NBSTSA CSFA Exam Questions

Correct answer: Regulate calcium levels

The parathyroid glands are crucial for regulating calcium levels in the blood through the secretion of Parathyroid Hormone (PTH). This hormone increases blood calcium levels by mobilizing calcium from bones, increasing calcium reabsorption in the kidneys, and enhancing calcium absorption in the intestine, maintaining critical calcium homeostasis necessary for various physiological processes.

Regulating blood sugar levels is the role of the pancreas, specifically through the actions of insulin and glucagon, and is unrelated to the parathyroid glands.

The control of metabolism is managed by thyroid hormones, which are produced by the thyroid gland, not the parathyroid glands.

The production of thyroid hormones is a function of the thyroid gland itself, not parathyroid glands.

Correct answer: Narrowing of the sphincter exiting the stomach

Pyloric stenosis involves the abnormal narrowing of the pyloric sphincter, the muscle that regulates food passage from the stomach to the small intestine. This condition results in significant obstruction, requiring surgical correction to restore normal gastrointestinal function and relieve symptoms such as projectile vomiting in infants.

Conditions involving a blockage in the ileum, twists in the colon (volvulus), and herniation through the diaphragm (diaphragmatic hernia) are unrelated to pyloric stenosis. These conditions affect different parts of the gastrointestinal tract and have distinct clinical presentations and treatment approaches.

Correct answer: Metzenbaum scissors

Metzenbaum scissors are typically passed to the surgeon for removing the internal mammary artery because they are designed for delicate dissection and cutting of fine tissues. This makes them ideal for the precise work needed in coronary artery bypass grafting procedures.

Mayo scissors are generally used for cutting heavier tissues and are not suited for the delicate dissection required in removing the internal mammary artery. DeBakey forceps are used for grasping and holding tissues, not for cutting or dissecting. Senn retractors are used for holding back tissues and are not suitable for the removal of the internal mammary artery.

Correct answer: Facilitating smooth instrument exchanges through the ports

Facilitating smooth instrument exchanges through the ports is essential in minimally invasive colectomies to ensure efficiency and maintain the sterile field. This role is crucial as it helps to minimize disruptions during the procedure and supports the surgeon’s workflow.

Providing manual retraction of tissues is not typically an important consideration during endoscopic procedures. Controlling the insufflation pressure is usually handled by the anesthesiologist or a dedicated technician, not the surgical assistant. Closing the skin incisions is a task performed at the end of the procedure and does not represent the primary role of the assistant relating to instrument exchange during the surgery.

Correct answer: Assembling the mesher only according to the manufacturer's instructions

Proper preparation of a mesher for surgery involves assembling it strictly according to the manufacturer's instructions. This ensures that each part of the mesher is correctly placed and functional, significantly reducing the risk of malfunction during the procedure.

Warming the mesher is unnecessary and does not impact its performance.

While proper storage is important for maintaining the device, it does not prepare it for immediate surgical use.

Patient identification practices are crucial for handling biological specimens but are not relevant to the preparation of surgical instruments.

Correct answer: Check the lens of the endoscope

Checking the lens of the endoscope is the first and most immediate step to troubleshoot a blurry image on the monitor. Often, smudges or debris on the lens can cause blurriness, and cleaning the lens can quickly restore clear visibility, ensuring the procedure can continue smoothly.

Increasing the brightness on the monitor does not resolve the underlying issue of a dirty or obstructed lens.

Adjusting the position of the endoscope might help with focus issues but is not the primary step when addressing blurriness.

Checking the connectivity of the light source is essential for brightness problems, but it does not directly impact the clarity of the image, which is primarily dependent on the cleanliness of the lens.

Correct answer: Sigmoid colon

The sigmoid colon is the most frequently affected part of the colon in colorectal cancer cases. Its anatomical location near the rectum makes it susceptible to cancerous changes. The sigmoid colon is often involved in colorectal cancer due to its tendency to form polyps that can become cancerous.

The transverse colon, located horizontally across the abdomen, is less frequently a site for colorectal cancer due to its position and function.

The ascending colon, which rises on the right side of the abdomen, is another potential site for cancer but is less commonly affected than the sigmoid colon.

The descending colon, located on the left side of the abdomen, is less frequently involved in colorectal cancer cases, with the sigmoid colon remaining the most common area requiring surgical resection due to its higher incidence of cancer occurrence.

Correct answer: Keeping the operating room doors closed as much as possible.

One of the most important practices for achieving aseptic conditions and reducing microbial contamination is keeping the operating room doors closed as much as possible. This practice helps maintain the sterile field by preventing the introduction of airborne contaminants, such as dust and microorganisms, from the surrounding environment.

Hand hygiene is crucial, but the focus should be on proper surgical scrubbing and sterile glove use rather than relying solely on hand sanitizer.

Surgical instruments should remain sterile once opened, and any contamination requires replacement, not disinfection, to maintain sterility.

While prophylactic antibiotics can help reduce the risk of postoperative infections, they are not a substitute for proper aseptic techniques in the operating room.

Correct answer: Using chlorhexidine for skin preparation

Using chlorhexidine for skin preparation is the most effective action in reducing the risk of infection transmission when preparing a patient for surgery. Chlorhexidine is a broad-spectrum antiseptic that effectively reduces the microbial load on the skin, significantly lowering the risk of introducing pathogens to the surgical site. Its prolonged antimicrobial action ensures that the skin remains antiseptic throughout the procedure, providing an additional layer of protection against infection.

Shaving with a razor can damage the skin and increase infection risk due to micro-abrasions.

Sterile dressings are important for post-operative care but do not reduce the microbial load on the skin prior to surgery.

Double gloving provides extra protection for healthcare workers but does not directly reduce infection risk for the patient.

Correct answer: Doyen intestinal clamp

The Doyen intestinal clamp is the correct instrument to use for clamping a section of the bowel in an open abdominal procedure. It is specifically designed to handle bowel tissue gently and securely without causing trauma.

The Babcock clamp, while useful for grasping, is not designed for clamping. Hemostats are intended for smaller vessels and not for the larger, delicate bowel tissue. Allis forceps are not appropriate for this task as they are used for grasping, not clamping.

Correct answer: Ensuring there are no wrinkles in the stockings

The most important step when applying antiembolic stockings to a surgical patient is ensuring there are no wrinkles in the stockings. Wrinkles can create pressure points that can lead to skin irritation and compromised circulation, reducing the effectiveness of the stockings in preventing embolism.

Applying the stockings only after the patient has been anesthetized is not advisable, as they should be applied before anesthesia to ensure a proper fit and effectiveness. Selecting a size based on patient comfort alone is insufficient; the stockings must be properly measured to ensure they provide the necessary compression. Removing the stockings immediately after surgery is not recommended as they need to remain in place postoperatively to prevent embolism until the patient is fully ambulatory.

Correct answer: Adrenal gland

The adrenal glands are primarily responsible for the condition of Cushing's syndrome because they are the direct producers of cortisol. When there is an overproduction of cortisol, it is typically the adrenal cortex that is at fault, leading to the clinical manifestations of Cushing's syndrome.

The thyroid gland is crucial for metabolic regulation through thyroid hormone production but it does not produce cortisol and thus is not responsible for Cushing's syndrome.

The pituitary gland, though it influences cortisol production via ACTH secretion, does not produce the hormone directly.

The kidneys are involved in excretory functions and do not have a role in the production of cortisol, making them irrelevant in the context of Cushing's syndrome.

Correct answer: Hyperglycemia

Hyperglycemia is the condition most likely to contribute to delayed wound healing in diabetic patients. High glucose can impair the function of immune cells, reducing their ability to fight infection and clear debris from the wound site. It also affects blood vessels, leading to reduced circulation and oxygen delivery to the wound, which are critical for tissue repair and regeneration.

Adequate nutrition is essential for wound healing, providing the building blocks for tissue repair and energy for cellular processes.

Hyperoxygenation can enhance healing by increasing oxygen availability and supporting tissue regeneration and immune function.

Surgical trauma is a normal aspect of the healing process, with healing times depending more on the patient's underlying health and metabolic status than the presence of surgical trauma itself.

Correct answer: Intermittent suction with an endoscopic suction-irrigator

In a laparoscopic procedure encountering excess fluid accumulation, the appropriate suction technique is intermittent suction with an endoscopic suction-irrigator. This method allows for effective fluid removal while maintaining visibility, which is crucial in such procedures.

The Yankauer tip does not provide the necessary control when applying suction and cannot typically be used in a laparoscopic procedure. A bulb syringe is inefficient for large fluid volumes and is not used in laparoscopic procedures. A Frazier tip is designed for more delicate and localized suctioning.

Correct answer: 121°C (250°F)

Sterilization in an autoclave using steam under pressure is achieved at a minimum temperature of 121°C (250°F). This temperature, combined with a specific pressure and time duration, ensures that all microbial life forms, including highly resistant bacterial spores, are destroyed, making the instruments safe for medical procedures.

Using 100°C (212°F) is insufficient for sterilization as it is only the boiling point of water at atmospheric pressure and cannot destroy all spores. While 134°C (273°F) is effective for sterilization, it is not necessary as 121°C is adequate. 105°C (221°F) falls short of the required threshold, failing to ensure complete microbial destruction.

Correct answer: Vesicovaginal fistula

A vesicovaginal fistula is a direct connection between the bladder and the vagina, often resulting from surgical complications, trauma, or disease processes. This condition leads to continuous leakage of urine from the bladder into the vaginal vault, causing significant discomfort and requiring surgical correction.

A urethral diverticulum involves a pouch-like extension of the urethra and does not involve a direct connection between the bladder and the vagina.

A ureterocele is a cystic dilation at the end of the ureter and is not related to vaginal connections.

A cystocele refers to the prolapse of the bladder into the vagina due to weakened pelvic support structures but it does not create an abnormal connection between the bladder and the vagina.

Correct answer: Every six months or as recommended by the manufacturer

Regular calibration of diagnostic equipment every six months or according to the manufacturer's recommendations ensures its accuracy and reliability. This proactive approach helps maintain high standards of patient care by preventing inaccuracies that could lead to misdiagnosis or inappropriate treatments.

Calibrating only when issues are noticeable can lead to extended periods of inaccurate readings, while annual calibration might not suffice for frequently used equipment. Calibrating before each use, although thorough, is impractical and unnecessarily time-consuming, causing operational delays without significant benefits over regular calibration schedules.

Correct answer: Alert the anesthesiologist and increase intravenous fluids

Alerting the anesthesiologist and increasing intravenous fluids is crucial in this scenario because it addresses the potential hypovolemia or shock by increasing blood volume and pressure. Immediate communication with the anesthesiologist ensures coordinated care to stabilize the patient quickly and effectively.

Applying a tourniquet above the surgical site is not appropriate as it is typically used for limb surgeries and can cause further complications. Raising the patient's legs might help increase venous return but is insufficient as immediate fluid resuscitation is likely essential in this situation. Stopping the procedure and preparing for cardiopulmonary resuscitation (CPR) is premature unless there are signs of cardiac arrest; immediate fluid resuscitation is a more appropriate first step.

Correct answer: Balfour retractor

The Balfour retractor is most suited for providing exposure during an abdominal aortic aneurysm repair because it offers deep and wide retraction, allowing for excellent visualization of the abdominal cavity. This is important for the intricate and extensive nature of this procedure.

The Weitlaner retractor is more suitable for superficial and smaller incisions, not for the deep exposure required in this surgery. The Senn retractor is used for smaller, superficial procedures and does not provide the necessary depth. The Richardson retractor, while useful for deep retraction, is not as effective as the Balfour retractor for the extensive exposure needed in abdominal aortic aneurysm repair.

Correct answer: Atherosclerosis

Atherosclerosis is characterized by the buildup of plaque in the coronary arteries, leading to their thickening and hardening. This plaque consists of fats, cholesterol, and other substances, which accumulate over time and narrow the arteries, restricting blood flow and increasing the risk of heart disease and stroke.

Cardiomyopathy affects the heart muscle directly, altering its structure and function, but it does not involve the buildup of plaque in the arteries.

Myocardial infarction is an acute event resulting from a blockage in the coronary arteries and is typically due to a clot rather than chronic thickening.

Angina pectoris is a symptom of reduced blood flow often caused by atherosclerosis, but it is not the condition itself.