FLS Modules Exam With Complete Solutions!!!

Laproscopic instruments diameter and length ranges - ANS 2-10mm, 30-45cm hopkins rod lens - ANS light has to travel back through the rod to capture the image. decreasing light in the camera for... - ANS decreasing diameter, increasing scope angle (ie 5mm and 30 degree has less light than 10mm 0 degree) When is zero degree scope most useful - ANS when working in a small area directly in line with the scope and ports, like the pelvis how to check fiber optics light connection - ANS black dots= broken fibers why does it fog up? - ANS temperature and humidity discrepancy between the OR and body tools for defogging - ANS FRED antifog (must dry before putting back in), put laparoscope in hot water methods to clean a smudged lens - ANS gently wipe on clean tissue (liver, uterus, bowel), remove scope and clean with hot water and gauze Insufflation gas type and reasoning - ANS CO2- readily available, inexpensive, non combustable, warmed and humidified better high flow insufflation - ANS 10 or more L per minute preventing loss of pneumo with suctioning - ANS keep suction tip below the fluid level most common light source - ANS 300W xenon lamp Troubleshooting steps: gas preOP - ANS 1. check that co2 tank is full 2. check co2 tank gasket is secured 3. check that spare co2 tank is available in the OR troubleshooting steps: image - ANS 1. check that the monitor is plugged in and turned on 2. check that all cables are connected securely troubleshooting steps: loss of working space: insufflator settings: measured pressure is the same or higher than the preset pressure - ANS 1. the patient may not be adequately relaxed or there is a mechanical block of gas flow 2. inspect abdomen for rhythmic muscle contraction and palpate the abdomen for firmness 3. check port valves to make sure they are open 4. check for kinks in tubing and make sure no one is standing on them troubleshooting steps: loss of working space: insufflator settings: low pressure and high flow rate - ANS 1. there is a leak in the insufflation circuit 2. check that the tubing has not become disconnected from insufflator or port 3. check that all valves are closed 4. check all port sites for leaking co2 5. check for foley catheter bag distention or bowel distention troubleshooting steps: loss of working space: insufflator settings: low pressure and no flow - ANS 1. make sure that the insufflator power is on 2. check gas level in the tank troubleshooting steps: loss of working space: complete loss of operative image - ANS 1. check for disconnected power cords, video cables 2. check for blown light source bulb 3. check for disconnected light cable Monopolar electrosurgery curcuit - ANS electrical surgical unit--active electrode--patient tissue--dispersive electrode (grounding pad) low frequency from wall source to high frequency at active electrode monopolar: tissue coagulation - ANS occurs as a result of tissue heating and protein denaturation. monopolar: desiccation - ANS tissue temp rises---water is evaporated from the tissue-- increased impedance--- electricity stops flowing because of increased resistance--tissue turns brown, bubbles and steams. Hemostasis due to fibrous binding between dehydrated, denatured cells of vessel endothelium monopolar: current density - ANS amount of current flowing through cross sectional area. directly proportional to power, inversely related to tissue resistance ie larger the area, less current density monopolar: cut mode - ANS heat tissue quickly. cell water is converted to steam, causing the cell to explode. minimal later thermal tissue damage, but poor thermal coagulation. unmodulated waveform with low voltage. electrode should not contact tissue directly. monopolar: coag mode - ANS rapid surface heating, shallow depth of necrosis- fulguration. intermittent wave with high voltage significant cutting does not occur because heat is more widely dispersed potential hazards of laparoscopic monopolar: current diversion - ANS risk of current diversion. current follows path of least resistance and can pass through unintentional tissue potential hazards of laparoscopic monopolar: capacitive coupling - ANS transfer of current from an active electrode through its insulation to a passive electrode. active electrode (such as monopolar hook) can give a charge if it touches a grasper or camera briefly, they store energy, then they contact tissue and injure it bipolar definition - ANS tissue is placed between two electrodes. current flows only through the tissue contiguous with both electrodes. lower energy requirement, less lateral tissue damage. Can seal vessels up to 7mm bipolar energy delivery - ANS computer measures tissue impedance of grasped tissue--.controlled energy delivery-- denaturation of collagen--creation of permanent seal bipolar hazards: inadvertent thermal injury - ANS avoid activating the device in close proximity to adjacent organs