Plastic Surgery/Reconstruction

Question 1

cleft lip and palate

1. one in how many hundreds of births?
2. More common in males or females?
3. Associated with more than syndromes?
4. Occur as a defect of palatal growth in the what trimester?
5. Diagnosed by ultrasound at what range of weeks gestation?
6. Primary cleft lip repair at what months of age?
7. Primary cleft palate repair at what months of age?
8. Lip revisions occur in early or late childhood?
9. Palatal revisions including bone graft at what years of age?

Answer 1

1. 1:700 births
2. males
3. 400
4. first
5. 18-20 weeks
6. 3 months
7. 6 months
8. early
9. 10 years

Question 2

Cleft Lip & Palate
1. preop interview should include what 4 things? (BH, G, FTT, RFM)
2. do bilateral cleft lips have more incidence of difficult airway?
3. Incidence of difficult direct laryngoscopy is approximately
what % in children with micrognathia but only about what % in those without?
4. Cleft palate patients usually have a what in place? (PO)
5. is face mask induction complicated?
6. for laryngoscopy, use a straight blade and guide it into the right what to stay out of the cleft? (PG)
7. what ETT is a good choice?
8. paralysis isn’t necessary, but can help with placement of what? (R)

Answer 2

1. birth history, genetics, failure to thrive, risk for malnutrition
2. yes
3. 50%, 4%
4. palatal obturator
5. no
6. pharyngeal gutter
7. oral RAE
8. rectractor

Question 3

Triad of Pierre Robin sequence:

1. what 2 anatomy features? (M, G)
2. resp distress the first what hour range after birth?

Answer 3

1. micrognathia, glossoptosis

2. 24-48 hours

Question 4

Cleft Lip & Palate

1. dingman retractors can cause hypoperfusion to where? (T)
2. consider releasing the dingman retractors after how many hours?
3. use short acting opioids like what range of fentanyl?
4. surgeon may place bilateral blocks where? (I)
5. can you use an oral airway?
6. surgeon may place a suture where to prevent an airway obstruction (T)
7. cleft palate procedures are at risk for airway obstruction d/t what 3 things? (UAN, AE, RA)

Answer 4

1. tongue
2. 2 hours
3. 1-2 mcg/kg
4. infraorbital blocks
5. no
6. tongue
7. upper airway narrowing, acute edema and residual anesthetic

Question 5

Cleft Lip and Palate

1. consider what mg/kg of decadron to help with airway edema?
2. extubate the pt awake after return of what? (AR)
3. feeding with what fluids is permissible as soon as the child is awake? (C)
4. may bottle feeding or nursing be limited?

Answer 5

1. 0.5 mg/kg
2. airway reflexes
3. clears
4. yes

Question 6

Craniosynostosis

1. craniosynostosis are premature fusion of cranial what? (S)
2. Dolichocephaly is a premature fusion of what suture?
3. brachycephaly is the premature fusion of what suture?
4. Plagiocephaly is a premature fusion of what suture?
5. Dolichocephaly is elongation along what axis?
6. brachycephaly is elongation along what axis?
7. Plagiocephaly is elongation in which anatomical direction?
8. which is the most common?

Answer 6

1. sutures
2. sagittal
3. coronal
4. lamboid
5. anterior-posterior
6. left-right
7. posteriorly
8. Dolichocephaly

Question 7

Craniosynostosis equipment for the management of a difficult what should be in the room? (A)

Answer 7

airway

Question 8

Craniosynostosis increased ICP

1. what fraction of children with crouzon’s have increased ICP?
2. what % range of single suture craniosynostosis have increased ICPs?
3. is early surgery indicated to prevent an increased ICP?
4. OSA resulting in hypoxemia and hypercarbia may lead to an increase in what blood volume and thereby exacerbate intracranial what? (C, H)
5. is hydrocephalus rare in nonsyndromic craniosynostosis?
6. what 3 meds can be given to decrease ICP? (M, L, D)
7. should a VP shunt be considered when ICP is high?

Answer 8

1. 1/3
2. 10-20%
3. yes
4. cranial, hypertension
5. yes
6. mannitol, laxis, dexamethasone
7. yes

Question 9

Strategies to control ICP:

1. mild to moderate what? (H)
2. ETCO2 range of what mmHg?
3. avoiding what volume state? (H)
4. give what % saline solution?

Answer 9

1. hyperventilation
2. 30-35 mmHg
3. hypervolemic
4. 3%

Question 10

Craniosynostosis increased ICP

1. Craniofacial surgeries allow for an increased what volume and they decrease what pressure? (C, I)
2. pts still need to be monitored post craniofacial surgeries for increases in what? (I)

Answer 10

1. cranial, ICP

2. ICP

Question 11

Craniosynostosis induction

1. what type of induction usually?
2. want to keep these children doing what until you are certain you can mask ventilate and control the airway? (SB)
3. a lot of times what type of intubation is performed via a what? (FVL)
4. ensure a leak around the ETT at less than what cm H2O?
5. after airway secure, place what 2 things?
6. what type of med should be given surgeries for craniosynostosis? (A)

Answer 11

1. inhalational
2. spontaneously breathing
3. fiberoptic via an LMA
4. 20 cm H2O
5. art line, another IV
6. antifibrinolytic

Question 12

Amicar:

1. what is bolus mg/kg and give it over how many hours?
2. give what mg/kg/hr infusion range during the procedure?

Answer 12

1. 100 mg/kg over 1 hour

2. 10-15 mg/kg/hr

Question 13

TXA:

1. what dose on induction? (mg/kg)
2. then give every how many hours?

Answer 13

1. 10 mg/kg

2. 4 hours

Question 14

craniofaical reconstructions involves what 2 surgical teams?

Answer 14

1. neurosurgery

2. plastics

Question 15

Craniosynostosis

1. infuse what ml/kg of crystalloid prior to incision?
2. give what ml/kg of PRBC with incision?
3. if hypotensive during surgery, give what for resuscitation?
4. use narcotic boluses because light anesthesia means more what? (BL)
5. keep pt more what to prevent blood loss? (H)

Answer 15

1. 20 ml/kg
2. 5 ml/kg
3. PRBC
4. blood loss
5. hypotensive

Question 16

venous air embolism:

1. occurance is as high as what %?
2. surgical sight above or below heart?
3. does SV or CV increase risk?
4. does hypovolemia or hypervolemia increase risk?

Answer 16

1. 83%
2. above
3. SV
4. hypovolemia

Question 17

VAE:

1. massive VAE causes outflow obstruction from RV or LV and collapse of what?
2. smaller VAE causes a decrease in what, increase or decrease in BP and ischemia in what 2 places? (C, M, C)
3. to prevent, increase or decrease HOB?
4. to prevent, what can be placed on exposed bone edges? (BW)
5. to prevent, what can be added to vent?
6. to prevent, what volemic state should be kept?

Answer 17

1 RV, c/v collapse

2. decrease CO, decreased BP, myocardium, cerebrum
3. decrease HOB
4. bone wax
5. PEEP
6. normovolemia

Question 18

can le fort fx be difficult to mask ventilate?

Answer 18

yes

Question 19

what are 5 concerns with lefort 3 fx? (MBL, AD, B, CL, I)

Answer 19

1. massive blood loss
2. airway difficulty
3. blindness
4. CSF leak
5. infection

Question 20

skin lesions:

1. what % of congenital pigmented nevi become malignant?
2. straight forward procedures with short acting what?

Answer 20

1. 7%

2. narcotics

Question 21

congenital hand anomalies:

1. syndactyly is most commonly associated with what syndrome?
2. syndactyly is associated with what heart rhythm abnormality?
3. polydactyly is associated with what anomalies?

Answer 21

1. apert
2. prolonged QT
3. VACTERL

Question 22

what does VACTERL stand for?

Answer 22

1. vertebral
2. anal
3. cardiac
4. tracheal
5. esophageal
6. renal
7. limb