Online exam Flashcards
(235 cards)
1
Q
Which of the following degrees of endoscope is MOST commonly used during a laparoscopic cholecystectomy?
A.30° B.45° C.70° D.120°
A
A 30° scope
2
Q
During laparoscopic cholecystectomy, the surgeon requests an intraoperative cholangiogram in which the hepatic tree is not visible. Which of the following should be anticipated? A.cystic duct stenosis B.pancreatic atresia C. common bile duct injury D. retained pancreatic duct stone
A
common bile duct injury
3
Q
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
4
Q
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/
Steep reverse Trendelenburg position decreases venous return. Sequential compression stockings are applied to prevent deep venous thrombosis.
5
Q
A Native American is scheduled for a below-knee amputation due to diabetic complications. The patient requests that the specimen be preserved and later buried with him when he dies. Which of the following is the BEST response?
A. Deviation from hospital policy concerning surgical specimens is not allowed.
B. Cultural or religious requirements are more important than safety standards.
C.The pathology department must decide on the final disposition of the specimen.
D. The facility should safely accommodate the patient’s request.
A
/The facility should safely accommodate the patient’s request/
This response demonstrates cultural sensitivity.
6
Q
A patient presents with a systolic blood pressure less than 70 and increasing abdominal distention. An exploratory celiotomy reveals an actively bleeding traumatic injury to the liver. Which of the following techniques should be performed FIRST? A. placement of aortic clamp B. Pringle maneuver C. placement of Rummel tourniquet D. partial liver resection
A
/Pringle maneuver/ The Pringle maneuver directly controls the blood supply to the liver.
7
Q
A patient who has been treated for a staph infection of a surgical wound has been on prolonged clindamycin. The patient has had severe diarrhea for two weeks with a positive spore forming bacteria culture. Which of the following is the MOST likely treatment? A. Discontinue all antibiotic therapy. B. Begin immunotherapy. C. Reintroduce normal flora. D. Perform an exploratory laparotomy.
A
/Reintroduce normal flora/
This treatment normalizes all flora within the bowel, eliminating excess growth of the bacteria.
8
Q
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/
The subclavian vein is a continuation of the axillary vein and is located just deep to the middle third of the clavicle, running parallel to it (close anatomic relationship between the subclavian vein and the clavicle) and is the first vessel encountered beneath the clavicle.
9
Q
Which of the following incisions is usually used for an open cholecystectomy? A. McBurney's B. Pfannenstiel C. lower midline D. right subcostal
A
/right subcostal/
(Kocher) incision is appropriate for operations on the liver, gallbladder, and biliary tract.
10
Q
How should peel pouches be placed in an autoclave for sterilization? A. flat B. stacked C. on their side D. individually
A
on their side
11
Q
McBurney’s incision
A
The McBurney’s incision is made in the right lower quadrant and is typically used for appendectomy.
12
Q
Pfannenstiel incision
A
The Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis, is most often employed for Cesarean section.
13
Q
lower midline incision
A
A typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly. This is usually used for distal colon and pelvic surgery.
14
Q
Trendelenburg position complication
A
Arterial compression, Cardiac overload, Respiratory alkalosis
15
Q
The brachiocephalic artery bifurcates into the
A
right subclavian artery (innominate artery), which arises at the level of the right sternoclavicular joint curving behind the scalenus anterior muscle passing upwards and laterally, and the right common carotid artery.
16
Q
The left subclavian artery arises from the
A
arch of aorta behind the left common carotid artery
17
Q
The brachial plexus is located
A
in the neck and axilla and is composed of the anterior branches of the lower four cervical and first two thoracic spinal nerves.
18
Q
The aortic arch lies between
A
the ascending and descending portions of the aorta, located behind the manubrium.
19
Q
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
A
/rotating burr/
removes small increments of bone.
20
Q
Bone wax
A
hemostatic agent
21
Q
Oscillating saw
A
used for linear cuts.
22
Q
Bone cement
A
used in orthopedics to stabilize implants.
23
Q
Which of the following are used for skin preparation prior to surgery?
- Triclosan 1%
- alcohol 70%
- povidone-iodine
- 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
- True. Triclosan 1% is a prep solution.
- True. Alcohol 70% is a prep solution.
- True. Povidone-iodine is a prep solution.
24
Q
Glutaraldehyde
A
carcinogenic disinfectant/sterilant.
25
When considering the plan of care for an 80-year-old obese male with diabetes undergoing thoracotomy for lobectomy, which of the following immediate factors can be altered to influence wound healing?
A. the time of day the procedure is performed
B. the patient's BMI
C. the suture material selected
D. a postoperative exercise program
/the suture material selected/
| Appropriate suture material and size may be immediately chosen based on individual patient factors.
26
Sutures are usually removed within the fifth to sixth day postoperatively. Sutures should be left in longer in which of the following situations?
1. Incision is closed under tension.
2. Incision is in the hand.
3. Patient is diabetic.
4. Suture tracts show signs of infection.
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, 2, and 3 only
1. True. Incisions closed under tension usually need a longer time to heal; therefore, sutures are left in longer.
2. True. Incisions in the hand take longer to heal because movement slows the healing process.
3. True. Patients with diabetes usually have wounds that take longer to heal, so the sutures would need to remain in longer to facilitate healing.
27
Suture tracts show signs of infection
Suture tracts that show signs of infection should be removed immediately to allow for wound drainage and irrigation.
28
During the time out, 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
to effectively communicate patient identification issues or concerns
29
```
If a Kelly clamp is left in a patient who underwent a cholecystectomy, which of the following legal charges can be filed?
A. primum non nocere
B. res ipsa loquitur
C. foreseeability
D. intentional tort
```
/Res ipsa loquitur/
| (or the thing speaks for itself) is a doctrine that applies to injuries sustained by a patient while in the OR.
30
primum non nocere
Primum non nocere (or first do no harm) is a statement that guides a physician in the care of a patient.
31
Foreseeability
applies to the doctrine which provides proximate cause in negligence, which states that something similar was likely to happen in a different situation under similar circumstances.
32
Intentional tort
means intentionally causing harm.
33
```
An allergy to fish necessitates caution when administering which of the following drugs?
A. papaverine
B. heparin sodium (Coumadin®)
C. dexamethasone sodium phosphate
D. protamine sulfate
```
/Protamine sulfate/
is a purified form of protamine used in surgery to neutralize the anticoagulant action of heparin. Protamine is found in fish sperm and named for the fish from which it is derived.
34
Papaverine
chemical derived from the opium poppy that is used as a smooth muscle relaxant during surgery.
35
Heparin sodium
primarily derived from porcine intestinal mucosa and is used in surgery as a systemic anticoagulant.
36
Dexamethasone sodium
a synthetic glucocorticoid drug used primarily for its anti-inflammatory properties.
37
```
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.
```
/near cortex is overdrilled/
| Cortical screws can function in interfragmentary compression if the hole in the near cortex is overdrilled.
38
Which of the following is an effective way to estimate proper femoral nail diameter and length of an acute, severely comminuted femur fracture?
A. preoperative radiographs of the affected leg
B. postoperative radiographs of the affected leg
C. postoperative radiographs of the unaffected leg
D. preoperative radiographs of the unaffected leg
/preoperative radiographs of the unaffected leg/
The size and length of the femur of the uninjured leg should be similar to the size and length of the femur prior to the acute fracture.
39
```
During application of a cast, additional padding is often required to protect bony prominences of patients at greater risk for pressure injury. Which of the following padding materials is MOST commonly used in this situation?
A. stockinette
B. Kerlix roll
C. Webril
D.Kling
```
/Webril/
is commonly used to provide additional padding on bony prominences to prevent pressure injuries. It is applied over the initial layer of padding and held in place by plaster that is applied over it
40
```
A hemoglobin level of 5 g/dL MOST likely indicates which of the following?
A. need for a blood transfusion
B. a patient is dehydrated
C. hemochromatosis
D. congestive heart failure
```
/need for a blood transfusion/
| Hemoglobin below 10 g/dL is likely symptomatic and requires blood transfusion.
41
```
Use of social media to discuss a patient is a violation of patient confidentiality and
A.Borrowed Servant Rule.
B. HIPAA.
C. doctrine of res ipsa loquitur.
D. extension doctrine.
```
HIPAA provides confidentiality of health data.
42
```
Which of the following is a normal adult hematocrit range?
A. 21 - 36%
B. 37 - 52%
C. 54 - 69%
D. 72 - 87%
```
/37 - 52%/
| A hematocrit range of 37 to 48% is normal for a female. A hematocrit range of 45 to 52% is normal for a male.
43
hematocrit range 21 - 36%
A hematocrit range of 21 to 36% is considered low and may require a blood transfusion.
44
hematocrit range 54 - 69%
A hematocrit range of 54 to 69% is abnormally high and would result in polycythemia.
45
hematocrit range 72 - 87%
A hematocrit range of 72 to 87% is abnormally high and may be caused by tissue hypoxia, dehydration, and blood doping.
46
```
The minimum depth of split thickness skin grafts is which of the following?
A. 1 mm
B. 0.3 mm
C. 0.5 mm
D. 2 mm
```
0.3 mm
47
```
The maximum depth of split thickness skin grafts is which of the following?
A. 1 mm
B. 0.3 mm
C. 0.5 mm
D. 2 mm
```
1 mm
48
```
Given the following lab values:
increased PT
increased PTT
increased fibrin degradation products
decreased fibrinogen
```
```
Which of the following is MOST likely?
A. von Willebrand's disease
B. sickle cell anemia
C. disseminated intravascular coagulation
D. hemophilia
```
/Disseminated intravascular coagulation/
is an acute condition where the proteins that control clotting become overactive and will result in both increased PT and PTT.
49
von Willebrand's disease
a chronic condition where the patient is missing the von Willebrand protein, the PTT increases, but PT is within normal limits.
50
sickle cell anemia
a chronic condition with misshapen red blood cells, clotting times are shorter.
51
hemophilia
a chronic condition where the patient lacks sufficient blood clotting proteins, will result in an elevated PTT, but PT remains within normal limits.
52
```
Which of the following prostate procedures involves a transvesical approach?
A. simple retropubic
B. suprapubic
C. radical perineal
D. laparoscopic
```
/suprapubic/
| This procedure involves an incision that enters the urinary bladder.
53
simple retropubic
This procedure involves an incision in the anterior prostatic capsule and does not enter the bladder.
54
radical perineal
This procedure involves an incision between the scrotum and anus and does not enter the bladder.
55
laparoscopic prostatectomy
Laparoscopic prostatectomy uses a similar technique as the radical perineal procedure, or radical retropubic, neither of which enter the bladder.
56
```
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.
```
/neurovascular injury/
A chest tube is always placed above the rib to avoid injury to the neurovascular bundle, which runs on the superior aspect of the intercostal space.
57
Which of the following angled plates is MOST frequently chosen for a compression hip screw fixation?
A. 130° B. 135° C. 145° D. 150°
/135° angle/
plates are most frequently chosen for compression hip screw fixation because of ease of placement and excellent clinical results
58
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
/pulmonary embolism/
is a postoperative complication of laparoscopic Roux-en-Y. Sudden onset anterior chest pain, shortness of breath, and sweating profusely are all signs of pulmonary embolism
59
```
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.
```
/round ligaments/
contain the uterine appendages, including the fallopian tubes, ovaries, and associated ligaments. The uterus must be excised from the round ligaments for eventual removal.
60
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
/latissimus dorsi and internal oblique /
The latissimus dorsi curves upward from the lower back around the arm to the armpit. The internal oblique muscle would be involved.
61
```
A split thickness skin graft is harvested using a
A. #10 blade.
B. dermatome.
C. mesher.
D. beaver blade.
```
dermatome.
62
```
A patient with known bovine allergies presents with persistent internal oozing of blood from the liver bed. Which of the following hemostatic agents should be used?
A. Avitene
B. Instat
C. Surgiflo
D. Surgicel
```
/Surgicel/
| This hemostatic agent is oxidized cellulose, which is a plant derivative.
63
Which of the following incisions can be used to enter the prostatic capsule during a suprapubic prostatectomy?
1. vertical
2. transverse
3. flank
4. posterior
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 4 only
D. 3 and 4 only
/1 and 2 only/
1. True. The vertical incision is used to enter the prostatic capsule during a suprapubic prostatectomy.
2. True. The transverse incision is used to enter the prostatic capsule during a suprapubic prostatectomy.
64
Fomon, Cottle, and Aufricht retractors are all considered which of the following kinds of instrument?
A.neuro B. CV C. ENT D. ortho
ENT
65
A 46-year-old patient presents to plastic surgeon for reconstruction, status post-MOHS' excision of basal cell cancer removal from right medial cheek. Which of the following should be considered for the MOST acceptable cosmetic outcome?
A. closure along relaxed skin tension lines
B. use of absorbable and retention sutures
C.tissue expansion in preparation for primary closure
D. meshed split thickness skin grafting
/closure along relaxed skin tension lines/
Langer's lines are natural lines of tension formed by the relationship of the skin to the underlying musculature and are the ideal place to hide surgical incisions.
66
An Esmarch bandage is MOST frequently used for which of the following types of surgery?
A. bariatric B. general C. podiatric D. vascular
podiatric
| Esmarch bandages are used in podiatric surgery to exsanguinate the extremity to provide a bloodless field.
67
```
A patient undergoing a 6-hour pelvic tumor debulking procedure is experiencing progressively worsening hypotension and tachycardia. At 4 hours into the operation, the anesthesia provider indicates that the patient's oxygen saturation is starting to decrease. Which of the following should be administered to this patient to correct the issues?
A.epinephrine
B. normal saline
C. blood products
D.morphine
```
blood products
During a long operation, blood loss is increased. Hypotension and tachycardia are signs of moderate blood loss. Decreasing blood oxygen levels are a sign of major blood loss. Administration of blood products will increase blood volume and improve the amount of oxygen carried to the body.
68
Which of the following are rotator cuff muscles?
1. teres major and teres minor
2. supraspinatus and teres minor
3. levator scapulae and infraspinatus
4. infraspinatus and subscapularis
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 4 only
D. 3 and 4 only
2 and 4 only
2. True. Supraspinatus and teres minor are two of the four rotator cuff muscles. Remember SITS (supraspinatus, infraspinatus, teres minor, and scapularis).
4. True. Infraspinatus and supraspinatus are two of the four rotator cuff muscles. Remember SITS (supraspinatus, infraspinatus, teres minor, and scapularis).
69
```
After a mitral valve replacement, a patient coming off bypass shows signs of cardiac ischemia. Which of the following MOST likely happened during the procedure to cause this?
A. ligation of the inferior vena cava
B. occlusion of the circumflex artery
C.occlusion of the innominate vein
D.ligation of the subclavian artery
```
occlusion of the circumflex artery
If placed too deep, sutures placed posterolaterally (in the 7-8 o'clock position) on the mitral valve could occlude the circumflex artery.
70
```
Which of the following lies between the lung and the chest wall?
A. mediastinum
B. aortic arch
C. pleura
D. pericardial cavity
```
pleura
The pleural cavity is a closed space within which the lung resides. As the lung expands into the space, it picks up a layer of pleura, which is called the visceral pleura. The remainder of the pleura is called the parietal pleura.
71
To reduce the incidence of surgical site infection in a patient with an anticipated Class 2 wound, which of the following actions should be taken?
1. Remove hair at the surgical site.
2. Maintain a blood glucose level of 70 - 110 mg/dl.
3. Regulate normothermia.
4. Administer 72 hours of prophylactic antibiotics.
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
1. True. This is included in Surgical Care Improvement Project (SCIP) protocols.
2. True. This is included in SCIP protocols.
3. True. This is included in SCIP protocols.
72
```
Prior to elective surgery requiring general anesthetic, what is the recommended MINIMUM amount of time a patient should be NPO?
A.1 hour
B.2 hours
C.3 hours
D.4 hours
```
4hrs
73
When positioning a patient for an anterior cruciate ligament (ACL) repair, it is MOST important to place the tourniquet as high as possible on the thigh, slightly angle the leg holder (if used) towards the patient's head, and drape as high toward the thigh as possible to
A.place additional ports.
B.allow the guide pin to emerge through a prepped and draped area.
C.use a six-inch ace bandage to wrap the extremity.
D.prevent contamination of the sterile area.
B. allow the guide pin to emerge through a prepped and draped area.
When draping a leg for an ACL, the guide pin will usually come through the skin through the thigh. The tourniquet leg holder must be placed at a slight angle back toward the patient's head and draped as high toward the thigh as possible in order for the guide pin to emerge through a prepped and draped area.
74
```
A purse-string suture is MOST commonly used for excision of the
A.liver.
B.appendix.
C.stomach.
D. uterus.
```
B. appendix
75
```
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.
76
```
During a posterolateral approach for an intracapsular hip fracture, which of the following muscles would be released along with the short external rotators and capsule from the posterior aspect of the femur as a single musculocapsular flap?
A.gluteus medius
B.gemelli
C.quadratus femoris
D.piriformis
```
D. The piriformis muscle arises from the sacrum and inserts at the highest point on the greater trochanter. It is an extensor and lateral rotator of the femur.
77
A 16-year-old male comes to the OR for acute open appendectomy. Ten minutes into the procedure, surgeon requests further muscle relaxation to facilitate exposure. The anesthesia provider informs the surgeon that the patient is tachycardic, febrile, and has increased end tidal CO2. Which of the following is the MOST appropriate first step?
A.Anesthesia provider administers additional muscle relaxant.
B.Anesthesia provider treats tachycardia with medication.
C.Anesthesia provider administers additional narcotics.
D.Anesthesia provider discontinues inhalant anesthesia.
D.Anesthesia provider discontinues inhalant anesthesia.
| The patient exhibits symptoms of malignant hyperthermia crisis and the first step is to discontinue triggering agents.
78
Which of the following are safety factors to consider when using electrosurgery units (ESU)?
1. All active electrodes should be stored in an insulated holster.
2. All jewelry should be removed to prevent risk of potential burns to the patient.
3. Any malfunctioning ESU should be serviced before and after each case.
4. Dispersive electrodes should not be located in proximity to internal implants.
A.1, 2, and 3 only
B.1, 2, and 4 only
C.1, 3, and 4 only
D.2, 3, and 4 only
B.1, 2, and 4 only
1. True. The active electrode should always be placed in a non-conductive holster to prevent contact with the patient or drapes.
2. True. To prevent an alternate burn site, all metal jewelry must be removed from the patient.
4. True. Internal implants impede conduction of the dispersive electrode due to scar tissue.
79
```
The MOST common complication of an external fixator is
A.pin tract infection.
B.compartment syndrome.
C.delayed union.
D.neurovascular impalement.
```
A.pin tract infection.
| Occurring in 30% of patients, the most common complication is pin tract infection
80
```
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
| run between the greater curvature of the stomach and the spleen.
81
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.
According to the standard of informed consent, the physician should explain the procedure and answer the patient's questions.
82
```
Which of the following is the specialized head holder used for craniotomies and is attached to the standard OR bed?
A.Mayfield
B.halo
C.Wilson frame
D.donut
```
A.Mayfield
| The Mayfield provides the stability and access needed for this procedure.
83
Wilson frame
used for spinal surgery.
84
```
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.
| A gentle touch can provide comfort to the patient and reduce stress.
85
Which of the following are desired outcomes for the Bankart procedure?
1. preventing recurrence of dislocation
2. reducing arthritic changes
3. tightening of the infraspinatus muscle
4. restoring joint motion
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, 2, and 4 only
1. True. The Bankart procedure is a treatment for anterior shoulder dislocation.
2. True. Chronic dislocation of the shoulder joint contributes to subsequent arthritic changes.
4. True. The Bankart procedure contributes to restoration of joint motion.
86
```
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 is a high-level disinfectant.
87
Example of a low-level disinfecting agent
iodophor solution
| quaternary ammonium
88
Example of a intermediate-level disinfecting agent
isopropyl alcohol
89
```
Which of the following nerves innervates the latissimus dorsi muscle?
A.thoracodorsal
B.long thoracic
C.lateral pectoral
D.medial pectoral
```
A.thoracodorsal
90
```
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 cannula tip is placed into the ascending aorta and provides blood flow downstream away from the heart.
91
A patient who is opposed to the acceptance of blood transfusion on religious principle is undergoing a hysterectomy. During surgery, there was significant blood loss causing hematocrit to drop to 30% with a resulting drop in oxygen saturation. Under these conditions, which of the following is the appropriate response?
A.Transfuse whole blood.
B.Increase IV fluid drip to allow hemodilution.
C.Change IV fluid to dextrose 5% with water.
D.Transfuse platelets.
B.Increase IV fluid drip to allow hemodilution.
Hemodilution is a relative increase in the volume of blood plasma resulting in a decrease in the measure of concentration of red blood cells allowing for greater circulating volume.
92
```
Which of the following types of laser is used in retinal surgery?
A.Excimer
B.argon
C.Nd:YAG
D.carbon dioxide
```
B.argon
| The argon laser is effective in coagulation and sealing retinal tears.
93
Nd:YAG laser
In ophthalmology, the Nd:YAG is used for capsulotomies, anterior adhesions, and vitreous bands.
94
Excimer laser
The Excimer laser is used in laser in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). The Excimer, or pulsed gas laser, emits an ultraviolet light beam, vaporizing tissue by breaking down molecular tissue bonds in a minute targeted area.
95
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.
Before complete closure, blood flow is temporarily restored through the arteries to wash away debris, such as free plaque, air, or thrombi
96
```
Which of the following is the MOST plausible cause for blurry vision, metallic taste, and tinnitus following a local anesthetic injection?
A.central nervous system toxicity
B.epinephrine response
C.vasovagal response
D.allergic reaction
```
A.central nervous system toxicity
| These are the classic signs and symptoms when local anesthetic is introduced into the central nervous system.
97
```
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
| Long arm casts are used for immobilization of elbow fractures.
98
```
A wound that is known to be infected at the time of surgery and is left open to be closed at a later date is categorized as
A.first intention.
B.granulation.
C.delayed primary closure.
D.second intention.
```
C.delayed primary closure.
Wound closure is delayed or secondary for the purpose of walling off an area of gross infection or where extensive tissue was removed. The edges are closed 4-6 days postoperatively after meticulous debridement.
99
first intention.
primary closure of a wound.
100
granulation.
(secondary intention) occurs when the wound is allowed to close on its own.
101
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
B.1, 2, 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.
102
```
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 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.
103
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.
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.
104
To reduce radiation exposure to a patient's reproductive organs, shields should be placed over which of the following regions?
1. hips
2. abdomen
3. upper leg
4. thoracic cavity
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
105
```
During a posterolateral approach to the hip, which of the following structures usually found superficially to the obturator and gemelli should be identified and protected?
A.sciatic nerve
B.superior gluteal
C.inferior gluteal
D.lateral femoral cutaneous nerve
```
A.sciatic nerve
The sciatic nerve (largest nerve in the body) arises from the lumbosacral plexus. It emerges from the pelvis below the piriformis and enters the thigh between the ischial tuberosity and the greater trochanter.
106
superior gluteal nerve
The superior gluteal nerve supplies the gluteus medius, minimus, and tensor fasciae. The nerve exits the pelvis and enters the gluteal region through the upper margin of the greater sciatic notch just superior to the piriformis muscle and travels with the superior gluteal artery between the gluteus medius and minimus.
107
inferior gluteal nerve
The inferior gluteal nerve supplies the gluteus maximus. The susceptibility of the nerve to injury during a posterior approach to the hip may be explained by its close relationship to the deep surface of the gluteus maximus.
108
lateral femoral cutaneous nerve
The lateral femoral cutaneous nerve arises from L2 and L3 and passes lateral to the psoas muscle, which passes underneath the lateral portion of the inguinal ligament and supplies the lateral thigh.
109
```
An 18-year-old patient undergoing general anesthesia for a laparoscopic cholecystectomy is experiencing the following:
hypercarbia
tachypnea
tachycardia
hypoxia
metabolic acidosis
respiratory acidosis
cardiac dysrythmias
elevation of body temperature
```
```
Which of the following conditions is MOST likely?
A.cardiac arrest
B.malignant hyperthermia
C. respiratory arrest
D depolarizing muscle blocking
```
B.malignant hyperthermia
110
```
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
| The robotic endowrist mimics the coordinated actions of the human arm.
111
```
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
112
```
During a carotid endarterectomy, the patient's heart rate drops to 30 bpm. This is likely due to stimulation of the
A.hypoglossal nerve.
B.vagus nerve.
C.jugular vein.
D. carotid artery.
```
B.vagus nerve.
| The vagus nerve can affect the heart rate when stimulated during carotid surgery
113
hypoglossal nerve
The hypoglossal nerve is a motor nerve that innervates the musculature of the tongue
114
Which of the following is the BEST method for a circulator to transfer medications from an ampule?
A.holding an ampule while surgical technologist draws from ampule with a filter needle
B drawing into syringe with an 18-gauge needle, removing the needle, and ejecting into sterile container on back table
C.holding an ampule while surgical technologist draws from ampule with an 18-gauge needle
D.drawing into syringe with a filter needle, removing the needle, and ejecting into sterile container on back table
D. drawing into syringe with a filter needle, removing the needle, and ejecting into sterile container on back table
115
Taper point needles are generally used in which of the following tissue types?
1. gastrointestinal
2. tendons
3. adipose
4. vascular
A.1, 2, and 3 only
B.1, 2, and 4 only
C.1, 3, and 4 only
D.2, 3, and 4 only
C.1, 3, and 4 only
1. gastrointestinal
3. adipose
4. vascular
116
Which of the following bones make up the pelvic girdle?
1. coccyx
2. acetabulum
3. sacrum
4. os coxae
A.1, 2, and 3 only
B.1, 2, and 4 only
C.1, 3, and 4 only
D.2, 3, and 4 only
C.1, 3, and 4 only
| The coccyx, sacrum, and os coxae make up the pelvic girdle. The os coxae consist of the ilium, ischium, and pubis.
117
```
The active chemical used for sterilization in a Steris unit is
A.glutaraldehyde.
B.peracetic acid.
C.hydrogen peroxide.
D.cobalt 60.
```
B. 35% peracetic acid and some premixed buffering agents are contained in a canister that is used in the Steris unit as the active sterilant.
118
hydrogen peroxide used for sterilization
Hydrogen peroxide is usually contained in a cartridge and used with the Sterrad unit.
119
cobalt 60 used for sterilization
Cobalt 60 is an ionizing radiation form of sterilization and is usually used to sterilize most prepackaged materials received from manufacturers.
120
glutaraldehyde used for sterilization
Glutaraldehyde is a chemical sterilant usually used for scopes.
121
```
An 81-year-old woman has just had a thrombectomy of an upper extremity arteriovenous fistula. Which of the following is the MOST appropriate skin suture technique?
A.subcuticular, absorbable
B.subcuticular, nonabsorbable
C.interrupted, nonabsorbable
D.interrupted, absorbable
```
C.interrupted, nonabsorbable
This is an appropriate skin closure technique for friable, delicate, and thin skin. This type of suture is considered the strongest and most secure.
122
```
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
| Posterior placement will allow adequate anterior displacement of the cervix for viewing the posterior cul-de-sac.
123
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.
The robotic arm eliminates tremor associated with manual operation of the endoscope. Further benefits accrued by the use of robotic assistance include greater stability of view, less inadvertent smearing of the lens, and the absence of fatigue.
124
```
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
Upon opening of the aneurysmal sac, the lumbar vessels, which enter the posterior aortic wall, are ligated with vascular suture.
125
common hepatic
The common hepatic artery arises from the aorta above the level of the superior mesenteric and is the primary blood supply for the liver
126
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.within 1 cm of the femoral articular surface.
127
```
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.
128
```
A burn victim has been taken to the OR for debridement of the wounds on his leg. In order to facilitate new tissue growth, the MOST appropriate dressing is
A.pressure.
B.bolster.
C.wet-to-dry.
D.occlusive.
```
C.wet-to-dry.
129
```
Which of the following catheter sizes is MOST appropriate following thoracotomy in an adult patient?
A.12 Fr
B.16 Fr
C.20 Fr
D.30 Fr
```
D.30 Fr
130
When assessing the postoperative patient, the surgical first assistant should demonstrate competency in
1. recognition of physiological complications.
2. management of physiological emergencies.
3. interpretation of monitoring data.
4. associated surgical pathologies.
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
1. recognition of physiological complications.
2. management of physiological emergencies.
3. interpretation of monitoring data.
131
```
A patient with an internal defibrillator presents with a malignant intrahepatic lesion. Which of the following is the safest methodology for resection?
A.ESU
B.LASER
C.harmonic scalpel
D.vessel sealing
```
C.harmonic scalpel
| most advantageous in transecting hepatic parenchyma and will not interfere with defibrillator.
132
```
Which of the following sterilants is utilized by the Steris System I sterilizer?
A.hydrogen peroxide
B.ozone gas
C ethylene oxide
D.peracetic acid
```
D.peracetic acid
133
Rough and excessive handling of tissue (intestines or blood vessels) by the surgical first assistant can result in which of the following results?
1. paralytic ileus
2. portal insufficiency
3. hypovolemia
4. increased inflammatory response
A.1 and 2 only
B.1 and 4 only
C.2 and 3 only
D.3 and 4 only
B.1 and 4 only
1. paralytic ileus
4. increased inflammatory response
134
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.
135
```
Which of the following arteries may be detached and reanastomosed to the graft during an abdominal aortic aneurysm (AAA) resection?
A.renal
B.inferior mesenteric
C.celiac
D.left gastric
```
A.renal
| The renal arteries may be detached and reanastomosed to the graft.
136
Which of the following should take place when an incorrect and unresolved count occurs?
A.filing an incident report
B.noting the occurrence in the patient's permanent record
C.documenting the incident on the MedWatch reporting form
D.reporting the incident to The Joint Commission
A.filing an incident report
137
```
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.
```
B.Repair the glenoid labrum
138
```
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
| vertical field in which objects can be seen in focus.
139
stereopsis
Stereopsis is binocular viewing; each eye has a slightly different view of the object under the microscope.
140
working distance
Working distance is the combination of objective lenses, interchangeable eyepieces, and surgeon preference.
141
focal length
Focal length ranges from 100 to 400 mm and it defines the working distance.
142
```
Which of the following is the BEST treatment option for a local anesthesia toxicity?
A.albumin
B.IV lipids
C.IV LR
D.IV saline (0.45%)
```
B.IV lipids
143
```
In the steam sterilization process, biological indicators should be run with all implantable devices. These indicators should contain
A.Clostridium perfringens.
B.Staphylococcus aureus.
C.Bacillus subtilis.
D.Bacillus stearothermophilus.
```
D.Bacillus stearothermophilus.
144
```
Which of the following nerves is frequently damaged after fractures or wounds to the elbow?
A.brachial
B.ulnar
C.median
D.palmar
```
B.ulnar
| The ulnar nerve runs on the lateral aspect of the elbow.
145
brachial
The brachial nerve is located in the upper arm.
146
median
The median nerve runs along the dorsal aspect of the forearm.
147
palmar
The palmar nerve runs through the palm.
148
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. Transversalis is a fascial layer encountered during an abdominal hernia repair.
C.levator ani
D.perivaginal fascia
C.levator ani
| The definition of a rectocele repair states that the levator ani muscle can be used to build up the perineum.
149
transversalis fascia
Transversalis is a fascial layer encountered during an abdominal hernia repair.
150
Transversalis is a fascial layer encountered during an abdominal hernia repair.
The pelvic diaphragm gives support to the abdominal pelvic viscera in this region.
151
```
A 70-year-old patient with a history of tuberculosis undergoes a wedge resection of the right upper lobe of the lung. When the lung is reinflated, which of the following may cause poor lung compliance?
A.decompression sickness
B.excessive scarring
C.excessive carbon dioxide
D. Damage to the phrenic nerve
```
B.excessive scarring
152
decompression sickness
Decompression sickness, also called nitrogen narcosis, occurs when nitrogen gas bubbles form in the bloodstream causing joint pain, dizziness, fatigue, paralysis, and unconsciousness.
153
Damage to the phrenic nerve
Damage to the phrenic nerve will cause diaphragm paralysis.
154
```
What is the normal range of red blood cells in a complete blood count for an adult male?
A.3.5–5.2 x 103/nl
B.4.6–6.2 x 106/nl
C.12.0–16.0 g/dl
D.14.0–18.0 g/dl
```
B. 4.6–6.2 x 106/nl
| normal range of red blood cells for an adult male
155
```
What is the normal range of red blood cells in a complete blood count for a 6-12 month old?
A.3.5–5.2 x 103/nl
B.4.6–6.2 x 106/nl
C.12.0–16.0 g/dl
D.14.0–18.0 g/dl
```
A. 3.5–5.2 x 103/nl
| is the normal range of red blood cells for a 6-12 month old.
156
```
What is the normal range of hemoglobin in an adult female?
A.3.5–5.2 x 103/nl
B.4.6–6.2 x 106/nl
C.12.0–16.0 g/dl
D.14.0–18.0 g/dl
```
C. 12.0–16.0 g/dl is the normal range of hemoglobin for an adult female.
157
```
What is the normal range of hemoglobin in an adult male?
A.3.5–5.2 x 103/nl
B.4.6–6.2 x 106/nl
C.12.0–16.0 g/dl
D.14.0–18.0 g/dl
```
D. 14.0–18.0 g/dl
| is the normal range of hemoglobin for an adult male.
158
Disaster plans developed by the hospital disaster committee should be tested in drills how many times per year?
A.1 B.2 C.3 D. 4
B.2
159
```
A 42-year-old female presents status post-mastectomy with immediate reconstruction and radiation therapy. Skin breakdown necessitates implant removal and the placement of a new flap. Which of the following is the MOST appropriate flap to place?
A.latissimus flap
B.tram flap
C.free flap
D. paramedian flap
```
A.latissimus flap
160
For steam sterilization, linen packs must be
A.placed on their sides.
B.placed crisscross on top of each other.
C.placed in the middle of the sterilizer one at a time.
D.laid flat with spaces in-between.
A.placed on their sides.
161
How many times should medications be checked in the OR before administration?
A.1 B.2 C.3 D. 4
B.2
Medication is checked first between a registered nurse and surgical technologist; medication is checked a second time and verbally stated when handing it to the surgeon.
162
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.
Thrombin will cause blood in the vessel to clot and will cause thrombosis, which can lead to death if not realized and corrected immediately.
163
```
Blood spattering on the lens of an operative microscope should be removed with
A.alcohol.
B.water.
C.fred.
D.saline.
```
B. water
164
Fred solution
Fred is an anti-fog solution for endoscopes, not a cleaning solution for the lens of an operative microscope.
165
```
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
Chest tubes are attached to the drainage system after the pleural space is closed to begin the process of evacuating blood and fluids from the pleural cavity, as well as to re-establish negative pressure in the intrapleural space.
166
```
Which of the following casts should be applied to a non-displaced humeral fracture?
A.Wedge
B.hanging
C.sugar tong
D.Munster
```
B. hanging cast
is a cylinder cast used to apply to the arm with the elbow flexed. It extends from the shoulder to over the hand, leaving the thumb and fingers free. A wire loop is incorporated at the wrist. A strap through this loop and around the neck suspends the arm. The weight of the cast provides traction to the humerus.
167
Wedge cast
A Wedge cast has a wedge-shaped portion cut from the cast. The edges are brought together and reinforced by plaster. This cast is used to overcome angulation of the fracture.
168
sugar tong cast
A sugar tong cast is twice as long as the lower arm and hand and is used for fractures of the ulna or radius.
169
Munster cast
A Munster cast is used for fractures of the radius or ulna with callous formation.
170
```
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
| Osteosarcoma can be seen in the patient as a result of previous radiation and chemotherapy
171
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.
Interrupted retention suturing effectively provides a secondary suture line relieving strain on the wound and providing a better opportunity for healing by first intention.
172
```
During a hepatic resection, which of the following ligaments separates the left lateral and the left medial segments of the liver?
A.gastrohepatic
B.falciform
C.triangular
D.coronary
```
B. falciform
ligament separates the left lateral and medial segments along the umbilical fissure and anchors the liver to the anterior abdominal wall.
173
gastrohepatic ligament
centrally located just left of the gallbladder.
174
triangular ligament
The left and right triangular ligament separates the two sides of the liver to the diaphragm.
175
coronary ligament
The coronary ligament extends from the triangular ligament anteriorly and extends to the underside of the liver to the peritoneum over the kidney.
176
```
In which of the following electrosurgeries can the grounding pad be safely omitted?
A.argon beam
B.bipolar
C.ball electrode
D.active electrode
```
B. Bipolar
| energy goes from the generator to an active tip of a special forceps to the inactive tip and returns to the generator.
177
```
During a cholecystectomy, it is important to isolate which of the following ligaments, consisting of the common bile duct, hepatic artery, and portal vein?
A.gastrohepatic
B.hepatoduodenal
C.triangular
D.coronary
```
B .hepatoduodenal
The hepatoduodenal ligament is also known as the porta hepatis and contains the common bile duct, hepatic artery, and portal vein.
178
```
Treatment of complete heart block should include
A.atrial defibrillation.
B.implanting a permanent pacemaker.
C.administration of nitroglycerin.
D.cardiopulmonary resuscitation.
```
B. Implanting a permanent pacemaker
| returns the heart to a functional rhythm.
179
```
Prior to leaving the OR, the dressing on the abdominal wound is saturated. Which of the following should occur?
A.Apply an occlusive dressing.
B.Apply a non-adherent dressing.
C.Apply a wound vac.
D.Apply a secondary dressing
```
D.Apply a secondary dressing
180
```
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.
181
```
Event-related sterility is concerned with
A.time.
B.integrity.
C.pressure.
D.temperature.
```
B.integrity.
182
Which of the following methods of routine sterilization is considered optimal for processing nonporous stainless steel instruments?
A.steam cycle at 250°F (121°C) for 3 minutes
B.steam cycle at 250°F (121°C) for 10 minutes
C.steam cycle at 270°F (132°C) for 3 minutes
D.steam cycle at 270°F (132°C) for 10 minutes
D.steam cycle at 270°F (132°C) for 10 minutes
183
```
Which of the following is the MOST likely reason for the radiographic finding?
A.COPD
B.empyema
C.pneumothorax
D.pneumonia
```
C.pneumothorax
| a potential complication of the procedure and would be immediately identified with postoperative chest x-ray
184
Which of the following treatments is MOST appropriate in this setting? treatment of choice for pneumothorax.
A.broad-spectrum antibiotics
B.first course of chemotherapy
C.thoracostomy
D.thoracentesis
C. Thoracostomy
| with chest tube insertion is the treatment of choice for pneumothorax.
185
thoracentesis
(removal of fluid from the pleural cavity)
186
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.
will keep the bone cool to avoid cracking and will also keep it moist, which will help to prevent bone dust from floating in the air.
187
```
A patient returns to the OR 1 week postoperatively with wound dehiscence. Which of the following phases of the wound healing process has been interrupted?
A.inflammatory
B.proliferative
C.remodeling
D.granulation
```
B. proliferative phase
involves collage synthesis and pulling together of wound edges, which adds strength to the wound. This phase was interrupted or failed during the 1-week period. This phase lasts from hours after injury up to 2 weeks.
188
inflammatory phase
The inflammatory phase involves additional blood flow to the area to aid in healing and to bring leukocytes to the area to fight infection. This phase adds no strength to the wound and lasts from immediately up to 4 days.
189
remodeling phase
The remodeling phase involves the maturation of a scar. It begins at approximately 2 weeks after surgery and can last for 1 year.
190
granulation phase
granulation portion of the proliferative phase.
191
```
The distal portion of the Javid shunt used during carotid endarterectomy is inserted into which of the following arteries?
A.external carotid
B.internal carotid
C.common carotid
D.middle cerebral
```
B.internal carotid
Blood flow to the brain and orbital cavities is directed from the common carotid artery through the internal carotid artery.
192
```
The BEST method of managing blood loss during a traumatic liver injury or hepatic resection is
A.harmonic scalpel.
B.suture ligation.
C.Kocher maneuver.
D.Pringle maneuver.
```
D.Pringle maneuver.
| The Pringle maneuver is used to control bleeding via intermittent vascular occlusion of the portal triad.
193
Kocher maneuver
The Kocher maneuver is used to expose and mobilize the duodenum.
194
harmonic scalpel.
A harmonic scalpel is an instrument that cuts and permanently coagulates tissue with vibration.
195
A pledgeted suture is used for hemostasis during arteriotomy closure to
A.align the sutureplacement.
B.add bulk to the injury site.
C.reduce bleeding at the suture site.
D.provide traction for increased exposure.
```
C.reduce bleeding at the suture site.
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 or for use when bleeding might occur through needle holes in a major vessel.
```
196
```
Pulling on the wrist to reduce a radius fracture incorporates which of the following principles of surgical assisting?
A.traction-countertraction
B.internal-external rotation
C.extension-flexion
D.supination-pronation
```
A.traction-countertraction
| Traction-countertraction pulls tissues taut for easier dissection and identification of vital structures
197
internal-external rotation
Internal-external rotation describes the direction in which force is applied.
198
extension-flexion
Extension-flexion describes the motion in which force is applied.
199
```
Which of the following pieces of equipment would be MOST appropriate for a panniculectomy?
A.individual smoke evacuator
B.full body warming blanket
C.bipolar cautery
Dinsufflator
```
A.individual smoke evacuator
| This case produces a lot of plume from ESU, a smoke evacuator should be used to ensure environmental safety in OR.
200
During arterial embolectomy, which of the following catheters is used for clot removal?
```
A.
Swan-Ganz
B.
Groshong
C.
Fogarty
D.
Broviac
```
C. The Fogarty
| arterial embolectomy catheter is typically used to remove arterial clots during an embolectomy procedure
201
Swan-Ganz
The Swan-Ganz catheter is placed into the pulmonary artery to measure pulmonary pressure.
202
Groshong
The Groshong is a central venous catheter used for medication administration.
203
Broviac
The Broviac catheter is usually used for long-term intravascular access.
204
Which of the following arch-shaped midline structures separates the right and left hemispheres of the brain and is a continuation of dura mater?
```
A.
falx cerebri
B.
tentorium cerebella
C.
fissure of Rolando
D.
fissure of Sylvius
```
A.
falx cerebri
The falx cerebri is a fold of dura matter that separates the cerebral hemispheres.
205
tentorium cerebella
The tentorium cerebella is a fold of dura matter that separates the hemispheres from the cerebellum.
206
fissure of Rolando
The fissure of Rolando (central sulcus) separates the parietal lobe from the frontal lobe. It is an important landmark because the convolution in front of it contains the higher centers for control of movements for the opposite side of the body.
207
fissure of Sylvius
The fissure of Sylvius separates the frontal lobe from the temporal lobe
208
What is the normal respiration and heart rate for a 6-year-old child?
```
A.
10-40 breaths/min, 80-130 beats/min
B.
12-20 breaths/min, 60-100 beats/min
C.
16-22 breaths/min, 70-110 beats/min
D.
20-30 breaths/min, 70-120 beats/min
```
C.
| 16-22 breaths/min, 70-110 beats/min
209
What is the normal respiration and heart rate for a 1-year-old child?
```
A.
10-40 breaths/min, 80-130 beats/min
B.
12-20 breaths/min, 60-100 beats/min
C.
16-22 breaths/min, 70-110 beats/min
D.
20-30 breaths/min, 70-120 beats/min
```
A.
| 10-40 breaths/min, 80-130 beats/min
210
What is the normal respiration and heart rate for a 3-year-old child?
```
A.
10-40 breaths/min, 80-130 beats/min
B.
12-20 breaths/min, 60-100 beats/min
C.
16-22 breaths/min, 70-110 beats/min
D.
20-30 breaths/min, 70-120 beats/min
```
B.
| 12-20 breaths/min, 60-100 beats/min
211
What is the normal respiration and heart rate for a 10-year-old child?
```
A.
10-40 breaths/min, 80-130 beats/min
B.
12-20 breaths/min, 60-100 beats/min
C.
16-22 breaths/min, 70-110 beats/min
D.
20-30 breaths/min, 70-120 beats/min
```
D.
| 20-30 breaths/min, 70-120 beats/min
212
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
213
The main consideration in surgical needle selection is
```
A.
to minimize microbial growth.
B.
stabilization within the jaws of the needle-holder.
C.
to minimize trauma.
D.
corrosion resistance.
```
C.
| to minimize trauma.
214
Which of the following is a common complication when transporting a post-anesthesia patient?
```
A.
decreased cardiac output
B.
hypervolemia
C.
embolism
D.
mitral stenosis
```
A.
| decreased cardiac output
215
During an ORIF of the distal radius, the surgeon may transect the transverse carpal ligament to
A.
provide exposure for the procedure.
B.
provide increased wrist range-of-motion postoperatively.
C.
reduce the possibility of carpal tunnel syndrome postoperatively.
D.
reduce the possibility of de Quervain's tenosynovitis postoperatively.
C.
| reduce the possibility of carpal tunnel syndrome postoperatively.
216
Which of the following is the desired effect of atropine when used as a preoperative medication?
```
A.
drowsiness
B.
pain relief
C.
decreased anxiety
D. drying of secretions
```
D. drying of secretions
217
The ideal core temperature range for the postoperative patient is
```
A.
90°F (32°C) to 93°F (34°C).
B.
97°F (36°C) to 100°F (38°C).
C.
104°F (40°C) to 108°F (42°C).
D.
111°F (44°C) to 115°F (46°C).
```
B.
| 97°F (36°C) to 100°F (38°C).
218
Which of the following positions should be utilized for posterior colpotomy?
```
A.
prone
B.
supine
C.
lithotomy
D.
Fowler's
```
C.
| Colpotomy is an incision into the vagina. The lithotomy position is necessary for access to this region of the body.
219
Which of the following muscles may be retracted during a thyroidectomy?
```
A.
gastrocnemius
B.
triceps
C.
sternocleidomastoid
D.
temporalis
```
C.
| sternocleidomastoid
220
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.
| operative microscope
221
In the application of arch bars, which of the following would the surgeon MOST likely use between the teeth and around the bar?
```
A.
0-1 Dexon
B.
5-0 to 6-0 Vicryl
C.
25- or 28-gauge stainless steel wire
D.
34- or 36-gauge stainless steel wire
```
C.
| 25- or 28-gauge stainless steel wire
222
An ophthalmologist orders his post-cataract patient to receive an anti-infective anti-inflammatory solution applied to the surface of the operative eye. Which of the following is MOST appropriate administration?
```
A.
hard contact lens with eye drops
B.
collagen corneal shield
C.
perforated aluminum eye shield
D.
traditional eye pad
```
B.
| collagen corneal shield
223
During surgery, which of the following would an indwelling Foley catheter accomplish?
1. Maintain bladder decompression.
2. Permit accurate measurement of output.
3. Allow for constant monitoring of electrolytes.
4. Facilitate bladder irrigation.
```
A.
1, 2, and 3 only
B.
1, 2, and 4 only
C.
1, 3, and 4 only
D.
2, 3, and 4 only
```
B. 1, 2, and 4
1. Maintain bladder decompression.
2. Permit accurate measurement of output.
4. Facilitate bladder irrigation.
224
Capacitive coupling occurs
A.
when electricity flows from one conductive substance to another.
B.
when an active electrode touches the tip of another conductive object.
C.
when damage is unnoticed until later and infection develops at the burn site.
D.
when an active electrode insulator is inserted into a conductive metal sheath.
C.
| when damage is unnoticed until later and infection develops at the burn site.
225
During a laparoscopic lysis of adhesions, a walled-off abscess is entered and purulent material is released into the abdomen. The surgical first assistant should alert the team that they will need
```
A.
water irrigation.
B.
hydrogen peroxide irrigation.
C.
saline irrigation.
D.
glycine irrigation.
```
C.
| saline irrigation.
226
glycine irrigation.
Glycine is used as an irrigant in the bladder
227
Which of the following describes the property of sound that is related to the frequency of the wavelength?
```
A.
harmonics
B.
ultrasound
C.
radiation
D.
convection
```
A.
| harmonics
228
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
```
C.
1, 3, and 4 only
1. sciatic
3. obturator
4. femoral cutaneous
229
Which of the following is the MOST likely complication when positioning the patient in prone position, when the arms are positioned above the head?
```
A.
shoulder dislocation
B.
brachial plexus injury
C.
ulnar nerve injury
D.
elbow dislocation
```
B.
| brachial plexus injury
230
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
231
During total hip arthroplasty through an anterolateral approach, which of the following maneuvers is needed to dislocate the femoral head?
```
A.
abduction and internal rotation
B.
abduction and external rotation
C.
adduction and internal rotation
D.
adduction and external rotation
```
D.
| adduction and external rotation
232
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
233
mode ultrasound
mode ultrasound projects a two-dimensional image on an oscilloscope screen. The image appears as dots from the echoes of the signal
234
duplex ultrasound
Duplex ultrasound is a combination of the pulse Doppler and the real time B. mode image ultrasonogram.
235
angiography
Angiography is a study used to evaluate the vascular system using fluoroscopy and contrast medium.
