Free CSFA Exam Flashcards

Correct patient identity, correct surgical site/side, and correct procedure — required by the Universal Protocol to prevent wrong-patient, wrong-site, and wrong-procedure surgery.

The intended usage/purpose of the closure, the tissue type being sutured, and the specific characteristics of the wound (tension, contamination, cosmetic priority) — not habit or availability alone.

From the incision site outward to the periphery in a circular motion; once a sponge reaches the periphery it is discarded rather than returned to the center, keeping the cleanest area at the incision site.

Gentle tissue handling, meticulous hemostasis, strict aseptic technique, accurate anatomic dissection, and tension-free closure — minimizing trauma to preserve blood supply and reduce infection and scarring.

Opposing tension is placed on tissue from two directions to create a taut, visible dissection plane, letting the surgeon separate structures cleanly with less inadvertent injury to surrounding anatomy.

Current flows from the active electrode through the patient's body to a dispersive (grounding) pad and back to the generator; if current finds an unintended alternate path (current diversion), it can burn tissue at a distant contact site.

Bipolar current flows only between the two tips of the forceps through the grasped tissue — no grounding pad or whole-body circuit is needed, so there is no current-diversion risk to surrounding structures.

Over a large, well-vascularized muscle mass close to the surgical site, avoiding bony prominences, scar tissue, and metal implants — poor placement increases burn risk and circuit impedance.

Ligation (tying off the vessel with suture) and applying a mechanical hemostatic clip — both provide lasting occlusion, unlike temporary measures.

Direct digital pressure (for diffuse oozing), vessel loops (encircle without crushing), and a pneumatic tourniquet — a tourniquet's inflation time is capped at about 2 hours to avoid ischemic and nerve injury.

For diffuse oozing from a raw surface where no single discrete bleeding vessel can be clamped or tied — thrombin-soaked Gelfoam adds an enzymatic clotting boost on top of the mechanical scaffold.

Its round body has no cutting edges, so it separates tissue fibers rather than slicing them — ideal for softer, more friable tissue where minimizing trauma matters more than penetrating force.

Both have triangular, sharp-edged bodies for tough tissue like skin; a conventional cutting needle has its cutting edge on the inner curvature (risking suture pull-through), while a reverse-cutting needle places it on the outer curvature, reducing that risk — commonly preferred for skin closure.

Monofilament passes smoothly with minimal tissue drag and fewer surfaces to harbor bacteria, but has more memory/kinking; braided suture handles and knots more securely with higher tensile strength, but its interstices can trap bacteria.

Vicryl (polyglactin 910) or PDS are absorbable and broken down by the body — used for internal layers; nylon or Prolene are non-absorbable and remain permanently or require removal — used for skin closure or mesh reinforcement.

Thinner. More zeros means a smaller diameter suture (5-0 is finer than 2-0) — fine sutures are used for delicate tissue like vessels or skin, thicker sutures for high-tension closures like fascia.

The vertical mattress suture, placed with a far-far bite followed by a near-near bite on the return pass — the added superficial bite rolls the skin edges outward for better apposition and cosmetic healing.

Each loop locks into the prior stitch, adding compressive tension along the wound edge — useful for hemostasis in a bleeding tissue plane, though it can compromise blood supply if pulled too tight.

Primary intention: clean edges approximated and closed immediately (minimal scar). Secondary intention: wound left open to heal by granulation and contraction (used for contaminated wounds). Tertiary (delayed primary) intention: left open briefly to confirm no infection, then surgically closed days later.

Linear staplers fire parallel rows of staples (often with a cutting blade) to divide and seal tissue such as bowel; intraluminal/circular staplers create a circular anastomosis, most commonly for GI reconnections like esophagojejunostomy.

The Bookwalter is a table-mounted, self-retaining system built for deep, sustained abdominal exposure without tiring an assistant's hands; the Army-Navy is a simple handheld retractor suited to small, superficial wounds needing brief retraction.

A Penrose drain is open and passive, wicking fluid by gravity/capillary action from a superficial space; a Jackson-Pratt drain is a closed system using a compressible bulb to create active suction, suited to deeper spaces where measurable output matters.

Before the case begins (baseline), before closing any body cavity, at skin closure, and whenever new items are added to the field or personnel are relieved — accurate counts prevent retained surgical items, a preventable 'never event.'

CO2 is typically insufflated to 12-15 mmHg; the Veress needle is a blind-entry instrument whose spring-loaded blunt inner stylet retracts on contact with the abdominal wall and springs back out once inside the peritoneal cavity, shielding viscera during entry.

The wound is cleaned and prepared — excess blood and debris removed and surrounding skin addressed — so the dressing chosen (dry gauze, negative-pressure therapy, etc.) matches the wound's drainage and healing needs.

Earlier removal (about 5-7 days) is favored in well-vascularized, low-tension areas like the face for cosmetic results, while higher-tension areas like the trunk or extremities are typically left 10-14 days to preserve wound strength and prevent dehiscence.

Ensure the patient's safety and privacy — removing drapes, cords, and instruments from the patient, guarding against fall or self-extubation injury, and maintaining dignity through transfer out of the OR.

State practice acts, facility policy, and direct delegation by the supervising surgeon — a CSFA assists under the surgeon's direction and never independently performs tasks outside that delegated first-assist role.

Oxygen (an enriched or open O2 source), fuel (drapes, alcohol-based prep, hair), and an ignition source (electrocautery, laser); risk is reduced by letting prep solutions fully dry and coordinating cautery activation with the anesthesia provider when supplemental oxygen is in use.

A minimum of 121°C (250°F) for roughly 15-30 minutes, depending on the load — steam displaces air downward within the chamber under gravity alone, without a mechanical vacuum assist.

A pump actively pulls air out of the chamber before steam is injected at a higher 132°C (270°F), giving faster, more reliable penetration into packs and shorter overall cycle times than gravity displacement.

For heat- and moisture-sensitive items — certain endoscopes, plastics, and electronic components — that would be damaged by autoclaving; EtO requires an extended aeration period afterward to clear toxic residue before the item is safe to use.

It verifies adequate air removal in a prevacuum steam sterilizer; it is run once daily in an empty chamber before the first instrument load of the day.

A Class 5 integrating indicator confirms that all critical sterilization parameters — time, temperature, and steam saturation — were met for that specific load; prions resist routine steam sterilization, so contaminated instruments require an extended cycle at 134°C rather than standard parameters.

The cystic duct, the common hepatic duct, and the inferior edge of the liver; safely identifying the cystic artery and duct within this triangle before clamping or cutting is key to avoiding bile duct injury.

Bounded by the inferior epigastric vessels laterally, the rectus sheath edge medially, and the inguinal ligament inferiorly; a direct inguinal hernia pushes through this triangle's floor, medial to the epigastric vessels.

An indirect hernia is congenital, exiting through the deep inguinal ring lateral to the inferior epigastric vessels and following the spermatic cord or round ligament; a direct hernia is an acquired weakness that bulges directly through Hesselbach's triangle, medial to those vessels.

Nerve (femoral nerve), Artery (femoral artery), Vein (femoral vein), Empty space (femoral canal), Lymphatics — the lateral-to-medial order matters for locating structures during femoral vascular or hernia procedures.

It innervates the intrinsic muscles that control vocal cord movement; injury can cause hoarseness or, if bilateral, airway compromise — it runs close to the inferior thyroid artery and the ligament of Berry, both high-risk dissection zones.

It connects the anterior and posterior cerebral circulations through communicating arteries, providing collateral blood flow that can maintain brain perfusion if one contributing vessel becomes occluded.

The four rotator cuff muscles — Supraspinatus, Infraspinatus, Teres minor, Subscapularis — which stabilize the humeral head in the glenoid; recognizing each is essential for shoulder arthroscopy and repair assisting.

Below the arcuate line, the posterior rectus sheath disappears, leaving only transversalis fascia behind the rectus muscle — this thinner posterior support is a recognized area of relative weakness relevant to abdominal wall closure and hernia risk.

Roughly 70-75% arrives via the portal vein (nutrient-rich, lower-oxygen blood from the gut) and about 25-30% via the hepatic artery (oxygen-rich) — this dual supply is why isolated arterial injury alone is less likely to cause total hepatic ischemia.

The celiac trunk supplies foregut derivatives — stomach, spleen, liver, and proximal duodenum; the SMA supplies midgut structures from the distal duodenum through the proximal two-thirds of the transverse colon.

T10 — the esophagus and both vagus nerves pass through this diaphragmatic opening, making it the relevant landmark in hiatal hernia repair and fundoplication.

The femoral head depends on retinacular vessels (branches of the medial/lateral femoral circumflex arteries) that run along the femoral neck; a displaced intracapsular fracture can tear these vessels, while extracapsular fractures spare them because they lie outside the joint capsule.

Staphylococcus aureus is the leading SSI pathogen; MRSA (methicillin-resistant S. aureus) strains resist standard beta-lactam antibiotics, requiring alternative agents such as vancomycin.

Clean, Clean-Contaminated, Contaminated, and Dirty-Infected classifications predict a wound's relative infection risk, guiding decisions on prophylactic antibiotics and whether to close the wound primarily or leave it open.

A life-threatening hypermetabolic reaction to volatile anesthetics or succinylcholine, causing rapid temperature rise, muscle rigidity, and tachycardia; treated immediately with IV dantrolene sodium plus active cooling and discontinuing the triggering agent.

Protamine sulfate reverses heparin by binding and neutralizing it; Vitamin K (phytonadione) reverses warfarin by restoring vitamin K-dependent clotting factor synthesis — the two work through different mechanisms and are not interchangeable.