EXAM COVERAGE
Anatomy & Surgical Landmarks
Upper Extremity: Bones, joints, muscles, nerves (median, ulnar, radial, peroneal),
vasculature, and positioning.
Lower Extremity: Bones, joints (hip, knee, ankle), ligaments (patellar, cruciate), nerves
(sciatic, tibial), vasculature (popliteal, femoral), and landmarks.
Head & Neck: Thyroid, parathyroid, carotid arteries, cranial nerves (V, VII, X, XII),
triangles of the neck, and recurrent laryngeal nerve.
Thorax & Abdomen: Heart valves, thoracic outlet, peritoneum, mesentery, abdominal wall
layers, and the GI tract from esophagus to rectum.
Specific Abdominal Organs: Pancreas, liver (lobes), gallbladder (cystic duct/artery, Calot's
triangle), spleen, stomach, and colon (taenia coli, marginal artery).
Pelvis & Perineum: Uterus (broad ligament), bladder, ureters, prostate, and innervation
(pudendal, hypogastric).
Nervous System: Spinal nerve roots, brachial plexus, and sympathetic/parasympathetic
responses.
Surgical Procedures & Techniques
General Surgery: Thyroidectomy, parotidectomy, mastectomy, laparotomies (incisions),
hernia repairs, bowel resections, and cholecystectomy.
GI Surgery: Gastrectomy (Billroth I/II), Whipple procedure, colectomies, ostomies, and
anastomosis techniques.
Orthopedics: Arthroscopy (knee/shoulder), arthroplasty (hip/knee), fracture fixation, and
spine surgery.
Vascular: Carotid endarterectomy, femoral-popliteal bypass, and ligation procedures.
Urology/OB-GYN: Nephrectomy, adrenalectomy, hysterectomy, and C-sections.
Thoracic: Cardiac poudrage, lung resections, and procedures for chest trauma.
Laparoscopy: Veress needle technique, pneumoperitoneum, and port placement.
Anesthesia, Pharmacology, & Physiology
Anesthesia: Epidural, emergence from anesthesia, and effects of Trendelenburg position.
Pharmacology: Insulin, Pitocin, corticosteroids, ibuprofen, antacids (Axid, Reglan),
antihypertensives (loop diuretics), antibiotics (penicillin, cephalosporins), and local
anesthetics (lidocaine).
Physiology: Fluid balance, acid-base imbalances, shock (hypovolemic, neurogenic), and
organ function (endocrine, renal).
Pathophysiology: Cardiac tamponade, cyanosis, bradycardia, diabetes, Parkinson's, asthma,
gout, and tetany.
,Wound Closure & Suturing
Suture Materials: Absorbable vs. non-absorbable, monofilament vs. braided, and specific
indications/contraindications (silk in GU tract).
Suturing Techniques: Interrupted, continuous, mattress, subcuticular, Cushing (does not
penetrate mucosa), Connell (penetrates mucosa), purse-string, and ligatures.
Wound Management: Healing (primary/secondary intention), dead space, debridement,
dehiscence, and evisceration.
Patient Positioning & Safety
Positioning: Supine, prone, Trendelenburg, and effects on anatomy and physiology.
Surgical Complications: Seroma, infection, nerve damage (long thoracic, recurrent
laryngeal), and hemodynamic instability.
Equipment Use: Cautery (bipolar vs. monopolar), suction tips (Frazier), and use of the
operative microscope.
AORN Wound Classification: Class IV (Dirty Infected) for ruptured appendix.
250 MCQS
1. A surgeon requests a "stick tie" for a deep vessel. What alternative term describes this
suture?
A) Interrupted suture
B) Subcuticular suture
C) Suture ligature
D) Purse-string suture
Answer: C) Suture ligature
*Rationale: *A suture ligature is also known as a stick tie. It is a technique where a needle is passed
through the tissue and then tied around the vessel to ensure hemostasis.
2. In a patient presenting with symptoms of cardiac tamponade, what is the primary
pathophysiological mechanism causing the low blood pressure?
A) Decreased cardiac output
B) Peripheral vasodilation
C) Bradycardia
D) Hypovolemia
Answer: A) Decreased cardiac output
*Rationale: *Cardiac tamponade compresses the heart, preventing it from filling properly. This leads
to a decrease in stroke volume and, consequently, a drop in cardiac output and blood pressure.
3. A patient in the prone position for a lumbar laminectomy has the dorsal roots of the spinal
nerves oriented in which manner?
,A) Deep to its corresponding ventral roots
B) Superficial to its corresponding ventral roots
C) Lateral to its corresponding ventral roots
D) Medial to its corresponding ventral roots
Answer: B) Superficial to its corresponding ventral roots
*Rationale: *In the prone position, the dorsal (posterior) roots are oriented superficially, as they are
closer to the surgeon. The ventral (anterior) roots lie deep to them.
4. During a femoral-popliteal bypass, the distal anastomosis is performed at a specific
anatomical landmark. What is this landmark?
A) The femoral triangle
B) The adductor hiatus
C) The popliteal fossa
D) The inguinal ligament
Answer: B) The adductor hiatus
*Rationale: *The adductor hiatus is an opening in the adductor magnus muscle. It serves as the
anatomical landmark where the femoral artery passes through to become the popliteal artery, making
it the site for the distal anastomosis.
5. The surgical assistant is asked to gently supinate, then pronate, the wrist of a 14-year-old
patient positioned at 80 degrees to the torso. The movement of the operative thumb would be
described as:
A) Thumb superior, then inferior
B) Thumb inferior, then back to superior
C) Thumb medial, then lateral
D) Thumb lateral, then medial
Answer: B) Thumb inferior, then back to superior
*Rationale: *Supination of the hand causes the palm to face anteriorly (thumb up). *Pronation causes
the palm to face posteriorly (thumb down). Therefore, the thumb moves from a superior to an inferior
position and back.
6. Which of the following statements is true regarding the use of silk suture material?
A) It is ideal for closing skin due to its high tensile strength.
B) It is recommended for use in the urinary bladder as it is non-irritating.
C) It should be avoided in the gallbladder and kidney as it can become a nucleus for stone formation.
D) It is the most inert material available.
Answer: C) It should be avoided in the gallbladder and kidney as it can become a nucleus for stone
formation.
, *Rationale: *Silk is a non-absorbable, braided suture. *Its braided nature can trap bacteria and it can
serve as a nidus for stone formation in the urinary and biliary tracts. ***
7. A patient with a history of crushing chest trauma exhibits chest pain radiating to the back,
low blood pressure, and muffled heart sounds. The most likely diagnosis is:
A) Myocardial infarction
B) Cardiac tamponade
C) Tension pneumothorax
D) Aortic dissection
Answer: B) Cardiac tamponade
*Rationale: *The classic triad for cardiac tamponade is hypotension, muffled heart sounds, and
distended neck veins. The pain can radiate, and the cause is often trauma, making cardiac tamponade
the most likely diagnosis.
8. The lumbosacral trunk joins with the sacral plexus to form which of the following nerves,
which is the largest nerve in the body?
A) Femoral nerve
B) Obturator nerve
C) Sciatic nerve
D) Pudendal nerve
Answer: C) Sciatic nerve
*Rationale: *The sciatic nerve is the largest and longest nerve in the body. *It is formed by the
lumbosacral trunk and the sacral plexus. ***
9. Immediate surgery is required for all of the following conditions except:
A) Complete small bowel obstruction
B) Cecal volvulus
C) Bile peritonitis
D) Massive rectal prolapse
Answer: D) Massive rectal prolapse
*Rationale: *Massive rectal prolapse is a distressing but not acutely life-threatening condition and can
often be managed non-operatively or electively. The other three conditions are acute emergencies
that can lead to ischemia, sepsis, and death.
10. What is the primary purpose of using a "bumper" or guard on a tension suture?
A) To improve cosmetic outcome
B) To prevent the suture from pulling through the skin
C) To act as a splint for the wound
D) To reduce the risk of infection
Anatomy & Surgical Landmarks
Upper Extremity: Bones, joints, muscles, nerves (median, ulnar, radial, peroneal),
vasculature, and positioning.
Lower Extremity: Bones, joints (hip, knee, ankle), ligaments (patellar, cruciate), nerves
(sciatic, tibial), vasculature (popliteal, femoral), and landmarks.
Head & Neck: Thyroid, parathyroid, carotid arteries, cranial nerves (V, VII, X, XII),
triangles of the neck, and recurrent laryngeal nerve.
Thorax & Abdomen: Heart valves, thoracic outlet, peritoneum, mesentery, abdominal wall
layers, and the GI tract from esophagus to rectum.
Specific Abdominal Organs: Pancreas, liver (lobes), gallbladder (cystic duct/artery, Calot's
triangle), spleen, stomach, and colon (taenia coli, marginal artery).
Pelvis & Perineum: Uterus (broad ligament), bladder, ureters, prostate, and innervation
(pudendal, hypogastric).
Nervous System: Spinal nerve roots, brachial plexus, and sympathetic/parasympathetic
responses.
Surgical Procedures & Techniques
General Surgery: Thyroidectomy, parotidectomy, mastectomy, laparotomies (incisions),
hernia repairs, bowel resections, and cholecystectomy.
GI Surgery: Gastrectomy (Billroth I/II), Whipple procedure, colectomies, ostomies, and
anastomosis techniques.
Orthopedics: Arthroscopy (knee/shoulder), arthroplasty (hip/knee), fracture fixation, and
spine surgery.
Vascular: Carotid endarterectomy, femoral-popliteal bypass, and ligation procedures.
Urology/OB-GYN: Nephrectomy, adrenalectomy, hysterectomy, and C-sections.
Thoracic: Cardiac poudrage, lung resections, and procedures for chest trauma.
Laparoscopy: Veress needle technique, pneumoperitoneum, and port placement.
Anesthesia, Pharmacology, & Physiology
Anesthesia: Epidural, emergence from anesthesia, and effects of Trendelenburg position.
Pharmacology: Insulin, Pitocin, corticosteroids, ibuprofen, antacids (Axid, Reglan),
antihypertensives (loop diuretics), antibiotics (penicillin, cephalosporins), and local
anesthetics (lidocaine).
Physiology: Fluid balance, acid-base imbalances, shock (hypovolemic, neurogenic), and
organ function (endocrine, renal).
Pathophysiology: Cardiac tamponade, cyanosis, bradycardia, diabetes, Parkinson's, asthma,
gout, and tetany.
,Wound Closure & Suturing
Suture Materials: Absorbable vs. non-absorbable, monofilament vs. braided, and specific
indications/contraindications (silk in GU tract).
Suturing Techniques: Interrupted, continuous, mattress, subcuticular, Cushing (does not
penetrate mucosa), Connell (penetrates mucosa), purse-string, and ligatures.
Wound Management: Healing (primary/secondary intention), dead space, debridement,
dehiscence, and evisceration.
Patient Positioning & Safety
Positioning: Supine, prone, Trendelenburg, and effects on anatomy and physiology.
Surgical Complications: Seroma, infection, nerve damage (long thoracic, recurrent
laryngeal), and hemodynamic instability.
Equipment Use: Cautery (bipolar vs. monopolar), suction tips (Frazier), and use of the
operative microscope.
AORN Wound Classification: Class IV (Dirty Infected) for ruptured appendix.
250 MCQS
1. A surgeon requests a "stick tie" for a deep vessel. What alternative term describes this
suture?
A) Interrupted suture
B) Subcuticular suture
C) Suture ligature
D) Purse-string suture
Answer: C) Suture ligature
*Rationale: *A suture ligature is also known as a stick tie. It is a technique where a needle is passed
through the tissue and then tied around the vessel to ensure hemostasis.
2. In a patient presenting with symptoms of cardiac tamponade, what is the primary
pathophysiological mechanism causing the low blood pressure?
A) Decreased cardiac output
B) Peripheral vasodilation
C) Bradycardia
D) Hypovolemia
Answer: A) Decreased cardiac output
*Rationale: *Cardiac tamponade compresses the heart, preventing it from filling properly. This leads
to a decrease in stroke volume and, consequently, a drop in cardiac output and blood pressure.
3. A patient in the prone position for a lumbar laminectomy has the dorsal roots of the spinal
nerves oriented in which manner?
,A) Deep to its corresponding ventral roots
B) Superficial to its corresponding ventral roots
C) Lateral to its corresponding ventral roots
D) Medial to its corresponding ventral roots
Answer: B) Superficial to its corresponding ventral roots
*Rationale: *In the prone position, the dorsal (posterior) roots are oriented superficially, as they are
closer to the surgeon. The ventral (anterior) roots lie deep to them.
4. During a femoral-popliteal bypass, the distal anastomosis is performed at a specific
anatomical landmark. What is this landmark?
A) The femoral triangle
B) The adductor hiatus
C) The popliteal fossa
D) The inguinal ligament
Answer: B) The adductor hiatus
*Rationale: *The adductor hiatus is an opening in the adductor magnus muscle. It serves as the
anatomical landmark where the femoral artery passes through to become the popliteal artery, making
it the site for the distal anastomosis.
5. The surgical assistant is asked to gently supinate, then pronate, the wrist of a 14-year-old
patient positioned at 80 degrees to the torso. The movement of the operative thumb would be
described as:
A) Thumb superior, then inferior
B) Thumb inferior, then back to superior
C) Thumb medial, then lateral
D) Thumb lateral, then medial
Answer: B) Thumb inferior, then back to superior
*Rationale: *Supination of the hand causes the palm to face anteriorly (thumb up). *Pronation causes
the palm to face posteriorly (thumb down). Therefore, the thumb moves from a superior to an inferior
position and back.
6. Which of the following statements is true regarding the use of silk suture material?
A) It is ideal for closing skin due to its high tensile strength.
B) It is recommended for use in the urinary bladder as it is non-irritating.
C) It should be avoided in the gallbladder and kidney as it can become a nucleus for stone formation.
D) It is the most inert material available.
Answer: C) It should be avoided in the gallbladder and kidney as it can become a nucleus for stone
formation.
, *Rationale: *Silk is a non-absorbable, braided suture. *Its braided nature can trap bacteria and it can
serve as a nidus for stone formation in the urinary and biliary tracts. ***
7. A patient with a history of crushing chest trauma exhibits chest pain radiating to the back,
low blood pressure, and muffled heart sounds. The most likely diagnosis is:
A) Myocardial infarction
B) Cardiac tamponade
C) Tension pneumothorax
D) Aortic dissection
Answer: B) Cardiac tamponade
*Rationale: *The classic triad for cardiac tamponade is hypotension, muffled heart sounds, and
distended neck veins. The pain can radiate, and the cause is often trauma, making cardiac tamponade
the most likely diagnosis.
8. The lumbosacral trunk joins with the sacral plexus to form which of the following nerves,
which is the largest nerve in the body?
A) Femoral nerve
B) Obturator nerve
C) Sciatic nerve
D) Pudendal nerve
Answer: C) Sciatic nerve
*Rationale: *The sciatic nerve is the largest and longest nerve in the body. *It is formed by the
lumbosacral trunk and the sacral plexus. ***
9. Immediate surgery is required for all of the following conditions except:
A) Complete small bowel obstruction
B) Cecal volvulus
C) Bile peritonitis
D) Massive rectal prolapse
Answer: D) Massive rectal prolapse
*Rationale: *Massive rectal prolapse is a distressing but not acutely life-threatening condition and can
often be managed non-operatively or electively. The other three conditions are acute emergencies
that can lead to ischemia, sepsis, and death.
10. What is the primary purpose of using a "bumper" or guard on a tension suture?
A) To improve cosmetic outcome
B) To prevent the suture from pulling through the skin
C) To act as a splint for the wound
D) To reduce the risk of infection
