Plastic and Reconstructive Surgery

Plastic and Reconstructive Surgery Indian Medical PG Question 1: Following radical surgery for the carcinoma of breast, reconstruction of the breast can be performed by using the following procedures except

• A. Silicone implants
• B. Transversus abdominis muscle flap (TRAM flap)
• C. Latissimus dorsi flap (LD flap)
• D. Deltopectoral flap (Correct Answer)

Plastic and Reconstructive Surgery Explanation: ***Deltopectoral flap*** - The **deltopectoral flap**, also known as the Bakamjian flap, is primarily used for **head and neck reconstruction**, particularly for defects in the pharynx, esophagus, or oral cavity. - It involves tissue from the shoulder and chest wall, but its design and vascular supply make it unsuitable for **breast reconstruction** after radical mastectomy, which requires significantly more volume and different tissue characteristics. *Silicone implants* - **Silicone implants** are a common method for breast reconstruction, offering a less invasive option than flap procedures. - They are placed either beneath the pectoral muscle or subcutaneously to restore breast volume and shape. *Transversus abdominis muscle flap (TRAM flap)* - The **TRAM flap** is a widely used and versatile autologous tissue reconstruction method, utilizing tissue from the lower abdomen to create a new breast mound. - It can be either pedicled (retaining its original blood supply) or free (requiring microvascular anastomosis), providing a natural-feeling and long-lasting reconstruction. *Latissimus dorsi flap (LD flap)* - The **latissimus dorsi (LD) flap** involves transferring muscle, fat, and skin from the back to the chest to reconstruct the breast. - It is particularly useful for smaller breasts or when combined with an implant, and it can provide good aesthetic results with reliable blood supply.

Plastic and Reconstructive Surgery Indian Medical PG Question 2: What is the classification of intelligence corresponding to an IQ score of 90-109?

• A. Below average
• B. Average (Correct Answer)
• C. Slightly below average
• D. Above average

Plastic and Reconstructive Surgery Explanation: ***Average*** - An **IQ score** range of **90-109** is traditionally classified as **Average** intelligence. - This range represents the **mean** and surrounding **standard deviation** of IQ scores in the general population. *Below average* - This classification usually corresponds to IQ scores in the range of **70-79** or **80-89**, depending on the specific scale. - It does not represent the central tendency of the population's intelligence. *Slightly below average* - This category typically corresponds to IQ scores in the range of **80-89**. - It falls just below the average range but is not as low as the "below average" classification. *Above average* - This classification is typically assigned to IQ scores that are in the range of **110-119** or higher. - It signifies cognitive abilities that are greater than the majority of the population.

Plastic and Reconstructive Surgery Indian Medical PG Question 3: What is the baseline platelet count required for surgery?

• A. 50,000/µL (50 × 10^9/L) (Correct Answer)
• B. 40,000/µL (40 × 10^9/L)
• C. 20,000/µL (20 × 10^9/L)
• D. 30,000/µL (30 × 10^9/L)

Plastic and Reconstructive Surgery Explanation: ***50,000/µL (50 × 10^9/L)*** - A platelet count of **50,000/µL** is considered the **minimum threshold** for safe surgical procedures. - This level is generally sufficient to achieve **adequate primary hemostasis** and minimize the risk of significant perioperative bleeding. *20,000/µL (20 × 10^9/L)* - A platelet count of **20,000/µL** is generally **too low** for most surgical interventions, as it significantly increases the risk of serious bleeding. - This level is often associated with a risk of **spontaneous bleeding**, particularly in mucous membranes. *40,000/µL (40 × 10^9/L)* - While closer to the safe threshold, a platelet count of **40,000/µL** might still be considered **suboptimal** for major surgeries, especially those with a high risk of blood loss. - Some surgeons and anesthesiologists may prefer a slightly higher count to ensure a wider **safety margin**. *30,000/µL (30 × 10^9/L)* - A platelet count of **30,000/µL** is generally **insufficient** for most surgical procedures and would likely necessitate **platelet transfusion** preoperatively. - Patients at this level are at an **increased risk of bleeding** during and after surgery.

Plastic and Reconstructive Surgery Indian Medical PG Question 4: Match List-I with List-II and select the correct answer using the code given below the Lists:

• A. A→4 B→3 C→2 D→1 (Correct Answer)
• B. A→1 B→3 C→2 D→4
• C. A→1 B→2 C→3 D→4
• D. A→4 B→2 C→3 D→1

Plastic and Reconstructive Surgery Explanation: ***A→4 B→3 C→2 D→1*** - A **symposium** (A) is characterized by a "discussion among the speakers" (4), where experts present different aspects of a topic, followed by interaction. - A **panel discussion** (B) involves a "series of speeches on a selected subject" (3) by panel members in front of an audience, often with interaction moderated by a chairperson. - A **workshop** (C) typically focuses on "arriving at a plan of action to solve the problem" (2) through practical, hands-on activities and collaborative problem-solving. - **Role-play** (D) is a technique where a "situation is dramatized" (1) by participants acting out roles to understand different perspectives or practice new skills. *A→1 B→3 C→2 D→4* - This option incorrectly matches "Symposium" with "Situation is dramatized" and "Role-play" with "Discussion among the speakers". - Role-play is about dramatizing a situation, while a symposium involves discussion among speakers. *A→1 B→2 C→3 D→4* - This option misaligns multiple matches, particularly with "Symposium" (A) and "Workshop" (C). - A workshop is about action plans, and a symposium is about discussions among speakers, not the other way around. *A→4 B→2 C→3 D→1* - This option incorrectly matches "Panel discussion" with "Arriving at a plan of action to solve the problem" and "Workshop" with "Series of speeches on a selected subject". - Workshops focus on action plans, and panel discussions involve a series of speeches.

Plastic and Reconstructive Surgery Indian Medical PG Question 5: Which of the following are correct regarding Blood substitutes ? 1. They are biomimetic. 2. They are extensively used in war injuries. 3. They are made of perfluorocarbon emulsions. 4. They are haemoglobin-based. Select the correct answer using the code given below :

• A. 2, 3 and 4
• B. 1 and 3 only
• C. 1, 2 and 3
• D. 1, 3 and 4 (Correct Answer)

Plastic and Reconstructive Surgery Explanation: ***1, 3 and 4*** - **Blood substitutes are biomimetic** - they are artificially engineered to mimic the oxygen-carrying capacity of natural red blood cells. - Blood substitutes fall into **two main categories**: perfluorocarbon (PFC) emulsions and hemoglobin-based oxygen carriers (HBOCs). Statement 3 and 4 correctly identify these two major types. - **PFC emulsions** can dissolve large amounts of oxygen and carbon dioxide, transporting gases to tissues through physical dissolution. - **Hemoglobin-based oxygen carriers** use modified hemoglobin (human, bovine, or recombinant) to bind and transport oxygen similar to natural red blood cells. *1, 2 and 3* - While statements 1 and 3 are correct, **statement 2 is incorrect**. - Blood substitutes are **NOT extensively used in war injuries** - most remain experimental or have very limited clinical approval. - Despite theoretical advantages (extended shelf life, no cross-matching needed), practical deployment has been minimal due to safety concerns and regulatory limitations. *2, 3 and 4* - This option incorrectly includes statement 2 about extensive use in war injuries, which is **factually inaccurate**. - Most blood substitutes have failed to gain widespread approval due to adverse effects including vasoconstriction, hypertension, and increased mortality in some trials. - It also incorrectly excludes statement 1 - the **biomimetic nature** is a fundamental defining characteristic of blood substitutes. *1 and 3 only* - While statements 1 and 3 are correct, this option is **incomplete**. - It fails to recognize that blood substitutes include **both perfluorocarbon-based AND hemoglobin-based** types - the two major categories in development. - Statement 4 about hemoglobin-based carriers is equally important and correct.

Plastic and Reconstructive Surgery Flashcard 1 of 5

Question: _____ flaps often skin with bone or muscle is transferred with the flap (osseocutaneous or myocutaneous flaps, respectively)

Answer: Composite

Plastic and Reconstructive Surgery Flashcard 2 of 5

Question: Midpalmar space is drained by incision in medial _____ web spaces

Answer: 2

Plastic and Reconstructive Surgery Flashcard 3 of 5

Question: _____ flaps are local flaps that ignore blood vessel paths

Answer: Random transposition

Plastic and Reconstructive Surgery Flashcard 4 of 5

Question: DIEP is a variant of TRAM flap where a microvascular technique is used and is based on _____ artery

Answer: deep inferior epigastric

Plastic and Reconstructive Surgery Flashcard 5 of 5

Question: The given image shows the pectoralis major flap, which is based on the _____ artery.

Answer: thoracoacromial