OMSITE 2025 QUESTIONS BANK UPDATED

OMSITE 2025 (QUESTIONS BANK) UPDATED

QUESTIONS WITH ALL COMPLETE

SOLUTIONS!!

• Alignment of which of the following is the most reliable for proper reduction

of the zygomaticomaxillary complex fracture?

• Frontozygomatic suture
• Sphenozygomatic suture
• Infraorbital rim
• Medial orbital rim Answer - Answer: B Rationale:

The sphenozygomatic suture area has been previously analyzed and shown to be an area for confirmation of alignment of the zygomatic arch and the zygomatic complex (ZMC). This has also been shown to key point for fixation thru biomechanical studies.The sphenozygomatic suture is a broad area along the greater wing of the sphenoid and can be approached along the internal aspect of the lateral orbit.Even in severe midface fractures the greater wing of the sphenoid is intact thus acting as a key landmark for proper reduction of the ZMC fracture.Reduction of the frontozygomatic suture or the infraorbital rim alone can result in errors due to the small surface area. The medial orbit is generally not involved in a ZMC fracture.

Reference: 1 / 4

Rohner D, Tay A, Meny CS, Hutmacker DW, Hammer B.: The sphenozygomatic

suture as a key site for osteosynthesis of the orbitozygomatic complex in

panfacial fractures: A biomechanical study in human cadavers based on clinical

practice. Plast Reconstr Surg 110: 1463, 2002.

Manson PN, Clark N, Robertson B, et al. Subunit principles in midface fractures: the importance of sagittal buttresses, soft tissue reductions and sequencing

treatments of segmental fractures. Plast Reconstr Surg 103: 1287, 1999.

• When the medial canthal ligament is attached to a bony segment in naso-

orbito-ethmoidal(NOE) fracture repair the transcanthal wire is best placed:

• after all soft tissue injuries have been addressed.
• anterior to the original insertion of the canthal ligament.
• posterior and inferior to the original insertion.

D. posterior and superior to the original insertion. Answer - Answer: D

Rationale:

The purpose of the trans-canthal wire is to secure the canthal ligament and boney segment in the pretraumatic position. Pull of the soft tissues displaces the bone and canthal ligament in an anterior and inferior direction. Therefore a wire placed posterior and superior to the original insertion provides a vector whose resistance to displacement is most ideal and provides the best alignment.

Reference:

OMS Knowledge Update, Volume three, Section 6. Abubaker AO and Strauss RA, eds. p TRA 75-76. Classification D - Trauma - Soft tissue Oral and Maxillofacial Surgery In- Training Examination (OMSITE) questions for the Trauma Section. 2 / 4

• A 21-year-old female is an unrestrained driver involved in a MVA. She suffers

a scalp laceration and is noted to have lost 1000mL of blood at the scene. You

would expect her vital signs to be consistent with:

• Pulse rate >100, normal systolic blood pressure, decreased pulse pressure,

respiratory rate of 20-30, urinary output of 20-30mL/hr.

• Pulse rate <100, normal systolic blood pressure, normal or increased pulse

pressure, respiratory rate of 14-20, urinary output of >30mL/hr.

• Pulse rate >120, decreased systolic blood pressure, decreased pulse

pressure, respiratory rate of 30-40, urinary output of 5-15mL/hr.

• Pulse rate >140, decreased systolic blood pressure, decreased pulse

pressure, respiratory rate of >35, urinary output that's negligible. Answer - Answer: A Rationale: These findings are consistent with a Class II hemorrhage, 750-1500ml, The vitals signs or such a blood loss are consistent with those in response A.Response D reflects the vital signs of a Type IV blood loss, Response C a Type III and Response B a Type I.

Reference:

1997 ATLS for Doctors, Sixth Edition.

• A 65-year-old man fell down the stairs. Upon examination of him, you notice

that he opens his eyes to speech, localizes pain, and mutters inappropriate

words. You assess his Glasgow coma scale (GCS) to be:

• 13
• 11

C. 9 3 / 4

• 7 Answer - Answer: B Rationale:

According to the Glascow Coma Scale, the patient can open his eyes in response to commands speech, (3 out of 4); localizes pain, (5 out of 5); yet produces inappropriate words, (3 out of 6); for a Glascow coma score of 11.

Reference:

1997 ATLS for Doctors, Sixth Edition

• A 79-year-old white male presents to your office for removal of carious

teeth. Medical history review reveals chronic obstructive pulmonary disease (COPD), hypertension, peptic ulcer disease, athlerosclerosis with occasional angina, and osteoarthritis. Daily medications include isosorbide dinitrate, furosemide, and acetaminophen. After conscious sedation with midazolam and local anesthesia with prilocaine, you note that in recovery he has slowly become ashen looking and the pulse oximetry reading has fallen to 85%. Which of the following measures is most appropriate?

• Intubation and hyperventilation with 100% oxygen
• Titrated administration of 0.4 mg flumazenil IV
• Methylene blue administration 1 mg/kg IV

D. Assisted ventilation by face mask with room air. Answer - Answer: C

Rationale:

This situation may appear to be pulmonary in origin, but in fact represents acquired methemoglobinemia. This condition can be precipitated by nitrates, (such as isosorbide dinitrate) acetaminophen, prilocaine, articaine, and a number of other medications, especially in genetically susceptible individuals.The oxidized (ferric) state of the methemoglobin molecule cannot be reversed by increasing the FIO2, which also may decrease the respiratory drive in COPD.Sedation reversal by flumazenil will have no effect on the condition.

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