NBSTSA CSFA Exam Questions

Correct answer: Place the specimen in a dry container

For frozen section analysis, the specimen should be placed in a dry container to maintain its integrity and prepare it for rapid freezing and pathological examination. This method ensures the tissue remains suitable for detailed and accurate analysis under the microscope.

Formalin immersion is not suitable for frozen sections; it is used for routine histology and not for the immediate analysis required for frozen sections. Flash freezing is typically handled by the pathology department, not the surgical team. Leaving the specimen on the sterile field risks its contamination and degradation and may delay analysis.

Correct answer: Absorbable synthetic suture

Using absorbable synthetic sutures for fascia closure ensures that the sutures provide necessary strength during the critical initial healing phase and then safely dissolve, eliminating the need for removal and reducing the risk of infection and foreign body reactions. These sutures balance strength and biodegradability, making them suitable for internal use.

Silk sutures, being non-absorbable, pose a higher risk for infection and prolonged foreign body reaction, making them unsuitable for fascia. Nylon sutures also remain in the body and can cause long-term irritation. Chromic gut sutures, while absorbable, degrade too quickly to offer the sustained support necessary for fascia healing.

Correct answer: Anaplasia

Anaplasia is a defining feature of metastatic cancer cells, characterized by a lack of differentiation and the presence of abnormal cell structures. This lack of differentiation is a hallmark of aggressive and metastatic tumors, setting them apart from benign tumors, which are typically well-differentiated and maintain normal cellular structures and functions.

Encapsulation refers to the presence of a fibrous capsule surrounding the tumor, which limits its growth and invasion into adjacent tissues.

Well-defined margins indicate that the tumor remains localized and does not infiltrate surrounding tissues.

Differentiation describes how closely the tumor cells resemble their normal counterparts, with benign tumors often being well-differentiated and maintaining normal cellular functions.

Correct answer: Recurrence of the hernia

Recurrence of the hernia is the most common complication because, even with successful surgery, there is always a risk of the hernia returning, especially if the underlying factors causing the hernia are not addressed. This means that, despite optimal surgical intervention, patients may still experience a recurrence due to factors like tissue weakness or physical strain.

Infection, while a possible complication, is not as common as hernia recurrence and can typically be prevented with proper surgical technique and postoperative care. Hematoma formation is less common and generally resolves with appropriate management. Adhesion formation is more likely in abdominal surgeries involving the peritoneum and is not as frequently a concern in hernia repairs.

Correct answer: Pineal gland

The pineal gland is essential for the production of melatonin, a hormone that regulates circadian rhythms. Melatonin secretion is influenced by light exposure, with higher levels produced in darkness, signaling the body to prepare for sleep. This hormone's cyclical production helps maintain the body's internal clock, promoting regular sleep patterns.

The thyroid gland regulates metabolism through thyroid hormones and is unrelated to melatonin production.

The adrenal gland, while involved in stress and metabolic regulation through cortisol and adrenaline, does not influence sleep cycles through melatonin production.

The pituitary gland, responsible for various hormonal functions related to growth, metabolism, and reproduction, also does not play a role in circadian rhythm regulation by producing melatonin.

Correct answer: Bone screws and plates

Bone screws and plates are crucial for orthopedic procedures involving the internal fixation of fractures. These supplies are specifically designed to stabilize and hold the broken bone pieces together, ensuring proper alignment and healing of the bone.

A catheter and drainage bag are used for urinary management and have no direct role in bone fracture fixation. Laparoscopic trocars are used in minimally invasive surgeries, which are unrelated to open orthopedic procedures. Suction tubing and canister, while important for maintaining a clear surgical field, are not directly involved in the fixation of fractures.

Correct answer: Reduces the risk of infection

The primary advantage of using a closed vacuum drainage system like a Hemovac in postoperative wound management is its ability to significantly reduce the risk of infection. By maintaining a closed environment and continuously evacuating fluids, it helps keep the wound clean and promotes a healthier healing process.

Cost-effectiveness is not the main benefit of these systems, as they are often more costly than alternative wound management approaches. These systems require more frequent attention than just weekly dressing changes. They are not intended for the dual purposes of drainage and irrigation, focusing solely on effective fluid evacuation to support wound healing.

Correct answer: Low power mode

Low power mode is most appropriate for performing delicate tissue dissection with a harmonic scalpel because it provides precise control and minimizes tissue damage. This setting ensures that the tissue is handled gently and accurately.

High power mode is more suitable for cutting thicker tissues and can cause excessive tissue damage in delicate dissections.

Pulsed mode is not typically used for delicate tissue dissection with the harmonic scalpel as it does not provide the necessary continuous precision.

Continuous mode, while suitable for consistent cutting, does not offer the same control as low power mode for delicate tissues.

Correct answer: Apply direct pressure to the bleeding site

In the event of a sudden arterial bleed during surgery, the first step the surgical first assistant should take is to apply direct pressure to the bleeding site. This action is critical for controlling the bleeding and stabilizing the patient.

Calling for additional assistance is important but should be done after or simultaneously with applying direct pressure, as it is not as important as controlling the bleeding. Increasing the patient's oxygen supply does not directly address the immediate bleeding issue. Clamping the bleeding artery is a secondary step that should follow the application of direct pressure to control the situation initially.

Correct answer: Transfuse packed red blood cells

In the context of complex cardiac surgery, a hematocrit level of 20% signifies severe anemia, requiring the transfusion of packed red blood cells to restore adequate oxygen delivery to tissues. By transfusing packed red blood cells, the patient's hemoglobin and hematocrit levels are increased, enhancing the blood's ability to transport oxygen and ensuring that vital organs receive adequate perfusion during the procedure.

Crystalloids can expand plasma volume but cannot increase red blood cell count or improve oxygenation such as transfuse packed red blood cells.

Platelet transfusion is appropriate for addressing thrombocytopenia or bleeding, but not anemia due to low red blood cell mass.

Ignoring the low hematocrit without intervention can lead to serious complications due to inadequate tissue oxygenation.

Correct answer: Uterine artery

The uterine artery is a major vessel supplying blood to the uterus, and its injury during a cesarean section can result in significant hemorrhage and a sudden drop in maternal blood pressure. Proper identification and management of this artery are crucial to prevent severe blood loss and hemodynamic instability during the procedure.

The ovarian artery, while important, is less likely to be damaged during a cesarean section and is not likely to cause the same immediate and severe drop in blood pressure.

The inferior vena cava, though a critical, large vessel, is not commonly affected during this surgery.

The fetal aorta is not related to the mother's blood pressure issues during a cesarean section and is not likely to be damaged by this procedure.

Correct answer: Before the induction of anesthesia

Pneumatic compression devices should be applied before the induction of anesthesia to prevent deep vein thrombosis. Applying the devices early ensures that prophylactic measures are in place from the beginning of the procedure, reducing the risk of clot formation.

Applying the devices after the surgical incision is made delays their protective benefits, and waiting until the final stages of surgery is too late to prevent initial thrombotic risks. Applying the devices only after the procedure is finished does not address the intraoperative risk of deep vein thrombosis, which is present throughout the surgery.

Correct answer: Hemoclip applier

The Hemoclip applier is the correct instrument for applying hemostatic clips during an open cholecystectomy when controlling bleeding from a small arterial branch. This tool is specifically designed for the task and ensures precise and secure placement of the clips to effectively stop the bleeding.

The Kelly clamp is used for clamping larger vessels or tissues and lacks the functionality to apply hemostatic clips. Metzenbaum scissors are intended for cutting delicate tissues and do not have the capability to apply clips. Kocher forceps are designed for grasping tissues but do not offer the precision required for securing hemostatic clips.

Correct answer: Allograft

An allograft refers to a tissue graft obtained from a donor who is genetically non-identical but of the same species. This type of graft is widely used in transplantation because it often allows for the necessary genetic compatibility while not requiring the donor and recipient to be genetically identical.

An autograft is derived from the patient's own tissue, ensuring compatibility without the risk of rejection; it is not from another individual. A xenograft comes from a different species and is often not suitable for human-to-human transplantation. An isograft involves genetically identical donors, which is only applicable in cases like identical twins.

Correct answer: Nonunion

Nonunion is the primary concern in scaphoid fractures due to the blood supply to this bone. The scaphoid receives blood in a retrograde fashion, meaning the blood supply enters the distal part of the bone and flows toward the proximal pole. This supply pattern makes the scaphoid particularly susceptible to avascular necrosis and nonunion when fractured, especially if the fracture disrupts the blood flow to the proximal pole.

Compartment syndrome typically occurs in injuries involving significant swelling or bleeding in a confined muscle compartment, such as with tibial or forearm fractures, rather than the scaphoid.

Osteomyelitis, a bone infection, is more likely in open fractures or after surgical procedures, which is not typical of scaphoid injuries.

Nerve compression is not a frequent complication of scaphoid fractures and is not a concern that is specific to this type of injury.

Correct answer: Maintaining strict aseptic technique

Maintaining strict aseptic technique is the most critical step to prevent infection during wound debridement. This ensures that no new pathogens are introduced into the wound, significantly reducing the risk of postoperative infection.

Using prophylactic antibiotics cannot alone prevent infection if aseptic techniques are not adhered to during the procedure. Applying a tourniquet is irrelevant to infection prevention and is used to control bleeding. While using sterile gloves is important, it is only one component of the overall aseptic technique needed to prevent infection.

Correct answer: Midline incision

The most appropriate type of surgical incision for gaining access to the abdominal cavity for a laparotomy is the midline incision. This incision provides excellent access to the entire abdominal cavity, allowing the surgeon to reach various organs and structures effectively, which is essential for a wide range of abdominal procedures.

The Pfannenstiel incision is typically used for pelvic surgeries, such as cesarean sections, and does not offer the same broad access to the abdominal cavity. The Kocher incision is mainly used for surgeries involving the liver and gallbladder, limiting its usefulness for general abdominal procedures. The McBurney incision is specific to appendectomies and does not provide the comprehensive access needed for a laparotomy.

Correct answer: Umbilical tape

Umbilical tape is the correct material for a Rummel tourniquet because it combines flexibility and strength, ensuring effective and safe vascular control. It is soft and pliable, minimizing the risk of vascular damage while maintaining the necessary pressure to control bleeding. This makes it ideal for the delicate task of vascular occlusion in a surgical setting.

Silk and nylon sutures are designed for tissue approximation and lack the necessary width and flexibility required for a Rummel tourniquet, which can lead to vessel injury. Metal clamps, while useful for temporary vessel occlusion, are too rigid and can cause significant damage to vessels, making them unsuitable for the Rummel technique.

Correct answer: Notify the surgeon and switch to a backup stapler

Notifying the surgeon and switching to a backup stapler ensures the procedure can continue without significant delay or risk to the patient. This immediate action prioritizes patient safety and maintains surgical efficiency. By promptly switching to a functional device, the surgical team can minimize disruptions and potential complications associated with a failed stapler.

Attempting to reload the stapler with new staples can cause further delay and may not resolve the underlying issue with the device.

Suggesting the surgeon reposition the stapler before attempting to redeploy it again could waste time and is not likely to fix the malfunction.

Manually placing sutures instead is a secondary option that should only be considered if no backup stapler is available, as it is generally slower and might not provide the same level of security as stapling.

Correct answer: Record the incident in the equipment maintenance log

Recording the incident in the equipment maintenance log provides a formal and traceable record of the malfunction. This record is essential for maintaining a comprehensive history of the equipment, which helps in identifying patterns or recurring issues and facilitates proper maintenance and timely repairs.

Making a verbal report to the manufacturer lacks the permanence and traceability of a written log. Verbal reports can be easily forgotten or miscommunicated, leading to potential oversight of critical issues.

Writing an email to the manufacturer, while useful, is secondary because it does not ensure immediate documentation within the organization's own maintenance system and can be lost or overlooked.

Providing an impression of the likely cause of the malfunction is speculative and could lead to inaccurate records or misdirected maintenance efforts.