ITE Practique Flashcards by Compte Partagé

List 4 surgical techniques for facelift

subcutaneous facelift
SMAS plication
SMAS ressection
Skoog facelift (skin and smas as single unit)
Subperiosteal facelift

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Name 4 retaining ligaments of face relivant to facelift

Orbitomalar retaining ligament
Zygomatic osteocutaneous ligament (malar membrane/septum)
Madibular osteocutaneous ligament
Parotid retaining ligament
Platysma mandibular ligament
Masseteric cutaneous ligament

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What is the landmark for the greater auricular nerve

McKinney’s point which corresponds to 6.5cm below the EAC/tragus along the SCM

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Name 4 modifications to the paramedian forehead flap to increase pedicle lenght

Scoring of galea
Hockey stick design
Extension of flap into hair bearing scalp
Dissection of vessels to their origin at the orbital rim
Tissu expansion

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Other than paramedian flap, list 2 other pedicled flaps that can be used to reconstruct this defect

Scalping flap
Melolabial flap
Washio retro-auricular flap
ADD

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At what gestational age do the following complete their formation
A. Lip
B. Palate

A. Lip - 6 months
B. Palate - 12 months

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What is the probability of a child being born with CLP if:
A. Another child had CLP
B. The parent has CLP
C. Another child and parent has CLP

A. 3-4%
B. 4%
C. 17%

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Name 3 areas of endochondral ossification in the growing mandible

Coronoid process
Symphisis
Condyle

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Name 3 surgical consideration that differ in pediatric mandible fracture management vs. adult

Use of resorbable plates
Later removal of hardware
Monocortical screws along lower border
Use of circummandibular wires
Minimal periosteal stripping

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Name 2 deleterous sequalaes that can complicate ORIF of the pediatric mandible

Damage to developping teeth
Facial growth disruption
Migration of hardware

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Name 2 advantages and 2 disadvantages of alloplastic breast reconstruction

Advantages:
- shorter surgery
- shorter hospital stay
- No donnor site morbidity
Disadvantages
- need for implant change
- increased risk of infection
- risk of capsular contracture
- ALCL risk

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Your patient presents with acquire involutional ptosis. Name 4 tests that should be performed on physical exam prior to surgery

Visual fields
Visual acuity
EOM
MRD (marginal reflex distance)
Lacrimal function (Shirmer’s test)
Test frontalis function
Evaluation of levator excursion
Bells phenomenon test

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Name 3 surgical methods to correct mild to moderate acquired ptosis

Blepharoplasty skin resection
Levator aponeurotic plication
Muller muscle ressection (Putterman)
Superior tarsal resection (Fasanella-Servat)

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Name 3 potential complication from correction of mild to moderate ptosis

Lagophtalmos (overesction)
Persistant ptotis (under resection)
Infection
Hematoma
Blindness
Asymetry
Exposure keratitis

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What is the sensitivity of physicial exam in detecting breast implant rupture?

ADD

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What is the most sensitive and specific test to diagnose implant rupture

MRI

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Name 3 factors associated with implant rupture

Trauma to the chest
Manifacturer defect
Larger implants
Technical error (damage or the implant during surgery)
Age of the implant
Undergoing needle biopsy

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What is the effect of extracapsular implant rupture on the risk of developing breast cancer

None

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Name 2 key components of the surgical treatment of a symptomatic, subglandular, extra-capsular rupture of a silicone implant

En bloc excision
Complete removal of siliconomas

Need to double check answers

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Patient presents to your clinic with nodules secondary to filler injections. What are some potential causes of this

Infection
Foreing body reaction/biofilm
Superficial injection
Filler hypersensitivity
Hematoma formation

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What is the treatment for an infected nodule post filler injection

Cultures
Antibiotics

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Patient presents with delayed nodules following hydroxyappatite injections. What is your prefered treatment

Corticosteroid injections
Triamcinolone acetonide injections

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Patient presents with cold visible swelling to the face after injection of HA for tear trough deformity. What is your primary choice in managing this patient?

Injection of hyaluronidase

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Your patient presents to clinic with a nodule following a history of numerous prior filler injections. What diagnostic test can you ask to confirm weather or not these were done with permamant of non permanant fillers

Ultrasound
MRI

Need to confirm this answer

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List 5 ways to optimize patency when performing a vascular anastomosis

1. Tension free closure 2. Adequate spacing of sutures 3. Minmal handling to prevent damage to endothelium 4. Maintain moist environement (prevent dessication) 5. Avoid large needles 6. Perform anastomosis outside zone of injury/radiation

What is the cold and hot ischemia times for the following? A. Skin B. Muscle C. Bones

A. Skin Cold = 12hrs Warm = 4-6hrs B. Muscle Cold = 8hrs Warm = <2hrs C. Bones Cold = 24hrs Warm= <3hrs

Describe the pathophysiology and clinial observation of non-reflow phenomenon

Pathophysiology: swelling in vascular endothelium leading ot platelet aggregation and leakage to interstitial space Observation: excellent blood flow followed by flap ischemia | Need to confirm this answer

List the 3 stages of wound healing and one cell type in each

Inflammation: macrophaes Fibroproliferative: fibroblasts Remodelling: myofybloblasts

Name an absolute contra-indication to the use of silver sulfadiazine

Sulfa allergy

Draw an antia-buch local rotation flap

ADD photo

Name 2 modifiers to the antia-buch rotation that can be made

1. Burrows triangle at inferior portion of the ear 2. V-Y advancement at the helical crus region

Describe the classification for ring avulsion injuries

While performing your replant surgery you notice a 1.5cm gap between your vessels. What can you do to reestablish blood flow

1. Use of contralateral digital artery 2. Venous flowthrough 3. Veine graft | Need to double check answer

What is an absolute contraindication to microsurgical repair of a ring avulsion

1. Hemodynamic instability 2. Severely crushed of mangled extremity 3. Smoking | Need ot confirm answer

Name the arterial branches to the nasal septum

1. Septal branch of superior labial artery 2. Anterior septal branch of ethmoid artery 3. Posterior septal branch of sphenopalatine artery

On which branche of the nasal septum is the mucoperichondrial flap based?

septal branch of the superior labial artery

Define gynecomastia

Excessive proliferation/enlargment of glandular tissue in the male breast

Define pseudo-gynecomastia

Enlargement of male breast due to excessive fatty tissue

In the context of pubertal gynecomastia, which laboratory tests would you order?

None Only need history and physical exam | Need to double check answer

Name 3 pharmacological causes for gynecomastia

1. Cannabis 2. Estrogen 3. Spironolactone 4. Anabolic steroids

Name 4 pathologic causes for gynecomastia

Cirrhosis Pituatary tumor Breast or adrenal neoplasm Hyper/hypothyroidism

What is a z-plasty

Double opposition triangular transposition flaps

Name 2 uses of z-plasty

Lenghtening of scar ADD

Describes the angles and lenghtening associated with each angle in z-plasty

Name 3 critical factors that will affect the outcomes of a z-plasty

- Angles - dissection of skin flaps - tension of the skin perpendicular

Name 3 physical findings that would increase your suspicion for inhalation injury in the context of burns

1. Cabonaceous sputum 2. Singed nasal hair 3. Sooth around vocal cords 4. Hoarseness

Name 3 important predictors of mortality in burns

1. Age >60 2. Burn TBSA >40% 3. Presence of inhalation injury ## Footnote Rates of mortality based on the presence of (X) factors 1 factor: 2 factors: 3 factors:

What is the most important predictor of burn mortality

TBSA percentage

With use of tumescent solution, what is the infiltrate to aspirate ratio in super wet liposuccion?

1:1 | Wet 200-300c per area Superwet 1:1 Tumescent 2-3:1

You see a child with the following lesion. A. What are the two growth phases of this lesion? B. If it was present at birth what would the diagnosis be

A. Proliferation and Involution B. Congenital hemangioma

Approximately what percent of hemangiomas will regress to the point where they do not need surgery?

50%

List 4 indications for early intervention in a patient with a hemangioma

- Ulceration and bleeding - Obliteration of structures (ie. Ears, nose, etc) - Deprivation amblyopia - Airway obstruction - Pedunculated and removed with minimal scar that is estimated to be better than outcome with natural regression

A similar lesion to hemangioma is kaposiform hemangioendothelioma. If this presents with consumptive coagulopathy, what is the diagnosis?

Kassabach-Merit phenomenon

Which burn patients (excluding chemical, electrical and inhalation injuries) require fluid resuscitation?

1. Children and elderly with TBSA over 10% 2. Adults TBSA over 20%

What are 3 hematologicla findings associated with Kassabach-Merit phenomenon

- platelet sequestration (throbocytopenia) - low fibrinogen - increases D-dimer - elevated PT/APTT

In reviewing the anatomy of the abdominal wall, you read about the 3 zones of blood supply of the unoperated abdomen. Describe each zone's blood supply

Zone 1: DIEA/DSEA Zone 2: External iliac artery (pudendal artery) Zone 3: Intercostal arteries ## Footnote Double check answer

What nerve is responsible for numbness of the anterolateral thigh after abdominoplasty?

Lateral femoro-cutaneous nerve

What is the composition of a typical tumescence solution?

1:1:1:1 trick - 1L NS - 1% lidocaine (50cc) - 1ml of epi (1:1000) - 10ml of sodium bicarb

What is the most common post-operative complication of liposuccion?

Contour irregulaties

A 63 y/o male patient presents with mandibular pain and trismus following treatment for floor of mouth SCC with close margins and post-operative radiotherapy about 1 year ago. What is your most likely diagnosis other than osteoradionecrosis

1. Recurrent malignancy

Name a type of work for each of the levels litterature evidence

You parform a biopsy for a patient that comes back suggestive of osteoradionecrosis. What conservative management options are available?

ADD

What are 2 potential risk factors leading to osteoradionecrosis of the mandible following radiation

- >60 Gy - Brachytherapy - Comcomittant chemotherapy

List 2 clinical features of osteoradionecrosis of the mandible

- pathological fractures - fistula formation - pain - ulcer with exposure of underlying bone - ADD

Your patient presents with the following lesions. A. What is your most likely diagnosis B. Name 3 other potential DDx

A. pyogenic granuloma B. Other DDX: - SCC - Arterial ulcer - Collagen vascular disease - Necrobiosis lipoidica diabeticorum

List 4 risk factors for pyoderma gangrenosum granular on history

1. Trauma 2. Systemic disease (UC, IBD, Crohns) 3. Previous biopsy 4. Long duration 5. Failed previous treatments

Name 4 non surgical treatments for pyoderma gangrenosum

1. Topical corsticosteroids or systemic cortisone 2. Wound care 3. Hyperbaric O2 4. Topical tacrolimus 5. Cromolyn sodium

Name 4 compression sites of the PIN

1. Leashe of Henry 2. Leading edge of supinator 3. Arcade of Frosh 4. Medial edge of ECRB

Name 2 less common causes of PIN palsy

1. Pseudogout 2. Vascular malformation 3. Radia head fracture 4. Bening tumors | Need to double check answer

Wartenburd syndrome is a compression neuropathy... A. Of which nerve B. Between which 2 muscles

A. Radial sensory nerve B. ECRL and brachioradialis

Describe the Wartenburg sign

Clinical finding of ulnar nerve deficit manifested by abduction of the 5th finger due to unopposed action of radially innversated extensor muscles (digiti minimi, digitorum communis ) againt a weak palmar interossei (weak adduction)

Your patient presents with the following XR. A. What is your most likely diagnosis B. Name 4 other potential DDx for this lesion

A. Enchondroma B. Other DDX - Simple bone cyst - Osteoblastoma - Giant cell tumor - Aneurysmal bone cyst

What is the management of most bony tumors of the fingers (2)

1. Curretage 2. Bone graft

Other than XR and CT scan. What 2 other modalities that can be used to elucidate the natuee of a bony lesion

1. Biopsy 2. MRI

Describe the Leddy packer classification

Name 2 techniques for acute repair of a Type 1 jersey finger

1. Bone anchor 2. Pull-through stitch ## Footnote **type 1 means no bony fragment**

Name 3 options for repair of chronic jersey finger

1. Two stage reconstruction with tendon graft 2. One stage with tendon transfer 3. DIP arthrodesis

Your patient presents with a suspected retrobulbar hematoma. A. name 3 non-surgical steps to manage this complication B. Name 2 surgical intervention that can be done

A. Non-surgical - raise head of bed - timolol - mannitol B. Surgical - lateral canthotomy/cantholysis - urgent evacuation in operating room

What is the vascular pedicle of the deltopectoral flap

Intercostal perforators of the internal mammary artery

Name 3 mechanisms that occur during 2 staged flap harvest

1. Dilatation of choke vessels 2. Ischemic preconditionning 3. Neoangiogenesis

Dissection of to which lateral landmark is considered to be reliable when raising a delto-pectoral flap

Deltopectoral groove

Your patient presents to clinic with the following.. Name 3 elements of lower eyelid deformity.

1. Excess skin 2. Herniation of fat from lower eyelids compartments 3. Muscle weakness 4. Tear through deformity

Your patient presents with the following. Name 3 surgical steps to correct his eyelid laxity

1. Fat ressection 2. Skin ressection 3. Lateral canthoplasty

Name 2 etiological factors for diplopia following blepharoplasty

1. Oedema 2. Inferior or superior oblique muscle injury

Name 2 vascular anomalies associated with Kasabach-Merritt phenomenon

1. Kaposiform hemangioendotheliomas (KHE) 2. Tufted angioma

Name 2 common medical therapies to treat Kasabach-Merritt phenomenon

1. Vincristine (#1) 2. Steroids 3. Interferon

Whatis the space of Poirier

Virtual space between the lunate and capitate around the radioscaphocapitate ligament and long radiolunate ligament

How do you calculate the scapholunate angle

1. On lateral x-ray 2. Line between axis of scaphoid 3. Interlip line acros the lunate 4. Scaphoid angle = angle between these 2 lines

What is considered normal scapholunate angle

30-60o

With normal wrist motion, how much movement occurs at A. Radiocarpal joint B. Midcarpal joint

A. Radiocarpal = 60% B. Midcarpal = 40%

How does ulnar variance change with forearm pronation and supination

Supination increases (unlar -) Pronation decreases (ulnar +) ** trick - ulnar Pronation = Plus

You see the following patient in clinic. A. What is your leading diagnosis? B. What are feature associated with this condition

A. Rhinophyma B. Features - sebaceous hyperplasia - bulbous nasal tip - telangiectasia - 15-30% risk of BCC

Name 3 non-surgical and 3 surgical treatments for rhinophyma

Non-surgical - avoidance of sun - acutane - topical metronidazole - avoidance of food trigers (ie. spicy, coffee, tea) - CO2 laser Surgical - dermabrasion - dermaplaning - tangential excision of hypertrophic appendages - excision with electrocautery | answers

Patient presents with the following. A. What are 3 clinical indications for early repair B. Name 2 CT findings that would warrant early repair

A. Clinical exam: - Restricted EOM (Entrapment of inferior rectus) - persistant occulocardiac reflex - Significant vertical dystopia - Enophtalmos >2mm - Diplopia >2 weeks B. CT findings - involvement of >50% of total floor surface - Entrapment of IR on imaging - Other fractures needing repair

True or false. There is a correlation between developing enophtalmos and diplopia after orbital floor fractures.

FALSE

Name 2 modifiable factors crucial to outcomes in ulnar nerve repair

1. Little to no delay 2. Tension free repair 3. Adequate alignement of nerve fibers (motor -> motor and sensory->sensory)

Name 2 methods to confirm ulnar nerve recovery

1. Tinnel 2. EMG 3. Motor and sensory exam

ITE Practique Flashcards

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