CSFA Practice Questions 2026: 8 Exam-Style Items Explained

Answer: A — Cause the least possible trauma to the tissue

Needle selection is driven by the tissue: the right point, body and size let the needle pass with the least trauma, in line with Halsted's principle of gentle tissue handling. Taper points suit soft tissue such as bowel and vessels; cutting and reverse-cutting points suit tough tissue such as skin.

• B. Surgical needles are all made from corrosion-resistant stainless steel alloys, so this does not separate one choice from another.
• C. Stability in the needle holder matters, and flattened needle bodies help, but it is a design feature, not the reason for choosing one needle over another.
• D. An oversized needle makes a bigger track and more trauma. Needle size is matched to the tissue and suture, not to speed.

Answer: B — Ligating the vessel with a free tie or a suture ligature

A transected artery needs mechanical, permanent hemostasis: a tie around the clamped end, a suture ligature (stick tie) for a large vessel or short pedicle, or clips. Topical agents and pressure are meant for capillary or venous oozing, not arterial bleeding.

• A. Absorbable gelatin sponge is a topical adjunct for oozing surfaces; it will not hold an arterial bleeder against arterial pressure.
• C. A drain removes blood and fluid after the fact. It does not stop bleeding and can hide ongoing hemorrhage.
• D. A pressure dressing goes on after closure and cannot control an open arterial bleeder inside the wound.

Answer: B — To take pressure off the dependent axilla and protect the brachial plexus

In the lateral position the dependent shoulder carries body weight, which can compress the brachial plexus and axillary vessels. A roll placed just caudal to the axilla, under the upper chest wall rather than in the armpit, lifts the chest so the dependent shoulder and neurovascular bundle are off-loaded. The radial pulse in the dependent arm is checked after placement.

• A. Head support comes from a pillow or head rest sized to keep the cervical spine neutral, not from the axillary roll.
• C. The intercostal spaces are widened by flexing the table or raising the kidney rest, not by the axillary roll.
• D. The pelvis and torso are stabilized with a beanbag, padded supports, a safety strap and tape, not with the axillary roll.

Answer: A — Notify the surgeon immediately to evaluate for compartment syndrome

Pain out of proportion to the injury, pain on passive stretch, a tense compartment and numbness are signs of acute compartment syndrome, a surgical emergency that may need fasciotomy within hours. The surgeon must be told at once; meanwhile any tight dressing or cast is loosened and the limb is kept at heart level.

• B. Raising the leg well above the heart lowers arterial inflow and can worsen ischemia; the limb is kept at heart level, and ice does not treat compartment syndrome.
• C. More analgesia masks the key symptom and delays a time-critical diagnosis.
• D. Waiting for the next routine check wastes hours, and muscle and nerve damage can become permanent within hours of ischemia.

Answer: B — To capture surgical plume, which carries toxic gases, fine particles and possibly viable biologic material

Surgical plume contains toxic gases and vapors such as benzene, hydrogen cyanide and formaldehyde, fine particulates and possibly viable biologic material. NIOSH and AORN recommend capturing it at the source with a smoke evacuator to protect the team and the patient, so it is a hazard-control measure.

• A. The sterile field is maintained by aseptic technique; a smoke evacuator does not make the field more or less sterile.
• C. Clearer visibility is a side benefit, especially in laparoscopy, but the reason it is recommended is protecting people from plume.
• D. Removing smoke does not remove fuel, oxygen or the ignition source, so it is not a fire-prevention measure.

Answer: C — High-level disinfection

Spaulding sorts items by infection risk. Semicritical items, those that contact mucous membranes or non-intact skin such as flexible endoscopes and laryngoscope blades, need at least high-level disinfection, with sterilization preferred when practical. Critical items that enter sterile tissue need sterilization; noncritical items that touch only intact skin need low-level disinfection.

• A. Low-level disinfection is for noncritical items that touch only intact skin, such as blood pressure cuffs.
• B. Intermediate-level disinfection kills mycobacteria and most viruses but is used for noncritical items; it falls short of the high-level standard required for mucous membrane contact.
• D. Cleaning removes soil and bioburden and must always come first, but on its own it does not disinfect the device.

Answer: A — Left ventricle at the cardiac apex

The cardiac apex, formed by the left ventricle, lies at the left fifth intercostal space at about the midclavicular line, which is where the apex beat is felt. The cardiac notch of the left lung leaves the heart less covered there, so a penetrating wound at this point threatens the left ventricle and pericardium, with a risk of tamponade.

• B. The right ventricle forms most of the front of the heart, but it lies mainly behind the sternum and the left parasternal area, medial to the midclavicular line.
• C. The spleen sits in the left upper quadrant behind ribs 9 to 11 near the midaxillary line, well below and lateral to this point.
• D. The left atrium forms the back (base) of the heart, the chamber farthest from an anterior chest wound.

Answer: B — Femoral nerve

The femoral nerve enters the thigh lateral to the femoral artery in the femoral triangle. It supplies the quadriceps, which extend the knee, and gives anterior cutaneous branches to the front and medial thigh plus the saphenous nerve to the medial leg, so weak knee extension with anteromedial thigh numbness localizes to it.

• A. The obturator nerve supplies the hip adductors and a patch of skin on the medial thigh; it does not extend the knee.
• C. The sciatic nerve runs in the back of the thigh and supplies the hamstrings and everything below the knee, not the quadriceps.
• D. The genitofemoral nerve is sensory to a small area of the upper anterior thigh and the genital region and plays no part in knee extension.