ITE Practique Flashcards
List 4 surgical techniques for facelift
- subcutaneous facelift
- SMAS plication
- SMAS ressection
- Skoog facelift (skin and smas as single unit)
- Subperiosteal facelift
Name 4 retaining ligaments of face relivant to facelift
- Orbitomalar retaining ligament
- Zygomatic osteocutaneous ligament (malar membrane/septum)
- Madibular osteocutaneous ligament
- Parotid retaining ligament
- Platysma mandibular ligament
- Masseteric cutaneous ligament
What is the landmark for the greater auricular nerve
McKinney’s point which corresponds to 6.5cm below the EAC/tragus along the SCM
Name 4 modifications to the paramedian forehead flap to increase pedicle lenght
- Scoring of galea
- Hockey stick design
- Extension of flap into hair bearing scalp
- Dissection of vessels to their origin at the orbital rim
- Tissu expansion
Other than paramedian flap, list 2 other pedicled flaps that can be used to reconstruct this defect
- Scalping flap
- Melolabial flap
- Washio retro-auricular flap
- ADD
At what gestational age do the following complete their formation
A. Lip
B. Palate
A. Lip - 6 months
B. Palate - 12 months
What is the probability of a child being born with CLP if:
A. Another child had CLP
B. The parent has CLP
C. Another child and parent has CLP
A. 3-4%
B. 4%
C. 17%
Name 3 areas of endochondral ossification in the growing mandible
- Coronoid process
- Symphisis
- Condyle
Name 3 surgical consideration that differ in pediatric mandible fracture management vs. adult
- Use of resorbable plates
- Later removal of hardware
- Monocortical screws along lower border
- Use of circummandibular wires
- Minimal periosteal stripping
Name 2 deleterous sequalaes that can complicate ORIF of the pediatric mandible
- Damage to developping teeth
- Facial growth disruption
- Migration of hardware
Name 2 advantages and 2 disadvantages of alloplastic breast reconstruction
Advantages:
- shorter surgery
- shorter hospital stay
- No donnor site morbidity
Disadvantages
- need for implant change
- increased risk of infection
- risk of capsular contracture
- ALCL risk
Your patient presents with acquire involutional ptosis. Name 4 tests that should be performed on physical exam prior to surgery
- Visual fields
- Visual acuity
- EOM
- MRD (marginal reflex distance)
- Lacrimal function (Shirmer’s test)
- Test frontalis function
- Evaluation of levator excursion
- Bells phenomenon test
Name 3 surgical methods to correct mild to moderate acquired ptosis
- Blepharoplasty skin resection
- Levator aponeurotic plication
- Muller muscle ressection (Putterman)
- Superior tarsal resection (Fasanella-Servat)
Name 3 potential complication from correction of mild to moderate ptosis
- Lagophtalmos (overesction)
- Persistant ptotis (under resection)
- Infection
- Hematoma
- Blindness
- Asymetry
- Exposure keratitis
What is the sensitivity of physicial exam in detecting breast implant rupture?
ADD
What is the most sensitive and specific test to diagnose implant rupture
MRI
Name 3 factors associated with implant rupture
- Trauma to the chest
- Manifacturer defect
- Larger implants
- Technical error (damage or the implant during surgery)
- Age of the implant
- Undergoing needle biopsy
What is the effect of extracapsular implant rupture on the risk of developing breast cancer
None
Name 2 key components of the surgical treatment of a symptomatic, subglandular, extra-capsular rupture of a silicone implant
- En bloc excision
- Complete removal of siliconomas
Need to double check answers
Patient presents to your clinic with nodules secondary to filler injections. What are some potential causes of this
- Infection
- Foreing body reaction/biofilm
- Superficial injection
- Filler hypersensitivity
- Hematoma formation
What is the treatment for an infected nodule post filler injection
Cultures
Antibiotics
Patient presents with delayed nodules following hydroxyappatite injections. What is your prefered treatment
- Corticosteroid injections
- Triamcinolone acetonide injections
Patient presents with cold visible swelling to the face after injection of HA for tear trough deformity. What is your primary choice in managing this patient?
Injection of hyaluronidase
Your patient presents to clinic with a nodule following a history of numerous prior filler injections. What diagnostic test can you ask to confirm weather or not these were done with permamant of non permanant fillers
Ultrasound
MRI
Need to confirm this answer
List 5 ways to optimize patency when performing a vascular anastomosis
- Tension free closure
- Adequate spacing of sutures
- Minmal handling to prevent damage to endothelium
- Maintain moist environement (prevent dessication)
- Avoid large needles
- Perform anastomosis outside zone of injury/radiation
What is the cold and hot ischemia times for the following?
A. Skin
B. Muscle
C. Bones
A. Skin
Cold = 12hrs
Warm = 4-6hrs
B. Muscle
Cold = 8hrs
Warm = <2hrs
C. Bones
Cold = 24hrs
Warm= <3hrs
Describe the pathophysiology and clinial observation of non-reflow phenomenon
Pathophysiology: swelling in vascular endothelium leading ot platelet aggregation and leakage to interstitial space
Observation: excellent blood flow followed by flap ischemia
Need to confirm this answer
List the 3 stages of wound healing and one cell type in each
Inflammation: macrophaes
Fibroproliferative: fibroblasts
Remodelling: myofybloblasts
Name an absolute contra-indication to the use of silver sulfadiazine
Sulfa allergy
Draw an antia-buch local rotation flap
ADD photo
Name 2 modifiers to the antia-buch rotation that can be made
- Burrows triangle at inferior portion of the ear
- V-Y advancement at the helical crus region
Describe the classification for ring avulsion injuries
While performing your replant surgery you notice a 1.5cm gap between your vessels. What can you do to reestablish blood flow
- Use of contralateral digital artery
- Venous flowthrough
- Veine graft
Need to double check answer
What is an absolute contraindication to microsurgical repair of a ring avulsion
- Hemodynamic instability
- Severely crushed of mangled extremity
- Smoking
Need ot confirm answer
Name the arterial branches to the nasal septum
- Septal branch of superior labial artery
- Anterior septal branch of ethmoid artery
- Posterior septal branch of sphenopalatine artery
On which branche of the nasal septum is the mucoperichondrial flap based?
septal branch of the superior labial artery
Define gynecomastia
Excessive proliferation/enlargment of glandular tissue in the male breast
Define pseudo-gynecomastia
Enlargement of male breast due to excessive fatty tissue
In the context of pubertal gynecomastia, which laboratory tests would you order?
None
Only need history and physical exam
Need to double check answer
Name 3 pharmacological causes for gynecomastia
- Cannabis
- Estrogen
- Spironolactone
- Anabolic steroids
Name 4 pathologic causes for gynecomastia
Cirrhosis
Pituatary tumor
Breast or adrenal neoplasm
Hyper/hypothyroidism
What is a z-plasty
Double opposition triangular transposition flaps
Name 2 uses of z-plasty
Lenghtening of scar
ADD
Describes the angles and lenghtening associated with each angle in z-plasty
Name 3 critical factors that will affect the outcomes of a z-plasty
- Angles
- dissection of skin flaps
- tension of the skin perpendicular
Name 3 physical findings that would increase your suspicion for inhalation injury in the context of burns
- Cabonaceous sputum
- Singed nasal hair
- Sooth around vocal cords
- Hoarseness
Name 3 important predictors of mortality in burns
- Age >60
- Burn TBSA >40%
- Presence of inhalation injury
Rates of mortality based on the presence of (X) factors
1 factor:
2 factors:
3 factors:
What is the most important predictor of burn mortality
TBSA percentage
With use of tumescent solution, what is the infiltrate to aspirate ratio in super wet liposuccion?
1:1
Wet 200-300c per area
Superwet 1:1
Tumescent 2-3:1
You see a child with the following lesion.
A. What are the two growth phases of this lesion?
B. If it was present at birth what would the diagnosis be
A. Proliferation and Involution
B. Congenital hemangioma
Approximately what percent of hemangiomas will regress to the point where they do not need surgery?
50%
List 4 indications for early intervention in a patient with a hemangioma
- Ulceration and bleeding
- Obliteration of structures (ie. Ears, nose, etc)
- Deprivation amblyopia
- Airway obstruction
- Pedunculated and removed with minimal scar that is estimated to be better than outcome with natural regression
A similar lesion to hemangioma is kaposiform hemangioendothelioma. If this presents with consumptive coagulopathy, what is the diagnosis?
Kassabach-Merit phenomenon
Which burn patients (excluding chemical, electrical and inhalation injuries) require fluid resuscitation?
- Children and elderly with TBSA over 10%
- Adults TBSA over 20%
What are 3 hematologicla findings associated with Kassabach-Merit phenomenon
- platelet sequestration (throbocytopenia)
- low fibrinogen
- increases D-dimer
- elevated PT/APTT
In reviewing the anatomy of the abdominal wall, you read about the 3 zones of blood supply of the unoperated abdomen. Describe each zone’s blood supply
Zone 1: DIEA/DSEA
Zone 2: External iliac artery (pudendal artery)
Zone 3: Intercostal arteries
Double check answer
What nerve is responsible for numbness of the anterolateral thigh after abdominoplasty?
Lateral femoro-cutaneous nerve
What is the composition of a typical tumescence solution?
1:1:1:1 trick
- 1L NS
- 1% lidocaine (50cc)
- 1ml of epi (1:1000)
- 10ml of sodium bicarb
What is the most common post-operative complication of liposuccion?
Contour irregulaties
A 63 y/o male patient presents with mandibular pain and trismus following treatment for floor of mouth SCC with close margins and post-operative radiotherapy about 1 year ago. What is your most likely diagnosis other than osteoradionecrosis
- Recurrent malignancy
Name a type of work for each of the levels litterature evidence
You parform a biopsy for a patient that comes back suggestive of osteoradionecrosis. What conservative management options are available?
ADD
What are 2 potential risk factors leading to osteoradionecrosis of the mandible following radiation
- > 60 Gy
- Brachytherapy
- Comcomittant chemotherapy
List 2 clinical features of osteoradionecrosis of the mandible
- pathological fractures
- fistula formation
- pain
- ulcer with exposure of underlying bone
- ADD
Your patient presents with the following lesions.
A. What is your most likely diagnosis
B. Name 3 other potential DDx
A. pyogenic granuloma
B. Other DDX:
- SCC
- Arterial ulcer
- Collagen vascular disease
- Necrobiosis lipoidica diabeticorum
List 4 risk factors for pyoderma gangrenosum granular on history
- Trauma
- Systemic disease (UC, IBD, Crohns)
- Previous biopsy
- Long duration
- Failed previous treatments
Name 4 non surgical treatments for pyoderma gangrenosum
- Topical corsticosteroids or systemic cortisone
- Wound care
- Hyperbaric O2
- Topical tacrolimus
- Cromolyn sodium
Name 4 compression sites of the PIN
- Leashe of Henry
- Leading edge of supinator
- Arcade of Frosh
- Medial edge of ECRB
Name 2 less common causes of PIN palsy
- Pseudogout
- Vascular malformation
- Radia head fracture
- Bening tumors
Need to double check answer
Wartenburd syndrome is a compression neuropathy…
A. Of which nerve
B. Between which 2 muscles
A. Radial sensory nerve
B. ECRL and brachioradialis
Describe the Wartenburg sign
Clinical finding of ulnar nerve deficit manifested by abduction of the 5th finger due to unopposed action of radially innversated extensor muscles (digiti minimi, digitorum communis ) againt a weak palmar interossei (weak adduction)
Your patient presents with the following XR.
A. What is your most likely diagnosis
B. Name 4 other potential DDx for this lesion
A. Enchondroma
B. Other DDX
- Simple bone cyst
- Osteoblastoma
- Giant cell tumor
- Aneurysmal bone cyst
What is the management of most bony tumors of the fingers (2)
- Curretage
- Bone graft
Other than XR and CT scan. What 2 other modalities that can be used to elucidate the natuee of a bony lesion
- Biopsy
- MRI
Describe the Leddy packer classification
Name 2 techniques for acute repair of a Type 1 jersey finger
- Bone anchor
- Pull-through stitch
type 1 means no bony fragment
Name 3 options for repair of chronic jersey finger
- Two stage reconstruction with tendon graft
- One stage with tendon transfer
- DIP arthrodesis
Your patient presents with a suspected retrobulbar hematoma.
A. name 3 non-surgical steps to manage this complication
B. Name 2 surgical intervention that can be done
A. Non-surgical
- raise head of bed
- timolol
- mannitol
B. Surgical
- lateral canthotomy/cantholysis
- urgent evacuation in operating room
What is the vascular pedicle of the deltopectoral flap
Intercostal perforators of the internal mammary artery
Name 3 mechanisms that occur during 2 staged flap harvest
- Dilatation of choke vessels
- Ischemic preconditionning
- Neoangiogenesis
Dissection of to which lateral landmark is considered to be reliable when raising a delto-pectoral flap
Deltopectoral groove
Your patient presents to clinic with the following..
Name 3 elements of lower eyelid deformity.
- Excess skin
- Herniation of fat from lower eyelids compartments
- Muscle weakness
- Tear through deformity
Your patient presents with the following. Name 3 surgical steps to correct his eyelid laxity
- Fat ressection
- Skin ressection
- Lateral canthoplasty
Name 2 etiological factors for diplopia following blepharoplasty
- Oedema
- Inferior or superior oblique muscle injury
Name 2 vascular anomalies associated with Kasabach-Merritt phenomenon
- Kaposiform hemangioendotheliomas (KHE)
- Tufted angioma
Name 2 common medical therapies to treat Kasabach-Merritt phenomenon
- Vincristine (#1)
- Steroids
- Interferon
Whatis the space of Poirier
Virtual space between the lunate and capitate around the radioscaphocapitate ligament and long radiolunate ligament
How do you calculate the scapholunate angle
- On lateral x-ray
- Line between axis of scaphoid
- Interlip line acros the lunate
- Scaphoid angle = angle between these 2 lines
What is considered normal scapholunate angle
30-60o
With normal wrist motion, how much movement occurs at
A. Radiocarpal joint
B. Midcarpal joint
A. Radiocarpal = 60%
B. Midcarpal = 40%
How does ulnar variance change with forearm pronation and supination
Supination increases (unlar -)
Pronation decreases (ulnar +)
** trick - ulnar Pronation = Plus
You see the following patient in clinic.
A. What is your leading diagnosis?
B. What are feature associated with this condition
A. Rhinophyma
B. Features
- sebaceous hyperplasia
- bulbous nasal tip
- telangiectasia
- 15-30% risk of BCC
Name 3 non-surgical and 3 surgical treatments for rhinophyma
Non-surgical
- avoidance of sun
- acutane
- topical metronidazole
- avoidance of food trigers (ie. spicy, coffee, tea)
- CO2 laser
Surgical
- dermabrasion
- dermaplaning
- tangential excision of hypertrophic appendages
- excision with electrocautery
answers
Patient presents with the following.
A. What are 3 clinical indications for early repair
B. Name 2 CT findings that would warrant early repair
A. Clinical exam:
- Restricted EOM (Entrapment of inferior rectus)
- persistant occulocardiac reflex
- Significant vertical dystopia
- Enophtalmos >2mm
- Diplopia >2 weeks
B. CT findings
- involvement of >50% of total floor surface
- Entrapment of IR on imaging
- Other fractures needing repair
True or false. There is a correlation between developing enophtalmos and diplopia after orbital floor fractures.
FALSE
Name 2 modifiable factors crucial to outcomes in ulnar nerve repair
- Little to no delay
- Tension free repair
- Adequate alignement of nerve fibers (motor -> motor and sensory->sensory)
Name 2 methods to confirm ulnar nerve recovery
- Tinnel
- EMG
- Motor and sensory exam
