5th year

1 - A 56-year-old woman undergoes resection of the conjunctiva and Müller muscle

for treatment of blepharoptosis. Which of the following structures is encountered
immediately anterior to the Müller muscle?

A) Capsulopalpebral fascia

B) Central fat pad

C) Levator palpebrae superioris muscle

D) Lockwood ligament

E) Retro-orbicularis oculi fat

2 - A 75-year-old man comes to the office because of a squamous cell carcinoma of

the lower lip. A wide local excision, removing two thirds of the lower lip extending
inferiorly to the chin crease but sparing both oral commissures and bilateral
selective neck dissections, is performed. Which of the following is the most
appropriate method of reconstruction?

A) Estlander flap

B) Facial artery musculomucosal flap

C) Karapandzic flap

D) Primary closure

E) Radial forearm fasciocutaneous free flap

3 - A 32-year-old man with Bell palsy comes for evaluation of nasal obstruction. He
says that the left side of his nose constantly feels clogged. Physical examination
shows left facial paralysis and collapse of the left external valve. Which of the
following muscles is most likely paralyzed?

A ) Depressor septi nasi

B ) Levator labii superioris

C ) Procerus

D ) Risorius

E ) Transverse nasalis
4 - A 9-year-old girl is brought for evaluation by her mother because of a 1-year
history of headaches and precocious puberty. Physical examination shows café-au-
lait spots over her abdomen and a bony prominence of her right parieto-occipital
area. CT scan of the calvarium shows fibrous dysplasia. Which of the following is
the most likely diagnosis?

A ) Klippel-Feil syndrome

B ) McCune-Albright syndrome

C ) Paget disease

D ) Proteus syndrome

E ) Renal osteodystrophy

5 - A 21-year-old man has an intercanthal distance of 37 mm (N = 30 mm), and an

interorbital distance of 35 mm (N = 28 mm). Which of the following is the most
likely diagnosis?

A ) Esotropia

B ) Exophthalmos

C ) Exotropia

D ) Hypertelorism

E ) Pseudohypertelorism

6 - An otherwise healthy 13-year-old girl comes to the office because of a 3-year

history of facial asymmetry that has worsened progressively. Examination shows a
coup de sabre deformity on the right with the depression extending to the neck.
There is thinning of the skin and fat of the right cheek. Which of the following
additional findings is most likely in this patient?

A ) Bilateral disease

B ) Inflammatory changes in the skin

C ) Involvement of the tongue in the disease process

D ) Mandibular and maxillary hypoplasia

E ) Vascular malformations
7 - A 1-year-old male infant is brought to the office because of congenital ptosis of
the left eye. On examination, the eyelid margin covers 4 mm of the upper limbus,
and levator excursion is 4 mm. Which of the following is the most appropriate
treatment?

A ) Fasanella-Servat procedure

B ) Frontalis suspension with sling

C ) Levator advancement

D ) Müller muscle resection

E ) Observation

8 - A 76-year-old man comes to the office for consultation regarding a 5-year history
of upper eyelid ptosis. He has no history of serious illness or trauma and takes no
medications. Which of the following is the most likely cause?

A ) Levator dehiscence

B ) Muscular dystrophy

C ) Myoneural dysfunction

D ) Oculomotor (III) nerve palsy

E ) Paralysis of the Müller muscle

9 - Which of the following cranial nerves is responsible for parasympathetic

innervation to the parotid gland?

A) Trigeminal (V) nerve

B) Vestibulocochlear (VIII) nerve

C) Glossopharyngeal (IX) nerve

D) Vagus (X) nerve

E) Hypoglossal (XII) nerve

10 - Regarding Nonsurgical treatment of various congenital lop ear with
thermoplastic splinting all true except.

A) has been reported in children of neonatal age.

B) Remodeling can be performed once per week

C)The average time for treatment was 1.9 months

D)70% of cases could be treated with good results

E) All patients showed remarkable improvement within the first one to two days after
beginning the treatment

11 - Which of the following facial abnormalities is most characteristic of a patient

with Teacher Collins syndrome?

A Oblique mandibular plane angle

B Orbital hypertelorism

C Negative overjet

D Positive overbite

E Vertical maxillary deficiency

12 - The Lymphatic Anatomy of the Lower Eyelid and Conjunctiva, witch of the
fallowing incorrect.

A) these lymphatic vessels have valves like those in the limbs

B) consist of superficial and deep collecting lymphatic systems.

C)The superficial lymphatic system drained the eyelids and was dominant laterally

D)damage to both the superficial and deep lymphatic systems, especially laterally, may
be responsible for post- operative chemosis and edema

E) persistant chemosis and edema of the eyelid is a well-recognized and, at times,

distressing complication of periorbital surgery.

13 - Where does the temporoparietal fascia lie?

A. Above the pericranium and beneath the temporalis muscle

B. Above the temporalis muscle and beneath the temporalis muscular fascia

C. Beneath both the skin and the temporalis muscular fascia

D. As an extension of the galea aponeurotica as it extends inferior to the superior

temporal line

E. None of the above

14 - Which is not true concerning Temporalis transfer for dynamic facial palsy
reconstruction

A. More frequently performed than masseter transfer because greater excursion of

movement

B. Anatomy: Fan-shaped muscle, originates from temporal fossa and inserts into
coronoid process of mandible

C. Blood supply: Anterior deep temporal artery, posterior deep temporal artery, medial
temporal artery

D. Innervation: Maxillary branch of trigeminal nerve

E. Can transfer and suture muscle with its fascial extensions to eyelids, ala of nose, oral
commissure, and upper and lower lips

15 - A 30-year-old man comes to the office because of a frontal headache and

persistent watery drainage from the right nostril 2 weeks after undergoing
septorhinoplasty. Which of the following is the most appropriate next step in
management?

A ) Place nasal packing for 48 hours

B ) Start oral antihistamines
C ) Start vasoconstrictor nasal spray
D ) Test nasal discharge for beta-2 transferrin
E ) Reassure the patient that these symptoms are normal

16 - Which one of the following statements is correct regarding reconstruction of

eyelid defects?
A. Only defects of less than 20% can be closed directly.

B. Defects greater than 75% can often be closed with canthotomy and cantholysis alone.

C. Defects of 50% to 75% can usually be closed using myocutaneous advancement flaps.

D. Selection of reconstructive technique is based on whether the defect is partial-

thickness or full-thickness only.

E. The lower lid is best reconstructed using the upper lid as a donor site.

17 - What is the key reason why vascularized bone flaps are preferred for
reconstruction of mandibular defects following resection of malignant tumors?

A. They are more resistant to the effects of radiotherapy.

B. They encourage more radical excision margins.

C. They facilitate re-excision where close margins are obtained.

D. They are more cost effective than non-vascularized options.

E. They have very low donor site morbidity

18 - Which one of the following is correct when managing patients with post-tumor
resection defects of the oropharynx?

A. Most soft palate defects are well managed with prosthetic devices.

B. Larger tongue base defects are more safely treated with laryngectomy.

C. Pharyngeal wall defects usually require free tissue reconstruction.

D. Local flaps for tongue base reconstruction are associated with low complication rates.

E. Large tongue defects benefit from free muscle transfer with motor reinnervation

19 - Which one of the following sensory nerves is most likely to be intentionally

sacrificed in migraine surgery, resulting in an area of residual paresthesia?

A. Greater occipital nerve

B. Lesser occipital nerve

C. Supraorbital nerve

D. Supratrochlear nerve

E. Zygomaticotemporal nerve

20 - For management of a patient with an unstable ZMC fracture, which one of the
following statements is correct?

A. All four articulations must be reduced and stabilized with monocortical miniplates and
screws.

B. The patient is likely to have permanent deformity even if accurate reduction and
stabilization is achieved.

C. Fixation of the zygomaticofrontal articulation should ideally be performed first

following reduction.

D. The best surgical approach is through a combination of intraoral and lower

blepharoplasty incisions.

E. Accurate reduction of the zygomaticotemporal articulation is most important.

21 - Regarding neck dissection, the following are true EXCEPT:

A. Functional neck dissection removes level1 through level 5 but preserving non
lymphatic structures.

B. Radical neck dissection removes level 1 through level 5 including spinal accessory
nerve, internal jugular vein and sternocleidomastoid muscle.

C. MRND I is radical neck dissection with preservation of spinal accessory nerve.

D. MRND II is radical neck dissection with preservation of internal jugular vein.

E. MRND III is the same as functional neck dissection

22 - Which one of the following statements is correct regarding the aesthetic

subunits of the cheek?

A. There are four overlapping zones.

B. The buccomandibular zone is usually the largest.

C. Zone 1 comprises three smaller subunits.

D. Two borders in common are found between zones 2 and 3.

E. Zone 3 is best reconstructed with a cervicofacial flap.

23 - Which one of the following techniques may be useful in patients who have
sustained marginal mandibular nerve injury?

A. Temporalis transfer

B. Masseter transfer

C. Free gracilis transfer

D. Digastric transfer

E. Partial pectoralis minor transfer

24 - Check reconstruction

A-advancement flap should anchored to periostum of zygoma or maxilla at level of lower

eyelid to prevent ectropian.

B-Banner flaps are the simple form of advancement flap.

C-Biolobed flaps are frequently used in check reconstruction because of laxity of check
skin.

D-inferolateral based rotation flaps had high risk of necrosis of its distal part.

E-cervicopectoral flap based primarily on the internal mammary perforating vessels with
variable contribution from perforation arise from thoracoacromial vessels.

25 - Lip reconstruction:

A-the color and elevation of white roll is created by par peripheralis component of
orbicularis oris.
B-the labial vessels lie anterior to orbicularis oris muscle.

C-large lateral defect of upper lip is best to reconstructed with Abbe flap from lower lip.

D-Karapandizc flap is musculocutaneous rotation advancement flap.

E-for defect greater than 80% the Karapandizc flap is best option for lip reconstruction.

26 - Nasal reconstruction

A-the skin of columella and alar rim is thin and mobile.

B-local flap used for nasal reconstruction is adds skin to nasal surface.

C-cooling for first 36 hours improves take of composite chondrocutaneous grafts.

D-vertical paramedian flap is based on supraorbital pedicel.

E-A three stage forehead flap usually used for normal healthy person with small defect
and no scar.

27 - Eyelid reconstruction:

A-An ideal donor site in anterior lamellar defect is full thickness skin graft from
contralateral upper eyelid.

B-Cutler-Beard bridge flap is full thickness composite flap from the upper eyelid.

C-full thickness defect that are 25% or more in zone two of lower eyelid can approach by
superiorly based Tenzel flap.

D-healing by secondary intension is not accepted method in medial canthus defect.

E-canthoplasty involved rescued the canthal ligament in a new position.

28 - Ear reconstruction

A-the most easy part to reconstruct is the ear lobule.

B-canaloplasty is recommended in patient with unilateral microtia.

C-for amputated ear,removing the skin from cartilage and burying it beneath
retroauricular skin is good choice.

D-staphylococcus bacterial infection is common after ear reconsruction for acquired ear
deformity more than congenital microtia.

E-best option for amputated ear reconstruction is attempt of immediate microvascular

implantation.

29 - Tumor of lower lip:

A - have a late metastasis rate of about 40%.

B- may present with metastasis to neck nodes in up to 30%of patient at time of

presentation.

C- are significantly more frequent in males.

D- are associated with poor oral hygiene.

E- are most commonly basal cell carcinoma.

30 - A method of nose reconstruction in which the post auricular skin is raised on

the superficial temporal vessels is:

A-Washio flap.

B-Banner flap.

C-Worthin flap.

D-Rintala flap.

E-Gillie flap.

31 - The ideal flap to reconstruct a moderate sized defect on the lower lip that
maintans the sensation and sphincter function is:
A-Abbe flap.

B-Estlander flap.

C-modified Bernard Burrow procedure.

D-Karapandzic flap.

E-McGregor flap.

32 - In patient with craniofacial microsomia , which of following nerve is most

frequently involved?

A- Optic.

B- Trigeminal.

C- Facial.

D- Acoustic.

E- Spinal accessory.

33 - An inferior turbinoplasty is performed in those patients with inferior turbinate

hypertrophy causing symptomatic nasal airway obstruction.Which of the following
procedures can not be adopted:

A. Outfracturing alone.
B. Submucous morselization of the turbinate bone.

C. submucous resection of the anterior onethird to one-half of the inferior turbinate.

D. The posterior portion of the conchal bone is resected.

E. Submucous diathermy.

34 - Which of the following pinnaplasty techniques is based on Gibson’s principle?

A. Wood-Smith.
B. Converse–Wood-Smith.
C. Furnas.
D. Chongchet.
E. Mustarde.

35 - A 62-year-old woman is concerned that she has developed deep creases from the
corner of her mouth to her chin (marionette lines). Which of the following is the
most likely cause of these findings?

A) Attenuation of mandibular ligaments.

B) Dermal thinning.
C) Mimetic muscle contraction.
D) Viscoelastic stretching.
E) Volume deflation.

36 - A 25-year-old woman undergoes rhinoplasty to correct a bulbous tip, the tip

continues to look bulbous. Which of the following techniques is most likely to
improve this persistent deformity?

A ) Additional cephalic trimming.

B ) Columellar strut grafting.
C ) Lateral crural mattress suture.
D ) Shield grafting.
E ) Spreader grafting.

37 - The dominant vascular supply of the rectus abdominis muscle originates from
which of the following vessels?

A ) Common femoral.
B ) External iliac.
C ) Internal iliac.
D ) Internal mammary.
E ) Superficial femoral

38 - What is the main blood supply to the nasal tip after an open rhinoplasty?
A. Lateral nasal.

B. Columellar.

C. Angular.

D. Dorsal nasal.

E.Superior labial.

39 - When examining a young patient with ptosis of the upper eyelids, which one of
the following may be useful to differentiate between congenital and acquired
causes?

A. Strabismus.

B. Amblyopia.

C. Telecanthus.

D. Lagophthalmos.

E. Hypoglobus.

40 - In a 45-year-old patient with segmental extratemporal facial nerve loss

following radical parotidectomy, which one of the following is the most
suitable immediate reconstruction method?

A. Direct nerve repair.

B. Cross-face nerve graft.

C. Ipsilateral facial nerve graft.

D. Temporalis transfer.

E. Free gracilis transfer.

41 - Which of the following statements is correct regarding an Estlander flap?

A. It is ideally suited to reconstruct central lip defects.

B. It is only suitable for defects less than half the lip width.

C. It is a two-stage process requiring division at two weeks.

D. Blood supply is from the contralateral labial artery of the opposite lip.

E. Postoperative commissure distortion is rarely observed.

42 - Which of the following statements is correct regarding the Karapandzic flap?

A. It should only be used for lower lip reconstruction.

B. Full-thickness dissection is required throughout.

C. Some branches of the facial nerve will have to be divided.

D. The flap is only full thickness medially.

E. Oral competence is preserved without microstomia.

43 - .Which of the followings is correct regarding gold weight prosthesis as an option

for Upper eyelid reanimation following facial nerve paralysis.

A ) Allowing coverage of the upper limbus at rest.

B ) Bringing the upper eyelid to within 2 to 4 mm of the lower eyelid.

C ) Enabling complete closure of the upper eyelid.

D ) Enabling the most rapid closure of the upper eyelid.

E ) Providing the best symmetry with the contralateral eye.

44 - When planning to do suction assisted liposuction of about 2500 cc from the

abdomen alone for 90 kg healthy person using superwet solution,which of the
followings is incorrect?
A- The patient can be discharged to home in the same day of surgery

B- Drain is recommended.

C - can be performed without need for Foley’s catheter

D - Ideal suction assisted cannula to be used is bendable

E - If it is done under general anesthesia, the injected superwet solution contains 2.5 liters
of ringer lactate, 2.5 ml of 1:1000 adrenaline and 1300 mg of lidocaine.

45 - When harvesting split calvarial bone for calvarial reconstruction, which

anatomic area is normally preferred?

A. Occipital

B. Frontal

C. Parietal

D. Temporal

E. No specific region is preferred.

46 - A 60-year-old man is evaluated for a painful unilateral facial rash with blisters,
intense ear pain, and complete ipsilateral facial nerve paralysis. Which of the
following is the most likely diagnosis?

A Cholesteatoma

B Facial myokymia

C Lyme disease

D Möbius syndrome

E Ramsay Hunt syndrome

47 - An otherwise healthy 46-year-old woman undergoes botulinum toxin type A

(Botox) treatment for severe glabellar lines. Twelve units of Botox is administered
into each corrugator muscle. Eight days later, the patient comes to the office
because of ptosis of the right eyelid. Which of the following muscles is most likely
inadvertently affected in this patient?

A Frontalis

B Levator palpebrae superioris

C Müller muscle

D Orbicular muscle of the eye

E Procerus

48 - During routine brachioplasty, which of the following nerves is/are most likely at
risk during typical dissection?

A Lateral antebrachial cutaneous nerve

B Medial antebrachial cutaneous nerve

C Sensory branches of the axillary nerve

D Sensory branches of the radial nerve

49 - A healthy 65-year-old woman is evaluated because of drooping of the upper

eyelids. Examination shows high eyelid creases and 3 mm of ptosis. Levator
excursion measures 10 mm. Which of the following is most likely to correct the
blepharoptosis in this patient?

A Brow lift surgery

B Fasanella-Servat procedure

C Frontalis sling

D Levator advancement

E Upper eyelid blepharoplasty

50 - Accidental division of the great auricular nerve during rhytidectomy most

commonly results in which of the following outcomes?
A Gustatory sweating

B Inability to elevate the brow

C Loss of sensation to the temporal scalp

D Numbness of the earlobe

E Paralysis of the posterior auricular muscle

GOOD LUCK