1
Q
What are Langer lines?
A
Lines that follow the direction of collagen fibers in the skin and are generally perpendicular to muscle tension.
2
Q
Why should surgical incisions be made parallel to Langer lines?
A
They heal better and produce less scarring because there is less tension on the wound edges.
3
Q
What happens when incisions are made perpendicular to Langer lines?
A
Greater wound tension leading to wider scars and poorer cosmetic outcomes.
4
Q
What are the three layers of the skin?
A
Epidermis
Dermis
Subcutaneous tissue
5
Q
Why is subcutaneous tissue important in surgical healing?
A
It has poor vascularity, especially in obese patients, increasing risk for seroma formation and wound complications.
6
Q
What are the three main parts of the thyroid gland?
A
Right lobe
Left lobe
Isthmus
7
Q
Which nerve must be protected during thyroid surgery?
A
The recurrent laryngeal nerve.
8
Q
Which glands must be preserved during thyroidectomy?
A
The parathyroid glands.
9
Q
Which blood vessels must be controlled during thyroid surgery?
A
The superior and inferior thyroid vessels.
10
Q
Which two electrolytes are most important for cardiac contraction?
A
Potassium (K⁺) and Calcium (Ca²⁺).
11
Q
What cardiac complication can occur with hypokalemia?
A
Cardiac arrhythmias.
12
Q
What cardiac effect can occur with hypocalcemia?
A
Weak myocardial contractions.
13
Q
What is the normal blood pH?
A
7.35 – 7.45
14
Q
What pH level indicates acidosis?
A
Less than 7.35
15
Q
What pH level indicates alkalosis?
A
Greater than 7.45
16
Q
Which artery supplies the upper extremity?
A
The subclavian artery.
17
Q
Which arteries primarily supply the brain?
A
Internal carotid arteries
Vertebral arteries
18
Q
Which arteries arise from the internal carotid artery?
A
Anterior cerebral artery
Middle cerebral artery
19
Q
Which cerebral artery is a direct branch of the internal carotid artery and frequently involved in strokes affecting speech?
A
The middle cerebral artery (MCA).
20
Q
Which two arteries supply most of the gastrointestinal tract?
A
Superior mesenteric artery (SMA)
Inferior mesenteric artery (IMA)
21
Q
Which GI structures are not primarily supplied by SMA/IMA?
A
Stomach
Duodenum
Distal rectum
22
Q
Why is knowledge of SMA and IMA important for surgeons?
A
It is critical during colon resections, ischemic bowel cases, and abdominal aortic aneurysm repairs.
23
Q
What is the inner lining of the GI tract called?
A
The epithelium (mucosa).
24
Q
What are the primary functions of GI mucosa?
A
Absorption
Secretion
Protection
25
Where is the White Line of Hilton located?
Between the internal and external anal sphincters.
26
Why is the White Line of Hilton clinically important?
It is an important landmark in hemorrhoid and fistula surgery.
27
Which structure connects the lateral ventricles to the third ventricle?
The Foramen of Monro.
28
Which structure connects the third ventricle to the fourth ventricle?
The Aqueduct of Sylvius (cerebral aqueduct).
29
What structure produces cerebrospinal fluid (CSF)?
The choroid plexus.
30
What structure separates the two cerebral hemispheres?
The Falx cerebri.
31
What does the Fissure of Sylvius separate?
The frontal and temporal lobes.
32
What does the Central Sulcus (Fissure of Rolando) separate?
The frontal and parietal lobes.
33
Where is Broca’s area located?
In the frontal gyrus of the frontal lobe.
34
Damage to Broca’s area causes what condition?
Expressive aphasia (difficulty producing speech).
35
What are emissary veins?
Veins that connect intracranial venous sinuses to extracranial veins.
36
Why are emissary veins clinically important?
They can provide a pathway for infection to spread between the scalp and intracranial structures.
37
Which cells produce collagen during wound healing?
Fibroblasts
38
Why is collagen important in surgical wound healing?
Collagen provides tensile strength to healing wounds.
39
What complication can occur if collagen production is impaired?
Wound dehiscence
40
Which patients often experience delayed collagen production and wound healing?
* Diabetic patients
* Smokers
* Malnourished patients
41
What is the normal adult cardiac output?
5–6 liters per minute
42
What formula defines cardiac output?
CO = Heart Rate × Stroke Volume
43
What intraoperative problems occur when cardiac output decreases?
Hypotension
Poor tissue perfusion
Delayed emergence from anesthesia
44
Which organ experiences decreased perfusion first when cardiac output drops?
Kidneys
45
What does the azygos vein drain?
The right side of the vertebral column.
46
Into which vessel does the azygos vein empty?
The superior vena cava (SVC).
47
Why is the azygos vein important surgically?
It is encountered during:
* Posterior thoracic surgery
* Esophageal surgery
* Vertebral exposure
48
Which artery supplies the midgut?
Superior Mesenteric Artery (SMA)
49
What GI structures are supplied by the SMA?
* Cecum
* Ascending colon
* Hepatic flexure
* Proximal transverse colon
50
What are the three branches of the celiac trunk?
* Left gastric artery
* Splenic artery
* Common hepatic artery
51
What mnemonic helps remember celiac trunk branches?
“Liver – Stomach – Spleen”
52
What is the Axillary Tail of Spence?
An extension of breast tissue into the axilla, usually from the upper outer quadrant.
53
Why is the Axillary Tail of Spence clinically important?
It is a common site for breast cancer.
54
What are the Suspensory Ligaments of Cooper?
Fibrous ligaments that attach breast tissue to the skin and pectoral fascia.
55
Damage to Cooper’s ligaments may cause what physical finding?
Skin dimpling of the breast
56
Which arteries supply the breast?
* Internal mammary artery
* Axillary artery branches
* Lateral thoracic artery
57
What is the retromammary space?
Loose areolar tissue between the breast and pectoralis major muscle allowing breast mobility.
58
Why is the retromammary space important surgically?
It is the dissection plane used during mastectomy.
59
Where are Rotter’s nodes located?
Between pectoralis major and pectoralis minor muscles.
60
What is another name for Rotter’s nodes?
Interpectoral lymph nodes
61
Which nerve innervates the serratus anterior muscle?
Long thoracic nerve
62
Injury to the long thoracic nerve causes what condition?
Winged scapula
63
Which nerve innervates the latissimus dorsi muscle?
Thoracodorsal nerve
64
Why is the thoracodorsal nerve important during breast surgery?
It must be preserved during axillary lymph node dissection and breast reconstruction.
65
Which nerve is associated with vagotomy and recurrent ulcers if missed?
Nerve of Grassi
66
What do the veins of Sappey drain?
The diaphragm
67
Why are the veins of Sappey important in portal hypertension?
They can serve as collateral venous pathways.
68
What structures form the Triangle of Calot?
* Cystic duct
* Common hepatic duct
* Inferior edge of the liver
69
Why is the Triangle of Calot important in surgery?
It is where the cystic artery is identified during cholecystectomy.
70
What lymph node is located within the Triangle of Calot?
Node of Lund (cystic lymph node)
71
Where is Hartmann’s pouch located?
At the infundibulum of the gallbladder near the cystic duct.
72
Why is Hartmann’s pouch clinically important?
It is a common site for gallstone impaction.
73
What is the accessory pancreatic duct called?
Duct of Santorini
74
Where does the duct of Santorini drain?
nto the minor duodenal papilla.
75
What are hepatic ductules?
Small bile ducts that drain bile from the liver toward the gallbladder and bile ducts.
76
What complication can occur if hepatic ductules are injured during surgery?
Bile leak
77
What is the arcuate line?
The point where the posterior rectus sheath ends inferiorly.
78
What structures form the posterior rectus sheath above the arcuate line?
The internal oblique splits, forming both anterior and posterior sheaths.
79
What happens below the arcuate line regarding rectus sheath anatomy?
All aponeuroses pass anterior to the rectus muscle, leaving the rectus resting on transversalis fascia.
80
Why is the arcuate line clinically important?
There is an increased risk of herniation below the arcuate line.
81
What is the linea alba?
A fibrous midline structure formed by fusion of the rectus sheaths.
82
Where does the linea alba extend?
From the xiphoid process to the pubic symphysis.
83
Why is the linea alba commonly used for surgical incisions?
It is an avascular plane that provides strong fascial closure and minimal bleeding.
84
Where does the external iliac artery become the femoral artery?
At the inguinal ligament.
85
How can you distinguish the external iliac artery from the femoral artery?
Above the inguinal ligament → external iliac
Below the inguinal ligament → femoral artery
86
What is the Space of Riolan?
An avascular zone in the mesentery left of the middle colic artery used for safer mesenteric division.
87
What is the Marginal Artery of Drummond?
A continuous arterial arcade along the mesenteric border of the colon connecting SMA and IMA circulation.
88
What is the Arc of Riolan?
A direct anastomotic vessel between the SMA and IMA.
89
Why is the Arc of Riolan important clinically?
It provides collateral circulation during mesenteric ischemia or arterial occlusion.
90
What are Heister’s valves?
Spiral folds in the cystic duct that help keep the duct open.
91
Why are Heister’s valves important surgically?
They can complicate cholangiography or catheter passage.
92
What is the Sphincter of Oddi?
A muscular sphincter controlling bile and pancreatic secretion into the duodenum.
93
Where is the Sphincter of Oddi located?
At the distal common bile duct entering the duodenum.
94
What does the falciform ligament divide?
The right and left lobes of the liver.
95
What structure is contained within the falciform ligament?
The ligamentum teres (obliterated umbilical vein).
96
What arteries supply the stomach?
* Left gastric
* Right gastric
* Left gastroepiploic
* Right gastroepiploic
* Short gastric arteries
97
From which arterial trunk does the stomach primarily receive blood supply?
The celiac trunk.
98
What is the mesentery?
A fold of peritoneum that anchors the small intestine to the posterior abdominal wall.
99
What structures are contained within the mesentery?
* Blood vessels
* Nerves
* Lymphatics
100
Why is the mesentery important clinically?
It plays a role in volvulus and internal hernias.
101
What forms the pelvic diaphragm?
* Levator ani muscle
* Coccygeus muscle
102
What is the primary function of the pelvic diaphragm?
It provides support for pelvic organs and maintains pelvic floor stability.
103
Where is the splenic flexure located?
Between the transverse colon and descending colon.
104
Why is the splenic flexure clinically important?
It is a watershed area prone to ischemia.
105
What is Jackson’s membrane?
A peritoneal fold near the cecum that may complicate cecal mobilization.
106
What is the Berry ligament?
The suspensory ligament connecting the thyroid gland to the trachea.
107
Why is the Berry ligament important surgically?
It is a high-risk area for recurrent laryngeal nerve injury.
108
What is a nonrecurrent laryngeal nerve?
A rare anatomical variant where the laryngeal nerve travels directly to the larynx without looping.
109
Which nerve innervates the latissimus dorsi?
The thoracodorsal nerve.
110
Why is the thoracodorsal nerve important in breast surgery?
It must be preserved during axillary lymph node dissection.
111
Which nerve innervates the diaphragm?
The phrenic nerve.
112
From which spinal levels does the phrenic nerve arise?
C3–C5
Mnemonic: “C3, 4, 5 keep the diaphragm alive.”
113
Where is the cricoid cartilage located?
It is located distal to the thyroid cartilage and proximal to the thyroid gland.
114
What makes the cricoid cartilage unique in the airway?
It is the only complete cartilaginous ring in the airway.
115
Why is the cricoid cartilage an important surgical landmark?
It is used as a landmark during tracheostomy and endotracheal intubation.
116
Which nerve runs closely with the inferior thyroid artery?
The recurrent laryngeal nerve (RLN).
117
Why is the recurrent laryngeal nerve at risk during thyroidectomy?
Because it runs very close to the inferior thyroid artery, making it vulnerable during vessel ligation.
118
What complication results from injury to the recurrent laryngeal nerve?
Vocal cord paralysis.
119
What arteries supply the thyroid gland?
* Superior thyroid artery (branch of external carotid)
* Inferior thyroid artery (branch of thyrocervical trunk)
120
Which vein provides shared venous drainage for the pancreas, liver, and intestines?
The portal vein.
121
What condition results from increased pressure in the portal venous system?
Portal hypertension.
122
Which structure surrounds the head of the pancreas?
The C-shaped loop of the duodenum.
123
Why is the head of the pancreas clinically important?
It is involved in:
* Whipple procedure
* Obstructive jaundice
124
What type of epithelium lines the GI mucosa?
Simple columnar epithelium.
125
What are the main functions of GI simple columnar epithelium?
* Absorption
* Secretion
126
What are rugae?
Folds in the inner wall of the stomach that allow the stomach to expand during digestion.
127
128
What is the Ampulla of Vater?
The junction where the common bile duct and pancreatic duct join.
129
Where does the Ampulla of Vater empty?
Into the second portion of the duodenum.
130
Why is the Ampulla of Vater clinically significant?
It is a common site of gallstone obstruction.
131
What is another name for Poupart’s ligament?
The inguinal ligament.
132
What does Poupart’s ligament divide?
The inguinal region from the femoral region
133
What are the boundaries of Hesselbach’s triangle?
* Rectus abdominis (medial)
* Inferior epigastric vessels (lateral)
* Inguinal ligament (inferior)
134
What type of hernia occurs within Hesselbach’s triangle?
A direct inguinal hernia.
135
From which artery does the uterine artery originate?
The anterior division of the internal iliac artery.
136
What surgical mnemonic describes the relationship between the uterine artery and ureter?
“Water under the bridge.”
Ureter (water) passes under the uterine artery (bridge).
137
Where does the ovarian artery originate?
Directly from the abdominal aorta.
138
What is the mesovarium?
A peritoneal fold that suspends the ovary from the posterior leaf of the broad ligament.
139
What is the broad ligament?
A double layer of peritoneum extending from the uterus to the pelvic wall.
140
Which ligament travels within the upper portion of the broad ligament toward the inguinal canal?
The round ligament.
141
What structures are found in the anterior mediastinum?
* Thymus
* Ascending aorta
* Lymph nodes
142
Why is the anterior mediastinum clinically important?
It is involved in:
* Thymectomy procedures
* Mediastinal tumors
143
What is the choroid?
The highly vascular layer of the eye that nourishes the retina.
144
Which arteries branch from the ophthalmic artery?
* Supraorbital artery
* Supratrochlear artery
145
What is the action of the superior rectus muscle?
Moves the eye upward and medially.
146
Which airway cartilage forms the only complete ring?
The cricoid cartilage.
147
Which nerve lies close to the inferior thyroid artery and is at risk in thyroidectomy?
The recurrent laryngeal nerve.
148
Which artery is a branch of the internal iliac artery and crosses over the ureter?
The uterine artery.
149
Which artery arises directly from the abdominal aorta to supply the ovary?
The ovarian artery.
150
Which arteries supply the nose?
Branches of:
* Internal maxillary artery (external carotid system)
* Facial artery (external maxillary)
151
What vascular structure is responsible for most epistaxis (nosebleeds)?
Kiesselbach’s plexus
152
What are the five branches of the facial nerve (CN VII)?
Mnemonic: To Zanzibar By Motor Car
* Temporal
* Zygomatic
* Buccal
* Marginal mandibular
* Cervical
153
Which surgical procedures place the facial nerve at risk?
* Parotid surgery
* Facelift procedures
* Mandibular exposure
154
Through which structure does the mental nerve exit the mandible?
The mental foramen
155
Why is the mental foramen important surgically?
It must be avoided during:
* Mandibular plating
* Dental nerve blocks
* Chin procedures
156
What bones form the zygomatic arch?
* Temporal process of the zygomatic bone
* Zygomatic process of the temporal bone
157
What is the primary muscle of the pelvic floor?
Levator ani
158
What is the main function of the levator ani muscle?
Supports pelvic organs and helps prevent pelvic organ prolapse.
159
What artery supplies the urinary bladder?
Branches of the internal iliac artery.
160
Why is bladder blood supply important during surgery?
Important in:
* Radical cystectomy
* Pelvic trauma surgery
161
How is the portal vein formed?
By the union of:
* Superior mesenteric vein (SMV)
* Splenic vein
162
What are the two terminal branches of the sciatic nerve?
* Tibial nerve
* Common peroneal (fibular) nerve
163
What condition results from peroneal nerve injury?
Foot drop
164
Where does the anterior cruciate ligament (ACL) attach?
From the posterolateral femoral condyle to the anterior tibial plateau.
165
What is the main function of the ACL?
Provides anterior stability to the knee joint.
166
What is a condyle?
A rounded articular prominence of bone, often forming part of a joint.
167
Where is the odontoid process (dens) located?
On the C2 vertebra (Axis).
168
What is the nucleus pulposus?
The gelatinous center of an intervertebral disc.
169
What occurs when the nucleus pulposus herniates?
It may compress spinal nerve roots, causing pain or neurologic deficits.
170
What cavities of the brain contain cerebrospinal fluid (CSF)?
The ventricles of the brain.
171
What structure produces CSF?
The choroid plexus.
172
Which renal vein crosses anterior to the abdominal aorta?
The left renal vein.
173
What complication can occur when the left renal vein is compressed?
Nutcracker syndrome
174
What are the three branches of the aortic arch?
* Brachiocephalic trunk
* Left common carotid artery
* Left subclavian artery
175
What are the terminal branches of the abdominal aorta?
The right and left common iliac arteries.
176
Where do the coronary arteries originate?
From the sinuses of Valsalva in the ascending aorta.
177
What are the two main branches of the left coronary artery?
* Left anterior descending (LAD)
* Circumflex artery
178
Which coronary artery is known as the “widow maker”?
The Left Anterior Descending (LAD) artery.
179
Where does the thoracic duct begin?
At the cisterna chyli.
180
Where does the thoracic duct drain?
Into the left venous angle (junction of left subclavian and internal jugular veins).
181
During which surgery is the thoracic duct at risk of injury?
Left neck dissections
182
What portion of the breast lies on the pectoralis major muscle?
Approximately two-thirds.
183
What portion of the breast lies on the serratus anterior muscle?
Approximately one-third.
184
What is another name for the mitral valve?
The bicuspid valve.
185
What is the function of the mitral valve?
Prevents backflow from the left ventricle into the left atrium.
186
Which cranial nerve branch pattern is critical during parotid surgery?
The five branches of the facial nerve (CN VII).
187
Which anatomical landmark must be avoided during mandible fixation?
The mental foramen.
188
Where does deoxygenated blood from the right ventricle travel first?
Through the pulmonary arteries to the lungs.
189
What makes the pulmonary arteries unique compared to systemic arteries?
They carry deoxygenated blood.
190
What structure is the dilation at the base of the internal carotid artery?
The carotid sinus.
191
What is the function of the carotid sinus?
It contains baroreceptors that regulate blood pressure.
192
Why is the carotid sinus clinically important during carotid surgery?
Manipulation can cause reflex bradycardia and hypotension.
193
What are the three meninges layers (superficial to deep)?
Dura mater
Arachnoid mater
Pia mater
Mnemonic: DAP
194
What does the Fissure of Sylvius (Sylvian fissure) separate?
The frontal lobe from the temporal lobe.
195
Which cranial nerve is the primary sensory nerve of the face?
The trigeminal nerve (CN V).
196
What clinical condition is associated with irritation of the trigeminal nerve?
Trigeminal neuralgia.
197
Which cranial nerve provides parasympathetic control to thoracic and abdominal organs?
The vagus nerve (CN X).
198
From which part of the brain does the vagus nerve originate?
The medulla oblongata.
199
What important branch of the vagus nerve affects voice function?
The recurrent laryngeal nerve.
200
Which cranial nerve innervates the superior oblique muscle?
The trochlear nerve (CN IV).
Mnemonic: SO4
201
Which cranial nerve innervates most extraocular muscles?
The oculomotor nerve (CN III).
202
Which muscles are innervated by the oculomotor nerve (CN III)?
* Superior rectus
* Inferior rectus
* Medial rectus
* Inferior oblique
* Levator palpebrae
203
Which cranial nerve innervates the lateral rectus muscle?
The abducens nerve (CN VI).
Mnemonic: LR6 SO4 — all others III
204
What structure separates the cerebrum from the cerebellum?
The tentorium cerebelli.
205
What is another name for the tentorium cerebelli?
The transverse dural fold.
206
Which nerves are located in the axilla?
* Lateral pectoral
* Medial pectoral
* Long thoracic
* Thoracodorsal
207
Injury to the long thoracic nerve causes what condition?
Winged scapula
208
Which muscle is innervated by the thoracodorsal nerve?
The latissimus dorsi.
209
What is the minimum number of air exchanges required per hour in the OR?
15 air exchanges per hour.
210
How many of the OR air exchanges must be fresh air?
At least 3 exchanges.
211
What is the primary goal of the surgical assistant intraoperatively?
To provide optimal exposure of the operative field.
212
What actions support the surgical assistant’s goal of exposure?
* Retraction
* Suction
* Hemostasis
* Gentle tissue handling
213
Which patient population has the highest risk of latex allergy?
Children with spina bifida.
214
Why do patients with spina bifida have higher latex sensitivity?
Because of repeated early exposure to latex medical devices.
215
What is meant by surgical conscience?
Prioritizing the patient’s safety and well-being above all other factors.
216
What behaviors demonstrate surgical conscience?
* Speaking up about unsafe practices
* Correcting breaks in sterile technique
* Advocating for patient safety
217
What causes chemical burns during surgical skin preparation?
Alcohol-based prep solutions pooling under the patient and not being allowed to dry before electrosurgery is used.
218
Which patients are at higher risk for chemical burns from skin prep solutions?
* Supine patients
* Obese patients
* Excess prep solution use
* Failure to blot pooled solution
219
What should the surgical assistant check before draping after skin prep?
Check under the patient and drapes for pooled prep solution.
220
What is a frozen section?
A rapid intraoperative pathology examination used for preliminary diagnosis.
221
Why are frozen sections performed during surgery?
* Confirm malignancy
* Evaluate surgical margins
* Identify tissue type
222
Are frozen section results considered final pathology?
No. They are preliminary results; permanent pathology follows later.
223
What practice results in the lowest surgical site infection (SSI) rate?
No hair removal unless necessary.
224
If hair must be removed before surgery, what method should be used?
Electric clippers.
225
What is myocardial ischemia?
Decreased oxygen supply to the heart muscle.
226
What complications can result from myocardial ischemia?
* Hypotension
* Dysrhythmias
* Cardiac instability
227
Why do infants lose body heat quickly during surgery?
* Thin subcutaneous fat
* Large surface area-to-body-mass ratio
228
What complication can result from intraoperative hypothermia in infants?
Metabolic instability.
229
What is the earliest sign of malignant hyperthermia (MH)?
Increased end-tidal CO₂ (ETCO₂).
230
Why does ETCO₂ increase early in malignant hyperthermia?
Rapid hypermetabolism increases CO₂ production.
231
What are other signs of malignant hyperthermia?
* Tachycardia
* Muscle rigidity
* Hyperthermia (late sign)
232
What factors affect intraoperative fluid balance?
* Blood loss
* Third spacing
* Fluid replacement
* Insensible losses
233
What complications can occur with fluid imbalance during surgery?
* Hypovolemia
* Electrolyte shifts
* Acid-base imbalance
234
Vitamin D deficiency leads to what electrolyte imbalance?
Hypocalcemia.
235
Why is vitamin D important for calcium balance?
It enables intestinal absorption of calcium.
236
Acid–base imbalances during surgery often indicate problems with what?
* Hypoxia
* Hypothermia
* Hypovolemia
237
When interpreting acid–base disturbances, what should be assessed first?
Oxygenation status.
238
What is the purpose of platelet transfusion?
To maintain clotting ability.
239
Do platelets contribute to oxygen transport?
No — they are responsible for clot formation.
240
What is the proper arm position when the patient is supine?
* Armboards less than 90°
* Palms facing upward
241
Why must arms be positioned less than 90° during surgery?
To prevent brachial plexus injury.
242
Which nerve is commonly injured if arms are improperly positioned during surgery?
The ulnar nerve.
243
What is a shearing injury?
When the skin remains stationary while underlying tissue shifts.
244
Where do shearing injuries most commonly occur?
* Sacrum
* Heels
245
Why must legs be lowered slowly after lithotomy position?
To prevent sudden hypotension due to blood redistribution.
246
How should legs be lowered after lithotomy?
Slowly and simultaneously.
247
What is the typical upper extremity tourniquet pressure?
250–300 mmHg.
248
What is the recommended lower extremity tourniquet pressure?
Systolic blood pressure + 50 mmHg.
249
What complications can result from excessive tourniquet pressure?
* Nerve injury
* Muscle damage
* Compartment syndrome
250
If parents are unavailable during a pediatric emergency, who may provide consent?
Two consulting physicians.
251
What ethical principle allows emergency treatment without parental consent?
Life-saving treatment in emergencies.
252
What legal principle applies to provider negligence in healthcare?
Each provider is personally responsible for their own actions.
253
Is “following orders” a legal defense for negligence?
No.
254
What is carcinoma in situ?
Malignant cells confined to the epithelium.
255
What key characteristic defines carcinoma in situ?
Cells have not penetrated the basement membrane.
256
Which blood component is used to treat clotting problems and thrombocytopenia?
Platelets
257
What are platelets primarily responsible for?
Blood clot formation
258
Which blood component is responsible for oxygen delivery?
Red Blood Cells (RBCs)
259
Which blood component provides clotting factors?
Plasma
260
Which blood product is the most common source of bacterial contamination during transfusion?
Platelets
261
Why are platelets more susceptible to bacterial contamination?
They are stored at room temperature, which promotes bacterial growth.
262
A transfusion reaction with fever and chills should raise suspicion for contamination of which product?
Platelets
263
What is a tort?
A civil wrong committed against a person or property.
264
What are examples of torts in healthcare?
* Negligence
* Assault
* Battery
265
What does liability mean in healthcare?
Legal responsibility for one’s own actions.
266
Are surgical team members legally responsible for their own conduct?
Yes. Each provider is individually accountable.
267
What is the normal BUN (Blood Urea Nitrogen) range?
7–20 mg/dL
268
What does the BUN level reflect?
Kidney function and hydration status
269
What is the normal urine specific gravity?
1.015–1.025
270
What does high urine specific gravity indicate?
Dehydration
271
What does low urine specific gravity indicate?
Overhydration or kidney dysfunction
272
What is the normal RBC count in adult males?
4.2–6.1 million/µL
273
What condition does a low RBC count indicate?
Anemia
274
What is the normal sodium level (Na⁺)?
136–145 mEq/L
275
What symptoms can occur with hyponatremia?
* Confusion
* Seizures
276
What is the normal potassium level (K⁺)?
3.5–5.0 mEq/L
277
Why is potassium imbalance dangerous?
It can cause cardiac arrhythmias.
278
What ECG change is associated with hyperkalemia?
Peaked T waves
279
What is the normal urine pH range?
4.6–8.0
280
What is the normal WBC count?
4,000–11,000/mm³
281
A WBC count of 14,000/mm³ likely indicates what?
Infection or inflammation
282
How can tissues be protected during CO₂ laser surgery?
Use wet towels or sponges.
283
Why are wet sponges used during laser procedures?
To prevent thermal injury and fire risk.
284
What is the goal of hemostasis?
To prevent blood loss.
285
What are the three mechanisms of hemostasis?
Mechanical
Thermal
Chemical
286
What is hypovolemic shock?
Shock caused by significant loss of circulating blood volume.
287
What is the earliest vital sign change in hypovolemic shock?
Tachycardia
288
Why does tachycardia occur early in hypovolemic shock?
The body compensates for reduced circulating volume.
289
What are late signs of hypovolemic shock?
* Hypotension
* Cool, clammy skin
* Altered level of consciousness
290
What cardiac effect occurs during a vagal response?
Bradycardia
291
What medication may be required for vagal-induced bradycardia?
Atropine
292
What is atelectasis?
Collapse of alveoli in the lungs.
293
What helps prevent postoperative atelectasis?
* Early ambulation
* Incentive spirometry
* Deep breathing exercises
* Adequate pain control
294
Why is laser plume dangerous?
It may contain viable viral particles and toxic chemicals.
295
What device is most commonly used in the OR to prevent pressure ulcers?
Gel pads
296
What are the most common pressure injury sites during surgery?
* Sacrum
* Heels
* Elbows
* Occiput
297
What positioning errors commonly lead to nerve injuries in surgery?
Improper padding, excessive joint extension or flexion, and pressure on nerves.
298
Which nerve is most commonly injured in the lithotomy position?
Common peroneal nerve
299
Improper hip flexion in lithotomy may injure which nerve?
Obturator nerve
300
Which nerve may be injured from excessive hip flexion in lithotomy?
Femoral nerve
301
Which nerve injury can occur with hyperflexion of the hip during lithotomy?
Sciatic nerve
302
How should the legs be positioned in the lateral surgical position?
* Lower leg = flexed
* Upper leg = straight
* Pillow placed between legs
303
Why is a pillow placed between the legs in lateral positioning?
To protect the peroneal nerve and maintain alignment.
304
Where should an axillary roll be placed?
Under the chest at the level of the axilla.
305
Why is an axillary roll used in lateral chest positioning?
To prevent brachial plexus compression and maintain circulation.
306
Where should an axillary roll never be placed?
Directly in the axilla
307
What commonly causes ulnar nerve injury during surgery?
Elbow resting on an unpadded surface.
308
How can ulnar nerve injury be prevented?
* Padding under elbows
* Palms supinated (up)
* Armboards less than 90°
309
Where should surgical drains exit the body?
Through a separate stab wound adjacent to the main incision.
310
Why should drains exit through a separate incision?
To reduce contamination risk and preserve the primary incision.
311
What dressing type is used for moderate to heavy drainage?
Three-layer dressing
312
What are the purposes of a three-layer surgical dressing?
* Absorb drainage
* Protect incision
* Prevent skin maceration
313
What does Chvostek’s sign indicate?
Hypocalcemia
314
How is Chvostek’s sign tested?
Tapping the facial nerve, causing facial muscle twitching.
315
Which patient has the highest risk for fluid volume deficit?
Trauma patients with extensive burns
316
Why do burn patients develop severe fluid loss?
* Capillary leakage
* Third spacing
* Evaporative fluid loss
317
What process allows white blood cells to engulf bacteria and debris?
Phagocytosis
318
Which immune defense line includes phagocytosis and inflammation?
The second line of defense.
319
Which drug increases myocardial contractility?
Calcium chloride
320
What conditions may require calcium chloride administration?
* Hypocalcemia
* Cardiac arrest
* Hyperkalemia
321
Which nervous system produces fight-or-flight responses?
The sympathetic nervous system
322
What physiologic effects occur with sympathetic stimulation?
* Increased heart rate
* Increased blood pressure
* Bronchodilation
323
What medication treats malignant hyperthermia?
Dantrolene
324
How does dantrolene treat malignant hyperthermia?
It blocks calcium release from the sarcoplasmic reticulum.
325
What is tachyphylaxis?
A rapid decrease in drug effectiveness after repeated doses.
326
What is the mechanism of action of heparin?
It enhances antithrombin III, preventing further clot formation.
327
Does heparin dissolve existing clots?
No. It prevents clot formation.
328
What is the only depolarizing neuromuscular blocking agent?
Succinylcholine (Anectine).
329
What anesthetic complication can succinylcholine trigger?
Malignant hyperthermia
330
Why is lidocaine with epinephrine traditionally avoided in fingers and hands?
Because epinephrine may compromise circulation in end-arterial areas.
331
In which patients should epinephrine definitely be avoided?
* Peripheral vascular disease
* Compromised circulation
332
What is the normal hematocrit range for adult males?
42–52%
333
What is the normal hematocrit range for adult females?
37–47%
334
What does high hematocrit indicate?
Dehydration
335
What does low hematocrit indicate?
Anemia
336
Why do patients often develop hypothermia during anesthesia?
Anesthesia causes vasodilation and heat redistribution.
337
Which patient population is most susceptible to intraoperative hypothermia?
Infants
338
How many grams are in 1 kilogram?
1,000 grams
339
What is the maximum recommended time between drawing arterial blood and analyzing ABGs?
10 minutes
340
What does PaCO₂ measure?
The partial pressure of carbon dioxide in arterial blood.
341
What is the normal PaCO₂ range?
35–45 mmHg
342
What condition results from elevated PaCO₂?
Respiratory acidosis
343
What condition results from decreased PaCO₂?
Respiratory alkalosis
344
What does HCO₃⁻ (bicarbonate) measure?
The metabolic component of acid-base balance.
345
What is the normal bicarbonate (HCO₃⁻) level?
22–26 mEq/L
346
What condition results from elevated bicarbonate?
Metabolic alkalosis
347
What condition results from low bicarbonate?
Metabolic acidosis
348
What does hematocrit measure?
The percentage of red blood cells in whole blood.
349
What is the primary preoperative effect of atropine?
Drying respiratory secretions
350
What class of drug is atropine?
Anticholinergic
351
What additional effects does atropine produce?
* Increased heart rate
* Reduced risk of bradycardia
352
Loss of the eyelid reflex occurs during which stage of anesthesia?
Stage II (excitement stage)
353
What is the most common complication during emergence from anesthesia?
Hypoxia
354
Which drug reverses the effects of heparin?
Protamine sulfate
355
Which drug is used to treat hypotension during surgery?
Levophed (norepinephrine)
356
What class of drug is Levophed?
Vasopressor
357
What is the onset time for heparin after IV administration?
About 3 minutes
358
What type of drug is Cephalothin (Keflin)?
First-generation cephalosporin antibiotic
359
Which antibiotic is generally avoided in pediatric patients?
Ciprofloxacin
360
Why is ciprofloxacin avoided in children?
Risk of cartilage damage.
361
What are the major toxicities of aminoglycosides?
* Ototoxicity
* Nephrotoxicity
362
What are examples of aminoglycoside antibiotics?
* Gentamicin
* Tobramycin
363
What infections are penicillinase-resistant penicillins commonly used to treat?
Staphylococcal infections, especially traumatic wound pathogens.
364
What class of drug is Meperidine (Demerol)?
Opioid analgesic
365
What type of drug is Secobarbital?
Barbiturate
366
What is the common preoperative use of secobarbital?
Sleep aid or sedative
367
What is the generic name for Marcaine?
Bupivacaine
368
How does bupivacaine compare to lidocaine?
Bupivacaine lasts longer.
369
What type of IV solution is Dextran?
Colloid plasma expander
370
What is the purpose of Dextran?
To expand plasma volume.
371
What is the most common isotonic IV solution?
0.9% Sodium Chloride (Normal Saline)
372
What happens to cells in an isotonic solution?
No fluid shift occurs.
373
What effect does a hypotonic solution have on cells?
Fluid moves into cells.
374
What effect does a hypertonic solution have on cells?
Fluid moves out of cells.
375
What enzyme is added to local anesthetics to increase tissue diffusion?
Hyaluronidase
376
What is anaphylaxis?
A severe, life-threatening allergic reaction.
377
What are common signs of anaphylaxis?
* Hypotension
* Bronchospasm
* Urticaria
* Airway edema
378
What drug is the first-line treatment for anaphylaxis?
Epinephrine
379
What type of hypersensitivity reaction is anaphylaxis?
Type I hypersensitivity
380
What is the first-line prophylactic antibiotic used in many clean surgical procedures?
Cefazolin
381
Cefazolin belongs to what antibiotic class?
Cephalosporins
382
What maneuver is used to prevent aspiration during induction of anesthesia?
Cricoid pressure (Sellick maneuver)
383
During what anesthetic technique is cricoid pressure typically applied?
Rapid sequence intubation
384
Which drug is used to reverse opioid-induced respiratory depression?
Naloxone (Narcan)
385
What conditions may require calcium chloride administration?
* Hyperkalemia
* Hypocalcemia
* Cardiac arrest
386
Which drug is commonly used to treat ventricular arrhythmias?
Lidocaine
387
What patient condition commonly impairs wound healing due to poor tissue perfusion?
Peripheral vascular disease
388
What is the most common cause of delayed wound healing?
Wound infection
389
Postoperative wound erythema and tenderness are commonly caused by which organism?
Group B Streptococci
390
What are the three phases of wound healing?
Inflammatory
Proliferative
Maturation
391
Why is a square knot preferred in surgical closure?
It creates a secure, flat knot with equal tension.
392
Retention sutures are commonly used with which type of incision?
Vertical midline incision
393
What type of stitch is the Lambert stitch?
Inverting bowel stitch
394
Which layers are incorporated in a Lambert stitch?
Seromuscular layer and submucosa
395
What surgical procedure commonly uses Lambert sutures?
Bowel closure
396
What factors combine to form thrombin?
Prothrombin + thromboplastin + calcium
397
What is the normal upper limit for Activated Clotting Time (ACT)?
120 seconds
398
In which types of surgery is ACT commonly monitored?
Cardiac and vascular surgery
399
What type of suture is PDS (Polydioxanone)?
Absorbable monofilament suture with long-term wound support.
400
What is tensile strength?
he amount of tension a suture can withstand before breaking.
401
Which suture technique is placed around a lumen to close a structure?
Purse-string suture
402
What is capillarity in suture material?
The ability of a suture to transmit fluid along its strand.
403
Which sutures have the highest capillarity?
Braided or multifilament sutures.
404
What is serosanguineous drainage?
Blood-tinged fluid commonly seen early after surgery.
405
What is wound dehiscence?
Partial separation of a surgical wound.
406
When does wound dehiscence most commonly occur?
Postoperative days 5–10
407
Why does dehiscence often occur around days 5–10?
Because collagen breakdown temporarily exceeds tensile strength.
408
What is evisceration?
Complete wound separation with protrusion of internal organs.
409
What is delayed (tertiary) wound closure?
A wound left open initially and closed later after infection risk decreases.
410
When are surgical staples typically removed?
5–7 days postoperatively, depending on wound healing.
411
What is commonly used to reinforce subcuticular closures?
Steri-Strips
412
What are the classic signs of inflammation?
* Redness
* Heat
* Swelling
* Pain
413
Which maneuver is used to mobilize the duodenum during a Whipple procedure?
Kocher maneuver
414
What is the purpose of the Kocher maneuver?
To mobilize the duodenum by releasing lateral peritoneal attachments.
415
Where is the preferred site for parathyroid autotransplantation?
Forearm
416
Why is the forearm used for parathyroid autotransplantation?
It allows easy monitoring and biopsy if hyperfunction recurs.
417
What is the major concern when draining a gangrenous gallbladder?
Contamination from bile spillage
418
What complication can occur if bile leaks into the peritoneal cavity?
Peritonitis
419
Which nerve is at risk during thyroidectomy?
Recurrent laryngeal nerve
420
What is the primary biliary anastomosis created during a Whipple procedure?
Hepaticojejunostomy
421
What three anastomoses are typically created during a Whipple procedure?
* Hepaticojejunostomy
* Pancreaticojejunostomy
* Gastrojejunostomy
422
What mnemonic helps remember the three Whipple reconnections?
“Three reattachments” — bile, pancreas, stomach
423
What is the definition of a hernia?
A rupture or protrusion of an organ through a weakened structure or cavity wall.
424
What is an incarcerated hernia?
A hernia that cannot be manually reduced.
425
What complication can occur with an incarcerated hernia?
Strangulation leading to ischemia.
426
Direct inguinal hernias occur medial or lateral to the inferior epigastric vessels?
Medial
427
Where does an indirect inguinal hernia pass?
Through the internal inguinal ring.
428
What is the most common hernia in females?
Femoral hernia
429
What is a sliding hernia?
A hernia in which part of a visceral organ forms part of the hernia sac.
430
Which organs commonly form a sliding hernia?
* Colon
* Bladder
431
What structure lies within the Triangle of Doom?
External iliac vessels
432
Where is the Triangle of Doom located?
Inferior to the internal inguinal ring.
433
Why must surgeons avoid stapling in the Triangle of Doom?
Risk of major vascular injury.
434
Which nerves are found in the Triangle of Pain?
* Genitofemoral nerve
* Lateral femoral cutaneous nerve
435
Where is the Triangle of Pain located?
Inferior to the iliopubic tract
436
Which nerves should be identified during inguinal hernia repair?
* Iliohypogastric nerve
* Ilioinguinal nerve
437
What is the preferred anastomosis after total abdominal colectomy for ulcerative colitis?
Ileoanal anastomosis
438
Which portion of the GI tract is least commonly affected in Crohn’s disease?
Rectum
439
What pattern of inflammation occurs in ulcerative colitis?
Continuous inflammation beginning in the rectum.
440
What structure marks the junction between the duodenum and jejunum?
Ligament of Treitz
441
Where is the intercostal neurovascular bundle located?
Along the inferior border of each rib.
442
What is the order of structures in the intercostal neurovascular bundle?
Vein – Artery – Nerve (VAN).
443
Which nerves are dissected during highly selective vagotomy?
Nerves of Latarjet
444
What is intussusception?
A condition in which a segment of intestine telescopes into another segment.
445
In which population is intussusception most common?
Pediatric patients
446
What congenital defect results from failure of abdominal contents to return to the peritoneal cavity and are covered by a membranous sac?
Omphalocele
447
What is the key difference between omphalocele and gastroschisis?
* Omphalocele: herniated organs covered by a sac
* Gastroschisis: exposed abdominal organs with no covering membrane
448
What congenital condition presents with projectile non-bilious vomiting and an olive-shaped mass in the RUQ?
Pyloric stenosis
449
What electrolyte imbalance commonly occurs with pyloric stenosis?
Hypochloremic metabolic alkalosis
450
What is the surgical treatment for pyloric stenosis?
Ramstedt pyloromyotomy
451
What condition is caused by absence of ganglion cells in the colon?
Hirschsprung’s disease
452
What is the most common intraabdominal tumor in children?
Nephroblastoma (Wilms tumor)
453
What condition causes enlargement of male breast tissue?
Gynecomastia
454
What structures are removed in a modified radical mastectomy?
* Entire breast
* Axillary lymph nodes
455
Which muscles are preserved in a modified radical mastectomy?
Pectoralis major and pectoralis minor
456
Where is a sigmoid colostomy typically brought through?
Rectus abdominis muscle
457
What structure is exposed using the Kocher maneuver?
Pancreas and retroperitoneum
458
What surgical maneuver mobilizes the descending colon to expose the abdominal aorta?
Mattox maneuver
459
What is the most common liver cancer?
Metastatic liver disease
460
What is removed during a trisegmentectomy of the liver?
All liver tissue to the right of the falciform ligament
461
Which artery is at risk during cholecystectomy?
Right hepatic artery
462
What laboratory findings suggest cholangitis?
* Elevated WBC
* Elevated bilirubin
* Elevated alkaline phosphatase
* Positive blood cultures
463
What tumor occurs at the junction of the right and left hepatic ducts?
Klatskin tumor (hilar cholangiocarcinoma)
464
Where is Meckel’s diverticulum typically located?
Approximately 2 feet from the ileocecal valve
465
What is the Rule of 2s for Meckel’s diverticulum?
* 2 feet from ileocecal valve
* 2 inches long
* 2% population
* 2 types of ectopic tissue
466
Which nerve must be preserved during radical neck dissection?
Spinal accessory nerve (CN XI)
467
Which muscles are innervated by the spinal accessory nerve?
* Trapezius
* Sternocleidomastoid
468
What incision types may be used for a tracheostomy?
* Transverse incision
* Midline incision
469
Which arteries must be preserved during pancreas retrieval?
* Splenic artery
* Superior mesenteric artery
470
Which artery must be identified and ligated to preserve hepatic artery flow during liver procurement?
Gastroduodenal artery (GDA)
471
Why is the gastroduodenal artery ligated during liver procurement?
To prevent arterial steal from the hepatic artery.
472
Which vascular structures must be anastomosed during a liver transplant?
* Hepatic artery
* Portal vein
* Inferior vena cava
* Bile duct
473
Which vessel’s patency is critical for liver graft survival?
Hepatic artery
474
What is Zenker’s diverticulum?
An outpouching of the posterior esophagus above the upper esophageal sphincter.
475
Which part of the stomach is used in a Nissen fundoplication?
Fundus
476
What type of wrap is created in a Nissen fundoplication?
360° gastric wrap around the esophagus
477
What postoperative complication is associated with gastric bypass surgery?
Dumping syndrome
478
Why does pancreatic head adenocarcinoma cause jaundice?
Compression of the common bile duct.
479
What is the most common physical finding in portal hypertension?
Splenomegaly
480
Which retractors are commonly used to retract the strap muscles during thyroid surgery?
Green retractors
481
What is a cholesteatoma?
A benign growth in the mastoid bone.
482
What complications can occur from cholesteatoma?
* Hearing loss
* Ossicle erosion
483
During abdominoperineal resection (APR), which artery is identified, ligated, and divided during the perineal dissection?
Inferior rectal artery
484
For which condition is abdominoperineal resection (APR) most commonly performed?
Low rectal cancer involving the anal sphincter
485
What patient position provides the best exposure for pilonidal cystectomy?
Kraske (jackknife) position
486
What is an enterocele?
A herniation of the cul-de-sac of Douglas (rectouterine pouch).
487
Enteroceles are commonly associated with what condition?
Pelvic floor weakness
488
Which incision may be required for hiatal hernia repair?
Thoracoabdominal incision
489
What is the purpose of the reverse Trendelenburg position?
* Improves visualization of upper abdominal structures
* Uses gravity to move abdominal contents downward.
490
What nerve must be protected when a patient is placed in lithotomy position with candy cane stirrups?
Common peroneal nerve
491
What is the correct patient position for a Cesarean section?
Supine with right side elevated using a wedge
492
What is the most common ovarian cyst?
Follicular cyst
493
What is the treatment for recurrent cervical cancer after radiation therapy?
Pelvic exenteration
494
What pressure is typically maintained during laparoscopic pneumoperitoneum?
14–16 mmHg
495
Which ligament contains the uterine arteries?
Cardinal ligament (transverse cervical ligament)
496
What laser is used to perform a posterior capsulotomy after cataract surgery?
YAG laser
497
What technique provides intermittent eyelid retraction during ophthalmic surgery?
Traction sutures
498
What procedure repairs retinal detachment by indenting the sclera?
Scleral buckling
499
What surgery treats chronic dacryocystitis?
Dacryocystorhinostomy (DCR)
500
During tympanoplasty, if the stapes footplate cannot move, where is the graft secured?
Oval window
501
Which structures must be preserved during mastoidectomy?
* Facial nerve
* Mastoid sinus
502
What is the early treatment for chronic otitis media?
Myringotomy
503
What incision provides optimal exposure for frontal sinus fractures?
Coronal incision
504
What is the medical term for nosebleed?
Epistaxis
505
Which nerve must be identified and preserved during submandibular gland removal?
Lingual nerve (branch of trigeminal nerve – CN V3)
506
What device is applied prior to plating in mandibular fracture repair to ensure proper occlusion?
Arch bars
507
Why must wire scissors accompany patients after mandibular fracture fixation?
To rapidly cut fixation wires if airway compromise or vomiting occurs
508
What is a common autologous bone donor site for mandibular reconstruction?
Fibula
509
Why is the fibula commonly used for mandibular reconstruction?
* Adequate bone length
* Reliable vascular pedicle
510
Which flap may be recommended for breast reconstruction in smoking patients?
Free TRAM flap (Transverse Rectus Abdominis Myocutaneous flap)
511
Why is the TRAM flap advantageous for breast reconstruction?
Provides well-vascularized tissue for reconstruction
512
What is the most common cause of skin graft failure?
Hematoma formation beneath the graft
513
What patient position may be used for radical cystectomy with ileal conduit?
Low lithotomy position
514
What solution is commonly used for distention during diagnostic cystoscopy?
Water
515
Which urinary diversion is temporary rather than permanent?
Nephrostomy tube
516
Why is radical lymphadenectomy performed in testicular cancer?
Because testicular cancer spreads through predictable lymphatic pathways
517
Where is a transplanted kidney placed during kidney transplantation?
Iliac fossa
518
Which donor kidney is preferred for transplantation?
Left kidney
519
Why is the left kidney preferred for transplant donation?
It has a longer renal vein, making vascular anastomosis easier.
520
What is Denonvilliers fascia?
Also called rectovesical fascia, supporting the bladder and prostate region.
521
What is Gerota’s fascia?
The fibrous fascia surrounding the kidney
522
What type of drug is mannitol?
Osmotic diuretic
523
What complication may occur 2–5 days after inguinal hernia repair?
Ischemic orchitis
524
Where should the kidney lift be placed during nephrectomy positioning?
Directly below the iliac crest
525
Which veins must be clamped and ligated during left kidney procurement?
* Adrenal vein
* Gonadal vein
* Lumbar veins
526
Which nerve is at risk during a lateral lower leg fasciotomy?
Superficial peroneal nerve
527
What functions are supplied by the superficial peroneal nerve?
* Foot eversion muscles
* Sensation to the dorsum of the foot
528
What graft is considered the most reliable for primary ACL reconstruction?
Patellar tendon graft
529
Which tendons are involved in De Quervain’s disease?
* Abductor pollicis longus
* Extensor pollicis brevis
530
What is a Smith’s fracture?
A reverse Colles’ fracture caused by falling on the back of the hand with the wrist flexed.
531
Which carpal bone is most commonly fractured?
Scaphoid
532
Why is a scaphoid fracture clinically important?
Risk of avascular necrosis due to poor blood supply.
533
What is a Boxer’s fracture?
Fracture of the fifth metacarpal.
534
Which fracture is most commonly associated with fat embolism syndrome?
Femur fracture
535
Which meniscus is most commonly injured in the knee?
Medial meniscus
536
Why are C3–C5 spinal injuries life-threatening?
They can impair the phrenic nerve, which controls the diaphragm.
537
What nerve is compressed in carpal tunnel syndrome?
Median nerve
538
Which muscle becomes paralyzed when the long thoracic nerve is injured?
Serratus anterior
539
What joints are fused in a triple arthrodesis?
* Talonavicular joint
* Calcaneocuboid joint
* Subtalar joint
540
Why is the pronator teres muscle an important landmark in forearm fractures?
It helps identify nearby neurovascular structures.
541
What structure is repaired during a Bankart procedure?
The anterior capsule and labrum are reattached to the glenoid rim.
542
What condition is treated with a Bankart repair?
Anterior shoulder instability or recurrent shoulder dislocations
543
Which nerve is most commonly injured in a mid-shaft humeral fracture?
Radial nerve
544
What clinical sign may occur with radial nerve injury?
Wrist drop due to loss of wrist and finger extension.
545
Which nerve is most frequently injured in shoulder dislocation?
Axillary nerve
546
What symptoms occur with axillary nerve injury?
* Loss of shoulder abduction
* Numbness over the lateral shoulder
547
Which structure compresses the median nerve in carpal tunnel syndrome?
Transverse carpal ligament
548
What digits experience numbness in carpal tunnel syndrome?
* Thumb
* Index finger
* Middle finger
* Half of the ring finger
549
Which movement is most painful in supraspinatus tendinitis?
Shoulder abduction
550
What is the preferred imaging modality to diagnose a rotator cuff tear?
MRI
551
Which tendon is commonly involved in rotator cuff repair procedures?
Subscapularis tendon
552
What defines a Monteggia fracture?
* Fracture of the proximal third of the ulna
* Dislocation of the radial head
553
What causes a Boutonniere deformity?
Laceration or avulsion of the extensor tendon at the PIP joint
554
At which joint does Boutonniere deformity occur?
Proximal interphalangeal (PIP) joint
555
What test is commonly used to evaluate an ACL injury?
Anterior drawer test
556
What is the function of the acetabular labrum?
Provides stability to the femoral head by deepening the acetabulum.
557
What structure bridges the acetabular notch to complete the hip socket?
Transverse ligament
558
Where does the patellar ligament attach proximally?
Patella
559
Where does the patellar ligament attach distally?
Tibial tuberosity
560
Which bone articulates with the distal tibia to form the ankle joint?
Talus
561
What is the function of the glenoid labrum?
A fibrocartilage rim that increases stability of the shoulder joint
562
During a segmental pulmonary resection for lung cancer, what lymph nodes must be removed and sent for pathology?
Lobar lymph nodes.
563
How is a thoracotomy wound classified?
Clean-contaminated, because the respiratory tract is entered under controlled conditions.
564
What is the most common cause of mitral stenosis?
Rheumatic fever.
565
What is the most common congenital heart defect?
Ventricular septal defect (VSD).
566
What vein is commonly used as a conduit for coronary artery bypass grafting?
Great saphenous vein.
567
What artery is commonly used as a conduit for CABG?
Internal mammary artery (IMA).
568
During open abdominal aortic aneurysm (AAA) repair, which vessels are clamped first before the aorta?
Iliac arteries.
569
Why are the iliac arteries clamped first during AAA repair?
To control distal blood flow and reduce bleeding.
570
What is the primary purpose of an arteriovenous (AV) fistula?
Hemodialysis vascular access.
571
Why are AV fistulas preferred for dialysis?
They provide high-flow vascular access for repeated dialysis treatments.
572
What device prevents emboli from traveling from the lower extremities to the lungs?
Inferior vena cava (IVC) filter.
573
What surgical procedure may also be used to prevent pulmonary embolism?
IVC plication.
574
During carotid endarterectomy, which artery is typically incised first?
Common carotid artery.
575
In which vein does deep vein thrombosis most commonly occur?
Left iliac vein.
576
Why can hypotension occur in Fowler’s position during neurosurgery?
Decreased venous return and blood pooling in the lower extremities.
577
What major complication may occur during a posterior fossa craniotomy performed in the sitting position?
Venous air embolism.
578
Epidural hematomas are most commonly caused by injury to which artery?
Middle meningeal artery.
579
Epidural hematomas are commonly associated with fractures of which bone?
Temporal bone.
580
What surgical device is commonly used to treat hydrocephalus?
Ventriculoperitoneal (VP) shunt.
581
During anterior cervical discectomy, screws placed too laterally may injure which structure?
Vertebral arteries.
582
What is a chalazion?
Inflammation of a Meibomian gland in the eyelid.
583
What class of medication is furosemide (Lasix®)?
Loop diuretic.
584
What fluorescent dye is used intraoperatively to evaluate tissue perfusion and vascular flow?
Indocyanine Green (ICG).
585
Besides perfusion assessment, what other structure can ICG help evaluate during surgery?
Ureter patency.
586
What portion of the stomach surrounds the lower esophageal sphincter?
Cardia.
587
What artery supplies the cecum and terminal ileum?
Ileocolic artery.
588
Which artery supplies the ascending colon?
Right colic artery.
589
Which artery supplies the transverse colon?
Middle colic artery.
590
Which artery supplies the descending colon?
Left colic artery.
591
Which artery supplies the rectum from the inferior mesenteric artery?
Superior rectal artery.
592
What type of cast is used to treat nondisplaced humeral fractures?
Hanging arm cast.
593
During total knee arthroplasty, which instrument protects the popliteal artery?
Blunt Hohmann retractor.
594
What is the correct prep sequence for femoral-popliteal bypass surgery?
Abdomen → Thigh → Knee → Groin → Foot.
595
What type of suture is the Connell stitch?
Full-thickness inverting intestinal suture.
596
What stapling device is commonly used to divide the appendix from the cecum?
GIA stapler.
597
Where is the lymph node of Calot located?
Within Calot’s triangle during cholecystectomy.
598
What does Grey-Turner’s sign indicate?
Flank ecchymosis associated with hemorrhagic pancreatitis.
599
Through which vein are pacemaker leads typically inserted?
Subclavian vein.
600
Where is the standard insertion site for a chest tube?
5th intercostal space at the mid-axillary line.
601
What is the conus medullaris?
The terminal end of the spinal cord.
602
The Achilles tendon inserts into which bone?
Calcaneus.
603
What is the most common classification system for growth plate fractures?
Salter-Harris classification.
604
During a posterolateral approach to the hip, which muscle is released with the short external rotators?
Piriformis.
605
What is the surgical treatment for testicular torsion?
Orchiopexy.
606
Which nerve runs parallel to the common carotid artery within the carotid sheath?
Vagus nerve.
607
What technique is commonly used for liposuction using large-volume local anesthetic solution?
Tumescent technique.
608
What type of reaction occurs when plaster casts harden?
Exothermic reaction.
609
What is a Colles fracture?
Fracture of the distal radius.
610
After TURP surgery, what catheter is typically placed?
Three-way Foley catheter with a 30 mL balloon.
611
What artery supplies the latissimus dorsi flap?
Thoracodorsal artery.
612
After mitral valve replacement, ischemia may indicate injury to which coronary artery?
Circumflex artery.
613
What is a pantaloon hernia?
Presence of both direct and indirect inguinal hernias simultaneously.
614
Cooper’s ligament is an important landmark during which hernia repair?
McVay repair.
615
What muscle surrounds the spermatic cord and testes?
Cremaster muscle.
616
What portion of the colon is most commonly affected by volvulus?
Sigmoid colon.
617
What is peristalsis?
Wave-like smooth muscle contractions that move food through the GI tract.
618
What artery is typically found within the Triangle of Calot?
Cystic artery.
619
Where is the pyloric sphincter located?
Between the stomach and the duodenum.
620
What structures form the pouch-like sacs of the colon?
Haustra.
621
What is the most common location for cerebral aneurysms?
Circle of Willis.
622
What procedure is used to treat vertebral compression fractures by injecting bone cement?
Kyphoplasty.
623
Which cranial nerve controls hearing and balance?
Vestibulocochlear nerve (CN VIII).
624
What type of tumor arises from astrocytes in the brain?
Astrocytoma.
625
What is the largest part of the brain responsible for conscious thought and voluntary movement?
Cerebrum.
626
What structure connects the two cerebral hemispheres?
Corpus callosum.
CSFA Master
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