OMSITE 2025 (QUESTIONS BANK) UPDATED
QUESTIONS WITH ALL COMPLETE
SOLUTIONS!!
1. Alignment of which of the following is the most reliable for proper reduction
of the zygomaticomaxillary complex fracture?
A. Frontozygomatic suture
B. Sphenozygomatic suture
C. Infraorbital rim
D. 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:
,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.
1. When the medial canthal ligament is attached to a bony segment in naso-
orbito-ethmoidal(NOE) fracture repair the transcanthal wire is best placed:
A. after all soft tissue injuries have been addressed.
B. anterior to the original insertion of the canthal ligament.
C. 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.
,1. 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:
A. Pulse rate >100, normal systolic blood pressure, decreased pulse pressure,
respiratory rate of 20-30, urinary output of 20-30mL/hr.
B. Pulse rate <100, normal systolic blood pressure, normal or increased pulse
pressure, respiratory rate of 14-20, urinary output of >30mL/hr.
C. Pulse rate >120, decreased systolic blood pressure, decreased pulse
pressure, respiratory rate of 30-40, urinary output of 5-15mL/hr.
D. 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.
1. 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:
A. 13
B. 11
C. 9
, D. 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
1. 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?
A. Intubation and hyperventilation with 100% oxygen
B. Titrated administration of 0.4 mg flumazenil IV
C. 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.
QUESTIONS WITH ALL COMPLETE
SOLUTIONS!!
1. Alignment of which of the following is the most reliable for proper reduction
of the zygomaticomaxillary complex fracture?
A. Frontozygomatic suture
B. Sphenozygomatic suture
C. Infraorbital rim
D. 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:
,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.
1. When the medial canthal ligament is attached to a bony segment in naso-
orbito-ethmoidal(NOE) fracture repair the transcanthal wire is best placed:
A. after all soft tissue injuries have been addressed.
B. anterior to the original insertion of the canthal ligament.
C. 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.
,1. 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:
A. Pulse rate >100, normal systolic blood pressure, decreased pulse pressure,
respiratory rate of 20-30, urinary output of 20-30mL/hr.
B. Pulse rate <100, normal systolic blood pressure, normal or increased pulse
pressure, respiratory rate of 14-20, urinary output of >30mL/hr.
C. Pulse rate >120, decreased systolic blood pressure, decreased pulse
pressure, respiratory rate of 30-40, urinary output of 5-15mL/hr.
D. 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.
1. 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:
A. 13
B. 11
C. 9
, D. 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
1. 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?
A. Intubation and hyperventilation with 100% oxygen
B. Titrated administration of 0.4 mg flumazenil IV
C. 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.
