Post-test

Post-test

1. With regards to the effects of chemoimmobilization on the phases of wound healing, Lee et al evaluated the microscopic effects of botulinum toxin A injections on overlying healing wounds in a rat-surgical wound model. Which of the following most accurately describes the effects of botulinum toxin A injections on the overlying healing wound?

   • Decreased number of fibroblasts, increased collagen maturation, shorter inflammatory phase and lower expression of inflammatory markers (TGF-β1)

   • Increased number of fibroblasts, decreased collagen maturation, shorter inflammatory phase and lower expression of inflammatory markers (TGF-β1)

   • Decreased number of fibroblasts, decreased collagen maturation, shorter inflammatory phase and lower expression of inflammatory markers (TGF-β1)

   • Decreased number of fibroblasts, increased collagen maturation, longer inflammatory phase and higher expression of inflammatory markers (TGF-β1)

2. Temporarily paralyzing the surrounding muscles of a healing facial wound with Botox injections has been shown to improve the appearance of the resulting facial scar. This technique is otherwise known as chemoimmobilization. Gassner and Sherris have described reformulating Botox in a solution of 1% lidocaine with 1:100,000 epinephrine. Which of the following best explains the purpose of this reformulation when used for chemoimmobilization?

   • The addition of 1:100,000 epinephrine helps to fully eliminate the pain and discomfort associated with the injection of Botox.

   • Since most patients do not attain full chemodenervation of the treated muscle groups for 48 to 72 hours after injection with Botox alone, adding 1% lidocaine is a useful method that allows the surgeon to better predict the delayed paralysis ensuing from botulinum toxin A

   • The addition of 1% lidocaine will help to increase the duration of action of Botox on the targeted muscle groups

   • Adding 1% lidocaine with 1:100,000 epinephrine is to help extend the shelf-life of the botulinum toxin A

3. What is the earliest time after surgery that a surgical scar may be optimized with laser treatment?

   • At the time of surgery

   • 1 week post-op

   • 2 weeks post-op

   • 4–6 weeks post-op

4. What is the most appropriate technology for treatment of traumatic and elective tattoos?

   • Pulsed dye laser

   • Fractional laser

   • Chemical peel

   • Q-switched laser

5. Which scar treatment technology offers potential for least down-time and fastest tissue recovery?

   • Ablative CO2

   • Dermabrasion

   • Pulsed dye laser

   • Fractionated laser

6. Which of the following is not true regarding keloid and hypertrophic scars?

   • Hypertrophic scars contain primarily type 3 collagen

   • The majority of individuals who develop keloid and hypertrophic scars are young with and age range of 10-30 years old

   • Hypertrophic scars are composed of abnormally thick, irregularly branched and disorganized type 1 and type 3 collagen

   • Keloid scars extend beyond the general geographic margins of the original wound

7. Hypertrophic scars are notable for the following characteristics, EXCEPT:

   • Occurring when there are major skin wounds, including those resulting from surgery, trauma, and burns

   • Occurring after very small injuries or weak inflammatory processes including acne and injections

   • Usually improving naturally with the process of scar maturation

   • Generally become obvious within weeks after injury after which they rapidly increase in size for 3–6 months

8. A 40-year-old healthy female is taken to the operating room to close a 2 by 2 centimeter (cm) full thickness cheek Mohs defect with a rhomboid skin flap. What is the post-operative plan for antibiotic coverage (patient has no allergies)?

   • Amoxicillin/Clavulonic Acid given for three days

   • Cephalasporin given for two weeks

   • Clindamycin given for one week

   • No antibiotics required

9. When is the optimal time for surgical wound healing to occur for soft tissue reconstruction if a patient is currently receiving adjuvant radiation therapy?

   • Concurrently with the radiation

   • 6 months post radiation completion

   • Between 3 weeks and 3 months after completion of therapy

   • 12 months post radiation completion

10. A 45-year-old female is attempting to purchase an over-the-counter (OTC) cream to assist in the appearance of her facial surgical scar. What do you recommend?

    • Onion extract creams appear to provide the best evidence for scar prevention

    • Hydration and sun protection are the most likely to assist in scar prevention

    • Vitamin E extracts and massage are most likely to help

    • Don't recommend any treatments, refer patient to product inserts as best information

11. A patient has a cutaneous defect overlying the mesolabial fold that extends onto the skin overlying the zygoma. Surgical excision and closure are indicated. What are the most important things to take into account?

    • Place incisions within the relaxed skin tension lines (RSTLs) and close as tensionless as possible

    • Healing by secondary intention offers the best result possible

    • Mark out the incision to ellipse the defect and attempt primary closure however possible

    • Skin graft the site

12. An 18 year old African American male presents for treatment of a recurrent earlobe keloids. Which of the following is the most appropriate treatment strategy?

    • Local excision followed by serial Kenalog injections

    • Wide local excision

    • Wide local excision followed by external beam radiation therapy (EBRT)

    • external beam radiation therapy (EBRT) alone

13. Which of the following is the most appropriate suture to use when closing the skin following the excision of a cervical keloids

    • Prolene

    • Chromic

    • Mersilene

    • Vicryl

14. Advantages of second intention healing include:

    • Low rate of infection

    • Allows close monitoring of wound bed for recurrence

    • Minimizes perioperative morbidity and costs

    • All of the above

15. Which of the following defects is most amenable to second intention healing?

    • Central forehead in a 41 year old Hispanic woman

    • Central, superior cheek in 58 year old Caucasian woman

    • Superficial lower lip vermillion in 75 year old Caucasian man

    • Nasal tip 63 year old Caucasian woman

16. During this phase of wound healing, fibroblasts produce collagen which becomes increasingly organized over time, changing the final appearance of a scar

    • Hemostasis

    • Remodeling

    • Proliferation

    • Inflammation

17. Undermining detaches the skin from the underlying deep tissue and allows tension-free closure of the epidermis. In which layer should undermining be performed?

    • Subdermal fat layer

    • Between the epidermis and the dermis

    • Below the subdermal fat

    • Just superficial to the muscle

18. Of the following, which technique is used to irregularize and lengthen a scar?

    • W-plasty

    • Geometric broken line closure

    • Fusiform excision

    • Z-plasty