SSTEP Clinical Knowledge Exam (3 Month Follow-Up)

Question 1 of 60

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1. Which of the following statements regarding hand hygiene is NOT correct?

Select one of the following:

Health care workers (HCWs) should clean their hands with an antiseptic-containing agent before and after each contact with a patient
The use of soap and water for hand washing is required when hands are visibly soiled with blood or bodily fluids
Alcohol-based hand rubs are inferior to antimicrobial soaps for hand decontamination
Vancomycin-resistant enterococci are frequently isolated from the hands of HCWs

Explanation

Question 2 of 60

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Question 3 of 60

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2. Out of the following four indicators, the best clinical sign of successful fluid resuscitation and end-organ perfusion in a patient with hemorrhagic shock is:

Select one of the following:

An increase in blood pressure
An increase in urine output
An increase in arterial oxygenation
A decrease in tachycardia

Explanation

Question 4 of 60

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Explanation

Question 5 of 60

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3. Technical errors during surgical procedures are MOST likely to occur:

Select one of the following:

During routine procedures in complex patients
In high-complexity operations
Due to surgical inexperience
Due to inadequate resident supervision

Explanation

Question 6 of 60

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Explanation

Question 7 of 60

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4. In the AD DAVID system for writing post-op orders, the “I” is an abbreviation for 3 things. Of the following, what does the “I” NOT stand for?

Select one of the following:

Investigations
IV
“Ins and outs” (intake and output)
Irrigation

Explanation

Question 8 of 60

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Explanation

Question 9 of 60

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5. The risk of developing a surgical site infection is dependent on all of the following factors, EXCEPT:

Select one of the following:

Hyperthermia
Immunosuppression
Diabetes mellitus
Length of operation

Explanation

Question 10 of 60

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Explanation

Question 11 of 60

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6. Of the following, what is NOT considered a phase of normal wound healing?

Select one of the following:

Proliferation
Remodeling
Exfoliation
Hemostasis and inflammation

Explanation

Question 12 of 60

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Question 13 of 60

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7. Please choose the CORRECT statement regarding wound healing and closure.

Select one of the following:

Wound healing via secondary intention leads to improved scar formation and superior cosmetic outcome
A contaminated wound from an open fracture should be immediately closed via primary intention
Wound healing via primary intention requires manual approximation of wound edges and healing through the normal stages of wound healing
Wound healing via tertiary intention is reserved for simple, uncomplicated lacerations

Explanation

Question 14 of 60

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Question 15 of 60

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8. With regards to the fundamental principles of antibiotic prophylaxis in surgery, which of the following are INCORRECT?

Select one of the following:

The antibiotic of choice should be active against organisms usually found at the site of surgery
During surgeries that go longer than expected, the antibiotic should be re-dosed to ensure adequate levels
The antibiotic should be given 30 minutes prior to the incision
The antibiotic should be continued for 7 days post surgery to prevent antibiotic resistance

Explanation

Question 16 of 60

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Question 17 of 60

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9. What is NOT a benefit of laparoscopic surgery versus open surgery?

Select one of the following:

Decreased trauma to the abdominal wall and decreased post-operative scarring
Shorter recovery time
Decreased post-operative pain
Improved tactile sensation of tissues

Explanation

Question 18 of 60

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Explanation

Question 19 of 60

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10. Which of the following is NOT a physiological consequence of routine laparoscopic surgery?

Select one of the following:

Hypercarbia due to absorption of CO2 used to create a pneumoperitoneum
Decreased blood return from the lower body back to the heart
Decreased systemic blood pressure
Decreased lung volume and residual functional capacity

Explanation

Question 20 of 60

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Explanation

Question 21 of 60

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11. You are preparing to make an abdominal incision for a laparotomy as you suspect your patient has complex perforated appendectomy. What is the correct order of the layers you will cut through, starting with the most superficial layer?

Select one of the following:

Skin, superficial fascia (Camper’s and Scarpa’s), external oblique, internal oblique, transversus abdominis, transversalis fascia, extraperitoneal fascia, parietal peritoneum
Skin, extraperitoneal fascia, superficial fascia (Camper’s and Scarpa’s), external oblique, internal oblique, transversus abdominis, parietal peritoneum
Skin, superficial fascia (Camper’s and Scarpa’s), extraperitoneal fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, parietal peritoneum
Skin, extraperitoneal fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, superficial fascia (Camper’s and Scarpa’s), parietal peritoneum

Explanation

Question 22 of 60

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Explanation

Question 23 of 60

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12. Of the following, what is NOT an indication for chest tube insertion?

Select one of the following:

Pneumothorax
Pulmonary edema
Hemothorax
Postoperative cardiac surgery

Explanation

Question 24 of 60

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Explanation

Question 25 of 60

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13. Regarding chest tubes, which of the following answers is correct?

Select one of the following:

If a chest tube needs to be repositioned further into the chest cavity after insertion, simply advance it further as necessary
A chest X-ray should ALWAYS be taken to confirm the location of a chest tube
Routine chest tubes should be placed in the second intercostal space in the anterior axillary line
Prophylactic antibiotics (most commonly cefazolin) are indicated for chest tube insertions to prevent infection

Explanation

Question 26 of 60

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Question 27 of 60

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14. A security guard sustains a left thoraco-abdominal stab wound. He is alert, talking, and hemodynamically stable. On examination, his abdomen is soft and non-tender. The most appropriate management would be:

Select one of the following:

Observation
Diagnostic peritoneal tap
CT thorax, abdomen, and pelvis
Laparotomy

Explanation

Question 28 of 60

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Question 29 of 60

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15. A 30-year-old male pedestrian presents with a posterior left knee dislocation after being hit by a car. He has no distal pulses in his left leg. The most appropriate next step in his management would be to:

Select one of the following:

Take the patient to the operating room
Reduce dislocation in the ER
Obtain an angiogram
Start IV heparin

Explanation

Question 30 of 60

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Question 31 of 60

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16. Comparing internal and external fixation, which of the following is true?

Select one of the following:

Internal fixation is generally preferable for open fractures
External fixation makes access for wound care more difficult
External fixation is useful in very comminuted fractures
Internal fixation is less invasive than external fixation

Explanation

Question 32 of 60

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Question 33 of 60

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17. A patient is brought into the trauma bay after a high-speed motor vehicle collision. He has decreased breath sounds on the right with a deviated trachea to the left, a laceration of his left radial artery with pulsatile bleeding, and an obvious deformity of his right thigh with bone protruding through a 7-cm wound. Which of the following is the most important next step in his management?

Select one of the following:

Chest tube on the left (5th intercostal space, mid-axillary line)
Pressure dressing on the left forearm
Sterile dressing on the right thigh wound, antibiotics, tetanus booster
Needle thoracotomy on the right (2nd intercostal space, mid-clavicular line)

Explanation

Question 34 of 60

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Question 35 of 60

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18. Which of the following is true?

Select one of the following:

Lag screws cause compression, stabilization, and healing mainly through secondary bone healing
External fixation causes compression and healing mainly through primary bone healing
Casting, splinting, and bracing result in callus formation leading to secondary bone healing
Bone plating induces absolutely stability and mainly leads to healing via secondary bone healing

Explanation

Question 36 of 60

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Question 37 of 60

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19. A primipara is in labour and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is:

Select one of the following:

Ease of repair
Lower blood loss
Less dyspareunia
Less extension of the incision

Explanation

Question 38 of 60

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Question 39 of 60

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20. A patient sustained a laceration of the perineum during delivery. It involved the muscles of perineal body but not the anal sphincter. Such a laceration would be classified as:

Select one of the following:

First degree
Second degree
Third degree
Fourth degree

Explanation

Question 40 of 60

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Explanation

Question 41 of 60

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21. Which of the following statements about episiotomy is FALSE?

Select one of the following:

Episiotomy incisions are repaired anatomically in layers
Mediolateral or lateral episiotomy may be associated with more blood loss than median one
Indications for episiotomy include avoiding an imminent perineal tear, the use of forceps, breech delivery, and the delivery of premature infants.
In general, the earlier the episiotomy is done during delivery, the more beneficial it will be in speeding up the delivery

Explanation

Question 42 of 60

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Question 43 of 60

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22. Which is NOT an indication for urethral catheterization?

Select one of the following:

Chronic obstruction causing hydronephrosis
Acute urinary retention (BPH, blood clots, etc.)
Traumatic injury to the lower urinary tract causing painful urination
Intermittent decompression for neurogenic bladder

Explanation

Question 44 of 60

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Question 45 of 60

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23. Urethral strictures also occur away from the ureterointestinal anastomosis. These are most commonly found in the _____ ureter.

Select one of the following:

Left
Right
Pelvic ureters
Infantile

Explanation

Question 46 of 60

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Explanation

Question 47 of 60

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24. With regard to acute traumatic subdural hematoma, which of the following is true?

Select one of the following:

Blood products collect between the inner surface of the calvarium and dura
Bleeding usually results from tearing of the bridging veins
Cerebral contusions are infrequently seen
Burr hole drainage is the surgical treatment of choice

Explanation

Question 48 of 60

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Explanation

Question 49 of 60

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25. The most common location for spontaneous intracerebral hemorrhage secondary to hypertension is the:

Select one of the following:

Cerebellum
Cerebral white matter
Basal ganglia
Brainstem

Explanation

Question 50 of 60

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Question 51 of 60

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26. Indications for treatment of an unruptured intracerebral aneurysm include all of the following except:

Select one of the following:

Size >10 mm
Symptomatic lesion
Two 1st degree relatives with cerebral aneurysms
History of subarachnoid hemorrhage secondary to another treated aneurysm

Explanation

Question 52 of 60

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Question 53 of 60

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27. For local excision, what is generally the best shape to use for ease of closure?

Select one of the following:

S-Shape
Ellipse
Rectangle
Square

Explanation

Question 54 of 60

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Question 55 of 60

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28. To minimize scarring, in what orientation should incision lines be placed in reference to the lines of minimal tension?

Select one of the following:

Circumferential
Cross
Parallel
Perpendicular

Explanation

Question 56 of 60

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Question 57 of 60

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29. An 8-year-old girl has a 2.5 cm breast mass that is enlarging just beneath her left nipple-areolar complex. Her mother first noticed this mass 2 months previously. Management may include all of the following, EXCEPT:

Select one of the following:

In-depth history for a review of systemic symptoms
Ultrasound imaging
Fine-needle aspiration
Excisional biopsy

Explanation

Question 58 of 60

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Question 59 of 60

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30. A 62-year-old patient comes to clinic with a suspicious 2.0 cm lesion, which characteristic of the lesion would make you want to avoid investigating with a punch biopsy?

Select one of the following:

Ulcerated
Pigmented
Rapidly growing
Hard horn present

Explanation

Question 60 of 60

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	Created by Justin Wang about 9 years ago