Reconstructive Surgery MCQs

Follicular carcinoma can normally only be differentiated from follicular adenoma by the architecture on histology. For this reason, follicular lesions on FNA are unable to be diagnosed as malignant in the absence of clinical features such as metastases. Multiple foci of follicular carcinoma are seldom seen and lymph node involvement is much less common than in papillary carcinoma. Blood-borne metastases are more common and the eventual mortality rate, although still low, is twice that of papillary cancer. Hurthle cell tumours are a rare variant of follicular neoplasm in which oxyphil (Hurthle, Askanazy) cells predominate histologically. Hurthle cell cancers are associated with a poorer prognosis. Reference : Bailey & Love's short practice of surgery, chapter: 55, Edition: 28th, Pg: 868

Renal agenesis is the complete absence of one kidney. It results from failure of connection between the metanephric blastema and the ipsilateral ureteric bud . This condition is an autosomal dominant trait with incomplete penetrance. Typically, there is an absent ipsilateral ureter and the ipsilateral hemi-trigone is missing in the bladder. The remaining kidney is usually hypertrophic but may also be dysplastic. In addition, the ipsilateral testis and vas deferens are usually absent and in some patients the adrenal gland on the affected side is missing as well. Females with the condition may have an absent ovary or Fallopian tube . Renal agenesis is different from renal aplasia where there is a small dysplastic kidney. Reference : Bailey & Love's short practice of surgery 28 th Edition, Chapter 82, The Kidney and Ureter, Pg: 1466.

Anterior colporrhaphy can lead to formation of vesicovaginal fistula. Causes of vesicovaginal fistula include - Obstetric - Protracted or neglected labour. Gynaecological - Total hysterectomy and anterior colporrhaphy. Radiotherapy . Direct neoplastic infiltration . Exceptionally, carcinoma of the cervix ulcerates through the anterior fornix to implicate the bladder. Reference : Bailey & Love's Short Practice of Surgery 28 th Edition, Chapter 83, The Urinary Bladder, Pg: 1505.

The concept of damage control surgery (DCS) was developed because severely traumatised patients with impaired physiology have poor outcomes after lengthy and complex surgical reconstructive procedures performed shortly after their trauma. Prolonged procedures result in additional trauma and further immune and physiological derangement The 'triad of death' is a cycle of: Acidosis Coagulopathy Hypothermia, may develop and result in multi-organ failure and death Reference : Bailey & Love's short practice of surgery, chapter: 27, Edition: 28th, Pg: 358

Ans is 'c' i.e. 75% Z-plasty is a very common interposition surgical technique utilized in plastic and reconstructive surgery to revise scars. In general, the greater the angle, the greater the gain in wound length. Tissue Lengthening with Z-Plasty Type of Z-Plasty Increase in Length of Central Limb (%) Simple 45-degree 50 Simple 60-degree 75 Simple 90-degree 100 Four-flap with 60-degree 150 angles Double-opposing 75 Five-flap 125 Or Angles compared to gain in length are as follows: 30-degree angle results in a 25% gain in length 45-degree angle results in a 50% gain in length 60-degree angle results in a 75% gain in length 75-degree angle results in a 100% gain in length 90-degree angle results in a 125% gain in length

The group A β-haemolytic Streptococcus can destroy split grafts completely (and also convert a donor site to a full-thickness defect) and so the presence of this microorganism is a contraindication to grafting. Reference : Bailey & Love's short practice of surgery 28th Edition, Chapter 47, Plastic and reconstructive surgery, Pg: 686