ABSA (American Board of Surgical
Assistant) Exam Questions with Verified
Answers
Question 1: During a laparoscopic cholecystectomy on a 45-year-old female
with a history of acute cholecystitis, the surgeon encounters dense
adhesions between the gallbladder and the duodenum. To safely dissect this
area and avoid thermal injury to the bowel, which energy device is most
appropriate for the surgical assistant to prepare and hand to the primary
surgeon?
A. Monopolar electrocautery
B. Ultrasonic shears
C. Argon beam coagulator
D. Standard bipolar forceps
CORRECT ANSWER: B. Ultrasonic shears
Rationale: Ultrasonic shears provide simultaneous cutting and coagulation
with minimal lateral thermal spread, making them ideal for dissecting near
delicate structures like the duodenum.
Question 2: A surgical assistant is retracting the liver during an open right
hepatectomy. The surgeon requests a retractor that will provide broad,
atraumatic exposure of the right lobe without causing parenchymal fracture.
Which instrument is the most appropriate choice?
A. Richardson retractor
B. Harrington retractor
C. Malleable retractor
D. Bookwalter fixed retractor with a broad, padded blade
CORRECT ANSWER: D. Bookwalter fixed retractor with a broad, padded
blade
Rationale: A fixed retractor with a broad, padded blade distributes pressure
evenly across the liver parenchyma, preventing capsular tear and subcapsular
hematoma during prolonged retraction.
Question 3: While assisting in an open inguinal hernia repair, the surgeon
identifies the ilioinguinal nerve running through the inguinal canal. What is
the primary clinical significance of preserving this nerve during the
dissection and mesh placement?
A. It provides motor innervation to the cremaster muscle.
B. It provides sensory innervation to the anterior scrotum/labia majora and
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,medial thigh.
C. It controls the internal anal sphincter.
D. It supplies motor function to the lower abdominal muscles.
CORRECT ANSWER: B. It provides sensory innervation to the anterior
scrotum/labia majora and medial thigh.
Rationale: The ilioinguinal nerve provides sensation to the upper medial thigh
and anterior perineum; injury or entrapment during hernia repair causes
chronic neuropathic pain in these regions.
Question 4: During a total abdominal hysterectomy, the surgeon is ligating
the uterine artery. The surgical assistant must be aware of the anatomical
relationship between the uterine artery and the ureter to prevent iatrogenic
injury. Which phrase best describes this relationship?
A. The ureter passes over the uterine artery.
B. The ureter passes under the uterine artery ("water under the bridge").
C. The ureter runs parallel and lateral to the uterine artery.
D. The ureter is located anterior to the uterine artery.
CORRECT ANSWER: B. The ureter passes under the uterine artery ("water
under the bridge").
Rationale: The ureter passes inferior and posterior to the uterine artery near
the cervix; clamping the uterine vessels without identifying the ureter risks
ureteral ligation or transection.
Question 5: A patient is undergoing a carotid endarterectomy for severe
symptomatic stenosis. The surgeon requests a shunt to maintain cerebral
perfusion during the cross-clamping of the carotid artery. Which type of
shunt is most commonly used for this procedure?
A. Fogarty catheter
B. Pruitt-Inahara shunt
C. Blakemore tube
D. Penrose drain
CORRECT ANSWER: B. Pruitt-Inahara shunt
Rationale: The Pruitt-Inahara shunt is specifically designed for carotid
endarterectomy, featuring balloons at both ends to secure it within the
common and internal carotid arteries while maintaining blood flow to the
brain.
Question 6: During a total knee arthroplasty, the surgeon is preparing to
cement the femoral component. The surgical assistant is tasked with mixing
the polymethylmethacrylate (PMMA) bone cement. Which phase of the
cement curing process is characterized by a loss of stickiness and is the
optimal time for the surgeon to apply the cement to the bone?
A. Mixing phase
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,B. Waiting phase
C. Working phase (dough phase)
D. Setting phase
CORRECT ANSWER: C. Working phase (dough phase)
Rationale: The dough phase occurs when the cement loses its stickiness and
becomes pliable, making it the ideal consistency for handling, packing, and
pressurizing into the cancellous bone.
Question 7: A surgical assistant is setting up for a transurethral resection of
the prostate (TURP). The surgeon requests continuous irrigation to maintain
visualization and prevent clot retention. Which irrigation fluid is most
appropriate for use with monopolar electrocautery during this procedure?
A. Normal saline (0.9% NaCl)
B. Lactated Ringer's solution
C. 1.5% Glycine or sterile water
D. 5% Dextrose in water
CORRECT ANSWER: C. 1.5% Glycine or sterile water
Rationale: Non-electrolyte solutions like glycine or sterile water must be used
with monopolar cautery to prevent the dispersion of electrical current, which
would occur with electrolyte-containing fluids like normal saline.
Question 8: While assisting in a posterior spinal fusion for scoliosis, the
surgeon is placing pedicle screws. The surgical assistant hands the surgeon a
probe to palpate the walls of the drilled pilot hole. What is the primary
purpose of this step?
A. To measure the exact depth of the spinal canal.
B. To ensure all five walls of the pedicle are intact bone and no breach has
occurred.
C. To deliver local anesthetic into the epidural space.
D. To coagulate bleeding from the cancellous bone.
CORRECT ANSWER: B. To ensure all five walls of the pedicle are intact bone
and no breach has occurred.
Rationale: Palpating the pilot hole with a blunt probe verifies that the bony
walls of the pedicle are intact, preventing misplaced screws that could injure
the spinal cord or nerve roots.
Question 9: During a laparoscopic appendectomy, the surgeon identifies the
base of the appendix and requests an endoloop to ligate the appendiceal
stump. How many endoloops are typically applied to the appendiceal stump
to ensure secure closure and prevent a postoperative leak?
A. One
B. Two
C. Three
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, D. Four
CORRECT ANSWER: B. Two
Rationale: Standard surgical practice involves placing two endoloops (or a
combination of endoloops and an endostapler) on the appendiceal stump to
provide a secure, redundant seal and prevent stump blowout.
Question 10: A patient is undergoing a modified radical mastectomy. The
surgeon is dissecting the axillary lymph nodes and requests careful
identification of the long thoracic nerve. Injury to this nerve would result in
which specific postoperative physical finding?
A. Inability to abduct the arm past 90 degrees
B. Winged scapula
C. Loss of sensation over the deltoid
D. Weakness in elbow flexion
CORRECT ANSWER: B. Winged scapula
Rationale: The long thoracic nerve innervates the serratus anterior muscle;
injury causes paralysis of this muscle, leading to medial protrusion of the
scapula, clinically known as a "winged scapula."
Question 11: During an open splenectomy for trauma, the surgeon is ligating
the splenic vessels at the hilum. The surgical assistant must be cautious to
avoid injuring the tail of which adjacent organ, which is located within the
splenorenal ligament?
A. Duodenum
B. Left kidney
C. Pancreas
D. Stomach
CORRECT ANSWER: C. Pancreas
Rationale: The tail of the pancreas extends into the splenorenal ligament and
lies immediately adjacent to the splenic hilum, making it highly susceptible to
iatrogenic injury during splenic vessel ligation.
Question 12: A surgical assistant is preparing the skin for a midline
laparotomy. The surgeon requests a chlorhexidine gluconate and isopropyl
alcohol prep. What is the primary advantage of this specific antiseptic
combination over povidone-iodine?
A. It provides immediate color change to indicate adequate coverage.
B. It has persistent antimicrobial activity and is not inactivated by blood or
serum.
C. It is safe for use on mucous membranes and open wounds.
D. It causes less contact dermatitis in patients with sensitive skin.
CORRECT ANSWER: B. It has persistent antimicrobial activity and is not
inactivated by blood or serum.
Page 4 of 68
Assistant) Exam Questions with Verified
Answers
Question 1: During a laparoscopic cholecystectomy on a 45-year-old female
with a history of acute cholecystitis, the surgeon encounters dense
adhesions between the gallbladder and the duodenum. To safely dissect this
area and avoid thermal injury to the bowel, which energy device is most
appropriate for the surgical assistant to prepare and hand to the primary
surgeon?
A. Monopolar electrocautery
B. Ultrasonic shears
C. Argon beam coagulator
D. Standard bipolar forceps
CORRECT ANSWER: B. Ultrasonic shears
Rationale: Ultrasonic shears provide simultaneous cutting and coagulation
with minimal lateral thermal spread, making them ideal for dissecting near
delicate structures like the duodenum.
Question 2: A surgical assistant is retracting the liver during an open right
hepatectomy. The surgeon requests a retractor that will provide broad,
atraumatic exposure of the right lobe without causing parenchymal fracture.
Which instrument is the most appropriate choice?
A. Richardson retractor
B. Harrington retractor
C. Malleable retractor
D. Bookwalter fixed retractor with a broad, padded blade
CORRECT ANSWER: D. Bookwalter fixed retractor with a broad, padded
blade
Rationale: A fixed retractor with a broad, padded blade distributes pressure
evenly across the liver parenchyma, preventing capsular tear and subcapsular
hematoma during prolonged retraction.
Question 3: While assisting in an open inguinal hernia repair, the surgeon
identifies the ilioinguinal nerve running through the inguinal canal. What is
the primary clinical significance of preserving this nerve during the
dissection and mesh placement?
A. It provides motor innervation to the cremaster muscle.
B. It provides sensory innervation to the anterior scrotum/labia majora and
Page 1 of 68
,medial thigh.
C. It controls the internal anal sphincter.
D. It supplies motor function to the lower abdominal muscles.
CORRECT ANSWER: B. It provides sensory innervation to the anterior
scrotum/labia majora and medial thigh.
Rationale: The ilioinguinal nerve provides sensation to the upper medial thigh
and anterior perineum; injury or entrapment during hernia repair causes
chronic neuropathic pain in these regions.
Question 4: During a total abdominal hysterectomy, the surgeon is ligating
the uterine artery. The surgical assistant must be aware of the anatomical
relationship between the uterine artery and the ureter to prevent iatrogenic
injury. Which phrase best describes this relationship?
A. The ureter passes over the uterine artery.
B. The ureter passes under the uterine artery ("water under the bridge").
C. The ureter runs parallel and lateral to the uterine artery.
D. The ureter is located anterior to the uterine artery.
CORRECT ANSWER: B. The ureter passes under the uterine artery ("water
under the bridge").
Rationale: The ureter passes inferior and posterior to the uterine artery near
the cervix; clamping the uterine vessels without identifying the ureter risks
ureteral ligation or transection.
Question 5: A patient is undergoing a carotid endarterectomy for severe
symptomatic stenosis. The surgeon requests a shunt to maintain cerebral
perfusion during the cross-clamping of the carotid artery. Which type of
shunt is most commonly used for this procedure?
A. Fogarty catheter
B. Pruitt-Inahara shunt
C. Blakemore tube
D. Penrose drain
CORRECT ANSWER: B. Pruitt-Inahara shunt
Rationale: The Pruitt-Inahara shunt is specifically designed for carotid
endarterectomy, featuring balloons at both ends to secure it within the
common and internal carotid arteries while maintaining blood flow to the
brain.
Question 6: During a total knee arthroplasty, the surgeon is preparing to
cement the femoral component. The surgical assistant is tasked with mixing
the polymethylmethacrylate (PMMA) bone cement. Which phase of the
cement curing process is characterized by a loss of stickiness and is the
optimal time for the surgeon to apply the cement to the bone?
A. Mixing phase
Page 2 of 68
,B. Waiting phase
C. Working phase (dough phase)
D. Setting phase
CORRECT ANSWER: C. Working phase (dough phase)
Rationale: The dough phase occurs when the cement loses its stickiness and
becomes pliable, making it the ideal consistency for handling, packing, and
pressurizing into the cancellous bone.
Question 7: A surgical assistant is setting up for a transurethral resection of
the prostate (TURP). The surgeon requests continuous irrigation to maintain
visualization and prevent clot retention. Which irrigation fluid is most
appropriate for use with monopolar electrocautery during this procedure?
A. Normal saline (0.9% NaCl)
B. Lactated Ringer's solution
C. 1.5% Glycine or sterile water
D. 5% Dextrose in water
CORRECT ANSWER: C. 1.5% Glycine or sterile water
Rationale: Non-electrolyte solutions like glycine or sterile water must be used
with monopolar cautery to prevent the dispersion of electrical current, which
would occur with electrolyte-containing fluids like normal saline.
Question 8: While assisting in a posterior spinal fusion for scoliosis, the
surgeon is placing pedicle screws. The surgical assistant hands the surgeon a
probe to palpate the walls of the drilled pilot hole. What is the primary
purpose of this step?
A. To measure the exact depth of the spinal canal.
B. To ensure all five walls of the pedicle are intact bone and no breach has
occurred.
C. To deliver local anesthetic into the epidural space.
D. To coagulate bleeding from the cancellous bone.
CORRECT ANSWER: B. To ensure all five walls of the pedicle are intact bone
and no breach has occurred.
Rationale: Palpating the pilot hole with a blunt probe verifies that the bony
walls of the pedicle are intact, preventing misplaced screws that could injure
the spinal cord or nerve roots.
Question 9: During a laparoscopic appendectomy, the surgeon identifies the
base of the appendix and requests an endoloop to ligate the appendiceal
stump. How many endoloops are typically applied to the appendiceal stump
to ensure secure closure and prevent a postoperative leak?
A. One
B. Two
C. Three
Page 3 of 68
, D. Four
CORRECT ANSWER: B. Two
Rationale: Standard surgical practice involves placing two endoloops (or a
combination of endoloops and an endostapler) on the appendiceal stump to
provide a secure, redundant seal and prevent stump blowout.
Question 10: A patient is undergoing a modified radical mastectomy. The
surgeon is dissecting the axillary lymph nodes and requests careful
identification of the long thoracic nerve. Injury to this nerve would result in
which specific postoperative physical finding?
A. Inability to abduct the arm past 90 degrees
B. Winged scapula
C. Loss of sensation over the deltoid
D. Weakness in elbow flexion
CORRECT ANSWER: B. Winged scapula
Rationale: The long thoracic nerve innervates the serratus anterior muscle;
injury causes paralysis of this muscle, leading to medial protrusion of the
scapula, clinically known as a "winged scapula."
Question 11: During an open splenectomy for trauma, the surgeon is ligating
the splenic vessels at the hilum. The surgical assistant must be cautious to
avoid injuring the tail of which adjacent organ, which is located within the
splenorenal ligament?
A. Duodenum
B. Left kidney
C. Pancreas
D. Stomach
CORRECT ANSWER: C. Pancreas
Rationale: The tail of the pancreas extends into the splenorenal ligament and
lies immediately adjacent to the splenic hilum, making it highly susceptible to
iatrogenic injury during splenic vessel ligation.
Question 12: A surgical assistant is preparing the skin for a midline
laparotomy. The surgeon requests a chlorhexidine gluconate and isopropyl
alcohol prep. What is the primary advantage of this specific antiseptic
combination over povidone-iodine?
A. It provides immediate color change to indicate adequate coverage.
B. It has persistent antimicrobial activity and is not inactivated by blood or
serum.
C. It is safe for use on mucous membranes and open wounds.
D. It causes less contact dermatitis in patients with sensitive skin.
CORRECT ANSWER: B. It has persistent antimicrobial activity and is not
inactivated by blood or serum.
Page 4 of 68
