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E REFERENCE: Brunicardi, Charles; Schwartz's Principles of Surgery; 8th edition; 2005; pg. 347, 865 56 During a routine shoulder arthroscopy on a patient with instability, a surgeon notices that the patient has a type II SLAP lesion. Which of the following is the appropriate treatment for this finding? A. Resect the tissue. B. Repair the glenoid labrum. C. No treatment is necessary. D. Perform a biceps tenolysis. EXPLANATIONS: (u) A. Resection of the tissue will not resolve any issues wi…

which of the following congenital anomalies does the urethra open on the underside of the penis
A. chordee
B. epispadias
C. phimosis
D. hypospadias

D.

Which of the following are used for skin preparation prior to surgery?
1. Triclosan 1%
2. alcohol 70%
3. povidone-iodine
4. glutaraldehyde
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only

A. 1,2,and 3 only

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

In patients who develop fever, abdominal pain, and profuse diarrhea, the MOST frequently seen antibiotic-associated enterocolitis is due to which of the following organisms?
A. Enterobacter cloacae
B. Enterococcus faecalis
C. Pseudomonas aeruginosa
D Clostridium difficile

D

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. The clamp on the internal carotid artery should be removed last so that all debris left in the area is flushed out through the external carotid artery.

During a routine abdominal hysterectomy, the anesthesiologist notes that the patient is becoming progressively tachycardic. He notes that there has been virtually no blood loss. The surgeon requests additional muscle relaxation because the patient's abdominal musculature is "tightening up." The esophageal temperature probe indicates a core body temperature of 103°F (39°C). The anesthesiologist notices that the CO2 monitors are alarming with high levels. The anesthesiologist turns off his anesthetic agent, hyperventilates the patient with 100% oxygen, and administers which of the following drugs?

A. succinylcholine
B. dantrolene
C. atropine
D. epinephrine

B.The scenario is describing the anesthesia emergency malignant hyperthermia (MH). Dantrolene is the medication given to combat MH (2-3 mg/kg until signs are controlled). Some signs of MH are tachycardia, tachypnea, hypercarbia, muscle stiffness and rigidity, hypoxia, elevated BP, cardiac dysrhythmias, changes in CO2 absorption, and elevated temperature.

A pledgeted suture is used for hemostasis in liver injury to
A. align the suture placement.
B. add bulk to the injury site.
C. reduce the likelihood of suture cut- through.
D. provide traction for increased exposure.

C. Pledgeted sutures (buttresses) are sutures passed through a small patch of reinforcing material (usually Teflon). This type of suture is used in areas where the surgeon considers buffering to be beneficial, particularly in delicate or friable tissue.

During cardiac arterial bypass grafting, a surgeon needs to vasodilate and stop arterial spasm. Which of the following drugs should be used?
A. papaverine
B. heparin
C. protamine
D. norepinephrine

A. Papaverine stops spasming and relaxes smooth muscles, especially those of large arteries.

When ligating the short gastric arteries, placing them under too much tension may result in a tear of the
A. splenic capsule.
B. lesser omentum.
C. celiac trunk.
D. common bile duct.

A. The splenic capsule is attached to the short gastric arteries and tension would result in tearing.

Which of the following is needed to complete the circuit on an ESU when using a monopolar electrode tip?
A. a bipolar forceps
B. an insulated holster
C. an active electrode
D. a dispersive pad

D. The dispersive pad disperses high-frequency current released through the active electrode and provides low current density return from tissues back to the generator to complete the circuit.

A complication of steep reverse Trendelenburg position is
A. deep vein thrombosis.
B. arterial compression.
C. cardiac overload.
D. respiratory alkalosis.

A. Steep reverse Trendelenburg position decreases venous return. Sequential compression stockings are applied to prevent deep venous thrombosis.

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. Thrombin will cause blood in the vessel to clot and will cause thrombosis, which can lead to death if not realized and corrected immediately.

According to Maslow's Hierarchy of Needs, which of the following patient needs should be met first?
A. esteem
B. belonging
C. physiological
D. safety

C. Physiological needs must be met first before any of the other needs can be considered. Physiological needs include breathing, circulation, and the patient's physical condition.

An epidural catheter is introduced into a patient in the preoperative holding room. When the patient is given a bolus of local anesthetic in the OR, the surgical first assistant observes hypotension and signs of complete respiratory failure. Which of the following is the MOST likely cause?
A. migration of the epidural catheter through the dura
B. poor cardiac output
C. administration of ropivacaine instead of bupivacaine
D. use of a Bier block

A. With patient movement, the epidural catheter may migrate through the dura. A bolus injection into the subdural space can cause total spinal anesthesia resulting in hypotension and respiratory failure.

Taper point needles are generally used in which of the following tissue types?
1. gastrointestinal
2. tendons
3. adipose
4. vascular

1. It is used on GI tissues to reduce the amount of tissue trauma.
3. Adipose is a less dense tissue and a taper needle works well.
4. Vascular tissue needs a taper to prevent further tissue damage as well.

A threaded cortical screw cannot provide compression of bone fragments unless the
A. hole is tapped.
B. screw is self-tapping.
C. near cortex is overdrilled.
D. screw is cannulated.

C. Cortical screws can function in interfragmentary compression if the hole in the near cortex is overdrilled.

Which of the following is a normal adult hematocrit range?
A. 21 to 36%
B. 37 to 52%
C. 54 to 69%
D. 72 to 87%

B. A hematocrit range of 37 to 48% is normal for a female. A hematocrit range of 45 to 52% is normal for a male.

Excessive limb lengthening during total hip arthroplasty can increase the risk of injury to the
A. median nerve.
B. sciatic nerve.
C. brachial plexus.
D. celiac artery

B. Sciatic nerve injury is a complication of total hip arthroplasty. The risk increases with limb lengthening of the operative side.

Which of the following disease processes can affect cranial nerve VII?
1. acoustic neuroma
2. mastoid infections
3. hydrocephalus
4. Bell's Palsy
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only

1. True. Cranial nerve VII controls motor and sensory impulses to the face for facial expression, tearing, and salivation. Acoustic neuroma may damage cranial nerve VII.
2. True. Mastoid infections may spread to cranial nerve VII and cause paralysis if not treated.
4. True. Bell's Palsy is a viral infection that affects cranial nerve VII.

A patient involved in a motor vehicle crash arrives in the OR. The patient presents with the following:
The surgical first assistant should prepare the OR for
A. a ORIF left femoral fracture.
B. a left temporal craniotomy.
C. a repair of the left temporal laceration.
D. an exploratory laparotomy.

D. Clinical hypotension and blood in the urine indicate intra-abdominal injury. Exploratory laparotomy is necessary and should be the initial step in the surgical treatment of the patient.

During digital reanastomosis, which of the following items is commonly used?
A. operative microscope
B. nerve stimulator
C. epiphyseal staple
D. micro-oscillating saw

A. Vascular repair during a digital reanastomosis will typically require the utilization of an operative microscope, micro-instruments, and micro-suture.

When a flank approach is used for a nephrectomy, which of the following muscles are involved?
A. serratus anterior and trapezius
B. gluteus maximus and pectoralis major
C. latissimus dorsi and internal oblique
D. transverse abdominis and rectus abdominis

C. The latissimus dorsi curves upward from the lower back around the arm to the armpit. The internal oblique muscle would be involved.

Immediately following an arthroscopic assisted anterior cruciate ligament (ACL) reconstruction, a patient's knee is typically placed in
A. a hinged knee brace.
B. a posterior splint.
C. a long-leg cast.
D. an anterior splint.

A. A hinged knee brace is most commonly used following ACL reconstruction.

Joseph button-end knife, Ballenger swivel knife, and Cottle elevator are all considered which of the following kinds of instrument?
A. neuro
B. CV
C. ENT
D. ortho

C. These instruments are used in ENT surgery for septoplasty or rhinoplasty.

Which of the following has been shown to have proven benefit in the prevention of postoperative wound infections?

1. administrating appropriate antibiotics within 1 hour of incision time
2. maintaining suitable antibiotic coverage for 48-72 hours postoperatively
3. irrigating the wound with normal saline
4. irrigating the wound with antibiotic-based solution
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only

1. True. There is a general trend toward providing a single preoperative dose, as antibiotics prophylaxis may not impart any benefit at all beyond the initial dosing.
3. True. Serial irrigation of the operative field and the surgical wound with saline solution has shown benefit in controlling wound inoculum.

During a carotid endarterectomy, the arteries are unclamped and reclamped before arteriotomy closure is performed to
A. flush free debris from the carotid bulb.
B. restore complete blood flow to the brain.
C. increase collateral flow.
D. ensure patency of the carotid body.

A. Before complete closure, blood flow is temporarily restored through the arteries to wash away debris, such as free plaque, air, or thrombi.

When performing compression hip screw fixation, the lag screw is inserted

A. into the femoral neck with the threads 2 cm lateral to the fracture site.
B. within 1 cm of the femoral articular surface.
C. into the articular cartilage of the femoral head.
D. in the superior aspect of the femoral head.

B. Lag screw placement within 1 cm (10 mm) of the femoral articular surface is considered optimal for fracture fixation.

Which of the following are the most common lasers used in gynecological surgery?
A. ruby and CO2
B. Nd:YAG and argon
C. argon and ruby
D. CO2 and Nd:YAG

D. Both CO2 and Nd:YAG lasers are used for gynecological surgery.

Which of the following capsules must be entered to gain access to the kidney or suprarenal gland for repair?
A. Camper's fascia
B. renal corpuscle
C. Gerota's fascia
D. suprarenal cortex

C. Gerota's fascia is a dense capsule made of connective tissue and perinephric fat that encapsulates both the kidney and suprarenal gland.

While a patient is in the lithotomy position, which of the following nerves are at risk for injury?
1. sciatic
2. phrenic
3. obturator
4. femoral cutaneous
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only

1. True. The sciatic nerve is in the lower extremities and arises from L4-S3.
3. True. The obturator nerve is in the lower extremities and arises from L2-L4.
4. True. The femoral cutaneous nerve is in the lower extremities and arises from L2-L3.

Blood spatterings on the lens of an operative microscope should be removed with
A. alcohol.
B. water.
C. fred.
D. saline.

B. Distilled water is used with a cotton ball or cotton-tipped applicator when removing blood, water, and irrigating solutions from the lens surface.

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. The pressure of the 30 cc balloon against the walls of the urethra, where the prostate was removed by electrocautery, allows hemostasis, while the lumen of the catheter can be used to irrigate clots from the bladder.

In axillary node dissection, the sentinel node is
A. closest to the primary tumor.
B. located along the thoracic nerve.
C. part of the thoracic duct.
D. located along the superior vena cava.

A. A sentinel node is a lymph node that receives drainage from a tumor and is likely to harbor metastatic disease.

Which of the following catheters is used primarily for suprapubic drainage for poor-risk patients?
A. Foley
B. Malecot
C. urethral
D. Pezzer

D. The Pezzer catheter is used for poor-risk patients who have uremia, neurogenic bladder syndrome, or long-standing urinary retention.

Which of the following incisions is usually used for an open cholecystectomy?
A. McBurney's
B. Pfannenstiel
C. lower midline
D. right subcostal

D. The right subcostal (Kocher) incision is appropriate for operations on the liver, gallbladder, and biliary tract.

Which of the following must be adhered to when positioning a patient laterally for thoracotomy?
1. padding pressure points
2. protecting nerves and vessels
3. preventing hyperextension of limbs
4. flexing upper legs

A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only

1. True. All pressure points should be padded for all positions to prevent pressure injuries.
2. True. Protecting nerves and vessels must be done during positioning and would be applicable.
3. True. Hyperextension of the arms relates to preventing nerve and vessel damage.

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. Diprivan® is used for induction and maintenance of anesthesia for sedation and hypnosis.

Heparin is used as an anticoagulant to prevent clotting.

Papaverine stops vasospasms and relaxes smooth muscles, especially those of large arteries.

Furosemide (Lasix®) is used on adults and children for the treatment of edema by producing urine.

INFO

A patient scheduled for elective surgery has a positive pregnancy test. Which of the following is MOST appropriate?
A. Proceed with surgery regardless of the trimester.
B. Only proceed with surgery during the first trimester.
C. Use a general anesthetic with a halogenated agent only.
D. Defer the surgery until after the delivery.

D. Elective surgical procedures should be deferred until after delivery of the neonate, once the anatomic and physiologic changes of pregnancy have returned to normal.

Which of the following methods of suturing should be used to close a deep layer located on the medial edge of a myocutaneous flap closure of a sacral decubitus ulcer?
A. simple running with 0 Vicryl SH
B. Cushing suture with 1 Prolene FS
C. Halstead suture with 0 Vicryl CTX
D. half-buried mattress suture with 0 PDS FS

D. The half-buried mattress (Grey-Turner) method of suture is a series of inverted interrupted horizontal or vertical mattress stitches. In this method, the knot is tied deep to avoid the incision line and prevent irritation. The interrupted status helps to avoid wound dehiscence should a suture fail. PDS has the same qualities of Vicryl, but is monofilament so it does not lend itself to wicking of possible SSI. The 0 gauge is an appropriate gauge suture. The FS needle is an appropriate needle selection for closing this layer.

Which of the following tests measures the velocity of the flow of red blood cells?
A. Doppler
B. B. mode ultrasound
C. duplex ultrasound
D. angiography

A. Doppler measures the velocity of the flow of red blood cells.

1. mode ultrasound projects a two-dimensional image on an oscilloscope screen. The image appears as dots from the echoes of the signal.
2. Duplex ultrasound is a combination of the pulse Doppler and the real time B. mode image ultrasonogram.
3. Angiography is a study used to evaluate the vascular system using fluoroscopy and contrast medium.

INFO

A 70-year-old patient who underwent an 8-hour colon resection is at the greatest risk for which of the following?
A. diverting colostomy
B. postoperative infection
C. myocardial infarction
D. hyperthermia

B. All 3 components to this question are contributing factors to higher risk of wound infection: 1) the age of the patient, 2) the extended time of the procedure, and 3) the wound classification.

When a surgeon places a 2-stage venous cannula for cardiopulmonary bypass, where should the cannula be placed?
A. ascending aorta
B. right atrium
C. right ventricle
D. right superior pulmonary vein

B. The right atrium sends deoxygenated blood to the bypass unit through the venous cannula.

A. The ascending aorta carries oxygenated blood to the patient via the aortic cannula.
C. The right ventricle is not used in the bypass circuit at all.
D. The right superior pulmonary vein is used for left ventricular venting through a vent cannula

INFO

Using Standard Precautions, which of the following is proper procedure when handling contaminated items?
A. removing scalpel blades by hand
B. disposing suctioned body fluids into a drain connected to a sanitary sewer
C. placing sharps in an emesis basin for disposal into the biohazard trashbag
D. discarding used needles by hand

B. Suctioned body fluids may safely be poured down a drain connected to a sanitary sewer.

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 the surgical first assistant consider during wound closure?

A. Multifilament, absorbable suture material provides for optimal wound healing.
B. A continuous suture line should be utilized.
C. An interrupted retention suture should be utilized.
D. Use of blunt surgical needles is a consideration in the presence of infection.

C. Interrupted retention suturing effectively provides a secondary suture line relieving strain on the wound and providing a better opportunity for healing by first intention.

Vertical-banded gastroplasty (VAB) and gastric bypass Roux-en-Y are common procedures performed in which of the following types of surgery?
A. colorectal
B. general
C. bariatric
D. thoracic

C. This is common description of two bariatric procedures done today

Which of the following are reasons for keeping the OR at a relative humidity level of between 50 - 55%?
1. reduced risk of infection
2. lower levels of patient discomfort
3. minimization of static electricity
4. depressed waste anesthesia gas

A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only

EXPLANATIONS:
1. True. Humidity levels above 60% are conducive to bacterial growth, so OSHA recommends having humidity remain between 50 - 55%.
3. True. High humidity increases the risk of electrical conductivity, which could lead to fires in the OR. Lower humidity levels will minimize the static electricity in the room.

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. The gastric arteries run between the greater curvature of the stomach and the spleen.

A. The splenic artery runs retroperitoneal below the stomach
C. The common duct is medial to the stomach.
D. The pancreatic duct is retroperitoneal and underneath the stomach.

INFO

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