Plastic Surg Quiz 1 Samplex

Plastic Surgery Principles: Lines, Grafts & Flaps _B_1. Wound closure by this type of healing involves no surgical manipulation. Spontaneous healing is allowed to evolve. a. Primary intention b. Secondary intention c. Tertiary intention _D_2. The following instruments can be used to coaptate the wounds in primary closure of a wound: a. Sutures b. Tapes c. Staple d. All of the above _D_3. In this stage of wound healing, collagen fibers start to align themselves to make a strong covalent bond among the collagen: a. Inflammatory phase b. Epithelialization c. Collagen formation d. Scar maturation _C_4. To minimize scarring, the following should be done except: a. Debride all devitalized tissue b. Remove foreign bodies c. Handle tissues harshly so as to remove all the unnecessary foreign bodies d. Prevent infection _B_5. True of Langer’s lines except: a. Used to design skin incisions & diminish tension across the incision b. When possible, incisions should be placed parallel to the long axis of the underlying muscle c. In the cheek, lines are oriented obliquely d. In the forehead, lines are oriented horizontally _C_6. Difference between a graft and a flap except: a. A graft needs a vascular recipient bed while a flap has its own blood supply b. Where a padded & durable cover is needed to reconstruct an integumentary defect over vital structures, tissues devoid of perivascular membrane or over implants, a flap is the choice c. A graft is a more complicated option than a flap according to the reconstructive ladder of plastic surgery d. Most common cause of skin graft failure are hematoma, infection & movement while that of the flap is venous congestion. _A_7. Why should a wound be kept moist after debridement? a. To avoid loss of proteinaceous fluid & necrosis of the superficial wound layers b. To avoid infection c. To let the wound breathe d. To make sutures easy to apply if needed _A_8. True of a split-thickness graft: a. Involves only the epidermis and some parts of the dermis b. Has tissue bulk c. Contract less compared to a full-thickness graft d. Donor site is most often closed since re-epithelialization does not happen spontaneously _C_9. Which is more suitable for reconstruction when late contracture is expected from the wound? a. Thin split-thickness graft b. Thick split-thickness graft c. Full-thickness graft d. Axial flap _C_10. If there is erythema about the suture line: a. Doesn’t matter; may just be a suture reaction b. Remove suture immediately c. Give antibiotic therapy d. Debride _D_11. Three steps in the “take” of a skin graft except: a. Imbibition b. Inosculation c. Revascularization d. Debridement _C_12. When a large amount of graft is needed, where do we usually acquire a graft? a. Arms and chest b. Shoulders & back c. Thigh & buttocks d. Hands and feet _B_13. Spindle-shaped cells appearing during day 3 of wound healing: a. Collagen

b. Tropocollagen c. Kinins _B_14. True of a random flap: a. Based on a named blood vessel b. Examples are advancement flaps & rotation flaps c. Rely on the high-perfusion pressures found in the Subdermal plexus to sustain the flap d. Can provide a reproducible & stable skin or skin/muscle flap _A_15. Because of the reliable blood supply, an axial flap can be used to provide much-needed length and bulk that a random flap cannot provide: a. True b. False Burns _A_16. Area of cutaneous injury where cells have been disrupted & tissue is irreversibly damaged at the time of injury: a. Zone of coagulation b. Zone of stasis c. Zone of hyperemia _D_17. The following may be used to improve blood flow and prevent necrosis of cells involved in the zone of stasis except: a. Bradykinin antagonists b. Subatmospheric wound pressures c. Thromboxane A2 d. None of the above _C_18. Which of the following is not true? a. First degree burn is localized to the epidermis only b. Damaged by a flame occurs from superheated, oxidized air c. Treatment directed at the control of inflammation immediately after injury may spare the zone of coagulation d. A partial thickness burn >10% TBSA warrants a burn center e. All second-degree burns have some depth of dermal damage _C_19. Superficial & deep partial thickness burns both reepithelialize from retained dermal structures. Which type of dermal structure is not involved from the ff list? a. Hair follicles b. Sweat glands c. Subcutaneous fat d. Rete ridges _B_20. The following is true of a deep partial thickness burn except one: a. Pale & mottled b. Heals in 7-14 days c. Do not blanch to touch d. Painful to pinprick _A_21. The following is true of a superficial partial thickness burn except one: a. Pale & mottled b. Heals in 7-14 days c. Blanch to touch d. Sensitive to temp _D_22. Calculate the % burn in this burnt child with the anterior trunk fully burned plus the right arm (sparing the left extremity). Circumferential upper extremities are also involved including the perineum. Half of the face cannot be recognized anymore. a. 90% b. 80% c. 70% d. 60% _A_23. In resuscitation of a burned patient, which of the following is not true? a. LRS without dextrose is the fluid of choice for every burned patient. b. Venous access I burned skin can be used instead of no venous access at all nd c. Colloid can be given during the 2 24hrs at 0.30.5ml/kg/%burn d. If burns are 10-25% of BSA, blood is given after first 24hrs _C_24. A layer of hardened epidermis due to burns is called: a. Mottled area b. Necrotic area c. Eschar d. Nevi Give 4 ideal characteristics of a dressing:

25. Protects skin from maceration 26. Removes necrotic debris 27. Minimizes bacterial growth 28. Encourages re-epithelialization _B_29. Difference between a nonyielding eschar in the extremities and a constricting truncal eschar: a. Eschar in the extremities is more severe b. In truncal extremities, chest expansion may be limited; in the extremities, venous outflow & arterial inflow may be impeded c. Only truncal eschar requires escharotomies d. Escharatomy will do better in extremities than in the trunks _D_30. Which structure is severely injured in an electrical burn? a. Bones b. Nerves c. Blood d. Muscles _B_31. Which structure is the least resistant (choices #30) _A_32. What is the most significant injury during an electrical burn? a. Within the deep tissue & subsequent edema formation causing vascular compromise to any area distal to the injury b. Nerve paralysis since nerves are very vulnerable c. Circulation to distal vascular beds d. Fracture for being thrown from the electrical jolt or falling from heights after disengaging from the electrical current _C_33. Initial evaluation of an electrically-burned patient involves: a. The usual ABCs of trauma b. Pulmonary assessment c. Cardiopulmonary resuscitation d. Antimicrobial therapy to prevent infection _D_34. How do chemicals cause burn injury? a. Protein denaturation b. Formation of protein esters c. Dessication of the tissue d. All of the above _B_35. Correct management of chemical burns: a. Neutralize with the opposite agent b. Lavage with copious amounts of clean water c. Wipe with plenty of toothpaste to ease the pain d. Debride area of injury _A_36. Which is a more severe burn: alkali or acid? a. Alkali b. Acid c. Same 37. Explain answer in #36. Because the body cannot buffer the alkali allowing them to burn much longer inside the body 38. Why is neutralization of a chemical burn not recommended? The resultant heat released by neutralization causes further damage _D_39. The following patients are for hospital admission except for one: a. Electrical current passed through the mouth of an orally fixated child b. Self-inflicted burn by a depressed woman c. Soft tissue trauma is evident from the patient d. A scald from hot water in the dorsum of the hand 40. Patient has burned forearms, rt. and left, posterior trunk and the neck due to playing with fire in the garbage area. Calculate the crystalloid needed for initial resuscitation. Patient is 70kg. right and left forearms: 9% posterior trunk: 18% neck: 4% TBSA: 31% Parkland formula (V): TBSA(%) x weight (kg) x 4 Crystalloid needed: 31% x 70kg x 4 = 8680 st 41. How much crystalloid solution is needed for the 1 8hrs? ½ of (V): 4340 nd 42. In the 2 24 hours, what fluid management is appropriate for this patient? Colloids _C_43. True of Biobrane except: a. A synthetic dressing b. Provides a barrier to moisture loss & painless wound bed that does not need dressing changes c. Adherent immediately after placing it to the wound so you can remove it immediately to prevent accumulation of exudate d. Has no antimicrobial properties _C_44. Not true from the following statements: a. If burn involves the face, it is considered a major burn

b. Diagnosis & prognosis of burns depends on age, area & depth of burn & co-morbidities. c. Only 45% of burned patients are minor; the other 65% are all major burns d. Fourth degree burns includes the epidermis, dermis, subcutaneous fat and underlying muscle & bones _B_45. Most commonly used topical antibiotic salve for wound care; a. Mafenide acetate b. Silver sulfadiazine c. Polymyxin B d. Mupirocin _D_46. Alterations in metabolism during severe burns are due in part to release of this hormone/s: a. Glucocorticoid b. Catecholamine c. Glucagon d. All of the above Match the following type of burns with the correct management: _C_47. Superficial thickness _B_48. Superficial partial thickness _A_49. Deep partial thickness _A_50. Full thickness A. Excision & grafting B. Daily dressing changes with topical antibiotics, cotton gauze & elastic wraps or skin substitutes C. Supportive; symptom-relief