Breast and cosmetic

Question 1

A 78-year-old man is evaluated because of superior visual field obstruction and drooping eyelids. Physical examination notes a levator excursion of 10 mm and a margin-reflex distance 1 of 2 mm. A photograph is shown. Phenylephrine eye drops do not significantly change the position of the eyelid margin. Which of the following procedures is most appropriate for this patient?
A) Direct brow lift
B) Frontalis sling
C) Levator advancement
D) Tarsoconjunctival Müllerectomy
E) Upper eyelid blepharoplasty

Answer 1

C. Levator advancement

• aponeurotic blepharoptosis. This is the result of dehiscence or disinsertion of the levator aponeurosis from the tarsal plate. This is characterized by ptosis of the eyelid margin, a high or absent lid crease, good levator function, and thin eyelid tissue. This patient has the following criteria that support the diagnosis: a margin-reflex distance 1 of 2 mm, a high eyelid crease noted on the photograph, and good (10 mm) levator function noted on examination.

Question 2

A 28-year-old woman undergoes open septorhinoplasty secondary to internal nasal valve narrowing. During elevation of the mucoperiosteal flap, there is brisk arterial bleeding from the superior dorsal cranial septum. Which of the following arteries is the most likely source of the bleeding?
A) Angular
B) Anterior ethmoid
C) Internal maxillary
D) Posterior septal
E) Sphenopalatine

Answer 2

B. anterior ethmoid

Question 3

An otherwise healthy 13-year-old boy is brought to the plastic surgeon’s office because of a 6-month history of bilateral breast enlargement. The patient takes no medications. There is no family history of breast cancer. Examination shows bilateral, 3-cm, firm, rubbery, subareolar masses without nipple discharge. No testicular masses are noted. Workup shows no other abnormalities. The patient reports that he is afraid of being teased. Which of the following is the most appropriate management?
A) Direct surgical excision
B) Initiation of tamoxifen
C) Liposuction
D) Mammography
E) Observation

Answer 3

E. observation

Question 4

A 51-year-old woman comes to the office because of unilateral fullness, pain, and swelling of the lower cheek after undergoing rhytidectomy and platysmaplasty 6 weeks ago. Which of the following is the most likely cause of this patient’s symptoms?
A) Digastric muscle hypertrophy
B) Low hyoid bone position
C) Sialocele
D) Simple ranula
E) Tail of parotid pleomorphic adenoma

Answer 4

C. sialocele

Question 5

A 62-year-old woman undergoes face and neck rhytidectomy. Preoperatively, oral clonidine is administered, and at the time of incision, intravenous tranexamic acid is administered. Topical platelet-rich plasma is applied to the superficial musculoaponeurotic system, followed by fibrin tissue sealant. Drains are placed prior to skin closure. Which of the following perioperative interventions is most likely to lead to a decreased risk for postoperative hematoma in this patient?
A) Intravenous administration of tranexamic acid
B) Oral administration of clonidine
C) Placement of drains
D) Topical application of platelet-rich plasma
E) Use of fibrin tissue sealant

Answer 5

D. clonidine

Question 6

A 56-year-old woman is referred for evaluation because of chronic pain in the left breast after undergoing mastectomy and implant-based reconstruction. The patient also reports hypersensitivity at the mastectomy flaps, diminished sensation in the proximal medial left arm, and burning pain in the left chest wall. On examination, the breasts appear normal and are somewhat firm to the touch. There are no signs of infection. Which of the following is the most appropriate next step in management?
A) Capsule excision
B) Implant removal
C) Initiation of gabapentin
D) Intraincisional injection of triamcinolone
E) Ultrasonography of the breast

Answer 6

C. gabapentin

Question 7

A patient with Fitzpatrick Type V skin presents for removal of a 5-year-old tattoo on his forearm that is primarily black in color. The most appropriate laser for removal of the pigment in this patient uses which of the following wavelengths?
A ) 532 nm
B ) 694 nm
C) 755 nm
D ) 1064 nm
E) 10,600 nm

Answer 7

D ) 1064 nm

Question 8

A 64-year-old man with upper eyelid dermatochalasis and lower eyelid fat pad pseudoherniation with skin excess undergoes a bilateral skin-only upper blepharoplasty and lower blepharoplasty with a subciliary approach. During the next 12 weeks, the patient reports dry eye symptoms that worsen progressively. Which of the following glands is most likely dysfunctional in this patient?
A ) Lacrimal
B) Meibomian
C) Moll
D ) Wolfring
E) Zeis

Answer 8

B. meibomian

Meibomian glands (also named tarsal glands, palpebral glands, and tarsoconjunctival glands) are sebaceous glands located inside the tarsal plate at the rims of the eyelid

Question 9

A 56-year-old woman is scheduled for carbon dioxide laser treatment of facial rhytides. Which of the following is the primary chromophore for a carbon dioxide laser?
A) Deoxyhemoglobin
B ) Melanin
C) Methemoglobin
D) Oxyhemoglobin
E) Water

Answer 9

E. water

Question 10

A 46-year-old woman undergoes circumareolar mastopexy to address aesthetic concerns after breast-feeding her three children. Which of the following suboptimal outcomes is most likely to result from the circumareolar approach?
A) Bottoming out
B) Constricted inferior pole
C) Flattened projection
D) Superior nipple dislocation
E) Wound separation

Answer 10

C. flattened projection

superior nipple dislocation- Wise pattern, inferior pedicle
wound- wise pattern
scar widening- all
vertical masto- constricting inferior pole

Question 11

A 20-year-old woman presents with a right-sided sunken anterior chest wall, hypoplasia of the breast, superiorly placed nipple-areola complex, normal pectoralis muscle, and normal sternal position. Which of the following is the most likely diagnosis?
A) Anterior thoracic hypoplasia
B) Breast hypoplasia
C) Poland syndrome
D) Scalp-ear-nipple syndrome
E) Tuberous breast deformity

Answer 11

A. anterior thoracic hypoplasia
posterior displacement of the ribs, an anteriorly unilateral sunken chest wall, hypoplasia of the ipsilateral breast, and a superiorly displaced nipple-areola complex. However, the sternum and pectoralis major are normal
Scalp-ear-nipple syndrome is characterized by a triad: areas of hairless raw skin over the scalp (present at birth and healing during childhood), prominent hypoplastic ears with nearly absent pinnae, and bilateral amastia.

Question 12

A 55-year-old woman is evaluated because of an abnormal mammogram of the right breast. History includes neither an inherited gene mutation nor a strong family history of breast disease. She undergoes ultrasound-guided core needle biopsy, which discloses pleomorphic lobular carcinoma in situ. Which of the following is the most appropriate next step?
A) Chemotherapy
B ) Radiation
C) Repeat mammography in 6 months
D) Surgery
E) Observation only

Answer 12

D. surgery

Question 13

A 34-year-old man undergoes a four-lid blepharoplasty. Before he leaves the facility, he reports to the postanesthesia recovery nurse that he has severe pain in the right eye and visual acuity changes that include flashes and a sensation that a shade has been pulled over the eye. Preliminary diagnosis is retrobulbar hematoma. Which of the following is the most appropriate initial management of this patient?
A) Evacuation of the hematoma within the next 3 hours
B) Intravenous administration of acetazolamide 500 mg
C) Intravenous administration of mannitol 20% 1.5 to 2 g/kg
D) Lateral canthotomy
E) Three-dimensional CT scan of the orbits

Answer 13

D. lateral canthotomy

Give mannitol 20% 1.5 to 2 g/kg intravenously (with the first 12.5 g over a 3-minute period and the remainder over a 30-minute period), 500 mg of acetazolamide intravenously, 95% oxygen/5% carbon dioxide to dilate intraocular vessels, methylprednisolone sodium succinate 100 mg intravenously, and betaxolol, one drop immediately, then twice daily. These actions should be taken while the patient is being taken back to the operating room for re-exploration.

Question 14

A 13-year-old girl is brought to the office by her mother because of a birthmark that has recently begun to grow since menarche. Physical examination shows the mass is well-circumscribed and nontender, and it lies within the inframammary fold. There is no evidence of an infectious process, and results of laboratory workup are normal for the patient’s age. Which of the following is the most likely diagnosis?
A) Mondor disease
B) Poland syndrome
C) Polythelia
D) Tubular breast deformity
E) Virginal breast hypertrophy

Answer 14

C. polythelia

breast tissue from ectoderm, 5th week gestation

Question 15

A 35-year-old woman with the BRCA1 mutation wants bilateral prophylactic mastectomies and is judged to be a good candidate for nipple-sparing mastectomy. Which of the following incisions for this procedure is associated with the highest risk for nipple-areola complex ischemia?
A) Horizontal radial incision
B) Inferior mammary fold incision
C) Inferior radial incision
D) Periareolar

Answer 15

D. periareolar

Question 16

A 29-year-old woman presents for a consultation for a reduction mammaplasty. Her mother was diagnosed with breast cancer at age 44 years, and her older sister was recently diagnosed with ovarian cancer at age 40 years. On examination, the patient has macromastia of both breasts with grade 3 ptosis. No masses are noted. Which of the following is most appropriate next step?
A) Genetics evaluation
B) Mammography
C) MRI
D) Prophylactic mastectomy
E) Ultrasonography of the breasts

Answer 16

A genetics

Question 17

A 28-year-old man is evaluated for rhinoplasty because he is dissatisfied with the appearance of his nose. Examination shows an underprojected nasal tip, moderate dorsal hump with a wide bony base, wide nasal base width with significant alar flaring, and moderate septal cartilage deviation. Rhinoplasty is scheduled to address these issues. Which of the following parts of the rhinoplasty is most appropriate to perform last?
A) Alar flare reduction
B) Bilateral osteotomy
C) Placement of a columellar strut graft D) Removal of the dorsal hump
E) Septal cartilage resection

Answer 17

A. Alar flare reduction

alar base surgery should be predominantly performed last because tip position has to be addressed completely before evaluating the alar flaring and nasal base width.

Question 18

A 59-year-old woman comes to the office because she is dissatisfied with the appearance of her face. History includes abdominoplasty 2 years ago. Physical examination shows loss of mid face volume, jowls, and moderate neck ptosis. She has minimal adiposity in the lower abdomen. In addition to rhytidectomy, fat grafting is being considered to improve the mid face volume. Which of the following is the most appropriate donor site for fat grafting in this patient?
A) Abdomen
B) Back
C) Glutealregion
D) Innerthighs
E)Submental area

Answer 18

D. inner thighs

Question 19

A 32-year-old woman presents for neck rejuvenation. On examination, she has diffuse neck lipodystrophy involving the central and lateral neck. There is good skin recoil without excess skin, no visible platysmal edges, and no jowling. The patient is interested in a single treatment. Which of the following treatments will have the best aesthetic result?
A) Cryolipolysis
B) Deoxycholic acid
C) Direct excision
D) Lower rhytidectomy
E) Suction-assisted lipectomy

Answer 19

E. suction assisted lipectomy

Question 20

The flow resistance of a liposuction cannula is directly proportional to which of the following factors?
A) Internal diameter
B) Length
C) Suction strength
D) Tubing weight

Answer 20

B. length

Question 21

A 25-year-old woman who had a cheek filler placed 1 week ago is concerned about the asymmetry of her cheeks. She directly messages the plastic surgeon on the practice’s social media account. Which of the following is the most appropriate response from the surgeon?
A) Answer the patient’s concerns through direct messaging
B) Ask office staff to call the patient
C) Block the patient on the account
D) Ignore the message
E) Make a new social media post regarding cheek asymmetry after filler

Answer 21

B. block the patient on the account

Question 22

Answer 22

E. 35% Trichloroacetic acid, papillary dermis

Question 23

A 23-year-old woman is concerned about excess fat bulging in the bilateral flanks. Cryolipolysis is recommended. Which of the following is the primary mechanism for achieving the outcomes in cryolipolysis?
A) Apoptosis
B) Atrophy
C) Necroptosis
D) Pyroptosis

Answer 23

A. apoptosis

Question 24

A 57-year-old woman who underwent a mastectomy and axillary lymph node dissection is evaluated because of left arm lymphedema. Preoperatively, she received neoadjuvant chemotherapy. She reports that she uses compression garments every day, and she wakes up at night with pain and numbness in the index and middle fingers of the left hand. Examination shows pitting edema of the left arm. A Tinel sign is present over the median nerve at the left wrist, and the physician cannot pinch the skin over the dorsal aspect of the hand. Which of the following is a CONTRAINDICATION to liposuction as a treatment modality in this patient?
A) Carpal tunnel syndrome
B) Pitting edema
C) Positive Stemmer sign
D) Preoperative treatment with neoadjuvant chemotherapy
E) Use of compression garments

Answer 24

B. pitting edema

Question 25

A 58-year-old woman presents to the clinic because of concerns with smiling 2 days after undergoing a rhytidectomy. On examination, the right lower lip rides over the lower teeth and cannot be pulled down with grimacing. Which of the following right-sided nerves is most likely injured?
A) Buccal
B) Greater auricular
C) Marginal mandibular
D) Mental
E) Zygomatic

Answer 25

C. marginal mandibular

paralysis of lower lip, can’t show teeth on affected side

mental nerve is just sensory

Question 26

A 25-year-old woman requests removal of multiple small bumps near the margin of the areolae bilaterally because she believes they signify breast cancer. On examination, the plastic surgeon determines that the concerning areas are normal physiological structures of the areolae. The most likely outcomes if these structures are removed is a decrease in which of the following aspects of the areola?
A) Contractility
B) Pigmentation
C) Sensation
D) Size
E) Skin lubrication

Answer 26

E. skin lubrication

Montgomery glands or tubercles are accessory glands that vary in number and size and are often noted near the margin of the areola. Should these be removed, there is a potential for decreased quality of the skin of the areola. The character of these structures is not related to breast cancer

Question 27

A 42-year-old woman comes to the office to discuss abdominoplasty. Physical examination shows wide diastasis recti and excess skin above and below the umbilicus. Which of the following findings in this patient’s history would be the strongest indication for further evaluation for thrombophilia and possible deep vein thrombosis chemoprophylaxis?
A) Family history of malignant hyperthermia
B) Sleep apnea
C) Three previous miscarriages
D) Type 2 diabetes
E) 20-Year history of smoking two packs of cigarettes daily

Answer 27

C. three previous miscarriages

Question 28

A 51-year-old man diagnosed with Norwood Stage 4 pattern of androgenic alopecia applies topical minoxidil daily. Which of the following best describes the proposed mechanism of action of this medication?
A) Alpha-granule activation leading to release of transforming growth factor and vascular endothelial growth factor
B) 5-Alpha reductase type II inhibitor leading to decreased dihydrotestosterone concentration
C) Cytochrome C oxidase oxidation leading to increased adenosine triphosphate production
D) Potassium channel opening leading to blood vessel dilation
E) Prostaglandin F2alpha analog leading to increased outflow of aqueous fluid

Answer 28

D) Potassium channel opening leading to blood vessel dilation
Minoxidil is believed to work primarily by increasing blood flow by opening potassium channels leading to vasodilation at the follicular level, which promotes hair regrowth or hair stabilization in those follicles affected

Finasteride inhibits 5-alpha reductase type II, leading to decreased circulating levels of dihydrotestosterone, which leads to maintenance and/or increased amounts of terminal hairs in the anagen phase by inhibiting and sometimes reversing miniaturization of the hair follicle.

Question 29

A 15-year-old girl is brought to the plastic surgeon because of breast asymmetry. Examination shows a minimally tender, mobile mass of the upper outer quadrant of the left breast that measures approximately 4 cm in size. The patient reports that the mass has been present for 2 years. Which of the following is the most appropriate next step in management?
A) Excisional biopsy
B) Incisional biopsy
C) Mammography
D) MRI
E) Ultrasonography

Answer 29

E. US

Question 30

A 16-year-old girl is referred for evaluation of breast asymmetry. She wears a size 36C brassiere, but she notes that the right breast does not fill the cup. On examination, the left breast appears normal, and the right breast has no identifiable nipple-areola complex or palpable glandular tissue. The pectoralis muscle and ribs appear normal. The patient’s development is consistent with Tanner stage 4. Which of the following is the most likely diagnosis?
A ) Amastia
B ) Amazia
C) Anterior thoracic hypoplasia
D) Athelia
E) Poland syndrome

Answer 30

A. amastia

Amastia is the complete absence of the nipple-areola complex and glandular breast tissue. Athelia is the absence of the nipple-areola complex; however, the glandular tissue is present. Amazia is absence of the breast tissue, but a normal nipple-areola complex is present.

Question 31

A 62-year-old woman comes to the office for a facial rejuvenation consultation. She also expresses dissatisfaction about the thinning of her hair over the last few years. Physical examination shows that she has maintained her frontal hairline and has generalized thinning of her hair. Which of the following is the most appropriate initial treatment for the female pattern hair loss in this patient?
A ) Bimatoprost
B ) Finasteride
C) Minoxidil
D) Spironolactone

Answer 31

C. minoxidil

Question 32

A 30-year-old man presents with increased, rounded scleral show of the lateral triangle 4 months after undergoing open reduction and internal fixation of an orbital floor fracture. The patient reports no vision changes. Physical examination shows no ptosis. Which of the following is the most likely cause of the increased scleral show in this patient?
A) Cranial nerve III injury
B) Failure to suspend the lateral canthal tendon
C) Orbital floor plate malposition
D) Undiagnosed medial orbital wall fracture
E) Weakness of the inferior rectus muscle

Answer 32

B) Failure to suspend the lateral canthal tendon

medial wall fracture: results in vision changes due to medial rectus malfunction and no enopthalmos

cranial nerve III: ptosis

plate malposition: vision changes

Question 33

A 70-year-old woman is evaluated because of left-sided breast cancer diagnosed after workup for persistent erythema of the skin. History includes type 1 diabetes (hemoglobin A1C concentration of 5%). The patient wears a D-cup brassiere, and BMI is 34 kg/m2. Examination of a specimen obtained on biopsy demonstrates tumor cells infiltrating the dermis. Which of the following risk factors is the strongest indicator for delayed, rather than immediate, breast reconstruction in this patient?
A) Advanced age
B) BMI category
C) Breast size
D) Cancer type
E) Medical comorbidity

Answer 33

D. cancer type

Question 34

A 32-year-old woman presents with “double-bubble” deformities after undergoing primary augmentation mammaplasty 5 years ago because of a history of tuberous breasts. She has undergone several revisionary procedures to lessen the appearance of the native inframammary crease, but they were not successful. Implant exchange from the submuscular plane to the subglandular plane is planned. This procedure will most likely improve the “double-bubble” deformities in this patient through which of the following mechanisms?
A) Eliminating muscular displacement of the implant
B) Minimizing formation of a peri-implant capsule
C) Preventing ptosis of the breast tissue over the implant
D) Releasing the superficial fascial attachments to the skin

Answer 34

D) Releasing the superficial fascial attachments to the skin

Question 35

A 60-year-old woman who is considering silicone implant-based postmastectomy reconstruction asks about what she should expect for postoperative surveillance imaging. Which of the following is the best recommendation for asymptomatic surveillance in this patient?
A) High-resolution ultrasonography 5 years postimplantation
B) Implant displacement mammography 1 year postimplantation
C) Monthly self-examinations of the breasts
D) Noncontrast CT scan 7 years postimplantation
E) Noncontrast MRI 3 years postimplantation

Answer 35

A. US 5 years

Question 36

A 25-year-old woman comes to the office to discuss labiaplasty because of discomfort and dissatisfaction with the appearance of her labia. Examination shows asymmetry and prominence of the labia minora and clitoral hood. An edge labiaplasty and clitoral hood reduction are planned. Dissection in which of the following anatomic areas presents the greatest risk for sexual dysfunction and permanent injury to the sensory nerves in this patient?
A) Anterior clitoral hood
B) Clitoral frenulum
C) Interlabial sulcus
D) Lateral clitoral hood
E) Vaginal fourchette

Answer 36

A. anterior clitoral hood

Sensation to the clitoris is carried in paired dorsal nerves located in the anterior clitoral hood between the 2 o’clock and 11 o’clock positions. These nerves run just below the superficial fascia of the clitoral hood and can be injured if resection is more than skin-only. In contrast to “skin-only resection” of the clitoral hood, edge resection of excess labia minora is a full thickness resection

Question 37

A 32-year-old woman presents for bilateral reduction mammaplasty. She is administered 1 g tranexamic acid (TXA) intravenously before incision. Which of the following best describes the mechanism of action of TXA?
A) Activates proteins C and S
B) Inhibits antithrombin III
C) Inhibits platelet aggregation
D) Inhibits proteolysis of protease-activated receptor-1
E) Prevents plasmin from binding to fibrin

Answer 37

E. prevents plasmin from binding fibrin

Tranexamic acid is a synthetic reversible competitive inhibitor to the lysine receptor found on plasminogen. The binding of this receptor prevents plasmin (the activated form of plasminogen) from binding to and ultimately stabilizing the fibrin matrix.

Question 38

A 46-year-old woman who has moderate acne scars on her face is interested in improving the appearance of the scars. She has Fitzpatrick Type IV skin. The patient is very concerned about possible postprocedure dyspigmentation. Which of the following is the most appropriate technique that would address the patient’s concerns?
A) Chemical peeling
B) Dermabrasion
C) Full-field CO2 laser
D) Microneedling
E) Onion extract-based scar gel

Answer 38

D. micro needling

Question 39

A 54-year-old woman with Fitzpatrick Type III skin plans to undergo Er:YAG laser (2940 nm) resurfacing to improve the appearance of periorbital rhytides. Prior to treatment, the plastic surgeon recommends a topical agent that inhibits enzymatic conversion of tyrosine to dihydroxyphenylalanine. Which of the following agents did the surgeon most likely discuss?
A) Brimonidine
B) Fluocinolone acetonide
C) Hydroquinone
D ) Tretinoin
E) Zinc oxide

Answer 39

C. hydroquinone
Hydroquinone decreases melanin production by enzymatically inhibiting the conversion of tyrosine to dihydroxyphenylalanine.
Tretinoin promotes cornified cell detachment and enhances shedding.
Fluocinolone acetonide is a potent corticosteroid that is often used in conjunction with tretinoin and hydroquinone to treat pre-existing PIH and/or for pretreatment of the skin prior to laser resurfacing
brimonidine- vasoconstriction, used with topical steroids
zinc- barrier

Question 40

A 48-year-old woman presents to the office with chemosis in the right eye 17 days after undergoing bilateral upper and lower blepharoplasties with lateral canthopexy. Treatment with ocular lubrication and eye patching during the past 10 days has resulted in no improvement. On examination, she is able to close her eyes despite pronounced conjunctival prolapse. The color of the conjunctivae has a whitish appearance. Which of the following is the most appropriate next step to achieve the quickest resolution of chemosis in this patient?
A) Administration of celecoxib
B) Administration of methylprednisolone
C) Administration of tobramycin/dexamethasone eye drops
D) Conjunctival plication
E) Conjunctivotomy

Answer 40

E) Conjunctivotomy

Question 41

A 45-year-old woman comes to the office for a facial rejuvenation consultation because she wants to look her best at an upcoming high school reunion in 10 days. Which of the following is the best treatment to recommend for this patient?
A) 30 U of botulinum toxin type A injected to the forehead and crow’s feet
B) 30% Glycolic acid peel
C) Phenol (carbolic acid) peel
D) Superficial papillary dermabrasion
E) 20% Trichloroacetic acid peel

Answer 41

A. Botox

Question 42

A 24-year-old woman with a round face comes to the office to discuss buccal fat pad removal. The parotid duct travels through which of the following structures of the buccal fat pad prior to emptying intraorally via the Stensen duct?
A) Buccal extension of the posterior lobe
B) Inferior portion of the anterior lobe
C) Intermediate lobe
D) Posterior portion of the anterior lobe
E) Pterygoid extension of the posterior lobe

Answer 42

D. posterior portion of anterior lobe

question removed

Question 43

A 61-year-old woman comes to the office to discuss facial rejuvenation. Physical examination shows neck and jowl laxity, diastasis of platysma bands, and brow ptosis. Management with rhytidectomy, a superficial musculoaponeurotic system (SMAS) flap, platysmaplasty, and subcutaneous lateral brow lift is planned. Injury to the facial nerve in which of the following anatomic areas of dissection is most likely?
A) Sub-SMAS, at the lateral malar eminence
B) Sub-SMAS, 2 cm anterior to the tragus
C) Sub-SMAS, 1 cm inferior to the zygomatic arch
D) Subcutaneous, 6.5 cm inferior to the caudal edge of the external auditory meatus
E) Subcutaneous, 1 cm superior to the tail of the eyebrow

Answer 43

A) Sub-SMAS, at the lateral malar eminence

zygomatic branches exit the parotid gland anteriorly and innervate the zygomaticus major, which is superficially positioned just lateral to the malar eminence. The zygomatic and masseteric ligaments are fibrous bands located in this same area, which can obscure the correct plane of dissection. Injury to the zygomatic branches can result in an asymmetric smile.

Question 44

A 70-year-old woman considers a mastopexy to address the ptosis she has experienced after the onset of menopause. A decrease in which of the following hormones is most responsible for the involutional changes of the breast glandular parenchyma?
A ) Estrogen
B) Follicle-stimulating hormone
C) Luteinizing hormone
D ) Prolactin
E) Testosterone

Answer 44

A. estrogen

Question 45

A 53-year-old woman comes to the office because she would like to improve the appearance of her jowls. She elects to undergo injection adipocytolysis of the inferior jowl fat pad. A line drawn between which of the following structures best defines the lateral limit of the fat pad?
A) Antegonial notch and ear lobule
B) Lateral canthus and antegonial notch
C) Lateral canthus and prejowl sulcus
D) Oral commissure and antegonial notch
E) Oral commissure and prejowl sulcus

Answer 45

B. lateral canthus and antegonial notch

Question 46

A 36-year-old man presents to the office with submental fullness and undergoes injection adipocytolysis with deoxycholic acid. Seven weeks later, the patient reports diffuse patches of hair loss in his beard around the injection site. Which of the following is the most appropriate next course of action?
A) Injection of platelet-rich plasma
B) Oral administration of finasteride
C) Reassurance
D) Topical application of bimatoprost
E) Topical application of minoxidil

Answer 46

C. reassurance

Question 47

A 5-year-old boy is brought to the office by his mother because she is concerned about the shape of his ears. Examination shows antihelical underdevelopment and increased conchal depth with anterior rotation. When this deformity is corrected by recreating the antihelical fold, Mustardé sutures are placed. These sutures adjust the position of the scapha relative to which of the following structures?
A) Conchal bowl
B) Cymba
C) Mastoid bone
D) Posterior sulcus
E) Tragus

Answer 47

A. conchal bowl

Question 48

A 35-year-old woman with Grade II ptosis undergoes mastopexy augmentation with a superomedial pedicle. Which of the following arteries provides the primary blood supply to the nipple-areola complex with this procedure?
A) Anterior intercostal
B) Internal mammary
C) Lateral thoracic
D) Posterior intercostal
E) Thoracoacromial

Answer 48

B. internal mammary

Question 49

A 25-year-old woman who weighs 143 lb (65 kg) undergoes awake liposuction in an accredited office-based procedural room with a registered nurse and a surgeon. She was preoperatively treated with oral alprazolam 1 mg and intramuscular meperidine 50 mg. Intraoperatively, the patient is given tumescent lidocaine solution to 45 mg/kg. During the procedure, she reports that she is experiencing a metallic taste in her mouth and has a numbing sensation in her lips. Fifteen minutes later, she exhibits abrupt signs of confusion and agitation; her blood pressure has fallen from 125/88 mmHg to 95/60 mmHg, and her heart rate has increased from 80 bpm to 108 bpm. Which of the following is the most appropriate initial management of this patient?
A) Administer flumazenil 0.2 mg intravenously over 15 seconds
B) Administer an intramuscular injection of naloxone hydrochloride to the thigh
C) Administer 20% lipid emulsion bolus 1.5 mL/kg intravenously over 1 minute D) Secure the airway to maintain oxygenation and prevent hypoxia and acidosis
E) Stop the procedure and call for help

Answer 49

E. stop and call for help

Question 50

A 30-year-old woman expresses interest in a reduction mammaplasty 3 months after the birth of her child while still breast-feeding. She is counseled to wait until her breasts have returned to their baseline size after cessation of breast-feeding. Which of the following hormones is most directly responsible for milk production and the related breast enlargement?
A ) Estrogen
B) Luteinizing hormone
C) Oxytocin
D) Progesterone
E) Prolactin

Answer 50

E. prolactin