Multiple Choice Questions MCQ

Question 29# Print Question

Issues relating to local flaps in the reconstruction of traumatic lower limb injuries:

A. The lateral head of gastrocnemius is larger than the medial head

B. Use of the medial head of gastrocnemius leads to a significant functional deficit

C. Use of a proximally based soleus flap leads to a significant functional deficit

D. Scoring of the fascia of gastrocnemius can allow the flap to cover a larger area

E. Soleus and gastrocnemius have the same pattern of vascular supply

Question 26# The critical zones of injury in a burn that can be influenced by early effective management include:
A. Zone of coagulative necrosis
B. Zone of hyperaemia
C. Zone of stasis
D. A and C
E. B and C
B and C. B and C are correct. The zone of coagulative necrosis is nonviable, and thus not reversible, while the zones of hyperaemia and stasis are potentially salvageable. Early burns management is aimed at preventing the progression of the potentially viable zones into coagulative necrosis. These zones were described by Jackson. References: 1. Jackson DM. The diagnosis of the depth of burning. Br J Surg 1952; 40: 566-96.

Question 27# With respect to paediatric burns which of the following is true?
A. They have lower energy needs
B. They have thicker skin
C. They have a larger surface area to body mass ratio
D. Renal concentrating ability is better than an adult
E. Hypertrophic scarring is less common
They have a larger surface area to body mass ratio. Children have higher energy needs, thinner skin, and immature kidneys. While healing is quicker in children, the incidence of hypertrophic scarring is greater. Children also have a larger surface area to body mass ratio.

Question 28# With regards to burn excision:
A. Fascial excision provides excellent cosmesis
B. The technique of tangential excision was published by Janzekovic in 1970
C. Fascial excision leads to significant blood loss
D. Late excision after antimicrobial dressings have been applied for a number of weeks leads to better outcomes
E. None of the above
The technique of tangential excision was published by Janzekovic in 1970. Zora Janzekovic published her technique of tangential excision for burns in 1970. Fascial excision leads to reduced blood loss compared with tangential excision, but at the cost of poor cosmesis depending on the area involved. Early burn excision leads to improved outcomes. References: 1. Janzekovic Z. A new concept in the early excision and immediate grafting of burns. J Trauma 1970; 10(12): 1103-8.

Question 30# The ideal skin substitute would be:
A. Resistant to shear stresses
B. Toxic
C. Inelastic
D. Antigenic
E. Epidermal only
Resistant to shear stresses. A skin substitute would require adherence to the wound bed (resistant to shear stresses), not be rejected (non-toxic,non-antigenic) and function as skin (elastic and have all components of skin including dermis).

Question 29# Issues relating to local flaps in the reconstruction of traumatic lower limb injuries:
A. The lateral head of gastrocnemius is larger than the medial head
B. Use of the medial head of gastrocnemius leads to a significant functional deficit
C. Use of a proximally based soleus flap leads to a significant functional deficit
D. Scoring of the fascia of gastrocnemius can allow the flap to cover a larger area
E. Soleus and gastrocnemius have the same pattern of vascular supply
Scoring of the fascia of gastrocnemius can allow the flap to cover a larger area. Scoring of the gastrocnemius fascia extends the potential area of cover and reach. The medial head of gastrocnemius is bigger than the lateral. Each of gastrocnemius and soleus muscles is expendable without undue donor functional morbidity. The pattern of vascular supply for each head of gastrocnemius is Type I, and for soleus Type II. References: 1. Mathes SJ, Nahai F. Reconstructive surgery: principles, anatomy & technique. New York, USA: Churchill Livingstone, 1997.