Body Contouring — MCQs
Complications of sling procedures (TVT) for USI are all except:
All of the following are primarily restrictive operations for morbid obesity, except which of the following?
A patient with grossly contaminated wound presents 12 hours after an accident. His wound should be managed by -
Incisions for medicolegal autopsy include all except?
In which of the following situations is breast conservation surgery not indicated?
Which flap is commonly used in breast reconstruction?
Genioplasty procedure is used for:
If severe bony undercuts exist, what is the best treatment?
A 40-year-old woman was brought to the casualty 8 hours after sustaining burns on the abdomen, both limbs, and back. What is the best formula to calculate the amount of fluid to be replenished?
A woman was brought to the casualty 8 hours after sustaining burns on the abdomen, both the limbs and back. What will be the amount of fluid to be used for resuscitation in the first 24 hours as per Parkland formula?
Body Contouring Indian Medical PG Practice Questions and MCQs
Question 1: Complications of sling procedures (TVT) for USI are all except:
- A. Obturator nerve injury is about 10% (Correct Answer)
- B. Overactive bladder in about 7% cases
- C. Injury to bladder and wound haematoma
- D. Sling erosion particularly with polytetrafluoroethylene (Goretex)
Explanation: ***Obturator nerve injury is about 10%*** ✓ **CORRECT ANSWER (NOT a complication of TVT)** - **Obturator nerve injury** is exceedingly rare during **TVT (Tension-free Vaginal Tape)** procedures, which use a retropubic approach through the space of Retzius. - This complication is primarily associated with **TOT (Trans-Obturator Tape)** procedures where the tape passes near the obturator foramen, not with standard retropubic TVT. - The incidence of obturator nerve injury in TVT is essentially negligible (<0.1%), nowhere near 10%. *Overactive bladder in about 7% cases* - **De novo overactive bladder (OAB)** symptoms or worsening of pre-existing OAB can occur in 3-15% of patients after TVT procedures, with 7% being a commonly cited figure. - This occurs due to changes in bladder neck support, urethral kinking, or irritation from the sling material. *Injury to bladder and wound haematoma* - **Bladder injury/perforation** occurs in 2-5% of TVT cases due to the retropubic passage of needles close to the bladder, which is why intraoperative cystoscopy is routinely performed. - **Wound hematoma** can occur at the vaginal or suprapubic incision sites as a common surgical complication from tissue dissection and bleeding. *Sling erosion particularly with polytetrafluoroethylene (Goretex)* - **Sling erosion** into the vagina or urethra is a documented complication of synthetic slings, with rates of 0.5-3% for modern materials. - **Polytetrafluoroethylene (Goretex)**, an older first-generation mesh material, was associated with significantly higher rates of erosion (up to 10%) and infection compared to modern monofilament polypropylene meshes, which is why it has been largely discontinued for sling procedures.
Question 2: All of the following are primarily restrictive operations for morbid obesity, except which of the following?
- A. Laparoscopic adjustable gastric banding
- B. Roux-en-Y operation (Correct Answer)
- C. Vertical band gastroplasty
- D. Duodenal switch operation
Explanation: **Roux-en-Y operation** - The **Roux-en-Y gastric bypass** is considered a **malabsorptive as well as a restrictive procedure** because it creates a small gastric pouch and bypasses a significant portion of the small intestine. - This dual mechanism leads to greater weight loss compared to purely restrictive surgeries. *Vertical band gastroplasty* - **Vertical band gastroplasty** is a **purely restrictive procedure** that creates a small pouch and restricts outflow, but does not involve nutrient malabsorption. - It is less commonly performed now due to higher rates of weight regain and complications compared to other bariatric surgeries. *Laparoscopic adjustable gastric banding* - **Laparoscopic adjustable gastric banding** is a **purely restrictive procedure** where an inflatable band is placed around the upper part of the stomach to create a small pouch. - This limits the amount of food that can be consumed at one time and slows gastric emptying, but does not alter nutrient absorption. *Switch duodenal operation* - The **duodenal switch operation** (biliopancreatic diversion with duodenal switch) is primarily a **malabsorptive procedure** with a restrictive component. - While it includes creation of a small gastric pouch, its most significant effect on weight loss comes from bypassing a large portion of the small intestine, leading to **significant malabsorption**.
Question 3: A patient with grossly contaminated wound presents 12 hours after an accident. His wound should be managed by -
- A. Thorough cleaning with debridement of all dead and devitalised tissue without primary closure (Correct Answer)
- B. Primary closure over a drain
- C. Covering the defect with split skin graft after cleaning
- D. Thorough cleaning and primary repair
Explanation: ***Thorough cleaning with debridement of all dead and devitalised tissue without primary closure*** - For a **grossly contaminated wound** presenting 12 hours after injury, thorough **wound lavage** and **debridement** of all non-viable tissue are crucial to reduce bacterial load. - **Delayed primary closure** or **secondary intention healing** is preferred over primary closure in such cases to prevent infection spread. *Primary closure over a drain* - **Primary closure** of a grossly contaminated wound significantly increases the risk of **wound infection**, even with a drain. - Drains may help with fluid collection but do not sufficiently mitigate the risk of infection in a dirty wound. *Covering the defect with split skin graft after cleaning* - Applying a **skin graft** to a potentially infected wound is contraindicated as it will likely fail due to the **bacterial burden**. - Grafting is typically performed on clean, well-vascularized wound beds. *Thorough cleaning and primary repair* - While **thorough cleaning** is essential, **primary repair** (closure) of a grossly contaminated wound is associated with a high risk of **surgical site infection**. - **Delayed closure** allows for observation and further debridement if necessary.
Question 4: Incisions for medicolegal autopsy include all except?
- A. 'Y' shaped
- B. Modified 'Y' shaped
- C. Modified 'I' shaped (Correct Answer)
- D. 'T' shaped
Explanation: **Modified 'I' shaped** - The **modified 'I' shaped** incision is not a standard or recognized incision for a medicolegal autopsy. - Standard autopsy incisions are designed to provide comprehensive access while maintaining anatomical integrity as much as possible for future viewing or reconstruction. *'Y' shaped* - The **'Y' shaped incision** is a commonly used incision in medicolegal autopsies, starting at the shoulders and meeting at the xiphoid process, then extending to the pubic symphysis. - This incision allows for optimal exposure of the neck, chest, and abdominal organs. *Modified 'Y' shaped* - The **modified 'Y' shaped incision** is a variation of the standard 'Y' incision, often used to avoid cutting through prominent scars or to provide better access in specific cases. - It maintains the general principle of broad exposure while adapting to individual circumstances. *'T' shaped* - The **'T' shaped incision** is another recognized incision, though less common than the 'Y' shape, primarily used for better exposure of the neck and chest in certain circumstances. - It involves a horizontal incision across the upper chest, intersecting with a vertical midline incision.
Question 5: In which of the following situations is breast conservation surgery not indicated?
- A. SLE
- B. Large pendular breast
- C. Diffuse microcalcification
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - All listed scenarios—**large pendular breast**, **SLE**, and **diffuse microcalcification**—represent situations where breast conservation surgery is generally contraindicated or challenging. - Their presence often necessitates alternative treatment approaches, such as mastectomy, to achieve optimal oncologic and cosmetic outcomes. *Large pendular breast* - While not an absolute contraindication, a **very large or pendulous breast** can make it difficult to achieve a satisfactory cosmetic outcome after breast conservation surgery. - The disproportionate breast size post-lumpectomy may lead to significant **asymmetry**, requiring further reconstructive procedures. *SLE* - Patients with **Systemic Lupus Erythematosus (SLE)** are at an increased risk of complications from radiation therapy, a mandatory component of breast conservation surgery. - They tend to experience more severe and prolonged **acute and chronic skin reactions** to radiation, which can significantly impair healing and quality of life. *Diffuse microcalcification* - **Diffuse microcalcification** within the breast can indicate widespread in situ carcinoma (e.g., DCIS) or an invasive carcinoma with extensive intraductal component. - In such cases, achieving **clear surgical margins** with breast conservation surgery can be challenging and often leads to multiple re-excisions or an increased risk of local recurrence.
Question 6: Which flap is commonly used in breast reconstruction?
- A. DIEP based on deep inferior epigastric perforator vessels (Correct Answer)
- B. Gluteal flap based on superior gluteal artery
- C. Latissimus dorsi flap based on thoracodorsal artery
- D. TRAM based on transverse rectus abdominis muscle
Explanation: ***DIEP based on deep inferior epigastric perforator vessels*** - The **DIEP flap** is currently the **most preferred autologous flap** for breast reconstruction and is increasingly commonly used in modern practice. - It uses tissue from the lower abdomen, providing excellent volume and a natural-feeling breast mound, while being nourished by **deep inferior epigastric perforator vessels**. - Key advantage: **Muscle-sparing technique** that preserves the rectus abdominis muscle, minimizing abdominal wall morbidity compared to older techniques like TRAM. - Considered the **gold standard** for abdominal-based breast reconstruction. *Gluteal flap based on superior gluteal artery* - While gluteal flaps (like the **SGAP** based on the **superior gluteal artery**) are used for breast reconstruction, they are typically considered a secondary option when abdominal tissue is unavailable or unsuitable. - Harvesting can be more challenging and may result in a less ideal breast shape compared to abdominal flaps. - Less commonly used compared to abdominal-based flaps. *Latissimus dorsi flap based on thoracodorsal artery* - The **latissimus dorsi flap** is a reliable and commonly used option, particularly for smaller breasts or partial reconstruction. - However, it often requires an implant to achieve sufficient volume (not purely autologous reconstruction). - It involves transferring muscle from the back, which can lead to back weakness or contour deformities. - While frequently used, it is not the preferred choice when autologous tissue from the abdomen is available. *TRAM based on transverse rectus abdominis muscle* - The **TRAM flap** was historically a very common choice for breast reconstruction but involves taking a significant portion of the rectus abdominis muscle. - This leads to higher rates of abdominal wall weakness, hernias, or bulges compared to muscle-sparing techniques. - It is currently **less commonly used** than the DIEP flap due to its higher donor site morbidity and has been largely superseded by the DIEP technique.
Question 7: Genioplasty procedure is used for:
- A. To change the attachment of genioglossus muscle in pre-prosthetic procedure
- B. To change the position of genial tubercles
- C. To modify the position of the chin (Correct Answer)
- D. To modify the attachment of anterior belly of digastric
Explanation: ***To modify the position of the chin*** - **Genioplasty** is a surgical procedure specifically designed to **reshape** or **reposition the chin** for aesthetic or functional purposes. - It involves **osteotomy** (cutting and repositioning a section of the chin bone/mandible) or **implant placement** to achieve a more harmonious facial profile. - **Clinical indications** include micrognathia (receding chin), prognathism (protruding chin), asymmetry, or vertical height deficiencies. - The procedure allows for **three-dimensional repositioning** of the chin in anteroposterior, vertical, and transverse dimensions. *To change the attachment of genioglossus muscle in pre-prosthetic procedure* - While genioglossus muscle attachment can be a concern in some pre-prosthetic procedures, using the term "genioplasty" for this specific muscle reattachment is **inaccurate**. - Procedures involving the genioglossus muscle in a pre-prosthetic context are more related to **vestibuloplasty** or deepening the floor of the mouth to improve denture retention. - This would be a **genial tubercle reduction procedure**, not a genioplasty. *To change the position of genial tubercles* - The genial tubercles are bony projections on the **lingual aspect of the mandible** where the genioglossus and geniohyoid muscles attach. - Although genioplasty involves altering the mandible, directly "changing the position of genial tubercles" as the **primary goal** is not the definition of genioplasty. - Any alteration of genial tubercles during genioplasty is an **incidental consequence** of the chin bone repositioning, not the procedure's defining purpose. *To modify the attachment of anterior belly of digastric* - The anterior belly of the digastric muscle attaches to the **digastric fossa** on the inferior border of the mandible. - Modifying this specific muscle attachment is **not the primary purpose** or a defining characteristic of a genioplasty procedure. - Genioplasty focuses on the **chin's overall position and aesthetic contour**, not specific muscle attachment modifications.
Question 8: If severe bony undercuts exist, what is the best treatment?
- A. Remove all undercuts so that no undercut exists (Correct Answer)
- B. Nothing but do only alveolar ridge contouring
- C. Remove undercut on one side
- D. None of the above
Explanation: ***Remove all undercuts so that no undercut exists*** - **Severe bony undercuts** can prevent the proper seating and insertion of a removable prosthesis, leading to trauma and instability. - **Complete removal** of such undercuts creates a uniform, unobstructed path of insertion, ensuring the prosthesis can be placed and removed without damaging tissues. *Nothing but do only alveolar ridge contouring* - **Alveolar ridge contouring** alone might not be sufficient to address severe bony undercuts, as these often involve areas beyond the immediate ridge crest. - Leaving severe undercuts can still cause ongoing **trauma** to the soft tissues during prosthesis insertion and removal, leading to pain and ulceration. *Remove undercut on one side* - Removing undercuts on only one side while leaving others untreated can lead to a **compromised path of insertion**. - This approach may not fully resolve the problem, potentially still causing difficulty in seating the prosthesis or leading to **uneven stress distribution** upon insertion. *None of the above* - This option is incorrect because removing all severe bony undercuts is indeed a standard and often necessary treatment to ensure successful prosthetic rehabilitation.
Question 9: A 40-year-old woman was brought to the casualty 8 hours after sustaining burns on the abdomen, both limbs, and back. What is the best formula to calculate the amount of fluid to be replenished?
- A. 2 mL/kg x %TBSA
- B. 4 mL/kg x %TBSA (Correct Answer)
- C. 8 mL/kg x %TBSA
- D. 4 mL/kg x %TBSA in first 8 hours followed by 2 mL/ kg/hour x %TBSA
Explanation: ***4 mL/kg x %TBSA*** - This is the **Parkland formula** (also known as Baxter formula), which is the most widely accepted method for calculating fluid resuscitation in burn patients. - The formula calculates a **total 24-hour fluid requirement** of **4 mL of Ringer's lactate per kilogram of body weight per percentage of total body surface area (%TBSA)** burned. - **Timing protocol:** Half of the calculated total volume (2 mL/kg x %TBSA) is given in the **first 8 hours post-burn**, and the remaining half over the **next 16 hours**. - This is the **gold standard** for initial burn fluid resuscitation. *2 mL/kg x %TBSA* - This represents **only half the total 24-hour fluid volume** recommended by the Parkland formula. - Using only 2 mL/kg x %TBSA as the total would lead to **severe under-resuscitation**, increasing the risk of burn shock, acute kidney injury, and other complications. - This volume is correct only for the **first 8 hours**, not the total calculation. *8 mL/kg x %TBSA* - This suggests **twice the fluid volume** recommended by the Parkland formula. - Administering 8 mL/kg x %TBSA would result in **over-resuscitation**, leading to complications such as pulmonary edema, abdominal compartment syndrome, acute respiratory distress syndrome (ARDS), and extremity compartment syndrome. *4 mL/kg x %TBSA in first 8 hours followed by 2 mL/kg/hour x %TBSA* - This option incorrectly suggests giving the **entire 24-hour calculated volume** in the first 8 hours, then continuing with an additional **hourly rate**. - This would result in **massive over-resuscitation** and life-threatening complications. - The correct Parkland protocol gives **half the total** (2 mL/kg x %TBSA) in the first 8 hours, then the **remaining half over 16 hours** (not an additional continuous rate).
Question 10: A woman was brought to the casualty 8 hours after sustaining burns on the abdomen, both the limbs and back. What will be the amount of fluid to be used for resuscitation in the first 24 hours as per Parkland formula?
- A. 2 mL/kg x %TBSA
- B. 8 mL/kg x %TBSA
- C. 4 mL/kg x %TBSA (Correct Answer)
- D. 4 mL/kg x %TBSA in first 8 hours followed by 2 mL/kg x %TBSA
Explanation: ***4 mL/kg x %TBSA*** - The **Parkland formula** for fluid resuscitation in burn patients is **4 mL/kg** of Ringer's lactate per percent TBSA burned per 24 hours. - This gives the **total volume for 24 hours**: half is administered in the first 8 hours post-burn, and the remaining half over the subsequent 16 hours. *2 mL/kg x %TBSA* - This value represents only half of the required fluid resuscitation according to the **Parkland formula** and is insufficient for adequate resuscitation over 24 hours. - This amount would typically be given in scenarios where burns are minor or as maintenance fluid, not for acute burn resuscitation. *8 mL/kg x %TBSA* - This amount is **double** the recommended fluid resuscitation as per the standard **Parkland formula** and could lead to fluid overload, causing complications like **pulmonary edema** or **acute respiratory distress syndrome (ARDS)**. - Excessive fluid administration can also worsen tissue edema and compartment syndrome. *4 mL/kg x %TBSA in first 8 hours followed by 2 mL/kg x %TBSA* - This option is **incorrectly phrased** and suggests using two different formulas rather than understanding that 4 mL/kg x %TBSA is the **total 24-hour calculation**. - The Parkland formula calculates one total amount (4 mL/kg x %TBSA for 24 hours), which is then distributed as half in the first 8 hours and half in the next 16 hours—not calculated separately as this option implies.
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