CSFA General Practice 3 — Questions and Answers
Question 1: When performing blunt dissection in the retroperitoneal space, the surgical first assistant must avoid injury to the ureter, which can be identified by its characteristic:
- Bright yellow adipose coating
- Peristaltic movement when stimulated (Correct answer)
- Pulsatile flow visible under loupe magnification
- White fibrous appearance similar to a tendon
Correct answer: Peristaltic movement when stimulated
The ureter can be identified intraoperatively by its peristaltic worm-like movement when gently stimulated, distinguishing it from surrounding vessels and lymphatics.
Question 2: A patient is positioned in the lithotomy position for a prolonged pelvic procedure. The surgical first assistant should be aware that this position carries a risk of:
- Brachial plexus stretch injury
- Compartment syndrome of the lower extremities (Correct answer)
- Pressure ulcer on the occiput
- Femoral nerve compression
Correct answer: Compartment syndrome of the lower extremities
Prolonged lithotomy position can compress the calf compartments in stirrups, reducing perfusion and leading to lower extremity compartment syndrome, particularly in surgeries exceeding two hours.
Question 3: During an open cholecystectomy, the surgical first assistant must identify Calot's triangle. Which THREE structures define this anatomical triangle?
- Cystic duct, common bile duct, and liver edge
- Cystic duct, cystic artery, and common hepatic duct
- Common hepatic duct, liver edge, and cystic duct (Correct answer)
- Cystic duct, portal vein, and hepatic duct
Correct answer: Common hepatic duct, liver edge, and cystic duct
Calot's triangle is bounded by the cystic duct inferiorly, the common hepatic duct medially, and the inferior edge of the liver superiorly, with the cystic artery coursing within it.
Question 4: The surgical first assistant is asked to assist with hemostasis using a harmonic scalpel. This device achieves coagulation through which mechanism?
- High-frequency electrical current
- Ultrasonic vibration causing protein denaturation (Correct answer)
- Cryotherapy and vasoconstriction
- Laser energy absorbed by hemoglobin
Correct answer: Ultrasonic vibration causing protein denaturation
The harmonic scalpel uses ultrasonic vibrations at 55,500 Hz to denature proteins, coagulate vessels, and cut tissue simultaneously without passing electrical current through the patient.
Question 5: Which suture material is MOST appropriate for closing a contaminated abdominal fascia when delayed healing is expected?
- Polyglactin 910 (Vicryl)
- Polypropylene (Prolene) (Correct answer)
- Plain gut
- Silk
Correct answer: Polypropylene (Prolene)
Polypropylene is a non-absorbable, monofilament suture that maintains its tensile strength indefinitely and is resistant to bacterial colonization, making it suitable for contaminated fields.
Question 6: During a bowel resection, the surgical first assistant uses a linear stapler. The color-coded staple cartridge used for thick tissue such as bowel is MOST likely:
- White (2.5 mm staples)
- Blue (3.5 mm staples)
- Green (4.8 mm staples) (Correct answer)
- Gold (4.1 mm staples)
Correct answer: Green (4.8 mm staples)
Green cartridges contain 4.8 mm staples designed for thick tissue such as bowel and lung parenchyma, providing adequate compression without tissue necrosis.
Question 7: When managing a patient on the OR table who is in the Trendelenburg position, which physiological change should the surgical first assistant anticipate?
- Decreased intracranial pressure
- Increased venous return to the heart (Correct answer)
- Decreased respiratory tidal volume
- Increased mean arterial pressure in the lower extremities
Correct answer: Increased venous return to the heart
Trendelenburg (head-down) position causes blood to pool toward the thorax, increasing venous preload and cardiac output, but also increases intracranial pressure and can impair ventilation.
CSFA General Practice 3
When performing blunt dissection in the retroperitoneal space, the surgical first assistant must avoid injury to the ureter, which can be identified by its characteristic: