Free CSFA Practice Test: 50 Questions With Explanations

Correct answer: C. Under the right upper chest, just below the axilla

The roll sits below the dependent axilla so the chest wall, not the axilla, bears weight — that keeps pressure off the brachial plexus and axillary vessels. A puts pressure exactly where it should be relieved. B supports the upper arm but does nothing for the dependent side. D describes the kidney rest/flexion point, not the axillary roll.

Source: ASA, Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies — Summary of recommendations, PDF p.6; protective padding and positioning

Correct answer: A. Left lateral thigh over clean, dry, intact skin and well-perfused muscle

Place the pad on a large, well-perfused muscle mass near the site, away from bony prominences and away from metal implants. B places the pad directly over the prosthesis; an implant does not automatically exclude every site on that limb. C and D are bony prominences with little muscle.

Source: CONMED, Dispersive Electrode Placement — p.1, Placement Site

Correct answer: D. Hold the incision until the discrepancy is resolved

Universal Protocol requires discrepancies found during verification to be addressed before the procedure starts. A, B, and C all start surgery with an unresolved conflict about the site — the exact error the time-out exists to stop.

Source: The Joint Commission, Universal Protocol — Universal Protocol, preprocedure verification and time-out, PDF pp.12–14; The Joint Commission, 2026 hospital-goals transition webinar — PDF p.5, Universal Protocol transition statement

Correct answer: B. Poole suction tube

A Poole suction is built to remove large amounts of fluid and is used inside the abdomen. A Frazier tip (A) is a fine, angled tip used mainly in ENT and neurosurgery, so it would clear a big pool slowly. A Yankauer (C) is used mainly for surface suction. A bulb syringe (D) is not designed for continuous large-volume suction.

Source: American College of Surgeons, Common Surgical Instruments — PDF p.2, graspers/clamps; p.3, suction tubes

Correct answer: D. Pull the opposite tissue away from the surgeon's traction

Traction and countertraction in opposite directions put the plane under tension to expose the plane. A moves both sides together, so the plane doesn't open. B removes the tension the dissection depends on. C keeps the field dry but doesn't open anything.

Source: University of Iowa, Thyroidectomy and Thyroid Lobectomy — Operative steps, especially step 11; relevant anatomy

Correct answer: A. Under direct laparoscopic view, after locating and avoiding the inferior epigastric vessels

The inferior epigastric vessels run deep to the rectus muscle, and secondary trocars go in under direct vision after the vessels are identified. B passes blind through the vessels' path. C aims toward the bladder rather than identifying a safe lower-abdominal entry. D gives up the view needed to identify underlying structures.

Source: Vanderbilt Global Surgical Atlas, Trocar Positioning and Placement — PDF p.8, lower abdominal secondary-port placement

Correct answer: C. Confirm the decompression tube is removed and the calibration bougie is clear of the stapler jaws

Confirm with anesthesia that the separate decompression tube has been removed, and confirm that the calibration bougie is not caught in the stapler jaws. A calibration tube intentionally used to size the sleeve is not the same as a tube left in the staple line. A changes position without checking tube clearance. B releases the working space without removing a tube from the staple line. D advances a separate tube into the operative field rather than confirming clearance.

Source: Sharma et al., Misadventure during laparoscopic sleeve gastrectomy — Why did it happen? / How to prevent it?; SAGES, Laparoscopic Sleeve Gastrectomy: What Is the Ideal Bougie Size? — Background: calibration bougie/orogastric tube before gastric resection

Correct answer: B. Vessel loop

Vessel loops are synthetic cords used to identify, retract, and occlude vessels, nerves, and tendons. A Babcock grasps tubular structures like bowel; Allis and Kocher clamps have teeth that can injure vessels.

Source: NIH AccessGUDID, Richard-Allan Vessel Loop — GMDN definition, code 61916; American College of Surgeons, Common Surgical Instruments — PDF p.2, graspers/clamps; p.3, suction tubes

Correct answer: D. Severe peripheral arterial disease in that leg

Compromised circulation, such as peripheral artery disease, is a listed contraindication to tourniquet use. D identifies compromised arterial supply in the limb being considered. Controlled hypertension, a remote appendectomy, and a healed wrist fracture do not identify that limb-specific circulation problem.

Source: AORN, Guideline Update: Pneumatic Tourniquet Safety — Contraindications and assessment

Correct answer: C. Recount, tell the surgeon, and search before closing

Count discrepancies are handled by recounting, notifying the surgeon, and searching the patient and room; imaging follows if the item still isn't found. A, B, and D all close over a possible retained item. (Facility policy can handle a life-threatening emergency differently.)

Source: ACS, Prevention of Unintentionally Retained Surgical Items After Surgery — Recommendations: counts, discrepancies, wound exploration and imaging

Correct answer: B. A suture ligature (stick tie)

A suture ligature is anchored by passing the needle through the tissue before tying, so it's used on deep structures and large vessels where a tie could slip. A can slip off a large pedicle. C and D aren't reliable for a large vascular pedicle.

Source: Ethicon, Wound Closure Manual — Printed pp.19, 22, 25–26, 49–51 (PDF pp.24, 27, 30–31, 54–56)

Correct answer: A. Only two structures are seen entering the gallbladder

The critical view requires a cleared hepatocystic triangle, the lower third of the gallbladder off the liver bed, and only two structures (cystic duct and artery) entering the gallbladder. B isn't required. C goes beyond the lower third. D comes after the view.

Source: SAGES, Safe Cholecystectomy Multi-Society Practice Guideline — Question 1, critical view of safety; ACS, Critical View of Safety Minimizes Risk of Bile Duct Injury — Three criteria for the critical view

Correct answer: D. Remove it once hemostasis is achieved

SURGICEL labeling says to remove it after hemostasis when it's used near bony foramina, areas of bony confine, the spinal cord, or the optic nerve, because it can swell and press on neural structures. A and B leave it in the danger zone. C seals it in.

Source: SURGICEL, Essential Product Information — PDF pp.1–2, warnings/contraindications

Correct answer: B. Inject slowly and in increments, aspirating frequently

Incremental injection with frequent aspiration is the recommended approach. C is a trap: a negative aspiration does not rule out intravascular placement. A raises toxicity risk. D does not address accidental intravascular injection.

Source: ASRA, Practice Advisory on Local Anesthetic Systemic Toxicity — Table 2, PDF p.5 / printed p.156; Xylocaine prescribing information, DailyMed — Maximum Recommended Dosages; concentration; precautions on aspiration

Correct answer: A. Reverse cutting

Reverse cutting needles are commonly used for skin. Taper points are for soft, easily penetrated tissue; blunt points are for friable tissue like liver; spatula needles are for ophthalmic work.

Source: Ethicon, Wound Closure Manual — Printed pp.19, 22, 25–26, 49–51 (PDF pp.24, 27, 30–31, 54–56)

Correct answer: C. Monofilament

A monofilament strand has no interstices to harbor bacteria, which matters in a contaminated field. A braided strand (A) has spaces that can hold organisms. B describes visibility rather than strand construction. D describes absorption speed, not whether the strand is braided. Monofilament construction does not make a suture infection-proof or settle the entire closure choice.

Source: Ethicon, Wound Closure Manual — Printed pp.19, 22, 25–26, 49–51 (PDF pp.24, 27, 30–31, 54–56)

Correct answer: D. A surgeon's knot

A surgeon's knot doubles the wrap on the first throw, adding friction so it helps hold while the second throw goes down. A is an unstable knot. B reduces knot security. C doesn't change slipping and adds a sharps risk.

Source: Ethicon, Wound Closure Manual — Printed pp.19, 22, 25–26, 49–51 (PDF pp.24, 27, 30–31, 54–56)

Correct answer: B. Tell the surgeon so the glove gets changed

Gloves are changed when a perforation is noted. A, C, and D all leave a known breach in the sterile barrier.

Source: AORN, Guideline in Focus: Sterile Technique in the OR — Glove monitoring and replacement; WHO, Global Guidelines for SSI Prevention, glove evidence appendix — p.1, glove perforation/replacement context

Correct answer: C. Fresh, without fixative, promptly

Frozen section needs fresh, unfixed tissue and is a STAT procedure. A fixes the tissue. B delays it. D isn't how frozen sections are prepared.

Source: UC Davis Pathology, Specimen Collection — Intraoperative consultation / frozen section

Correct answer: A. Squeeze the bulb, then close the stopper

Closing the stopper while the bulb is squeezed creates negative pressure. B is a different system. C and D leave no suction.

Source: Cleveland Clinic, Jackson-Pratt Drain — How the drain works; emptying/compressing the bulb

Correct answer: D. An anti-skid foam pad and straps, placed according to the positioning-system instructions

An anti-skid pad and straps, placed according to the positioning-system instructions, are used to prevent sliding. Shoulder braces (A) can cause compression or stretch injury to the brachial plexus. B doesn't stop the torso from sliding. C is unsafe.

Source: ASA, Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies — Summary of recommendations, PDF p.6; protective padding and positioning; Xodus Medical, Pink Pad Instructions for Use — pp.1–2, preparation/use and precautions

Correct answer: B. Sites 10 mm or larger

Fascial closure for ports 10 mm or larger is the general practice; smaller sites are closed selectively. A treats all 5-mm sites as requiring routine closure. C excludes nonumbilical large ports. D omits closure altogether. Port location, enlargement and patient factors can also affect the decision.

Source: ACS Case Reviews, Port-site Hernia — Discussion and conclusion

Correct answer: A. A neutral zone for setting down and picking up sharps

The hands-free or neutral-zone technique is recommended as an added safety measure to reduce hand-to-hand transfer of sharps. B and C keep sharps moving hand to hand. D is a classic cause of needlesticks.

Source: ACS, Statement on Needlestick and Sharps Safety — Hands-free technique/neutral zone recommendations

Correct answer: B. 730 mL

1,450 − 900 = 550 mL from suction; add 180 mL from sponges (1 g ≈ 1 mL) = 730 mL. A forgets the sponges. C forgets to subtract irrigation. D adds irrigation instead of subtracting.

Source: AWHONN, Quantification of Blood Loss Practice Brief — Tables 1–2, PDF p.2 / printed p.159

Correct answer: B. To orient the valves with the intended arterial flow through the graft

Reversing the vein aligns its one-way valves with the intended flow through the graft toward the coronary target. It does not destroy or deactivate the valves. A is not the reason: reversing a vein also reverses its native caliber taper rather than guaranteeing an aortic size match. C and D are not changed by reversing the same segment.

Source: Portugal et al., Distribution of saphenous vein valves and its practical importance — Introduction, Results and Discussion: unidirectional valves, caliber and reversed grafts; Improvement in forward coronary blood flow by using a reversed saphenous vein — Abstract: functional valves in reversed grafts

Correct answer: D. A wound with an exposed anastomosis

The FDA's non-powered NPWT guidance lists exposed anastomotic sites as a contraindication. A, B, and C do not state that contraindication, but being absent from this list does not make a wound an appropriate indication: the particular device's labeling still controls. This guidance is not a universal contraindication list for every powered or non-powered system.

Source: FDA, Non-powered Suction Apparatus Intended for NPWT: Special Controls Guidance — Sections 3 (scope) and 11 (labeling: contraindications and warnings)

Correct answer: A. Cool or room temperature

Splinting material sets with an exothermic reaction that can burn skin; cool or room-temperature water is recommended. B raises burn risk. C and D aren't the recommendation.

Source: Royal Children’s Hospital Melbourne, Cast Care — Appendix 1, plaster backslab application: water temperature; Halanski et al., Thermal Injury With Contemporary Cast-Application Techniques — Abstract: Methods, Results and Conclusions

Correct answer: C. Stop, confirm the balloon is fully deflated, and get help if resistance persists

Stop rather than force the catheter. Confirm that the balloon is fully deflated and seek help if resistance persists; incomplete deflation is one possible cause, not a diagnosis established by resistance alone. A and B both force the catheter against a possible obstruction or inflated balloon. D does not resolve or assess that problem.

Source: Memorial Sloan Kettering, How To Remove Your Urinary (Foley) Catheter — Video transcript: balloon deflation and resistance during withdrawal

Correct answer: D. Coordinate with anesthesia to reduce oxygen safely, then wait

Near the face, the delivered oxygen is reduced to the minimum needed to avoid hypoxia, or stopped, and the team waits a few minutes before using an ignition source. A enriches the oxygen. B traps oxygen under the drapes. C skips the oxygen step entirely.

Source: ASA, Prevention and Management of Operating Room Fires — PDF p.7, open oxygen delivery near an ignition source

Correct answer: A. Notify the surgeon before proceeding

The clinician performing the procedure bears primary responsibility for informed consent, and a patient who doesn't understand her surgery needs that clinician before anything goes forward. B does not replace the operating clinician's consent discussion when the patient remains uncertain; the team can still reinforce explanations within its role. C and D ignore a sign that consent may not be valid.

Source: ACS, Principles Underlying Surgeon Responsibility Toward the Patient — Principle 5, informed consent

Correct answer: B. Bipolar electrosurgery

In bipolar, current returns through the second tip of the instrument, confining it to the target tissue and reducing interference with implanted devices. A routes current near the device. C and D choose monopolar techniques rather than the preferred bipolar option; the highest setting is not the recommended way to minimize interference.

Source: ASA, Perioperative Management of Patients With Cardiac Implantable Electronic Devices — PDF p.8 / printed p.232, electrosurgery

Correct answer: C. A hybrid: metal cannula, plastic anchor

Hybrid trocars keep stray capacitive energy from dissipating through the abdominal wall. An all-metal system (A) lets it dissipate. B is a protective monitoring approach. D checks for insulation failure, a different mechanism; capacitive coupling can occur even when insulation is intact.

Source: AfPP, Laparoscopic Surgery Standards Collection — Single-page excerpt: electrosurgery/capacitive coupling

Correct answer: D. The hot blade can burn the bowel

The blade and clamp arm can stay hot after activation, so unintended contact with tissue can burn it. A is false. B isn't the hazard. C describes monopolar electrosurgery, not an ultrasonic device.

Source: Stryker, Reprocessed HARMONIC FOCUS Shears Instructions for Use — PDF p.5, hot blade/clamp-arm warnings

Correct answer: B. To expand it and let fluid drain

Meshing expands the surface area and lets fluid drain, reducing hematoma and seroma under the graft. A and C aren't functions of meshing. D is not a guaranteed benefit: meshing can leave a visible mesh pattern.

Source: Zimmer, Meshgraft Skin Graft Mesher brochure — PDF p.2, expansion and drainage description; Humeca, Mesher and V-carriers technical description — Drainage and mesh-pattern description

Correct answer: A. Irrigate at the drill site to cool it

Friction from drilling heats bone, and excessive heat can cause thermal injury. Continuous cooling irrigation helps. B is false. C is a hemostatic agent, not a coolant. D adds heat.

Source: AO Surgery Reference, Ring Fixation — Schanz screw insertion: slow drilling and irrigation

Correct answer: D. Recurrent laryngeal nerve

The recurrent laryngeal nerve ascends in the tracheoesophageal groove, closely related to the inferior thyroid artery; injury presents with hoarseness or voice change. A is outside the field. B causes diaphragm problems. C affects the tongue.

Source: University of Iowa, Thyroidectomy and Thyroid Lobectomy — Operative steps, especially step 11; relevant anatomy

Correct answer: C. Indirect inguinal

Indirect hernias pass through the deep ring lateral to the inferior epigastric vessels; direct hernias are medial, in Hesselbach's triangle. Femoral hernias are below the inguinal ligament. Spigelian hernias are at the semilunar line.

Source: University of Washington, Inguinal Hernia Teaching Case — Anatomy answers: direct versus indirect hernia

Correct answer: B. Common peroneal (fibular)

The common peroneal nerve wraps around the fibular head and can be compressed there by a leg support in lithotomy; deep fibular involvement causes foot drop. Femoral injury weakens knee extension. Obturator injury weakens adduction. Tibial injury affects plantar flexion.

Source: ASA, Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies — Summary of recommendations, PDF p.6; protective padding and positioning

Correct answer: A. The femoral head's blood supply is likely disrupted

The medial femoral circumflex artery supplies the femoral head through retinacular vessels. Displaced intracapsular fractures can disrupt them and carry a high risk of avascular necrosis, so older adults usually get a hemiarthroplasty or total hip arthroplasty. B does not identify the fracture's vascular problem. C adds a shaft fracture that the stem does not describe. D is false: arthroplasty requires anesthesia.

Source: AO Surgery Reference, Femoral Neck Fracture Complications — Section 3, vascular supply and avascular necrosis; AAOS, Management of Hip Fractures in Older Adults — p.30, unstable femoral neck fractures

Correct answer: C. Its blood flows retrograde to the proximal pole

Dorsal carpal branches of the radial artery enter at the dorsal ridge and reach the proximal pole by retrograde flow, so a proximal fracture can cut that pole off. A is wrong because the scaphoid does have a blood supply. B names the wrong supplying artery. D mistakes the bony proximal pole for cartilage alone.

Source: AO Surgery Reference, Scaphoid Waist Fracture Definition — Vascularity of the scaphoid

Correct answer: D. Ileocolic artery

The ileocolic artery is a branch of the superior mesenteric artery and its pedicle is divided in an oncologic right hemicolectomy. Management of right-colic and middle-colic branches depends on the vascular anatomy and resection extent; middle-colic involvement is not limited to extended resections. A, B, and C supply the left colon and rectum.

Source: Vanderbilt Global Surgical Atlas, Laparoscopic Right Colectomy — PDF p.1, vascular map and operative discussion

Correct answer: A. Hepatic vein or vena cava bleeding

The Pringle maneuver clamps the hepatoduodenal ligament (hepatic artery proper, portal vein, common bile duct) to stop blood flowing into the liver. With inflow occlusion confirmed, persistent posterior bleeding points to the hepatic veins or the inferior vena cava, which the clamp doesn't control. B and C are exactly the inflow vessels the clamp occludes. D is a dangerous assumption.

Source: WSES, Liver Trauma: 2020 Guidelines — Operative management: bleeding despite Pringle maneuver

Correct answer: B. The first node draining the tumor

The sentinel node is the first node to which cancer is most likely to spread from the tumor. There can be more than one, and it's found with a radioactive tracer, blue dye, or both. A describes size, not drainage order. C describes depth, not drainage order. D is wrong because a sentinel node can be free of cancer.

Source: National Cancer Institute, Sentinel Lymph Node Biopsy — What is a sentinel lymph node? / How is it performed?

Correct answer: D. Left anterior descending; from the subclavian artery

The internal mammary artery branches off the subclavian artery, and the LIMA is typically grafted to the LAD. A and B give the wrong usual origin and target pairing. C gives the usual target but incorrectly names the axillary artery as the origin.

Source: Manipal research record, A Rare Variant of the Internal Thoracic (Mammary) Artery — Abstract: usual origin and observed variant; ACC/AHA/SCAI, Coronary Artery Revascularization Guideline Slide Set — Slide 101, bypass conduits

Correct answer: C. Ureter

The ureter runs inferior to the uterine artery near the cervix ("water under the bridge") and can be injured when uterine vessels are ligated. A, B, and D aren't in that relationship.

Source: Texas Tech, Pelvic Viscera Anatomy Lecture — Uterine artery and ureter relationship

Correct answer: A. Minimize direct tumor handling and coordinate blood-pressure control with anesthesia

Minimizing tumor manipulation and coordinating with anesthesia help limit catecholamine-related instability. SAGES does not establish early adrenal vein ligation as necessary to prevent instability during laparoscopic adrenalectomy. B continues the provoking manipulation. C can provoke catecholamine release. D is dangerous: a beta-blocker isn't started before alpha-blockade.

Source: SAGES, Minimally Invasive Treatment of Adrenal Pathology — Timing of adrenal vein ligation; pheochromocytoma perioperative recommendations

Correct answer: B. The narrow aganglionic segment

The pull-through removes the part of the bowel missing nerve cells, which is the narrowed distal segment, and connects healthy bowel to the anus. Removing only dilated bowel (A) would leave the distal aganglionic obstruction; appearance alone does not establish which bowel has normal nerve cells. C and D are wrong.

Source: NIDDK, Treatment for Hirschsprung Disease — Pull-through surgery

Correct answer: B. Alcohol rub doesn't kill C. difficile spores

C. difficile forms spores that alcohol hand rub doesn't effectively kill or remove; soap-and-water washing physically removes them. A is false; it's a bacterium. C overstates it, since washing removes spores rather than kills them. D is false. During an outbreak, CDC encourages soap-and-water washing after care of affected patients in addition to appropriate gloves and gown; it does not recommend restricting access to alcohol-based hand rub. Washing does not guarantee removal of every spore.

Source: CDC, Clinical Safety: Hand Hygiene — C. difficile section and outbreak recommendations

Correct answer: B. 27 mL

4.5 mg/kg × 60 kg = 270 mg (under the 300 mg cap); 1% = 10 mg/mL, so 27 mL. A is a decimal error. C uses the 300 mg cap. D uses the 7 mg/kg dose that applies only with epinephrine. This is a label-ceiling calculation, not a recommended dose for an individual patient.

Source: Xylocaine prescribing information, DailyMed — Maximum Recommended Dosages; concentration; precautions on aspiration

Correct answer: C. Stop triggers; give dantrolene

When malignant hyperthermia is suspected, stop the triggering agents, call for help, hyperventilate with 100% oxygen, and give dantrolene. Sevoflurane and succinylcholine are triggering agents. A and B add triggers. D treats a symptom while the trigger continues.

Source: MHAUS, Managing a Crisis — Emergency steps 1–3