NBSTSA General Surgery 5 — Questions and Answers
Question 1: What is the correct method for passing a sharp instrument to the surgeon on the sterile field?
- Hand it directly handle-first while the surgeon looks away
- Use the neutral zone (hands-free technique) (Correct answer)
- Announce verbally and toss it across the field
- Use a non-sterile forceps to transfer it
Correct answer: Use the neutral zone (hands-free technique)
The neutral or hands-free zone technique places the sharp instrument in a designated area so the surgeon retrieves it without simultaneous hand contact, reducing sharps injuries.
Question 2: During a splenectomy, inadvertent injury to which adjacent organ is a common intraoperative complication?
- Liver
- Pancreatic tail (Correct answer)
- Right kidney
- Duodenum
Correct answer: Pancreatic tail
The tail of the pancreas lies in close proximity to the splenic hilum, making it vulnerable to injury during ligation of splenic vessels.
Question 3: Which suture technique is preferred for closing a bowel enterotomy to minimize luminal narrowing?
- Continuous locking suture longitudinally
- Transverse closure with interrupted or running suture (Correct answer)
- Purse-string suture only
- Vertical mattress suture
Correct answer: Transverse closure with interrupted or running suture
Closing an enterotomy transversely (perpendicular to the bowel axis) prevents luminal stenosis compared to longitudinal closure.
Question 4: What is the scrub technologist's role when the surgeon requests a 'loaded' needle holder?
- Hand an empty needle holder with suture placed separately
- Present the needle holder with the needle properly loaded and suture trailing (Correct answer)
- Pass the needle holder without a needle and await further instruction
- Clamp the suture with the needle holder tip
Correct answer: Present the needle holder with the needle properly loaded and suture trailing
A loaded needle holder has the needle secured at the correct position (2/3 from tip, perpendicular to the jaws) with suture trailing, ready for immediate use.
Question 5: Which energy device uses ultrasonic vibration to simultaneously cut and coagulate tissue?
- Monopolar electrosurgery
- Bipolar electrosurgery
- Harmonic scalpel (ultrasonic shears) (Correct answer)
- Argon beam coagulator
Correct answer: Harmonic scalpel (ultrasonic shears)
The harmonic scalpel converts electrical energy to mechanical ultrasonic vibration, denaturing tissue proteins to cut and seal vessels simultaneously with minimal thermal spread.
Question 6: A surgeon requests a 'figure-of-eight' suture during fascial closure. What does this suture pattern accomplish?
- Creates a single-layer purse-string closure
- Provides extra strength by incorporating two bites in a crossing pattern (Correct answer)
- Is used only for skin closure
- Achieves hemostasis in vascular structures exclusively
Correct answer: Provides extra strength by incorporating two bites in a crossing pattern
The figure-of-eight suture takes two crossing bites of tissue, distributing tension over a wider area for stronger fascial closure.
Question 7: What is the term for the inadvertent surgical creation of a connection between two loops of bowel during dissection?
- Anastomotic leak
- Enterotomy
- Enterocutaneous fistula
- Iatrogenic enterotomy (Correct answer)
Correct answer: Iatrogenic enterotomy
An iatrogenic enterotomy is an unintended opening in the bowel wall created during surgical dissection, requiring immediate recognition and repair.
NBSTSA General Surgery 5
What is the correct method for passing a sharp instrument to the surgeon on the sterile field?