Plastic and Reconstructive Surgery Practice Questions

Q: What is the characteristic of Poland Syndrome?

Amastia with the absence of the Pectoralis major. **Explanation:** **Poland Syndrome** is a rare congenital anomaly characterized by the underdevelopment or absence of the chest wall muscles on one side of the body. The hallmark of this condition is the **absence of the sternocostal head of the Pectoralis major muscle**. 1. **Why Option A is Correct:** In Poland Syndrome, the primary defect involves the Pectoralis major. Because the underlying pectoral fascia and muscle are crucial for breast development, patients often present with **Amastia** (absence of breast tissue) or severe breast hypoplasia. Therefore, the combination of Amastia and the absence of the Pectoralis major is the defining characteristic. 2. **Why Other Options are Incorrect:** * **Options B & D:** **Athelia** refers specifically to the absence of the nipple-areola complex. While the nipple may be small or displaced in Poland Syndrome, the complete absence of the nipple (athelia) is less common than the absence of the breast gland itself (amastia). * **Options C & D:** While the **Pectoralis minor** may also be absent in severe cases, the diagnostic "must-have" feature for Poland Syndrome is the absence of the **Pectoralis major**. **NEET-PG High-Yield Pearls:** * **Laterality:** It is most commonly **unilateral** and occurs more frequently on the **right side**. * **Associated Features:** Often associated with **ipsilateral Symbrachydactyly** (short, webbed fingers). * **Etiology:** Thought to be caused by a vascular insult (interruption of blood supply) in the **subclavian artery** during the 6th week of gestation. * **Rib Defects:** May involve absence of the 2nd to 4th ribs, leading to lung herniation or paradoxical chest wall movement.

Q: To assess the perfusion in a free flap, what is the best technique?

Prick test. ### Explanation Monitoring free flap perfusion is critical for the early detection of microvascular compromise (arterial insufficiency or venous congestion). **Why the Prick Test is the Correct Answer:** The **Prick Test (Clinical Monitoring)** remains the **gold standard** and the most reliable technique for assessing flap viability. It involves pricking the flap with a 25-gauge needle. * **Normal:** Bright red blood within 2–3 seconds indicates healthy perfusion. * **Arterial Insufficiency:** No blood or very slow, pale flow. * **Venous Congestion:** Rapid, dark/cyanotic blood flow. Clinical assessment (color, temperature, capillary refill, and the prick test) is superior to most technologies because it is instantaneous, cost-effective, and highly accurate in experienced hands. **Analysis of Incorrect Options:** * **A. Pulse Oximetry:** While it measures oxygen saturation, it is often unreliable in flaps due to low pulsatile flow and difficulty in probe fixation. * **B. Laser Doppler Velocitometry:** This measures capillary blood flow using the Doppler shift. While sensitive, it is prone to "motion artifacts" and high false-alarm rates, making it less definitive than clinical assessment. * **C. Fluorescein and Dermal Fluorometry:** This involves IV injection of dye to check for fluorescence under a Wood’s lamp. It is invasive, can cause allergic reactions, and cannot be used for continuous monitoring. **Clinical Pearls for NEET-PG:** * **Most common cause of flap failure:** Venous thrombosis (more common than arterial). * **Critical Period:** Most flap failures occur within the first **24–48 hours**. * **Handheld Doppler:** Useful for identifying the "pedicle signal," but a positive signal does not always guarantee distal tissue perfusion. * **Gold Standard for Monitoring:** Clinical observation (Color, Temperature, Capillary Refill, and Prick Test).

Q: Blisters are characteristically seen in which type of burn?

Superficial second-degree burn. **Explanation:** The presence of **blisters (bullae)** is the hallmark clinical feature of **Superficial Second-Degree (Partial-thickness) burns**. In these burns, the injury extends through the epidermis into the papillary layer of the dermis. The damage to the dermo-epidermal junction leads to local inflammatory mediator release, causing increased capillary permeability. This results in fluid accumulation between the layers, manifesting as thin-walled, fluid-filled blisters. These wounds are typically pink, moist, and exquisitely painful because the sensory nerve endings remain intact and exposed. **Analysis of Incorrect Options:** * **Option A (Superficial first-degree burn):** These involve only the epidermis (e.g., sunburn). They present with erythema and pain but **no blisters**. The skin barrier remains intact. * **Option C (Third-degree burn):** These are full-thickness burns involving the entire dermis and underlying structures. The tissue appears leathery, charred, or waxy white. Because the dermal plexus and nerve endings are destroyed, these burns are **painless and do not form blisters.** * **Option D (Deep first-degree burn):** This is a misnomer in standard burn classification. First-degree burns are by definition superficial. If a burn is "deep," it is classified as second or third-degree. **NEET-PG High-Yield Pearls:** * **Pain Assessment:** Superficial 2nd-degree burns are the **most painful**; 3rd-degree burns are anesthetic (painless). * **Capillary Refill:** Present in superficial 2nd-degree; absent in deep 2nd-degree and 3rd-degree burns. * **Healing:** Superficial 2nd-degree burns usually heal within 7–14 days with minimal scarring. * **Rule of Nines:** Remember that 1st-degree burns are **excluded** from the Total Body Surface Area (TBSA) calculation for fluid resuscitation.

Q: A 70-year-old male with a known malignancy presents with elevated erythropoietin levels and a packed cell volume (PCV) of 52%. Which tumor is most likely responsible?

Renal Cell Carcinoma. ### Explanation **Correct Answer: A. Renal Cell Carcinoma (RCC)** The clinical presentation of elevated erythropoietin (EPO) and an increased packed cell volume (PCV) in the presence of a malignancy is a classic example of a **Paraneoplastic Syndrome**. **Renal Cell Carcinoma** is the most common tumor associated with ectopic EPO production. The tumor cells (specifically the clear cell variant) can inappropriately secrete erythropoietin, which stimulates the bone marrow to produce excess red blood cells, leading to **secondary polycythemia**. While the classic triad of RCC (flank pain, hematuria, and palpable mass) is seen in only 10% of cases, paraneoplastic syndromes like erythrocytosis, hypercalcemia, and Stauffer syndrome are high-yield diagnostic clues. **Why other options are incorrect:** * **Medullary Thyroid Carcinoma (B):** This tumor arises from parafollicular C-cells and typically secretes **Calcitonin**. It is associated with MEN 2A and 2B syndromes but does not cause erythrocytosis. * **Gastric Carcinoma (C) and Colorectal Carcinoma (D):** These GI malignancies are more commonly associated with **iron-deficiency anemia** due to chronic occult blood loss, rather than polycythemia. **High-Yield Clinical Pearls for NEET-PG:** * **Differential Diagnosis for Ectopic EPO Production:** Remember the mnemonic **"Potentially High Hematocrit"**: **P**heochromocytoma, **H**epatocellular carcinoma, **H**emangioblastoma (Cerebellar), and **R**enal cell carcinoma. * **Stauffer Syndrome:** A paraneoplastic manifestation of RCC characterized by reversible hepatic dysfunction (elevated ALP) in the absence of liver metastases. * **Most common histological type of RCC:** Clear cell carcinoma (originates from the proximal convoluted tubule).

Q: What is Cock's peculiar tumor?

Chronic infection of a sebaceous cyst. ### Explanation **Cock’s Peculiar Tumor** is a clinical misnomer. It is not a true neoplastic malignancy but rather a **chronic infection of a sebaceous cyst**, typically occurring on the scalp. #### Why Option C is Correct: When a sebaceous cyst (trichilemmal or pilar cyst) on the scalp undergoes recurrent infection and ulceration, it leads to the formation of exuberant, fleshy **granulation tissue**. This growth can break through the cyst wall, appearing as a fungating, foul-smelling mass that clinically mimics a Squamous Cell Carcinoma (SCC). The term "peculiar" refers to its deceptive appearance—it looks like a malignant tumor but is histologically benign. #### Why Other Options are Incorrect: * **Option A (Rodent Ulcer):** This refers to **Basal Cell Carcinoma (BCC)**. While it can occur on the face/nose, it typically presents as a pearly-bordered ulcer with telangiectasia, not a fungating mass arising from a cyst. * **Option B (Local Osteomyelitis):** This is an infection of the bone (e.g., Pott’s Puffy Tumor). While it involves the cranium, it presents as a fluctuant swelling due to subperiosteal abscess, not a fleshy, ulcerated cutaneous mass. * **Option D (Keratin Horn):** Also known as a cutaneous horn, this is a conical projection of cohesive keratin. While it can arise from a sebaceous cyst, it lacks the fleshy, fungating, and infected characteristics of Cock’s tumor. #### NEET-PG High-Yield Pearls: * **Commonest Site:** Scalp. * **Clinical Mimic:** Squamous Cell Carcinoma (Epithelioma). * **Key Differentiating Feature:** Cock’s tumor is soft and lacks the indurated base and everted edges characteristic of true malignancy. * **Treatment:** Complete excision of the cyst and the granulation tissue.

Q: What is the most common pathology seen in the scalp?

Sebaceous cyst. **Explanation:** The scalp is the most common site in the body for **sebaceous cysts** (also known as pilar or trichilemmal cysts). This is due to the high density of hair follicles and associated sebaceous glands in the scalp. These cysts arise from the outer root sheath of the hair follicle. Clinically, they are characterized by being firm, non-tender, and attached to the skin (often showing a characteristic **punctum**), but they remain mobile over the underlying aponeurosis. **Analysis of Options:** * **A. Dermoid:** While dermoid cysts (specifically external angular dermoids) are common in the head and neck region, they occur along lines of embryonic fusion. They are deep to the skin and often fixed to the periosteum, making them less common than sebaceous cysts. * **C. Hemangioma:** These are common benign vascular tumors of infancy, but they are not the most frequent pathology of the scalp across the general population. * **D. Metastasis:** The scalp can be a site for cutaneous metastasis (e.g., from follicular thyroid carcinoma or renal cell carcinoma), but this is a rare occurrence compared to benign cystic lesions. **NEET-PG High-Yield Pearls:** * **Cock’s Peculiar Tumor:** A sebaceous cyst on the scalp that suppurates and ulcerates, mimicking a Squamous Cell Carcinoma (fungating appearance). * **Turban Tumor:** Refers to a **cylindroma**, a benign adnexal tumor that can cover the entire scalp. * **Layers of Scalp:** Remember the mnemonic **SCALP** (Skin, Connective tissue, Aponeurosis, Loose areolar tissue, Periosteum). Sebaceous cysts reside in the **Skin** layer. * **Emissary Veins:** Located in the "Dangerous area of the scalp" (Loose areolar tissue), they can transmit infection from the scalp to the intracranial dural venous sinuses.

Q: What is true about cleft lip?

Unilateral cases are more common on the left side.. ### Explanation **1. Why Option D is Correct:** Epidemiological studies consistently show that unilateral cleft lip is more common than bilateral, and among unilateral cases, the **left side** is affected significantly more often (ratio of approximately 2:1). While the exact embryological reason remains debated, this is a high-yield statistical fact frequently tested in surgical exams. **2. Analysis of Incorrect Options:** * **Option A:** Cleft lip occurs due to the failure of fusion between the **Maxillary process** and the **Medial Nasal process**. The frontal process contributes to the forehead, while the lateral nasal processes form the alae of the nose. * **Option B:** Cleft palate can be associated with both unilateral and bilateral cleft lips. In fact, approximately 70% of unilateral cleft lips are associated with a cleft palate. * **Option C:** Cleft lip is typically repaired at **3 to 6 months** of age, not in the neonatal period. Surgeons often follow the **"Rule of 10s"** to determine fitness for surgery (10 weeks old, 10 lbs weight, and 10 g/dL hemoglobin). **3. Clinical Pearls for NEET-PG:** * **Incidence:** Cleft lip (with or without palate) is more common in **males**, whereas isolated cleft palate is more common in **females**. * **Most Common Type:** Unilateral incomplete cleft lip. * **Surgical Technique:** The most common procedure for unilateral repair is the **Millard Rotation-Advancement Flap**. For bilateral repair, the **Manchester or Millard repair** is used. * **Cleft Palate Repair:** Usually performed between **9 to 18 months** to allow for maxillary growth but before significant speech development begins (Wardill-Kilner or Bardach technique).

Question 1

What is the characteristic of Poland Syndrome?

Accepted Answer

Amastia with the absence of the Pectoralis major

Answer

Athelia with the absence of the Pectoralis major

Answer

Amastia with the absence of the Pectoralis minor

Answer

Athelia with the absence of the Pectoralis minor

Question 2

What will not happen with inadequate resuspension?

Accepted Answer

Malar prominence

Answer

Temporal hollowing

Answer

Angle of mouth drooping

Answer

Witch chin

Question 3

A male presents with multiple soft, non-fixed swellings over his body and a positive family history. What is the most likely diagnosis?

Accepted Answer

Muir-Torre syndrome

Answer

Dercum's disease

Answer

Multiple Endocrine Neoplasia (MEN)

Answer

Pierre Robin syndrome

Question 4

To assess the perfusion in a free flap, what is the best technique?

Accepted Answer

Prick test

Answer

Pulse oximetry

Answer

Laser Doppler velocitometry

Answer

Fluorescein and dermal fluorometry

Question 5

Blisters are characteristically seen in which type of burn?

Accepted Answer

Superficial second-degree burn

Answer

Superficial first-degree burn

Answer

Third-degree burn

Answer

Deep first-degree burn

Question 6

A 70-year-old male with a known malignancy presents with elevated erythropoietin levels and a packed cell volume (PCV) of 52%. Which tumor is most likely responsible?

Accepted Answer

Renal Cell Carcinoma

Answer

Medullary thyroid carcinoma

Answer

Gastric Carcinoma

Answer

Colorectal Carcinoma

Question 7

What is Cock's peculiar tumor?

Accepted Answer

Chronic infection of a sebaceous cyst

Answer

Rodent ulcer of the nose

Answer

Local osteomyelitis of the cranium

Answer

Keratin horn

Question 8

A 7-year-old boy presents after a motorcycle crash sustained while unrestrained in the back of a minivan. His vital signs are stable, but he complains of left upper quadrant abdominal pain. A FAST scan reveals scanty fluid in the left colic gutter. An abdominal and pelvic CT scan with intravenous and oral contrast shows a splenic parenchymal blush (arterial extravasation) and a deep parenchymal tear, classifying the spleen as a grade III injury. The child remains hemodynamically stable. What is the recommended next step?

Accepted Answer

Continuous hemodynamic monitoring, celiac angiogram, and angioembolization of the splenic artery.

Answer

Immediate exploration in the operating room.

Answer

If hemodynamic instability develops, aggressive fluid resuscitation including a repeated bolus of 20 mL/kg lactated Ringer's solution, followed by a liver-spleen scan.

Answer

Monitoring only.

Question 9

What is the most common pathology seen in the scalp?

Accepted Answer

Sebaceous cyst

Answer

Dermoid

Answer

Hemangioma

Answer

Metastasis

Question 10

What is true about cleft lip?

Accepted Answer

Unilateral cases are more common on the left side.

Answer

Occurs due to a defect in the fusion of the frontal and nasal processes.

Answer

Only bilateral cases are associated with cleft palate.

Answer

Is repaired in the neonatal period.

Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery — MCQs

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