HealthcareOctober 3, 202611 min read

CSFA Exam Mnemonics: 11 Memory Tricks for Surgical First Assistants

11 memory hooks for the lists and sequences the CSFA keeps testing, each with when to use it and where it lets you down.

  • 11Mnemonics
  • 4Domains covered
  • 175 itemsReal exam
  • 240 minTime limit
  • $350Exam fee
Surgical first assisting mnemonics and memory tricks for the CSFA exam

Table of Contents

How to use a mnemonic on exam day

A mnemonic is a retrieval cue, not understanding. It gets a list or a sequence back out of memory under time pressure; it does not tell you which item on the list the question wants. Each card below therefore has two extra lines: Use it when — the kind of CSFA question where the hook pays off — and Careful — where the shortcut breaks or the exam sets a trap around it.

Learn the meaning first. Read the expansion until it makes sense, then use the hook to recall it. A mnemonic you cannot unpack is worth nothing on a scenario item.

Perioperative Care

Halsted's principles of tissue handling

“Gentle Hands Bring All Tissues Accurately Down”

  1. GGentle handling of tissue
  2. HHemostasis that is meticulous
  3. BBlood supply preserved
  4. AAsepsis strictly maintained
  5. TTension kept to a minimum on tissue and suture lines
  6. AAccurate apposition of tissue layers
  7. DDead space obliterated

Use it when: Tissue-handling and closure items that ask which choice best follows good technique, such as closing dead space or avoiding strangling ties.

Careful: Some texts list six principles or merge two of these; the content is the same. Minimal tension does not mean loose: approximate tissue, do not strangle it, because over-tight sutures cause ischemia and necrosis. Dead space is closed with sutures or managed with a drain, not by pulling tissue together under tension.

Methods of hemostasis

“Must Try Clamping”

  1. MMechanical: clamps, ties and suture ligatures, clips, staples, pressure, bone wax, tourniquets, vessel loops
  2. TThermal: monopolar and bipolar electrosurgery, ultrasonic devices, advanced bipolar vessel sealers, laser, argon beam
  3. CChemical: absorbable gelatin, oxidized regenerated cellulose, microfibrillar collagen, topical thrombin, fibrin sealants, and vasoconstrictors such as epinephrine

Use it when: When matching the method to the bleeding source: an artery needs a mechanical method; ooze from a raw surface suits thermal or chemical methods.

Careful: Separate temporary from permanent: tourniquets, vessel loops, non-crushing clamps and digital pressure are temporary, while ligation, clips, cautery and sealing are permanent. Topical thrombin is never injected, because intravascular thrombin can cause fatal clotting. Keep microfibrillar collagen out of cell-saver suction. Bone wax is mechanical, not chemical.

Giving the surgeon visualization

“See It Right Soon”

  1. SSuction: tip in the pool, not on tissue; Yankauer for volume, Frazier for fine work, Poole for abdominal fluid
  2. IIrrigation: warm saline to clear the field, then suction
  3. RRetraction: steady, the lightest force that gives exposure, blades padded with moist sponges
  4. SSponging: blot (dab), never wipe, which tears tissue and dislodges clots

Use it when: Exposure questions that ask what the assistant does to keep the operative field visible.

Careful: Deep self-retaining retractor blades in abdominal and pelvic cases can compress the femoral nerve against the psoas, so check lateral blade depth and release pressure periodically in long cases. Never suction directly on bowel or a nerve; in laparoscopy, constant suction collapses the pneumoperitoneum.

Positioning injuries by position

“Supine elbow, Lithotomy knee, Lateral armpit, Prone eyes”

  1. SupineUlnar nerve at the elbow (pad it, palm up); brachial plexus if an arm board is abducted past 90 degrees
  2. LithotomyCommon peroneal (fibular) nerve where the fibular head meets the stirrup
  3. LateralDependent brachial plexus and axillary vessels; roll under the upper chest just caudal to the axilla
  4. ProneEyes and face: no pressure on the globes (postoperative vision loss); breasts and genitalia free; chest rolls from clavicle to iliac crest

Use it when: When a stem names a position and asks which nerve or structure is most at risk, or which device protects it.

Careful: Lithotomy also endangers the saphenous nerve at the medial knee and the femoral and sciatic nerves with extreme hip flexion, so legs go up and down together and slowly. Keep arm abduction under 90 degrees in every position. In prone, the abdomen must hang free so ventilation and venous return are not impeded.

Ancillary Duties

Stray energy in laparoscopic electrosurgery

“I Don't Cook”

  1. IInsulation failure: a crack in the active electrode's insulation leaks current to bowel outside the camera view
  2. DDirect coupling: the active electrode touches another metal instrument or the scope
  3. CCapacitive coupling: current is induced through intact insulation into nearby conductive material, worse with high-voltage coag modes and hybrid metal-plastic trocars

Use it when: Laparoscopic burn questions: how a bowel injury happened out of view, or which practice reduces the risk.

Careful: Prevention means inspecting insulation, using the lowest effective power and lower-voltage waveforms when possible, avoiding hybrid trocar systems, keeping the active tip in view and using active electrode monitoring. A thermal bowel injury may not show until days later as peritonitis.

Reversible causes of cardiac arrest

“5 H's and 5 T's”

  1. HHypovolemia
  2. HHypoxia
  3. HHydrogen ion (acidosis)
  4. HHypokalemia or hyperkalemia
  5. HHypothermia
  6. TTension pneumothorax
  7. TTamponade, cardiac
  8. TToxins
  9. TThrombosis, pulmonary
  10. TThrombosis, coronary

Use it when: Arrest scenarios in the OR where you must name the cause the team can reverse: hemorrhage, tension pneumothorax after a line, drug or local anesthetic toxicity, embolism.

Careful: The current AHA list has five of each. Hypoglycemia and trauma appear on older lists and some study cards. In the OR, hemorrhage and tension pneumothorax are causes the surgical team may need to fix directly while resuscitation continues.

Advanced Science

Femoral triangle contents, lateral to medial

“NAVEL”

  1. NNerve (femoral)
  2. AArtery (femoral)
  3. VVein (femoral)
  4. EEmpty space (femoral canal)
  5. LLymphatics (deep inguinal nodes)

Use it when: Groin injury, femoral access, femoral hernia and vascular exposure questions.

Careful: The femoral nerve lies outside the femoral sheath; the sheath holds the artery, vein and canal. A femoral hernia comes through the femoral canal below the inguinal ligament and medial to the vein, which is why the vein is at risk during repair. An inguinal hernia sits above the ligament.

Critical view of safety in cholecystectomy

“Clear, Lift, Two”

  1. ClearThe hepatocystic triangle is cleared of fat and fibrous tissue
  2. LiftThe lower third of the gallbladder is separated from the liver bed (cystic plate)
  3. TwoTwo, and only two, structures are seen entering the gallbladder: the cystic duct and cystic artery

Use it when: Laparoscopic cholecystectomy steps and bile duct injury prevention questions.

Careful: Calot's triangle as first described used the cystic artery as its upper border; the hepatocystic triangle used today is bounded by the cystic duct, the common hepatic duct and the inferior edge of the liver. Nothing is clipped or cut until all three criteria are met; if they cannot be reached, bail-out options include subtotal cholecystectomy or conversion.

Classic abdominal incisions and what they open

“Kocher Cuts the Cholecyst, McBurney Meets the appendix, Pfannenstiel Plumbs the Pelvis, Chevron Crowns the liver”

  1. KocherRight subcostal: open gallbladder and biliary tract (left subcostal for the spleen)
  2. McBurneyOblique muscle-splitting incision at McBurney's point, one-third of the way from the ASIS to the umbilicus: appendectomy
  3. PfannenstielLow transverse suprapubic incision: cesarean section, hysterectomy, pelvic organs
  4. ChevronBilateral subcostal: liver, pancreas, wide upper-abdominal exposure
  5. MidlineVertical through the linea alba: fast, extendable exposure for trauma and exploratory laparotomy

Use it when: When asked which incision fits a named operation or which structures lie under a given incision.

Careful: Kocher names three different things: the incision, the toothed clamp and the Kocher maneuver (mobilizing the duodenum). The Rocky-Davis incision is the transverse version at McBurney's point. A Pfannenstiel gives limited upper exposure, so it is a poor choice when the pathology may extend above the pelvis.

Wound Closure and Healing

Intentions of wound healing

“First sew, second grow, third wait then sew”

  1. 1stPrimary intention: edges brought together at surgery with sutures, staples or adhesive; fastest, smallest scar
  2. 2ndSecondary intention: wound left open to fill with granulation tissue and contract (abscess cavity, pressure injury); slower, wider scar
  3. 3rdTertiary intention (delayed primary closure): left open, usually 3 to 5 days, until contamination is controlled, then closed

Use it when: Closure-decision questions: how a contaminated or infected wound will be managed and what kind of scar to expect.

Careful: Third intention is a deliberate plan for contaminated or dirty wounds, not a failed second intention. Negative pressure wound therapy can be used on open wounds and on closed incisions, but it does not change which intention describes the wound.

Phases of wound healing

“Healing Is Pretty Magical”

  1. HHemostasis (minutes): platelet plug, clot and fibrin
  2. IInflammation (about the first 4 days): neutrophils, then macrophages, clear debris and bacteria
  3. PProliferation (about day 4 to week 3): granulation tissue, collagen, new epithelium, contraction
  4. MMaturation or remodeling (about week 3 to a year or more): collagen reorganizes and the scar gains strength

Use it when: Questions on what happens to a wound at a given time, when it is weakest, and what slows healing.

Careful: A healed scar reaches at most about 80% of the original tissue's tensile strength. Older textbooks fold hemostasis into inflammation and teach three phases (lag, proliferative, maturation); the events are the same. Steroids, diabetes, smoking, malnutrition and infection stall the inflammatory and proliferative phases. Time ranges vary by source.

Numbers worth memorising

Some surgical first assisting facts have no shortcut — they are just numbers the exam expects you to know cold. These are the ones that show up most often in the item bank.

FactValueWhy it gets tested
CSFA exam format175 questions (150 scored) in 4 hours; 99 of 150 to pass25 pretest items cannot be identified
Adult pneumoperitoneum pressureCommonly 12-15 mmHgHigher pressure cuts venous return and raises CO2 absorption
Arm board abductionLess than 90 degreesBeyond 90 degrees stretches the brachial plexus
Compartment syndrome thresholdDelta pressure (diastolic minus compartment pressure) under 30 mmHgCommonly used fasciotomy trigger alongside clinical signs
Adult blood volumeAbout 70 mL/kg (about 5 L at 70 kg)Base for estimating blood-loss percentage
Hemorrhage classes (ATLS)I up to 15%, II 15-30%, III 31-40%, IV over 40% of blood volumeBlood pressure usually falls only from class III
Negative pressure wound therapy-125 mmHg continuous is the common defaultSettings vary by device and wound; follow the order
Delayed primary closureUsually 3-5 days after surgeryThird intention for contaminated wounds
Scar tensile strengthAt most about 80% of original tissueWhy hernia and dehiscence risk persists
Typical suture removal timesFace 3-5 days; scalp and trunk 7-10 days; extremities 10-14 daysTypical ranges; the surgeon's order decides

Build your own in three steps

The best mnemonic is the one you made, because making it is half the memorising.

  1. 1Pick a list the outline tests as a sequence or a set — steps, signs, contraindications. Single facts do not need a hook.
  2. 2Take the first letter of each item and build a phrase that is vivid or absurd. Odd sticks; sensible fades.
  3. 3Test it cold the next day on practice questions. If you recalled the phrase but missed the item, the hook is fine and the understanding is not.

Now test the hooks on real questions

ExamCert AI has 1,188 CSFA questions with explanations. Mnemonics stick when you use them to answer something — drill by domain and see which ones hold up.

Practise CSFA on ExamCert AI

Or start with the 8 free CSFA practice questions we walked through, answers and distractors explained.

FAQ

What does NAVEL stand for in surgery?

NAVEL lists the femoral triangle from lateral to medial: femoral Nerve, Artery, Vein, Empty space (femoral canal) and Lymphatics. The nerve lies outside the femoral sheath.

What are Halsted's principles?

Gentle tissue handling, meticulous hemostasis, preserved blood supply, strict asepsis, minimal tension, accurate apposition of tissue and obliteration of dead space. 'Gentle Hands Bring All Tissues Accurately Down' covers all seven.

What are the three methods of hemostasis?

Mechanical (clamps, ties, clips, pressure, bone wax), thermal (electrosurgery, ultrasonic and vessel-sealing devices) and chemical (topical agents such as gelatin, oxidized cellulose, collagen and thrombin). 'Must Try Clamping' keeps the order, and the exam also asks whether each method is temporary or permanent.

Are mnemonics enough to pass the CSFA exam?

No. Most CSFA items are scenarios in which you apply anatomy, hemostasis or exposure to a specific case. Mnemonics help you recall lists under time pressure, but you still need practice questions to use them in context.

Sources

Exam facts come from NBSTSA; clinical content was checked against the references below.

Checked October 3, 2026. Outlines, fees and clinical guidance change — confirm with NBSTSA and your program before test day.