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POS Fluids + Electrolytes > POS Plastic Surgery > Flashcards

POS Plastic Surgery Flashcards

1
Q

A 45 year old woman presents with a 1cm chronic ulceration of the skin over a burn scar on the forearm. The lesion is there for 6 months and is not painful. She was burned 15 years ago and no skin graft was needed. Which of the following is the most likely diagnosis?

A. Squamous cell carcinoma
B. Malignant Fibrous Histiocytoma
C. Chronic Infection
D. Heterotopic Ossification

A

A. Squamous cell carcinoma

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2
Q

A

A family is brought to the hospital after a fire. Which one of these can be managed locally and doesn’t require transfer to a burn center?

A. A 40 year-old man with 9% TBSA over chest/abdomen
B. A 35 year-old woman with 25% TBSA involving face/neck
C. A 17 year-old girl with no external burns but signs of inhalational injury.
D. A 18 year-old boy with 4% TBSA full thickness burns.

A

A. A 40 year-old man with 9% TBSA over chest/abdomen

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3
Q

A 60 year old woman with a 40 year history of smoking presents with a painless 2cm nodule just anterior to the sternomastoid muscle and inferior to the angle of the mandible. The most appropriate means to obtaining a tissue diagnosis is?

A
  1. Fine-needle aspiration for cytology
  2. Ultrasound-guided core needle biopsy for histopathology
  3. Incisional surgical biological biopsy
  4. Excisional Surgical Biopsy
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4
Q

African lady presents new dark streak in nail bed suspect melanoma, most likely dx:

A. Lentigo
B. Arcal Lentigious Melanoma
C. Superficial Spreading
D. Nodular

A

B. Arcal Lentigious Melanoma

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5
Q

All are associated with increased risk of BCC except

A

A. UV
B. Nevus Sebaceous
C. Keratocanthosis
D. Actinic Keratosis (SCC risk)

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6
Q

A 44 year old woman with a history of seizure disorder pours a pan of hot grease over herself during a seizure. She has burns to her chin, chest, and abdomen. On inital evaluation, her wounds are red with pale areas centrally, slow to blanch and dry in the central portion of the wound. This patient has most likely sustained a?

A
  1. Superficial burn
  2. Superficial partial-thickness burn
  3. Deep partial-thickness burn
  4. Full-thickness burn
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7
Q

The flap question that comes up every year: flap described as cool, flat, congested:

A. Heparin
B. Leeches
C. Explore
D. Observe

A

C. Explore

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8
Q

A man has 1st degree burns to his entire right arm, 2nd degree burns to his anterior thorax and abdomen and 3rd degree burns circumeferentially to his left thigh and lower leg. The total percent Body Surface Area (% BSA) burned is:

A. 18%
B. 27%
C. 35%
D. 45%

A

D. 45%

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9
Q

In a free flap which one of the following organs has the least amount of tolerance to ischemia:

A. Bone
B. Muscle
C. Fat
D. Peripheral Nerve

A

D. Peripheral Nerve

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10
Q

All are side effects of silver sulfadiazine in the treatment of burns except?

A. Neutropenia
B. Electrolyte abnormalities
C. Hepatitis
D. Hemolytic Anemia
E. Intersitial Nephritis

A

B. Electrolyte abnormalities

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11
Q

Patient had severe burns (>2nd) of TBSA 25%, weighs 100KGs, presenting after 3 hours, how much fluid should you give him over the next 5 hours?

A. 1000 cc/hr
B. 500 cc/hr
C. 2000 cc/hr
D. 4000 cc/hr

A

A. 1000 cc/hr
(25% * 100KG * 4 in 24 hours 5L in first 8 (8-3=5) Divide by 5 hours = 1L/hr

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12
Q

A patient presents with an ulcer. He tells you that he had a previous burn 20 years ago. The ulcer has rolled adges. What is the best management?

A. Debride
B. Antibiotics
C. Biopsy
D. Dressing

A

B. Antibiotics

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13
Q

What contributes to the development of diabetic foot ulcer?

A. Peripheral nerve disease
B. Ostemyelitis
C. Microvascular disease

A

A. Peripheral nerve disease

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14
Q

Patient lawn mowing, laceration across hand with median nerve and tendon palsy

A. Repair in OR
B. Irrigate and close yourself in ER
C. Sterile dressing, keflex, refer to plastic surgeon for repair
D. Another one with a specialist

A

C. Sterile dressing, keflex, refer to plastic surgeon for repair

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15
Q

What are three zones of burn?

A. Zone of coagulation, hyperemia, and stasis
B. Eschar, stasis, hyperemia
C. Hemostasis, edema, hyperemia

A

C. Hemostasis, edema, hyperemia

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16
Q

Where can you put a split thickness graft?

A. Muscle without fascia
B. Nerve without pernervium
C. SC tissue with organized clot
D. Bone without periosteum

A

A. Muscle without fascia

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17
Q

Mole for 10 years, it’s doubled in size in the last 6 months and its showing funny colors, what do you do?

A. Incisional Biopsy
B. Wide excision biopsy 10 mm margins
C. Wide excision biopsy 20 mm margins
D. Observe in 6 months

A

A. Incisional Biopsy

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18
Q

What is the required margin or a 2mm deep melanoma?

A. 2cm
B. 1cm
C. 0.5cm

A

A. 2cm

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19
Q

What dressing would you apply to a split-thickness skin graft?

A. Vaccum Dressing
B. Wet to dry dressing
C. Silver sulfadiazene

A

A. Vaccum Dressing

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20
Q

Regarding silver sulfadiazine, side effect is

A. Decreased granuolcytes
B. Nephrotoxic
C. Carbonic Anhydrase Inhibitors

A

A. Decreased granuolcytes

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21
Q

A 45 year old woman presents with a 1cm chronic ulceration of the skin over a burn scar on the forearm. The lesion is there for 6 months and is not painful. She was burned 15 years ago and no skin graft was needed. Which of the following is the most likely diagnosis?

A. Squamous cell carcinoma
B. Malignant Fibrous Histocytoma
C. Chronic Infection
D. Heterotopic Ossification

A

A. Squamous cell carcinoma

22
Q

Patient has subcutaneous mass on the dorsal aspect of the proximal forearm for many years. Suddenly doubled in size. MRI was done and was inconclusive and cannot rule out malignancy. He is planned for an excisional biopsy, which of the following biopsy techniques is best to follow?

A. Longitudinal Incision
B. Transverse Incision
C. Excision with a 1cm ellipse of overlying skin
D. Incision along the relaxed skin tension lines (RSTL)

A

A. Longitudinal Incision

23
Q

Which of the following statements regarding burn depth is true?

A. First-degree burns are characterized by erythema, pain, and blistering of the skin.
B. Second-degree burns involve the epidermis only.
C. Third-degree burns are characterized by erythema, pain, bullae, and moisture from fluid extravasation.
D. Third-degree burns blanch to the touch.

A

D. Third-degree burns blanch to the touch.

23
Q

How do you tell the difference between flap and graft?

A. Flap has blood supply and graft has to obtain blood from recipient bed.
B. Flap is muscle, bone, nerve and graft is only skin.
C. Flap has to obtain blood from recipient bed while graft has blood supply.
D. Graft requires microvascular surgery

A

A. Flap has blood supply and graft has to obtain blood from recipient bed.

23
Q

In terms of classification of melanoma, Clark level 4 responds to invasion into what layer of skin?

A. Epidermis only
B. Superficial papillary dermis
C. Reticular dermis
D. Deep papillary dermis

A

C. Reticular dermis
Clark’s level is a related staging system, used in conjunction with Breslow’s depth, which describes the level of anatomical invasion of the melanoma in the skin. Breslow’s depth was used as a prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded.

23
Q

Squamous cell CA of lip, 2.1 x 1.1cm, no mets, no nodes, what do you do?

  1. Surgical excision
  2. Surgery plus rads
  3. Surgery plus chemo
  4. Surgery plus chemo and rads
A
  1. Surgical excision
23
Q

8 years ago, patient had a neck burn. Now presents with chronic sinus from mastoid area. How do you treat this?

A. VAC to wound
B. Reexcision
C. Silver sulfadiazine and observe
D. Biopsy

A

D. Biopsy
(Margolin ulcer chronic wound cancer)

23
Q

How do you manage a patient with a 5-digit amputation if you are in a remote hospital 5 hours from a plastics centre?

  1. Try to do the surgery yourself
  2. Lay each digit close to the amputated stump and splint
  3. Put all of the fingers in a single bag with ice in the bag
  4. Place each finger individually in a sterile, moist dressing and place in a plastic bag, then place that bag in a bag with ice.
A
  1. Place each finger individually in a sterile, moist dressing and place in a plastic bag, then place that bag in a bag with ice.
23
Q

Management of hydofluoric acid burn (acid burn)

A. Irrigate with NS 30 minutes (dilution not neutralization)
B. Irrigate with water for 15 minutes
C. Calcium carbonate gel
D. STSG

A

C. Calcium carbonate gel

24
Q

What is the most common cause of death in a burn patient?

  1. Pneumonia
  2. Hypovolemia
  3. UTI
  4. MI
A
  1. Pneumonia
25
Q

All of the following burn injuries require a referral to a burn center, EXCEPT?

  1. A 5% TBSA second degree burn of the face in a 40 year old man
  2. A 3% TBSA second degree burn to the hand in a 25 year old woman
  3. A 4% TBSA full-thickness burn of the knee in a 30 year old woman
A
  1. A 5% TBSA second degree burn of the face in a 40 year old man
26
Q

Split thickness skin graft can be used over:

A. Tendon
B. Infected Wound
C. Bone with intact periosteum

A
27
Q

For 2nd degree burn in lower leg, on dressing at home, your instructions for dressing include all except:

  1. Non Adherent
  2. Avoid bacterial contamination
  3. Compression dressings to reduce edema
A
  1. Compression dressings to reduce edema
28
Q

Meshed graft is better than non-meshed graft because all the following, except:

  1. Provides larger coverage of the surface area
  2. Best for face due to their better healing
  3. Donor site epitheialization is faster
A
  1. Best for face due to their better healing
29
Q

With regards to melanoma in black people which of the following is true:

  1. Women more than men (man more than women)
  2. Common in soles and palms
  3. Occurs on the face
A
  1. Common in soles and palms
30
Q

Post debridement in the thigh with area of exposed muscles, measuring 20X20cm:

  1. Primary Closure
  2. Secondary Closure
  3. Delayed primary
  4. Skin graft
A
31
Q

A 65 year old woman presents with a two month history of pain and swelling in the left thigh. You can palpate a roughly 6cm mass in the vastus lateralis muscle. You are suspicious of soft tissue sarcoma. The best way for you to make a diagnosis is?

  1. Fine needle aspiration cytology ofthe mass
  2. Incisional biopsy of the mass
  3. CT Scan leg
  4. MRI leg
A
  1. MRI leg
32
Q

The difference between a split thickness and full thickness skin graft include:

  1. Better take of the split thickness skin graft in an infected area
  2. More durable coverage
  3. Easier to match pigmentation
A
  1. Better take of the split thickness skin graft in an infected area
33
Q

It is possible to place a skin graft on a wound infected with all of the following bacteria except:

A. Staph. Aureus
B. Streptococcus
C. Proteus
D. Pseudomonas
E. Pasteurella

A

B. Streptococcus

34
Q

What is the deepest burn that you can get for spontaneous epithelialization to stilll occur?

A. epithelium
B. Superficial papillary dermis
C. Deep papillary dermis
D. Reticular layer

A

C. Deep papillary dermis

35
Q

The most significant prognostic factor for soft tissue sarcoma is:

A. Site
B. Size
C. Grade
D. Cell type

A

C. Grade

36
Q

Metabolic acidosis is a complication of topical application of:

  1. Sodium Mafenide
  2. Silver Nitrate
  3. Silver Sulfadiazine
  4. Betadine
  5. Bacitracin
A
  1. Sodium Mafenide
37
Q

The main complication of topical silver nitrate is:

A. Metabolic Acidosis
B.Metabolic Alkalosis
C. Hyperkalemia
D. Hypocalcemia
E. Hyponatremia

A

E. Hyponatremia

38
Q

The most common source of infection in burn patients is:

  1. Burn wound
  2. Urinary tract infection
  3. Pneumonia
  4. Thrombophlebitis
  5. Endocarditis
A
39
Q

Smoke inhalation is most reliably excluded by:

A. Absence of carbonaceous sputum
B. Normal carboxyhemoglobin level
C. Normal Xenon-133 inhalation scan
D. Normal Chest X-ray
E. Normal flexible bronchoscopy

A

E. Normal flexible bronchoscopy

40
Q

Hyponatremia is a complication of topical application of:

A. Bacitracin
B. Povidone-iodine
C. Silver sulfadiazine
D. Sulfamylon
E. Silver Nitrate

A

E. Silver Nitrate

41
Q

The most common retroperitoneal sarcoma is:

  1. Liposarcoma
  2. Fibrosarcoma
  3. Leiomyosarcoma
  4. Neurosarcoma
A
  1. Liposarcoma
42
Q

Advantage of full thickness over split thickness skin graft is:

  1. Less wound contraction
  2. Better take
  3. More resistance to infection
  4. Better sensory function
A
  1. Less wound contraction
43
Q

The most important prognostic variable for melanoma is:

  1. Gender
  2. Age
  3. Clark’s level
  4. Breslow’s thickness
  5. Complexion
A
  1. Breslow’s thickness
44
Q

The risk of regional node mestases in 0.70 mm thick melanoma is:

A. <5%
B. 10%
C. 20%
D. 30%
E. 50%

A

A. <5%

POS Fluids + Electrolytes (5 decks)

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