Plastic and Reconstructive Surgery Practice Questions

Q: Pulp space infection is known as:

Felon. ### Explanation **1. Why "Felon" is the Correct Answer:** A **Felon** is a subcutaneous infection of the **pulp space** of the distal finger. The anatomy of the fingertip is unique; it contains numerous vertical fibrous septa that connect the dermis to the periosteum of the distal phalanx. These septa create closed, high-pressure compartments. When infection occurs (usually due to *Staphylococcus aureus*), the resulting edema increases pressure within these tight spaces. If left untreated, this can lead to **compartment syndrome of the pulp**, causing ischemic necrosis of the bone (osteomyelitis) or the skin. **2. Why the Other Options are Incorrect:** * **Paronychia:** This is an infection of the **soft tissue folds around the nail** (the lateral nail fold). It is the most common hand infection and is usually superficial. * **Perionychia:** This is a general term referring to inflammation or infection of the **perionychium** (the entire structure surrounding the nail, including the paronychium and eponychium). * **Onychonychia:** This is not a standard clinical term for a specific hand infection; it is likely a distractor derived from "Onychia" (inflammation of the nail matrix). **3. Clinical Pearls for NEET-PG:** * **Management:** Incision and drainage (I&D) are mandatory if fluctuance or severe tension is present. The incision should be made where the tension is maximal to avoid injuring the digital nerves/vessels. * **Complication:** The most feared complication of an untreated felon is **distal phalangeal osteomyelitis** due to pressure necrosis of the bone. * **Kanavel’s Signs:** Remember these for **Flexor Tenosynovitis** (another high-yield hand infection): 1. Finger held in flexion, 2. Uniform swelling (fusiform), 3. Tenderness along the tendon sheath, 4. Pain on passive extension.

Q: Which anatomical structure of significance is encountered in the Gillies approach?

Superficial temporal artery. **Explanation:** The **Gillies approach** (temporal approach) is a classic surgical technique used for the reduction of isolated fractures of the **zygomatic arch**. 1. **Why Option A is correct:** The incision is made approximately 2.5 cm superior and anterior to the helix of the ear, within the hairline. This incision is placed directly over the **superficial temporal artery** and its accompanying vein. Surgeons must be cautious to identify, retract, or ligate these vessels to prevent significant hemorrhage and hematoma formation. The dissection then proceeds through the superficial temporal fascia (temporoparietal fascia) to reach the deep temporal fascia, where an elevator is inserted to reduce the fracture. 2. **Why other options are incorrect:** * **Facial artery:** This artery crosses the inferior border of the mandible at the anterior border of the masseter. It is far inferior to the temporal surgical site. * **Lingual nerve:** This is a branch of the mandibular nerve (V3) located in the submandibular region and floor of the mouth. It is not encountered during extra-oral approaches to the zygoma. **High-Yield Clinical Pearls for NEET-PG:** * **Anatomical Plane:** In the Gillies approach, the elevator is passed **deep to the deep temporal fascia** but **superficial to the temporalis muscle**. This "potential space" leads directly to the medial surface of the zygomatic arch. * **Nerve at Risk:** The **temporal branch of the facial nerve** is the most significant neural structure at risk. To protect it, the incision must be made posterior to its course, and dissection must stay deep to the superficial temporal fascia. * **Alternative:** The **Keen approach** is the intra-oral equivalent for zygomatic arch reduction (incision in the gingivobuccal sulcus).

Q: What is the most common nerve injured during facelift surgery?

Frontal branch of facial nerve. **Explanation:** The correct answer is **D. Frontal branch of facial nerve**. In facelift surgery (rhytidectomy), the **frontal (temporal) branch of the facial nerve** is the most commonly injured nerve. This is due to its extremely superficial and vulnerable course as it crosses the middle third of the zygomatic arch. It lies within the sub-SMAS (Superficial Musculoaponeurotic System) plane, specifically just deep to the temporoparietal fascia. Because facelift dissections often occur in this exact plane to achieve skin and tissue elevation, the nerve is highly susceptible to traction or transection. Injury results in brow ptosis and the inability to wrinkle the forehead. **Analysis of Incorrect Options:** * **A. Zygomatic branch:** While it is at risk during midface dissection, it has extensive arborization (multiple interconnections) with the buccal branch, making clinical deficits rare even if a small twig is injured. * **B. Greater auricular nerve:** This is the most common **sensory** nerve injured during a facelift (often near the Erb’s point over the sternocleidomastoid). However, when a question asks for "nerve injury" without specifying sensory, the focus is typically on the motor morbidity of the facial nerve branches. * **C. Mandibular branch:** This is the second most common motor nerve injured. It is vulnerable near the angle of the mandible where it becomes superficial, but statistically, the frontal branch remains the most frequent site of injury. **High-Yield Clinical Pearls for NEET-PG:** * **Pitanguy’s Line:** A surface landmark used to identify the course of the frontal branch (from 0.5 cm below the tragus to 1.5 cm above the lateral eyebrow). * **Most common sensory nerve injured:** Greater Auricular Nerve (leads to numbness of the lower ear lobe). * **Danger Zone:** The "McGregor’s Patch" (zygomatic cutaneous ligaments) is a key area where dissection must be precise to avoid nerve damage.

Q: The term "universal tumor" refers to which of the following?

Lipoma. **Explanation:** **Lipoma** is termed the **"universal tumor"** because it is the most common benign mesenchymal tumor and can occur in almost any part of the body where fat is present. It is most frequently found in the subcutaneous tissues of the trunk, neck, and proximal extremities, but it can also occur in internal organs (e.g., gastrointestinal tract, heart, or brain). **Why the other options are incorrect:** * **Adenoma:** This is a benign tumor of glandular origin (e.g., pleomorphic adenoma of the parotid). It is tissue-specific and not "universal." * **Papilloma:** This is a benign epithelial tumor growing exophytically (outward) in nipple-like projections. It is common in the skin, bladder, or breast ducts but lacks the ubiquitous distribution of lipomas. * **Fibroma:** While common, these are benign tumors of connective tissue that are less frequent than lipomas and do not carry the specific clinical moniker of "universal tumor." **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Sign:** Lipomas are typically soft, painless, mobile, and possess a characteristic **"slip sign"** (the tumor slips away from the finger on palpation). * **Dercum’s Disease (Adiposis Dolorosa):** A rare condition characterized by multiple painful lipomas, usually in postmenopausal women. * **Madelung’s Disease:** Symmetric lipomatosis involving the neck, head, and upper trunk, often associated with chronic alcoholism. * **Histology:** They are composed of mature adipocytes and are usually enclosed within a delicate capsule. * **Treatment:** Most are asymptomatic and require no treatment. If symptomatic or for cosmetic reasons, surgical excision or liposuction is performed.

Question 1

Pulp space infection is known as:

Accepted Answer

Felon

Answer

Paronychia

Answer

Perionychia

Answer

Onychonychia

Question 2

Which anatomical structure of significance is encountered in the Gillies approach?

Accepted Answer

Superficial temporal artery

Answer

Facial artery

Answer

Lingual nerve

Answer

All of the above

Question 3

What is the most common nerve injured during facelift surgery?

Accepted Answer

Frontal branch of facial nerve

Answer

Zygomatic branch of the facial nerve

Answer

Greater auricular nerve

Answer

Mandibular branch of facial nerve

Question 4

The term "universal tumor" refers to which of the following?

Accepted Answer

Lipoma

Answer

Adenoma

Answer

Papilloma

Answer

Fibroma

Question 5

A scalp defect measuring 3-6 cm is best closed by which of the following methods?

Accepted Answer

Local flaps

Answer

Primary simple closure

Answer

Split skin grafting

Answer

Secondary closure

Question 6

A 6-year-old girl presents with a several-week history of an anterior cervical midline mass and throat pain. Following a course of antibiotics, her inflammation and erythema resolved, but the mass persisted. Her mother recalls similar symptoms when the child was 3 years old, which resolved spontaneously. The mass appears to rise upward when the girl sticks out her tongue. What is the most common diagnosis?

Accepted Answer

Thyroglossal duct cyst

Answer

Lingual thyroid

Answer

Branchial cleft remnant

Answer

Cervical neck abscess

Question 7

A 3-year-old boy is referred after his initial pediatrician's assessment for an undescended testicle. On exam, his left testicle is normal and in place. He has no evidence of hernias. However, his right hemiscrotum is empty, and there is a testicle-sized mass palpable at the pubic tubercle. What is the most appropriate next step?

Accepted Answer

Right orchiopexy and right inguinal hernia repair

Answer

Observation until age 5

Answer

Right orchiopexy

Answer

Right orchiopexy and right testicle biopsy

Question 8

A 1-month-old infant presents with an umbilical hernia. The hernia is reducible but prolapses again almost immediately. What is true regarding this defect?

Accepted Answer

It is present in all children at birth.

Answer

It will not close spontaneously.

Answer

It should be repaired if still present at 3 months of age.

Answer

It should be repaired at this time if it is greater than 1 cm in diameter.

Question 9

What is the best treatment for capillary nevus?

Accepted Answer

Argon laser treatment

Answer

Full thickness skin graft

Answer

Dermabrasion

Answer

Tattooing

Question 10

A young boy presents with a scald injury of the arm. The lesion is pink, oozing, and painful to pinprick. What is the most appropriate management?

Accepted Answer

Collagen dressing

Answer

Paraffin gauze dressing with the wound left open

Answer

Excision and grafting

Answer

Application of 1% silver sulfadiazine

Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery — MCQs

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