Free Plastic Surgery Practice Questions

Question 1

Seven hours after free anterolateral thigh flap coverage of a tibial defect, the skin paddle becomes purple and tense, with nearly instantaneous capillary refill and brisk dark bleeding on pinprick. The arterial pedicle Doppler signal is unchanged. Blood pressure and temperature are normal, and releasing the dressing does not improve the examination. The patient can safely undergo another anesthetic. What is the appropriate response to the discordant clinical and Doppler findings?

Accepted Answer

Return urgently to the operating room to evaluate and restore venous outflow.

Answer

Observe the flap because its arterial Doppler signal is unchanged.

Answer

Begin leech therapy instead of operative exploration.

Answer

Begin therapeutic heparin and defer exploration until its effect on flap color is assessed.

Question 2

Final pathology after primary oncoplastic breast-conserving surgery shows a 16-mm invasive ductal carcinoma without an associated in situ component. The closest margin is 0.6 mm; no tumor touches ink. Imaging and pathology are concordant, all imaging targets were removed, and whole-breast irradiation is planned. The patient has not received neoadjuvant treatment. Which recommendation regarding the surgical margin is supported by the SSO-ASTRO consensus?

Accepted Answer

Proceed with the planned adjuvant treatment without routine margin re-excision.

Answer

Re-excise to establish a 2-mm minimum margin.

Answer

Re-excise the entire tumor bed to obtain a 5-mm minimum margin.

Answer

Recommend completion mastectomy because tissue rearrangement makes a submillimeter margin unacceptable.

Question 3

A cyclist develops weak finger abduction and reduced sensation over the palmar small finger and ulnar half of the ring finger. Sensation over the dorsoulnar hand is preserved. Flexor carpi ulnaris, the small-finger flexor digitorum profundus, and median-innervated thenar muscles have normal strength. Where does this combination most strongly localize the lesion?

Accepted Answer

Guyon canal, proximal to the ulnar nerve bifurcation

Answer

The lower trunk of the brachial plexus

Answer

The ulnar nerve at the cubital tunnel

Answer

The deep motor branch distal to the Guyon canal bifurcation

Question 4

At a cleft-team visit, a 6-year-old with a repaired palate has normal vowel resonance but audible nasal air escape on /s/ and /z/. There is no palatal fistula. Nasoendoscopy demonstrates complete velopharyngeal closure during correctly articulated pressure consonants, including coached /s/ productions without nasal escape. The parents ask whether another operation would improve speech. Which treatment targets the demonstrated problem?

Accepted Answer

Articulation therapy targeting oral placement and airflow

Answer

Construction of a superiorly based pharyngeal flap

Answer

Sphincter pharyngoplasty to reduce the velopharyngeal opening

Answer

Revision with a secondary Furlow palatoplasty

Question 5

An 80-kg adult is assessed immediately after a flame injury. The entire anterior trunk and entire left arm have moist, blistered, painful burns. The entire right leg has only superficial epidermal erythema, with dry, intact skin and no blistering; no other areas are injured. There is no electrical or inhalation injury. Using the adult rule of nines and the 2024 American Burn Association recommendation, what is the initial first-24-hour crystalloid volume estimate, before adjustment to the patient's resuscitation response?

Accepted Answer

4,320 mL

Answer

7,200 mL

Answer

8,640 mL

Answer

14,400 mL

Question 6

Persistent nasal obstruction develops after dorsal hump reduction. Examination shows an inverted-V contour and narrowing between the dorsal septum and upper lateral cartilages. Supporting this segment laterally improves airflow. The septum is otherwise straight, the inferior turbinates are not enlarged, and the alar rims remain stable during inspiration. Which graft is best suited to the deficient support?

Accepted Answer

Bilateral dorsal spreader grafts

Answer

Bilateral alar batten grafts

Answer

A caudal septal extension graft

Answer

A columellar strut graft

Question 7

Following implant-based breast reconstruction, a patient is satisfied with the breast at rest but has painful superior displacement and marked contour distortion when she presses her palms together. The breast is soft at rest, ultrasound shows an intact implant without a fluid collection, and the overlying tissue provides adequate coverage. The implant lies beneath pectoralis major. Which revision most directly removes the cause of the movement-related deformity?

Accepted Answer

Convert the implant pocket to a prepectoral position.

Answer

Perform lateral capsulorrhaphy in the existing pocket.

Answer

Exchange for a smaller implant in the existing subpectoral pocket.

Answer

Perform capsulotomy while maintaining pectoralis coverage of the implant.

Question 8

A 67-year-old with diabetes has a persistent plantar forefoot ulcer despite appropriate off-loading. The wound has no purulence, spreading erythema, or exposed bone. Before definitive coverage, vascular testing shows an ankle-brachial index of 1.46, a toe pressure of 22 mmHg, and monophasic pedal Doppler waveforms. How should these results alter the reconstructive plan?

Accepted Answer

Seek urgent vascular assessment for possible revascularization.

Answer

Proceed with flap coverage on the basis of the ankle-brachial index.

Answer

Begin prolonged empiric antibiotics before coverage.

Answer

Recommend primary amputation because the toe pressure precludes healing.

Question 9

After release of a mature palmar burn contracture in a child, the defect has a well-vascularized bed suitable for either a full-thickness graft or a thin, unmeshed split-thickness graft. The surgeon selects full-thickness skin to limit recurrent contracture. Compared with the thin split-thickness graft, what mechanical behavior should be expected from the full-thickness graft?

Accepted Answer

Greater immediate recoil, with less contraction during healing

Answer

Less immediate recoil, with more contraction during healing

Answer

Greater immediate recoil and greater later wound-bed contraction

Answer

Less recoil after harvest and less contraction during healing

Question 10

Reconstruction is being planned for a toddler with marked thumb hypoplasia and a normally mobile index finger. Which anatomic finding most strongly favors index-finger pollicization over reconstruction that preserves the hypoplastic thumb?

Accepted Answer

An absent or unstable carpometacarpal joint

Answer

A tight first web space

Answer

Marked thenar muscle hypoplasia

Answer

Metacarpophalangeal ulnar collateral ligament deficiency

Free Plastic Surgery Practice Questions

Domain 1: Core of Knowledge/General Plastic Surgical Principles and Techniques 16% of exam

Question 1

Question 2

Domain 3: Plastic Surgery of the Integument 10% of exam

Question 3

Domain 4: Plastic Surgery of the Head & Neck 18% of exam

Question 4

Question 5

Domain 5: Plastic Surgery of the Upper Extremity 15% of exam

Question 6

Question 7

Domain 7: Plastic Surgery of the Lower Extremity 9% of exam

Question 8

Domain 10: Plastic Surgery of the Breast 15% of exam

Question 9

Question 10

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