NBSTSA General Surgery 2 — Questions and Answers
Question 1: Which layer of the abdominal wall is encountered immediately deep to the external oblique muscle?
- Transversus abdominis
- Internal oblique (Correct answer)
- Peritoneum
- Transversalis fascia
Correct answer: Internal oblique
The internal oblique muscle lies directly beneath the external oblique in the abdominal wall layers.
Question 2: During a laparoscopic cholecystectomy, what structure is identified at the hepatocystic triangle to confirm safe dissection?
- Critical view of safety (Correct answer)
- Rouviere's sulcus
- Calot's triangle apex
- Cystic plate
Correct answer: Critical view of safety
The critical view of safety requires the hepatocystic triangle to be cleared of fat and fibrous tissue with two structures seen entering the gallbladder.
Question 3: A patient undergoing an inguinal hernia repair has an indirect hernia. Where does the hernia sac originate?
- Hesselbach's triangle
- Femoral canal
- Internal inguinal ring (Correct answer)
- External inguinal ring
Correct answer: Internal inguinal ring
Indirect inguinal hernias originate at the internal inguinal ring and pass through the inguinal canal lateral to the inferior epigastric vessels.
Question 4: Which instrument is most appropriate for grasping the bowel during intestinal surgery without causing injury?
- Kocher clamp
- Babcock forceps (Correct answer)
- Allis clamp
- Ochsner clamp
Correct answer: Babcock forceps
Babcock forceps have an atraumatic design with fenestrated blades that gently encircle bowel without crushing the tissue.
Question 5: During an open appendectomy, which incision is most commonly used?
- Pfannenstiel incision
- McBurney's incision (Correct answer)
- Midline laparotomy
- Kocher incision
Correct answer: McBurney's incision
McBurney's incision is made at McBurney's point (1/3 the distance from the ASIS to the umbilicus) and is standard for open appendectomy.
Question 6: What is the primary purpose of using a wound protector/retractor sleeve during laparoscopic-assisted colon surgery?
- Maintain pneumoperitoneum
- Prevent wound infection and tumor implantation (Correct answer)
- Facilitate camera placement
- Control hemorrhage
Correct answer: Prevent wound infection and tumor implantation
Wound protectors reduce wound infection rates and prevent port-site tumor implantation during oncologic bowel surgery.
Question 7: Which suture material is most appropriate for closing a contaminated abdominal fascia?
- Silk
- Chromic gut
- Polypropylene (Prolene) (Correct answer)
- Polyglactin (Vicryl)
Correct answer: Polypropylene (Prolene)
Polypropylene is a non-absorbable monofilament that resists infection and maintains tensile strength in contaminated fields.
NBSTSA General Surgery 2
Which layer of the abdominal wall is encountered immediately deep to the external oblique muscle?