Online exam Flashcards
Which of the following degrees of endoscope is MOST commonly used during a laparoscopic cholecystectomy?
A.30° B.45° C.70° D.120°
A 30° scope
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
common bile duct injury
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
middle meningeal
A complication of steep reverse Trendelenburg position is A. deep vein thrombosis. B. arterial compression. C. cardiac overload. D. respiratory alkalosis.
/deep vein thrombosis/
Steep reverse Trendelenburg position decreases venous return. Sequential compression stockings are applied to prevent deep venous thrombosis.
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.
/The facility should safely accommodate the patient’s request/
This response demonstrates cultural sensitivity.
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
/Pringle maneuver/ The Pringle maneuver directly controls the blood supply to the liver.
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.
/Reintroduce normal flora/
This treatment normalizes all flora within the bowel, eliminating excess growth of the bacteria.
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
/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.
Which of the following incisions is usually used for an open cholecystectomy? A. McBurney's B. Pfannenstiel C. lower midline D. right subcostal
/right subcostal/
(Kocher) incision is appropriate for operations on the liver, gallbladder, and biliary tract.
How should peel pouches be placed in an autoclave for sterilization? A. flat B. stacked C. on their side D. individually
on their side
McBurney’s incision
The McBurney’s incision is made in the right lower quadrant and is typically used for appendectomy.
Pfannenstiel incision
The Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis, is most often employed for Cesarean section.
lower midline incision
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.
Trendelenburg position complication
Arterial compression, Cardiac overload, Respiratory alkalosis
The brachiocephalic artery bifurcates into the
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.
The left subclavian artery arises from the
arch of aorta behind the left common carotid artery
The brachial plexus is located
in the neck and axilla and is composed of the anterior branches of the lower four cervical and first two thoracic spinal nerves.
The aortic arch lies between
the ascending and descending portions of the aorta, located behind the manubrium.
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
/rotating burr/
removes small increments of bone.
Bone wax
hemostatic agent
Oscillating saw
used for linear cuts.
Bone cement
used in orthopedics to stabilize implants.
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
- True. Triclosan 1% is a prep solution.
- True. Alcohol 70% is a prep solution.
- True. Povidone-iodine is a prep solution.
Glutaraldehyde
carcinogenic disinfectant/sterilant.
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.
Sutures are usually removed within the fifth to sixth day postoperatively. Sutures should be left in longer in which of the following situations?
- Incision is closed under tension.
- Incision is in the hand.
- Patient is diabetic.
- 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
- True. Incisions closed under tension usually need a longer time to heal; therefore, sutures are left in longer.
- True. Incisions in the hand take longer to heal because movement slows the healing process.
- True. Patients with diabetes usually have wounds that take longer to heal, so the sutures would need to remain in longer to facilitate healing.
Suture tracts show signs of infection
Suture tracts that show signs of infection should be removed immediately to allow for wound drainage and irrigation.
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
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.
primum non nocere
Primum non nocere (or first do no harm) is a statement that guides a physician in the care of a patient.
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.
Intentional tort
means intentionally causing harm.
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.
Papaverine
chemical derived from the opium poppy that is used as a smooth muscle relaxant during surgery.
Heparin sodium
primarily derived from porcine intestinal mucosa and is used in surgery as a systemic anticoagulant.
Dexamethasone sodium
a synthetic glucocorticoid drug used primarily for its anti-inflammatory properties.
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.
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.
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
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.
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.
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.
hematocrit range 21 - 36%
A hematocrit range of 21 to 36% is considered low and may require a blood transfusion.
hematocrit range 54 - 69%
A hematocrit range of 54 to 69% is abnormally high and would result in polycythemia.
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.
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
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
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.
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.
sickle cell anemia
a chronic condition with misshapen red blood cells, clotting times are shorter.
hemophilia
a chronic condition where the patient lacks sufficient blood clotting proteins, will result in an elevated PTT, but PT remains within normal limits.
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.
simple retropubic
This procedure involves an incision in the anterior prostatic capsule and does not enter the bladder.
radical perineal
This procedure involves an incision between the scrotum and anus and does not enter the bladder.
laparoscopic prostatectomy
Laparoscopic prostatectomy uses a similar technique as the radical perineal procedure, or radical retropubic, neither of which enter the bladder.
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.
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
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
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.
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.
A split thickness skin graft is harvested using a A. #10 blade. B. dermatome. C. mesher. D. beaver blade.
dermatome.
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.
Which of the following incisions can be used to enter the prostatic capsule during a suprapubic prostatectomy?
- vertical
- transverse
- flank
- 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/
- True. The vertical incision is used to enter the prostatic capsule during a suprapubic prostatectomy.
- True. The transverse incision is used to enter the prostatic capsule during a suprapubic prostatectomy.
Fomon, Cottle, and Aufricht retractors are all considered which of the following kinds of instrument?
A.neuro B. CV C. ENT D. ortho
ENT
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.
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.
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.
Which of the following are rotator cuff muscles?
- teres major and teres minor
- supraspinatus and teres minor
- levator scapulae and infraspinatus
- 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
- True. Supraspinatus and teres minor are two of the four rotator cuff muscles. Remember SITS (supraspinatus, infraspinatus, teres minor, and scapularis).
- True. Infraspinatus and supraspinatus are two of the four rotator cuff muscles. Remember SITS (supraspinatus, infraspinatus, teres minor, and scapularis).
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.
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.
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?
- Remove hair at the surgical site.
- Maintain a blood glucose level of 70 - 110 mg/dl.
- Regulate normothermia.
- 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
- True. This is included in Surgical Care Improvement Project (SCIP) protocols.
- True. This is included in SCIP protocols.
- True. This is included in SCIP protocols.
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
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.
A purse-string suture is MOST commonly used for excision of the A.liver. B.appendix. C.stomach. D. uterus.
B. appendix
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.
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.
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.
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
- True. The active electrode should always be placed in a non-conductive holster to prevent contact with the patient or drapes.
- True. To prevent an alternate burn site, all metal jewelry must be removed from the patient.
- True. Internal implants impede conduction of the dispersive electrode due to scar tissue.
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
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.
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.
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.
Wilson frame
used for spinal surgery.
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.
Which of the following are desired outcomes for the Bankart procedure?
- preventing recurrence of dislocation
- reducing arthritic changes
- tightening of the infraspinatus muscle
- 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
- True. The Bankart procedure is a treatment for anterior shoulder dislocation.
- True. Chronic dislocation of the shoulder joint contributes to subsequent arthritic changes.
- True. The Bankart procedure contributes to restoration of joint motion.
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.
Example of a low-level disinfecting agent
iodophor solution
quaternary ammonium
Example of a intermediate-level disinfecting agent
isopropyl alcohol
Which of the following nerves innervates the latissimus dorsi muscle? A.thoracodorsal B.long thoracic C.lateral pectoral D.medial pectoral
A.thoracodorsal
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.
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.
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.
Nd:YAG laser
In ophthalmology, the Nd:YAG is used for capsulotomies, anterior adhesions, and vitreous bands.
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.
