CSFA General Practice 5

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?

Accepted Answer

Mass closure with a running #1 PDS suture using a 4:1 suture-to-wound length ratio

Answer

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:

Accepted Answer

Bone cement implantation syndrome (BCIS)

Answer

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?

Accepted Answer

Short gastric vessels (gastrosplenic ligament)

Answer

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?

Accepted Answer

Penrose drain

Answer

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:

Accepted Answer

Adequate blood supply and tension-free anastomosis

Answer

Anastomotic integrity depends primarily on adequate vascular perfusion and absence of tension; ischemia or tension are the leading causes of anastomotic breakdown.

CSFA - Certified Surgical First Assistant Practice Test

CSFA - Certified Surgical First Assistant Practice Test

CSFA General Practice 5