E1

E1.A The operating room, equipment, instruments, and sutures

Question: All of following are examples of hand held retractor except

a. Army Navy
b. Bookwalter
c. Deaver
d. Richardson

Answer: B. Bookwalter
Rationale: Army Navy, Deaver, and Richardson are all hand held retractors. On the other
hand, Bookwalter allows free hand operation and is mainly used in the chest or the
abdomen.

Question: Used for cleaning the airway of blood, saliva and other secretions.
a. Operating table
b. Suction machine
c. Ventilator machine
d. Scrub links

Answer: B. Suction machine

Rationale: Suction machine is used to suction various fluids that may be a hindrance for
an operation.

Question: This type of suture provides minimal tissue reaction

a. Monofilament
b. Multifilament
c. Absorbable
d. Non-Absorbable

Answer: A, Monofilament
Rationale: Monofilament construction of sutures provides the minimal tissue reaction
because of its smooth surface, as compared to multifilament construction.

Question: What is the ideal size for an IN-PATIENT SURGERY FACILITY for
procedures requiring more staff?
A. 250 sq.ft
B. 400 sq.ft
C. Minimum of 600 sq.ft
 D. none of the above

Answer: C. Minimum of 600 sq.ft.

Rationale: For the OUT-PATIENT SURGERY FACILITY, the size requirement is a
minimum clear floor area of 250 square feet; while for an INPATIENT SURGERY FACILITY, the
size requirement is a minimum clear floor area of 400 square feet, however, for procedures
requiring more staff, it should be a minimum of 600 square feet.

Question: Surgical Scrubbing is recommended to be done for at least

a. 3 minutes
b. 1 minute
c. 6 minutes
d. 10 minutes
Answer: C. 5 to 6 minutes
Rationale: According to the World Health Organization guidelines, surgical scrubbing is
recommended to be done for at least 5 to 6 minutes

E1.B Asepsis and antisepsis

Question: (_________-based) antiseptics have the advantage of having good

antimicrobial action and of drying quickly.
A. Iodine
B. Alcohol
C. Hydrogen Peroxide
D. Chloroxylenol

Answer: B. Alcohol
Rationale: Regarding Surgical site infection prevention, (Darouiche et al.,) analyzing 850
patients, showed superiority of 2% alcoholic solution over 10% aqueous PVI at 30 days after
aseptic surgery.

Question: The _____ is a solid physical barrier, and almost no microorganisms are able to
penetrate and cause infection.
A. Capsule
B. Hair
C. Skin
D. Blood

Answer: C. Skin
Rationale: Skin preparation reduces the skin flora and hence the risk of Surgical Site
Infection.
 Question: It is one of the minor injuries that involves making an incision through the burn
necrotic skin to get rid of the unnecessary tissue.
1) Breast biopsy
2) Burn excision
3) Cataract surgery
4) Heart replacement

Answer: Burn Excision

Rationale: Burn excision is one of the minor injuries that a surgeon should check in doing
skin preparation. Getting rid of the unnecessary tissue is needed in preparation for the next
procedure.

Question: It is the prevention of infection by applying substances that inhibits or arrest

the growth and multiplication of infectious micro-organisms on living tissues

A. Asepsis
B. Disinfection
C. Antisepsis
D. Sepsis

Answer: C
Rationale: Antisepsis is defined as the destruction or inhibition of microorganisms on
living tissues, thereby limiting or preventing the harmful results of infection.

Question: Chlorhexidine is one of the solutions needed for skin preparation. Give one
advantage of using this solution.
a. Limited pH range
b. Drying effect on the skin
c. Contraindicated for use on multiple areas of the body
d. Fast onset of action

Answer: Fast onset of Action

Rationale: Chlorhexidine disrupts microbial cell membranes and precipitates cell
contains. Of all the choices, fast onset of action is one of its advantages. Other choices are the
solution’s disadvantage.

E1.C Animal bites

Question: Which of the following is incorrect in the initial management of animal bites?
 A. Apply alcohol, povidone iodine or any antiseptic
B. For a deep wound apply pressure to stop any bleeding
C. If soap is not available, the wound should be thoroughly and extensively washed
with water
D. Wounds should be immediately sutured

Answer: Wounds should be immediately sutured

Rationale: Suturing of wounds should be avoided since it may inoculate the virus deeper
into the wounds.

Question: In this clinical stage, nonspecific symptoms and paresthesias are present in
patients with rabies.
A. Prodromal
B. Acute neurologic
C. Paralytic
D. Encephalitic

Answer: A
Rationale: The disease usually begins with a prodromal stage which lasts for two to ten
days with nonspecific symptoms and paresthesias, with itching or burning pain at wound site.

Question: Which of the following is the causative agent for tetanus, a toxin-producing
obligate anaerobe, which is found in the soil ?
A. Clostridium botulinum
B. Lyssavirus
C. Clostridium tetani
D. Clostridium perfringens

Answer: C
Rationale: Tetanus is a disease caused by Clostridium tetani, a toxin-producing obligate
anaerobe, which is found in the soil and gut of mammals. The spores cannot be eliminated from
the environment. They may enter the body through compromises in the skin barrier or mucous
membranes.

Question: Which of the following is an indicated Post-exposure prophylaxis in Category

III exposure but not in Categories I and II?
A. Washing of exposed area
B. Vaccines
C. RIB
 D. All of the above

Answer: C
Rationale: Rabies immunoglobulin is indicated in Category III rabies exposure but not in
Categories I and II according to the Definitions of Exposure by WHO. Wound washing is
indicated throughout all categories and vaccines are indicated for Categories II and III.

Question: Which of the following sites is not considered an exigent risk for rabies?
A. Face
B. Feet
C. Head
D. Spine

Answer: B. Feet.
Rationale: Bites on the following sites are more exigent risk of rabies and need for rabies
prophylaxis than do bites to the arms and legs: Face, head, neck, spine.

E2
E2.A The operating room, equipment, instruments, and sutures

Question: Area in an operating room where operations are done and operating room attire
is required. Staff and other personnel in normal clothing are not allowed to enter.
A. Unrestricted zone
B. Semi restricted zone
C. Restricted zone/ Sterile area
D. Disposal zone

Answer: C
Rationale: Unrestricted zone is the area where staff can stay in their normal clothing.
Semi-restricted zone is where the supply center is located. Disposal zone is an area in
which all dirty or utilized materials and linen are gathered. Restricted zone/Sterile area as
the name implies is a sterile zone where operations are done and operating room attire is
required.

Question: The following are some of the applications of absorbable sutures, except:
A. Facial lacerations
 B. Hand lacerations
C. Lacerations of the tongue
D. Prosthesis attachment

Answer: D.
Rationale: Absorbable sutures are used in treating facial lacerations, hand lacerations,
and tongue lacerations. On the other hand, non-absorbable sutures are used
in procedures involving prosthesis attachment.

Question: Designed to hang over the operating table for easy reach of the surgical
materials that are used frequently
a. Back table
b. Mayo stand
c. Ring stand
d. Kick bucket

Answer: b. Mayo Stand

Rationale: The back table is located at the back of the operating room, containing other
surgical instruments that will be used in the procedure, a ring stand holds basins
containing sterile solutions for rinsing instruments and moistening sponges and a kick
bucket is a waste receptacle.

Question: This instrument is used to cut thick or tough tissue

a. Mayo
b. Metzenbaum
c. Iris
d. Allis
Answer: Mayo
Rationale: Mayo scissors have semi blunt tips. The blades and handlings are stronger
than in Metzenbaum scissors (Schneider et. al 2017) . It is used to: (1) cut thick or tough tissue
(e.g Fascia) (2) cut suture.

Question: Natural sutures are derived from;

A. Purified animal tissues
B. Purified serosa of bovine intestines
C. Sheep submucosa
D. All of the above
 Answer: D
Rationale: Natural sutures are derived from purified animal tissues such as serosa of
bovine intestines. Silk and catgut are types of natural sutures and are derived from sheep
submucosa.

E2.B Asepsis and antisepsis

Question: The following are sterile members of the operating room, EXCEPT:
A. Surgeon
B. Registered Nurse
C. Certified Surgical Technologist
D. Scrub Nurse
Answer: B.
Rationale: The Registered Nurse role is generally that of the “circulator”. The circulator
is responsible for the patient care during the operation. He or she assesses the patient, assists the
anesthesiologist, completes operating room records and dispenses items to the sterile team.
Surgeon, Certified Surgical Technologist, & Scrub Nurse are sterile personnel in the operating
room.

Question: TRUE OR FALSE: Gowns are considered sterile only from the waist to chin
level in front and the sleeves to 4 inches above the elbows.
A. True
B. False
Answer: B.
Rationale: Gowns are considered sterile only from the waist to shoulder level in front
and the sleeves to 2 inches above the elbows.

Question: Antiseptic solution that is widely available and do not stain nor cause allergic
reactions to the skin; it is highly flammable and can cause irritation to mucous membrane
body parts such as the cornea
A. Povidone-iodine
B. Chlorhexidine Gluconate
C. Alcohol Solutions
D. All of the above

Answer: C. Alcohol solutions

Rationale: Povidone-iodine is widely available. However, it causes staining and allergic
reactions; Chlorhexidine Gluconate is very expensive and is not widely available; Alcohol does
not stain nor cause allergic reactions to the skin, it is widely available, and can cause irritation to
the mucous membrane parts such as the cornea or ears, and is also highly flammable.

Question: In skin preparation, which among the following techniques must be observed
to prevent contamination of the surgical site.

A. Scrub the skin in a circular motion starting at the center of the surgical site and
moving outward.
B. Reused the sponge after reaching the outer edge. You can only bring a soiled
sponge back toward the center of the area twice.
C. Rinse the area in the linear manner with a sterile sponge or gauze.
D. apply the antiseptic solution from outer moving to inner surgical site

Answer: A. Scrub the skin in a circular motion starting at the center of the surgical site
and moving outward.
Rationale: Scrub the skin in a circular motion starting at the center of the surgical site and
moving outward will remove microorganisms in the immediate area, preventing contamination
of the surgical site.

Question:The proper hand scrubbing technique makes use of hospital-approved antiseptic

scrub sponge and it has 2 sides, the non-abrasive and the abrasive side. Which of the
following parts specifically uses the abrasive side of the sponge?
A. Hands
B. Arms
C. Fingertips
D. All of the above

Answer: C
Rationale:When performing proper hand scrubbing technique, the abrasive side of the
antiseptic scrub sponge is used only for the fingertips while the non-abrasive side are used for
hands, elbows and arms

E2.C Animal bites

Question: The initial management for animal bite are the following EXCEPT
A.Wounds shall be immediately and vigorously washed and flushed with soap and water
preferably for 10-15 minutes
B.Apply alcohol, povidone iodine or any antiseptic
C.Any ointment, cream or wound dressing shall be applied to the bite site
 D.Suturing of wounds shall be avoided but if suturing is unavoidable,the sutures should
be loose and not interfere with free bleeding and drainage

Answer: C
Rationale: Any ointment, cream or wound dressing shall not be applied to the bite site
because it will favor the growth of bacteria and will occlude drainage of the wound.

Question: Which of the following falls under Category II of rabies exposure?

A. Licking of intact skin
B. Touching or feeding animals
C. Nibbling of uncovered skin
D. Single or multiple transdermal bites or scratches

Answer: C
Rationale: Licking of intact skin and touching/feeding an animal falls under category I,
while single or multiple transdermal bites or scratches is under category III.

Question: What is the causative agent of tetanus infection, a serious, potentially

life-threatening infection that can be transmitted by an animal or human bite?
A. Bacillus anthracis
B. Clostridium tetani
C. Rabies virus

Answer: B
Rationale: Tetanus is a disease caused by Clostridium tetani, a toxin-producing obligate
anaerobe, which is found in the soil and gut of mammals.

Question: In this stage of rabies infection, the virus reaches the CNS and replicates most
exclusively within the gray matter.
A. Incubation period
B. Prodomal stage
C. Acute neurologic stage
D. Coma

Answer: C
Rationale: Acute neurologic stage is associated with objective signs of developing CNS
disease. It is the stage when the virus reaches the CNS and replicates most exclusively within the
gray matter that lasts for 2-7 days.
 Question: What is the recommended dose given for the administration of rabies
immunoglobulin?

A. 15 IU/ kg for Human RIG

B. 20 IU/ kg for Human RIG
C. 25 IU/ kg for Human RIG
D. 30 IU/ kg for Human RIG

Answer: B
Rationale: According to world health organization the recommended dose given for the
administration of rabies immunoglobulin is 20 IU/ kg for Human RIG (HRIG) or 40 IU/ kg of
Equine RIG (ERIG)