CSFA General Practice 5 — Questions and Answers
Question 1: During abdominal closure, the fascia is under significant tension. Which closure technique distributes tension most evenly and reduces the risk of fascial dehiscence?
- Simple interrupted sutures 1 cm apart
- Mass closure with a running #1 PDS suture using a 4:1 suture-to-wound length ratio (Correct answer)
- Figure-of-eight sutures at 2 cm intervals
- Subcuticular absorbable suture only
Correct answer: Mass closure with a running #1 PDS suture using a 4:1 suture-to-wound length ratio
The Smead-Jones or running mass closure technique with a 4:1 suture-to-wound length ratio (taking small bites frequently) has the lowest dehiscence rate for high-tension abdominal fascia closure.
Question 2: A patient undergoing total hip arthroplasty in the lateral decubitus position develops intraoperative hypotension after cementation. The MOST likely cause is:
- Fat embolism from reaming
- Bone cement implantation syndrome (BCIS) (Correct answer)
- Positional air embolism
- Latex allergy reaction
Correct answer: Bone cement implantation syndrome (BCIS)
Bone cement implantation syndrome occurs when bone cement monomer, fat, and marrow particles embolize during pressurization, causing hypotension, hypoxia, and cardiac arrhythmias.
Question 3: When assisting with a laparoscopic Nissen fundoplication, the surgical first assistant must ensure complete mobilization of the gastroesophageal junction. Which structure must be divided to create a tension-free wrap?
- Hepatoduodenal ligament
- Short gastric vessels (gastrosplenic ligament) (Correct answer)
- Gastrorenal ligament
- Falciform ligament
Correct answer: Short gastric vessels (gastrosplenic ligament)
Division of the short gastric vessels in the gastrosplenic ligament mobilizes the gastric fundus sufficiently to create a tension-free 360-degree wrap around the esophagus.
Question 4: Which type of surgical drain relies on gravity and capillary action for passive drainage, without suction?
- Jackson-Pratt (JP) drain
- Blake drain
- Penrose drain (Correct answer)
- Hemovac drain
Correct answer: Penrose drain
The Penrose drain is a flat latex tube that drains passively by gravity and capillary action, without a reservoir or vacuum, and exits through a dependent portion of the wound.
Question 5: During a right hemicolectomy, the surgical first assistant is assisting with the ileocolic anastomosis. The MOST important factor in reducing anastomotic leak risk is ensuring:
- The anastomosis is completed in under 15 minutes
- Adequate blood supply and tension-free anastomosis (Correct answer)
- Double-layer suture technique is always used
- The bowel is clamped distally before suturing
Correct answer: Adequate blood supply and tension-free anastomosis
Anastomotic integrity depends primarily on adequate vascular perfusion and absence of tension; ischemia or tension are the leading causes of anastomotic breakdown.
Question 6: In the event of a fire in the operating room, the surgical team should follow the RACE protocol. What does the 'C' in RACE stand for?
- Call for help
- Contain the fire (Correct answer)
- Check the patient
- Close all doors
Correct answer: Contain the fire
RACE stands for Rescue (patients in immediate danger), Alarm (activate the fire alarm), Contain (close doors to limit fire spread), and Extinguish or Evacuate.
Question 7: During an exploratory laparotomy for trauma, the surgical first assistant identifies a grade III liver laceration with active bleeding. The MOST appropriate initial maneuver to control hemorrhage is:
- Direct suture ligation of bleeding vessels
- Pringle maneuver (occlusion of the hepatoduodenal ligament) (Correct answer)
- Packing the liver and temporary abdominal closure
- Immediate hepatic artery ligation
Correct answer: Pringle maneuver (occlusion of the hepatoduodenal ligament)
The Pringle maneuver occludes the portal triad (portal vein, hepatic artery, bile duct) by compressing the hepatoduodenal ligament, reducing hepatic inflow and allowing time for definitive hemorrhage control.
CSFA General Practice 5
During abdominal closure, the fascia is under significant tension.
Which closure technique distributes tension most evenly and reduces the risk of fascial dehiscence?