 2/3
233
Q

Effects of ulnar nerve palsy

A

CLAWING IS WORSE IN LOW VS HIGH ULNAR NERVE PALSY

low: loss of key pinch and clawing and loss of integration of flexion
high: FCU, FDP 4/5 also lost

234
Q

Goals of tendon transfers for ulnar nerve palsy

A

restore key pinch, correct clawing, integrate finger flexion, and restore FDP 4/5

235
Q

Tendon transfer for ulnar nerve palsy

A 
Clawing corrections: FDS, BR,  FCR, ECRL, ECRB 
1. ECRL or ECRB to lateral bands (BRAND)
2. FDS lasso
3. FDS to lateral bands or P1
4.
236
Q

PIN innervation

A

all extensors except ECRL/ECRB

237
Q

Indications for ORIF of scaphoid fracture

A 
>1mm displacement, comminution, angulation (intrascaphoid angle greater than 35 degrees), open fracture, 
carpal instability (scapholunate angle> 60 degrees, radiolunate angle >15 degrees)
238
Q

X-rays to get for scaphoid fractures

A

usual 3 view plus PA clenched fist view in ulnar deviation

239
Q

Nerve transfer for AIN palsy

A

brachialis br of musculocutaneous nerve to AIN in the upper arm

240
Q

Nerve transfer for ulnar nerve injury

A

AIN to ulnar nerve in forearm

241
Q

Nerve transfer for axillary nerve injury resulting in loss of deltoid, shoulder abduction and external rotation

A

triceps branch of the radial nerve to axillary nerve

242
Q

when do limb buds appear?

243
Q

When does digital separation occur?

A

between days 44-54

244
Q

Treatment of Head and neck cancer?
Stage I
Stage II
Stage III and IV

A

Stage I: surgical resection or XRT
Stage II: surgical resection or XRT + neck dissection
Stage III and IV - surgical resection + XRT + Neck dissection

245
Q

General order of tooth eruption

A

first molar –> central incisor –> lateral incisor –> first premolar –> canine

246
Q

Treatment of BRONJ

A

stage 1 - antiseptic rinses
stage 2 - rinse and superficial debride, abx
stage 3 - surgical debridement, rinse, abx
2016 #122

247
Q

Arterial supply of the trapezius

A

dorsal scapular and transverse cervical

248
Q

Margins for BCC

A
  • 3 to 4 mm for BCC <2cm on face or low-risk

- 10mm if >2cm, morpheaform, high risk, recurrent, on trunk/extremiteis

249
Q

Margins for SCC

A

4-6mm
<2cm = 4mm
>2cm, high-risk, goes to subQ = 6mm

250
Q

Margins for melanoma

A 
insitu: 0.5mm
<1mm = 1cm
1-4mm = 2cm
>4mm = 2cm
don't include fascial layer
251
Q

VPI with coronal gap

A

sphincer pharyngoplasty

252
Q

VPI with minimal circular gap and good lateral wall movement

A

pharyngeal flaps

253
Q

Indications for approval for panniculectomy

A
  1. inability to walk normally
  2. Chronic pain and ulceration in the skin fold
  3. Pannus is below the pubis
  4. Intertrigo of the pannis over 3 months with treatment
  5. Stable weight for at least 6 months and 18 months after gastric bypass
254
Q

Poiseuille law

A

(viscosity x length)/radius^4

255
Q

Causes of gynecomastia

A

drugs, unresolved pubertal gynecomastic, idiopathic.

256
Q

Treatments of gynecomastia

A

Tamoxifen, raloxifene - gynecomastia <1 year

Surgical - painful, present > 1year

257
Q

Eyelid reconstruction techniques for defects > 60%

A

Upper lid: Bridge (Cutler-Beard) flap; Tenzel flap, Temporal (Fricke) flap
Lower lid: hughes tarsoconjunctival flap, tripier flap, Mustarde flap, temporal (fricke flap)

258
Q

Eyelid reconstruction techniques up to 60%

A

Upper lid: Tenzel flap, lower lid-sharing flap (Mustarde), direct closure up to 30%
Lower lid: primary up to 20%, Tenzel, vertical myocutanouse cheek lift,

259
Q

Eyelid recons that supply both anterior and posterior lamella

A

Cutler-beard, Tenzel, primary closure, lid-sharinge (Mustarde), Fricke flap

260
Q

Partial thickness eyelid recon

A

Tripier flap, forehead flap, Hughes,

261
Q

Guideline for cardiac clearance

A
  1. Is there need for emergency NCS? If yes, proceed with surgery.
  2. Are there active cardiac conditions (unstable coronary syndromes, decompensated heart failure, significant arrhythmias, severe valvular disease)? If yes, evaluate and treat per specific guidelines before considering NCS.
  3. Is the NCS considered low risk (e.g., superficial and ophthalmologic procedures)? If yes, proceed with low-risk NCS.
  4. Does the patient have good functional capacity (METs >= 4) without symptoms? If yes, proceed with NCS.

Is there need for emergency NCS? If yes, proceed with surgery.
Three or more clinical risk factors undergoing vascular surgery: consider testing if it will change management
One or two clinical risk factors undergoing vascular surgery or one or more clinical risk factors undergoing intermediate-risk surgery: either proceed with surgery with heart rate control (beta blockade) or consider noninvasive testing if it will change management

262
Q

Tx for injury to motor branch after endo CTR resulting in loss of opposition?

A

camitz opponensplasy = PL to APB

PL is median innervated but only motor branch is gone in this scenario

263
Q

Tx for loss of thumb opposition after combined high median and ulnar nerve palsy?

A

Burkhalter opponensplasty = EIP to APB

Median is gone so cannot use PL which is median innervated

264
Q

Tx for high median nerve injury resulting in loss of FPL

A

brachioradialis to FPL

265
Q

transfers for EPL rupture

A

EIP or
EDQ or
ECRL

266
Q

Thenar muscles

A

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Innverated by median except deep FPB (ulnar)

267
Q

Innervation of the anterior hard palate

A

Sphenopalatine

268
Q

Innervation of the soft palate and uvula

A

lesser palatine

269
Q

Use for a lateral crural turnover flap

A

pinched tip due to crural deformity, deformed ala, external valve stenosis
- addresses convex or concave lower lateral crura

270
Q

Treatment for bulbous nose

A

Lateral crural strut
Cephalic trim
Transdomal suture

271
Q

Treatment for boxy tip

A

domal sutures, do transdomal first, then interdomal

272
Q

Technique for more tip rotation

A

cephalic trim, lateral crura shortening

273
Q

Technique for less tip rotation

A

spreader grafts, medial crura shortening

274
Q

Treatment for hanging columella

A

Transfixation incision to access the columella, then perform caudal septum resection

275
Q

Treatment for tongue cancer >3cm

A

surgical excision, XRT, regional lymphadenectomy

276
Q

General rules for Head and Neck XRT

A
  1. Recurrence
  2. Residual disease
  3. Perineural invasion
  4. extracapsular extension
  5. T3 T4
  6. 2 or more nodes
277
Q

Up to how much tongue can be closed primarily?

278
Q

Sensation to the anterior 2/3 of the tongue

A

lingual nerve (V3), taste via chorda tympani (VII)

279
Q

Sensation and taste to the posterior 1/3 of tongue

A

glossopharyngeal (IX)

280
Q

What muscle dilates the nostrils

A

Levator labii superioris

281
Q

What is the nasal tip angle of divergence
What is normal?
What makes a boxy tip?
What makes a bulbous tip?

A
  • angle between the middle crura
  • normal is 30-60 degrees
  • boxy tip is >60 degrees
  • bulbous is flat
282
Q

Correction of internal valve collapse

A
  • butterfly graft
  • spreader grafts
  • flaring sutures
  • splay grafts
283
Q

Correction of external valve collapse

A
  • Alar batten grafts

- lateral crural struts/turnover

284
Q

Nerve responsible for plantar flexion, foot inversion, and plantar sensation?

A

Tibial nerve (innervated the superficial and deep posterior compartments)

285
Q

Nerve responsible for leg abduction

A

Superior gluteal nerve

286
Q

Nerve responsible for leg adduction

A

Obturator nerve

287
Q

Predicted recurrent of Cleft lip AND Palate

a. 1 sibling
b. 1 parent
c. 2 siblings
d. 1 parent, 1 sibling

A

a. 4%
b. 4%
c. 9%
d. 16%

288
Q

Predicted recurrent of Cleft palate alone

a. 1 sibling
b. 1 sibling + FHx
c. 1 sibling + another anomoly
d. 2 siblings
e. 1 parent
f. 1 parent, 1 sibling

A

a. 4%
b. 7%
c. 2%
d. 1%
e. 2-6%
f. 15%

289
Q

Embryology of cleft lip

A

Failure of medial nasal and maxillary prominences to merge

290
Q

Embryology of cleft palate

a. primary palate
b. secondary palate

A

a. failure of fusion of medial and lateral palatine processes
b. failure of fusion of lateral palatine processes with each other and the nasal septum

291
Q

a. what does the frontonasal prominences become?
b. Maxillary prominence?
c. Medial nasal prominence?
d. Lateral nasal prominence?
e. Mandibular prominence?

A

a. divides into the medial and lateral nasal process –> forehead, nose, and top of the mouth
b. lateral lip elements that fuse with philtrum
c. nose, septum, philtrum, cupid’s bow, premaxilla to incisive foramen
d. alae
e. mandible

292
Q

How to determine between sphincteroplasty vs. pharyngeal flaps?

A

Satisfactory lateral pharyngeal wall movement and sagittal or circular velopharyngeal closure patterns should be treated with a pharyngeal flap. A large posterior gap with coronal, circular, or bowtie patterns of closure and good velar elevation, but poor lateral wall motion, should be treated with a sphincter pharyngoplasty

293
Q

Sensation to the posterior and inferior nasal septum, premaxilla palate extending back to maxillary cuspid

A

Nasopalatine (v2)

294
Q

Sensation to the palate except the premaxilla palate

A

Anterior palatine (greater palatine) nerve (v2)

295
Q

SEnsation to the maxillary sinus, cuspid, and incisor region

A

Anterior superior alveolar n (V2

296
Q

Sensation to the floor of the mouth

A

Lingual (v3) and chorda tympanii (CN7)

297
Q

Sensation to the cheeck

A

Buccal nerve (V3)

298
Q

Innervation of the parotid

A

Auricuotemporal nerve (V3)

299
Q

INnervation of the meibomian glands

A

lacrimal nerve (V1)

300
Q

Innervation of the lacrimal gland

A

facial nerve parasympathetics travelling with lacrimal nerve (v1)

301
Q

Innervation of nasal and palatal secretory glands

A

Facial nerve parasympathetics travel with pterygopalatine (V2)

302
Q

taste for anterior 2/3 of tongue, sublingual and submandibular glands

A

Linguinal nerve (V3) and chorda tympanii (7)

303
Q

Main characteristics of Goldenhar (Oculoauriculovertebral spectrum)

A 
Epibulbar dermoids
Varied microsomia
Hemifacial microsomia
Colobomas (upper eyelid)
Vertebral/rib anomalies
frontal bossing, low hairline
304
Q

Associated with agenesis of the sphenoid wing

A

Neurofibromatosis

A Plastics Written Board Review (4 decks)

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