NCCPA Surgical Principles 2 — Questions and Answers
Question 1: Which suture material is MOST appropriate for closing a contaminated abdominal wound?
- Silk
- Polypropylene (Prolene) (Correct answer)
- Chromic gut
- Polyglactin (Vicryl)
Correct answer: Polypropylene (Prolene)
Polypropylene is a monofilament, nonabsorbable suture that resists infection better than braided materials in contaminated fields.
Question 2: A patient develops a fever on postoperative day 1-2. The MOST likely cause is:
- Wound infection
- Pneumonia
- Urinary tract infection
- Wind (atelectasis) (Correct answer)
Correct answer: Wind (atelectasis)
Early postoperative fever (days 1-2) is classically attributed to atelectasis causing cytokine release.
Question 3: Which layer of the abdominal wall provides the greatest tensile strength for fascial closure?
- Skin
- Subcutaneous fat
- Anterior rectus sheath (external oblique aponeurosis) (Correct answer)
- Peritoneum
Correct answer: Anterior rectus sheath (external oblique aponeurosis)
The anterior rectus sheath and external oblique aponeurosis provide the greatest tensile strength and are the critical layers for secure fascial closure.
Question 4: Damage control surgery is BEST described as:
- Complete definitive repair of all injuries in a single operative session
- Staged surgery prioritizing hemorrhage control and contamination prevention over definitive repair (Correct answer)
- Laparoscopic exploration for abdominal trauma
- Delayed surgery until the patient is fully resuscitated
Correct answer: Staged surgery prioritizing hemorrhage control and contamination prevention over definitive repair
Damage control surgery involves abbreviated initial surgery to control hemorrhage and contamination, followed by ICU resuscitation and planned return to the OR for definitive repair.
Question 5: Which electrolyte abnormality is MOST commonly associated with massive blood transfusion?
- Hypernatremia
- Hypercalcemia
- Hypocalcemia (Correct answer)
- Hypermagnesemia
Correct answer: Hypocalcemia
Citrate used as a preservative in packed red blood cells chelates ionized calcium, causing hypocalcemia during massive transfusion.
Question 6: The MOST important factor in preventing surgical site infections is:
- Postoperative antibiotics for 5 days
- Appropriate preoperative antibiotic timing within 60 minutes of incision (Correct answer)
- Use of laparoscopic technique
- Draining all wound dead space
Correct answer: Appropriate preoperative antibiotic timing within 60 minutes of incision
Administering prophylactic antibiotics within 60 minutes before incision is the single most evidence-based intervention for reducing surgical site infections.
Question 7: A Hartmann's procedure involves:
- End colostomy with oversewing of the rectal stump, without anastomosis (Correct answer)
- Primary anastomosis of sigmoid colon to rectum
- Loop ileostomy with sigmoid resection
- Subtotal colectomy with ileorectal anastomosis
Correct answer: End colostomy with oversewing of the rectal stump, without anastomosis
Hartmann's procedure is resection of the sigmoid colon with creation of an end colostomy and a blind rectal pouch, used when primary anastomosis is unsafe.
NCCPA Surgical Principles 2
Which suture material is MOST appropriate for closing a contaminated abdominal wound?