FLS FINAL EXAM ACTUAL QUESTIONS AND ANSWERS
GRADED A+
✔✔Capacitive coupling - ✔✔Transfer current from active electrode through insulation to
passive electrode- electrode to plastic part another LSC instrument
- if constant contact w/ tissue will not store energy and no injury
✔✔Direct coupling - ✔✔monopolar instrument in direct contact w/ metal portion of
another instrument
✔✔Besides capacitative coupling and direct coupling, other hazards of electrocautery -
✔✔- Current diversion
- Narrow return circuit
✔✔Bipolar - ✔✔- forceps w/ two twins (one active other return)
- no pt return electrode required)
- no capacitative coupling
- works in "wet" operative field
- less thermal spread compared to monopolar
✔✔bipolar seals vessels up to _____ mm in diameter - ✔✔7 mm
✔✔ultrasonic coagulation shears seals vessels up to ____ mm in diameter - ✔✔5 mm
✔✔ultrasonic coagulation shears - ✔✔- combo compression and friction
- ONE active blade
- monopolar capacity w/ the one blade
- no capacitative coupling
- high power (MAX): cut
- low power (MIN): coag
✔✔How many days prior to surgery does warfarin has to be discontinued? - ✔✔3 days
✔✔ASA 2 - ✔✔Mild to moderate systemic disease
✔✔ASA 3 - ✔✔severe systemic disease that limits patient activity, may or may not be
related to reason for surgery
✔✔ASA 4 - ✔✔Severe systemic disturbances that limit patient and are life-threatening
with or without surgery
✔✔ASA 5 - ✔✔Little change for survival but surgery last resort (resuscitative effort)
✔✔ASA classes that may not be appropriate for LSC sx - ✔✔ASA 4 and 5
, - body cannot handle decreased venous return, need for hyperventilation
✔✔Length of trocar needed for obese pt - ✔✔>100 mm
✔✔ABSOLUTE C/I to LSC Sx - ✔✔- Inability to tolerate laparotomy
- Hypovolemic shock
- Lack proper surgeon training/experience
- Lack appropriate institutional support
✔✔Relative C/I to LSC Sx - ✔✔- Inability to tolerate GETA
- Long-standing peritonitis
- Large abd/pelvic mass
- Massive incarcerated ventral and inguinal hernias
- Severe cardiopulmonary dz
✔✔NOT C/I to LSC Sx - ✔✔- Diaphragm injury
- GI bleed
- Performed viscus
- Bowel obstruction
- Abd trauma if HD stable
- COPD
- Renal insufficiency
✔✔Preop precautions - ✔✔Be aware of
- Visceral arterial aneurysm (risk injury w/ trocar insertion)
- prior ventral hernia repair w/ mesh (NO blind entry w/ veress or trocar through mesh!)
- H/o peritonitis (risk adhesions and enterotomy)
- Cirrhosis (increased risk of bleeding and ascites leak through ports/wounds)
- Intestinal obstruction
✔✔GETA pre-meds - ✔✔BZ, atropine/glycopyrrolate (prevent bradyarrhythmia from
pneumoperitoneum), H2 blocker
✔✔CO2 benefits - ✔✔- Rapidly absorbed
- Easily eliminated (diffusion coefficient 20x CO2)
- Suppresses combustion
- Readily available
- Inexpensive
✔✔Chemical effects of CO2 - ✔✔- Increase arterial and end tidal CO2
- Decrease serum pH w/ greatest change in first 20 min (SS after 1h)
✔✔Pressure effects of CO2 - ✔✔Pulm
- Reduced functional residual capacity
- Reduced pulmonary compliance
GRADED A+
✔✔Capacitive coupling - ✔✔Transfer current from active electrode through insulation to
passive electrode- electrode to plastic part another LSC instrument
- if constant contact w/ tissue will not store energy and no injury
✔✔Direct coupling - ✔✔monopolar instrument in direct contact w/ metal portion of
another instrument
✔✔Besides capacitative coupling and direct coupling, other hazards of electrocautery -
✔✔- Current diversion
- Narrow return circuit
✔✔Bipolar - ✔✔- forceps w/ two twins (one active other return)
- no pt return electrode required)
- no capacitative coupling
- works in "wet" operative field
- less thermal spread compared to monopolar
✔✔bipolar seals vessels up to _____ mm in diameter - ✔✔7 mm
✔✔ultrasonic coagulation shears seals vessels up to ____ mm in diameter - ✔✔5 mm
✔✔ultrasonic coagulation shears - ✔✔- combo compression and friction
- ONE active blade
- monopolar capacity w/ the one blade
- no capacitative coupling
- high power (MAX): cut
- low power (MIN): coag
✔✔How many days prior to surgery does warfarin has to be discontinued? - ✔✔3 days
✔✔ASA 2 - ✔✔Mild to moderate systemic disease
✔✔ASA 3 - ✔✔severe systemic disease that limits patient activity, may or may not be
related to reason for surgery
✔✔ASA 4 - ✔✔Severe systemic disturbances that limit patient and are life-threatening
with or without surgery
✔✔ASA 5 - ✔✔Little change for survival but surgery last resort (resuscitative effort)
✔✔ASA classes that may not be appropriate for LSC sx - ✔✔ASA 4 and 5
, - body cannot handle decreased venous return, need for hyperventilation
✔✔Length of trocar needed for obese pt - ✔✔>100 mm
✔✔ABSOLUTE C/I to LSC Sx - ✔✔- Inability to tolerate laparotomy
- Hypovolemic shock
- Lack proper surgeon training/experience
- Lack appropriate institutional support
✔✔Relative C/I to LSC Sx - ✔✔- Inability to tolerate GETA
- Long-standing peritonitis
- Large abd/pelvic mass
- Massive incarcerated ventral and inguinal hernias
- Severe cardiopulmonary dz
✔✔NOT C/I to LSC Sx - ✔✔- Diaphragm injury
- GI bleed
- Performed viscus
- Bowel obstruction
- Abd trauma if HD stable
- COPD
- Renal insufficiency
✔✔Preop precautions - ✔✔Be aware of
- Visceral arterial aneurysm (risk injury w/ trocar insertion)
- prior ventral hernia repair w/ mesh (NO blind entry w/ veress or trocar through mesh!)
- H/o peritonitis (risk adhesions and enterotomy)
- Cirrhosis (increased risk of bleeding and ascites leak through ports/wounds)
- Intestinal obstruction
✔✔GETA pre-meds - ✔✔BZ, atropine/glycopyrrolate (prevent bradyarrhythmia from
pneumoperitoneum), H2 blocker
✔✔CO2 benefits - ✔✔- Rapidly absorbed
- Easily eliminated (diffusion coefficient 20x CO2)
- Suppresses combustion
- Readily available
- Inexpensive
✔✔Chemical effects of CO2 - ✔✔- Increase arterial and end tidal CO2
- Decrease serum pH w/ greatest change in first 20 min (SS after 1h)
✔✔Pressure effects of CO2 - ✔✔Pulm
- Reduced functional residual capacity
- Reduced pulmonary compliance
