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Surgery Internal Medicine Exam Guide 2025/2026: Clinical Q&A with Rationales for Medical Students, PA & Nursing Programs

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This Surgery Internal Medicine Exam Guide (2025/2026 edition) is your go-to resource for mastering surgical and internal medicine concepts, whether you’re a medical student, PA, or nursing student preparing for clinicals, rotations, or exams. It includes over 200+ expertly structured Q&A items covering everything from operating room protocol to surgical complications, anatomy-based procedures, and instrument identification.

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Surgery IM questions and answers 2025/2026
latest update
what to do when helping out pre and post op - answer-See the patient before hand with/without your
provider

-See the patient after surgery - WITH your provider

-Introduce yourself, provide your name to circulating RN

-Assist with patient transport, removing bed from the room, returning bed to the room

-Assist with application of SCDs

-Assist with shaving/positioning/prepping at RN/MD/PA discretion

-Ask RN to show you how to place Foley catheter

-Pull your own gloves, ask if a gown is available

-Ask anesthesia if you can watch intubation



what NOT to do when helping pre and post op** - answer-DO NOT TOUCH ANYTHING BLUE

-Do not stand in the way

-Do not touch a prepped patient



what to do during surgery - answer-Once sterile, stay still until directed where to go

-Ask which side of the bed you should be on

(Typically this is opposite of the scrub RN)

-Place hands down on patient where they can be seen, but are out of the way

-Hold retractors when asked

-Ask if you can be taught to close (time willing)

-Answer questions!

(If you don't know say "I'm not sure, but I will look it up")



what NOT to do during surgery - answer-Ask "what is that structure"

(Should be phrased "May I ask a question? - what is that structure?")

-Do not touch the Mayo Stand

,(Neutral Zone)

-Do not grab instruments

(Resist the urge to help)

-Do not daze off

-Do not be scared to say you aren't sterile any longer



Staff in OR room - answer-Physician

-Anesthesia

-First assist (PA-C, RNFA)

-Circulator nurse

-Scrub tech, scrub RN



Positioning in the OR - answer-Supine

-Prone

-Right or Left Lateral Decubitus

-Lithotomy

-Jackknife

-Trendelenburg

-Reverse Trendelenburg



Hand washing - answerScrubbing/sterile technique is the single most important thing that can be done
to prevent the spread of infection in the OR



Hand washing purpose** - answer-To remove dirt, debris, transient microorganisms from hands, nails,
forearms, elbows

-Minimize colonized microbial counts

-Inhibit rapid regrowth of microorganisms



Three scrub styles - answer-First Scrub Stroke Style

,-First Scrub Timed Style

-Secondary Scrub



How long is timed scrub? - answer5 minutes



Stroke scrub - answer10 strokes per "side"



Secondary scrub - answer-If you have already done a primary scrub for the day, subsequent scrubs can
be done utilizing an alcohol based scrub liquid

-If you use the rest room, eat, or become grossly contaminated(dig in dirt, pop a zit etc), you must
repeat a primary scrub.

-Chlorhexidine vs. Alcohol



Betadine - answer-Stains brown color

-Desiccates skin

-Small chance of iodine/betadine related reaction

-For use on open wounds

-Start at center and circumferentially prep outward



Betadine scrub - answer-Mixed with hydrogen peroxide

-For use on dirty open wounds



Chlorhexadine AKA Hibiclens - answer-Stains orange color

-Small chance of local skin reaction

-For use on clean surfaces only

-Used if betadine or iodine allergy

-Scrub the intended incision site back and forth for 1 minute, then paint surrounding skin in
circumferential fashion

, The surgical field - answer-4 towels typically used to create a sterile zone around the patient's prepped
surgical site

(Secured with towel clips)

-Blue drape is then placed over towels to form the surgical field

-Mayo Stand is wheeled up by the scrub

-Neutral zone is established

-Surgical Pause/Time Out Occurs



What part of YOU is sterile? - answer-Hands

-Forearms up to elbows

-Nipples to waist



Is your back sterile? - answer-NO

-When changing positions at the table exchange back to back (roll technique) or step away and around



What part of the OR TABLE is sterile? - answer-Edge of the bed up

-Anything blue

-Light handles/covers



Cautery, Chemical, Cryoablation and Curettage - answer-Destructive methods of surgery require clean
technique only

-PPE (personal protective equipment) is important with destructive methods

-Destructive methods are often reserved for low-invasive cancerous lesions, precancerous lesions,
elderly patients, difficult to operate anatomy, coagulopathic patients or benign lesions.

(Consider biopsy first!)



Cryotherapy - Liquid Nitrogen - answer-When applied directly on the skin, liquid nitrogen will rapidly
evaporate (boiling heat transfer). The heat in the skin is quickly transferred to the liquid nitrogen,
causing skin to freeze (controlled frost bite)

-Freeze region with sustained blast of liquid nitrogen for 30 second duration. Allow to thaw. Repeat for
total of three freezes.
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