CSFA General Practice 2 — Questions and Answers
Question 1: During a laparoscopic procedure, the surgeon requests increasing the insufflation pressure. As the surgical first assistant, what is the primary concern with excessively high intra-abdominal pressure?
- Increased bleeding from port sites
- Impaired venous return and decreased cardiac output (Correct answer)
- Reduced visibility of the operative field
- Increased risk of bowel injury
Correct answer: Impaired venous return and decreased cardiac output
High intra-abdominal pressure compresses the vena cava, reducing venous return and decreasing cardiac output, which can cause hemodynamic instability.
Question 2: When assisting with wound closure, the surgical first assistant is asked to perform an interrupted suture technique. What is the primary advantage of interrupted sutures over a continuous running suture?
- Faster closure time
- Reduced risk of wound dehiscence if one suture breaks (Correct answer)
- Less tissue reaction
- Easier to remove postoperatively
Correct answer: Reduced risk of wound dehiscence if one suture breaks
Interrupted sutures provide security because if one suture fails, the others maintain wound integrity, whereas a continuous suture failure can cause the entire closure to open.
Question 3: A patient undergoing abdominal surgery suddenly develops bradycardia and hypotension during peritoneal traction. This response is MOST likely caused by:
- Malignant hyperthermia
- Vasovagal reflex stimulation (Correct answer)
- Pulmonary embolism
- Anaphylactic reaction
Correct answer: Vasovagal reflex stimulation
Peritoneal traction stimulates the vagus nerve, triggering a vasovagal reflex that causes bradycardia and hypotension.
Question 4: Which retractor is BEST suited for providing self-retaining exposure during an open abdominal procedure?
- Deaver retractor
- Bookwalter retractor (Correct answer)
- Richardson retractor
- Army-Navy retractor
Correct answer: Bookwalter retractor
The Bookwalter is a self-retaining retractor system that attaches to the operating table and provides hands-free abdominal exposure without requiring an assistant to hold it.
Question 5: During a thyroidectomy, the surgical first assistant must be particularly careful to identify and preserve which structure to prevent permanent hoarseness?
- Superior laryngeal nerve (external branch)
- Recurrent laryngeal nerve (Correct answer)
- Hypoglossal nerve
- Glossopharyngeal nerve
Correct answer: Recurrent laryngeal nerve
The recurrent laryngeal nerve innervates the intrinsic muscles of the larynx; bilateral injury causes permanent voice hoarseness or loss and potential airway compromise.
Question 6: The surgical first assistant notices a sponge count discrepancy at the time of wound closure. What is the MOST appropriate immediate action?
- Proceed with closure and document the discrepancy
- Notify the surgeon immediately and halt closure until resolved (Correct answer)
- Repeat the count twice and close if the second count matches
- Check the trash bag outside the room
Correct answer: Notify the surgeon immediately and halt closure until resolved
A sponge count discrepancy must be immediately reported to the surgeon and closure halted; the patient's body cavity and field must be thoroughly searched before closure.
Question 7: Which electrosurgical mode uses an interrupted, modulated current that produces a coagulating effect with minimal cutting?
- Cut mode
- Blend mode
- Coagulation mode (Correct answer)
- Bipolar mode
Correct answer: Coagulation mode
Coagulation mode delivers an interrupted, modulated waveform at a lower duty cycle, producing tissue desiccation and hemostasis rather than vaporization.
CSFA General Practice 2
During a laparoscopic procedure, the surgeon requests increasing the insufflation pressure.
As the surgical first assistant, what is the primary concern with excessively high intra-abdominal pressure?