Prometric Exam Questions for Plastic Surgery Specialists 2026: 20 MCQs with Answers on Burns, Wound Healing, Flaps and Grafts, Hand Trauma, Facial Fractures, Cleft Lip, Skin Cancer, Breast Reconstruction and Aesthetic Surgery Safety

The specialist plastic surgery paper (PLA5671 at DHA, and the equivalent SCFHS, QCHP and NHRA papers) is 100 to 150 single-best-answer questions in up to three hours with a pass mark of about 60%. The Gulf has a large aesthetic market, but the paper is a reconstructive surgeon's exam: burns, hand trauma, facial injury, cleft, skin cancer and breast reconstruction, with aesthetic surgery tested mainly through patient safety. The licensing route, including how aesthetic-only experience is assessed, is in the plastic surgeon guide.

Burns

Question 1

A 70 kg man has deep partial-thickness burns to the entire anterior trunk and the whole of the left arm after a kitchen fire. Using the Parkland formula, the fluid planned for the first 24 hours and the first 8 hours is:

1. 2 litres over 24 hours
2. About 7.6 litres over 24 hours (4 mL × 70 kg × 27%), half of it, about 3.8 litres, in the first 8 hours from the time of injury, titrated to urine output of 0.5 mL/kg/h
3. 15 litres in the first 8 hours
4. Oral fluids only

Answer: B. Anterior trunk 18% plus whole arm 9% gives 27%. Formulas are starting points; urine output guides titration, and over-resuscitation ("fluid creep") causes compartment syndromes and pulmonary oedema.

Question 2

Which burn should be referred to a specialist burns unit?

1. A 2% superficial scald on the thigh of an adult
2. Any full-thickness burn, partial-thickness burns over about 10% in adults or 5% in children, burns to the face, hands, feet, genitalia, perineum or major joints, circumferential burns, electrical or chemical burns, inhalation injury and burns in patients with significant comorbidity
3. Only burns over 50%
4. Sunburn

Answer: B. Referral criteria are tested directly; non-accidental injury in children is also a referral and safeguarding trigger.

Question 3

Six hours after a circumferential full-thickness burn to the forearm, the hand is cool, pale and paraesthetic with weak capillary refill. The correct action is:

1. Elevate and reassess in six hours
2. Urgent escharotomy along the mid-lateral lines of the limb, extending through the eschar to release constriction, with fasciotomy if compartment pressures remain high
3. Apply a tight dressing
4. Give anticoagulants

Answer: B. The eschar does not stretch as oedema develops; delay costs the limb. Circumferential chest burns may need escharotomy to allow ventilation.

Question 4

A patient with a high-voltage electrical injury has small entry and exit wounds and dark urine. The priority concerns are:

1. The wounds are small, so discharge
2. Cardiac monitoring for arrhythmia, deep tissue and muscle injury far exceeding the surface wounds, myoglobinuria requiring high-volume fluids and alkalinisation to protect the kidneys, compartment syndrome and fractures from tetany or falls
3. Topical antibiotics only
4. Immediate skin grafting

Answer: B. Electrical injury is an "iceberg" injury; fluid requirements exceed what surface area formulas predict.

Wound healing and reconstruction

Question 5

The phases of wound healing in order are:

1. Proliferation, haemostasis, inflammation, remodelling
2. Haemostasis, inflammation, proliferation (granulation, angiogenesis, epithelialisation, contraction) and remodelling (maturation), with collagen type III replaced by type I and wound strength reaching about 80% of normal
3. Remodelling, inflammation, proliferation
4. Inflammation only

Answer: B. Diabetes, smoking, malnutrition, steroids, infection, radiation and poor perfusion impair healing; vitamin C and zinc deficiencies are specific correctable factors.

Question 6

A diabetic patient has a 4 cm full-thickness defect over the Achilles tendon with exposed paratenon after debridement. The best reconstructive option is:

1. A split-thickness skin graft directly on bare tendon
2. A local or free flap (for example a reverse sural or free fasciocutaneous flap), or negative-pressure therapy to a graftable bed, because grafts do not take on bare tendon, bone or cartilage
3. Leave to heal by secondary intention
4. Primary closure under tension

Answer: B. The reconstructive ladder runs from secondary intention through primary closure, grafts, local flaps and regional flaps to free tissue transfer; a well-vascularised bed is the precondition for a graft.

Question 7

Which statement about skin grafts is correct?

1. Full-thickness grafts contract more than split-thickness grafts after healing
2. Split-thickness grafts take more reliably and cover larger areas but undergo more secondary contraction; full-thickness grafts give better colour, texture and less contraction, so they are preferred on the face and hands
3. Grafts survive on bare cortical bone
4. Haematoma under a graft improves take

Answer: B. Graft take passes through imbibition, inosculation and revascularisation; haematoma, seroma, shear and infection (especially beta-haemolytic streptococcus) are the causes of failure.

Question 8

Twelve hours after a free flap breast reconstruction, the flap is swollen, purple and bleeds dark blood briskly on pinprick, with a rapid capillary refill. The diagnosis and action are:

1. Arterial insufficiency; observe
2. Venous congestion; immediate return to theatre for exploration of the anastomosis, since salvage rates fall sharply after a few hours of venous occlusion
3. Normal appearance; continue monitoring
4. Infection; antibiotics

Answer: B. Arterial failure gives a pale, cool flap with slow refill and no bleeding on pinprick. Hourly clinical monitoring for the first 48 to 72 hours is the standard.

Hand and upper limb

Question 9

A patient cuts the volar aspect of the middle finger at the level of the proximal phalanx and cannot flex the distal interphalangeal joint but can flex the proximal interphalangeal joint. The injury is:

1. Flexor digitorum superficialis division only
2. Flexor digitorum profundus division in zone II, requiring repair with a strong core suture and epitendinous suture followed by an early controlled mobilisation protocol under hand therapy
3. Extensor tendon injury
4. Ulnar nerve injury

Answer: B. FDP flexes the DIP joint; FDS is tested by holding the other fingers extended. Zone II ("no man's land") repairs are prone to adhesions, hence early protected motion.

Question 10

A worker's thumb is amputated at the metacarpophalangeal joint by a clean saw cut. The amputated part should be transported:

1. Directly on ice
2. Wrapped in saline-moistened gauze inside a sealed plastic bag, placed in a container of iced water, never in direct contact with ice, with the patient referred urgently for replantation
3. In formalin
4. Dry at room temperature

Answer: B. Thumb, multiple digits, paediatric amputations and amputations through the palm or wrist are strong replantation indications; single non-thumb digits proximal to the FDS insertion are relative.

Question 11

After a laceration to the medial elbow, a patient has clawing of the ring and little fingers, numbness over the little finger and weakness of finger abduction. The nerve injured is:

1. Median nerve
2. Ulnar nerve; exploration and primary microsurgical repair within days is preferred for sharp injuries, with recovery at about 1 mm a day
3. Radial nerve
4. Musculocutaneous nerve

Answer: B. A high ulnar lesion produces less clawing than a low one (the ulnar paradox) because FDP to the ring and little fingers is also lost.

Question 12

A child presents with a hand that has a fused web between the middle and ring fingers. The ideal timing and principle for release of syndactyly is:

1. At birth
2. Usually between 6 and 18 months (earlier for border digits or complex cases), using interdigitating zigzag flaps and full-thickness skin grafts, releasing only one side of a digit at a time
3. After skeletal maturity
4. Release of both sides of the same digit in one operation

Answer: B. Releasing both sides at once endangers the digital blood supply.

Head and neck

Question 13

A patient has a facial laceration crossing the cheek after an assault. Which structures must be specifically examined before closure?

1. Hearing only
2. Facial nerve branches (forehead raise, eye closure, smile, lip depression), the parotid duct (saliva in the wound, cannulation if in doubt) and the lacrimal system if medial, with a documented examination before local anaesthetic
3. The thyroid gland
4. The vocal cords

Answer: B. Facial nerve injuries anterior to a vertical line from the lateral canthus are usually not repaired because of arborisation; posterior injuries are explored and repaired within 72 hours while the distal stump still stimulates.

Question 14

A patient has an orbital floor fracture with enophthalmos, diplopia on upward gaze and entrapment of the inferior rectus on CT. The management is:

1. Observation for six months
2. Surgical exploration and floor reconstruction, urgently in children with a "white-eyed" trapdoor fracture or with the oculocardiac reflex, and within about two weeks for persistent diplopia, large defects or enophthalmos
3. Antibiotics only
4. Enucleation

Answer: B. Advise against nose blowing; a retrobulbar haematoma with a tense proptosed eye is an emergency needing lateral canthotomy and cantholysis.

Question 15

The usual timing of primary repair for a child with unilateral complete cleft lip and palate is:

1. Lip and palate both at birth
2. Lip repair at about 3 to 6 months and palate repair at about 9 to 12 months (before speech develops), with feeding support, hearing surveillance for otitis media with effusion, alveolar bone grafting at mixed dentition and multidisciplinary follow-up
3. Lip at 5 years, palate at 10 years
4. Palate first, then lip at adolescence

Answer: B. The old "rule of tens" (10 weeks, 10 lb, haemoglobin 10) is still quoted for lip repair; velopharyngeal insufficiency and fistula are the late complications.

Skin cancer, breast and trunk

Question 16

A 60-year-old has a 1.5 mm Breslow thickness melanoma on the back without ulceration. The recommended excision margin and staging step are:

1. 0.5 cm margin, no further staging
2. Wide local excision with 1 to 2 cm margins (1 cm for 1 mm or less, 1 to 2 cm for 1 to 2 mm, 2 cm for over 2 mm) and sentinel lymph node biopsy offered for melanomas over about 0.8 mm or with ulceration
3. 5 cm margin
4. Radiotherapy alone

Answer: B. Adjuvant anti-PD-1 or BRAF/MEK therapy is now standard for resected stage III disease.

Question 17

A 70-year-old has a 1 cm nodular basal cell carcinoma on the nasal ala. The best treatment is:

1. Curettage and cautery
2. Complete excision with margin control, ideally Mohs micrographic surgery or excision with 4 mm margins and histological confirmation, followed by reconstruction (for example a nasolabial or bilobed flap) once margins are clear
3. Topical imiquimod
4. Observation

Answer: B. The nose, periorbital and periauricular regions are high-risk sites; morphoeic and infiltrative subtypes extend beyond the visible margin.

Question 18

A woman who will need post-mastectomy radiotherapy asks about reconstruction. The most appropriate advice is:

1. Immediate implant reconstruction is unaffected by radiotherapy
2. Radiotherapy increases capsular contracture and failure with implants, so options include delayed autologous reconstruction (for example a DIEP flap) after radiotherapy, or a staged approach with a temporary expander, discussed in the multidisciplinary team
3. Reconstruction is contraindicated
4. Fat grafting alone

Answer: B. Autologous tissue tolerates a radiated field better; smoking and obesity raise flap and donor-site complications.

Question 19

A paraplegic patient has a sacral pressure ulcer with exposed bone and purulent discharge. The management sequence is:

1. Immediate flap closure
2. Treat infection and osteomyelitis, debride, optimise nutrition (albumin, protein, zinc, vitamin C), control spasm and incontinence, offload with pressure-relieving surfaces, and only then reconstruct with a durable flap such as a gluteal fasciocutaneous or musculocutaneous flap
3. Skin graft directly onto bone
4. Dressings alone indefinitely

Answer: B. Stage 4 ulcers involve bone or muscle; recurrence is high without addressing the causes.

Aesthetic surgery safety

Question 20

Which statement about large-volume liposuction is correct?

1. There is no limit to aspirate volume in an office setting
2. Aspirate above about 5 litres is large-volume and should be performed in an accredited facility with overnight monitoring; lidocaine in tumescent solution is limited to about 35 mg/kg, and fat embolism, fluid overload, perforation and venous thromboembolism are the major risks
3. Tumescent lidocaine has no maximum dose
4. Liposuction treats obesity

Answer: B. Gulf regulators license aesthetic facilities by level; combining procedures, operating on patients with a BMI over 30 and inadequate VTE prophylaxis are recurring causes of adverse events on the papers.

How to practise

• Learn the formulas and criteria: Parkland, rule of nines and Lund-Browder, burns unit referral criteria, melanoma margins, lidocaine limits.
• Know the flap monitoring signs, the reconstructive ladder and why grafts fail.
• Practise hand examination logic: FDS vs FDP, nerve lesions, replantation indications.
• Practise under time in the Plastic Surgery bank with the error-log method.

Related sets: general surgery, orthopaedic surgery and dermatology. The exam structure for all specialties is in specialist practice questions online.

Frequently asked questions

How many questions are in the Prometric plastic surgery specialist exam?

Typically 100 to 150 single-best-answer MCQs in up to three hours, with a pass mark of about 60%, varying by authority.

Which plastic surgery topics come up most?

Burns, wound healing and flaps, hand trauma, facial fractures and lacerations, cleft lip and palate, skin cancer and breast reconstruction.

Does the exam test aesthetic surgery?

Yes, mainly through patient safety: liposuction limits, facility standards, patient selection and complications of common aesthetic procedures.

Can an aesthetic-only surgeon get a plastic surgery title in the Gulf?

The title requires recognised plastic and reconstructive surgery training; aesthetic experience alone is not usually sufficient, and the paper is reconstructive in emphasis.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.