Chapter 14 Exam: General Surgery

Front 1

“Bowel technique” refers to steps used by the surgical team to prevent postoperative:

a) adhesion formation

b) hemorrhage

c) incisional hernia formation

d) surgical site infection

Back 1

surgical site infection

Front 2

Which suturing technique is often used on the appendiceal stump?

a) interrupted

b) horizontal mattress

c) purse string

d) vertical mattress

Back 2

purse-string

Front 3

Which stage of breast cancer is characterized by evidence of distal metastasis?

a) Stage I

b) Stage II

c) Stage III- b

d) Stage IV

Back 3

Stage IV

Front 4

Surgical removal of the entire breast without any lymph nodes is a(n):

1. Excisional Biopsy
   
2. Simple Mastectomy
3. Segmental Mastectomy
4. Modified Radical Mastectomy

Back 4

Simple Mastectomy

Front 5

Which fascial sheet is attached to the iliac crest, linea alba, and pubis?

1. innominate
2. interparietal
3. Scarpa’s
4. transversalis

Back 5

Scarpa's

Front 6

Which anatomical structure is the largest mass of lymphatic tissue in the body?

1. Axillary sentinel node
2. Palantine tonsils
3. Spleen
4. Thymus

Back 6

Spleen

Front 7

Where is the gallbladder located in relation to the liver?

1. Inferior surface of the left lobe
2. Superior surface of the left lobe
3. Inferior surface of the right lobe
4. Superior surface of the right lobe

Back 7

Inferior surface of the right lobe

Front 8

For which type of hernia repair could a Penrose drain be used as a method of gentle traction of the spermatic cord?

1. laparoscopic Nissen fundoplication
2. McVay inguinal herniorrhaphy
3. Totally extraperitoneal patch (TEP)
4. Ventral/incisional herniorrhaphy
   

Back 8

McVay inguinal herniorrhaphy

Front 9

What is the name of the fibrous and serous capsule that covers the liver?

1. Bowman’s
2. Glisson’s
3. Tenon’s
4. Articular
   

Back 9

Glisson's

Front 10

If a mastectomy is scheduled to follow a breast biopsy and frozen section results indicate carcinoma, what is done?

1. Protect the field until second procedure begins
2. Bring up a Mayo stand with new instruments for the mastectomy.
3. Use same instruments, but be sure to change all gloves first
4. Re-prep, redrape patient; team changes gowns and gloves; and use new instruments.

Back 10

Re-prep, redrape patient; team changes gowns and gloves; and use new instruments.

Front 11

HBV, HCV, and alcohol abuse are precursors to which of the following diseases?

1. cirrhosis
2. cholelithiasis
3. diverticulitis
4. duodenal ulcer
   

Back 11

cirrhosis

Front 12

Great care is taken to identify and preserve the long thoracic and thoracodorsal nerves in which surgical procedure?

1. Laparoscopic Cholecystectomy
2. Laparoscopic Nissen Fundoplication
3. Modified Radical Mastectomy
   
4. Subtotal Gastrectomy

Back 12

Modified Radical Mastectomy

Front 13

Bifurcated drains and fluffy pressure dressings are used following mastectomy primarily to:

1. Make the change in chest contour less obvious
2. Prevent formation of hematoma and seroma
3. Provide comfort for the patient when she moves
4. Keep adhesions from forming between the skin and muscle
   

Back 13

Prevent formation of hematoma and seroma

Front 14

Surgical skin preps for breast procedures for carcinoma should be performed vigorously and thoroughly to prevent postoperative surgical site infections in immunocompromised patients.

True or False

Back 14

False

Front 15

The upper-hand and Thompson retractors are complex self-retaining retractors frequently used in major abdominal procedures

True or False

Back 15

True

Front 16

What is the name for the first lymph node in the axillary chain that is frequently biopsied in conjunction with a breast biopsy, lumpectomy, or mastectomy?

1. attendant 2. gaurdian

3. leader 4. sentinel

Back 16

Sentinel

Front 17

What type of incision is made for excisional biopsy of a centrally located breast mass involving the lactiferous ducts?

1. circumareolar
2. elliptical
3. inframammary
4. paramedian
   

Back 17

Circumareolar

Front 18

Which potentially life-threatening disease or condition can result from untreated thyrotoxicosis?

1. Crohn’s disease
2. Grave’s disease
3. Hashimoto’s disease
4. Thyroid storm
   

Back 18

Thyroid Storm

Front 19

A Maloney bougie dilator is used in which anatomical structure?

1. Common bile duct
2. Esophagus
3. Urethra
4. Cervix

Back 19

Esophagus

Front 20

A typical end-to-end bowel anastomosis is accomplished with which of the following suturing techniques?

1. one-layer, continuous technique for seromuscular approximation with absorbable suture

2. one-layer, interrupted technique for mucosal approximation only with silk suture

3. two-layer, continuous technique for seromuscular approximation with absorbable, interrupted for mucosa with silk suture

4. two-layer, interrupted technique for seromuscular approximation with silk; continuous for mucosa with absorbable suture

Back 20

two-layer, interrupted technique for seromuscular approximation with silk; continuous for mucosa with absorbable suture

Front 21

Which type of surgical procedure is used to release abnormal tissue connections in the abdominal viscera and layers?

1. anastomosis
2. fundoplication
3. herniorrhaphy
4. lysis of adhesions
   

Back 21

lysis of adhesion

Front 22

In a laparoscopic appendectomy, all of the following methods could be used for dissection of the appendix EXCEPT:

1. endoscopic linear stapler
2. ligating loop instrument
3. intraluminal circular stapler
4. intracorporeal suturing instrument
   

Back 22

intraluminal circular stapler

Front 23

During cholangiography, bubbles in the contrast media would likely:

1. cause a pulmonary embolus
2. give the appearance of a stone on x-ray
3. pass undetected through the biliary system
4. rupture the cystic duct from pressure exerted during injection
   

Back 23

Give the appearance of a stone on an X-ray

Front 24

A T-tube or wound drain left in place following laparoscopic cholecystectomy would MOST likely exit through:

1. a left subcostal stab wound
2. the umbilical port site incision
3. one of the 5 mm right port site incisions
4. the subxiphoid 10 mm port site incision
   

Back 24

one of the 5 mm right port site incisions

Front 25

What is the name of a gastric mass of indigestible vegetable fiber and hair that may require surgical excision?

1. bezoar
2. calculus
3. polyp
4. ulcer
   

Back 25

bezoar

Front 26

A vagotomy is a surgical treatment option for:

1. appendicitis
2. ductal carcinoma
3. gastric ulcers
4. pancreatitis
   

Back 26

gastric ulcers

Front 27

Where are the parathyroid glands located in relation to the thyroid?

1. anterior midline
2. posterior midline
3. dorsal, superior and inferior
4. ventral, superior and inferior

Back 27

dorsal, superior and inferior

Front 28

What is another name for an acquired ventral hernia through the linea semilunaris?

1. epigastric
2. femoral
3. inguinal
4. Spigelian
   

Back 28

Spigelian

Front 29

Which of the following is the MOST common permanent colostomy?

1. end
2. loop
3. end-loop
4. sigmoid
   

Back 29

sigmoid

Front 30

What type of hernia protrudes through the transversalis fascia in the area of Hesselbach’s triangle?

1. direct
2. femoral
3. indirect
4. umbilical
   

Back 30

direct

Front 31

The surgeon may request which of the following for irrigation to aid in destroying any residual tumor cells after dissection?

1. heparin
2. hydrogen peroxide
3. normal saline
4. sterile water

Back 31

sterile water

Front 32

What is the incision routinely used for open cholecystectomy?

1. McBurney
2. Pfannensteil
3. left subcostal
4. right subcostal

Back 32

right subcostal

Front 33

What is achieved by insufflation of carbon dioxide into the abdominal cavity?

1. pneumocephalus
2. pneumocytosis
3. pneumoperitoneum
4. pneumothorax

Back 33

pneumoperitoneum

Front 34

Pancreaticodudenectomy is also known as which of the following procedures?

1. Bassini-Shouldice
2. McVay
3. Nissen
4. Whipple

Back 34

Whipple

Front 35

What is another way of saying "cephalad to caudal"?

1. back to front
2. front to back
3. head to tail
4. inside to outside

Back 35

head to tail

Front 36

Which of the following is NOT a region of the pancreas?

1. Body
2. Capsule
3. head
4. tail

Back 36

Capsule

Front 37

Which type of viewing instrument would be used for surgical treatment of hemorroids?

1. anoscope
2. colonoscope
3. laparoscope
4. sigmoidoscope

Back 37

anoscope

Front 38

Conversion from a laparoscopic procedure to an open procedure is always a possibility that the surgical technologist should be prepared for.

True or False

Back 38

True

Front 39

The Triangle of Calot is an anatomical space bounded by stuctures in which surgical procedure?

1. appendectomy
2. cholecystectomy
3. herniorrhaphy
4. thyroidectomy

Back 39

cholecystectomy

Front 40

What is the reason for injecting saline through the cholangiogram catheter prior to the contrast media?

1. The saline will dilute the contrast dye
   
2. The saline will dilate the common duct
3. The saline will push any stones in the cystic duct through
4. The saline will test the patency of the cystic duct prior to injecting the contrast

Back 40

The saline will test the patency of the cystic duct prior to injecting the contrast

Front 41

The Hasson technique for establishing pneumoperitoneum requires the use of a Verres needle.

True or False

Back 41

True

Front 42

Dilation of the submucosal and subcutaneous venous plexus that lines the anal canal is called?

1. anal fissure
2. fistulo-in-ano
3. hemorrhoid
4. pilonidal cyst

Back 42

hemorroid

Front 43

The skin incision for a thyroidectomy will follow which anatomical lines?

1. Anterior axillary
2. Langer's
3. midclavicular
4. semilunar

Back 43

Langer's

Front 44

A surgical technologist may "run" or operate the laparoscopic camera durimg minimally invasive procedures to free up the hands of the surgeon and surgical first assistant.

True or False

Back 44

True

Front 45

A gastrostomy can be created by all of the following methods EXCEPT:

1. open
2. endovascular
3. laparoscopic
4. percutaneous

Back 45

endovascular

Front 46

Which incision is traditionally used for open appendectomy?

1. McBurney
2. median vertical
3. paramedian
4. Pfannansteil

Back 46

McBurney

Front 47

End-to-end, end-to-side, side-to-side, and Roux-en-Y are techniques for:

1. bowel anastomosis
2. mastectomy would closure
3. mesh placement in henorrhaphy
4. surgical skin prep

Back 47

bowel anastomosis

Front 48

Another name for tyroid tenaculum is:

1. Braun
2. Jacobs
3. Lahey
4. Schroeder

Back 48

Lahey

Front 49

What is the name for the type of hernis in which both direct and indirect defects are present?

1. diaphragmatic
2. epigastric
3. incisional
4. pantaloon

Back 49

pantaloon

Front 50

Which type of intestinal obstruction involves a telescoping of a portion of the intestine into another portion?

1. adhesive stricture
2. fecal impaction
3. intussusception
4. volvulus

Back 50

intussusception

Front 51

What does TEP stand for in general surgery?

1. totally endoscopic pancreatectomy
2. totally endoscopic pyloroplasty
3. totally extraperitoneal patch
4. totally extraperitoneal prolapse

Back 51

totally extraperitoneal patch

Front 52

Which type of hernia occurs below the abdominocrural crease and more frequently in females?

1. femoral
2. epigastric
3. direct inguinal
4. indirect inguinal

Back 52

femoral

Front 53

What term describes a benign condition of breast enlargement in men?

1. gynecomastia
2. hypoplasia
3. macromastia
4. micromastia

Back 53

gynecomastia

Front 54

A whipple procedure is done for treatment of a tumor in which abdominal organ?

1. liver
2. pancreas
3. rectum
4. spleen

Back 54

pancreas

Front 55

In which of the following abdominal incisions would the linea alba be opened down to the peritoneum?

1. Kocher subcostal
2. McBurney
3. median vertical
4. transverse

Back 55

median vertical

Front 56

What do the parathyroid glands regulate in the body?

1. Blood calcium concentration
2. growth hormones
3. immune response
4. insulin release

Back 56

Blood calium concentration

Front 57

For which surgical procedure would the Buie pile forceps be used?

1. appendectomy
2. breast biopsy
3. cholecystectomy
4. hemorrhoidectomy

Back 57

hemorrhoidectomy

Front 58

An intestinal stoma is created at a point below the costal margin, above the belt line, and at the lateral edge of which muscle?

1. external oblique
2. internal oblique
3. rectus abdominus
4. transversus abdominus

Back 58

rectus abdominus

Front 59

A needle-localization procedure may be performed in radiology for assistance in locating discrete masses in the:

1. breast
2. groin
3. liver
4. pancreas

Back 59

breast

Front 60

Which of the following are endocrine-secreting glands of the pancreas that make up only 1% of the organ?

1. acini
2. ampulla of Vater
3. islets of Langerhans
4. uncinate process

Back 60

islets of Langerhans

Front 61

Due to the vascular and friable nature of the liver, a surgeon may choose to use suture on which type of needle?

1. taper
2. blunt
3. spatula
4. cutting

Back 61

blunt

Front 62

What term is used for surgical opening of the abdominal or peritoneal cavity?

1. gastrectomy
2. gastrostomy
3. laparoscopy
4. laparotomy

Back 62

laparotomy

Front 63

Doyen, Kocher, Dennis, and Allen are names of which type of instrument?

1. abdominal retractors
2. intestinal clamps
3. laparoscopic graspers
4. tissue scissors

Back 63

intestinal clamps

Front 64

What type of hernia results from a failure of the deep internal ring to close during fetal development and allows intestinal protrusion into the scrotum?

1. direct
2. femoral
3. indirect
4. umbilical

Back 64

indirect

Front 65

The hepatic and splenic flexures are located proximally and distally in which part of the large intestine?

1. ascending
2. descending
3. sigmoid
4. transverse

Back 65

transverse

Front 66

Matching:

1. Difficulty swallowing or feeling of food sticking in the esophagus
2. Discomfort or tenderness that occurs with sudden release of pressure; a clinical sign of appendicitis
3. Type of hernia in which tissues are caught within a fascial defect; may become strangulated if not reduced
4. Broad sheet of fibrous tissue or expanded tendon that holds muscles together or connects muscle to bone
5. Being on or affecting the same side of the body the same side of the body
6. Antrectomy: removal of distal stomach and pylorus with anastomosis to duodenum; preferred approach for treatment of ulcer or neoplasm
7. Double-layer membrane of peritoneum attached to back wall of abdominal cavity that supports the small instestine
8. Inflammatory bowel disease that causes erosions in the lining of the large intestine
9. Yellowing of the skin and eyes due to buildup of bilirubin; visible sign of certain cancers and diseases of the organs of the biliary system
10. Noninvasive electro-generated shock waves used to break up calculi in the urinary or biliary system

Back 66

1. Dysphagia
2. rebound pain
3. strangulated
4. aponeurosis
5. ipsilateral
6. Billroth 1
7. Mesentary
8. Ulcerative Colitis
9. Jaundice
10. Lithotripsy

Hint 66

Answer choices

• lithotripsy
• mesentery
• Billroth 1
• dysphagia
• rebound pain
• aponeurosis
• strangulated
• ulcerative colitis
• jaundice
• ipsilateral

Front 67

Which surgical position is used exclusively for anorectal surgical procedures?

1. Kraske
2. supine
3. Trendelenburg
4. reverse Trendelenburg

Back 67

Kraske

Front 68

Which handheld retractor is specially designed for use in open cholecystectomy to elevate the liver?

1. Army-Navy (USA)
   
2. Green
3. Harrington
4. Parker

Back 68

Harrington

Front 69

Tetany is a serious potential post-op compliction of which type of surgical intervention?

1. appendectomy
2. colon resection
3. gastrectomy
4. thyroidectomy

Back 69

thyroidectomy

Front 70

Which statement is CORRECT regarding polyps and diverticula in the colon?

1. Both protrude inward into the lumen of the intestine
2. Both protrude outward from the lumen of the intestine
3. Polyps protrude inward, and diverticula protrude outward from the intestine
4. Diverticula protrude inward, and polyps protrude outward from the intestine

Back 70

Polyps protrude inward, and diverticula protrude outward from the intestine

Front 71

Which held hand retractors are frequently used to retract tissues during tyroidectomy?

1. Green
2. Harrington
3. malleable
4. Weinburg

Back 71

Green