Self Assessment and Review of PLASTIC SURGERY Rajiv Agarwal MBBS MS (Gen Surg) DNB (Gen Surg) MCh (Plast Surg) DNB (Plast Surg) Recipient of Indian National Science Academy ‘Young Scientist’ National award Professor, Department of Plastic Surgery, King George’s Medical University, Lucknow, UP, India Ramesh Chandra MS (Gen Surg) MS (Plast Surg) FRCS (Eng) Recipient of Dr BC Roy National Award Past President—Association of Plastic Surgeons of India Former Professor and Head, Department of Plastic Surgery, Former Principal and Dean, King George’s Medical College, Lucknow, UP, India Forewords by Kenneth E Salyer, USA Marita Eisenmann-Klein, Germany K Mathangi Ramakrishnan, India ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Panama City • London • Dhaka • Kathmandu ® Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. 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Inquiries for bulk sales may be solicited at: [email protected] This book has been published in good faith that the contents provided by the author(s) contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author(s) specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author(s). Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device. Self Assessment and Review of Plastic Surgery First Edition: 2013 ISBN : 978-93-5090-317-9 Printed at TRIBUTES I (RC) would like to pay my special tributes to my parents, Dr BR Agarwal and Mrs SD Agarwal for their support, guidance, all the love and care all through my life. I am indebted to my teachers for having shaped my career—Prof SC Mishra, Prof RV Singh, Prof A Charan, Prof RN Sharma, Prof PC Dubey, Prof NC Misra, Prof GP Agarwal from the department of surgery besides Prof BN Sinha and Prof MK Goel from the department of orthopaedics. I owe my special gratitude to Prof Bruce Bailey of Aylesbury for his guidance and support to me during my stay in UK and to Prof RN Sharma, my mentor for shaping my career in plastic surgery. FOREWORD Rajiv Agarwal and Ramesh Chandra have produced a new ‘Self Assessment and Review of Plastic Surgery’ book for all students and scholars of plastic surgery interested in furthering their expertise in plastic surgery through studying and taking this multiple-choice examination. These authors published a book in 2002 which was favorably reviewed by the Journal of plastic and reconstructive surgery. Because of its high demand and the enthusiastic response for an updated expanded version these authors have compiled over 1000 multiple-choice questions in 8 categories of the specialty of plastic and reconstructive surgery. Its purpose is to provide for those interested in entrance examinations in plastic surgery and also exit examination or certification examinations in plastic surgery. Although there are a few other books available for study there is just one by the name of plastic surgery review published by WB Saunders Company. The authors felt there was a huge demand for a book of this nature in India and they feel that this broad-based multiple-choice question examination will be used by many others located throughout the globe interested in refining their knowledge and skill in taking multiple-choice examination in plastic surgery and broadening their knowledge base. I was given a sample of questions from each of subspecialty sections and found these diverse and helpful. The design of answering the questions after a few questions with annotated references should provide a framework for detailed study of the various topics and questions which they have created. Although many of these questions seem straightforward and simple, they have provided answers which to some degree are all correct but there is one which is the answer for each question. Used properly students could achieve improvement in their knowledge while also practicing and learning the skill of multiple-choice examinations. This should serve as a useful additional tool for study by all those interested in plastic surgery examinations. The use of photographs is an added benefit in the examination process and is used today in various examinations for plastic surgery. I found the section of 51 questions on recent advances to be way too inadequate and short to cover the rapidly expanding recent knowledge base. I would encourage them to expand this section in there next edition to provide more updated expanded information. Overall I find this to be a useful ‘Self Assessment and Review of Plastic Surgery’ book and think it should be in the hands of all students of plastic surgery. KENNETH E SALYER MD Founder and Chairman, World Craniofacial Foundation, Dallas Texas USA FOREWORD Choosing plastic surgery as a specialty means to commit yourself to treat all patients—babies, children, adults and seniors from head to toe. This is just one out of many fascinating aspects of our specialty. However, the variety of our beloved specialty becomes a big challenge, when it comes to preparing for an examination. Although trainees in plastic surgery experience much more exposure to our techniques than trainees in other fields, there are very few training centers which can provide adequate expertise in all the subspecialties. While textbooks may give a basic insight, they cannot make the candidates feel well prepared for the challenge of an examination. Therefore, with great joy, I recommend the new book of Professor Ramesh Chandra and Dr Rajiv Agarwal for trainees in plastic surgery. Studying questions and answers of previous examinations or, as in this case, fictive questions with profound explanations in their answers, is a very effective way to prepare for examinations. The insight, provided in this book, certainly will help the candidates to feel confident and well prepared for questions within all fields of plastic surgery, not only for those which they know from their daily work. With the foundation of the IPRAS Trainees Association the International Confederation for Plastic Reconstructive and Aesthetic Surgery wants to create a forum for exchange and quality improvement in all aspects of plastic surgery training. Providing adequate tools for a successful examination is part of the program. IPRAS thanks Prof Chandra and Dr Agarwal for contributing a tool to this ambitious project. MARITA EISENMANN-KLEIN Prof hc Dr med Dr hc President International Confederation for Plastic Reconstructive and Aesthetic Surgery FOREWORD The concept of having a book on multiple choice questions “Self Assessment and Review of Plastic Surgery” in the super specialty of Plastic Surgery has been conceived by the former professor Dr Ramesh Chandra and his illustrious son Dr Rajiv Agarwal, the present professor is highly commendable. The current edition is the second book on the list. The editors have gone into great depth to formulate the questions, validate the important points and presented it in simple and explicit form to make the students understand. In the group of super specialty plastic surgery assumes a very important place, particularly the topics on congenital malformations and reconstructions in head and neck. Inclusion of the recent and past developing surgical technique 'Robotics in Plastic Surgery' is highly appreciated. All the subdivisions have been dealt in a very concentrated manner. This edition of the book must be in the armamentarium of every plastic surgeon who takes up postgraduation as well as seasoned teachers who need to get reaccredited to teach the students in an ongoing manner. Prof (MRS) K MATHANGI RAMAKRISHNAN Chairperson, Childs Trust Medical Research foundation Chief of Burns and Plastic Surgery Department Kanchi Kamakoti Childs Trust Hospital 12–A, Nageswara Road, Chennai–600 034. Tamil Nadu, India Past President: National Academy of Burns Past President: National Academy of Medical Sciences Past President: Association of Plastic Surgeons of India MESSAGE It is a pleasure to write a Message for the book on multiple choice questions in plastic surgery written by Dr Rajiv Agarwal and Dr Ramesh Chandra. They had earlier published a similar book in 2002. This book “Self Assessment and Review of Plastic Surgery” is an updated version with the special feature that each question answer is referenced. An explanation for the answer has also been provided. It helps the person to understand the subject. The book is comprehensive, covering all aspects of Plastic Surgery from history to the recent advances. The book will be an useful adjunct to both persons aspiring to enter the portals of Plastic Surgery and also for the already enrolled students. I would strongly recommend this book as a teaching aid in Plastic Surgery. A K SINGH Professor and Head, Department of Plastic Surgery, KG Medical University, Lucknow, UP, India & President Association of Plastic Surgeons of India PREFACE Plastic Surgery is an amalgam of both science and art as these are the pillars of a successful plastic surgeon in achieving excellence, consistent results and harmony in performing this surgery. The classical textbooks and operative atlases help in understanding the core subject of plastic surgery while a book of this nature helps to train the reader in solving the multiple choice questions on the subject. The trend of giving such questions is on the rise over the last several years in examinations as these allow an in-depth assessment of thecandidate which is totally objective precluding any bias which can hover on other methods of examination. Multiple choice ques- tions in plastic surgery examination have become the norm for various entrance examinations, in-service examinations especially of the American boards and even passing out examination in plastic surgery in many national and international universities. Currently very few books on multiple choice questions in plastic surgery exist in the market. These books often do not cover the vast expanse of the subject and leave many areas untouched. There was thus a genuine need among students, fellows, colleagues and established plastic and facial surgeons to develop a comprehensive text which is focussed on all the aspects of plastic surgery and which at the same time includes the key facts and knowledge of the subject which is relevant to the practice of plastic surgery. This book is an attempt to fill in this specific deficiency area and to provide the readers a comprehensive treatise of deft multiple choice questions which will not only test the knowledge of plastic surgery but will also assess the reader on his clinical skills and judgment based on the questions relating to clinical problems. The subject matter of plastic surgery has been covered in a total of seven independent sections dealing with general principles, aesthetic surgery, head and neck, craniofacial and cleft, oncoplastic surgery, trunk and lower extremity and finally upper limb and hand surgery. This is followed by a section of multiple choice questions based on recent advances in plastic surgery. The questions have been based on various, notable publications in plastic surgery over the last ten years. The seven sections offer incisive questions based on the particular subject from the historical aspect to the intricacies of diagnosis and treatment. The last section on recent advances is an assortment of questions without any particular subject loyalty. This section will make the reader abreast with questions on the current advances in plastic surgery. To eliminate any type of ambiguity in the answer to the particular question item, each of the questions in this book has been supported by specific and complete references detailing the authors and the journal so that the reader can refer to these for more information on that particular question stem. All questions also have specific answers and explanations which will provide the reader a grasp of the particular point that has been raised and discussed in the subject stem. The answers, explanations and references follow at the end of each section so that the reader can turn the pages and review these at convenience while the answers also remain hidden from the eye at the time of reading the question item. Plastic surgery is all about photographs and hence each section has also been augmented with succinct and unambiguous photo- graph based question items which would test the skill of the reader in clinical decision-making at the bedside. Special care has been exercised in designing the question stems in this book. All the questions are single response correct type, meaning that only one answer is correct out of all the given options. Majority of the question items have a positive stem and the answers also have a positive response so that the candidates are not confused in attempting these questions. It has also been our endeavor to develop and design the answers in such a way that primarily on first look all of the options may appear to be correct. In fact most of the options or alternatives that are given after the question are correct to a certain degree but there is only one option which is 'most' correct. This type of designing of question items helps to maximally test the genuine candidate and especially helps in putting out those who rely on guess work while solving the questions. An attempt has also been made to give the options in such a way that no two options are contradictory to each other so that the candidate zeroes on these two options easily and decides between the two and leaves behind the rest. To further add value to the questions, we have made an attempt to avoid asking those questions whose answers end with numbers as these confuse the reader. It is submitted that while every attempt has been made to cross check the accuracy of the answers, in case of any ambiguity the reader is advised to refer to standard textbooks. We hope that this work which has been based on our combined teaching experience of more than four decades in plastic surgery will prove useful and stimulating to the readers who will enrich their knowledge on the subject and will also help them in clearing the hurdle of examination in the discipline of not only plastic surgery but also allied specialities. RAJIV AGARWAL RAMESH CHANDRA [email protected] [email protected]