1
Q
What is Myofascial Pain Dysfunction (MPD)?
A) An articular disorder of the TMJ disc
B) A non-articular TMJ disorder presenting as dull regional masticatory myalgia that worsens with function and decreases range of motion
C) A neuralgia involving V3
D) An inflammatory condition of the TMJ capsule
A
Answer:
B) A non-articular TMJ disorder presenting as dull regional masticatory myalgia that worsens with function and decreases range of motion
2
Q
Q: MPD can involve which muscle groups?
A) Only masseter
B) Only temporalis
C) Supramandibular and/or inframandibular muscle groups
D) Sternocleidomastoid only
A
Answer:
C) Supramandibular and/or inframandibular muscle groups
3
Q
What is the most common TMJ disorder?
A) Internal derangement
B) Synovitis
C) Myofascial Pain Dysfunction (MPD)
D) Ankylosis
A
Answer:
C) Myofascial Pain Dysfunction (MPD)
4
Q
Which of the following is NOT an etiology of MPD?
A) Parafunctional habits (bruxism, nail biting, gum chewing)
B) Life stressors
C) Overjet > 6 mm or apertognathia
D) Condylar fracture
E) Loss of posterior dentition → muscle hyperactivity
A
Answer:
D) Condylar fracture
5
Q
Which of the following is a classic clinical manifestation of Myofascial Pain Dysfunction (MPD)?
A) Sharp preauricular pain localized to TMJ
B) Diffuse jaw pain involving muscles of mastication, worsens with function
C) Clicking/popping joint noises only
D) Deviation on opening without pain
A
Answer:
B) Diffuse jaw pain involving muscles of mastication, worsens with function
6
Q
Which oral findings may be associated with MPD? (Select all that apply)
A) Wear facets of dentition
B) Scalloping of the tongue
C) Morsicatio buccarum/labiorum/linguarum
D) Buccal exostoses
A
Answer:
A, B, C, D — all of the above
7
Q
MPD pain is usually diffuse, muscular, and facial. Which conditions are important differentials?
A) Trigeminal neuralgia
B) Atypical facial pain
C) Fibromyalgia
D) All of the above
A
Answer:
D) All of the above
8
Q
Q: Which of the following is a recommended NSAID regimen for MPD?
A) Ibuprofen 200 mg once daily × 1 week
B) Naproxen 500 mg BID × 2 weeks
C) Mobic (meloxicam) 15 mg TID × 1 week
D) Aspirin 81 mg daily
A
Answer:
B) Naproxen 500 mg BID × 2 weeks
(Other options: Ibuprofen 600 mg QID × 2 weeks, Mobic 7.5–15 mg daily × 2 weeks)
9
Q
Besides NSAIDs, which of the following are recommended treatments for MPD?
A) Occlusal appliance
B) Soft diet
C) Muscle relaxants
D) All of the above
A
Answer:
D) All of the above
10
Q
Myofascial Pain Dysfunction (Advanced Management)
Q1: Which muscle relaxants are commonly prescribed for MPD?
A) Diazepam and Lorazepam
B) Cyclobenzaprine and Baclofen
C) Gabapentin and Pregabalin
D) Ketorolac and Celecoxib
A
Answer:
B) Cyclobenzaprine and Baclofen
Cyclobenzaprine: 5–10 mg QHS (some advocate TID, but sedation/dizziness is a concern)
Baclofen: 5–10 mg TID
11
Q
Which of the following are non-pharmacologic treatments for MPD?
A) Warm compresses
B) Occlusal equilibration
C) Trigger point injections / Botox
D) Physical therapy
E) Replacing missing posterior dentition
A
Answer:
All of the above
12
Q
What is the definition of Degenerative Joint Disease (DJD) of the TMJ?
A) Acute bacterial infection of the joint
B) Chronic inflammatory arthritis within the TMJ, leading to articular cartilage degradation and subchondral bone remodeling
C) Displacement of the TMJ disc anteriorly
D) Fibrous ankylosis of the condyle
A
Answer:
B) Chronic inflammatory arthritis within the TMJ, leading to articular cartilage degradation and subchondral bone remodeling
13
Q
What is another term for non-inflammatory DJD of the TMJ?
A) Osteochondrosis
B) Osteoarthritis
C) Rheumatoid arthritis
D) Ankylosing spondylitis
A
Answer:
B) Osteoarthritis
14
Q
What is the key pathophysiologic mechanism in TMJ osteoarthritis?
A) Excessive synovial fluid production
B) Imbalance between catabolic and anabolic processes, leading to cytokine release (TNF-α, IL-1, IL-6) and collagenase activity
C) Increased bone deposition due to Wolff’s law
D) Autoimmune destruction of synovium
A
Answer:
B) Imbalance between catabolic and anabolic processes, leading to cytokine release (TNF-α, IL-1, IL-6) and collagenase activity
DJD/OA = joint disorder, due to catabolic cytokines degrading cartilage.
15
Q
What is the treatment approach for mild DJD of the TMJ?
A) Immediate surgery
B) Medications, physical therapy, or steroid/DMARDs depending on severity
C) Radiation therapy
D) Disc removal only
A
Answer:
B) Medications, physical therapy, or steroid/DMARDs depending on severity
16
Q
In mild DJD cases failing conservative management, what procedures may be considered?
A) Arthrocentesis and arthroscopic procedures
B) Condylectomy
C) Total joint replacement
D) Gap arthroplasty
A
Answer:
Arthrocentesis and arthroscopic procedures
17
Q
What is the treatment for advanced DJD with significant life disruption?
A) Occlusal splint therapy only
B) Arthroplasty or total joint replacement
C) Trigger point injections
D) Muscle relaxants
A
Answer:
B) Arthroplasty or total joint replacement
18
Q
Internal Derangement (ID) of the TMJ
Q4: What is the definition of Internal Derangement of the TMJ?
A) Chronic inflammatory arthritis of the joint
B) Displacement of the articular disk into an abnormal position relative to the condyle and fossa when teeth are in occlusion
C) Infection of the TMJ capsule
D) Fibrous ankylosis of the condyle
A
Answer:
B) Displacement of the articular disk into an abnormal position relative to the condyle and fossa when teeth are in occlusion
19
Q
What clinical problems may result from Internal Derangement?
A) Pain and instability
B) Decreased range of motion
C) Abnormal mandibular mobility
D) All of the above
A
Answer:
D) All of the above
20
Q
What type of joint is the temporomandibular joint (TMJ)?
A) Hinge joint
B) Ball-and-socket joint
C) Ginglymoarthrodial joint
D) Saddle joint
A
Answer:
C) Ginglymoarthrodial joint
Rotation = inferior joint space
Translation = superior joint space
21
Q
Which ligament surrounds the TMJ and is lined by synovium?
A) Collateral ligament
B) Capsular ligament
C) Temporomandibular ligament
D) Stylomandibular ligament
A
Answer:
B) Capsular ligament
22
Q
Which ligament surrounds the TMJ and is lined by synovium?
A) Collateral ligament
B) Capsular ligament
C) Temporomandibular ligament
D) Stylomandibular ligament
A
Answer:
B) Capsular ligament
23
Q
What are the functions of the synovium in the TMJ capsule?
A) Nutrition of joint structures
B) Immunosurveillance
C) Lubrication
D) All of the above
A
Answer:
D) All of the above
24
Q
Which are the functional ligaments of the TMJ?
A) Capsular, collateral, temporomandibular
B) Stylomandibular, sphenomandibular
C) Collateral, temporomandibular, stylomandibular
D) Capsular, stylomandibular, sphenomandibular
A
Answer:
A) Capsular, collateral, temporomandibular
25
Which are the accessory ligaments of the TMJ?
A) Capsular and collateral
B) Temporomandibular and capsular
C) Sphenomandibular and stylomandibular
D) Collateral and temporomandibular
Answer:
C) Sphenomandibular and stylomandibular
26
What type of cartilage composes the articular disc of the TMJ?
A) Hyaline cartilage
B) Elastic cartilage
C) Fibrocartilage
D) Calcified cartilage
Answer:
C) Fibrocartilage
27
Which part of the articular disc is highly vascular and innervated?
A) Anterior band
B) Intermediate band
C) Posterior band
D) Retrodiscal tissues
Answer:
D) Retrodiscal tissues
✅ Board Pearl:
Rotation = inferior compartment.
Translation = superior compartment.
Disc = fibrocartilage (not hyaline like most joints).
Retrodiscal tissue = pain-sensitive → key in internal derangements
28
Which arteries provide the primary vascular supply to the TMJ?
A) Facial, lingual, occipital
B) Superficial temporal, maxillary, masseteric
C) Superior thyroid, lingual, ascending pharyngeal
D) Posterior auricular, transverse facial
Answer:
B) Superficial temporal, maxillary, masseteric
29
30
What is the predominant nerve supply of the TMJ?
A) Inferior alveolar nerve
B) Auriculotemporal nerve
C) Masseteric nerve
D) Posterior deep temporal nerve
Answer:
B) Auriculotemporal nerve
31
Which additional nerves contribute to TMJ innervation besides the auriculotemporal nerve?
A) Masseteric and posterior deep temporal nerves
B) Lingual and buccal nerves
C) Zygomaticotemporal and infraorbital nerves
D) Chorda tympani and glossopharyngeal
Answer:
A) Masseteric and posterior deep temporal nerves
✅ Board Pearl:
TMJ blood supply = branches of ECA (superficial temporal + maxillary + masseteric).
TMJ innervation = mainly auriculotemporal (V3) + contributions from masseteric & posterior deep temporal (V3 branches).
32
What are the three zones of the TMJ articular disk?
A) Superior, middle, inferior
B) Anterior band, intermediate band, posterior band
C) Medial, lateral, central
D) Superior lamina, intermediate lamina, inferior lamina
Answer:
B) Anterior band, intermediate band, posterior band
33
What lies posterior to the articular disk and is highly vascular and innervated?
A) Masseter muscle
B) Retrodiscal tissues
C) Sphenomandibular ligament
D) Condylar neck
Answer:
B) Retrodiscal tissues
Board Pearl 💡
Disk = fibrocartilage (unlike most joints, which are hyaline).
Intermediate band = thinnest, load-bearing zone.
Retrodiscal tissue = vascular + innervated → main source of pain in internal derangements.
34
Which branch of the facial nerve is most relevant in TMJ surgery?
A) Buccal branch
B) Temporal branch
C) Marginal mandibular branch
D) Zygomatic branch
Answer:
B) Temporal branch
35
According to the Al-Kayat study, how far is the temporal branch of the facial nerve from the anterior border of the bony external auditory canal?
A) 0.1–0.5 cm
B) 0.8–3.5 cm
C) 4–6 cm
D) >5 cm
Answer:
B) 0.8–3.5 cm
36
At what landmarks does the temporal branch of the facial nerve become superficial to the SMAS layer?
A) 0.5 cm above zygomatic arch
B) 1.5–3 cm above zygomatic arch
C) 0.5 cm lateral to orbital rim
D) 1.5 cm lateral to orbital rim
Answer:
B) 1.5–3 cm above zygomatic arch
D) 1.5 cm lateral to orbital rim
37
Which vascular structure is clinically relevant during condylectomy, and where is it located?
A) Facial artery; lateral to condylar process
B) Maxillary vein; superior to condylar head
C) Internal maxillary artery; medial to condylar process, 20 mm below condylar head
D) Superficial temporal artery; medial to condylar process
Answer:
C) Internal maxillary artery; medial to condylar process, 20 mm below condylar head
38
What is the correct order of tissue layers when accessing the TMJ capsule surgically?
A) Skin → Periosteum → SMAS → Subcutaneous tissue → Capsule
B) Skin → Subcutaneous tissue → SMAS → Superficial layer of deep temporalis fascia → Periosteum/capsule
C) Skin → SMAS → Temporalis muscle → Capsule
D) Skin → Capsule directly
Answer:
B) Skin → Subcutaneous tissue → SMAS → Superficial layer of deep temporalis fascia → Periosteum/capsule
39
How is the superior joint space entered surgically?
A) Vertical incision along condylar neck
B) Horizontal incision just below superior border of glenoid fossa, anterior → posterior (retrodiscal tissue last)
C) Vertical incision posterior to condyle
D) Direct incision through retrodiscal tissue
Answer:
B) Horizontal incision just below superior border of glenoid fossa, anterior → posterior (retrodiscal tissue last)
40
What is a T-incision used for in TMJ surgery?
A) Entering inferior joint space
B) Exposing condylar process
C) Accessing retrodiscal tissue
D) Dissecting the SMAS
Answer:
B) Exposing condylar process
Horizontal limb = entry into upper joint space
Vertical limb = extends inferiorly in middle of condylar neck
41
What complication can occur if retrodiscal tissue is cut, and how is it controlled?
A) Nerve palsy; suturing capsule
B) Excessive bleeding; control with condyle reseating in fossa + pressure ± electrocautery
C) Joint ankylosis; corticosteroid injection
D) Disc perforation; collagen graft placement
Answer:
B) Excessive bleeding; control with condyle reseating in fossa + pressure ± electrocautery
42
Which Wilkes stage is characterized by painless clicking, no pain or locking, anterior disk displacement with normal contour, and no osseous changes?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Answer: A) Stage I
43
Which Wilkes stage shows occasional painful clicking with intermittent locking, anterior disk displacement with reduction, mild disk deformity, and no osseous changes?
A) Stage I
B) Stage II
C) Stage III
D) Stage V
Answer: B) Stage II
44
At which Wilkes stage are osseous changes first noted?
A) Stage II
B) Stage III
C) Stage IV
D) Stage V
Answer: C) Stage IV
45
At which Wilkes stage does anterior disk displacement without reduction first appear?
A) Stage II
B) Stage III
C) Stage IV
D) Stage V
Answer: B) Stage III
46
What is the main difference between Wilkes Stage IV and Stage V internal derangement?
A) Stage IV has anterior disk displacement with reduction; Stage V does not
B) Stage IV has osseous changes; Stage V does not
C) Stage IV shows disk perforation with osseous changes; Stage V shows disk perforation with severe osseous changes of condyle and fossa
D) Stage IV presents with painless clicking; Stage V presents with crepitus
C) Stage IV shows disk perforation with osseous changes; Stage V shows disk perforation with severe osseous changes of condyle and fossa
47
Which Wilkes stage is defined by frequent painful clicking, severe limitation of motion, anterior disk displacement without reduction, moderate disk deformity, and no osseous changes?
A) Stage II
B) Stage III
C) Stage IV
D) Stage V
Answer: B) Stage III
48
Which Wilkes stage is characterized by restricted range of motion, chronic pain with crepitus, anterior disk displacement without reduction, marked disk deformity, and osseous changes?
A) Stage II
B) Stage III
C) Stage IV
D) Stage V
Answer: C) Stage IV
49
Which Wilkes stage demonstrates joint pain with crepitus, disk displacement with marked deformity, and severe osseous changes of the condylar head and fossa?
A) Stage III
B) Stage IV
C) Stage V
D) Stage II
Answer: C) Stage V
50
At what Wilkes stage does crepitus typically begin?
A) Stage II
B) Stage III
C) Stage IV
D) Stage V
Answer: C) Stage IV
51
At what Wilkes stage is a perforated disk first noted?
A) Stage II
B) Stage III
C) Stage IV
D) Stage V
Answer: C) Stage IV
52
Which imaging modality is most useful for diagnosing disk displacement in TMJ?
A) Panoramic radiograph
B) CT scan
C) MRI (T1 and T2)
D) Ultrasound
Answer: C) MRI (T1 and T2)
🔑 Key: MRI shows anteromedial displacement, osseous changes, and abnormal disk contours.
53
In disk displacement with reduction, what clinical feature is most characteristic?
A) Crepitus during movement
B) Single painless click
C) Two clicks — one on opening and one on closing
D) No joint sounds
Answer: C) Two clicks — one on opening and one on closing
🔑 Key: Disk reduces on opening and re-displaces on closing.
54
In disk displacement without reduction, what is typically observed?
A) Two clicks (opening and closing)
B) Limited opening with deviation to ipsilateral side
C) Normal ROM with no pain
D) Crepitus only
Answer: B) Limited opening with deviation to ipsilateral side
🔑 Key: Condyle cannot pass over posterior band of the disk → restriction + deviation.
55
In Sawhney Type 1 TMJ ankylosis, what is the main radiographic finding?
A. Bony block bridging ramus and zygomatic arch
B. Flattened condylar head with close approximation to joint space
C. Flattened condyle fused to glenoid fossa medially
D. Wider bony block completely replacing joint
B. Flattened condylar head with close approximation to joint space ✅
56
Which Sawhney type shows bony fusion on the outer articular surface but no medial fusion?
A. Type 1
B. Type 2
C. Type 3
D. Type 4
B. Type 2
57
Sawhney Type 3 ankylosis is best described as:
A. Flattened condyle close to glenoid fossa without medial fusion
B. Flattened condylar head only
C. Bony block bridging mandibular ramus and zygomatic arch
D. Wider bony block replacing joint architecture
C. Bony block bridging mandibular ramus and zygomatic arch ✅
58
Complete replacement of the joint’s architecture with a wide bony block corresponds to which Sawhney type?
A. Type 1
B. Type 2
C. Type 3
D. Type 4
D. Type 4 ✅
59
In Sawhney’s classification of TMJ ankylosis, which type is characterized by a bony block bridging the mandibular ramus and zygomatic arch, but the joint architecture is still partially preserved?
A. Type I
B. Type II
C. Type III
D. Type IV
✅ Answer: C. Type III
60
In Sawhney’s classification, which type demonstrates a wide bony block bridging the mandibular ramus and zygomatic arch with complete replacement of joint architecture?
A. Type II
B. Type III
C. Type IV
D. Topazian Stage 3
✅ Answer: C. Type IV
61
The main difference between Sawhney Type III and Type IV TMJ ankylosis is:
A. Presence of fibrous vs. bony ankylosis
B. Location of condylar flattening
C. Preservation vs. obliteration of joint architecture
D. Involvement of sigmoid notch
✅ Answer: C. Preservation vs. obliteration of joint architecture
62
In Topazian Stage 1 ankylosis, which structure is involved?
A. Sigmoid notch
B. Entire condyle, sigmoid notch, and coronoid
C. Only condyle
D. Glenoid fossa
C. Only condyle
63
Topazian Stage 2 ankylosis extends to involve which structure?
A. Glenoid fossa
B. Sigmoid notch
C. Coronoid only
D. Ramus and zygomatic arch
B. Sigmoid notch ✅
64
Topazian Stage 3 ankylosis involves:
A. Only condyle
B. Condyle + sigmoid notch
C. Condyle, sigmoid notch, and coronoid
D. Ramus and zygomatic arch
C. Condyle, sigmoid notch, and coronoid ✅
B. Condyle + sigmoid notch ✅
65
What is the first step in the Seven-Step Kaban Protocol for treating TMJ ankylosis in pediatric patients?
A. Coronoidectomy on the affected side
B. Lining of the TMJ with temporalis flap
C. Aggressive resection of the ankylotic mass
D. Reconstruction of the ramus-condyle unit
Answer: C. Aggressive resection of the ankylotic mass
66
In the Kaban Protocol, what procedure is performed on the affected side after ankylotic mass resection to assess intraoperative mouth opening?
A. Contralateral coronoidectomy
B. Ipsilateral coronoidectomy
C. Costochondral grafting
D. TMJ prosthesis placement
Answer: B. Ipsilateral coronoidectomy
67
When is contralateral coronoidectomy indicated in the Kaban Protocol?
A. Always performed bilaterally
B. If MIO > 35 mm is already achieved
C. If MIO > 35 mm cannot be achieved and/or to dislocate the unaffected TMJ
D. Only in adults with ankylosis
Answer: C. If MIO > 35 mm cannot be achieved and/or to dislocate the unaffected TMJ
68
What is recommended to line the TMJ after ankylosis release in the Kaban Protocol?
A. Fat graft only
B. Temporalis myofascial flap or native disk (if salvageable)
C. Buccal fat pad only
D. Muscle-free graft
B. Temporalis myofascial flap or native disk (if salvageable)
69
How is the ramus-condyle unit reconstructed in the Kaban Protocol?
A. With prosthetic joint only
B. With costochondral graft only
C. With distraction osteogenesis (DO)
D. With bone marrow aspirate
Answer: C. With distraction osteogenesis (DO)
70
In distraction osteogenesis (DO) for TMJ ankylosis reconstruction, what is the typical distraction rate?
A. 0.5 mm/day
B. 1 mm/day
C. 2 mm/day
D. 3 mm/day
Answer: B. 1 mm/day
71
When does mobilization begin after distraction osteogenesis (DO) for TMJ ankylosis?
A. After 10 days of MMF
B. After 2 weeks
C. Immediately (day of operation)
D. After 1 month
Answer: C. Immediately (day of operation) ✅
72
After costochondral graft (CCG) reconstruction for TMJ ankylosis, when does mobilization typically begin?
A. Immediately after surgery
B. After 2–4 days
C. After 10 days of MMF
D. After 3 weeks
Answer: C. After 10 days of MMF
73
Treatment options for fibrous ankylosis include:
A. Discectomy only
B. Condylectomy
C. Lysis of adhesions and fibrosis ± discectomy
D. Prosthetic joint replacement
Answer: C. Lysis of adhesions and fibrosis ± discectomy ✅
74
Postoperative management of TMJ ankylosis surgery includes all EXCEPT:
A. Aggressive physiotherapy
B. Frequent follow-up
C. Radiation therapy in select cases
D. Prolonged immobilization to prevent recurrence
Answer: D. Prolonged immobilization to prevent recurrence ❌ (mobilization is key!)
75
What is the primary blood supply to the temporalis myofascial flap (used in TMJ reconstruction)?
A) Superficial temporal artery
B) Posterior auricular artery
C) Deep temporal arteries (from maxillary artery)
D) Occipital artery
Answer: C) Deep temporal arteries (from maxillary artery) ✅
76
What is the primary vascular supply to the temporalis myofascial flap used in TMJ surgery?
A) Middle meningeal artery
B) Superficial temporal artery
C) Anterior & posterior deep temporal arteries
D) Posterior auricular artery
Answer: C) Anterior & posterior deep temporal arteries ✅
77
The anterior and posterior deep temporal arteries are branches of which artery?
A) Facial artery
B) Internal maxillary artery
C) Superficial temporal artery
D) Lingual artery
Answer: B) Internal maxillary artery ✅
78
What artery provides additional contribution to the temporalis myofascial flap and arises from the superficial temporal artery?
A) Posterior auricular artery
B) Middle temporal artery
C) Transverse facial artery
D) Maxillary artery
Answer: B) Middle temporal artery ✅
79
The superficial temporal artery contributes to the temporalis flap blood supply by:
A) Being the primary supply
B) Providing only venous drainage
C) Contributing collateral flow
D) No contribution
Answer: C) Contributing collateral flow ✅
80
Venous drainage of the temporalis myofascial flap follows which of the following patterns?
A) Drains exclusively into facial vein
B) Does not follow arterial pathways
C) Parallels the arterial system
D) Drains into occipital vein
Answer: C) Parallels the arterial system ✅
81
What is the most common indication for using a costochondral graft (CCG) in OMFS?
A) TMJ reconstruction in adults
B) TMJ reconstruction in growing children
C) Cosmetic mandibular augmentation
D) Repair of nasal septum defects
Answer: B) TMJ reconstruction in growing children ✅
82
Which advantages are associated with costochondral grafts (CCG)?
A) High morbidity, low adaptation
B) Remodeling potential, low morbidity, low infection risk, reduced cost
C) Increased infection, poor adaptation
D) Minimal remodeling, but fast harvest
Answer: B) Remodeling potential, low morbidity, low infection risk, reduced cost ✅
83
How much rib length can typically be harvested in adults for a costochondral graft?
A) 5–7 cm
B) 7–10 cm
C) 12–17 cm
D) 20 cm
Answer: C) 12–17 cm ✅
84
Which ribs are most commonly used for costochondral grafts?
A) 1–3
B) 4–7
C) 8–10
D) 11–12
Answer: B) 4–7 ✅
85
Which rib is most commonly harvested for CCG due to favorable cosmetic incision in the inframammary crease?
A) Rib 4
B) Rib 5
C) Rib 6
D) Rib 7
Answer: C) Rib 6 ✅
86
Why is the right rib preferred over the left for costochondral graft harvest?
A) Better vascularity
B) Easier access
C) Avoids confusion with cardiogenic pain
D) Closer to sternum
Answer: C) Avoids confusion with cardiogenic pain ✅
87
Where is the incision typically made for costochondral rib graft harvest?
A) Subclavicular crease
B) Inframammary crease (~5 cm long)
C) Midline sternum
D) Supraclavicular fossa
Answer: B) Inframammary crease (~5 cm long) ✅
88
Dissection for rib harvest is carried through which anatomical planes?
A) Skin → Subcutaneous tissue → Pectoralis major → Rectus abdominis
B) Subcutaneous tissue → Fascia → Plane between pectoralis major & rectus abdominis
C) Subcutaneous tissue → Intercostal muscles → Pleura
D) Subcutaneous tissue → Latissimus dorsi → Serratus anterior
Answer: B) Subcutaneous tissue → Fascia → Plane between pectoralis major & rectus abdominis ✅
89
What is the purpose of straddling the 5th and 6th intercostal space with two fingers during rib harvest?
A) To locate the periosteum
B) To prevent slipping of instruments
C) To control bleeding
D) To measure graft length
Answer: B) To prevent slipping of instruments ✅
90
Which instrument is preferred for subperiosteal dissection during rib harvest to avoid pleural tears?
A) Doyen rib stripper
B) Molt periosteal elevator
C) Rib cutter
D) Sharp scalpel
Answer: B) Molt periosteal elevator ✅
(Doyen rib stripper is less favored due to pleural tear risk.)
91
In children, what is the maximum recommended length of rib cartilage to harvest in order to avoid overgrowth?
A) 1–2 cm
B) No more than 3 cm
C) 4–5 cm
D) 6 cm
Answer: B) No more than 3 cm (minimum 1 cm) ✅
92
What is the final intraoperative check for pleural tears during rib harvest?
A) Chest X-ray
B) Filling the cavity with normal saline and performing Valsalva maneuver
C) Visual inspection of pleura only
D) Fluoroscopy
Answer: B) Filling the cavity with saline + Valsalva maneuver ✅
93
After rib harvest, what suture material is commonly used to close the periosteal sleeve in children?
A) Silk 3-0
B) Vicryl 3-0 (polyglactin)
C) Nylon 3-0
D) Chromic gut 3-0
Answer: B) Vicryl 3-0 (polyglactin) ✅
94
Why is the periosteal sleeve closed after rib harvest in children?
A) To prevent pleural tears
B) To decrease chest wall deformity
C) To promote de novo regeneration of the rib
D) To prevent infection
Answer: C) To promote de novo regeneration of the rib ✅
95
The fascia between which two muscles is closed following rib harvest?
A) Latissimus dorsi and serratus anterior
B) Pectoralis major and rectus abdominis
C) Intercostals and external oblique
D) Pectoralis minor and platysma
Answer: B) Pectoralis major and rectus abdominis ✅
96
What imaging is ordered postoperatively to rule out pneumothorax or hemothorax?
A) CT chest
B) MRI chest
C) Chest X-ray
D) Ultrasound
Answer: C) Chest X-ray ✅
97
When may a patient typically return to normal activity after rib harvest?
A) Day 3 post-op
B) Day 7 post-op
C) 2 weeks post-op
D) 6 weeks post-op
Answer: B) Day 7 post-op ✅
98
For how long should strenuous activity be avoided after rib harvest?
A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 3 months
Answer: C) 6 weeks ✅
99
Algorithm for Rib Harvest Technique
1. Incision & Exposure
Make 5 cm inframammary crease incision.
Dissect through subcutaneous tissue, fascia, and the plane between pectoralis major & rectus abdominis.
2. Rib Identification & Periosteal Exposure
Use two fingers to straddle 5th–6th intercostal space → prevents instrument slippage.
Incise periosteum sharply down to the outer cortex of the rib.
3. Subperiosteal Dissection
Dissect rib circumferentially in subperiosteal plane (use molt periosteal; avoid Doyen rib stripper due to pleural tear risk).
4. Cartilaginous Incision
Use sharp blade for cartilaginous portion.
Children: harvest 1–3 cm only → avoid rib overgrowth and cartilaginous cap separation.
5. Rib Sectioning & Removal
Pull rib laterally.
Use protected rib cutter to section desired length.
6. Pleural Safety Check
Fill cavity with normal saline.
Anesthesiologist performs Valsalva maneuver → check for bubbles (pleural tear).
7. Closure
Close periosteal sleeve with 3-0 polyglactin (Vicryl) → promotes rib regeneration in children.
Close fascia (rectus ↔ pectoralis) with 3-0 resorbable suture.
Then subcutaneous tissue & skin closure.
8. Postoperative Management
Chest X-ray → rule out pneumothorax/hemothorax.
Return to normal activity: day 7.
Avoid strenuous activity: 6 weeks.
👉 Quick mnemonic to recall:
“I.D. – S.C.R.I.P.C.P.”
Incision
Dissect fascia
Straddle intercostal
Cut periosteum
Rib subperiosteal dissection
Incise cartilage
Pull rib & cut
Check pleura
Periosteal/fascia closure → Post-op
100
Q: What is a common complication when the cartilaginous cap separates from the harvested rib?
A: Failure of graft stability; managed by securing the cap with non-resorbable suture or harvesting another rib above.
101
What is the management when the cartilaginous cap separates from the harvested rib?
A. Discard graft and abandon procedure
B. Drill hole and secure with non-resorbable suture
C. Start over with rib below
D. Both B and C
✅ Answer: D. Both B and C
102
What is the pathophysiology of pneumothorax following rib harvest?
A: Air trapped between visceral and parietal pleura forms a one-way valve, preventing escape → progressive respiratory insufficiency and cardiovascular collapse.
103
Which of the following best describes the pathophysiology of pneumothorax?
A. Collapse due to pleural effusion
B. One-way valve trapping air between visceral and parietal pleura
C. Alveolar collapse from surfactant loss
D. Inflammation of pleural lining
✅ Answer: B. One-way valve trapping air between visceral and parietal pleural
104
Q: What are late clinical findings of pneumothorax?
A: Cyanosis, distension of neck veins, tracheal deviation, decreased consciousness.
105
Which of the following is NOT a late sign of pneumothorax?
A. Cyanosis
B. Distended neck veins
C. Hyperresonant chest wall with decreased breath sounds
D. Increased surfactant production
✅ Answer: D. Increased surfactant production
106
Q: What is the first-line treatment for pneumothorax after rib harvest?
A: 100% oxygen therapy to accelerate nitrogen washout and absorption of pleural air.
107
What is the first-line management for pneumothorax in the perioperative rib harvest patient?
A. Immediate thoracotomy
B. 100% oxygen therapy
C. Chest physiotherapy
D. Hyperbaric oxygen
✅ Answer: B. 100% oxygen therapy
108
Q: When is chest tube drainage indicated for pneumothorax after rib harvest?
A: When pneumothorax >10% or does not resolve with conservative management.
109
At what size is a pneumothorax typically managed with chest tube drainage?
A. Any visible pneumothorax
B. <5%
C. >10% or non-resolving
D. Only if symptomatic
✅ Answer: C. >10% or non-resolving
110
Q: At what pneumothorax size is tube thoracostomy required?
A: When pneumothorax >30% or complete lung collapse (100%).
111
A pneumothorax occupying ~30% of the hemithorax typically requires:
A. Observation only
B. Needle decompression only
C. Tube thoracostomy
D. Oxygen therapy alone
✅ Answer: C. Tube thoracostomy
112
What is the emergency landmark for needle decompression in pneumothorax?
A: Second intercostal space, midclavicular line.
113
Where should an IV catheter be placed for needle decompression of a tension pneumothorax?
A. Fifth intercostal space, midaxillary line
B. Second intercostal space, midclavicular line
C. Fourth intercostal space, parasternal line
D. Sixth intercostal space, posterior axillary line
✅ Answer: B. Second intercostal space, midclavicular line
114
Tube thoracostomy is typically performed at:
A. 2nd ICS midclavicular line
B. 4th ICS midaxillary line
C. 5th ICS just above 6th rib
D. 7th ICS posteriorly
✅ Answer: C. 5th ICS just above 6th rib
115
What is the preferred site for tube thoracostomy?
A: Fifth intercostal space, just above the top of the sixth rib, avoiding neurovascular bundle.
116
What is the management for pleural tear during rib harvest?
A: Place a suction catheter in the wound through the tear → purse-string suture closure while removing catheter
117
If a pleural tear is encountered during rib harvest, the best intraoperative management is:
A. Pack with hemostatic gauze
B. Close primarily without suction
C. Insert suction catheter and close with purse-string suture during removal
D. Place a permanent chest drain
✅ Answer: C. Insert suction catheter and close with purse-string suture during removal
118
The most common pathogen in otitis externa is:
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Pseudomonas
D. Haemophilus influenzae
✅ Answer: C. Pseudomonas
119
What topical antibiotics are recommended for otitis externa?
A: Topical fluoroquinolone otic drops.
120
Clinical signs of otitis media?
A: Ear pain, hearing difficulty, fever, bulging tympanic membrane, possible purulence.
121
A bulging tympanic membrane with purulence suggests:
A. Otitis externa
B. Otitis media
C. TM rupture
D. Hemotympanum
✅ Answer: B. Otitis media
122
What is the first-line antibiotic for acute otitis media?
A: Amoxicillin.
123
How should a broken instrument be managed during TMJ arthroscopy/arthrocentesis?
A:
Attempt removal arthroscopically if trained and fragment visible.
If not visible → obtain radiographs in multiple planes.
If unsuccessful/not trained → convert to open approach.
124
What is the next step if a broken instrument cannot be visualized during TMJ arthroscopy?
A. Leave in place
B. Convert directly to open surgery
C. Obtain radiographs in multiple planes
D. Call ENT immediately
✅ Answer: C. Obtain radiographs in multiple planes
125
What is hemotympanum and how is it evaluated?
A: Blood in the middle ear, evaluated by otoscopy.
126
Hemotympanum after TMJ arthroscopy is best initially evaluated by:
A. MRI
B. CT scan
C. Otoscopy
D. Tympanometry
✅ Answer: C. Otoscopy
127
Q: On otoscopy, what is typically seen in otitis externa?
A: Edematous external auditory canal (EAC) with possible discharge.
128
What complication is suspected if the external auditory canal (EAC) is damaged during surgery, and how is it managed?
A: Risk of stenosis → managed with antibiotic-impregnated sponge dressing to maintain opening, possibly plus antibiotic-hydrocortisone suspension for 14 days. Granulation tissue may be removed with bipolar cautery or silver nitrate.
129
What complication is suspected if the external auditory canal (EAC) is damaged during surgery, and how is it managed?
A: Risk of stenosis → managed with antibiotic-impregnated sponge dressing to maintain opening, possibly plus antibiotic-hydrocortisone suspension for 14 days. Granulation tissue may be removed with bipolar cautery or silver nitrate.
130
Why is violation of the middle cranial fossa a serious complication?
A: Because the fossa is only ~0.9 mm thick; perforation risks CSF leak and may require neurosurgical intervention
131
How are postoperative CSF leaks after middle cranial fossa violation usually managed?
A: CT/MRI to confirm → bed rest with head elevated 30° → antibiotics (e.g., cotrimoxazole). Most small leaks resolve within 1 week.
132
What are conservative management options for temporal branch facial nerve injury?
A: Observation, ophthalmology consult, lubrication/taping of eye at night, PT with electrical stimulation, and sometimes gold weights for eyelid.
133
What is auriculotemporal nerve syndrome (Frey’s syndrome), and how does it present?
A: Gustatory sweating, flushing, and warmth over temporal and preauricular areas due to auriculotemporal nerve injury (often during arthroscopy).
134
What is the usual prognosis of auriculotemporal nerve syndrome?
A: Typically temporary and resolves within 6 months.
135
What is the main risk if the external auditory canal (EAC) is damaged during surgery?
A. Excessive bleeding
B. Stenosis of the canal
C. Facial nerve paralysis
D. Auriculotemporal nerve syndrome
Answer: B. Stenosis of the canal
136
What is the approximate thickness of the middle cranial fossa at risk during TMJ surgery?
A. 3 mm
B. 2 mm
C. 0.9 mm
D. 5 mm
Answer: C. 0.9 mm
137
How are most postoperative CSF leaks after middle cranial fossa violation managed?
A. Immediate surgical repair
B. Bed rest, head elevation, antibiotics, most resolve within 1 week
C. Corticosteroid therapy
D. Radiation treatment
Answer: B. Bed rest, head elevation, antibiotics, most resolve within 1 week
138
Which muscles are affected by injury to the temporal branch of the facial nerve?
A. Masseter, temporalis
B. Frontalis, orbicularis, corrugator supercilii
C. Buccinator, orbicularis oris
D. Platysma, sternocleidomastoid
Answer: B. Frontalis, orbicularis, corrugator supercilii
139
What is the typical recovery time for temporal branch facial nerve injury?
A. 1–2 weeks
B. 3–6 months
C. 1 year
D. Permanent
Answer: B. 3–6 months
140
Auriculotemporal nerve syndrome (Frey’s syndrome) is characterized by which symptom?
A. Severe ear pain
B. Gustatory sweating, flushing, warmth over temporal/preauricular areas
C. Dizziness and tinnitus
D. Paralysis of mastication muscles
Answer: B. Gustatory sweating, flushing, warmth over temporal/preauricular areas
141
What is the usual prognosis of auriculotemporal nerve syndrome?
A. Permanent condition
B. Resolves in 6 months
C. Requires surgical repair
D. Requires nerve grafting
Answer: B. Resolves in 6 months
142
Which of the following is an indication for TMJ arthrocentesis?
A. Acute closed lock
B. TMJ arthralgia
C. Wilkes stage 1–3
D. All of the above
✅ Answer: D. All of the above
143
Which of the following is a contraindication to TMJ arthrocentesis?
A. Ankylosis
B. Overlying skin infection
C. Inability to appreciate regional anatomy (e.g., obese patients)
D. All of the above
✅ Answer: D. All of the above
144
What is the HolmLund-Hellsing line used for in arthrocentesis?
A. Locating the inferior alveolar nerve
B. Marking entry points for TMJ joint access
C. Measuring maximum incisal opening
D. Guiding condylar fracture reduction
✅ Answer: B. Marking entry points for TMJ joint access
145
The first point in arthrocentesis corresponds to:
A. Height of the articular eminence
B. Deepest point of the glenoid fossa
C. Condylar neck
D. Superior joint capsule
✅ Answer: B. Deepest point of the glenoid fossa
146
The average distance of joint entry from skin in arthrocentesis is:
A. 10 mm
B. 15 mm
C. 25 mm
D. 40 mm
✅ Answer: C. 25 mm
147
What solution is commonly used for TMJ arthrocentesis irrigation?
A. Normal saline
B. Lactated Ringer’s
C. Dextrose 5%
D. Sterile water
✅ Answer: B. Lactated Ringer’s
148
Which of the following can be injected into the joint after irrigation?
A. Steroid (Kenalog 40 mg/ml)
B. Hyaluronic acid (10 mg/ml)
C. Local anesthesia (Bupivacaine 0.5% with 1:200K epi)
D. Morphine (10 mg/ml)
E. All of the above
✅ Answer: E. All of the above
149
Postoperative management of TMJ arthrocentesis includes:
A. Aggressive range of motion exercises
B. NSAIDs
C. Splints
D. All of the above
✅ Answer: D. All of the above
150
Step-by-step Arthrocentesis
Prep & Position
Supine or semi-sitting; head turned to contralateral side, bite block in place.
Skin prep + drape; sterile gloves/field.
Mark Landmarks (Holmlund–Hellsing / canthotragal line)
Draw a line from lateral canthus → mid-tragus.
Point 1 (posterior port / glenoid fossa): 10 mm anterior to tragus and 2 mm inferior to the line.
Point 2 (anterior port / articular eminence): 20 mm anterior to tragus (≈10 mm anterior to Point 1) and 10 mm inferior to the line.
Local Anesthesia (no epi)
Infiltrate skin/capsule at marks with lidocaine/bupivacaine without epinephrine
(allows early facial nerve assessment and avoids masking erythema if doing diagnostic scope).
Joint Insufflation (Posterior point first)
At Point 1, place a 27-g needle into the superior joint space → confirm, then inject 1–2 mL LR to distend.
Create Anterior Port
At Point 2, insert an 18-g needle ≈45° superior–anterior, contact lateral zygomatic arch, walk off bone into the superior space.
Typical depth ~25 mm from skin.
Superior joint space capacity ≈3 mL.
Create Posterior Port / Outflow
Place an 18-g needle at Point 1 into the superior space (or use a Shepard cannula with in-/out-flow).
Lavage
Irrigate with ≥100 mL Lactated Ringer’s through the ports until clear.
Gently manipulate the mandible during lavage to lyse adhesions and encourage disc recapture.
Intra-articular Medication (after lavage)
Remove the anterior port; via remaining port inject one or a combo (per practice pattern):
Triamcinolone (Kenalog) 40 mg/mL
Hyaluronic acid 10 mg/mL
Local anesthetic (e.g., bupivacaine 0.5% with 1:200,000 epi for intra-articular analgesia)
Morphine 10 mg/mL
(Use typical small intra-articular volumes; tailor to patient and protocol.)
Manipulation & Assessment
Under local/sedation, mobilize the joint, then measure MIO and check excursion.
Close & Dress
Remove needles, apply gentle pressure; steri-strip/pressure dressing.
Post-op Plan
Aggressive ROM exercises, NSAIDs, and stabilization splint as indicated.
Ice 24–48 h; reinforce home exercises and follow-up.
151
Disk Reposition Procedure
Indication: Failure of conservative therapy, Wilkes Stages II–V.
Goal: Manually reposition the disk into its premorbid position.
Steps
- Incision
- Mark incision in the preauricular crease.
- Consider Al-Kayat extension for increased access.
- Incise through skin and subcutaneous tissue along entire length.
- Dissection
- Direct attention to the superior portion of incision.
- Dissect through temporoparietal fascia (TPF) and auricularis anterior muscle to reach temporalis fascia layer (glistening white).
-⚠️ Remember: Temporal branch of facial nerve runs within TPF, 8–35 mm (avg. 20 mm) from anterior external auditory meatus → use nerve stimulator/monitor.
- Exposure
- Palpate zygomatic arch.
- Incise through attached periosteum.
- Dissect subperiosteally until reaching joint capsule.
- Joint Entry
-Infiltrate joint capsule with local anesthetic or saline.
- Make an incision to enter superior joint space.
- Disk Mobilization
- Mobilize disk.
Assess for perforations:
Small perforation → repair.
Large perforation → excise disk.
Disk may be plicated (sutured back) to condyle to maintain position.
152
: What complication is suspected if the external auditory canal (EAC) is damaged during surgery, and how is it managed?
A: Risk of stenosis → managed with antibiotic-impregnated sponge dressing to maintain opening, possibly plus antibiotic-hydrocortisone suspension for 14 days. Granulation tissue may be removed with bipolar cautery or silver nitrate.
153
Why is violation of the middle cranial fossa a serious complication?
A: Because the fossa is only ~0.9 mm thick; perforation risks CSF leak and may require neurosurgical intervention
154
How are postoperative CSF leaks after middle cranial fossa violation usually managed?
A: CT/MRI to confirm → bed rest with head elevated 30° → antibiotics (e.g., cotrimoxazole). Most small leaks resolve within 1 week.
155
What is the significance of the temporal branch of the facial nerve in TMJ surgery?
A: It lies ~2 cm anterior to the EAC; injury causes weakness of frontalis, orbicularis, corrugator supercilii. Most recover in 3–6 months.
156
What are conservative management options for temporal branch facial nerve injury?
A: Observation, ophthalmology consult, lubrication/taping of eye at night, PT with electrical stimulation, and sometimes gold weights for eyelid.
157
What is auriculotemporal nerve syndrome (Frey’s syndrome), and how does it present?
A: Gustatory sweating, flushing, and warmth over temporal and preauricular areas due to auriculotemporal nerve injury (often during arthroscopy).
158
What is the usual prognosis of auriculotemporal nerve syndrome?
A: Typically temporary and resolves within 6 months.
159
What is the main risk if the external auditory canal (EAC) is damaged during surgery?
A. Excessive bleeding
B. Stenosis of the canal
C. Facial nerve paralysis
D. Auriculotemporal nerve syndrome
Answer: B. Stenosis of the canal
160
What is the approximate thickness of the middle cranial fossa at risk during TMJ surgery?
A. 3 mm
B. 2 mm
C. 0.9 mm
D. 5 mm
Answer: C. 0.9 mm
161
How are most postoperative CSF leaks after middle cranial fossa violation managed?
A. Immediate surgical repair
B. Bed rest, head elevation, antibiotics, most resolve within 1 week
C. Corticosteroid therapy
D. Radiation treatment
Answer: B. Bed rest, head elevation, antibiotics, most resolve within 1 week
162
Which muscles are affected by injury to the temporal branch of the facial nerve?
A. Masseter, temporalis
B. Frontalis, orbicularis, corrugator supercilii
C. Buccinator, orbicularis oris
D. Platysma, sternocleidomastoid
Answer: B. Frontalis, orbicularis, corrugator supercilii
163
What is the typical recovery time for temporal branch facial nerve injury?
A. 1–2 weeks
B. 3–6 months
C. 1 year
D. Permanent
Answer: B. 3–6 months
164
Auriculotemporal nerve syndrome (Frey’s syndrome) is characterized by which symptom?
A. Severe ear pain
B. Gustatory sweating, flushing, warmth over temporal/preauricular areas
C. Dizziness and tinnitus
D. Paralysis of mastication muscles
Answer: B. Gustatory sweating, flushing, warmth over temporal/preauricular areas
165
What is the usual prognosis of auriculotemporal nerve syndrome?
A. Permanent condition
B. Resolves in 6 months
C. Requires surgical repair
D. Requires nerve grafting
Answer: B. Resolves in 6 months
166
Which of the following is an indication for TMJ arthrocentesis?
A. Acute closed lock
B. TMJ arthralgia
C. Wilkes stage 1–3
D. All of the above
✅ Answer: D. All of the above
167
Which of the following is a contraindication to TMJ arthrocentesis?
A. Ankylosis
B. Overlying skin infection
C. Inability to appreciate regional anatomy (e.g., obese patients)
D. All of the above
✅ Answer: D. All of the above
168
What is the HolmLund-Hellsing line used for in arthrocentesis?
A. Locating the inferior alveolar nerve
B. Marking entry points for TMJ joint access
C. Measuring maximum incisal opening
D. Guiding condylar fracture reduction
✅ Answer: B. Marking entry points for TMJ joint access
169
The first point in arthrocentesis corresponds to:
A. Height of the articular eminence
B. Deepest point of the glenoid fossa
C. Condylar neck
D. Superior joint capsule
✅ Answer: B. Deepest point of the glenoid fossa
170
The average distance of joint entry from skin in arthrocentesis is:
A. 10 mm
B. 15 mm
C. 25 mm
D. 40 mm
✅ Answer: C. 25 mm
171
What solution is commonly used for TMJ arthrocentesis irrigation?
A. Normal saline
B. Lactated Ringer’s
C. Dextrose 5%
D. Sterile water
✅ Answer: B. Lactated Ringer’s
172
Which of the following can be injected into the joint after irrigation?
A. Steroid (Kenalog 40 mg/ml)
B. Hyaluronic acid (10 mg/ml)
C. Local anesthesia (Bupivacaine 0.5% with 1:200K epi)
D. Morphine (10 mg/ml)
E. All of the above
✅ Answer: E. All of the above
173
Postoperative management of TMJ arthrocentesis includes:
A. Aggressive range of motion exercises
B. NSAIDs
C. Splints
D. All of the above
✅ Answer: D. All of the above
174
In TMJ arthrocentesis, which landmark guides anterior and posterior port placement?
A. Mandibular notch
B. Zygomatic arch
C. Canthotragal (Holmlund–Hellsing) line
D. Condylar neck
Answer: C. Canthotragal (Holmlund–Hellsing) line ✅
175
The posterior port in TMJ arthrocentesis is located at:
A. 20 mm anterior and 10 mm inferior to the canthotragal line
B. 10 mm anterior and 2 mm inferior to the canthotragal line
C. 5 mm anterior and 5 mm inferior to the canthotragal line
D. 15 mm anterior and 2 mm superior to the canthotragal line
Answer: B. 10 mm anterior and 2 mm inferior ✅
176
The anterior port in TMJ arthrocentesis is placed at:
A. 20 mm anterior and 10 mm inferior to the canthotragal line
B. 10 mm anterior and 2 mm inferior to the canthotragal line
C. 25 mm anterior and 5 mm inferior to the canthotragal line
D. 15 mm anterior and 10 mm superior to the canthotragal line
Answer: A. 20 mm anterior and 10 mm inferior ✅
177
Which port is typically used for entry and infusion of irrigants during TMJ arthrocentesis?
A. Posterior port
B. Anterior port
C. Both ports interchangeably
D. Neither, fluid is aspirated manually
Answer: A. Posterior port ✅
178
Which port usually serves as the exit port for lavage fluid in TMJ arthrocentesis?
A. Posterior port
B. Anterior port
C. Both ports interchangeably
D. Neither, fluid is aspirated manually
Answer: B. Anterior port ✅
179
Which of the following is the sodium concentration in Lactated Ringer’s solution?
A. 154 mEq/L
B. 130 mEq/L
C. 100 mEq/L
D. 120 mEq/L
Answer: B. 130 mEq/L ✅
180
Which ion is present in Lactated Ringer’s but not in normal saline?
A. Sodium
B. Chloride
C. Potassium
D. Hydrogen
Answer: C. Potassium ✅
181
What is the concentration of calcium in Lactated Ringer’s?
A. 1 mEq/L
B. 2.7 mEq/L
C. 5 mEq/L
D. 10 mEq/L
Answer: B. 2.7 mEq/L ✅
182
The lactate in Lactated Ringer’s is primarily metabolized in which organ to become bicarbonate?
A. Kidney
B. Lung
C. Liver
D. Muscle
Answer: C. Liver ✅
183
What is the approximate osmolarity of Lactated Ringer’s solution?
A. 200 mOsm/L
B. 240 mOsm/L
C. 273 mOsm/L
D. 310 mOsm/L
Answer: C. 273 mOsm/L ✅
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