ABSA SURGICAL ASSISTANT CERTIFICATION (SA-C) EXAM
3 (PDF) | 2026 QUESTIONS & ANSWERS + RATIONALES |
STUDY GUIDE | 100% CORRECT
1. During a laparoscopic cholecystectomy, the surgeon requests a cholangiogram to visualize the
biliary tree. Where is the catheter typically inserted for this procedure?
A) Through the abdominal wall directly into the gallbladder
B) Into the cystic duct
C) Into the common bile duct
D) Into the duodenum via endoscopy
Correct Answer: B) Into the cystic duct
Rationale: Intraoperative cholangiography involves cannulating the cystic duct with a small
catheter to inject contrast dye, which then flows into the common bile duct and duodenum to
identify stones or anatomical variations. The gallbladder is not the access point.
2. A patient undergoing a carotid endarterectomy requires continuous monitoring of cerebral
perfusion. Which technique is most commonly used during this procedure?
A) Electroencephalography (EEG)
B) Transcranial Doppler ultrasound
C) Near-infrared spectroscopy (NIRS)
D) All of the above
Correct Answer: D) All of the above
Rationale: Cerebral monitoring during carotid endarterectomy can include EEG to detect
ischemia, transcranial Doppler to measure blood flow velocity, and NIRS to measure regional
oxygen saturation. Each provides complementary information about cerebral perfusion.
3. Which anatomical structure is at greatest risk during a modified radical neck dissection?
A) The phrenic nerve
B) The spinal accessory nerve (CN XI)
C) The hypoglossal nerve
D) The vagus nerve
Correct Answer: B) The spinal accessory nerve (CN XI)
Rationale: The spinal accessory nerve is at significant risk during neck dissections because it
traverses the posterior triangle of the neck. Injury causes shoulder drop and weakness. While
other nerves are also at risk, the spinal accessory nerve is a primary concern.
4. During a Whipple procedure (pancreaticoduodenectomy), which anastomosis is performed
first by most surgeons?
,A) Pancreaticojejunostomy
B) Hepaticojejunostomy
C) Gastrojejunostomy
D) Cholecystojejunostomy
Correct Answer: B) Hepaticojejunostomy
Rationale: In a Whipple procedure, the sequence of anastomoses typically begins with the
pancreaticojejunostomy (most critical and technically demanding), followed by
hepaticojejunostomy for biliary drainage. However, some surgeons prefer hepaticojejunostomy
first. The pancreatic anastomosis is the most critical due to risk of leak.
5. A patient is undergoing a total hip arthroplasty. Which position is the patient typically placed
in for a posterior approach?
A) Supine
B) Lateral decubitus with the operative side up
C) Prone
D) Trendelenburg
Correct Answer: B) Lateral decubitus with the operative side up
Rationale: The posterior approach to the hip is performed with the patient in the lateral decubitus
position, operative side up. This provides access to the posterior aspect of the hip joint. The
anterior approach uses supine positioning.
6. Which instrument is specifically designed for use in laparoscopic surgery to grasp and
manipulate tissue?
A) Babcock clamp
B) Grasping forceps
C) Allis clamp
D) Kocher clamp
Correct Answer: B) Grasping forceps
Rationale: Laparoscopic grasping forceps are long, slender instruments designed to pass through
trocars to grasp and manipulate tissue during minimally invasive surgery. Standard open
instruments like Babcock or Allis clamps are too short.
7. During a craniotomy, the surgical assistant must be aware of which critical structure located
just beneath the dura mater?
A) The arachnoid mater
B) The pia mater
C) The cerebral cortex
D) The superior sagittal sinus
Correct Answer: D) The superior sagittal sinus
, Rationale: The superior sagittal sinus runs along the superior margin of the falx cerebri, just
beneath the dura and skull. It is a major venous sinus that can cause significant hemorrhage if
injured. The arachnoid and pia are deeper layers.
8. A patient with a suspected malignant hyperthermia crisis is being treated. Which medication is
the specific antidote?
A) Dantrolene sodium
B) Sodium bicarbonate
C) Calcium chloride
D) Epinephrine
Correct Answer: A) Dantrolene sodium
Rationale: Dantrolene sodium is the specific antidote for malignant hyperthermia. It works by
inhibiting calcium release from the sarcoplasmic reticulum, reducing muscle contraction and heat
production. Sodium bicarbonate treats acidosis but is not the antidote.
9. During a nephrectomy, the renal artery and renal vein must be identified and ligated. Which
vessel is ligated first to prevent engorgement of the kidney?
A) Renal vein
B) Renal artery
C) Ureter
D) Adrenal vein
Correct Answer: B) Renal artery
Rationale: The renal artery is ligated first to prevent engorgement of the kidney with blood. If the
vein is ligated first, the kidney becomes congested and swollen, making dissection more difficult
and increasing blood loss.
10. Which of the following is a characteristic of a clean-contaminated surgical wound?
A) No inflammation encountered, respiratory, alimentary, genital, or urinary tract not entered
B) Controlled entry into respiratory, alimentary, genital, or urinary tract without unusual
contamination
C) Gross spillage from the gastrointestinal tract or acute inflammation
D) Penetrating trauma with retained devitalized tissue
Correct Answer: B) Controlled entry into respiratory, alimentary, genital, or urinary tract without
unusual contamination
Rationale: Clean-contaminated wounds involve controlled entry into a hollow viscus
(respiratory, alimentary, genital, or urinary tract) with minimal spillage. Clean wounds do not
enter these tracts. Contaminated wounds have gross spillage or acute inflammation.
11. During an open reduction and internal fixation (ORIF) of a distal radius fracture, which
structure is most at risk from the surgical approach?
A) The median nerve
B) The radial artery
3 (PDF) | 2026 QUESTIONS & ANSWERS + RATIONALES |
STUDY GUIDE | 100% CORRECT
1. During a laparoscopic cholecystectomy, the surgeon requests a cholangiogram to visualize the
biliary tree. Where is the catheter typically inserted for this procedure?
A) Through the abdominal wall directly into the gallbladder
B) Into the cystic duct
C) Into the common bile duct
D) Into the duodenum via endoscopy
Correct Answer: B) Into the cystic duct
Rationale: Intraoperative cholangiography involves cannulating the cystic duct with a small
catheter to inject contrast dye, which then flows into the common bile duct and duodenum to
identify stones or anatomical variations. The gallbladder is not the access point.
2. A patient undergoing a carotid endarterectomy requires continuous monitoring of cerebral
perfusion. Which technique is most commonly used during this procedure?
A) Electroencephalography (EEG)
B) Transcranial Doppler ultrasound
C) Near-infrared spectroscopy (NIRS)
D) All of the above
Correct Answer: D) All of the above
Rationale: Cerebral monitoring during carotid endarterectomy can include EEG to detect
ischemia, transcranial Doppler to measure blood flow velocity, and NIRS to measure regional
oxygen saturation. Each provides complementary information about cerebral perfusion.
3. Which anatomical structure is at greatest risk during a modified radical neck dissection?
A) The phrenic nerve
B) The spinal accessory nerve (CN XI)
C) The hypoglossal nerve
D) The vagus nerve
Correct Answer: B) The spinal accessory nerve (CN XI)
Rationale: The spinal accessory nerve is at significant risk during neck dissections because it
traverses the posterior triangle of the neck. Injury causes shoulder drop and weakness. While
other nerves are also at risk, the spinal accessory nerve is a primary concern.
4. During a Whipple procedure (pancreaticoduodenectomy), which anastomosis is performed
first by most surgeons?
,A) Pancreaticojejunostomy
B) Hepaticojejunostomy
C) Gastrojejunostomy
D) Cholecystojejunostomy
Correct Answer: B) Hepaticojejunostomy
Rationale: In a Whipple procedure, the sequence of anastomoses typically begins with the
pancreaticojejunostomy (most critical and technically demanding), followed by
hepaticojejunostomy for biliary drainage. However, some surgeons prefer hepaticojejunostomy
first. The pancreatic anastomosis is the most critical due to risk of leak.
5. A patient is undergoing a total hip arthroplasty. Which position is the patient typically placed
in for a posterior approach?
A) Supine
B) Lateral decubitus with the operative side up
C) Prone
D) Trendelenburg
Correct Answer: B) Lateral decubitus with the operative side up
Rationale: The posterior approach to the hip is performed with the patient in the lateral decubitus
position, operative side up. This provides access to the posterior aspect of the hip joint. The
anterior approach uses supine positioning.
6. Which instrument is specifically designed for use in laparoscopic surgery to grasp and
manipulate tissue?
A) Babcock clamp
B) Grasping forceps
C) Allis clamp
D) Kocher clamp
Correct Answer: B) Grasping forceps
Rationale: Laparoscopic grasping forceps are long, slender instruments designed to pass through
trocars to grasp and manipulate tissue during minimally invasive surgery. Standard open
instruments like Babcock or Allis clamps are too short.
7. During a craniotomy, the surgical assistant must be aware of which critical structure located
just beneath the dura mater?
A) The arachnoid mater
B) The pia mater
C) The cerebral cortex
D) The superior sagittal sinus
Correct Answer: D) The superior sagittal sinus
, Rationale: The superior sagittal sinus runs along the superior margin of the falx cerebri, just
beneath the dura and skull. It is a major venous sinus that can cause significant hemorrhage if
injured. The arachnoid and pia are deeper layers.
8. A patient with a suspected malignant hyperthermia crisis is being treated. Which medication is
the specific antidote?
A) Dantrolene sodium
B) Sodium bicarbonate
C) Calcium chloride
D) Epinephrine
Correct Answer: A) Dantrolene sodium
Rationale: Dantrolene sodium is the specific antidote for malignant hyperthermia. It works by
inhibiting calcium release from the sarcoplasmic reticulum, reducing muscle contraction and heat
production. Sodium bicarbonate treats acidosis but is not the antidote.
9. During a nephrectomy, the renal artery and renal vein must be identified and ligated. Which
vessel is ligated first to prevent engorgement of the kidney?
A) Renal vein
B) Renal artery
C) Ureter
D) Adrenal vein
Correct Answer: B) Renal artery
Rationale: The renal artery is ligated first to prevent engorgement of the kidney with blood. If the
vein is ligated first, the kidney becomes congested and swollen, making dissection more difficult
and increasing blood loss.
10. Which of the following is a characteristic of a clean-contaminated surgical wound?
A) No inflammation encountered, respiratory, alimentary, genital, or urinary tract not entered
B) Controlled entry into respiratory, alimentary, genital, or urinary tract without unusual
contamination
C) Gross spillage from the gastrointestinal tract or acute inflammation
D) Penetrating trauma with retained devitalized tissue
Correct Answer: B) Controlled entry into respiratory, alimentary, genital, or urinary tract without
unusual contamination
Rationale: Clean-contaminated wounds involve controlled entry into a hollow viscus
(respiratory, alimentary, genital, or urinary tract) with minimal spillage. Clean wounds do not
enter these tracts. Contaminated wounds have gross spillage or acute inflammation.
11. During an open reduction and internal fixation (ORIF) of a distal radius fracture, which
structure is most at risk from the surgical approach?
A) The median nerve
B) The radial artery
