NBSTSA CSFA Exam Prep 1 Correct

Answers Latest Version

1.A complication of steep reverse Trendelenburg position is

A.

deep vein thrombosis.

B.

arterial compression.

C.

cardiac overload.

D.

respiratory alkalosis.

A.

deep vein thrombosis.

Which of the following positions should be utilized for posterior

colpotomy?

A.

prone

B.

supine

C.

lithotomy

D.

Fowler's

C.
lithotomy

Which of the following BEST prevents hypothermia in the OR?

A.

forced air warming blanket

B.

warmed IV solution

C.

warmed irrigation solution

D.

multiple layers of warm blankets

A.

forced air warming blanket

OR humidity must be maintained between which of the following ranges?

A.

5% to 20%

B.

20% to 60%

C.

40% to 80%

D.

50% to 90%

B.

20% to 60%

An important process in which all team members must participate just prior
to incision is called the
A.

huddle.

B.

timeout.

C.

debriefing.

D.

consent.

B.

timeout.

Which of the following is Mohs surgery used to treat?

A.

malignant melanoma and basal cell carcinoma

B.

basal cell and squamous cell carcinoma

C.

malignant melanoma and squamous cell carcinoma

D.

basal cell and Merkel cell carcinoma

B.

basal cell and squamous cell carcinoma

When reviewing the chart for a patient scheduled for a mammoplasty, it is

noticed that the patient's K+ is 5.4. The patient is suffering from which of the
following?

A.

hyperkalemia
B.

hypokalemia

C.

hypercalcemia

D.

hypocalcemia

A.

hyperkalemia

Which of the following are the preferred positioning devices used during
surgical procedures?

A.

foam pads

B.

saline bags

C.

gel pads

D.

sheet rolls

C.

gel pads

When inserting a Foley catheter into a male patient, the surgical

first assistant encounters difficulty. Which of the following is the
NEXT step that the surgical first assistant should take?

A.

Proceed with force until the catheter goes in.

B.
Stop attempting and notify the surgeon.

C.

Abort the surgical procedure.

D.

Obtain a new kit and try again.

B.

Stop attempting and notify the surgeon.

Which of the following could occur as a result of a tourniquet causing

excessive pressure on the nerves?

A.

paralysis

B.

ischemia

C.

hematoma

D.

necrosis

A.

paralysis

Which of the following positions is used for an LAVH?

A.

reverse Trendelenburg

B.

supine

C.
lateral recumbent

D.

lithotomy

D.

lithotomy

Which of the following types of positioning injury occurs when underlying

tissue is stationary while the skeletal structure moves?

A.

friction injury

B.

pressure injury

C.

shear injury

D.

negativity injury

C.

shear injury

Which of the following patient positions would be MOST likely to cause an

obturator nerve injury?

A.

lateral

B.

prone

C.

lithotomy

D.
semi-Fowler's

C.

lithotomy

When the surgeon incises tissue, the surgical first assistant usually provides
a clear field by

A.

light adjustment.

B.

clamping.

C.

retraction.

D.

cauterizing.

C.

retraction.

Which of the following is known as a Kelly procedure?

A.

anterior colporrhaphy

B.

cervical conization

C.

Bartholin cyst marsupialization

D.

vulvectomy

A.
anterior colporrhaphy

Which of the following is a type of shunt used during a carotid

endarterectomy?

A.

Javid

B.

Fogarty

C.

Swan-Ganz

D.

Rummel

A.

Javid

Which of the following organs has a fragile collagen-rich capsule and must be
handled carefully?

A.

kidney

B.

gallbladder

C.

liver

D.

spleen

D.

spleen

Which of the following procedures would require a pneumatic tourniquet?

A.

femoral-popliteal bypass

B.

arteriovenous (AV) fistula creation

C.

total knee replacement

D.

intramedullary tibial nailing

C.

total knee replacement

When applying clamps to a major vessel that is to be preserved, which of the

following is the preferred clamp to use?

A.

Peon

B.

Crile

C.

Satinsky

D.

Ochsner

C.

Satinsky

Which of the following is a role of the surgical first assistant during robotics
cases?

A.

Place access cannula.

B.

Exchange instrument arms.

C.

Position the patient cart.

D.

Operate instruments from console.

B.

Exchange instrument arms.

Which of the following can be done to prevent wrong site surgeries?

A.

Bring the patient to the OR prior to the surgeon marking the site.

B.

Surgical first assistant should mark the patient if the surgeon is not
available.

C.

Surgeon must mark the surgical site preoperatively.

D.

Put an "X" or write the word "NO" on the non-operative side.

C.

Surgeon must mark the surgical site preoperatively.

When placing a drain for an abdominoplasty, which of the following is MOST

commonly used?

A.

Jackson-Pratt

B.

Malecot
C.

Pleur-Vac

D.

T-tube

A.

Jackson-Pratt

Injury to which of the following arteries is commonly seen in the

temporal lobes, where the skull is the thinnest and meningeal blood
vessels are numerous, and is the usual cause of epidural
hematomas?

A.

middle meningeal

B.

posterior meningeal

C.

temporal

D.

cerebral

A.

middle meningeal

Which of the following is the desired effect when applying a

partially threaded cancellous screw to a bone fragment?

A.

distraction

B.

rotation
C.

compression

D.

subluxation

C.

compression

During an abdominal hysterectomy, the surgeon initially isolates the

uterus by separating it from the

A.

bladder.

B.

round ligaments.

C.

broad ligaments.

D.

cervix.

B.

round ligaments.

During a carotid endarterectomy, the final occlusion clamp to be

removed after anastomosis is on the

A.

common carotid.

B.

internal carotid.

C.

external carotid.
D.

thyroid branch.

B.

internal carotid.

The primary purpose of a robotic device designed to hold and

maneuver a laparoscope is to

A.

eliminate tremor associated with operating an endoscope.

B.

replace the surgeon.

C.

decrease set-up time for an endoscope.

D.

reduce the incidence of fogging.

A.

eliminate tremor associated with operating an endoscope.

During a carotid endarterectomy, the arteries are unclamped and

reclamped before arteriotomy closure is performed to

A.

flush free debris from the carotid.

B.

restore complete blood flow to the brain.

C.

increase collateral flow.

D.

ensure patency of the carotid body.

A.

flush free debris from the carotid.

When opening the aneurysmal sac during resection of an abdominal

aortic aneurysm (AAA), which of the following arteries is ligated?

A.

lumbar

B.

supine mesenteric

C.

renal

D.

common hepatic

A.

lumbar

When entering the skull during a craniotomy, it is important to

prevent excess heat to the skull and to avoid floating bone dust by

A.

using a moist sponge to dab at the drill site.

B.

keeping suction close to the drill site.

C.

irrigating at the drill site with saline.

D.

using Raney clips to prevent the drill from getting hot.

C.

irrigating at the drill site with saline.

During arterial embolectomy, which of the following catheters is
used for clot removal?

A.

Swan-Ganz

B.

Groshong

C.

Fogarty

D.

Broviac

C.

Fogarty

A 3-way Foley catheter with a 30-cc balloon should be inserted

following a transurethral prostate resection (TURP) to

A.

irrigate and facilitate hemostasis.

B.

prevent the patient from getting out of bed.

C.

keep accurate input and output records.

D.

minimize postoperative hypertrophy.

A.

irrigate and facilitate hemostasis.

When should the patient's chest tubes be attached to the drainage

system during a thoracotomy?
A.

after the thoracic cavity is closed

B.

immediately upon insertion

C.

within an hour of the procedure

D.

upon arrival in the PACU

A.

after the thoracic cavity is closed

A 60-year-old obese patient with a history of diabetes and renal

insufficiency has undergone drainage of an abdominal abscess
through a midline incision. Which of the following should be
considered for wound closure?

A.

Multifilament, absorbable suture material provides for optimal

wound healing.

B.

A continuous suture line should be used.

C.

An interrupted retention suture should be used.

D.

Use of blunt surgical needles is a consideration in the presence of

infection.

C.

An interrupted retention suture should be used.

A 54-year-old female presents to the OR with a 4 cm oblique volar
forearm laceration and a 9 cm transverse dorsal forearm laceration
from a dog bite. Which of the following suturing methods and
materials is the BEST choice for closure of the wound?

A.

interrupted silk

B.

continuous polyglactin

C.

interrupted polypropylene

D.

continuous polyester

C.

interrupted polypropylene

In a previously infected wound that has been opened and debrided,

which of the following is the preferred suture material in the event
that subcutaneous tissue is closed?

A.

braided absorbable

B.

braided non-absorbable

C.

monofilament absorbable

D.

monofilament non-absorbable

C.

monofilament absorbable
During arterial cannulation in cardiopulmonary bypass (CPB), the
cannula tip must be directed into which of the following arteries?

A.

pulmonary

B.

brachiocephalic

C.√

aorta

D.

coronaries

C.

aorta

The primary purpose of a chest tube is to

A.

irrigate the chest.

B.

eliminate leaks in the lungs.

C.

prevent pulmonary emboli.

D.

re-establish negative pressure.

D.

re-establish negative pressure.

During surgical treatment for a cerebral aneurysm, the aneurysm

clip is placed at the

A.
neck of the aneurysm.

B.

apex of the aneurysm.

C.

arterial bifurcation.

D.

parent vessel.

A.

neck of the aneurysm.

Which mechanical method of hemostasis should a surgical first assistant use

in neurosurgery?

A.

Avitene

B.

thrombin spray

C.

Surgicel

D.

bone wax

D.

bone wax

Which of the following procedures is usually performed in conjunction with a

Nissen or Toupet Fundoplication?

A.

sleeve gastrectomy

B.
gastric bypass (Roux-N-Y)

C.

Transoral Incisionless Fundoplication (TIF)

D.

hiatal hernia repair

D.

hiatal hernia repair

A patient with both anterior and posterior knee joint instability and buckling
during downhill ambulation is BEST treated by which of the following surgical
interventions?

A.

ACL reconstruction

B.

total joint arthroplasty

C.

MCL reconstruction

D.

femoral chondroplasty

A.

ACL reconstruction

Unused culture tubes are placed on the back table prior to incision. Which of
the following should the surgical first assistant do NEXT?

A.

Swab the affected area.

B.

Obtain new culture swabs.

C.

Pass the culture swabs to the surgeon.

D.

Remove tops of tubes in preparation for culture.

B.

Obtain new culture swabs.

During a low anterior resection, the iliac artery is transected. Which of the
following is the MOST appropriate instrument to achieve hemostasis?

A.

Debakey angled vascular clamp

B.

Heaney clamp

C.

Rochester Pean clamp

D.

Bulldog clamp

A.

Debakey angled vascular clamp

When the surgical first assistant is placing the second port during a
diagnostic laparoscopy, which of the following is the MOST important step?

A.

skin incision

B.

direct visualization

C.

trocar selection
D.

patient positioning

B.

direct visualization

A patient presents with a thigh abscess that was cultured and diagnosed as
necrotizing fasciitis. Which of the following is the appropriate treatment?

A.

Pack the wound.

B.

Place a drain and close the wound.

C.

Close the wound.

D.

Debride all the necrotic tissue.

D.

Debride all the necrotic tissue.

Which of the following muscles is used to re-implant a section of the

parathyroid if it is inadvertently removed during a thyroidectomy?

A.

sternohyoid

B.

platysma

C.

sternocleidomastoid

D.

sternothyroid
C.

sternocleidomastoid

Before the initiation of cardiopulmonary bypass, it is important that the ACT

(Activated Clotting Time) is greater than

A.

100 seconds.

B.

400 seconds.

C.

500 seconds.

D.

1000 seconds.

C.

500 seconds.

During a thoracotomy for tumor resection, the surgeon wants to irrigate with
a solution that will cause tumor cells to lyse. Which of the following should
the surgical first assistant use?

A.

sterile water

B.

normal saline

C.

glycine

D.

sorbitol

A.
sterile water

A patient presents with extreme right lower quadrant pain, vomiting, and
fever. A CT scan indicates free fluid in the abdomen and the extreme pain
subsides. Which of the following is the MOST likely surgical intervention?

A.

open appendectomy

B.

laparoscopic appendectomy

C.

exploratory celiotomy

D.

laparoscopic cholecystectomy

A.

open appendectomy

In minimally invasive surgery, which of the following would involve Cartesian

coordinate geometry?

A.

robotic endowrist

B.

total joint design

C.

synthetic heart valve manufacture

D.

alignment of compound facial fractures

A.

robotic endowrist
Which of the following is a direct complication resulting from a total
laryngectomy with a radical neck dissection?

A.

pneumothorax

B.

cranial aneurysm

C.

ischemic stroke

D.

salivary fistula

D.

salivary fistula

Following an arteriovenous fistula procedure, a patient develops a condition

known as “steal syndrome." Which of the following is the MOST appropriate
action to remedy this condition?

A.

Revise fistula.

B.

Continue anticoagulant therapy

C.

Discontinue anticoagulant therapy.

D.

Revise fistula using an argyle shunt.

A.

Revise fistula.
Which of the following is the reason a surgeon would choose to use a locking
plate rather than a non-locking plate when repairing a bone fracture?

A.

low bone density

B.

comminuted fracture

C.

compound fracture

D.

high bone density

A.

low bone density

After a coronary artery bypass procedure, the patient is having difficulty

transitioning off the cardiopulmonary bypass machine. Which of the following
is the MOST frequently used intervention to address this situation?

A.

ventricular assist device

B.

high dose epinephrine

C.

intra-aortic balloon pump (IABP)

D.

extracorporeal membrane oxygenation (ECMO)

C.

intra-aortic balloon pump (IABP)

A patient requires breast reconstructive surgery for breast cancer. When the
surgeon places a tissue expander, which of the following muscles are lifted
to allow for the placement of the expander?

A.

pectoralis major, deltoid, and superior rectus sheath

B.

pectoralis minor, serratus anterior, and superior rectus sheath

C.

pectoralis major, serratus anterior, and superior rectus sheath

D.

pectoralis minor, serratus anterior, and latissimus dorsi

C.

pectoralis major, serratus anterior, and superior rectus sheath

Which of the following conditions may be induced when thrombin is used in

the management of hemostasis during a vascular procedure?

A.

thalassemia

B.

disseminated intravascular clotting

C.

thrombocytopenia

D.

von Willebrand's disease

B.

disseminated intravascular clotting

A patient presents with a traumatic soft tissue injury with a Class III wound.
Which of the following is the MOST appropriate dressing?

A.

Dermabond

B.

Telfa

C.

Tegaderm

D.

wound VAC

D.

wound VAC

Which of the following is an example of a secondary dressing?

A.

ACE bandage

B.

4 X 4 sponge

C.

wound VAC

D.

Telfa

A.

ACE bandage

Which type of drain is generally used for large open contaminated wounds
such as perirectal, perianal fistulas, and subcutaneous abscess cavities?

A.
Penrose

B.

Jackson-Pratt

C.

Hemovac

D.

Blake

A.

Penrose

Which of the following is a CONTRAINDICATION for the use of negative-

pressure wound therapy?

A.

skin grafts

B.

pressure ulcers

C.

skin flaps

D.

untreated osteomyelitis

D.

untreated osteomyelitis

Which of the following splints would be placed on a patient immediately

postoperative for an ORIF Olecranon fracture?

A.

long arm

B.
short arm

C.

long leg

D.

short leg

A.

long arm

If operating with multiple sharps on the surgical field, which of the following
is the MOST effective way to reduce potential injuries?

A.

Pass all sharps by hand.

B.

Keep all sharps on the mayo stand.

C.

Place the count board on the mayo stand.

D.

Utilize a neutral zone.

D.

Utilize a neutral zone.

A patient presented in the OR with a cervical spine fracture. Which of the

following traction devices is MOST appropriate?

A.

Gardner-Wells tongs

B.

Thomas splint

C.
traction splint

D.

Buck's traction

A.

Gardner-Wells tongs

Which of the following is the PRIMARY reason an elastic bandage would be

utilized on an extremity undergoing a skin graft?

A.

prevention of fluid accumulation at graft site

B.

post-op swelling of the surrounding tissues

C.

securement of underlying bulky dressings

D.

absorption of excess exudate and drainage

A.

prevention of fluid accumulation at graft site

Language barriers with a patient can be a stress-producing situation. One

way to help ease their anxiety is to

A.

speak slowly and loudly.

B.

use hand gestures.

C.

speak to their family members.

D.
use a gentle touch.

D.

use a gentle touch.

Who makes medical decisions for a patient with a living will?

A.

the surgeon

B.

the patient

C.

the patient's nearest living relative

D.

the social worker

B.

the patient

Which of the following forms of radiation is dispersed from a C-arm?

A.

complex

B.

non-ionizing

C.

columnar

D.

ionizing

D.

ionizing
During the timeout, why are all OR personnel required to stop all activity?

A.

to effectively communicate patient identification issues or concerns

B.

to allow the prep solution to dry

C.

to allow equipment to be set up for procedure

D.

to allow anesthesia to anesthetize the patient

A.

to effectively communicate patient identification issues or concerns

For efficiency and safety, the MOST appropriate approach for the surgical
first assistant to indicate that the long instrument may be needed and should
be opened while preparing for an exploratory laparotomy on an obese
patient is to

A.

determine that it is needed and open the long instrument set that
the CST had on hold.

B.

consult with the CST in order to have the long instrument set placed on the
field now.

C.

wait until the circulator returns from pre-op and ask him/her to have the set
counted and on the field.

D.

have the surgeon determine the need for the long instrument set
after the procedure begins.
B.

consult with the CST in order to have the long instrument set placed on the
field now.

A patient in the preoperative holding area has questions about a

surgical procedure. The surgical first assistant should

A.

ask the surgeon to speak with the patient.

B.

answer the questions.

C.

proceed with the procedure.

D.

ask the anesthesia provider to answer the questions.

A.

ask the surgeon to speak with the patient.

The surgical team is beginning their timeout. The x-ray tech walks in and
states he is going to leave C-Arm outside the OR. Which of the following
should the surgical team do NEXT?

A.

Continue with the timeout.

B.

Tell the x-ray tech OK and continue with timeout.

C.

Start over with the timeout.

D.

Tell the x-ray tech to be quiet or get out.

C.

Start over with the timeout.

To help reduce the risk of an electrostatic spark, which of the following

should be done?

A.

Maintain relative humidity in the correct range.

B.

Ask the circulator to move the electrocautery machine farther away

from the field.

C.

Wait until the patient is asleep to plug in the electrocautery and

turn it on.

D.

Use synthetic fiber blankets.

A.

Maintain relative humidity in the correct range.

In the event of a chemical spill in the OR, which of the following is the MOST
appropriate reference for exposure control and clean up?

A.

OSHA manual

B.

chemical label

C.

JCAHO standards

D.

Safety Data Sheets

D.

Safety Data Sheets

If the OR's humidity increases above 70% before the patient arrives to the
OR, which of the following steps should be taken?

A.

Tear down the sterile field and reset once the humidity level is
normal.

B.

Proceed as normal.

C.

Monitor room and proceed once the humidity has reached normal
levels.

D.

Rinse all instrumentation in saline.

A.

Tear down the sterile field and reset once the humidity level is
normal.

During a radical mastectomy, in addition to providing exposure, it is

imperative that the surgical first assistant

A.

inquires if a local anesthetic is available for the end of the procedure.

B.

ensures saline is on the field for irrigation.

C.

weighs the specimen.

D.

evacuates the smoke plume.

D.

evacuates the smoke plume.

A skin tag is removed from a patient under general anesthesia. It is not part
of the procedure and is not within the surgical site. Under which of the
following categories does this fall?

A.

negligence

B.

malpractice

C.

assault and battery

D.

Borrowed Servant Rule

C.

assault and battery

A patient requires an I&D of the thigh. The team has anticipated using 6
bottles of warm saline and brings them to the OR. During the 2-hour case,
only four of the bottles are used while the other two have become room
temperature. Which of the following actions should be taken with cool saline?

A.

Return to warmer within one hour.

B.

Immediately return to warmer.

C.

Put with cold saline stock.

D.

Cold saline cannot be used.

D.

Cold saline cannot be used.

Which of the following is an example of a high-level disinfecting

agent?

A.

glutaraldehyde

B.

isopropyl alcohol

C.

quaternary ammonium

D.

iodophor solution

A.

glutaraldehyde

Which of the following is the vertical dimension within which objects are seen
in focus?

A.

depth of field

B.

stereopsis

C.

working distance

D.

focal length

A.

depth of field
To model bone tissue in plastic and reconstructive surgery, which of the
following should be used?

A.

bone wax

B.

rotating burr

C.

oscillating saw

D.

bone cement

B.

rotating burr

An example of "cold" sterilization utilizes which of the following chemicals?

A.

glutaraldehyde

B.

phenol

C.

ethylene oxide

D.

hydrogen peroxide

C.

ethylene oxide

Geobacillis stearothermophilus is the biological indicator used in which of the

following sterilizers?

A.
steam

B.

dry heat

C.

ethylene oxide

D.

gas plasma

A.

steam

A tourniquet that displays an error message and fails to inflate should be

A.

turned off and restarted.

B.

used for the case.

C.

removed from service.

D.

reported to the charge nurse.

C.

removed from service.

When using a Dynamic Air removal system, which of the following is the
minimum required sterilization time for a wrapped instrument pan at 275ºF?

A.

3 minutes

B.
4 minutes

C.

15 minutes

D.

30 minutes

A.

3 minutes

Which of the following instruments is a bipolar electrosurgical instrument?

A.

Kleppinger forceps

B.

Harmonic scalpel

C.

L-hook cautery

D.

Maryland grasper

A.

Kleppinger forceps

Which of the following instruments is a traumatic laparoscopic dissecting

instrument?

A.

Prestige

B.

scissors

C.
Davis and Geck forceps

D.

tenaculum

B.

scissors

After completion of a femoral popliteal bypass, which of the following should

be used to detect blood flow to the foot?

A.

CT scan

B.

x-ray

C.

MRI

D.

Doppler

D.

Doppler

When a sterilized craniotomy set is opened, a hair is discovered in the set.

Which of the following is the MOST appropriate action?

A.

Remove the hair from the set.

B.

Proceed with the case as the set was sterilized.

C.

Replace the set.

D.
Clean affected instruments with betadine.

C.

Replace the set.

Which of the following is the MOST common staple used during a

laparoscopic right hemi-colectomy to transect the ilium?

A.

Insorb

B.

EEA

C.

ENDO-GIA

D.

linear

C.

ENDO-GIA

In the instance of dermoid cyst rupture, which of the following irrigants is

used to prevent chemical peritonitis caused by the sebaceous material?

A.

water

B.

lactated Ringer's

C.

normal saline

D.

bacitracin

B.
lactated Ringer's

Which of the following gases is less soluble in blood and could persist long
enough to cause a form of a gas embolus?

A.

carbon dioxide

B.

argon

C.

nitrogen

D.

krypton

B.

argon

When placing a patient prone using chest rolls, which direction should the
breasts be diverted?

A.

inward

B.

outward

C.

upward

D.

downward

A.

inward
When placing a patient in the lateral position, right side down with the aid of
a Vac-Pac bean bag, which of the following structures is compressed,
impairing blood flow?

A.

common iliac

B.

vena cava

C.

great saphenous vein

D.

aorta

B.

vena cava

Using a mesher on a split-thickness skin graft allows for

A.

greater coverage of the wound.

B.

better-looking results postoperatively.

C.

a smooth surface graft.

D.

retained serum on the recipient site.

A.

greater coverage of the wound.

Winged scapula is a condition brought on by an injury to which of

the following nerves?
A.

axillary

B.

medial pectoral

C.

long thoracic

D.

thoracodorsal

C.

long thoracic

An autoimmune disease that causes diffuse, bilateral enlargement

of the thyroid gland, and hyperthyroidism is

A.

Hashimoto's thyroiditis.

B.

goiter disease.

C.

Graves' disease.

D.

malignant disease.

C.

Graves' disease.

During an open reduction and internal fixation of a clavicular

fracture, the surgeon must use extreme caution when drilling screw
holes to avoid injury to which of the following structures, which lies
directly underneath the clavicle?
A.

subclavian vein

B.

subclavian artery

C.

brachial plexus

D.

aortic arch

A.

subclavian vein

Compression of which of the following structures is considered a surgical

emergency with a hemorrhage after a thyroidectomy?

A.

jugular vein

B.

carotid artery

C.

trachea

D.

esophagus

C.

trachea

The gallbladder drains into which of the following structures?

A.

thoracic duct
B.

hepatic duct

C.

common bile duct

D.

cystic duct

D.

cystic duct

During a laparoscopic cholecystectomy, the infundibulum of the gallbladder

is retracted to expose the

A.

artery of Drummond.

B.

ligament of Treitz.

C.

triangle of Calot.

D.

sphincter of Oddi.

C.

triangle of Calot.

A distinguishing feature of lupus is

A.

fatigue.

B.

joint pain.
C.

muscle pain.

D.

a butterfly rash.

D.

a butterfly rash.

Which of the following hemodynamic concepts describes the

resistance the heart must overcome to pump blood into the
systemic circulation?

A.

cardiac output

B.

preload

C.

contractility

D.

afterload

D.

afterload

The third ventricle empties into the fourth ventricle through which
of the following small ducts, which is the only exit for the third and
lateral ventricles?

A.

foramen of Monro

B.

aqueduct of Sylvius
C.

foramina of Luschka

D.

foramina of Magendie

B.

aqueduct of Sylvius

Which of the following types of hernia consists of a protrusion of fat

through defects in the abdominal wall located between the
umbilicus and the xiphoid process and symptoms of nausea and
slight upper abdominal pain?

A.

spigelian

B.

epigastric

C.

interparietal

D.

umbilical

B.

epigastric

Which of the following bones is the MOST superior tarsal and

articulates with the distal end of the tibia?

A.

calcaneus

B.

navicular
C.

talus

D.

cuboid

C.

talus

A latissimus dorsi flap used for breast reconstruction following a

mastectomy gets its main blood supply from which of the following
arteries?

A.

thoracodorsal

B.

long thoracic

C.

superior epigastric

D.

inferior epigastric

A.

thoracodorsal

A surgeon is performing a lumbar laminectomy and discectomy for an L5-S1

disc herniation that has protruded into the epidural space. Which of the
following parts of the disc should be removed?

A.

nucleus pulposus

B.

annulus fibrosus
C.

anterior annulus

D.

anterior ligament

A.

nucleus pulposus

During heart transplant surgery, which of the following is the correct order of
chamber/vessel anastomosis?

A.

right atrium, left atrium, aorta, pulmonary artery

B.

left atrium, right atrium, aorta, pulmonary artery

C.

aorta, pulmonary artery, left atrium, right atrium

D.

left atrium, right atrium, pulmonary artery, aorta

D.

left atrium, right atrium, pulmonary artery, aorta

During a Nissen fundoplication, care should be taken when placing

medial traction on the stomach to prevent avulsion of the

A.

splenic artery.

B.

gastric arteries.

C.

common duct.
D.

pancreatic duct.

B.

gastric arteries.

To reconstruct the pelvis after prolapse, which of the following

anatomical structures could be used as a supportive repair in
conjunction with the repair of a rectocele?

A.

transversalis fascia

B.

pelvic diaphragm

C.

levator ani

D.

perivaginal fascia

C.

levator ani

During chest tube placement, it is MOST important to place the tube

in the inferior aspect of the intercostal space to avoid

A.

neurovascular injury.

B.

pneumothorax.

C.

lung injury.

D.
rib fracture.

A.

neurovascular injury.

When performing a culdoscopy, the Sims tenaculum should be

placed on which of the following aspects of the cervix to assist with
visualization of the operative area?

A.

medial

B.

posterior

C.

anterior

D.

lateral

B.

posterior

During a carotid endarterectomy, the patient's heart rate drops to

30 beats/min. This is likely due to stimulation of the

A.

hypoglossal nerve.

B.

vagus nerve.

C.

jugular vein.

D.

carotid artery.
B.

vagus nerve.

Which of the following prostate procedures involves a transvesical

approach?

A.

simple retropubic

B.

suprapubic

C.

radical perineal

D.

laparoscopic

B.

suprapubic

A 47-year-old female is recovering nicely from a laparoscopic Roux-

en-Y gastric bypass procedure. On her first day at home following
discharge from the hospital, she develops sudden-onset anterior
chest pain and shortness of breath and begins sweating profusely.
Upon returning to the hospital emergency room, her ECG shows
tachycardia and her chest x-ray appears normal. Which of the
following is the MOST likely reason for her symptoms?

A.

acute respiratory distress syndrome (ARDS)

B.

acute myocardial infarction

C.

pulmonary embolism
D.

nosocomial pneumonia

C.

pulmonary embolism

A 35-year-old male presents with headache, palpitations, and diaphoresis

brought on by micturition. The patient's identical twin brother died of an
undiagnosed sudden death. Which of the following diagnoses is MOST likely?

A.

pheochromocytoma

B.

renal malignancy

C.

pituitary tumor

D.

lymphoma

A.

pheochromocytoma

A 68-year-old female presents with hip pain. She was treated 15 years ago
with radiation and chemotherapy for lobular breast cancer. Which of the
following is the MOST likely diagnosis?

A.

pathologic hip fracture

B.

traumatic hip fracture

C.

trochanteric bursitis
D.

osteoarthritis

A.

pathologic hip fracture

Which of the following is the goal of a supraglottic laryngectomy to preserve?

A.

ability to use the esopheal voice

B.

ability to speak with a tracheostomy

C.

natural ability to speak

D.

ability to taste food

C.

natural ability to speak

A patient presents in the ER with a bowel obstruction due to a recto-anal

mass. Which of the following surgical procedures can be used for a complete
resection of the mass?

A.

low anterior resection

B.

transverse colectomy

C.

abdominal perineal resection

D.

right hemi-colectomy
C.

abdominal perineal resection

A patient arrives in the ER following a ground level fall with changes in

personality and movement. The patient's CT scan shows a subdural
hematoma. In which of the following lobes is the MOST likely location of the
hematoma?

A.

parietal

B.

frontal

C.

occipital

D.

temporal

B.

frontal

A patient presents with a large benign tumor located 3 cm proximal to the

anal verge. The surgical first assistant should assist the team in preparing for
a

A.

low anterior resection.

B.

anoperineal repair.

C.

total colectomy.

D.

hemorrhoidectomy.
A.

low anterior resection.

A patient undergoing an aortic valve replacement is having difficulty

converting to NSR (normal sinus rhythm) and cannot be weaned from
cardiopulmonary bypass. Continued failure of the heart to beat correctly
after aortic valve replacement is MOST commonly caused by

A.

occlusion of the right coronary artery.

B.

high blood level potassium.

C.

remaining cardioplegia.

D.

defective defibrillator paddles.

A.

occlusion of the right coronary artery.

When performing a hysterectomy and ligating the broad ligament, which of

the following vascular structures lies within the broad ligament?

A.

internal iliac artery

B.

external iliac artery

C.

uterine artery

D.

medial superior genicular artery

C.

uterine artery

During laparoscopic pelviscopy, a trocar is accidentally placed into the

urinary bladder. The surgical first assistant should anticipate repair of which
smooth muscle layer?

A.

adventitia

B.

vesical plexus

C.

detrusor

D.

epithelium

C.

detrusor

A surgeon is performing an arthroscopic ACL reconstruction and needs

precise placement of the graft. Which of the following would aid in correct
graft placement?

A.

drill sleeve

B.

Hohmann retractors

C.

tension isometer

D.

interference screws
C.

tension isometer

A 91-year-old woman presents to the OR with a hip fracture. Efforts should

be made to correct the fracture as soon as possible to avoid complications
related to

A.

sartorius muscle injury.

B.

thrombophlebitis.

C.

lateral inferior genicular artery avulsion.

D.

peroneal nerve injury.

B.

thrombophlebitis.

While trying to arrest the heart during an aortic valve replacement surgery,
the surgical first assistant notices that the heart is not responding to the
instillation of cardioplegia and the left ventricle is distending. Which of the
following is the MOST likely cause of this situation?

A.

incorrect cardioplegia solution

B.

aortic insufficiency

C.

aortic dissection

D.

coronary artery disease

B.

aortic insufficiency

Which skin cancer is MOST likely to require the use of a radioactive isotope
tracing in conjunction with isosulfan blue sentinel node mapping and
excision?

A.

fibrosarcoma

B.

basal cell carcinoma

C.

squamous cell carcinoma

D.

malignant melanoma

D.

malignant melanoma

Which of the following is a potentially lethal pathogen that causes surgical

site infections and spreads via the lymphatic system?

A.

Streptococcus pyogenes

B.

Pseudomonas aeruginosa

C.

Clostridium perfringens

D.

Salmonella enterica

A.
Streptococcus pyogenes

Which of the following bacteria is found in the lining of the colon?

A.

Staphylococcus aureus

B.

Escherichia coli

C.

Streptococcus pyogenes

D.

Serratia marcescens

B.

Escherichia coli

Which of the following includes Clostridium difficile, Clostridium

perfringens, and Bacteroides fragilis?

A.

gram-negative

B.

aerobes

C.

gram-positive

D.

anaerobes

D.

anaerobes

Which of the following is the MOST prevalent microorganism that causes

osteomyelitis?
A.

Escherichia coli

B.

Staphylococcus aureus

C.

Clostridium difficile

D.

Candida albicans

B.

Staphylococcus aureus

Which of the following is the MOST common organism found in necrotizing

fasciitis?

A.

Streptococci other than group A

B.

Beta hemolytic streptococcus

C.

Vibrio

D.

Escherichia coli

B.

Beta hemolytic streptococcus

Which of the following is the surgical wound classification for a laparoscopic

pyeloplasty?

A.

Class I
B.

Class II

C.

Class III

D.

Class IV

B.

Class II

Which of the following can convert an MRSA-negative patient to an MRSA-

positive patient in the advanced age population?

A.

Vancomycin

B.

Cefazolin

C.

Kanamycin

D.

Bacitracin

A.

Vancomycin

During an emergency splenectomy, the surgical first assistant sustains a

needle-stick injury. Which of the following are the MOST appropriate actions
to take?

A.

Change gloves and wash wound with betadine.

B.
Break scrub and wash wound.

C.

Remain in sterile field and change gloves.

D.

Inquire about patient's social and medical history.

B.

Break scrub and wash wound.

Preoperative antibiotic prophylaxis should be administered at which of the

following points of a surgical procedure?

A.

at the time of the first incision

B.

30 minutes before incision

C.

15 minutes before the incision is closed

D.

at the time of the timeout

B.

30 minutes before incision

Which local anesthetic has the longest analgesic effect?

A.

bupivacaine

B.

lidocaine

C.
procaine

D.

mepivacaine

A.

bupivacaine

Prior to liposuction, 40 mL 1% lidocaine with epinephrine 1:100,000

and 1,000 mL saline are combined to create which solution?

A.

tumescent

B.

papaverine

C.

Dakin's

D.

Lugol's

A.

tumescent

During induction of anesthesia, the administration of propofol

(Diprivan®) would cause

A.

a hypnotic state and sedation to unconsciousness.

B.

thinning of the blood and prevention of clotting.

C.

relaxation of muscles and dilation of arteries.

D.
relaxation of the bladder and production of urine.

A.

a hypnotic state and sedation to unconsciousness.

Comparatively, which of the following patients is at greatest risk for

anesthesia complication during the operative phase?

A.

a patient who is undernourished

B.

a patient who is immunosuppressed

C.

a patient with COPD

D.

a patient with diabetes

C.

a patient with COPD

We have an expert-written solution to this problem!

If a patient does not wish to receive an allogenic blood transfusion, which of

the following is an available option to limit the risk of intra-operative blood
loss?

A.

Use Dextrose 5% in 0.9% NACL for an IV drip.

B.

Give the patient factor 7 intra-operatively.

C.
Use preoperative autologous blood donation.

D.

Use FFP instead of PRBC's.

C.

Use preoperative autologous blood donation.

An anesthesiologist is performing spinal anesthesia for a total knee

replacement. Shortly after the spinal, the patient develops shortness of
breath and respiratory distress. Which of the following has MOST likely
happened?

A.

postdural puncture headache

B.

hypotension

C.

total spinal anesthesia

D.

caudal anesthesia

C.

total spinal anesthesia

Which of the following analgesic drugs produces amnesia?

A.

ketamine

B.

propofol

C.

etomidate
D.

midazolam

A.

ketamine

Which of the following is the MAXIMUM dosage of bupivacaine without

epinephrine?

A.

150 mg

B.

175 mg

C.

200 mg

D.

225 mg

B.

175 mg

In pre-op, the patient denies taking any anticoagulants. In passing, the

patient's family mentions herbal remedies that the patient has been trying.
Which of the following remedies should the surgical first assistant be MOST
concerned about causing anticoagulation?

A.

St. John's wort, cinnamon, and vitamin E

B.

ginseng, licorice, and fish oil

C.

ginseng, kava-kava, and ginger

D.

St. John's wort, licorice, and fish oil

ginseng, licorice, and fish oil

The topical hemostatic agent thrombin should never be directly

injected or allowed to enter into a vessel because

A.

it causes uncontrollable vasospasms.

B.

the effects are reversed when directly injected and cause more
severe bleeding.

C.

it can cause clotting and may ultimately lead to death.

D.

the risk of infection increases with direct injection.

C.

it can cause clotting and may ultimately lead to death.

A 16-year-old male comes in for an emergency appendectomy. Surgeon

states that the abdominal wall is very rigid and asks if muscle relaxation has
been given. The patient is tachycardic and the end-tidal CO2 is rising. What
is the MOST likely cause?

A.

sepsis

B.

malignant hyperthermia

C.

acute peritonitis

D.
hypervolemia

B.

malignant hyperthermia

A patient weighing 150 kg is having a malignant hyperthermia crisis. Using

20 mg bottles of Dantrolene, which of the following is the MINIMUM number
of bottles that need to be given to the patient?

A.

18 bottles

B.

19 bottles

C.

20 bottles

D.

21 bottles

B.

19 bottles