DHA Plastic Surgery exam questions

6 worked Plastic Surgery practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Aesthetic Surgery and Non-surgical Procedures

   Ten days after botulinum toxin injection to the glabella, a woman develops a 2 mm drop of the left upper eyelid. What topical treatment can temporarily improve the lid position?

   1. AApraclonidine eye drops
   2. BPilocarpine eye drops
   3. CTimolol eye drops
   4. DAtropine eye drops
   Show answer and explanation

   Correct answer: A. Apraclonidine eye drops

   Toxin spreading to levator palpebrae superioris causes ptosis, and apraclonidine, an alpha-adrenergic agonist, stimulates Muller muscle to raise the lid by 1 to 2 mm while the toxin wears off. Careful injection above the orbital rim reduces the risk. Pilocarpine constricts the pupil and does not lift the lid.

   Reference: Carruthers and Carruthers, Botulinum Toxin: Procedures in Cosmetic Dermatology, 4th ed.

2. Question 2 · Craniofacial and Cleft Surgery

   A 4-month-old boy has a long, narrow head with frontal bossing and a palpable ridge along the midline of the skull vault. Which suture has fused prematurely?

   1. AMetopic suture
   2. BCoronal suture
   3. CLambdoid suture
   4. DSagittal suture
   Show answer and explanation

   Correct answer: D. Sagittal suture

   Premature fusion of the sagittal suture prevents widening of the skull, so growth occurs lengthwise, giving scaphocephaly. It is the most common single-suture synostosis. Metopic fusion gives a triangular forehead, and unilateral coronal fusion causes anterior plagiocephaly.

   Reference: Neligan, Plastic Surgery, 4th ed.

3. Question 3 · Hand and Upper Limb Surgery

   A man cuts the palmar aspect of his index finger between the distal palmar crease and the middle phalanx, dividing both flexor tendons. Which flexor tendon zone is injured?

   1. AZone I
   2. BZone III
   3. CZone II
   4. DZone IV
   Show answer and explanation

   Correct answer: C. Zone II

   Zone II extends from the A1 pulley at the distal palmar crease to the insertion of flexor digitorum superficialis on the middle phalanx, where both tendons lie in the tight fibro-osseous sheath. Repair here is technically demanding and prone to adhesions. Zone I lies distal to the superficialis insertion and contains only the profundus tendon.

   Reference: Green's Operative Hand Surgery, 8th ed.

4. Question 4 · Burns

   A laboratory worker splashes hydrofluoric acid onto the fingers. Pain is severe though the skin looks only mildly affected. After copious irrigation, what is the most important specific treatment?

   1. ATopical calcium gluconate gel
   2. BTopical sodium bicarbonate paste
   3. CTopical silver sulfadiazine cream
   4. DTopical polyethylene glycol wash
   Show answer and explanation

   Correct answer: A. Topical calcium gluconate gel

   Fluoride ions penetrate deeply and bind calcium and magnesium, causing severe pain, tissue necrosis and potentially fatal hypocalcaemia. Calcium gluconate gel binds the fluoride, and resistant cases may need intra-arterial or subcutaneous calcium. Bicarbonate neutralisation does not bind fluoride, and polyethylene glycol is used for phenol burns.

   Reference: Herndon, Total Burn Care, 5th ed.

5. Question 5 · Craniofacial and Cleft Surgery

   A 10-year-old is hit in the eye by a football. There is little bruising, but upward gaze is markedly restricted, and the child has nausea, vomiting and bradycardia. CT shows a small orbital floor fracture with the inferior rectus trapped. What is the most appropriate management?

   1. AUrgent release of the muscle and floor repair
   2. BSteroids and reassessment after 2 weeks
   3. CObservation until diplopia resolves
   4. DElective repair once swelling settles
   Show answer and explanation

   Correct answer: A. Urgent release of the muscle and floor repair

   A white-eyed blowout fracture in a child traps the muscle in a trapdoor fracture, and the oculocardiac reflex causes bradycardia and vomiting. Urgent surgery is needed to free the muscle before ischaemia causes lasting restriction. Waiting for swelling to settle, as is usual in adults, risks permanent motility loss.

   Reference: AO Surgery Reference, Craniomaxillofacial: Orbital floor fractures

6. Question 6 · Hand and Upper Limb Surgery

   During fasciectomy for Dupuytren disease with a 60 degree contracture of the little finger proximal interphalangeal joint, the surgeon is concerned about a spiral cord. Why is this cord dangerous?

   1. AIt displaces the digital neurovascular bundle centrally and superficially
   2. BIt contains the digital artery within its central fibres
   3. CIt tethers the flexor tendon sheath to the skin surface
   4. DIt is attached to the extensor hood dorsally
   Show answer and explanation

   Correct answer: A. It displaces the digital neurovascular bundle centrally and superficially

   The spiral cord, formed from the pretendinous band, spiral band, lateral digital sheet and Grayson ligament, wraps around and pulls the neurovascular bundle towards the midline and the skin. The bundle is therefore at high risk of injury during dissection. The cord does not contain the artery itself.

   Reference: Green's Operative Hand Surgery, 8th ed.