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Prepguidance
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Q1. The most appropriate management of a unicystic ameloblastoma of the mandible?

(A) Observation

(B) Enucleation and curettage

(C) Radical resection with at least a 1-cm margin

(D) Radiation therapy

Correct Answer - B

Answers explained

The most appropriate management of a unicystic ameloblastoma of the mandible is enucleation and curettage, with frequent follow-up examinations. This type of tumor typically occurs in patients age 20 to 30 years and is found within the posterior mandible. It originates within the epithelial wall of a dentigerous cyst. Recurrence is uncommon.

Observation is inadequate management. If this type of tumor is left untreated, it continues to grow and is locally destructive.

Radical resection and/or hemimandibulectomy is recommended for patients with peripheral or extraosseous ameloblastoma. These aggressive tumors recur in 20% of affected patients. A biopsy specimen shows acanthomatous variety. Microscopic examination shows features similar to squamous cell carcinoma. Radiation therapy is not necessary since unicystic ameloblastomas of the mandible are benign tumors. A conventional or intraosseous ameloblastoma without tumor involvement of the margins is effectively treated with marginal (segmental) mandibular resection. Cortical spread of the tumor indicates the need for en-bloc resection with a 1-cm margin.

Q2. NOT a characteristic of Horner’s syndrome?

(A) Enophthalmos

(B) Exophthalmos

(C) Miosis

(D) Ptosis

Correct Answer - B

Answers explained

Exophthalmos is not a feature of the Horner’s syndrome. The syndrome is due to sympathetic nervous system disturbance and should lead one to suspect the level of injury to be around T1 and T2 because of the location of the sympathetic ganglions close to that level. The syndrome is the result of paralysis of the cervical sympathetic nerves. Johann F Horner was a Swiss Ophthalmologist from 1831–1886.

Q3. The reconstructive techniques which is most likely to provide optimal tongue function following hemiglossectomy?

(A) Free fibular flap

(B) Free radial forearm flap

(C) Pedicled tongue flap

(D) Sternocleidomastoid flap

Correct Answer - B

Answers explained

In a patient who has undergone hemiglossectomy, a free radial forearm flap is most appropriate for reconstruction of the defect. This flap will provide a thin segment of tissue that will allow mobility of the reconstructed tongue.

Resurfacing of the oral cavity is also possible with this flap. The free fibular flap can be used for reconstruction of a segment of the mandible. Use of a sternocleidomastoid flap is associated with a high incidence of flap failure. A pedicled tongue flap or split-thickness skin graft would not provide sufficient tissue for reconstruction and would further limit tongue mobility.

Q4. Moberg flap is a volar advancement flap and is best used for reconstruction of ?

(A) Thumb reconstruction

(B) Finger reconstruction

(C) Toe reconstruction

(D) Dorsal hand reconstruction

Correct Answer - A

Answers explained

Moberg flap is especially indicated in cases of loss of terminal part of the thumb, where length and sensations are to be maintained. It is based on both the neurovascular pedicles and hence provides good sensation and is dependable because of its good vascularity. Flap can be advanced by 1.0-1.5 cm to cover the defect. It is specially indicated for the thumb because of presence of independent dorsal blood supply which prevents against necrosis of the dorsal skin.

Q5. Radiologically, the brachial plexus injuries are best evaluated by?

(A) Ultrasonography

(B) Plain X-Ray

(C) CT scan

(D) MRI scan

Correct Answer - D

Answers explained

The MRI scan would provide the maximum information in cases of brachial plexus injuries, whether it be fracture of cervical spine, pseudo-meningocoeles, avulsion of roots, nerve injuries or neuromas. Other modalities are also helpful but do not provide the same quantum of information as a MRI does.

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