Plastic Surgery (Prometric)

A 44-year-old woman had silicone implants placed for cosmetic augmentation eight years ago. She is asymptomatic, has no palpable mass, and has a normal clinical examination. Mammography is up to date and negative. She asks whether a normal mammogram is sufficient to monitor implant integrity. She has no family history suggesting a hereditary breast-cancer syndrome and no symptoms suggesting infection or malignancy. Which surveillance recommendation is most appropriate?

A 7-month-old infant is referred for progressive forehead narrowing present since early infancy. Head circumference remains on the 35th percentile, development is normal, and ophthalmologic examination shows no papilledema. A palpable midline ridge is present, but the severity of the cranial deformity is uncertain clinically. Genetic assessment finds no syndromic features, and MRI shows no hydrocephalus or intracranial anomaly. The low-dose three-dimensional CT reconstruction is shown. The family can complete standard postoperative follow-up. Which management is most appropriate?

A 58-year-old office worker has progressive nocturnal numbness in the small and ring fingers for 14 months. Examination shows intrinsic muscle wasting, weak finger abduction, and a positive Froment sign. Electrodiagnostic testing demonstrates severe conduction slowing across the elbow with denervation, while cervical imaging is normal. She has used nighttime elbow-extension splinting and activity modification for 6 months without improvement. There is no elbow arthritis or instability. Which treatment is most appropriate?

A 9-year-old boy sustained a 12% TBSA deep partial-thickness burn across the anterior neck and upper chest. The wounds are fully epithelialized three weeks ago, with no infection or open areas. He now has a raised, itchy, tight scar that limits neck extension. The family can attend therapy and obtain custom garments. He has no steroid contraindication, but the scar is still immature and rapidly changing. Which management is most appropriate?

A 41-year-old woman has visible implant rippling after prepectoral reconstruction. Her body mass index is 19 kg/m², mastectomy flaps are thin but healthy, MRI confirms intact implants, and there is no contracture or malposition. She prefers to retain the current pocket because pectoralis animation would interfere with competitive swimming. Which revision is most appropriate?

A 24-year-old woman sustains a high-energy crush injury with open comminuted fractures of the middle and distal tibia. After serial excisional debridement and stable fixation, the wound shown remains circumferential, measures 20 × 24 cm, and exposes viable tibia and hardware. Cultures are negative, inflammatory markers are falling, and computed tomographic angiography confirms patent posterior tibial vessels outside the injury zone. The foot remains warm with preserved plantar sensation and active movement. Which definitive coverage strategy is most appropriate?

A 19-year-old man seeks correction of prominent ears. He has realistic expectations, normal hearing, no previous auricular surgery, and symmetric conchal excess with an underdeveloped antihelical fold. The supplied clinical photograph shows the auricular configuration. Skin quality is good, and the ears project 28 mm from the mastoid. He wants a durable correction with minimal risk of an unnatural sharp fold. Which operative plan is most appropriate?

A 59-year-old woman presents fifteen years after silicone augmentation with contour loss and tender axillary fullness. MRI confirms extracapsular implant rupture, while breast imaging excludes malignancy and late seroma. Axillary ultrasonography shows the pattern in the image; core biopsy reveals foreign-body giant cells without malignant cells. The nodes are uncomfortable but mobile, and there is no arm edema. Which management is most appropriate?

A 59-year-old man with diabetic neuropathy has a recurrent plantar midfoot ulcer and progressive rocker-bottom deformity. Radiographs are shown. MRI excludes active osteomyelitis, inflammatory markers are normal, and toe pressure is 64 mmHg. The ulcer heals in a total-contact cast but reopens when he resumes walking because the midfoot remains unstable. He is medically optimized and can comply with prolonged protected weight bearing. Which definitive strategy best addresses recurrence?

A 58-year-old woman undergoes circumferential pharyngolaryngectomy for recurrent hypopharyngeal carcinoma. The defect extends from the tongue base to the cervical esophagus, the neck skin is intact, and the stomach and small bowel are healthy. Recipient vessels are suitable, pulmonary function is good, and the team prioritizes rapid restoration of a lubricated conduit with minimal bulk. Which reconstruction is most appropriate?