FLS Exam Questions With 100% Complete Solutions

Rod lense laparoscope - ANS dark or blurry image can occur. - Look at lens end up to light for black spots. - clouded image can also be from moisture in eye piece, can be dried with gauze Light source - ANS 300 watt xenon lamp preop check list - ANS - check that CO2 tank is attached to CO2 supply - if using CO2 tank, open valve to make sure tank is full, spare is available and no gas leaks - check all cables connected correct and securely - check availability of spare equipment - monitor insufflator settings, energy source settings, assist w/ monitor positioning and taking photos Loss of working space - ANS - check insufflator first - if pressure fine, pt may not be appropriately relaxed. - check valve on port conncted to insufflator tubing - check tubing along its entire path - If low pressure but high flow, may be a leak somewhere. - if low pressure and no flow, check insufflator to ensure power is on. check gas level in tanks Monopolar energy - ANS complete circuit low frequency from wall source to high frequency (instrument) - tissue coagulation occurs as a result of tissue heating. protein denaturation. - as tissue temp rises -> dessication tissue heating - ANS current density squared Current density - ANS the amount of current per unit area - current (Amps)/Area (cm2) large area of tissue contact, low current density cutting mode - ANS heat tissue quickly - minimal lateral thermal tissue damage but poor coagulation - low voltage, high frequency coagulation mode - ANS -rapid surface heating, minimal depth - heat more widely dispersed current diversion - ANS following path of least resistance. current passes through unintentional tissue electrosurgical precautions - ANS - inspect insultation carefully - uses lowest possible power setting - use lowest voltage waveform possible - use brief intermittent activation - do not activate unless in proximity to target tissue - do not activate in close proximity with another instrument - use bipolar when possible - do not use hybrid laparoscopic ports that mix metal with plastic. Capacitive coupling - ANS active to passive electrode. two conductors separated by an insulator hazards of bipolar sealing devices - ANS inadvertent thermal injury inadvertent cutting of vessels before adequate sealing improper device function if metal is contained within jaws ultrasonic dissection - ANS uses vibration to seal and divide tissue surgeon ergonomics - ANS - arms no more than 30 degrees abduction from trunk - elbows flexed between 60-120 degrees. ASA risk classification - ANS obese pts - ANS - longer trocars, place perpendicular to abd wall - typical length >100 mm. thin pts - ANS - elevate abd wall - place veress away from midline near costal margin - enter under direct visualization absolute contraindications to laparoscopy - ANS - inability to tolerate laparotomy - hypovolemic shock - lack of proper training - lack of institutional support relative contraindications - ANS - inability to tolerate general anesthesia - long standing peritonitis - large abd or pelvic mass - massive incarcerated hernias - severe cardiopulmonary disease NOT contraindication - ANS - diaphragm injury - GI bleed - perforated viscus - bowel obstruction - abd trauma - ectopic - obesity - COPD - renal insufficiency general anesthesia pre medications - ANS BZD, atropine if needed, glycopyrrolate, H2 blocker, sodium citrate Intraperitoneal check - ANS - loss of resistance with insertion - audible click as inner blunt spring loaded trocarreleases - freely mobile tip - no aspiration of blood - low insufflation pressure with low to medium flow - free flow of saline - hanging drop test - tympany with percussion of abdomen after insufflation pneumoperitoneum - ANS should be 10-15 mmhg which usually requires about 1-3L CO2 CO2 - ANS - rapidly absorbed - easily eliminated - suppresses combustion - readily available - inexpensive CHemical effects of CO2 pneumo - ANS - increase arterial CO2 - increase end tidal CO2 - decrease serum pH - equilibrate after 1 hour - greatest change in first 20 minutes - increased minute ventilation - reduced FRC - increased airway pressure and reduced pulm compliance -