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100
A 34-year-old man has had pain and swelling of the long and ring fingers for the past three days. On physical examination, there is a sausage-like appearance of the fingers. The patient has pain on passive stretch of the fingers and there is tenderness over the flexor tendon sheaths. Radiographs show swelling of the soft tissues. In addition to intravenous administration of antibiotics, which of the following is the most appropriate management? (A) Needle aspiration of the flexor tendon sheaths (B) Incision into the fingers (C) Incision into the joints (D) Incision into the palm (E) Opening and irrigation of the flexor digital sheath
What is (E) I&D
100
A 16 y/o basketball player is undergoing evaluation 12 hours after sustaining a nasal fracture. Physical examination of the fracture site shows marked edema. The radix is stable. A single fracture fragment is displaced from the bony nasal pyramid. Intranasal examination shows septal hematomas bilaterally. The following is most appropriate? (A) Drainage of the septal hematomas followed by closed reduction and splinting in three days (B) Immediate operative drainage of the septal hematomas, followed by closed reduction and splinting (C) Drainage of the septal hematomas and intraoral open reduction and internal fixation of the nasomaxilary suture line in three days (D) Closed reduction of the nasal fracture in three days, followed by submucosal resection and inferior turbinate infracture in six months (E) CT scan of the face to rule out a naso-orbitoethmoid fracture, followed by open reduction and internal fixation of the fractures and septoplasty
What is (A) Drainage, Closed Reduction & Splinting
100
Elongation and laxity of which of the following strctures are most likely to result in breast ptosis? (A) Clavipectoral fascia (B) Cooper s ligaments (C) Costoclavicular ligaments (D) Superficial fascia of the breast (E) Superficial fascia of the pectoralis muscle
What is (B) Cooper's Ligaments
100
A 28-year-old man has a markedly diminished dorsalis pedis pulse on the right after being stabbed with an ice pick in the right lower leg. In this patient, the most likely finding on physical examination is numbness at which of the following sites? (A) Dorsal foot (B) First web space (C) Lateral foot (D) Medial foot (E) Plantar foot
What is (B) First Web Space
100
Suction lipectomy is an effective procedure for management for each of the following conditions EXCEPT (A) axilary hyperhidrosis (B) HIV -associated lipodystrophy (C) liposarcoma (D) lymphedema (E) Madelung s disease
What is (C) Liposarcoma
200
The reported incidence of tendon complications associated with volar plating a distal radius fracture? (A) less than 2% (B) 2-9% (C) 10-20% (D) 25-40% (E) > 40%
What is (B) 2-9%
200
A 27-year-old man has articulation of the mesiobuccal cusp ofthe first upper molar with the distobuccal groove of the lower first molar. Cephalometric analysis shows increased SNB angle and negative ANB angle. Which of the following interventions are the most appropriate management of this patient's facial deformity? (A) Fronto-orbital advancement and LeFort I advancement (B) Le Fort I setback and jumping genioplasty (C) LeFort III advancement and mandibular advancement (D) Maxillary impaction and vertical reduction advancement genioplasty (E) Sagittal split osteotomy and maxillary advancement
What is (E) SSO & Maxillary Advancement
200
A 58-year-old woman is scheduled to undergo bilateral upper eyelid blepharoplasty. Preoperatively, the surgeon plans to resect skin, a strip of orbicularis oculi muscle, and a small amount of orbital fat. During the dissection, there is concern that the levator tendon has been lacerated just above the tarsal plate. This can be confirmed by visualizing which of the following structures through the laceration? (A) Capsulopalpebral fascia (B) Muller's muscle (C) Orbital septum (D) Retro-orbicularis oculi fat (E) Whitnall ligament
What is (B) Muller's Muscle
200
A 50-year-old man has noninfected wound dehiscence with exposure of the hardware two weeks after undergoing open reduction and internal fixation of an ankle fracture. The most appropriate treatment is: (A) Skin grafting (B) Coverage with a free flap (C) Application of an external fixator and skin grafting (D) Removal of the hardware and skin grafting (E) Removal of the hardware and coverage with a free flap
What is (B) Flap City
200
During suction lipectomy using tumescent anesthesia, total blood loss is expected to be what percentage of the total aspirate? (A) 1 % (B) 10% (C) 20% (D) 30% (E) 50%
What is (A) 1%
300
In patients with Dupuytren's disease, the spiral cord is composed of the spiral band and which of the following other structures of the normal fascia? (A) Cleland's ligament (B) Dorsal digital fascia (C) Grayson's ligament (D) Natatory ligament (E) Transverse fibers
What is (C) Grayson's
300
DAILLLYYYY DOUBLE!!!!!!!! Which of the following craniofacial anomalies is associated with orbital hypotelorism? (A) Crouzon syndrome (B) Frontonasal dysplasia (C) Frontonasal encephalocele (D) Trigonocephaly
What is (D) Hypotelorism ("ORBITAL HYPOTELORISM!!!!" - james bradley)
300
A 57-year-old woman is scheduled to undergo coronal brow lift because she has deep transverse creases at the level of the radix of the nose as well as glabellar creases and brow ptosis. For effective reduction of the transverse creases at the level of the radix, which of the following muscles should be addressed during the procedure? (A) Corrugator supercilia (B) Frontalis (C) Nasalis (D) Orbicularis oculi (E) Procerus
What is (E) Procerus
300
A 53-year-old man with a comminuted fracture of the midtibia has a 4 x 3-cm defect of the midanterior surface of the leg at the level of the fracture. He currently smokes two packs of cigarettes daily. Physical examination shows no palpable dorsalis pedis pulse. Which of the following surgical interventions is the most appropriate method of reconstruction in this patient? (A) Anterior tibialis muscle flap (B) Below-knee amputation (C) Gastrocnemius muscle flap (D) Gracilis free tissue transfer (E) Soleus muscle flap
What is (E) Soleus
300
A 45-year-old man who has achieved substantial weight loss from massive obesity is scheduled to undergo belt lipectomy for circumferential truncal excess. Which of the following is the most likely postoperative complication? (A) Deep venous thrombosis (B) Dehiscence (C) Infection (D) Seroma (E) Skin necrosis
What is (D) Seroma
400
A 35-year-old man who plays golf several times weekly has numbness and tingling in the ring and small fingers of the dominant right hand. Physical examination shows negative Tinel' s sign at the medial elbow and positive Tinel's sign at the ulnar wrist with normal dorsal ulnar sensation of the hand. The most appropriate management is surgical release of which of the following structures? (A) Arcade of Struthers and volar carpal ligament (B) Osborne's ligament and arcade of Struthers (C) Osborne's ligament and transverse carpal ligament (D) Pisohamate ligament and volar carpal ligament (E) Transverse carpal ligament and pisohamate ligament
What is (D) Guyon's canal release
400
The primary muscle responsible for condylar displacement in patients with a subcondylar fracture? (A) Medial Pterygoid (B) Temporalis (C) Buccinator (D) Lateral Pterygoid (E) Condylas Maximus
What is (D) Lateral Pterygoid
400
A 46-year-old woman comes to the office for evaluation of persistent erythema 2 weeks after she underwent full-face carbon dioxide laser resurfacing. Which of the following topical treatments is most appropriate to decrease this patient's postoperative erythema? A) Amoxicillin B) Ascorbic acid C) Hydroquinone D) Prednisone E) Valacyclovir
What is (B) Ascorbic Acid
400
A 25-year-old man is brought to the emergency department after he sustained a knife wound to the right lower extremity. Examination shows numbness of the lateral aspect of the leg and weakness in plantar flexion and eversion of the foot. Which of the following nerves was most likely injured in this patient? A) Femoral B) Obturator C) Peroneal D) Sural E) Tibial
What is (C) Peroneal
400
A 43-year-old woman is scheduled to undergo mastopexy and belt lipectomy in an accredited hospital setting for body contouring. She lost 150 lbs (68 kg) after undergoing bariatric surgery 3 years ago. The planned duration of the procedure is 6 hours. In the preoperative holding room, she is dressed in an air-heated gown. Maintenance of normothermia during the perioperative period is most likely to decrease the risk of which of the following complications in this patient? A) Deep venous thrombosis B) Fat necrosis C) Pulmonary embolism D) Seroma formation E) Surgical site infection
What is (E) SSI
500
DAILLLYYY DOUBBLEEE!!!! Six months after sustaining a traumatic amputation of the right index finger at the level of the distal interphalangeal joint, a 27 -year-old machinist has extension ofthe proximal interphalangeal joint of the index finger when he attempts to make a fist. Revision amputation and primary closure were performed at the time of the initial injury, and the patient has undergone occupational therapy for the past six months. Which of the following is the most appropriate management? (A) Osteotomy of the middle phalanx (B) Release of the sagittal bands (C) Sectioning of the lumbrical muscle (D) Tenolysis of the profundus tendon (E) Transfer of the interosseous muscle
What is (C) Sectioning of the Lumbrical Muscles
500
A 6-year-old boy with velopharyngeal incompetence is scheduled to undergo sphincter pharyngoplasty. He underwent cleft palate repair in infancy. In the sphincter pharyngoplasty procedure, which of the following muscles is elevated in the posterior tonsillar pillar? (A) Levator veli palatini (B) Palatoglossus (C) Palatopharyngeus (D) Stylopharyngeus (E) Superior pharyngeal constrictor
What is (C) Palatopharyngeus
500
A 45-year-old woman comes to the office for consultation regarding reduction mammaplasty because of pain of the neck and upper back. She currently wears a size 42 DDD brassiere and would like to be a C cup. A vertical reduction mammaplasty with a superomedial pedicle is planned. Which of the following is the dominant blood supply for this pedicle? A) Ascending branch from the fifth intercostal space B) Ascending branch from the sixth intercostal space C) Descending branch from the first intercostal space D) Descending branch from the second intercostal space E) Descending branch from the fourth intercostal space
What is (D) Descending branch from the 2nd intercostal space
500
A 24-year-old man comes to the office 3 months after closed reduction of a right knee dislocation. His knee is stable, but he still depends on an ankle/foot orthosis for ambulation. Physical examination shows decreased light-touch sensation along the dorsolateral aspect of the foot. Ankle eversion is absent. Sensation and motor function are otherwise intact. Nerve conduction testing is most likely to demonstrate a block in which of the following nerves? A) Common peroneal B) Lateral plantar C) Medial plantar D) Posterior tibial E) Superficial peroneal
What is (E) Superficial Peroneal
500
An otherwise healthy 38-year-old woman with a BMI of 34 kg/m2 is scheduled to undergo suction lipectomy of the abdomen, hips, and thighs using a tumescent technique and a 5000-mL lipoaspirate. The infiltrate contains lidocaine and epinephrine. Which of the following adjustments to the planned procedure is most appropriate to decrease the risk of intraoperative complications? A) Decreased rate of infusion of the wetting solution B) Infiltration of all areas simultaneously C) Removal of the epinephrine from the wetting solution D) Substitution of bupivacaine for lidocaine E) Use of a superwet technique instead of tumescent
What is (E) Superwet
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