Surgery and Cosmetics

Question 1

Which sclerosing agent can have a disulfiram like reaction? Which sclerosing agent has the highest risk of anaphylaxis?

Answer 1

Polidocanol = disulfiram like reaction
Sodium morrhuate = highest risk of anaphylaxis
*Both are detergent type sclerosants

Question 2

Who needs antibiotics before cutaneous surgery?

Answer 2

Prosthetic valves
h/o bacterial endocarditis
MVP with regurg OR MVP without regurg in man > 45
Any valve dysfunction 
Cardiac malformation 
Hypertrophic cardiomyopathy
CNS shunts

Question 3

Components in Jessner’s solution

Answer 3

resorcinol, salicylic acid and lactic acid (alpha hydroxyacid) in ethanol

Question 4

Gustatory flushing and sweating is a result of injury to which nerve? This nerve is a branch of which nerve?

Answer 4

Frey Syndrome = damage to auriculotemporal nerve (typically from parotid surgery). Auriculotemporal nerve is a branch of the mandibular branch of V2.

Question 5

How are absorbable sutures absorbed?

Answer 5

Natural materials (gut or silk): Proteolysis

Synthetic materials: hydrolysis

Question 6

Which absorbable suture has the highest tensile strength? The highest initial tensile strength?

Answer 6

Polydiaxanone (PDS) = highest tensile strength (absorbed over 180 days; 50% tensile strength at 4 weeks)

Poliglecaprone 25 (Monocryl) = highest initial tensile strength (absorbed over 90-120 days; 70% tensile strength at 1 week; 30% by 2 weeks)

Glycol acid (Maxon) also has high tensile strength and is absorbed over 180 days

Question 7

What is the difference between suture memory and plasticity?

Answer 7

Memory: tendency to retain natural configuration after deformation (determined by elasticity and plasticity). High memory sutures = polypropylene and nylon

Plasticity: Ability of suture to retain new length and form after being stretched (e.g. polypropylene)

Elasticity: ability to regain former shape after being stretched

Question 8

List dressings from least to most absorbent.

Answer 8

Films < hydrocolloids < hydrogels < foams < alginates

Question 9

Which sterilization technique dulls instruments? Which is the least dulling?

Answer 9

Steam autoclave (most common in office setting)

Least dulling: dry heat (oven)

Question 10

Which sterilization technique is not effective against hepatitis B?

Answer 10

Cold sterilization / chemical immersion

Question 11

Eyelid ptosis occurs as a result of botulinum toxin diffusion into which muscle? Treat with?

Answer 11

Levator palpebrae

Treat with apraclonidine 0.5% eye drops (alpha-adrenergic agonist); causes Muller’s muscles to contract

Question 12

What is a potential complication of injecting botox into crows feet while patient is smiling?

Answer 12

Ptosis of upper lip due to diffusion into Zygomaticus complex

Question 13

Potential complication of Thermal (non ablative radio frequency-based skin tightening system)?

Answer 13

Lipoatrophy

Question 14

Which fillers require pretesting? What do they all have in common?

Answer 14

All Bovine collagen

Zyderm I and II (b.collagen + lido)
Artecoll (polymethylmethacrylate beads in b. collagen); is permanent!
Zyplast (b.collagen + glutaraldehyde + lido)

Question 15

Which filler does not induce an inflammatory response?

Answer 15

Radiesse (calcium hydroxylapatite)

Is biocompatible (same as bone); can be seen on x-ray and lasts 9 months - 5 years

Question 16

Which fillers stimulate collagen growth?

Answer 16

Cultured fibroblasts
Calcium hydoxylapatite (Radiesse)
Poly-L-lactic Acid (Sculptra)

Question 17

Risk of treating white/peach/pink/flesh-toned tattoo with QS laser? Why?

Answer 17

Immediate change to dark gray.

Reduction of ferric oxide to ferrous oxide

Question 18

What is the targeted porphyrin of aminolevulinic acid, used in PDT?

Answer 18

Protoporphyrin IX

Is substrate for final rate-limiting step of heme synthesis.

Question 19

Which lasers have the highest potential to cause corneal damage (4)?

What is the chromophore?

Answer 19

Water

long pulse ND:Yag (1320 nm)
Diode
Er:Yag
Co2

Question 20

Damage to the temporal branch of the Facial nerve causes _________. Where is this nerve most at risk of damage?

Answer 20

Inability to raise eyebrow, flattening for forehead with decreased wrinkles on ipsilateral side; can cause visual field compromise over time.

“Danger zone” = between lines drawn from earlobe to lateral edge of eyebrow and from triages to just above and lateral to highest forehead crease; highest risk when it crosses midzygomatic arch.

Question 21

Damage to the zygomatic branch of the Facial nerve causes _____.

Answer 21

Highly variable due to cross-innervation of many muscles by temporal/buccal branches of facial nerve. Likely to have decreased ability to tightly close eye on ipsilateral side; lip elevation may be diminished as well.

Question 22

Damage to the buccal branch of the Facial nerve causes _____.

Answer 22

Buccinator dysfunction –> food accumulation between teeth and buccal mucosa.

Many anastomoses between buccal and zygomatic branches of facial nerve, so damage to these is typically not severe. If both damaged, drooling and muffled speech are likely.

Question 23

Damage to the marginal mandibular nerve causes _____. Where is this nerve at greatest risk?

Answer 23

Inability to form symmetric smile – cannot pull ipsilateral lower lip down and lateral or evert lower lip. Not apparent at rest.

Danger area: superficially courses over medial mandible just inferior and lateral to the lateral oral commissure.