NBSTSA General Surgery 3 — Questions and Answers
Question 1: During a thyroidectomy, which nerve must be identified and preserved to prevent hoarseness?
- Superior laryngeal nerve
- 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; injury causes hoarseness or voice loss.
Question 2: What is the correct sequence of steps when performing a stapled end-to-end anastomosis using a circular stapler?
- Insert anvil, fire stapler, check donuts, connect to stapler body
- Connect to stapler body, insert anvil, fire stapler, check donuts
- Insert anvil distally, connect to stapler body proximally, approximate, fire, inspect donuts (Correct answer)
- Fire stapler, insert anvil, check donuts, connect body
Correct answer: Insert anvil distally, connect to stapler body proximally, approximate, fire, inspect donuts
The anvil is placed in the distal bowel end, the stapler body is introduced proximally, both ends are approximated and fired, then the tissue donuts are inspected for completeness.
Question 3: Which anatomical structure forms the medial border of Hesselbach's triangle?
- Inguinal ligament
- Inferior epigastric vessels
- Lateral border of rectus abdominis (Correct answer)
- Femoral vein
Correct answer: Lateral border of rectus abdominis
Hesselbach's triangle is bounded medially by the lateral edge of the rectus abdominis, inferiorly by the inguinal ligament, and laterally by the inferior epigastric vessels.
Question 4: A scrub technologist notices the electrosurgical unit is producing minimal effect at the current setting during bowel surgery. What is the most likely cause?
- The patient return electrode is properly placed
- The active electrode tip has eschar buildup (Correct answer)
- The generator output is set too high
- The instrument is insulated correctly
Correct answer: The active electrode tip has eschar buildup
Eschar buildup on the active electrode tip increases impedance and reduces effective energy delivery; the tip should be cleaned regularly.
Question 5: During a Whipple procedure (pancreaticoduodenectomy), which structure is NOT routinely resected?
- Head of the pancreas
- Duodenum
- Distal common bile duct
- Body of the pancreas (Correct answer)
Correct answer: Body of the pancreas
The standard Whipple procedure removes the pancreatic head, duodenum, distal CBD, gallbladder, and part of the stomach, preserving the pancreatic body and tail.
Question 6: What is the appropriate action if a surgical sponge count is incorrect before wound closure?
- Close the wound and perform a postoperative X-ray
- Notify the surgeon immediately and search the wound and field (Correct answer)
- Document the discrepancy and proceed with closure
- Recount only the sponges on the back table
Correct answer: Notify the surgeon immediately and search the wound and field
An incorrect count must be immediately reported to the surgeon, and the wound and entire surgical field must be searched before closure.
Question 7: Which retractor system is most commonly used for deep pelvic exposure during a low anterior resection?
- Bookwalter retractor (Correct answer)
- Gelpi retractor
- Army-Navy retractor
- Richardson retractor
Correct answer: Bookwalter retractor
The Bookwalter retractor provides circumferential exposure with multiple interchangeable blades, making it ideal for deep pelvic procedures.
NBSTSA General Surgery 3
During a thyroidectomy, which nerve must be identified and preserved to prevent hoarseness?