Dermatologic and Cosmetic Surgery

8/11/2019 Dermatologic and Cosmetic Surgery

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Which of the following cosmetic injectables does not illicit an inflammatory response?

1 Radiesse (hydroxyapatite)

2 Artecoll (polymethylmethacrylate)

3 Silicone

4 Zyplast (collagen)

5 Sculptra (poly L-lactic acid)

Q/Q(M)-475342 Report a Problem

Which of the following cosmetic injectables does not illicit an inflammatory response?

1 Radiesse (hydroxyapatite)

Radiesse is an injectable, biodegradable filler composed of calcium hydroxyapatite microspheres. It is a

normal constituent of bone and is therefore biocompatible. Current studies are examining the role of

hydroxyapatite in augmenting the craniofacial skeleton.

Q/Q(M)-475342 Report a ProblemWhile removing sutures from an excision performed on the lateral neck, your patient reports decreased

sensation of the helix and lobule of the ipsilateral ear. Which of the following nerves was likely injured

during surgery?

1 Auriculotemporal nerve

2 Lesser occipital nerve

3 Auricular branch of vagus nerve

4 Greater auricular nerve5 Spinal accessory nerve


While removing sutures from an excision performed on the lateral neck, your patient reports decreased

sensation of the helix and lobule of the ipsilateral ear. Which of the following nerves was likely injured

during surgery?

4 Greater auricular nerve

Sensory innervation of the ear is provided by the greater auricular nerve, the auriculotemopral nerve, thelesser occipital nerve and the auricular branch of the vagus nerve. The greater auricular nerve is

composed of the C2 and C3 branches of the cervical plexus and lies in the posterior triangle of the neck.

It provides sensation to the helix, antihelix, antitragus, posterior auricle and the lobule. The spinal

accessory nerve is a motor nerve which innervates the trapezius muscle. This nerve is also subject to

injury in the lateral neck but would cause motor deficits rather than sensory deficits.


Alopecia neoplastica is most commonly associated with which malignancy?

1 Lymphoma

2 Squamous cell carcinoma

3 Breast carcinoma


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4 Colon carcinoma

5 Melanoma


Alopecia neoplastica is most commonly associated with which malignancy?

3 Breast carcinoma

While various malignancies have a predilection for metastasis to the scalp where they can cause hair

loss, alopecia neoplastica is most commonly associated with metastatic breast carcinoma.


What is the term used to describe the parallel nature of coherent light waves is?

1 monochromicity

2 coherence

3 collimation

4 energy

5 power


What is the term used to describe the parallel nature of coherent light waves is?

3 Collimation

Collimation is the parallel nature of coherent light waves. Monochromaticity is the emission of a single

wavelength. Coherence is the term for light waves traveling in phase. Energy is the fundamental unit of

work. Power is the rate of energy delivery measured in watts.


The role of imiquimod in the treatment of superficial basal cell carcinoma is based on the induction of

which cytokine?

1 Interleukin-2

2 Tumor growth factor-alpha

3 Interleukin-4

4 Interferon-gamma

5 Tumor necrosis factor-beta


The role of imiquimod in the treatment of superficial basal cell carcinoma is based on the induction of

which cytokine?

4 Interferon-gammaImiquimod is an immunomodulator which induces the production of cytokines that are involved in cell-

mediated immunity. These cytokines include interferon-alpha, interferon-gamma, interleukin-1,

interleukin-10 and tumor necrosis factor-alpha. Induction of these cytokines results in antiviral and


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antitumor activity in vivo.


Which of the following cosmetic injectables can be seen on routine dental x-rays?

1 Botox

2 Zyplast

3 Radiesse

4 Cosmoderm

5 Restylane


Which of the following cosmetic injectables can be seen on routine dental x-rays?

3 Radiesse

Radiesse is an injectable, biodegradable filler which is composed of calcium hydroxylapatite

microspheres. Calcium hydroxylapatite is a normal constituent of bone and thus can be seen on

radiographic imaging. Botox is botulinum toxin; Zyplast is bovine collagen; Cosmoderm is a non-animal

form of collagen; and Restylane is a non-animal form of hyaluronic acid.


Which of the following suture materials is most likely to cause infection?

1 Silk

2 Vicryl (polyglactin)

3 Prolene (polypropylene)

4 Nylon

5 PDS (polydioxanone)


Which of the following suture materials is most likely to cause infection?

1 Silk

Silk is a nonabsorbable braided suture which has been shown to aid in the production of infection. It is

believed that the interstices of braided or twisted suture materials enhance the potential for developing

infection by providing privileged sites which harbor bacteria.


The most important function of a postsurgical wound dressing is to

1 Immobilize the wound

2 Prevent wound infection

3 Prevent scar formation


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4 Reduce pain

5 Evert wound edges


The most important function of a postsurgical wound dressing is to

1 Immobilize the wound

Postsurgical wound dressings are intended to aid in hemostasis, prevent infection and provide a semi-

occlusive environment. The most important postoperative function is to immobilize the wound and

surrounding tissue to allow the newly formed platelet plugs to remain intact. Winton GB, Salasche SJ.

Wound dressings for dermatologic surgery. J Am Acad Dermatol 1985; 13: 1026-44


Which laser would not be a good choice for the treatment of a red cosmetic tattoo around the lips?

1 Carbon dioxide

2 Pulsed dye

3 Q-switched ruby

4 Alexandrite

5 Nd:YAG


Which laser would not be a good choice for the treatment of a red cosmetic tattoo around the lips?

3 Q-switched ruby

Q-switched lasers can be effectively used to remove tattoos. However, immediate darkening of white,

flesh colored, and pink/red tattoos has been reported after treatment with Q-switched lasers. Both ferric

oxide and titanium dioxide (found in tattoo pigments) may be both be reduced after heating by the laser

and produce dramatic darkening.


Botulinum toxin type A cleaves which protein in the presynaptic neuron?

1 Acetylcholine

2 Snap-25

3 Serotonin

4 Synaptobrevin (VAMP)

5 Syntaxin


Botulinum toxin type A cleaves which protein in the presynaptic neuron?

2 Snap-25

Botulinum toxin type A is FDA approved for the treatment of glabellar wrinkles. Botulinum toxins act


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by a three step process of binding, internalization by receptor medicated endocytosis and enzymatic

activation. It has specific light chain intracellular binding sites and different sites of action on different

SNARE (synaptosomal associated protein receptor [SNAP]) proteins. The SNARE proteins are

intimately involved in releasing acetylcholine at presynaptic terminals. Botulinum toxin A cleaves

SNAP-25 whereas B cleaves synaptobrevin.


Which of the following cosmetic injectables binds water to create volume, has a low allergic reaction

profile, and lasts 6 to 12 months?

1 Botulinum toxin

2 Calcium hydroxylapatite

3 Human-derived collagen

4 Hyaluronic acid

5 Silicone


Which of the following cosmetic injectables binds water to create volume, has a low allergic reaction

profile, and lasts 6 to 12 months?

4 Hyaluronic acid

Hyaluronic acid is a natural component of human connective tissue. As a cosmetic filler, hyaluronic acid

is an attractive alternative to currently available filler substances: its ability to bind water creates volume

and plumps the skin; its duration of action of approximately 6-12 months is appreciably longer than

conventional collagen; and since hyaluronic acid is chemically identical across all species,

hypersensitivity reactions are rare.Q/Q(M)-474743 Report a Problem

Which of the following complications has been reported with infraorbital injections of Botox?

1 Nystagmus

2 Blindness

3 Festooning

4 Astigmatism

5 Photophobia


Which of the following complications has been reported with infraorbital injections of Botox?

3 Festooning

Festooning of the lower eyelid is a recently reported complication of infraorbital Botox injections. The

affected patient had a prior lower lid blepharoplasty which likely weakened the orbicularis oculi muscle.

The author postulates that festooning resulted from further muscle weakness due to Botox treatment.



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A 78 year old man with an infiltrative basal cell carcinoma of the left nasal ala. what is the best

treatment option?

1 MOHS surgery

2 5-fluorouracil cream

3 Electrodessication and curettage

4 Standard excision

5 Imiquimod


A 78 year old man with an infiltrative basal cell carcinoma of the left nasal ala. what is the best

treatment option?

1 MOHS surgery

Based on the histopathologic classification and location, this infiltrative basal cell carcinoma (BCC) is

best treated with MOHS surgery to preserve normal tissue and structure. 5-fluorouracil cream is used totreat superficial BCC, squamous cell carcinoma in situ (SCCIS), and actinic keratoses.

Electrodessication and curettage is used to treat SCCIS and superficial BCC. Standard excision would

be possible if preservation of normal tissue and structure were not as crucial as in this area, the nasal ala.

Imiquimod is used to treat actinic keratoses and superficial basal cell carcinoma.


Which is an advantage of a split-thickness skin graft over a full-thickness skin graft?

1 Better color match

2 Better texture match

3 Less contraction

4 Decreased infection risk

5 Improved survival


Which is an advantage of a split-thickness skin graft over a full-thickness skin graft?

5 Improved survival

The major advantage of a split-thickness skin graft over a full-thickness graft is the increasedsurvivability. Full-thickness skin grafts have better color and texture match and less contraction. There is

no significant difference in infection risk.


The nasolabial two stage flap uses depends on which artery for flap survival:

1 Supratrochlear artery

2 Superior labial artery

3 Angular artery

4 Lateral Nasal artery


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5 Inferior labial artery


The nasolabial two stage flap uses depends on which artery for flap survival:

3 Angular artery

Angular artery provides blood supply for the nasolabial transposition flap.


Which of the following demonstrates the highest risk of metastasis?

1 SCC on the ear

2 SCC within a scar

3 SCC on the lip

4 SCC on the scalp

5 SCC on the nose


Which of the following demonstrates the highest risk of metastasis?

2 SCC within a scar

Location of tumor is an important risk factor for metastasis of squamous cell carcinoma. Compared with

a 10% likelihood of metastasis for tumors located on the ear or the lip, an SCC developing in the scar,

however, has been estimated to metastasize at a rate as high as 30-40%. .Q/Q(M)-474722 Report a Problem

How long after cutaneous infiltration of lidocaine with epinephrine is maximal vasoconstriction

achieved?

1 1 minute

2 7 minutes

3 15 minutes

4 30 minutes

5 1 hour


How long after cutaneous infiltration of lidocaine with epinephrine is maximal vasoconstriction

achieved?

3 15 minutes

The use of epinephrine with local anesthesia has two main advantages. Firstly, the epinephrine is avasoconstrictor and assists in controlling bleeding during surgery. Secondly, and also a direct result of

its vasoconstrictive effects, epinephrine helps prolong the duration of the anesthetic agent 100% to

200% by delaying its absorption from the surgical site. Although the anesthetic properties of lidocaine


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take effect within the first few minutes of infiltration, the vasoconstrictive effects of epinephrine require

approximately 15 minutes to fully develop.


Which of the following determines the wavelength of a laser?

1 Fluence

2 Q switch

3 Medium

4 Spot size

5 Pulse duration


Which of the following determines the wavelength of a laser?

3 MediumThe wavelength of a laser is determined by the medium.


The type of repair depicted in the photograph is a:

1 Rhombic flap

2 Nasolabial flap

3 Rotation flap

4 Full-thickness skin graft

5 Island pedicle flap


The type of repair depicted in the photograph is a:


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1 Rhombic flap

The rhombic flap is a type of transposition flap. The classic rhombic flap is designed with two 60 degree

angles and two 120 degree angles. The point of maximum tension is at the closure of the donor site.


All of the following are branches of the internal carotid artery except:

1 Ophthalmic artery

2 Angular artery

3 Supraorbital artery

4 Dorsal nasal artery

5 Supratrochlear artery


All of the following are branches of the internal carotid artery except:

2 Angular artery

Branches of the internal carotid artery include the ophthalmic artery, supraorbital artery, dorsal nasal

artery, supratrochlear artery, palpebral artery, and lacrimal artery. Branches of the external carotid artery

include the superficial temporal artery, facial artery (inferior labial, superior labial, angular branches),

maxillary artery, posterior auricular, and occipital artery. The external and internal carotid arteries

anastamose in the periorbital region.


Which ocular structure is at most risk of injury from an erbium: YAG laser?

1 Lens

2 Retina

3 Cornea

4 Vitreous humor

5 Iris


Which ocular structure is at most risk of injury from an erbium: YAG laser?

3 Cornea

Injury from lasers may occur via direct or indirect ocular exposure. Damage is generally wavelength

specific. Laser that target hemoglobin or pigment may cause damage to the retinal pigment or

vasculature while lasers that target water as a chromophore (carbon dioxide and erbium) can damage the

cornea.Q/Q(M)-477205 Report a Problem


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Which nerve provides the sensory innervation to the tragus?

1 Auricular branch of vagus

2 Facial

3 Glossopharyngeal

4 Auriculotemporal

5 Greater auricular


Which nerve provides the sensory innervation to the tragus?

4 Auriculotemporal

The auriculotemporal nerve which is a branch of the mandibular branch of the trigeminal nerve

innervates the tragus. The sensory innervation to the auricle is provided by the greater auricular nerve,

and to a lesser extent the lesser occipital nerve. The external auditory canal, concha, and posauricularsulcus supplied variably by 3 nerves - the auricular branch of the vagus (CNX), the facial nerve (CN7),

and the glossopharyngeal (CNIX).


A 60-year-old man receives cephalexin prophylaxis 60 minutes prior to his Mohs surgery for a BCC on

the nose. Which condition of his most likely necessitated prophylaxis?

1 History of CABG

2 Secundum atrial septal defect

3 Mitral valve prolapse with regurgitation

4 History of rheumatic fever without valve dysfunction

5 Pacemaker


A 60-year-old man receives cephalexin prophylaxis 60 minutes prior to his Mohs surgery for a BCC on

the nose. Which condition of his most likely necessitated prophylaxis?3 Mitral valve prolapse with regurgitation

Prior to Mohs patients who are at high risk should receive prophylaxis int he form of cephalexin (or

clindamycin or azithromycin if penicillin-allergic) 30-60 minutes prior to the procedures for non-oral

skin. High risk patients include those with prosthetic valves, a history of bacterial endocarditis, mitral

valve prolapse with regurgitation, mitral valve prolapse without regurgitation in MEN > 45 years, any

valve dysfuntion, cardiac malformation, hypertrophic cardiomyoopathy, CNS shunts, and more. Some

low-risk examples (no prophylaxis) include s/p CABG, pacemaker, murmur, or mitral valve prolapse

without regurgitation.


What part of the eye may be damaged by exposure to irradiation from the carbon dioxide laser?

1 Retina


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2 Lens

3 Sclera

4 Cornea

5 Iris


What part of the eye may be damaged by exposure to irradiation from the carbon dioxide laser?

4 Cornea

The carbon dioxide laser operates at a wavelength of 10,600 nm and targets water as a chromophore.

Because of the high water content of the cornea, it may be damaged by exposure to irradiation from the

carbon dioxide laser. Exposure to the erbium may cause corneal damage as well.


Cosmetic units are defined by each of the following anatomic boundaries except:

1 Nasal tip

2 Glabellar region

3 Nasofacial sulcus

4 Philtral ridge

5 Nasolabial folds


Cosmetic units are defined by each of the following anatomic boundaries except:

1 Nasal tip

The term cosmetic unit is used to define regions of the face by specific characteristics such as color,

texture, presence of hair, and prominence of sebaceous glands. In dermatologic surgery, it is preferable

to conceal incisions within the boundary lines of cosmetic units. In addition, moving skin from one

cosmetic unit to another should be avoided when possible to minimize the appearance of apposed skin of

dissimilar quality.


Which topical antiseptic works via denaturation of proteins?

1 Alcohols

2 Chlorhexidine

3 Iodine

4 Hexachlorophene

5 Triclosan



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Which topical antiseptic works via denaturation of proteins?

1 Alcohols

Alcohols exert their antimicrobials effect via denaturation of proteins ie DNA, RNA, lipids, etc.

Chlorhexidine, hexachlorophene, and triclosan disrupt the microbial cell membrane. Iodine and

iodophores work via oxidation/substitution for elemental form of iodine, thereby precipitating proteins.


The photograph demonstrates which of the following?

1 Split-thickness skin graft

2 Mohs layer


4 Dog ear

5 Composite graft


The photograph demonstrates which of the following?


A full-thickness skin graft (FTSG) is composed of the entire epidermis and dermis. Subcutaneous tissue

must be removed since the fat may compromise the viability of the graft.


When can a patient who undergoes follicular-unit hair transplantation expect hair growth of the grafted

follicles to begin?

1 7 to 10 days

2 1 month

3 2 to 3 months

4 6 months

5 9 months



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When can a patient who undergoes follicular-unit hair transplantation expect hair growth of the grafted

follicles to begin?

3 2 to 3 months

The use of follicular-unit grafts, which contain one to four hair follicles, represents the advancement inboth surgical technique and aesthetic outcome in the field of hair transplantation. The grafted hair

follicles typically begin to grow within 8 to 10 weeks of implantation and are expected to survive for the

individuals lifetime.


Which of the following is a complication of Thermage treatment?

1 Keloid formation

2 Lipoatrophy

3 Granuloma formation

4 Hyperpigmentation

5 Herpes simplex infection


Which of the following is a complication of Thermage treatment?

2 Lipoatrophy

Thermage (ThermaCool) is a nonablative radiofrequency-based system which uses volumetric heating to

induce tightening of the skin and dermal remodeling. Lipoatrophy is a late-occurring potential

complication of this technology.


Which of the following local anesthetic agents should not be used in children?

1 Bupivicaine

2 Etidocaine

3 Mepivicaine

4 Prilocaine

5 Benzocaine


Which of the following local anesthetic agents should not be used in children?

4 Prilocaine

Prilocaine should bot be used in children given the risk of methemoglobinemia.Methemoglobulinemia in

children can occur from exposure to oxidizing substances such as aniline dyes, prilocaine or pyrimidine.


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In methemoglobinemia, the iron in hemoglobin is oxidized from the ferrous state (Fe 2+) to ferric

(Fe3+) resulting in the inability to transport oxygen and carbon dioxide. Clinically, this condition results

in cyanosis.


Which of the following cosmetic injectables has the longest duration of action?

1 Botox


3 Restylane (hyaluronic acid)

4 Cosmoderm (collagen)

5 Myobloc


Which of the following cosmetic injectables has the longest duration of action?


Sculptra (called New-Fill outside of the US) is a biodegradable filler composed of poly-L-lactic acid, the

same material used in absorbable sutures. Preliminary studies have demonstrated longevity of the fillerat two years post-treatment. Valantin MA et al. Polylactic acid implants (New-Fill) to correct facial

lipoatrophy in HIV-infected patients: results of the open-label study VEGA. AIDS. 2003;17:2471-2477.


A Z- plasty is performed to:

1 Reorient a scar

2 Shorten the length of an excision

3 Close a wound on a convex surface

4 Obtain wound eversion

5 Make use of skin from an area of laxity


A Z- plasty is performed to:

1 Reorient a scar

A Z-plasty is a type of transposition flap that may be used to reorient a scar, especially when the scarcrosses skin tension lines. It is also used to change the scar length or vector and ease scar contractures.


Paradoxical darkening has been associated with Q-switched ruby, Q-switched alexandrite, Q-switched

Nd:Yag treatment of which tattoo color?

1 Green


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2 Red

3 Yellow

4 Black

5 Blue


Paradoxical darkening has been associated with Q-switched ruby, Q-switched alexandrite, Q-switched

Nd:Yag treatment of which tattoo color?

2 Red

Paradoxic darkening of flesh-tone, red, and white tattoo inks with QSRL, Q-switched Nd:YAG, and Q-

switched alexandrite lasers has been reported. The tattoo pigments most associated with this

phenomenon are iron oxide and titanium dioxide. Ferric sulfide is converted to ferrous sulfate by the

laser.


A patient who had liposuction 5 weeks ago presents with multiple firm nodules at the cannula insertion

sites. You suspect the diagnosis is:

1 Foreign body granuloma

2 Herpes simplex infection

3 Organized hematoma

4 Mycobacterial infection5 Cold panniculitis


A patient who had liposuction 5 weeks ago presents with multiple firm nodules at the cannula insertion

sites. You suspect the diagnosis is:

4 Mycobacterial infection

Atypical mycobacterial infections are occurring with increasing frequency after cosmetic surgery

procedures. These infections typically occur 4-14 weeks after a procedure as a late-occurringcomplication. Firm nodules at the treatment site or dehiscence of a previously healed wound may be

presenting signs of atypical mycobacterial infection.


Which of the following lasers uses a solid as its medium?

1 Argon laser

2 pulded dye laser

3 Alexandrite

4 Krypton


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5 carbon dioxide


Which of the following lasers uses a solid as its medium?

3 Alexandrite

Solid media lasers include alexandrite, KTP, ruby, Nd Yag, diode. Liquid media is found in the pulsed

dye laser. Gas media is used in argon, carbon dioxide, krypton, and cooper vapor laser.


Which post-operative complication is shown in the photograph?

1 Trap door deformity

2 Hypertrophic scar

3 Ectropion

4 Temporal nerve paralysis

5 Eclabium


Which post-operative complication is shown in the photograph?

3 Ectropion

Ectropion occurs when the eyelid margin turns outward away from the eye. In lower eyelid

reconstruction, tension should be oriented parallel to the lower eyelid to prevent the development of

ectropion.Q/Q(M)-474978 Report a Problem

Which of the following chemical peels does not need to be neutralized?

1 Salicylic acid

2 TCA 40%

3 Glycolic acid

4 Lactic acid

5 Phenol



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Which of the following chemical peels does not need to be neutralized?

1 Salicylic acid

Salicylic acid is a very superficial chemical peel that is used for acne, milia, keratolysis. This peel

localizes to the pores given its lipophilic nature. It is a self-neutralizing peel.


The cutaneous lip and chin are divided into cosmetic units by which anatomic boundary?

1 Vermillion border

2 Nasolabial fold

3 Marionette lines

4 Mental crease

5 Philtral ridgeQ/Q(M)-475488 Report a Problem

The cutaneous lip and chin are divided into cosmetic units by which anatomic boundary?

4 Mental crease

The term cosmetic unit is used to define regions of the face by specific characteristics such as color,

texture, presence of hair, and prominence of sebaceous glands. In dermatologic surgery, it is preferable

to conceal incisions within the boundary lines of cosmetic units. The mental crease, as demonstrated in

the photograph, divides the cutaneous lip and chin.


Damage to the zygomatic branch of the facial nerve leads to which of the following:

1 Facial asymmetry

2 Inability to pucker lips

3 Eyelid ectropion and inability to close eyelid

4 Unilateral eyelid ptosis

5 Winged scapula


Damage to the zygomatic branch of the facial nerve leads to which of the following:


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3 Eyelid ectropion and inability to close eyelid

Damage to the zygomatic nerve causes eyelid ectropion and inability to close eyelid.


The most appropriate suture for closing a wound on the buccal mucosa is:

1 Prolene

2 Silk

3 Monocryl

4 Braided nylon

5 PDS


The most appropriate suture for closing a wound on the buccal mucosa is:

2 Silk

The most appropriate suture for closing a wound on the buccal mucosa is silk. Other sutures may be

used as well, but classically, silk is used because of its soft nature.


Which of the following lasers has the greatest depth of penetration in the skin?

1 Pulsed dye laser (585 nm)

2 Diode (800 nm)

3 Nd: YAG (1064 nm)

4 Erbium: YAG (2940 nm)

5 CO2 (10,600 nm)


Which of the following lasers has the greatest depth of penetration in the skin?3 Nd: YAG (1064 nm)

The Nd: YAG laser emits energy at 1064nm near the infrared range and penetrates the skin to the level

of the deep dermal blood vessels. The target chromophore for this laser is melanin, thus its primary use

is in treating lesions such as nevus of Ota and removing black tattoo pigment. Although both the

erbium:YAG and CO2 lasers have longer wavelengths than the Nd: YAG, they are ablative lasers which

only penetrate to the level of the stratum corneum and superficial epidermis, respectively.


The most common adverse reaction seen with betadine is:

1 Ototoxity

2 Teratogenicity


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3 Allergic contact dermatitis

4 Seizures

5 Corneal damage


The most common adverse reaction seen with betadine is:

3 Allergic contact dermatitis

Most common side effect seen with betadine is allergic contact dermatitis, secondary to the iodine

component.


Which needle shape is most commonly used in cutaneous surgery?

1 1/4 circle

2 3/8 circle

3 1/2 circle

4 5/8 circle

5 compound curve


Which needle shape is most commonly used in cutaneous surgery?

2 3/8 circle

Needles are either straight or curved. Curved needles have their curvature described either as a fraction

of a circle or a compound curve. The greater the fraction of a circle, the more pronation and supination

of the wrist required by the surgeon to place the needle. The 3/8 circle needle is easy to use in large,

superficial areas and is the most commonly used needle for cutaneous surgery.


All of the following statements are true regarding imiquimod (Aldara) except:

1 It is FDA-approved for the treatment of actinic keratoses

2 It is FDA-approved for the treatment of a 1.2 cm superficial basal cell on the scalp

3 It is FDA-approved for the treatment of a 1.9 cm superficial basal cell on the chest

4 It is FDA-approved for the treatment of a 1.5 cm superficial basal cell on the leg

5 It is FDA-approved for the treatment of a 2.0 cm superficial basal cell on the back


All of the following statements are true regarding imiquimod (Aldara) except:

2 It is FDA-approved for the treatment of a 1.2 cm superficial basal cell on the scalp

Imiquimod (Aldara) is FDA-approved for the treatment of actinic keratoses and the treatment of

superficial basal carcinoma. With respect to basal cell carcinoma, treatment is indicated for primary


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tumors that are 2.0 cm or less, and that are located on areas of the body excluding the face, scalp and

anogenital region.


Which anatomic structure is likely to be severed during this repair?

1 Mental nerve

2 Angular artery

3 Buccal nerve

4 Labial artery

5 Marginal mandibular nerve


Which anatomic structure is likely to be severed during this repair?

4 Labial artery

The photograph demonstrates a wedge resection which is used to repair defects of the lower lip. Duringthis repair, the labial artery will be severed since it courses superficially between the mucosa and the

underlying muscle.


Treatment of acne scarring would be most effective with which modality?

1 Pulsed dye laser

2 Intense pulsed light

3 Photodynamic therapy

4 Radiofrequency

5 Nd:YAG laser


Treatment of acne scarring would be most effective with which modality?

5 Nd:YAG laser

Treatment with the nonablative 1064-nm Q-switched Nd:YAG provides significant improvement in skin

topography in patients with atrophic acne scars. The further improvements that are seen at 6-month

follow-up suggest that dermal remodeling is a process that continues long after treatment.



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The tensile strength of a wound 6 months after surgery compared to intact skin is:

1 15%

2 30%

3 50%

4 70%

5 100%


The tensile strength of a wound 6 months after surgery compared to intact skin is:

4 70%

The tensile strength of a wound approaches 70% of normal skin strength at 8 weeks postoperatively.

Wound healing is a process which takes many months, yet the tensile strength of a wound never exceeds80% of the tensile strength of intact skin. It is therefore critical to use long-lasting subcuticular sutures to

minimize the tension on a healing wound and prevent scar widening.


Healing by secondary intention will offer the most favorable cosmetic result at which location?

1 Nasal tip

2 Malar cheek

3 Chin

4 Forehead

5 Medial canthus


Healing by secondary intention will offer the most favorable cosmetic result at which location?

5 Medial canthus

Indications for healing of full-thickness skin wounds by secondary intention include infected wounds,

patients who refuse reconstructive surgery or who are poor surgical risks for reconstructive surgery, and

resection of tumors with high rates of recurrence. In addition, secondary intention, or granulation, can be

utilized when the cosmetic result is anticipated to be superior or equal to reconstruction. Disadvantages

of healing by granulation include prolonged wound healing time and somewhat unpredictable cosmetic

results. Anatomic sites lending themselves best to second intention healing, with excellent results, are

the concave areas on the face. These include the medial canthus, the nose-cheek junction, the auricular

concha, the preauricular cheek, and the retroauricular scalp. The nasal tip, malar cheek, chin and

forehead are all convex surfaces on the face.


A 40 year-old woman from Southern California has wrinkles at rest on her forehead, scattered

telangiectasia on her nose and a few seborrheic keratoses on her chest. What category in Glogau's

photoaging classification scale does this patient represent?


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1 Type 1

2 Type 2

3 Type 3

4 Type 4

5 Type 5


A 40 year-old woman from Southern California has wrinkles at rest on her forehead, scattered

telangiectasia on her nose and a few seborrheic keratoses on her chest. What category in Glogau's

photoaging classification scale does this patient represent?

3 Type 3

Glogaus photoaging scale is a classification system that employs clinical markers of photodamage todetermine an individuals level of photoaging. The scale ranges from Type 1 through Type 4, with

Type 4 demonstrating the most extensive photodamage. Type 3 on the Glogau scale is classified asadvanced photoaging and describes a patient who is typically 50 years of age or older, has wrinkles at

rest, telangiectasias, obvious dyschromias and visible keratoses.


Which one of the following best estimates the percent strength of a wound one month after surgery with

a primary closure?

1 30%

2 50%

3 70%

4 80%

5 90%


Which one of the following best estimates the percent strength of a wound one month after surgery with

a primary closure?

2 50%

One month after surgery with a primary closure a wound is approximately at 50% strength. Two weeks

after surgery it is at 5% strength. Three weeks after surgery it is at 20%. It never reaches 100% of its

original strength, its maximum strength is 90%.


Jessners solution contains all of the following except:

1 Salicylic acid

2 Resorcinol

3 Glycolic acid

4 Ethanol


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5 Lactic acid


Jessners solution contains all of the following except:

3 Glycolic acid

Jessners solution is a combination of resorcinol, salicylic acid, and lactic acid in ethanol that is used asa superficial peeling agent. The advantage of Jessners solution is that timing is unnecessary andneutralization is not performed. The lactic acid is an alpha hydroxy acid.


Which of the forms of electrosurgery can work in a wet field?

1 Electrocautery

2 Electrodessication

3 Electrofulguration

4 Electrosection

5 Electrocoagulation


Which of the forms of electrosurgery can work in a wet field?

1 Electrocautery

Electrocautery is the only one to work in a wet field as it has no current and works via heat.


An M-plasty is performed to:

1 Decrease tension on a wound

2 Obtain wound eversion


4 Reorient a scar5 Make use of excess tissue


An M-plasty is performed to:


An M-plasty is a variation of the fusiform excision where either one or both ends of the ellipse are

modified. The main advantages to performing an M-plasty are to shorten the length of an excision and to

correct dog-ears.Q/Q(M)-474723 Report a Problem


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All of the following thrombotic complications have been reported after discontinuing aspirin therapy

prior to surgery except:

1 Stroke

2 Myocardial infarction

3 Pulmonary embolism

4 Transient ischemic attack

5 Cerebral embolism


All of the following thrombotic complications have been reported after discontinuing aspirin therapy

prior to surgery except:

3 Pulmonary embolismKovich et al. reported thrombotic complications in patients who had stopped either coumadin or aspirin

peri-operatively. Thrombotic complications in patients who stopped warfarin included stroke, TIA,

myocardial infarction, cerebral embolism, death, DVT, pulmonary embolus, and blindness. Thrombotic

complications in patients who stopped aspirin included stroke, TIA, myocardial infarction, cerebral

embolism and death. No DVT or pulmonary embolus was reported.


Blue nodules in the skin are a potential complication of which cosmetic injectable?

1 Radiance (hydroxyapatite)

2 Silicone


4 Cosmoderm (collagen)



Blue nodules in the skin are a potential complication of which cosmetic injectable?


Although hyaluronic acid is believed to be inert in humans, rare reports exist of granulomatous foreign

body reactions to this material. Skin biopsy of a Restylane nodule demonstrates multinucleated giant

cells surrounding a blue amorphous material.


The use of topical vitamin K has been shown to:

1 Decrease the appearance of infraorbital pigmentation

2 Minimize the appearance of telangiectasia

3 Reduce the severity of laser-induced purpura

4 Increase collagen production


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5 Induce keratinocyte differentiation


The use of topical vitamin K has been shown to:

3 Reduce the severity of laser-induced purpura

Treatment of benign vascular lesions with the pulsed dye laser often produces significant postoperative

purpura. Topical vitamin K has been shown to decrease the severity of laser-induced purpura although

its mechanism of action has yet to be determined. No other cosmetic effects of topical vitamin K have

been proven to be statistically significant.


Which of the following injectable local anesthetics is the longest lasting?

1 Lidocaine

2 Bupivacaine

3 Meppivacaine

4 Procaine

5 Diphenhydramine


Which of the following injectable local anesthetics is the longest lasting?

2 BupivacaineBupivacaine is the longest lasting injectable local anesthetic-120-240 minutes without epinephrine, 180-

420 minutes with epinephrine. Lidocaine lasts 30-60 minutes without epinephrine, 120-360 with

epinephrine. Mepivacaine last 45-90 minutes without epinephrine, 120-360 with epinephrine. Procaine

lasts 15-60 minutes. Diphenhydramine lasts 30 minutes.


Which of the following parameters determines the wavelength of a laser?

1 Medium

2 Fluence

3 Spot size

4 Pulse duration

5 Lens length


Which of the following parameters determines the wavelength of a laser?

1 Medium

Laser light is monochromatic light that is emitted at a single wavelength. The wavelength of the laser is

determined by the medium in the optical cavity of the laser through which the light passes. The medium

may be solid, liquid or gas.


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The use of dermabrasion to improve the cosmesis of a scar is best performed how long after the initial

surgery?

1 1 week

2 3 weeks

3 6 weeks

4 6 months

5 1 year


The use of dermabrasion to improve the cosmesis of a scar is best performed how long after the initial

surgery?

3 6 weeksDermabrasion is the process of surgically planing or abrading the epidermis and dermis and is usually

carried out with a rapidly rotating wire brush or diamond fraise. Following dermabrasion,

reepithelialization from adnexal structures occurs with remodeling and replacement of collagen bundles

in the papillary and reticular dermis. This can result in improvement of surgical or acne scars. When

used in the post-operative period for surgical scars, dermabrasion is usually carried out 6 to 8 weeks

following the procedure. Regional dermabrasions are routinely carried out under local anesthesia. Post-

procedure complications include scarring, pigmentary alterations, persistent erythema, and infection.

Contraindications for dermabrasion include recent use of isotretinoin and recent facelift, browlift or

other procedure involving extensive undermining. Reactivation of herpes labialis can be prevented in the

lip area by administering antiviral prophylaxis.


Which of the following topical antibacterial agents demonstrates activity against Pseudomonas species?

1 Mupirocin

2 Erythromycin

3 Polymyxin

4 Bacitracin

5 Clindamycin


Which of the following topical antibacterial agents demonstrates activity against Pseudomonas species?

3 Polymyxin

Polymyxins are peptides produced by the organism Bacillus polymyxa. They are bactericidal against

Pseudomonas aeruginosa, Proteus mirabilis, Enterobacter, Klebsiella and Escherichia coli. Since they

provide little coverage against gram-positive organisms, polymyxins are often combined with other

antibacterial agents to increase their spectrum of activity.Q/Q(M)-474749 Report a Problem


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Treatment with which of the following lasers has been effective in psoriasis?

1 Carbon dioxide laser

2 Excimer laser

3 Ruby Laser

4 Pulsed dye laser

5 Alexandrite laser


Treatment with which of the following lasers has been effective in psoriasis?

2 Excimer laser

The excimer laser is a 308 nm wavelength laser that has been used to treat psoriasis. The excimer laser

has some advantages over ultraviolet therapy. By treating only involved skin, higher doses can be used

and clearance may occur with fewer treatments.


The repair demonstrated in the photograph is a:

1 Split-thickness skin graft

2 Interpolation flap


4 Rotation flap

5 Transposition flap



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The repair demonstrated in the photograph is a:

2 Interpolation flap

The postauricular flap is useful for repairing extensive defects of the helical rim, particularly when

cartilage is involved. It is an example of an interpolation flap.


Which of the following criteria carries the worst prognosis for a patient with a squamous cell

carcinoma?

1 Size of tumor > 1 cm

2 Depth of invasion > 4 mm

3 Perineural invasion

4 Anatomic location

5 Immunosuppression


Which of the following criteria carries the worst prognosis for a patient with a squamous cell

carcinoma?

2 Depth of invasion > 4 mm

Many factors contribute to the aggressive behavior of cutaneous squamous cell carcinoma. For example,

tumors in immunosuppressed patients and tumors with the histologic subtypes desmoplastic and

acantholytic are often biologically aggressive squamous cell carcinomas. Compared with other risk

factors, depth of invasion >4 mm and size > 2cm demonstrate the greatest risk for metastasis.


A surgeon plans to repair a defect on the lower lip with a wedge resection. All of the following

statements are true regarding wedge resection of the lower lip except?

1 a V-shaped excision is often used

2 the vermillion border is marked prior to excision

3 the repair involves a two layered closure of skin and mucosa

4 up to 1/3 of the lip can be excised and closed primarily

5 the mental crease should not be crossed


A surgeon plans to repair a defect on the lower lip with a wedge resection. All of the following

statements are true regarding wedge resection of the lower lip except?

3 the repair involves a two layered closure of skin and mucosa

The lower lip has such great elasticity that full-thickness lesions that involve up to 1/3 of the lip can be

excised and repaired primarily with excellent cosmetic and functional results. This type of repairrequires a three layered closure of mucosa, skin and muscle. Larrabee W. In: Principles of Facial

Reconstruction. Lippincott-Raven: Philadelphia, 1995; 182-183.


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Sensory innervation of the glabella and mid-forehead is provided by which nerve?

1 infratrochlear nerve

2 supraorbital nerve

3 supratrochlear nerve

4 temporal branch of the facial nerve

5 zygomatic branch of the facial nerve


Sensory innervation of the glabella and mid-forehead is provided by which nerve?

3 supratrochlear nerve

The supratrochlear, supraorbital and infratrochlear nerves are branches of the ophthalmic division of thetrigeminal nerve, supplying sensory innervation to the face. The supratrochlear nerve exits the orbit

approximately one centimete lateral to the midline and traverses upward along the medial supraorbital

rim along the supratrochlear notch. It provides sensory innervation to the medial upper eyelid and

glabella, the medial anterior forehead, and the scalp. The supraorbital nerve supplies the lateral forehead

and scalp as well as the upper eyelid. The infratrochlear nerve provides sensory innervation to the root

of the nose and to portions of the medial canthus. The facial nerve provides motor innervation to

muscles of the face. The temporal branch of the facial nerve supplies motor innervation to the upper

orbicularis oculi and the frontalis muscle, as well as the anterior and superior auricular muscles. The

zygomatic branch of the facial nerve provides innervation to the inferior portion of the orbicularis oculi,

zygomaticus minor and zygomaticus major muscles, as well as levator labii superioris. (Leffell's Manual

of Skin Surgery. 1997 p44.) (Surgical Anatomy of the Skin, Salasche et al, p 113-115.)


Which of the following has been implicated in the promotion of skin aging?

1 alpha-tocopherol

2 Homocysteine

3 Proanthocyanidin

4 beta carotene

5 alpha-lipoic acid


Which of the following has been implicated in the promotion of skin aging?

2 Homocysteine

Homocysteine is a sulfhydryl-containing amino acid produced during the conversion of methionine to

cysteine. Homocysteine can promote defects in fibrillin-1 and stimulate matrix metalloproteinase

production, leading to collagen and elastic fiber degradation. Homocystinuria, caused by a deficiency incystathionine beta-synthase, presents with osteoporosis, thin skin, and striae.



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All of the following are true statements regarding the immunohistochemical stain Melan-A except:

1 Antigen present in 80-100% of melanomas

2 Recognized by CD8+ T cells

3 Sensitive marker for melanocytic nevi

4 Effective in frozen and paraffin-embedded tissue

5 Reliably stains desmoplastic melanoma


All of the following are true statements regarding the immunohistochemical stain Melan-A except:

5 Reliably stains desmoplastic melanoma

E Melan-A is a 22-kDa cytoplasmic melanosome-associated glycoprotein also known as MART-1

(melanoma antigen recognized by T cells). It is a sensitive marker for both melanocytic nevi andmelanoma and may be used on frozen tissue sections as well as paraffin-embedded tissue. Although the

antigen is present in > 80% of melanomas, it does not reliably stain desmoplastic or spindle cell

melanomas.


Which one of the following lasers would be effective in the treatment of rhinophyma?

1 Pulsed dye laser

2 Ruby laser

3 Alexandrite laser

4 KTP laser



Which one of the following lasers would be effective in the treatment of rhinophyma?


The carbon dioxide laser is a 10,600 nm laser that can be used to treat rhinophyma. The advantage of the

carbon dioxide laser over steel or dermabrasion is that the laser is relatively bloodless. The erbium YAG

can also be used to treat rhinophyma.


Which statement is true regarding relaxed skin tension lines (RSTLs)?

1 they occur as a result of increased elastic tone

2 they lie parallel to the underlying muscles

3 the long axis of a wound often lies in the direction of the RSTL

4 incisional scars should be placed perpendicular to RSTLs


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5 smiling minimizes the appearance of RSTLs


Which statement is true regarding relaxed skin tension lines (RSTLs)?

3 the long axis of a wound often lies in the direction of the RSTL

Relaxed skin tension lines are creases in the skin that are present at rest and develop as a consequence of

the decreased elasticity that occurs with aging and solar damage. These lines lie perpendicular to the

underlying musculature and can be accentuated by smiling or frowning. An undermined circular wound

will often form an oval shape due to muscular tension, and will have its long axis oriented within these

relaxed tension lines. Knowledge of RSTLs is important in cutaneous surgery because placing incisions

within these lines will ensure the most favorable cosmetic result.


What is the tattoo pigment responsible for most lichenoid reactions?

1 Titanium dioxide

2 Carbon

3 Mercuric sulfide

4 Chromates

5 Iron oxide


What is the tattoo pigment responsible for most lichenoid reactions?

3 Mercuric sulfide

Lichenoid tattoo reactions are not as common as eczematous reactions, both of which are most

commonly caused by mercuric sulfide. Lichenoid reaction are likely to be mediated by delayed

hypersensitivity to a lymphocytic T-cell infiltrate.


Which of the following treatment modalities for basal cell carcinoma has the highest long term cure

rate?

1 MOHS surgery

2 Radiation

3 Cryotherapy

4 Electrodessication and curettage

5 Surgical excision


Which of the following treatment modalities for basal cell carcinoma has the highest long term cure

rate?

1 MOHS surgery


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Five year cure rates of basal cell carcinomas (BCC) treated with MOHS is about 99%. The other options

listed range from 90-92% five year cure rates.


A history of anaphylaxis is a contraindication to treatment with which cosmetic injectable?

1 Sculptra

2 Myobloc

3 Radiance

4 Cosmoderm

5 Restylane


A history of anaphylaxis is a contraindication to treatment with which cosmetic injectable?5 Restylane

Restylane is a hyaluronic acid gel produced by the Streptococcus species of bacteria. The package insert

for Restylane warns that its use is contraindicated in patients withsevere allergies manifested by ahistory of anaphylaxis or the presence of multiple severe allergies.


Compared to intact skin, what is the tensile strength of a wound 6 months after surgery?

1 30%

2 50%

3 70%

4 90%

5 100%


Compared to intact skin, what is the tensile strength of a wound 6 months after surgery?

3 70%

Tissue remodeling allows the host to develop a scar that is approximately 70% of the original strength of

the skin.


What risk does an organ transplant recipient have of developing melanoma?1 Same risk as general population

2 Less risk than general population


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3 3-fold increased risk

4 10- fold increased risk



What risk does an organ transplant recipient have of developing melanoma?


Organ transplant recipients are at risk for developing many cutaneous tumors. The risk of melanoma is

3-fold that of the general population whereas these patients have a 65-fold increased risk of developing

squamous cell carcinoma.


Which of the following lasers may cause milia formation as a post-procedure complication?

1 Excimer

2 KTP

3 Pulsed Dye

4 ND-Yag

5 Erbium


Which of the following lasers may cause milia formation as a post-procedure complication?

5 Erbium

The erbium (2940 nm) and carbon dioxide (10,600 nm) lasers may both cause milia formation after laser

skin resurfacing.


Which of the following topical antibacterial agents may cause neutropenia?

1 Mupirocin

2 Silver sulfadiazine

3 Polymyxin

4 Bacitracin

5 Povodine-iodine


Which of the following topical antibacterial agents may cause neutropenia?

2 Silver sulfadiazine

Silver sulfadiazine is most commonly used to prevent infection in second and third-degree burn patients.

Rare cases of leukopenia, neutropenia and kernicterus have been reported in patients using this topical

antibacterial agent. Consequently, silver sulfadiazine should be used cautiously and avoided in infants,


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nursing mothers and pregnant women. Silver sulfadiazine also has the potential to cause a

hypersensitivity reaction in patients with sulfa allergy.


The most appropriate laser to treat a port wine stain on an infants cheek would have which of the

following wavelengths?1 488 nm

2 532 nm

3 585 nm

4 694 nm

5 810 nm


The most appropriate laser to treat a port wine stain on an infants cheek would have which of thefollowing wavelengths?

3 585 nm

The 585nm pulsed dye laser (PDL) targets intravascular oxyhemoglobin and is considered the treatment

of choice for most benign vascular lesions. The original PDL had a wavelength of 577 nm which was

later modified to 585 nm to achieve deeper penetration yet still maintainvascular specificity.


A patient with end stage liver disease comes to your surgical practice. Which of the followinganesthetics should be used with this patient?

1 Benzocaine

2 Etidocaine

3 Lidocaine

4 Mepivicaine

5 Prilocaine


A patient with end stage liver disease comes to your surgical practice. Which of the following

anesthetics should be used with this patient?

1 Benzocaine

Benzocaine, an ester, should be used as it is the only anesthetic mentioned above that is metabolized by

the kidney and not the liver.


A physician using a carbon dioxide laser to treat verruca should be aware that all of the following

complications can occur except:


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1 Ocular damage

2 Transmission of viral disease

3 Purpura

4 Recurrence of lesion

5 Scarring


A physician using a carbon dioxide laser to treat verruca should be aware that all of the following

complications can occur except:

3 Purpura

The carbon dioxide laser uses a 10,600 nm wavelength to target water as a chromophore. Lasers that

target water may damage the cornea. The carbon dioxide laser can be used to destroy epidermal and

dermal lesions such as warts. HPV virus has been recovered in the laser plume after treatment withcarbon dioxide laser. Bovine papilloma virus recovered in the plume was even found to transmit disease

to calf skin. Scarring and recurrence have also been found to be potential complications.


The anatomic structure identified in the photograph is called the:

1 Triangular fossa

2 Concha

3 Antihelix

4 Scaphoid fossa

5 Tragus




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1 Triangular fossa

The triangular fossa of the ear is shown in the photograph. This anatomic structure is bordered by the

crura of the antihelix.


In organ transplant recipients, all of the following factors increase susceptibility to the development ofskin cancer except:

1 Fair skin (Fitzpatrick types I-III)

2 History of chronic sun exposure

3 Duration of immunosuppression

4 History of HPV infection

5 CD8 lymphocytopenia


In organ transplant recipients, all of the following factors increase susceptibility to the development of

skin cancer except:

5 CD8 lymphocytopenia

All organ transplant recipients are at increased risk for the development of cutaneous malignancies.

However, the above-mentioned factors, with the exception of choice E, place these individuals at further

risk. CD4 lymphocytopenia, rather than CD8, is another identified risk factor as is older age, history of

actinic keratoses and history of skin cancer.


A safe dose of lidocaine with epinephrine when used in tumescent anesthesia is:

1 3 mg/kg

2 4.5 mg/kg

3 7 mg/kg

4 20 mg/kg

5 50 mg/kg


A safe dose of lidocaine with epinephrine when used in tumescent anesthesia is:

5 50 mg/kg

The maximum recommended dosage of lidocaine in adults is 4.5 mg/kg without epinephrine, 7.0 mg/kg

with epinephrine, and 55 mg/kg in tumescent anesthesia for liposuction.


Which of the following sterilization methods has the negative side effect of dulling instruments?

1 chemical autoclave


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2 steam autoclave

3 dry heat

4 cold sterilization

5 gas sterilization


Which of the following sterilization methods has the negative side effect of dulling instruments?

2 steam autoclave

Steam autoclave is the most common type of sterilization used in the office setting. It is not to be used

with heat-sensitive plastics. A negative side effect of using steam autoclave is that it can dull sharp

instruments.


Which anesthetic has the shortest duration of action?

1 Mepivacaine

2 Procaine

3 Bupivacaine

4 Tetracaine

5 Prilocaine


Which anesthetic has the shortest duration of action?

2 Procaine

Procaine has the shortest duration of action, only lasting about 30-60 minutes. It is an ester anesthetic

and is commonly used in dentistry.


The relaxed skin tension lines overlying the scapula are:

1 Do not exist over the scapula

2 Oriented vertically

3 Oriented circumferentially

4 Oriented horizontally

5 Parallel to the underlying muscle groups


The relaxed skin tension lines overlying the scapula are:

2 Oriented vertically


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Relaxed skin tension lines (RSTLs) are creases in the skin that are present at rest and develop as a

consequence of the decreased elasticity that occurs with aging and solar damage. These lines lie

perpendicular to the underlying musculature. They tend to run vertically on the upper back whereas on

the central trunk, they are typically circumferential. Knowledge of RSTLs is important in cutaneous

surgery because placing incisions within these lines will ensure the most favorable cosmetic result.


Which of the following is true regarding lidocaine:

1 1% lidocaine is equal to 1g/10ml

2 Duration with no epinephrine is 4-6 hours

3 Maximum dose with no epinephrine is 7mg/kg

4 Beta blockers increase lidocaine levels

5 Allergy most commonly occurs to propylene glycol preservatives


Which of the following is true regarding lidocaine:

4 Beta blockers increase lidocaine levels

Beta blockers increase lidocaine levels. The rest of the answers are false. 1% lidocaine is equal to

1g/100ml or 10mg/ml. Duruation of lidocaine with no epi is 30-60 minutes. Maximum dose of lidocaine

with no epi is 4.5 mg/kg, with epi it is 7 mg/kg. Allergy to lidocaine is most commonly due to paraben

preservatives.


Formation of granulomas is a potential complication of treatment with:

1 Isotretinoin

2 Autologous fat

3 CO2 resurfacing

4 Silicone

5 HydroxychloroquineQ/Q(M)-474751 Report a Problem

Formation of granulomas is a potential complication of treatment with:

4 Silicone

Silicone is a synthetic, viscous compound which is composed of long polymers of dimethylsiloxanes.

Silikon-1000 is one silicone product which is available in the United States and is FDA-approved for the

ophthalmic treatment of complicated retinal detachment. The number 1000 refers to the productsviscosity which is measured in centistokes. As a reference, water has a viscosity of 100 centistokes and

mineral oil has a viscosity of about 350 centistokes. With respect to cosmetic applications, silicone is notFDA-approved for soft tissue augmentation. In addition to the occurrence of hypersensitivity reactions

and product migration, there have been many reports of granuloma formation after silicone injection,

even many years post-treatment.


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Full thickness skin grafts are more likely than split thickness skin grafts to demonstrate:

1 Alopecia

2 Contraction

3 Necrosis

4 Hypohidrosis

5 Hypopigmentation


Full thickness skin grafts are more likely than split thickness skin grafts to demonstrate:

3 Necrosis

Full thickness skin grafts have more adnexal structures, vessels, and structures to supply. Therefore, theyare more prone to necrosis. However, they are less prone to contraction, alopecia, hypohidrosis, and

hypopigmentation for similar structural reasons.


Which material is used to coat the jaws of the needle holder in the photograph?

1 Gold

2 Tungsten carbide

3 Copper

4 Stainless steel

5 Nickel


Which material is used to coat the jaws of the needle holder in the photograph?

2 Tungsten carbide

Tungsten carbide is believed to be a harder more durable material that allows for better grasping of the

needle. Needle holders with tungsten carbide jaws usually have gold-plated handles.



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Which of the following histochemical stains can be used intraoperatively during Mohs micrographic

surgery to confirm the diagnosis of extramammary Paget's disease?

1 Neuron-specific enolase

2 Toluidine blue

3 S-100

4 Cytokeratin 7

5 Myeloperoxidase


Which of the following histochemical stains can be used intraoperatively during Mohs micrographic

surgery to confirm the diagnosis of extramammary Paget's disease?

4 Cytokeratin 7Cytokeratin 7 is a structural component of the cytoskeleton that stains poorly differentiated tumors of

the epithelium. This low molecular weight cytokeratin positively stains Paget cells. Neuron-specific

enolase stains merkel cell carcinoma, toluidine blue stains mast cells and myeloperoxidase stains cells

with myeloid differentiation such as leukemia cells. S-100 protein is a non-specific stain that is

commonly used as an adjunctive marker in the diagnosis of melanoma.


Which of the following is true regarding a Baker-Gordon peel?

1 88% phenol is the most important component for efficacy

2 It contains salicytic acid

3 It contains resorcinol

4 It is considered a medium depth peel

5 Croton oil is considered the most important component for efficacy


Which of the following is true regarding a Baker-Gordon peel?5 Croton oil is considered the most important component for efficacy

Croton oil is considered the most important component for efficacy. It is a epidermolytic that enhances

penetration. A Baker Gordon peel is a deep peel that contains 88% phenol, tap water, croton oil, and

septisol.


The tissue temperature required for destruction of basal cell or squamous cell skin cancers with

cryotherapy:

1 -40 to 50C

2 0 to -10 C


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3 10 to 20 C

4 -60 to- 70 C

5 -10 to -20 C


The tissue temperature required for destruction of basal cell or squamous cell skin cancers withcryotherapy:

1 -40 to 50C

-40 to -50C is the temperature required in the treated skin to effectively destroy basal cell andsquamous cell skin cancers. To treat malignant skin lesions a thermocoupling device can be used to

measure the exact temperature of the skin while freezing. After anesthetizing the skin, this device is

inserted into the estimated depth of the skin lesion. Cryotherapy is then performed until the thermometer

reaches a temperature of approximately -50 degrees Celsius. Keratinocytes need to be frozen to -50

degrees Celsius for effective destruction, while melanocytes are destroyed at -5 degrees Celsius. To treat

cutaneous malignancies,-50 Degress Celsius is the effective temperature. For benign skin lesions such asverrucae, -20 degrees Celsius is effective.


Which of the following medicines has a newly reported side effect of eruptive epidermoid cysts?

1 Minocycline

2 Retinoids

3 Imiquimod

4 Denileukin difitox

5 Potassium iodide


Which of the following medicines has a newly reported side effect of eruptive epidermoid cysts?

3 Imiquimod

Imiquimod is a topical immunomodulator which induces the toll like receptor 7 and is used in the

treatment of genital warts, actinic keratoses, and superficial basal cell carcinomas. It has a newly

reported side effect of eruptive epidermoid cysts. Minocycline has side effects including a lupus-like

syndrome and hepatitis. Retinoids has numerous side effects including hypertriglyceridemia, elevated

liver enzymes, dryness of skin, teratogenicity, and most recently inflammatory bowel disease.

Denileukin difitox, an engineered protein combining interleukin-2 and Diphtheria toxin, used in mycosis

fungoides may cause vascular leak syndrome characterized by hypotension, edema, and pleural effusion.

Potassium iodide may lead to the Wolff-Chaikoff effect in which thyroid hormone synthesis is inhibited

from excess iodides that block organic iodides from binding in the thyroid.


Which part of the eye is most likely to be damaged to exposure to a pulsed dye laser?

1 Retina


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2 Cornea

3 Lens

4 Conjuctiva

5 Sclera


Which part of the eye is most likely to be damaged to exposure to a pulsed dye laser?

1 Retina

The pulsed dye laser operates at 585-nm and targets hemoglobin as a chromophore. It can pass through

the cornea and damage choroidal and retinal vasculature. Several infrared pigment-specific lasers (eg,

ruby, alexandrite, Nd:YAG) may also damage the retina by targeting the retinal pigment.


Pre-testing for allergy to collagen is required for which cosmetic filler?

1 Radiance

2 Artecoll

3 Perlane

4 Cosmoderm

5 Silicone


Pre-testing for allergy to collagen is required for which cosmetic filler?

2 Artecoll

Artecoll is a nonbiodegradable injectable filler composed of microspheres of polymethylmethacrylate

which are suspended in bovine collagen. As with other types of injectable bovine collagen, patients must

be tested for allergy to bovine collagen prior to treatment.


A patient with a deep vertical frown line in the glabellar region requests Botox. Treatment will mostly

target which one of the following muscles?

1 Oculi

2 Orbicularis oculi

3 Depressor superciliaris

4 Levator palpebrae superioris

5 Corrugator superciliaris



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A patient with a deep vertical frown line in the glabellar region requests Botox. Treatment will mostly

target which one of the following muscles?

5 Corrugator superciliaris

Although the procerus and orbicularis oculi muscles are contributory, the development of vertical

glabellar frown lines is mostly due to the overactivity of the corrugator supercilaris. These muscles

function to pull the eyebrow inferomedially.


Which ocular structure is at most risk of injury from an erbium:YAG laser?

1 Lens

2 Retina

3 Cornea

4 Iris

5 PupilQ/Q(M)-474728 Report a Problem

Which ocular structure is at most risk of injury from an erbium:YAG laser?

3 Cornea

The erbium:YAG laser is an ablative laser whose target chromophore is water. The cornea is an aqueous

structure and is therefore the most susceptible to damage from this laser.


What is the ratio of sodium bicarbonate to 1% lidocaine in a buffered lidocaine solution?

1 1:1

2 1:2

3 1:5

4 1:10

5 1:25


What is the ratio of sodium bicarbonate to 1% lidocaine in a buffered lidocaine solution?

4 1:10

The use of sodium bicarbonate in 1% lidocaine reduces the acidity of the local anesthetic. Unbuffered

lidocaine has pH of approximately 5.5 -7.0 and lidocaine with epinephrine has a pH of approximately

3.55.0. The addition of sodium bicarbonate at a ratio 1:10 raises the pH to a more physiologic level,thereby reducing the stinging sensation associated with injection. However, the addition of bicarbonate

also reduces the shelf-life of the lidocaine.

Q/Q(M)-477132 Report a ProblemThe main advantage of selecting 4-0 Vicryl rather than 5-0 Vicryl to suture a wound is:


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1 Smaller suture diameter

2 Increased tensile strength

3 Increased knot security

4 Smaller needle

5 Increased suture memory


The main advantage of selecting 4-0 Vicryl rather than 5-0 Vicryl to suture a wound is:

2 Increased tensile strength

Sutures are classified according to the United States Pharmacopeia (USP) criteria. This classification

system specifies the diameter of a given suture material that is required to produce a certain tensile

strength. The smaller the cross-sectional diameter of a suture material, the higher the USP number that is

assigned. Thus, 4-0 Vicryl will have greater tensile strength and a larger cross-sectional diameter than 5-

0 Vicryl.Q/Q(M)-474735 Report a Problem

Which porphyrin is targeted in aminolevulinic acid-photodynamic therapy?

1 Protoporphyrin IX

2 Uroporphyrinogen

3 Coproporphyrin III

4 Coproporphyrinogen

5 Porphobilinogen


Which porphyrin is targeted in aminolevulinic acid-photodynamic therapy?

1 Protoporphyrin IX

Protoporphyrin IX is the substrate for the final rate-limiting step of heme synthesis. This enzymatic

reaction is catalyzed by ferrochelatase. The preferential uptake of aminolevulinic acid by cancerous and

pre-cancerous cells results in higher concentrations of protoporphyrin IX. This can then be selectively

targeted by photodynamic therapy.


The use of EMLA cream is contraindicated in patients with which of the following?

1 Atopic dermatitis

2 Deomycin allergy

3 Sickle cell anemia

4 Methemoglobinemia

5 Peripheral neuropathy



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The use of EMLA cream is contraindicated in patients with which of the following?

4 Methemoglobinemia

The most serious adverse effect of eutectic lidocaine and prilocaine (EMLA) is methemaglobinemia. A

metabolite of prilocaine oxidizes hemoglobin to methemoglobin, which is less efficient in release of

oxygen leading to tissue hypoxia. Patients with congenital or idiopathic methemoglobinemia or infantsunder 1 year of age are at higher risk for the development of this side effect.


The Shaw scalpel is used:

1 As a form of electrocautery

2 To enhance cyst wall removal

3 For incision and drainage

4 For thicker tissue (back)

5 For delicate work around the eyes and ears


The Shaw scalpel is used:

1 As a form of electrocautery

The Shaw scalpel provides the ability to cut through tissue with minimal blood loss. This instrument

employs an elctronically heated metal cutting balde that heats up while it cuts through tissue, and

coagulates fine vessels when they are divided. This instrument has been used frequently for treatment ofrhinophyma and in parotid gland surgeries.


While contemplating the repair of a large cheek defect after Mohs surgery, you begin to anesthetize an

elderly lady who weighs 110 lbs. What is the maximum amount of 1% lidocaine with 2.5% epinephrine

that this patient can receive?

1 10 ml

2 35 ml

3 50 ml

4 350 ml

5 500 ml


While contemplating the repair of a large cheek defect after Mohs surgery, you begin to anesthetize an

elderly lady who weighs 110 lbs. What is the maximum amount of 1% lidocaine with 2.5% epinephrine

that this patient can receive?

2 35 ml

The maximum recommended dosage of 1% lidocaine with 2.5% epinephrine in adults is 7mg/kg. The

patient weighs 110 lbs (or 50 kg) which allows her 350 mg or 35 ml (1% lidocaine has 10mg of


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lidocaine perml) of the anesthetic.


Topical vitamin K has been shown to:

1 Increases epidermal differentiation

2 Reduce severity of postoperative purpura

3 Decrease epidermal pigmentation

4 Improve fine winkling

5 Improve skin hydration


Topical vitamin K has been shown to:

2 Reduce severity of postoperative purpura

Topical vitamin K reduced post later treatment purpura when applied after (not before) treatment of

telangectasia with the 585 nm pulsed dye laser.


Which of the following immunosuppressive agents may exert a protective effect against the

development of skin cancers in organ transplant patients?

1 Cyclosporine

2 Rapamycin

3 Tacrolimus

4 Corticosteroids

5 Azathioprine


Which of the following immunosuppressive agents may exert a protective effect against the

development of skin cancers in organ transplant patients?

2 Rapamycin

Rapamycin (also called sirolimus) is a macrolide antibiotic and a structural analog of FK 506. It is a

potent immunosuppressive agent which inhibits mTOR (a member of P13K family kinases). Despite its

immunosuppressive effects, preliminary data show a decreased incidence of skin cancer in organ

transplant patients treated with rapamycin and postulate that it may exert a protective effect against

cutaneous malignancies.



1 Soft triangle


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2 Columella

3 Cupids bow

4 Philtral ridge

5 Vermillion border



4 Philtral ridge

The philtral ridges are located at the upper middle lip and form part of the aesthetically important

cupids bow.


All of the following statements are true regarding theMCW Melanoma Cocktailexcept:

1 it is a mixture of monoclonal antibodies to MART-1

2 it is performed intraoperatively

3 it is a mixture of monoclonal antibodies to Melan-A

4 it demonstrates micrometastases in sentinel lymph nodes

5 it is a mixture of polyclonal antibodies to tyrosinase


All of the following statements are true regarding theMCW Melanoma Cocktailexcept:

5 it is a mixture of polyclonal antibodies to tyrosinase

TheMCW Melanoma Cocktailis an immunostain made up of monoclonal antibodies to MART-1,Melan-A and tryrosine. It is used intraoperatively during sentinel lymph node biopsy and allows for

rapid and accurate determination of micrometastases. Shidham VB et al. Optimization of an

immunostaining protocol for the rapid intraoperative evaluation of melanoma sentinel lymph node

imprint smears with theMCW Melanoma Cocktail. Cytojournal 2004;1(1):2.


Which tattoo pigment has been most commonly associated with pseudolymphomatous reactions?


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1 Mercuric sulfide

2 Cadmium sulfide

3 Phthalocyanine dyes

4 Malachite

5 Cobalt


Which tattoo pigment has been most commonly associated with pseudolymphomatous reactions?

1 Mercuric sulfide

Some delayed type hypersensitivity reactions may lead to pseudolymphoma, most commonly caused by

red tattoo pigment (mercuric sulfide).


The use of imiquimod (Aldara) for the treatment of superficial basal cell carcinoma is advocated at

which treatment regimen?

1 Five times a week for 6 weeks

2 Five times per week for 4 weeks

3 Three times a week for 6 weeks

4 Three times per week for 4 weeks

5 Three times a week for 10 weeks


The use of imiquimod (Aldara) for the treatment of superficial basal cell carcinoma is advocated at

which treatment regimen?

1 Five times a week for 6 weeks

Imiquimod (Aldara) was FDA-approved in 2004 for the treatment of superficial basal cell carcinoma.

The recommended treatment schedule is once daily, five times per week for a total of six weeks. Geisse

J et al. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two

phase III, randomized, vehicle-controlled studies.Q/Q(M)-477056 Report a Problem

The classic purpose for serrated scissors is:

1 For work on thicker tissues (back)

2 For work on delicate areas around the eyes and the ears

3 For gripping tissue while cutting

4 For tissue undermining

5 For sharp dissections of tissue



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The classic purpose for serrated scissors is:

3 For gripping tissue while cutting

Serrated scissors are used primarily for gripping tissue to prevent sliding while cutting.



1 Nasal ala

2 Soft triangle

3 Columella

4 Philtral ridge

5 Nasal groove



3 Columella

Dermatologic and Cosmetic Surgery

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