Quiz questions from dermatosurgery

Match the suture material with its characteristics.

1. Nylon a. absorbable multifilament

2. Silk b. absorbable monofilament

3. Polyglactin c. non-absorbable monofilament

4. Polydioxanone d. non-absorbable multifilament

a) a-c, b-d, c-a, d-b

b) a-d, b-b, c-a, d-c

c) a-d, b-c, c-a, d-b

d) a-b, b-c, c-a, d-d

Identify the type of suture as shown in Figure 1

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Figure 1:

Identify the type of suture

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1. Vertical mattress suture

2. Horizontal mattress suture

3. Simple interrupted suture

4. Running subcuticular suture

What is the recommended time interval for suture removal after an eyelid excision?

1. 2–3 days

2. 5–7 days

3. 3–5 days

4. 1–2 days

What will be referred suture size for performing a procedure over the forehead?

1. 2-0

2. 3-0

3. 1-0

4. 4-0

What will be the maximum depth of anesthesia attained by eutectic mixture of local anesthetics (EMLA) at the end of 2 h post application?

1. 3 mm

2. 6 mm

3. 5 mm

4. 4 mm

A 70 kg adult is planned for a dermatosurgical procedure with topical lidocaine. What will be the maximum safe dose recommended?

1. 200 mg

2. 350 mg

3. 300 mg

4. 250 mg

Rubin aging analysis classification system consists of the following components except

1. Pigmentary changes

2. Wrinkles

3. Skin texture

4. Age

Match the following lasers with their wavelengths:

1. Neodymium-doped yttrium aluminum garnet (Nd: YAG) - a) 694 nm

2. Alexandrite - b) 10600 nm

3. Ruby - c) 1064 nm

4. Carbon dioxide (CO₂) - d) 755 nm

a) a-c, b-d, c-a, d-b

b) a-d, b-b, c-a, d-c

c) a-d, b-c, c-a, d-b

d) a-b, b-c, c-a, d-d

The electrosurgical methods that work with higher frequency and voltage, but with lower amperage and damped current, are

1. Electrosection and electrofulguration

2. Electrocoagulation and electrodessication

3. Electrofulguration and electrocoagulation

4. Electrodessication and electrofulguration

A patient with a BCC (basal cell carcinoma) lesion was treated with cryotherapy. What will be the advised extent for the lateral spread of freeze to achieve adequate treatment in such malignant lesions

1. 5 mm

2. 3 mm

3. 2 mm

4. 10 mm

What is the appropriate freezing time (in seconds) applied for a genital wart in cryotherapy?

1. 5–10 s

2. 20–30 s

3. 50–60 s

4. 10–20 s

Identify the type of flap as shown in Figure 2

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Figure 2:

Identify the type of flap

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1. Transposition flap

2. Advancement flap

3. Rotation flap

4. Interpolation flap

Food and Drug Administration (FDA)-approved indications for dermal fillers are all except

1. Human immunodeficiency virus (HIV) associated lipoatrophy

2. Nasolabial fold

3. Lip augmentation

4. Marionette lines

Which surgical technique for vitiligo allows achieving a donor-to-recipient ratio of 1:10?

1. Cultured melanocyte suspension

2. Non-cultured melanocyte suspension

3. Thin split-thickness skin grafting

4. Suction blister roof grafting

The ECCA scale is utilized to grade the severity of which condition?

1. Acne scar

2. Aging

3. Melasma

4. Burn scars

What is the approximate number of holes produced after 15 dermaroller passes over an area of 2 × 2 cm?

1. 200

2. 250

3. 500

4. 1000

TCA (trichloroacetic acid) percentage used in the CROSS (Chemical reconstruction of skin scars) technique

1. 30%

2. 50%

3. 70%

4. 100%

All listed sclerosant agents are detergents except

1. Polidocanol

2. Sodium tetradecyl sulfate

3. Chromated glycerine

4. Ethanolamine oleate

Patient X with varicose veins was advised to undergo sclerotherapy. The dermatosurgeon explained that he would perform complete sclerosation of the entire varicose vein. Which technique does this refer to?

1. Fegan

2. Sigg

3. Tessari

4. Monfreux

Sclerosant agent with anesthetic property

1. Ethanol

2. Acetic acid

3. Sodium tetradecyl sulfate

4. Polidocanol

Name the instrument as shown in Figure 3

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Figure 3:

Instrument for Q21

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1. Nail splitter

2. Nail cutter

3. Nail scissors

4. Nail puller

Identify the instrument as shown in Figure 4

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Figure 4:

Instrument for Q22

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1. Nail spatula

2. Manekshaw’s manual dermabrader

3. Spoon curette

4. BP (Bard-Parker) handle

Green tattoos are best targeted by which type of laser?

1. Alexandrite laser

2. Excimer laser

3. Diode laser

4. CO₂ laser

Match the chemical peel and its derivative

1. Malic acid – grape wine

2. Glycolic acid – almonds

3. Tartaric acid – sugarcane

4. Salicylic acid – apple

5. Mandelic acid – willow bark

a) a-c, b-d, c-a, d-b, e-b

b) a-d, b-b, c-a, d-c, e-d

c) a-d, b-c, c-a, d-e, e-b

d) a-b, b-a, c-a, d-c, e-d

Baker Gordon peel consists of

1. Phenol 88%, tap water, septisol, salicylic acid

2. Phenol 88%, tap water, septisol, resorcinol

3. Phenol 88%, tap water, septisol, croton oil

4. Phenol 88%, lactic acid, septisol, croton oil

Expand LADD

1. Laser-assisted drug delivery

2. Light-assisted drug delivery

3. Laser ablation and drug diffusion

4. Light-amplified dermal debridement

A 45-year-old female received Botox injections for glabellar lines, following which she developed eyelid ptosis. what will be the next management?

1. Timolol eye drops

2. Apraclonidine eye drops

3. Brimonidine eye drops

4. Oxymetazoline eye drops

Name the dermal filler technique shown in the given image? [Figure 5]

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Figure 5:

Dermal filler technique

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1. Linear threading

2. Serial puncture

3. Fan technique

4. Cross-hatching

The compound used in the R0 protocol method in tattoo removal is

1. Perfluorodecalin

2. Calcium oxide

3. Magnesium oxide

4. TCA

Which of the following is not an indication for platelet-rich plasma (PRP) therapy?

1. Melasma

2. Vitiligo

3. Psoriasis

4. Infected ulcers

(a). a-c, b-d, c-a, d-b

(a). Vertical mattress suture: This technique aids in better eversion of wound edges while minimizing both dead space and tension on the wound.^[1]

(c). 3–5 days:

Due to thin skin, high vascularity, and rapid healing of the eyelids, sutures are usually removed within 3–5 days to minimize scarring while maintaining wound integrity.

(d). 4-0: Suture size indicates the strand’s diameter and is expressed in zeros; an increasing number of zeros corresponds to a progressively thinner strand. Forehead is a facial area that closes under some tension, which requires 4-0.^[1] However, suture size on the forehead depends on the size of the defect and tension on the wound as well.

(c). 5 mm: The depth of analgesia depends on the duration of application of EMLA. The maximum depth achieved is 5 mm at the end of 2 h of application.^[2]

(c). 300 mg: Topical lidocaine can be used safely up to a maximum of 300 mg in an adult weighing around 70 kg, with peak anesthetic effects within 2–5 min, which lasts for 30–45 min.^[2]

(d). Age: Rubin system classifies aging signs according to 3 levels, which include changes in pigment, wrinkles, and recognizes the textural changes in skin texture, which are defined as dull, leathery, and rough.^[3] Age is not a consideration for the system.

(a). a-c, b-d, c-a, d-b: Wavelengths of commonly used lasers are: Excimer 308 nm, Frequency-doubled Nd: YAG 532 nm, pulsed dye laser 585–595 nm, Ruby 694 nm, Diodes 810 nm, Alexandrite 755 nm, Nd: YAG 1064, Erbium: Glass 1540 nm, Erbium: YAG 2940 nm, Carbon Dioxide 10600 nm.^[4]

(d). Electrodessication and electrofulguration: (1) In electrodessication, tissue is treated using a damped current characterized by high frequency, very high voltage, and low amperage. (2) Electrofulguration operates on the same mechanism, but the active electrode is positioned away from the skin rather than in direct contact.^[5]

(a). 5 mm: Effective treatment requires the cryotherapy freeze to extend a minimum of 2 mm beyond the margin for benign lesions and ≥5 mm for malignant lesions.^[6]

(a). 5–10 s: Freeze time for condyloma acuminata is 5–10 s, verrucae plana around 3–5 s, for premalignant and malignant skin lesions, such as BCC, superficial squamous cell carcinoma (SCC), Bowen disease is around 20–30 s.^[6]

(b). Advancement flap: A segment of tissue is moved in a linear axis to reconstruct the defect.^[7]

(d). Marionette lines: The US FDA approved Nasolabial folds in 2006, Correction of HIV-associated facial lipoatrophy in 2004.^[8,9]

(b). Non-cultured melanocyte suspension: In a non-cultured melanocyte suspension, the donor–recipient ratio is 1:10. In a cultured melanocyte suspension, the donor–recipient ratio is 1:100. In the case of thin split-thickness skin grafts, the surface area harvested from the donor site is approximately equal to the area of the recipient site, giving a ratio of 1:1.^[10]

(a). Acne scar: Echelle d`Evaluation Clinique des cicatrices d`acne – A quantitative grading scale developed for evaluating the acne scarring.^[11]

(c). 500 holes: Microneedling, also known as dermaroller therapy, is indicated for treating atrophic scars and promoting skin renewal. It has 192 needles, 200 µm length, 70 µm diameter, and when rolled over an area 15 times, it produces 250 holes/cm².^[12]

(d). 100%: TCA can be used as a superficial (15–20%) and medium-depth (35–50%) peel. 90–100% is used in chemical reconstruction of skin scars to treat ice pick acne scars, as it stimulates neocollagenesis.^[13]

(c). Chromated glycerine: 4% polyiodinated iodine are chemical irritants used in sclerotherapy. Polidocanol, Sodium tetradecyl sulfate, Ethanolamine oleate, and sodium morrhuate are detergent groups used in sclerotherapy.^[14]

(b). Sigg technique: Also known as the Swiss technique/total vein sclerotherapy advocates achieving total sclerosis of the varicose vein, including involvement of incompetent perforator veins and the saphenofemoral junction^[14]

(d). Polidocanol: A detergent-based compound initially formulated as an anesthetic, later discovered to have sclerosing effects on small-diameter vessels when injected intradermally.^[14]

(a). Nail splitter: Used in nail procedures to remove a longitudinal strip of the nail plate during partial avulsion.^[15]

(a). Nail spatula: Used during nail procedures to lift the nail plate away from the nail bed and proximal fold.^[15]

(a). Alexandrite laser: Both ruby (694 nm) and alexandrite (755 nm) lasers can treat green tattoos, but the alexandrite laser is generally regarded as the preferred option. It is also effective for removing black and blue tattoos.^[16]

(c). a-d, b-c, c-a, d-e, e-b: Alpha-hydroxy acids are carboxylic acids containing a hydroxyl group on the carbon adjacent to the carboxyl moiety. They occur naturally in many fruits and foods, including malic acid derived from apples, citric acid from citrus fruits such as lemons and oranges, tartaric acid from grapes, glycolic acid from sugar cane, mandelic acid from almonds and peanuts, and lactic acid from milk.^[17]

(c). Phenol 88%, tap water, Septisol, croton oil: Baker Gordon peel aids in improving fine and moderate depth wrinkles. Phenol is utilized in deeper peels, whereas croton oil, a vesicant and epidermolytic agent, enhances depth.^[18]

(a). Laser-assisted drug delivery: LADD is to facilitate increased topical absorption mainly through the skin.^[19]

(b). Apraclonidine eye drops: Stimulation of alpha-adrenergic receptors induces contraction of the Müller muscle, leading to elevation of the upper eyelid.^[20]

(d). Cross-hatching technique in dermal fillers: This technique involves injecting two sets of linear threads at right angles to each other, spaced about 5–10 mm apart.^[21]

(a). Topical perfluorodecalin: The R20 technique for tattoo removal involves delivering multiple Q-switched laser passes within a single treatment session. Each pass causes transient epidermal whitening (“frosting”), which initially limits further laser penetration into the dermis. Waiting about 20 minutes allows the frosting to dissipate, enabling the next pass to reach the dermal pigment effectively. Typically, four passes are performed in one session using this 20-minute interval. In contrast, the R0 method employs perfluorodecalin to rapidly clear the frosting, allowing successive laser passes without the 20-minute wait. With this approach, multiple passes can be made in quick succession–often with only about a 5-s gap between passes.^[22]

(d). Infected ulcers: PRP has not been indicated in infected ulcers; however, it has been indicated in non-healing ulcers, acne scars, and other various dermatological indications such as alopecia areata, androgenetic alopecia, melasma, vitiligo, and wound healing.^[23]