Skin Deep
A 5-week-old female infant is evaluated for a 2-cm red lesion on her forehead. The lesion was noted at age 2 weeks and has grown rapidly. There are no other lesions and there was no herald patch at birth. Which of the following factors is most suggestive of infantile hemangioma?
A) Absence of herald patch
B) Absence of ulceration
C) Location
D) Patient gender
E) Rate of growth
What is E) Rate of growth
Hemangiomas are the most common tumors found in infancy. These vascular tumors are characterized by rapid growth and increased cellular proliferation. Hemangiomas typically present between 2 weeks old and 2 months old. Vascular malformations, on the other hand, are present at birth and grow slowly. The clinical course of a hemangioma is predictable and includes rapid proliferation during the first 9 months of life, followed by gradual involution until 3.5 years of age. Most cutaneous lesions are located in the head and neck, followed by the trunk, and then the extremities. Extracutaneous sites most commonly involve the parotid glands or liver. Reports of nervous system involvement are rare. Most hemangiomas can be diagnosed by history and physical examination alone. About 5% require biopsy or radiologic imaging. The tumor may involve both sexes but is five times more common in females. The onset of a red lesion followed by rapid growth is the sine qua non for infantile hemangioma. In 30 to 50% of cases, the hemangioma is preceded by a telangiectasia or bruise-like patch known as a herald patch. Some hemangiomas may ulcerate during their proliferative growth phase.
2021
A 60-year-old man comes to the office because of a 20-year history of rheumatoid arthritis. Which of the following is the most likely thumb deformity in this patient?
A) Boutonnière
B) Clinodactyly
C) Gamekeeper's thumb
D) Swan-neck
E) Thumb-in-palm
What is A, Boutonniere Deformity
Boutonnière deformity is the most common deformity in rheumatoid arthritis thumbs.
Swan-neck deformity #2
Pathophysiology: (MCP) joint synovitis which stretches the dorsal joint structures. The extensor pollicis brevis (EPB) tendon insertion is disrupted leading to a flexion deformity. Next, the extensor pollicis longus (EPL) tendon subluxes volar early causing flexion of the proximal phalanx.
Early treatment: synovectomy and extensor reconstruction
Late treatment: MCP joint arthrodesis.
Swan-neck deformity begins with carpometacarpal (CMC) joint synovitis causing bony erosion of the joint. The CMC joint will dorsiflex and radially subluxate causing an adduction contracture of the first metacarpal leading to hyperextension of the MCP joint.
Gamekeeper's thumb: from ulnar collateral ligament weakness.
Thumb-in-palm deformity is seen in patients with cerebral palsy.
Thumb clinodactyly is a congenital disorder. Abnormally bent
2017
A 24-year-old woman comes to the office to discuss augmentation mammaplasty. She is interested in subglandular implant placement and would like to discuss the risks of augmentation. Which of the following risks is more likely with smooth round silicone implants compared with textured anatomic silicone implants?
A) Anaplastic large cell lymphoma
B) Capsular contracture
C) Double capsule
D) Late seroma
E) Malrotation
What is B, Capsular contracture
More common in smooth round silicone implants than in textured implants. It is believed that the texturing of the implant is protective against significant capsule formation.
Several increased risks associated with textured anatomic implants. These include increased risks of late seroma and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), although this is very rare.
Double capsule is a complication more recently noted with the introduction of textured anatomic implants.
Malrotation can only be seen in an anatomic textured implant, because smooth round implants are symmetric in shape
2018
A 25-year-old man sustains a high-voltage electrical injury of the right upper extremity with an entrance wound over the volar aspect of the wrist. If increased compartment pressures are not adequately relieved in time, which of the following muscles is most likely to develop an ischemic contracture?
A) Brachioradialis
B) Extensor carpi radialis brevis
C) Flexor carpi radialis
D) Flexor digitorum profundus
E) Palmaris longus
What is D, FDP
"Profundus" Latin for Deep.
Has flexion contractures of the interphalangeal joints of the fingers and thumb due to ischemic necrosis of the flexor digitorum profundus (FDP) and flexor pollicis longus (FPL).
Volkmann ischemic contracture: The deeper muscles in the forearm sustain higher pressure sooner and for longer, causing them to be the most affected by compartment syndrome.
The FDP to the middle and ring fingers lies against the ulnar and interosseous membrane in the deep compartment of the forearm. These two muscle segments, in addition to the remaining segments of the FDP to the index and small fingers and the FPL, are the most likely to develop contracture.
2018
An otherwise healthy 46-year-old woman undergoes botulinum toxin type A (Botox) treatment for severe glabellar lines. Twelve units of Botox is administered into each corrugator muscle. Eight days later, the patient comes to the office because of ptosis of the right eyelid. Which of the following muscles is most likely inadvertently affected in this patient?
A) Frontalis
B) Levator palpebrae superioris
C) Müller muscle
D) Orbicular muscle of the eye
E) Procerus
What is B, Levator palpebrae superioris
Ptosis following botulinum toxin type A (Botox) treatment to the glabellar area is most commonly associated with inadvertent exposure of the levator palpebrae superioris muscle to Botox. This muscle is the primary upper eyelid elevator and is innervated by the third cranial nerve. The muscle portion arises from the greater wing of the sphenoid and is typically 40 mm long. The tendinous distal portion is 14 to 20 mm long and is termed the levator aponeurosis. The transition from the muscular to the tendinous portion occurs in the region of Whitnall’s ligament, a condensation of the superior sheath of the levator muscle.
Ptosis from Botox treatments most commonly occurs when the Botox spreads outside the intended target muscle. This is most commonly a technical error on the part of the injector by not staying high enough within the corrugator muscle and above the orbital rim. Ptosis from Botox injections cannot be reversed; however, the condition does completely resolve when the Botox effect wears off after several (3 to 4) months. Interval treatment to help improve, but not definitively treat, the ptosis consists of alpha-adrenergic eyedrops such as apraclonidine "Apra Kadabra!" or phenylephrine ophthalmic preparations, which cause stimulation of Müller's muscle to help improve the condition somewhat, but do not adequately resolve the ptosis. Müller's muscle is an accessory eyelid elevator and lies deep to the levator. It is innervated by the sympathetic nervous system. Contraction of this muscle (such as with pharmacologic stimulation) contributes about 2 mm to lid retraction.
2016
A 15-year-old boy is evaluated for clusters of open and closed comedones on his forehead, cheeks, and chin. Physical examination shows similar lesions on the upper chest and back. Which of the following is the mechanism of retinoic acid in the treatment of pustular acne?
A) Atrophy of pilosebaceous glands
B) Decreased cohesiveness of keratinocytes
C) Disruption of cell walls and denaturation of proteins
D) Interference with DNA synthesis
E) Suppression of metabolic processes of melanocytes
What is B) decreased cohesiveness of keratinocytes
In addition to treatment of acne and associated skin conditions, topical retinoids are also commonly used as a method of nonsurgical facial rejuvenation. Topical retinoids act by decreasing corneocyte adhesion in the stratum corneum, resulting in reduced follicular occlusion and comedone formation. In addition to acne treatments, topical retinoids also improve fine rhytides, correct mild hyperpigmentation changes, and create smoother skin.
Phenol chemical peels are used to improve rhytides and pigment changes in the aging face. They penetrate to the upper layer of reticular dermis and act by disrupting cell walls and denaturing proteins.
Hydroquinone causes reversible depigmentation of the skin and is also used in nonsurgical facial rejuvenation. It works by suppressing metabolic processes of the melanocyte, specifically the inhibition of the oxidation of tyrosine to 3,4-dihydroxyphenylalanine (DOPA). The depigmentation effect is reversible; if a patient stops using hydroquinone, the pigmentation changes will return.
5-Fluorouracil acts by interfering with DNA synthesis by blocking the methylation of deoxyuridylic acid. It is used in the treatment of cutaneous malignancy and is not used in the treatment of pustular acne.
Systemic isotretinoin remains the most effective and aggressive drug for severe cystic acne. It functions by causing atrophy of the pilosebaceous gland and attenuating the secretion of sebum. Isotretinoin is not used for cosmetic purposes. In fact, the reduced activity of the sebaceous glands predisposes patients to hypertrophic scarring, and any skin resurfacing procedure (chemical peel, carbon dioxide laser) is contraindicated in patients who have been on systemic retinoid therapy within 6 months to 1 year.
2016
A 44-year-old woman, gravida 4, para 3, is evaluated because of symptomatic macromastia. Bilateral reduction mammaplasty is planned. The patient's mother was diagnosed with postmenopausal breast cancer at 53 years of age; the patient underwent genetic testing which was negative for BRCA mutation. Physical examination shows the patient wears a size 32F brassiere and has grade III ptosis, shoulder grooving, dense breast tissue without palpable masses or nipple discharge, and intertrigo. According to current American Cancer Society recommendations, which of the following breast imaging methods should be used before the planned reduction mammaplasty in this patient?
A) Diagnostic mammography
B) MRI
C) Screening mammography
D) Thermography
E) Ultrasonography
What is C, screening mammography
ACS screening recommendations:
Average-risk, asymptomatic women: baseline screening mammogram at 40 to 44 years of age
Annual screening from 45 to 54
Biennial screening for women older than 55 years of age who are in good health and have a life expectancy of at least ten years.
This patient is asymptomatic, and is not a BRCA carrier, and meets criteria for a screening mammogram.
Diagnostic mammogram is performed to evaluate abnormalities found on screening mammogram, in the context of breast cancer history, or with physical exam findings such as a breast mass, nipple discharge, or breast pain.
*MRI is recommended as an adjunct to mammography in the case of a known BRCA mutation, if the first-degree relative is known to have the BRCA mutation but the patient is untested, or if there is a lifetime risk of 20 to 25% of breast cancer
2018
The association between craniofacial defects and cardiac malformations in patients with velocardiofacial syndrome results from a disruption in the cellular development of which of the following?
A) Cardiogenic mesoderm
B) Ectodermal placodes
C) Lateral plate mesoderm
D) Neural crest
E) Somites
What is D, Neural Crest
Neural crest cells derive from the ectoderm layer, specifically the neuroectoderm of the forebrain, midbrain, and hindbrain. The neural crest contributes significantly to the craniofacial region, and also to the conotruncal endocardial cushions that are responsible for dividing the outflow tract of the heart into separate pulmonary and aortic components. Therefore, defects in neural crest cell development will frequently result in malformations of both the craniofacial area and cardiac septum.
2014
A 35-year-old woman comes to the office to discuss improving the contour of her thighs. History includes gastric bypass surgery two years ago, followed by a stable 150-lb (68-kg) weight loss. Along with moderate horizontal excess skin, she has significant vertical excess skin, and a full-length vertical thighplasty is considered. This patient is at greatest risk for which of the following complications?
A) Hematoma
B) Infection
C) Labial spreading
D) Prolonged edema
E) Seroma
What is D, prolonged edema
Each of the complications listed in this question has a significant occurrence with thighplasty in the massive-weight-loss population, but prolonged edema has been shown to be a particular risk factor in patients getting a full-length vertical component in their thighplasty, presumably due to circumferential compression of the low pressure lymphatic system. Labial spreading is possible but not likely.
2018
A 55-year-old woman presents with androgenic alopecia. Her husband had a hair transplant 5 years ago. Which of the following characteristics of androgenic alopecia is more common in women than men?
A) More rapidly progressive
B) Not induced by dihydrotestosterone
C) Thinning tends to be frontoparietal
D) Topical minoxidil is ineffective
What is C, Thinning tends to be frontoparietal
Unlike in men, androgenic alopecia in women tends to spare the frontal hairline and tends to affect the frontoparietal scalp.
Like in men, it is a chronically progressive disease and causes miniaturization of scalp follicles through exposure of endogenous dihydrotestosterone in patients with increased scalp androgen receptors and 5-reductase concentrations.
Topical minoxidil has been shown to increase scalp blood supply and slow hair loss in both males and females.
2017
A 60-year-old woman with a history of rheumatoid arthritis presents with a boutonnière deformity of the long finger. The cause of this deformity is?
A) Destruction of the cartilage of the proximal interphalangeal joint
B) Dorsal subluxation of the lateral bands at the proximal interphalangeal joint
C) Metacarpophalangeal joint subluxation
D) Rupture of the distal extensor tendon
E) Synovitis at the proximal interphalangeal joint
What is synovitis at the proximal interphalangeal joint
Posture of a boutonnière: flexion of the proximal interphalangeal (PIP) joint and hyperextension of the DIP joint.
The common injury for non-rheumatoid patients that suffer traumatic injuries that lead to the deformity is a rupture of the central slip that means no active extension at the PIP joint. Over time, the lateral bands slip volarly and cause hyperextension of the distal joint.
Synovitis of the PIP joint leads to subsequent attenuation of the central slip, which leads to the same deformity (MC in RA)
2018
A 52-year-old woman comes to the office to discuss revision of breast reconstruction following mastectomy for breast cancer. She is undergoing adjuvant treatment with an agent that interferes with her body's natural mechanisms that promote native breast growth, but she cannot remember its name. She is most likely being treated with which of the following agents?
A) Alkylating agent (cyclophosphamide)
B) Anthracycline (doxorubicin)
C) Aromatase inhibitor (anastrozole)
D) Platinum agent (cisplatin)
E) Taxane (paclitaxel)
What is C, Aromatase inhibitor (anastrazole)
Aromatase inhibitors such as anastrozole impair conversion of androgens to estrogens. Estrogens promote normal breast tissue growth as well as growth of many breast cancers. The other options (taxanes, anthracyclines, alkylating agents, and platinum agents) are all chemotherapeutic agents that do not particularly target hormones involved in normal breast growth mechanisms.
2018
DAILY DOUBLE!!!
A 10-year-old boy with a history of obstructive sleep apnea and prior straight-line cleft palate repair is brought for evaluation of stigmatizing, hypernasal speech. There is no oronasal fistula present, and the velum appears to vault, but the palate elevates well with phonation. Which of the following is the best option for improvement of speech in this patient?
A) Continued speech therapy
B) Furlow palatoplasty
C) Posterior pharyngeal flap
D) Tonsillectomy
E) Use of a palatal lift device
What is B, Furlow Palatoplasty
Issue: significant hypernasality in the face of a prior straight-line cleft palate repair, without oronasal fistula and significant sleep apnea
VPI sx techniques: sphincter pharyngoplasty, posterior pharyngeal flap, and conversion Furlow palatoplasty.
This particular patient has:
1) vaulting of the velum: indicative of anterior placement of the levator veli palatini muscles, and also appears to have good palatal elevation. Both of these make him a promising candidate for a conversion Furlow palatoplasty.
2) Posterior pharyngeal flap surgery: not option given his sleep apnea type symptoms and good palatal mobility. Posterior pharyngeal flap would be preferable in a patient with poor motion of the velum, a coronal velopharyngeal port defect, and good lateral wall motion.
3) Further speech therapy would be unlikely to provide the patient with any significant improvement in hypernasality.
Although tonsillectomy may help with his sleep apnea type symptoms, it is more likely to cause hypernasality particularly w/ adenoidectomy
The use of a palatal lift device can be beneficial in patients with velopharyngeal insufficiency and poor palatal motion who are not candidates for or do not wish to undergo surgery.
2018
A 53-year-old woman is evaluated 6 weeks after undergoing blepharoplasty. Physical examination shows 1 mm of lagophthalmos with no dry-eye symptoms. The patient returns 8 months later for evaluation of dry eye, which began one month after undergoing laser-assisted in situ keratomileusis (LASIK) surgery. Which of the following is the most likely reason for this patient's dry-eye symptoms?
A) Blunted blink reflex secondary to decreased corneal reflex arc
B) Chronic use of vasoconstrictive eyedrops
C) Transient decrease in functioning of the orbicular muscle of the eye secondary to stretching from lid traction during surgery
D) Transient decrease in tear production caused by lacrimal gland pressure injury
E) Transient hypersensitivity of the cornea
What is A, blunted blink reflex secondary to decreased corneal reflex arc
Minimal lagophthalmos in the postoperative period following blepharoplasty is not uncommon and generally self-correcting.
Laser-assisted in situ keratomileusis (LASIK) procedure involves creation of a corneal flap that interrupts the long ciliary nerves of the ophthalmic division of the trigeminal nerve. The interruption of these nerves results in decreased sensation to the cornea and a decreased corneal reflex arc. Patients with compensated exposure from blepharoplasty may lose the compensatory blink in reaction to corneal irritation following LASIK. This may cause dry-eye symptoms. With time, the corneal reflex arc improves, and the transient neurotrophic keratopathy and dry-eye symptoms improve. The other options are unlikely to cause her symptoms of dry eyes.
2016
A 27-year-old woman presents with a multicolored decorative tattoo on her leg. She is interested in laser tattoo removal. On physical examination, over 80% of her tattoo has red and orange colors. Which of the following laser treatments would be most effective on the orange and red areas?
A) 755-nm Q-switched alexandrite
B) 532-nm Q-switched Nd:YAG
C) 1064-nm Q-switched Nd:YAG
D) 694-nm Q-switched ruby
What is B, 532-nm Q-switched Nd:YAG
RED/YELLOW/ORANGE: 532-nm Q-switched Nd:YAG
PURPLE: Q-switched 694-nm ruby laser
GREEN/BLUE/DARK: Q-switched Ruby 694 nm
GREEN: Q-switched 755-nm Alexandrite laser
BLACK:Q-switched Ruby 694-nm, 755-nm Alexandrite, or 1064-nm Nd:YAG lasers
2021
A 57-year-old right-hand–dominant woman with rheumatoid arthritis presents with 10/10 pain of the right thumb that is preventing her from painting, her primary activity. X-ray study shows rheumatoid changes in multiple joints; right thumb carpometacarpal (CMC) joint is consistent with Eaton stage 3-4 disease. On physical examination, the right thumb metacarpal base is prominent. Grind test result is positive. Which of the following is the most appropriate management to help this patient resume her normal activities?
A) Arthrodesis of the thumb CMC joint
B) Pyrocarbon implant arthroplasty of the thumb CMC joint
C) Referral to a rheumatologist for infliximab
D) Regimen of splinting, rest, and ibuprofen 800 mg 3 times daily
E) Trapeziectomy with ligament reconstruction and tendon interposition
What is E, Trapeziectomy with ligament recon and tendon interposition
Trapeziectomy with ligament reconstruction and tendon interposition is a good option for this patient, since she clearly has advanced CMC disease and seeks function requiring minimal strength with preservation of mobility postoperatively. If she were a laborer or needed significant grip strength, this option would be less acceptable*
Infliximab (Remicade) is a reasonable option when multiple joints are significantly involved. Not indicated in single joint disease
Arthrodesis would eliminate this patient’s pain, but it would mobility, negatively affecting her fine-motor work. Would make opposition difficult and may alter the way she holds her paintbrush.
Although FDA approved, thumb CMC silicone implants are inferior to trapeziectomy with ligament reconstruction and tendon interposition.
Pyrocarbon implant arthroplasty is intended for osteoarthritis; does not provide the soft-tissue stability required in this patient.
2014
In a Wise-pattern reduction mammaplasty using the superior medial pedicle, sensation is provided to the nipple-areola complex by which of the following nerves?
A) Lateral cutaneous branch of the fourth intercostal nerve
B) Lateral cutaneous branch of the second intercostal nerve
C) Medial pectoral nerve
D) Terminal branches of the fourth and fifth anterior intercostal nerves
E) Terminal branches of the second and third anterior intercostal nerves
What is D, the terminal branches of the fourth and fifth anterior intercostal nerve
The nipple-areola complex is innervated by the lateral cutaneous branch of the fourth intercostal nerve as well as the terminal branches of the fourth and fifth anterior intercostal nerves. However, when a superior medial pedicle in a reduction mammaplasty is used, the contribution from the lateral branch of the fourth intercostal nerve is excised. The lateral cutaneous branch of the second intercostal nerve is also known as the intercostobrachial nerve, which provides sensation to the medial and posterior upper arm. The medial pectoral nerve innervates portions of the pectoralis major and minor.
2018
A 37-year-old woman comes to the office for evaluation for cosmetic rhinoplasty. The patient repeatedly reports to the surgeon that she "is ugly" and "can't stand" her nose. Physical examination shows no abnormalities consistent with her concerns. Medical history includes five visits to different plastic surgeons in the past 4 months and each surgeon has declined to perform surgery. The surgeon refuses to perform the surgery and refers the patient to a health psychologist. The surgeon's decision is a demonstration of which of the following principles?
A) Beneficence
B) Iniquity
C) Justice
D) Maleficence
E) Noxiousness
What is A, Beneficence
In refusing to operate on a patient with body dysmorphic disorder and instead referring the patient to a health psychologist, the surgeon is practicing the ethical principle of beneficence—the doing of good.
The terms maleficence, iniquity, and noxiousness are all associated with doing harm.
Justice, the ethical principle requiring doctors to ensure that medical care is available to all, is not applicable to this scenario.
2018
A 25-year-old woman undergoes rhinoplasty to correct a bulbous tip. After a cephalic trim leaving 6 mm of the lower lateral cartilage, transdomal sutures, and infracture, the tip continues to look bulbous. Which of the following techniques is most likely to improve this persistent deformity?
A) Additional cephalic trimming
B) Columellar strut grafting
C) Lateral crural mattress suture
D) Shield grafting
E) Spreader grafting
What is C, Lateral crural mattress suture
The most likely cause for a persistent bulbous tip after traditional maneuvers is convexity of the lower lateral cartilages. Lateral crural mattress sutures are effective in improving this convexity. These sutures are placed spanning the convexity and then tightened to straighten the curvature. Another option would be an alar batten graft, which is a graft placed on the medial surface of the lower lateral cartilage. Additional cephalic trim could lead to weakening of the nasal tip support and would not correct the problem.
Columellar strut grafting, shield grafting, and spreader grafting will not effectively improve a naturally convex lower lateral cartilage.
2015
During which of the following phases of wound healing is collagen deposition the greatest?
A) Collagen deposition occurs equally during all phases of wound healing
B) Collagen deposition does not occur during wound healing
C) Inflammatory
D) Proliferative
E) Remodeling
What is D Proliferative Phase
Proliferative phase of wound healing occurs in two phases. Fibrin and fibronectin are formed during the initial proliferative period. Around day 3 of wound healing, fibroblasts appear and begin production of collagen. The proliferative phase ends between 2 to 4 weeks of wound healing when collagen accumulation reaches a maximum and collagen remodeling begins, marking the beginning of the remodeling phase of wound healing.
Inflammatory phase is dominated by white blood cells. There is an influx of polymorphonuclear leukocytes (PMNs), macrophages, and lymphocytes. PMNs are not essential to wound healing, but macrophages are essential. Sterile incisions normally heal without PMNs.
Type III collagen is converted to type I in the remodeling phase. In this phase there are increased collagen cross-linking and increased tensile strength.
Collagen deposition occurs during all phases of wound healing just not equally
2018
A 60-year-old woman with rheumatoid arthritis (RA) comes to the office because of the sudden inability to extend the right thumb. The patient reports no pain or swelling before the loss of extension. She notes her RA symptoms have been well controlled for over 10 years with low-dose prednisone and methotrexate. Physical examination shows strong flexion of the right thumb at the interphalangeal joint. The patient is unable to extend the thumb interphalangeal joint against resistance and is unable to lift the thumb off the tabletop when the palm is held flat. Full passive mobility of the thumb is noted. Rupture of which of the following tendons is most likely upon surgical exploration?
A) Abductor pollicis brevis at the metacarpophalangeal joint
B) Abductor pollicis longus at the carpometacarpal joint
C) Extensor pollicis brevis at the metacarpophalangeal joint
D) Extensor pollicis longus at the wrist
E) Flexor pollicis longus near the scaphoid
What is D EPL at wrist.
most common etiologies for rupture center around mechanical or vascular changes in the EPL within the third extensor compartment as the tendon bends around Lister's tubercle.
This appears to be related in part to the proximity of the tendon to an injury (in distal radius fractures) and to the "watershed" zone of perfusion of the EPL at Lister tubercle. In this patient with RA, the rupture is likely a combination of ischemia and direct inflammatory synovial infiltration of the tendon within the third compartment.
2019
After a nipple-sparing mastectomy, which of the following branches of an intercostal nerve predominantly provides remaining sensation to the nipple-areola complex?
A) Anterior branch of the fifth
B) Anterior branch of the fourth
C) Lateral branch of the fifth
D) Lateral branch of the fourth
E) Lateral branch of the third
What is B anterior branch of the 4th IC nerve
Cutaneous innervation of the female breast:
Medially: anterior cutaneous branches of 3rd-5tu intercostal nerves (Subcutaneous)
Laterally: lateral cutaneous branches of the 3rd-5th intercostal nerves. (Deep w/i pec fascia)
***The fourth intercostal nerve has further shown to be most consistent in various anatomical studies.
2018
After successfully completing training at an accredited United States or Canadian training institution, the maximum amount of time a surgeon is allowed to advertise as board eligible while seeking initial certification with the American Board of Plastic Surgery (ABPS) is which of the following?
A) 1 year
B) 3 years
C) 8 years
D) 10 years
E) There is no limit
What is C, 8 years
The policy recognizes physicians’ need to advertise with the term "Board Eligible" during their preparatory time for initial board certification, but closes off the potential for abuse through the use of the term indefinitely.
For the ABPS, the time period is restricted to a maximum of 8 years (7 years plus an additional 1 year allowance to meet the necessary practice requirement to successfully complete both written and oral examinations in plastic surgery).
Exceptions are considered in instances of military deployment, acute illness, or other individual circumstances according to review by the Member Board.
Once certified, diplomates of the ABPS must complete professionalism requirements, self assessment activities, practice improvement activities, and an examination every 10 years as required by the Maintenance of Certification Program in order to maintain their certification status.
2018
A 63-year-old woman undergoes a rhytidectomy with brow lift. Ipsilateral weakness of the forehead muscles is noted in the recovery room. The suspected injury is most likely immediately deep to which of the following?
A) Deep layer of the deep temporal fascia
B) Subdermal connective tissue
C) Superficial layer of the deep temporal fascia
D) Superficial temporal fat pad
E) Temporoparietal fascia
What is E, TPF
The temporal branch of the facial nerve is found just deep to the temporoparietal fascia AKA "superficial temporal fascia"
The facial nerve exits the stylomastoid foramen and the main trunk, pes anserinus, can be found 1 cm inferior and posterior, midway between the tragal pointer and the posterior belly of the digastric muscle.
Most mimetic facial muscles are innervated from the deep surface such as the temporalis. Exceptions are the buccinator, levator anguli oris, and mentalis (MLB!)
Injury to the temporal or cervical branches can leave more lasting deformities so management of injury is important. Therefore, when dissecting in the temporal zone it is critical to avoid entering deep to the temporoparietal fascia.
2018