Plastic Surgery Prometric exam questions with answers

1. Question 1Aesthetic Surgery and Non-surgical Proceduresmedium

   During injection of hyaluronic acid filler into the nasolabial fold, the patient feels sudden pain and the skin above the injection becomes blanched and mottled. What is the most appropriate immediate action?

   1. AContinue injecting slowly and massage the area
   2. BStop and inject hyaluronidase into the affected area
   3. CApply ice packs and review the next day
   4. DGive an oral steroid and arrange follow-up
   Show answer and explanation▾

   Answer: B. Stop and inject hyaluronidase into the affected area

   Pain with blanching and livedo indicates intravascular injection or compression of a vessel, which can progress to skin necrosis. Injection must stop at once and high-dose hyaluronidase should be given across the affected territory, with warm compresses and massage. Ice causes vasoconstriction and worsens ischaemia.

2. Question 2Aesthetic Surgery and Non-surgical Procedureshard

   A surgeon plans tumescent liposuction on a healthy 70 kg woman. Using the widely cited safe upper limit of 35 mg/kg of lidocaine in tumescent solution, what is the maximum total dose?

   1. A490 mg
   2. B2450 mg
   3. C1050 mg
   4. D3500 mg
   Show answer and explanation▾

   Answer: B. 2450 mg

   With a limit of 35 mg/kg, the maximum is 35 x 70 = 2450 mg. This higher limit applies only to dilute tumescent solution in subcutaneous fat, where absorption is slow and much is removed by aspiration. The usual limit for plain lidocaine infiltration is far lower, about 4.5 mg/kg.

3. Question 3Burnsmedium

   A ventilated patient with circumferential full thickness burns of the chest has rising airway pressures and falling tidal volumes despite sedation. The endotracheal tube is patent. What is the most appropriate intervention?

   1. AIncrease the inspiratory pressure limit
   2. BGive a bolus of intravenous fluid
   3. CPerform chest escharotomies
   4. DInsert bilateral chest drains
   Show answer and explanation▾

   Answer: C. Perform chest escharotomies

   Inelastic full thickness eschar around the chest restricts chest wall movement, and escharotomy releases it and restores ventilation. Raising pressures risks barotrauma without treating the cause. Chest drains treat pneumothorax, which is not suggested here.

4. Question 4Burnsmedium

   A scald on the forearm is dry, blotchy red and does not blanch on pressure, and sensation to pinprick is reduced. What is the most likely depth and expected course?

   1. ASuperficial burn, healing within 7 days
   2. BSuperficial partial thickness, healing within 14 days
   3. CDeep partial thickness, likely to need excision and grafting
   4. DFull thickness, needing amputation of the forearm
   Show answer and explanation▾

   Answer: C. Deep partial thickness, likely to need excision and grafting

   Fixed capillary staining that does not blanch with reduced sensation indicates a deep dermal burn, which usually takes over 3 weeks to heal and scars badly, so excision and grafting are usually recommended. Superficial partial thickness burns are moist, pink, blanching and painful. Full thickness burns are leathery and insensate but rarely need amputation.

5. Question 5Trunk and Lower Limb Reconstructioneasy

   A bedbound patient has a sacral wound with full thickness skin loss and visible subcutaneous fat, but no exposed bone, tendon or muscle. What stage is this pressure injury?

   1. AStage 1
   2. BStage 2
   3. CStage 4
   4. DStage 3
   Show answer and explanation▾

   Answer: D. Stage 3

   A stage 3 pressure injury involves full thickness skin loss with visible fat, without exposed fascia, muscle, tendon or bone. Stage 2 is partial thickness loss with exposed dermis, and stage 4 shows exposed bone, tendon or muscle. A wound whose base is obscured by slough or eschar is unstageable.

6. Question 6Craniofacial and Cleft Surgerymedium

   A newborn has a small jaw, a U-shaped cleft palate and intermittent upper airway obstruction with desaturation when supine. What is the first-line management of the airway?

   1. AImmediate tracheostomy
   2. BProne or lateral positioning
   3. CMandibular distraction osteogenesis
   4. DEarly palate repair
   Show answer and explanation▾

   Answer: B. Prone or lateral positioning

   In Pierre Robin sequence, micrognathia causes the tongue to fall back and obstruct the airway, and many infants are managed with prone or lateral positioning. A nasopharyngeal airway is added if needed. Distraction osteogenesis or tracheostomy is reserved for severe obstruction that does not respond.

7. Question 7Wound Healing, Grafts and Flapshard

   Six hours after a free anterolateral thigh flap to the leg, the flap is purple and swollen, with capillary refill under 1 second and dark blood on pinprick. What is the most appropriate next step?

   1. AElevate the leg and review in 4 hours
   2. BApply warm packs and increase fluids
   3. CReturn urgently to theatre to explore the pedicle
   4. DStart an intravenous heparin infusion and observe
   Show answer and explanation▾

   Answer: C. Return urgently to theatre to explore the pedicle

   A congested flap with brisk dark bleeding and rapid refill indicates venous outflow obstruction, which needs urgent surgical exploration, because salvage rates fall quickly with delay. Conservative measures waste time when the anastomosis may be thrombosed. Anticoagulation alone does not correct a mechanical problem such as kinking or thrombosis.

8. Question 8Wound Healing, Grafts and Flapseasy

   A split thickness graft on the forearm is inspected on day 5 and a large area has failed to take. What is the most common cause of skin graft failure?

   1. ACollection of blood or fluid under the graft
   2. BUse of a meshed rather than sheet graft
   3. CGraft harvested from the thigh donor site
   4. DInfection with Staphylococcus epidermidis
   Show answer and explanation▾

   Answer: A. Collection of blood or fluid under the graft

   Haematoma or seroma beneath the graft separates it from the bed and prevents imbibition and inosculation, making it the most common cause of graft loss. Shear and infection, especially with beta-haemolytic streptococci, are other important causes. Meshing actually allows fluid to drain and improves take.

9. Question 9Hand and Upper Limb Surgerymedium

   A rugby player catches his ring finger in an opponent's shirt. He cannot flex the distal interphalangeal joint when the middle phalanx is held, but can flex the proximal interphalangeal joint. What is the injury?

   1. AAvulsion of flexor digitorum superficialis
   2. BRupture of the central slip of the extensor
   3. CAvulsion of flexor digitorum profundus
   4. DRupture of the A2 flexor pulley
   Show answer and explanation▾

   Answer: C. Avulsion of flexor digitorum profundus

   Inability to flex the distal joint with the proximal joint intact indicates avulsion of flexor digitorum profundus, the jersey finger, which most often affects the ring finger. Early repair is needed because the tendon may retract into the palm and lose its blood supply. Pulley rupture causes bowstringing rather than loss of distal flexion.

10. Question 10Hand and Upper Limb Surgerymedium

    A man has a 5 mm laceration over the head of the third metacarpal after punching someone in the mouth 12 hours ago. The joint is swollen and painful to move. What is the most appropriate management?

    1. ASuture the wound and give oral antibiotics
    2. BApply adhesive strips and review in 48 hours
    3. CSurgical exploration and washout with antibiotics
    4. DSplint the hand and give an analgesic only
    Show answer and explanation▾

    Answer: C. Surgical exploration and washout with antibiotics

    A fight bite over the knuckle often penetrates the extensor mechanism and joint, inoculating oral flora such as Eikenella corrodens and anaerobes. Exploration, washout and antibiotics such as amoxicillin-clavulanate are required, and the wound is left open. Primary suturing traps bacteria and risks septic arthritis.

11. Question 11Skin Cancer and Head and Neck Reconstructionmedium

    Excision biopsy of a pigmented lesion on the back shows invasive melanoma with a Breslow thickness of 1.5 mm. What clinical margin is recommended for wide local excision?

    1. A0.5 cm
    2. B3 cm
    3. C1 to 2 cm
    4. D5 cm
    Show answer and explanation▾

    Answer: C. 1 to 2 cm

    For melanoma with Breslow thickness between 1 and 2 mm, current guidelines recommend wide local excision with a 1 to 2 cm clinical margin. Melanoma in situ needs about 0.5 to 1 cm, and tumours over 2 mm need 2 cm. Wider margins beyond 2 cm have not been shown to improve survival.

12. Question 12Skin Cancer and Head and Neck Reconstructionmedium

    A man has a recurrent morphoeic basal cell carcinoma with poorly defined borders on the nasal ala. Which treatment offers the highest cure rate while sparing tissue?

    1. AStandard excision with 4 mm margins
    2. BCryotherapy with a double freeze-thaw cycle
    3. CTopical imiquimod for 6 weeks
    4. DMohs micrographic surgery
    Show answer and explanation▾

    Answer: D. Mohs micrographic surgery

    Mohs micrographic surgery examines all the surgical margins, giving the highest cure rates for high-risk basal cell carcinoma, such as recurrent, morphoeic or ill-defined tumours on the central face, while sparing normal tissue. Standard 4 mm margins are adequate only for small well-defined low-risk lesions. Cryotherapy and imiquimod are for superficial low-risk tumours.

13. Question 13Trunk and Lower Limb Reconstructionmedium

    A motorcyclist has an open tibial fracture with bone exposed after debridement and a soft tissue defect that cannot be closed directly. Within what time frame should definitive soft tissue cover ideally be achieved?

    1. AWithin 6 hours of injury
    2. BWithin 3 weeks of injury
    3. CAfter bony union is confirmed
    4. DWithin 72 hours of injury
    Show answer and explanation▾

    Answer: D. Within 72 hours of injury

    Orthoplastic guidance recommends definitive soft tissue closure or cover within 72 hours of injury if it cannot be done at the first debridement, as delay increases infection and non-union. Waiting weeks or until union leaves bone exposed. Cover within 6 hours is not required, while debridement should be timely.

14. Question 14Wound Healing, Grafts and Flapsmedium

    A surgeon is choosing a skin graft for a defect on the palm of a child's hand, where later contracture would limit function. Which graft type shows the least secondary contraction?

    1. AThin split thickness graft
    2. BMeshed split thickness graft
    3. CThick split thickness graft
    4. DFull thickness skin graft
    Show answer and explanation▾

    Answer: D. Full thickness skin graft

    Secondary contraction, which occurs as the graft heals, is inversely related to the amount of dermis included, so full thickness grafts contract least. They show more primary contraction when harvested, but this is managed by sizing. Thin and meshed split grafts contract the most and are poor choices over flexor surfaces.

15. Question 15Wound Healing, Grafts and Flapsmedium

    A pedicled latissimus dorsi flap is planned for breast reconstruction. Which artery is the dominant pedicle of this muscle?

    1. AThoracodorsal artery
    2. BLateral thoracic artery
    3. CTransverse cervical artery
    4. DInternal thoracic artery
    Show answer and explanation▾

    Answer: A. Thoracodorsal artery

    The latissimus dorsi is a Mathes-Nahai type V muscle with a dominant pedicle from the thoracodorsal artery, a branch of the subscapular artery, and secondary segmental perforators. The thoracodorsal vessels allow a wide arc of rotation to the chest. The lateral thoracic artery supplies serratus anterior and the lateral breast.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.