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Diplomate exam > Plastic And Reconstructive Surgery > Flashcards

Plastic And Reconstructive Surgery Flashcards

1
Q

In using GAN for facial nerve reinnervation, what length of the GAN can be harvested?
Sural nerve?
Medial antebrachial cutaneous nerve?

A

10cm
70cm
20cm

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2
Q

How many epineural sutures in nerve-nerve anastomosis?

A

4, with 8-10mm of extra length for each anastamosis

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3
Q

Most common smile form dominated by action of zygomaticus major muscle. Corners of mouth move laterally and superiorly

A

Mona lisa smile

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4
Q

Smile type dominated by levator labii superioris muscle. Vertical elevation of the upper lip, lateral elevation of the upper mouth.

A

Canine smile.

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5
Q

Smile type with simultaneous elevation of the elevators and depressors of the lips and angles of the mouth.

A

Full denture smile/toothy smile

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6
Q

When to perform EMG prior to performing reanimation?

A

12 mos after

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7
Q

Most desired neural source for rejuvination of the paralyzed face?

A

Ipsilateral facial nerve

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8
Q

Single most important test to determine type of operative procedure to be performed?

A

EMG

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9
Q

Type of EMG pattern in reinnervation?

A

Polyphasic potentials

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10
Q

EMG pattern where normal denervated muscles exist?

A

Denervation or fibrillation potentials

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11
Q

EMG pattern when there is atrophy or congenital absence of muscle, provided there is proper electrode positioning.

A

Electrical silence.

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12
Q

Order of priority of reinnervation of nerve.

A

Buccal and zygomatic
Marginal mandibular
Temporal
Cervical

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13
Q

Pinna is composed of what type of cartilage?

A

Fibrocartilage

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14
Q

Bowl of the ear has 3 concavities?

A

Cavum concha
Cymba concha
Fossa triangularis

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15
Q

Sensory innervation if the ear?

A

CN 5 (auriculotemporal nerve)
CN 7
CN X (arnolds nerve)
C2 and c3

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16
Q

Cartilagenous protuberance at the helix?

A

Darwins tubercle

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17
Q

Otic placode arises at what week aog?

A

3rd

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18
Q

Six hillocks arise at how many weeks aog?

A

6weeks aog

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19
Q

Hillocks fuse at how many weeks?

A

12th week. Failure to do so will result in pre auricular sinuses.

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20
Q

Cartilage formation begins at how many weeks aog? (Ear)

A

7 weeks

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21
Q

Helix furls at how many weeks aog? Antihelix?

A

8-12 weeks, 12-16weeks

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22
Q

Normal auriculocephalic angle?

A

25-35 degrees

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23
Q

What auriculocephalic angle is considered abnormal?

A

> 40-45 degrees

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24
Q

Pinna is positioned how many mm from the scalp?

A

15-20mm

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25
Q

Otoplasty done at what age?

A

5-6

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26
Q

What age does ear attain 85% of adult size?

Fully adult size?

A

3 years old

5-6 years old

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27
Q

Another name for V-Y pushback palatoplasty?

A

Oxford method

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28
Q

What is Sutherland’s classification for nerve injury?

A

1st degree: reversible nerve block

2nd degree: Wallerian degeneration occurs but endoneurium stays intact and recovery is usually complete.

3rd degree: Endoneurium is destroyed but perineurium stays intact and recovery is incomplete.

4th degree: All is destroyed except for the epineurium; recovery is poor.

5th degree: Complete nerve transection; untreated recovery is not expected.

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29
Q

What is Hering’s Law?

A

Unilateral ptosis with contralateral lid retraction-if you cover the ptotic eye with a patch for 30-60 minutes, the retracted eye will settle into the normal position and the ptotic eye will reveal itself.

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30
Q

What are the 4 strategies in the correction of a deviated septum?

A
  1. Septum straightening
  2. Complete osteotomies, including intermediate osteotomies
  3. Long and wide spreader grafts for cartilaginous dorsal deviation
  4. Strategic camouflage
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31
Q

Average epidermal thickness.

A

0.1 mm

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32
Q

Melanocytes are derived from?

A

Neural crest cells.

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33
Q

Epidermis is derived from?

A

Ectoderm

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34
Q

Dermis is derived from?

A

Endoderm.

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35
Q

Contains ground substance with highly developed microcirculation?

A

Papillary dermis

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36
Q

Contains thick bundles of collagen and elastic fibers?

A

Reticular dermis

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37
Q

Classification of flaps? (4) (FARM)

A

Free microvascular flaps
Arterial cutaneous (axial) flaps
Random cutaneous
Myocutaneous and fasciocutaneous flaps

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38
Q

Vascular supply of random cutaneous flaps?

A

Subdermal plexus. Plane of dissection subcutaneous fat. Survival of flaps depend on perfusion pressure and not length to width ratio.

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39
Q

Blood supply of acial flaps?

A

Septocutaneous aa.

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40
Q

Needs microvascular anastamosis of artery and vein.

A

Free microvascular flaps.

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41
Q

Flap can tolerate ___of complete avascularity and survive.

A

13 hours

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42
Q

Pressure at which there is no longer enough intravascular pressur to maintain capillary blood flow.

A

Critical closing pressure.

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43
Q

Neovascularization, which begins 3-4days after flap transposition, occurs at what rate?

A

0.2mm/day

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44
Q

New capillaries join preexisting flap vessels.

A

Inosculation.

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45
Q

Is a vasodilator and inhibitor of platelet aggregation.

A

PGI 2.

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46
Q

Tissues tolerate short periods of ischemia fairly well but exhibit histologic injury after return of perfusion. May be due to free radicals or lactic acid.

A

Reperfusion injury.

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47
Q

Principal structural framework of extracellular matrix?

A

Collagen 1 and 2.

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48
Q

Increase in strain seen when a constant stress is applied to th skin.

A

Creep

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49
Q

Decrease in stress when skin is held under tension in constant strain.

A

Stress relaxation.

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50
Q

Force required to counteract the attachment between the dermis and the underlying tissue.

A

Shearing force

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51
Q

Reduction of shearing force and wound tension is decreased with undermining of up to?

A

4cm

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52
Q

Most common intrinsic factor affecting flap survival is?

A

Inadequate blood flow

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53
Q

Improves blood flow, conditions tissue to ischemia, closes AV shunts.

A

Delay

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54
Q

How many hours delay to be effective?

A

At least 24 hours.

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55
Q

Vasodilators to increase flap viability?

A 
Phenoxybenzamine
Phentolamine
Lidocaine
Isoflurane
Verapamil
Nitroglycerin (venous>arterial)
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56
Q

Leaching/hyperbaric oxygen improves what zone of viability?

A

Zone 1.

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57
Q

How long is the inflammatory phase?

A

2-5 days.

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58
Q

After ____ days, lymphocytes (-> Langerhans cells) become the dominating leukocyte subset.

A

14days

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59
Q

Nitric oxide greatest during?

A

Inflammatory phase.

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60
Q

How long is inflammatory phase in wound healing?

61
Q

In day one, what are the predominant cells in the wound?

A

50% neutrophils -> chemokines

62
Q

When do macrophages in the wound peak?

A

Day 3. Monocytes -> macrophages - central role im inflammatory phase.

63
Q

How long is proliferation phase?

A

5 days to 3 weeks.

64
Q

Proliferation phase recruits which cells?

A

Keratinocytes
Fibroblasts
Epithelial cells

65
Q

3 aspects of proliferation phase?

A
  1. Re epithelialization
  2. Formation of granulation tissue
  3. Wound contraction
66
Q

How many days post op keratinocyte proliferation?

67
Q

When does granulation tissue form?

A

3-4 days after injury, this replaces fibrin clot. Dermal matrix mostly fibroblasts. Angiogenesis starts.

68
Q

Wound contraction happens when?

A

2nd week. Fibronectin plays a role in wound contraction by binding to fibrin and providing a scaffold for fibroblast and keratinocyte migration and tissue support.

69
Q

When does remodeling phase in wound healing occur?

70
Q

Wound strength at one week? 3 weeks? 3 months/12weeks?

A

3%, 20%, 80%

71
Q

How many organisms/gram of tissue is infected?

A

10 power of 5 microorganisms/gram

72
Q

Name 5 fasciocutaneous flaps. RULLS

A 
Radial forearm
Ulnar forearm
Lateral arm
Lateral thigh
Suprascapular-parascapular
73
Q

Radial forearm flap avn?

A

Radial artery
Vena comitantes
Medial and lateral antebrachial cutaneous

74
Q

Ulnar forearm flap avn?

A

Ulnar aa
Vena comitantes
Medial and lateral antebrachial cutaneous

75
Q

Lateral arm flap avn?

A

Posterior radial collateral
Posterior radial collateral
Posterior cutaneous nerve of the forearm

76
Q

Lateral thigh flap avn?

A

Deep femoral
Vena comitantes
Lateral femoral cutaneous

77
Q

Suprascapular-parascapular flap avn?

A

Subscapular
Subscapular
None

78
Q

Name 2 muscle or myocutaneous flaps.

A

Rectus abdominis and latissimus.

79
Q

Rectus abdominis flap avn?

A

Deep inferior epigastric
Same
Thoracodorsal

80
Q

Latissimus flap avn?

A

Subscapular
Same
Thoracodorsal

81
Q

Name 4 osteocutaneous flaps

A

Fibula (25 cm)
Iliac crest (14-16cm)
Radius
Scapula (10-14 cm)

82
Q

Fibula osteocutaneous flap avn?

A

Peroneal
Peroneal
Lateral sural cutaneous

83
Q

Radius osteocutaneous flap avn?

A

Radial
Vena comitantes
Medial or lateral antebrachial cutaneous

84
Q

Scapular osteocutaneous flap avn?

A

Subscapular
Same
None

85
Q

Iliac crest osteocutaneous flap avn?

A

Deep circumflex iliac
Same
None

86
Q

Most versatile and reliable soft tissue flap?

A

Radial forearm fasciocutaneous. 12% of people have poor communication between deep and superficial arches.

87
Q

Mainstay of mandibular recon. Most donatable bone in the body with up to 25cm of bone available for harvest.

88
Q

To avoid pathologic fracture, get only this % of radius?

89
Q

Highest quality of bone for osteointegration for dental implantation?

A

Iliac crest flap

90
Q

Microsurgical technique: donor recipient vessel mismatch is?

91
Q

When the anterior vessel wall is not lifted from the posterior vessel wall.

A

Back walling.

92
Q

Two smooth forceps under sliding compression can confirm flow across the anastamosis.

A

Strip testing

93
Q

Three common mechanisms of thrombosis?

A

Stasis
Hypercoagulability
Vessel injury

94
Q

Most rapid method of anticoagulation?

95
Q

Most reliable monitoring technique and should be the end all test that determines the status of the flap.

A

Post op pin prick and visual inspection.

96
Q

Most free flap anastamotic ischemic complications occur within?

97
Q

Need to re exploration and revision occurs (for flaps)?

98
Q

In venous anastamosis thrombosis. In arterial anastamosis thrombosis?

A

Only venous anastomosis should be explored; both arteeial and venous component explored.

99
Q

3 variables that can be controlled in surgical lasers?

A

Power
Spot size
Exposure time

100
Q

Co2 causes protein denaturation at what temperature?

A

60-65c; at 100c causes carbonization, disintegration, smoke and gas generation.

101
Q

Among iv induction agents, can cause drop in bp?

A

Propofol

Thiopental

102
Q

Can be given im, but causes tachycardia and hypertension (iv induction)?

103
Q

Mc benzodiazepene? Onset 2-4 mins.

A

Midazolam.

104
Q

Depolarizing agent which raises K by 0.5 meq/l. Onset 60 seconds and duration 5mins.

A

Succinylcholine.

105
Q

Cause of “purse string” appearance of the mouth in the elderly?

A

Resorption of the mandibular and maxillary bone

106
Q

What is the Lyon’s hypothesis for genetic disease?

A

Inactivation of one X chromosome in females.

107
Q

Ideal nasofrontal angle

A

115-135 deg

108
Q

Ideal nasolabial angle?

A

F: 95-110 degree
M: 90 - 95 degree

109
Q

Ideal nasofacial angle?

A

30 - 40 degree (36)

110
Q

Ideal nasomental angle?

A

120 - 132 degree (4mm, 2mm)

111
Q

Ideal mentocervical angle?

A

80 - 95 degree

112
Q

Ideal position of the medial eyebrow?

A

10mm above medial canthus

113
Q

Normal intercanthal distance?

A

M: 26.5-38.7mm
F: 25.5-37.5mm

114
Q

Normal palpebral opening?

A

10-12mm height

28-30mm width

115
Q

Upper lid crease measurement?

A

7-15mm (11mm)

116
Q

Tip projection measurement?

117
Q

Lines of Blashko refers to:

A

Epidermal nevus

118
Q

Milia measurement?

119
Q

R/f for BCC?

A

Intermittent and intense sun exposure

120
Q

R/f for SCC?

A

Cumulative sun exposure

121
Q

Increased risk for melanoma?

122
Q

Picket fence histology?

123
Q

Aggressive form of bcc?

A

Ulcus terebrans

124
Q

Aggressive bcc?

A

> 6 mm face

> 10mm forehead, scalp, and neck

125
Q

Nevoid BCC otherwise known as?

A

Gorlin’s tumor

126
Q

Treatment for BCC?

A

Vismodegib - Sonic Hedgehog pathway

127
Q

Causative for scc?

A

Hpv 16, 18 (31, 33, 38)

128
Q

Aggressive scc?

A

> 2 cm in diameter

>4 mm depth

129
Q

Worst prognostic indicator for scc?

A

Perineural invasion

130
Q

Usually begin at 4th decade of life. Do not occur in palms and soles. Sharply demarcated and slightly raised, with keratotic plugs, flesh color to deep black. No malignant potential.

A

Seborrheic keratosis

131
Q

Hundreds of this, associated with adenoca.

A

Lesser-trelat sign

132
Q

Usually in adolescents. Looks like seborrheic keratosis but smaller.

A

Dermatosis papulosa nigra

133
Q

Common wart is caused by what strain of hpv?

A

Hpv 2 and 3.

134
Q

Dome like non pigmented papillomas, usually resolve spontaneously. Histologically with molluscum bodies.

A

Molluscum contagiosum.

135
Q

Aka solar keratosis, precancerous lesion in which 5-20% develop scca after the 2nd decade of life. No sharp demarcation, spread peripherally.

A

Actinic keratosis.

136
Q

Treatment for actinic keratosis?

A

Best removed and not watched. Usually by cryosurgery. If diffuse, can do dermabrasion, chemical peel, or laser resurface

137
Q

Most common malignancy in humans

138
Q

_____of bcca occur in the head and neck?

A

86%, mostly on the nose

139
Q

Genetic syndromes associated with bcca?

A

AD nevoid bcca

Xeroderma pigmentosum

140
Q

Is keratoacanthoma a variant of scca?

A

Yes. It proliferates, plateaus, then involutes

141
Q

2 forms of keratoacanthoma?

A

Giant (reaching 5cm) and eruptive (hundreds of papules)

142
Q

Can be used to induce involution in keratoacanthoma?

A

Methotrexate

143
Q

3rd mc skin ca

144
Q

2 growth phases of melanoma?

A

Radial

Vertical

145
Q

Mode of transmission for protruding ears?

A

AD, 5%. Insufficient helical furl and misshapen conchal bowl.

146
Q

Mustarde’s suture for protruding ears?

A

Multiple horizontal mattress

147
Q

How does hyperbaric oxygen help flaps?

A

Increase by 20% o2 carrying capacity

148
Q

Weight loss of ____ will decrease wound healing.

Diplomate exam (7 decks)

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