Monday, April 25, 2016

MCQ Primary Cleft Course for international trainees



MCQ Primary Cleft Course
Smiles 4 All

A charity project of www.smilemakernyc.com

A free primary cleft training resource for primary cleft trainees





1. ALL OF THE FOLLOWING ARE FEATURES OF THE UNILATERAL CLEFT LIP DEFORMITY -
•a.The Cupid’s bow is pulled up and the edge of the cleft lip is often thinned out because of the vermillion deficiency b.The orbicularis oris muscle in the lateral lip element ends upward at the margin of thecleft to insert into the alar wing. c.There are fibrous adhesions under the mucosa. The musculature between the philtral midline and the cleft is hypoplastic d.The philtrum is short and the ala cartilage on the cleft side is deformed .Two-thirds of the Cupid’s bow, one philtral column, and a dimple hollow are preserved.
•A.true
•B.false

2. IN UNILATERAL CLEFT LIP, THE SUPERFICIAL PART OF THE ORBICULARIS ORIS LOCATED IN THE VERMILION
•a. Is distorted along with the deep portion
•b. Inserts into the alar base
•c. Is simply interrupted without distortion
•d. Is hypoplastic and cannot be identified
•e.all of the above
•f. b
•a.true
•b.false

3. Our goal in cleft lip surgery is -
•1. Bring the Cupid’s bow to a more horizontal level
•2. Make both sides of the lip equal in size and length
•3. Exact placement of the stitch on the white roll
•4. Correct the alar defect as much as possible
•5. Eliminate the lip notch by a Z plasty/triangular mucosal flap
a. All of the above
b.None of the above
c. 1,2 and 3 only


4.In unilateral cleft nasal deformity, The inferior edge of the septum is dislocated out of the vomer groove and presents with the nasal spine in the floor of the normal nostril.
•A.true
•B.false
5. Our goal in cleft lip surgery is -
•1. Bring the Cupid’s bow to a more horizontal level
•2. Make both sides of the lip equal in size and length
•3. Exact placement of the stitch on the white roll
•4. Correct the alar defect as much as possible
•5. Eliminate the lip notch by a Z plasty/triangular mucosal flap
a. All of the above
b.None of the above
c. 1,2 and 3 only

6.In unilateral cleft nasal deformity, The inferior edge of the septum is dislocated out of the vomer groove and presents with the nasal spine in the floor of the normal nostril.
•A.true
•B.false

7. The following picture represents the anatomical markings of a normal lip
a.true b.false


8.The levator veli palatini muscle has a tendinous origin from inferior aspect of the petrous part of the temporal bone, on the proximal part of the apex just antero medial to the entrance into the carotid canal.Fleshy origins are from the tympanic part of the temporal bone and from the cartilage of the auditory tube
•a. the above statement is true
•b.false

9.The main function of the levator muscle is to a. tense the palate b. elevate of the soft palate
•a. the answer is a
•b. both a and b
•c.the correct answer is b

10.Both levator veli palatini and tensor veli palatini insert into the palatine aponeurosis
•a.true
•b.false

11. The greater palatine, gingiva,glands artery enters the palate through the greater palatine foramen and passes anteriorly on the lateral aspect of the hard palate to supply the palatal mucosa, and then proceeds to anastomose with the nasopalatine artery in the incisive canal
•a.true
•b.false

12. The bony part of the hard palate is covered by a specialized mucoperiosteum on both its oral and nasal surfaces.The posterior border possesses the palatine aponeurosis for attachment of the muscles of the soft palate
•a.true
•b.false

13. The muscles of the soft palate include Levator veli palatini ,Tensor veli palatini ,Musculus uvulae ,palatoglossus ,palatopharyngeus.
•a.true
•b. false

14. The pterygoid hook of the hamulus lies lateral to the maxillary tuberosity.
•a. true
•b. false, it is medial to the maxillary tuberosity

15. The soft palate’s anterior portion near its junction with the hard palate is almost fully mobile , whereas its posterior –most extent, the uvula is capable only of minimal movement.
•a. true statement
•b. false statement ; the soft palate junction with hard palate is immobile and the uvula is capable of great extension.

16. In cleft palate surgery ,levator muscle retropositioning is an essential step to ensure good speech outcomes.
•a.true
•b.false

17.The nasal lining is dissected from the palatal shelves during palatoplasty.During this procedure great care should be taken so that-
•a. the friable mucosa is not torn by rough handling
•b. the greater palatine artery is not injured in the process
18. Dissection of the anterior soft palate mucosa from the underlying levator muscle cause bleeding in younger patients due to
•a. abnormal blood vessels
•b. the presence of numerous gland which have a rich blood supply

19. It is best to raise the mucoperiosteal flap of the palate from-
•a. the midportion of the palate where the tissue attachment is looser and less vascular
•b. it does not make a difference

20. The nasal mucosal flaps during palate surgery are best raised- •a. from a lateral mucoperiosteal approach ,to avoid tearing the mucosa
•b. from a medial incision over the nasal mucosa

21.The common causes of palatal fistula are
•a. infection
•b. wrong technique with increased tension on repair
•c. all of the above

22. Submucus cleft palate is characterised by
•a.bifid uvula
•b.deficient midline muscle with zona pellucida
•c.osseous notch of the hard palate
•1. a and b
•2.all of the above

23. Following palatoplasty,the patient position post operatively is
1. supine
2.prone
3.lateral ,tonsillar position

A. It does not matter B. 3 is correct C. supine position is the best

24.The bulk of soft palate muscle is formed by the following muscle
•Tensor veli palatini
•Uvularis
•Levator veli palatini

25.Velopharyngeal closure is primarily due to the the action of the:
•Uvularis
•Palatoglossus
•Palatopharyngeus
•Superior constrictor
•Tensor veli palatini
•Levator veli palatine

26.Normal speech production requires the velopharyngeal port coupling of the nasal and oral cavities.
•a.true
•b.false

27.After primary palate repair and muscle repositiong ,all patients have satisfactory speech.
•True
•False

28.The functional goals of cleft palate surgery are-
•a.facilitate normal speech
•b.normal hearing
•c.minimal facial growth disturbance
•d.all of the above
•e.none of the above
•f.only a and b

29.The causes of VPI are the following:
•a.structural deficits
•b.neurogenic impairment
•c.mechanical interference to velopharyngeal closure
•d.all of the above
•e.only a and b

30.Severely hypertrophied tonsils should be removed before cleft palate repair in order toremove the mechanical obstruction and interference with velopharyngeal port closure.
•a.true
•b.false

31.The three common speech characteristics secondary to increased transmission through the nasal cavity are hypernasality, nasal emission,reduced aspiration and frication.
•a.true
•b.false

32. Velopharyngeal incompetency can be evaluated by-
•a. clinical evaluation
•b. instrumental evaluation
•c. all of the above
•d. only b

33. Inaudible nasal emission during vowel production can be diagnosed by
•a. electromyography
•b. the mirror test
•c. tissue paper test
•d.all of the above
•e. b and c

34. Plosive is a consonant sound made by closing the air passage and the releasing the air in a way that can be heard eg.p,t and top.
•a.true
•b.false

35. A consonant sound made by forcing breath out through a narrow space in the mouth with lips,teeth,tongue in a certain position eg. v,z is called
•a.voiced fricative
•b.voiceless fricative

36. A consonant sound made by forcing breath out through a narrow space in the mouth with lips,teeth,tongue in a certain position eg. F,s,h is called
•a.plosive
•b.voiceless fricative
•c.voiced fricative

37.Craniofacial clefts occur in 0.075-3.1 % of cleft births and include facial cleft deformity which involves
•a.the eye,
•b.the zygoma,
•c. the tm joint,
•d.the cranium
•e.all of the above

•38. Theories of causes for craniofacial cleft include focal fetal dysplasia,amniotic bands,chromosomal arrangements
•a.true
•b.false

•39.Oblique facial clefts -
•1. include Tessier clefts 3-5(lips) and 9-13(orbit region)
•2. may involve soft tissue and bone
•a.1and 2
•b.only 1

•40. Median cleft lip is also known as Tessier 0 -
•a.involves the lips and sometimes also the premax and nasal skeleton
•b.may be associated with a bifid nose and double frenulum
•c.some may have severe brain deformity and hypotelorism
•d.none of the above
•e.all of the above
•f.only a is correct

•41. Tessier 7 cleft is
•a. the same as lateral cleft lip and mostly unilateral
•b.the patient has macrostomia
•c.it is rare and occurs in 1:80,000 live births
•d.may occur with hemifacial microsomia
•e.can be repaired by a simple straight line closure of muscle and skin and a vermillion mucosa flap for the commisure
•f.all of the above

42.Topical tetracycline in cleft lip surgery is effective against methicillin resistant staph aureus and also streptococci pneumoniae,e coli and klebsiella pneumoniae
•a.true
•b.false

•43.Platelet rich plasma -
•a. is rich in growth factors,and is useful for restoring damaged tissues
•b.contains platelet derived growth factor which promotes collagen formation and cell growth
•c.fibroblast growth factor useful for tissue repair and collagen formation
•d.promotes wound healing through angiogenesis through endothelial growth factor
•e.enhances growth of epithelial cells through transforming growth factor TGF-B1
•f.helps in generation and growth of new keratinocytes through KGF keratinocyte growth factor

•44. Microneedling using 1.0mm microneedles is useful for
•a. remodelling of the skin by causing thousands of microscopic channels in the skin
•b. increases new tissue formation
•c.both are correct

•45.Platelet rich plasma is prepared from the patient’s own blood
•a.true
•b.false
•c.is artificially manufactured

46. The following challenges can occur in cleft palates
1.large and deep nasopharynx
2.short and immobile palate
3. very wide palate
A. true B. False C. Only 2 and 3 are correct

47. Both Furlows and Intravelar veloplasty for cleft palate have-
1.low morbidity rates
2.improved speech scores
3. low re operation rates
4.both present an advantage over potential airway obstruction procedures like the pharyngeal flap.
A. all of the above B. None of the above 3. Only 1 and 3 are correct

48. The following statement is wrong, “ Late repair of palate always means bad speech outcomes”
A. True B. False
49. Fracture of the hook of Hamulus-
1. causes mid ear effusion and hearing problems
2. it should be avoided
3. studies have shown that it is a safe and useful procedure in palatoplasty

A. All are correct B. Only 3 is correct C. Only 1 and 2 are correct

50. Complete cleft palate repair in 9-11 month old babies causes
1. post operative hypoxemia
2. bronchospasm
3. should be done as a two stage procedure to avoid potential complications
A. All are incorrect B. Only 1 and 2 are incorrect C. 3 is correct

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