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FLS |\Modules |\exam |\with |\correct |\answers
Laproscopic |\instruments |\diameter |\and |\length |\ranges |- |\CORRECT |
ANSWERS |\✔✔2-10mm, |\30-45cm hopkins |\rod |\lens |- |\CORRECT |\ANSWERS |\✔✔light |\has |\to |\travel |\back |
through |\the |\rod |\to |\capture |\the |\image. decreasing |\light |\in |\the |\camera |\for... |- |\CORRECT |\ANSWERS |
✔✔decreasing |\diameter, |\increasing |\scope |\angle |(ie |\5mm |\and |\ 30 |
degree |\has |\less |\light |\than |\10mm |\ 0 |\degree) When |\is |\zero |\degree |\scope |\most |\useful |- |\CORRECT |\ANSWERS |
✔✔when |\working |\in |\a |\small |\area |\directly |\in |\line |\with |\the |\scope |\and |\ports, |\like |\the |\pelvis how |\to |\check |\fiber |\optics |\light |\connection |- |\CORRECT |\ANSWERS |
✔✔black |\dots= |\broken |\fibers why |\does |\it |\fog |\up? |- |\CORRECT |\ANSWERS |\✔✔temperature |\and |
humidity |\discrepancy |\between |\the |\OR |\and |\body
tools |\for |\defogging |- |\CORRECT |\ANSWERS |\✔✔FRED |\antifog |(must |\dry |\before |\putting |\back |\in), |\put |\laparoscope |\in |\hot |\water methods |\to |\clean |\a |\smudged |\lens |- |\CORRECT |\ANSWERS |\✔✔gently |
wipe |\on |\clean |\tissue |(liver, |\uterus, |\bowel), |\remove |\scope |\and |\clean |
with |\hot |\water |\and |\gauze Insufflation |\gas |\type |\and |\reasoning |- |\CORRECT |\ANSWERS |\✔✔CO2- |
readily |\available, |\inexpensive, |\non |\combustable, |\warmed |\and |
humidified |\better high |\flow |\insufflation |- |\CORRECT |\ANSWERS |\✔✔ 10 |\or |\more |\L |\per |
minute preventing |\loss |\of |\pneumo |\with |\suctioning |- |\CORRECT |\ANSWERS |
✔✔keep |\suction |\tip |\below |\the |\fluid |\level most |\common |\light |\source |- |\CORRECT |\ANSWERS |\✔✔300W |\xenon |
lamp Troubleshooting |\steps: |\gas |\preOP |- |\CORRECT |\ANSWERS |\✔✔1. |\check |
that |\co2 |\tank |\is |\full |\
- |\check |\co2 |\tank |\gasket |\is |\secured |\
- |\check |\that |\spare |\co2 |\tank |\is |\available |\in |\the |\OR
troubleshooting |\steps: |\loss |\of |\working |\space: |\insufflator |\settings: |
low |\pressure |\and |\no |\flow |- |\CORRECT |\ANSWERS |\✔✔1. |\make |\sure |
that |\the |\insufflator |\power |\is |\on |\
- |\check |\gas |\level |\in |\the |\tank troubleshooting |\steps: |\loss |\of |\working |\space: |\complete |\loss |\of |
operative |\image |- |\CORRECT |\ANSWERS |\✔✔1. |\check |\for |\disconnected |
power |\cords, |\video |\cables - |\check |\for |\blown |\light |\source |\bulb
- |\check |\for |\disconnected |\light |\cable Monopolar |\electrosurgery |\curcuit |- |\CORRECT |\ANSWERS |\✔✔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 |- |\CORRECT |\ANSWERS |\✔✔occurs |\as |\a |
result |\of |\tissue |\heating |\and |\protein |\denaturation. monopolar: |\desiccation |- |\CORRECT |\ANSWERS |\✔✔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 |- |\CORRECT |\ANSWERS |\✔✔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 |- |\CORRECT |\ANSWERS |\✔✔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 |- |\CORRECT |\ANSWERS |\✔✔rapid |\surface |
heating, |\shallow |\depth |\of |\necrosis- |\fulguration. |\intermittent |\wave |
with |\high |\voltage |\
bipolar |\hazards: |\inadvertent |\thermal |\injury |- |\CORRECT |\ANSWERS |
✔✔avoid |\activating |\the |\device |\in |\close |\proximity |\to |\adjacent |\organs bipolar |\hazards: |\inadvertent |\cutting |\of |\vessels |\before |\adequate |
sealing |- |\CORRECT |\ANSWERS |\✔✔make |\sure |\to |\complete |\entire |
activation |\cycle |\prior |\to |\cutting bipolar |\hazards: |\improper |\functioning |\if |\metal |\is |\within |\the |\jaws |- |
CORRECT |\ANSWERS |\✔✔including |\clips |\or |\staples ultrasonic |\dissection |- |\CORRECT |\ANSWERS |\✔✔mechanical |\energy |
converted |\to |\high |\frequency |\ultrasonic |\vibration ultrasonic |\shears |- |\CORRECT |\ANSWERS |\✔✔consist |\of |\vibrating |\jaw |
or |\blade |\and |\a |\passive |\jaw. |\the |\passive |\jaw |\acts |\as |\a |\backstop |\to |
trap |\tissue |\against |\the |\active |\blade. |
active |\blade |\is |\unprotected |\and |\can |\damage |\tissue |\during |\or |\after |
use warfarin |\discontinue |\time |- |\CORRECT |\ANSWERS |\✔✔ 3 |\days
important |\history |\to |\consider |\preOP |(5) |- |\CORRECT |\ANSWERS |\✔✔1. |
history |\of |\DVT/PE
- |\hx |\radiation
- |\hx |\hip |\prosthetics
- |\sig |\cardiopulmonary |\conditions |(important |\to |\continue |
throughout |\preoperative |\period) - |\need |\for |\stress |\dose |\steroids NSAIDs |\including |\ASA |- |\CORRECT |\ANSWERS |\✔✔do |\not |\need |\to |\be |
discontinued ASA |\level |\not |\appropriate |\for |\lap |\surgery |- |\CORRECT |\ANSWERS |
✔✔4-5, |\might |\not |\be |\able |\to |\tolerate |\pneumoperitoneum |\due |\to |
decreased |\venous |\return |\and |\need |\for |\hyperventilation obese |\patients: |\trocar |\insertion |- |\CORRECT |\ANSWERS |\✔✔use |\of |
longer |\trocars |(up |\to |\100mm) thin |\patients: |\trocar |\insertion |- |\CORRECT |\ANSWERS |\✔✔1. |\elevate |
abdomen - |\consider |\placing |\veress |\needle |\away |\from |\the |\midline |\near |\the |
costal |\margin - |\consider |\utilizing |\open |\approach |\or |\visiport |\for |\direct |
visualization
- |\umbilical |\abnormalities |(difficulty |\gaining |\access |\or |\closing |\fascia)
- |\previous |\ventral |\hernia |\repair |\with |\mesh |(risk |\of |\difficult |\entry, |
closing |\abdominal |\wall) - |\hepatosplenomegaly |(risk |\of |\solid |\organ |\injury)
- |\cirrhosis |(risk |\of |\bleeding |\and |\post |\op |\ascites)
- |\intestinal |\obstruction |(risk |\of |\eneteromy |\and |\decreased |
visualization) - |\pregnancy |\
- |\thin |\body |\habitus lap |\cholecystectomy |\relative |\contraindications |(5) |- |\CORRECT |
ANSWERS |\✔✔1. |\gallbladder |\cancer - |\portal |\HTN
- |\cirrhosis
- |\acute |\cholecystitis
- |\mirizzi |\syndrome lap |\colon |\resection |\relative |\contraindications |(4) |- |\CORRECT |
ANSWERS |\✔✔1. |\large |\fixed |\mass - |\dense |\pelvic |\adhesions
- |\massive |\bowel |\dilation
- |\t4 |\tumors
lap |\appendectomy |\relative |\contraindications |(2) |- |\CORRECT |
ANSWERS |\✔✔1. |\phlegmon
- |\large |\abscess emergency |\laparoscopy |\relative |\contraindications |(3) |- |\CORRECT |
ANSWERS |\✔✔1. |\longstanding |\peritonitis - |\hemodynamic |\instability |\paritally |\correctable |\with |\resuscitation
- |\massive |\bowel |\dilation pelvic |\laparoscopy |\relative |\contraindications |(2) |- |\CORRECT |\ANSWERS |\✔✔1. |\large |\fixed |\mass
- |\inability |\to |\tolerate |\trendelenberg lap |\foregut |\procedures |\relative |\contraindications |(2) |- |\CORRECT |
ANSWERS |\✔✔1. |\previous |\gastric |\operation |\at |\GE |\juntion - |\hepatosplenomegaly lap |\antireflux |\surgery |\relative |\contraindications |(5) |- |\CORRECT |
ANSWERS |\✔✔1. |\esophogeal |\shortening - |\epithelial |\dysplasia
- |\previous |\gastric |\surgery |\at |\GE |\juntction
- |\liver |\enlargement
- |\large |\hiatal |\hernia
- |\FHT |\pre- |\and |\post-op lap |\SBO |\precautions |- |\CORRECT |\ANSWERS |\✔✔need |\to |\use |\a |\direct |
visualization |\entry epidural |\anesthesia |- |\CORRECT |\ANSWERS |\✔✔can |\be |\an |\adjunct |\to |
GA, |\and |\can |\provide |\improved |\muscle |\relaxation, |\post |\op |
anesthesia, |\and |\decrease |\duration |\of |\post-op |\ileus pre-op |\meds |\for |\GA |- |\CORRECT |\ANSWERS |\✔✔1. |\benzo- |\ease |\anxiety |\and |\cause |\amnesia - |\atropine- |\may |\prevent |\Brady |\arrhythmias |\caused |\by |
pneumoperitoneum |(but |\causes |\dry |\mouth) - |\glycopyrrelate- |\as |\above |\but |\less |\dry |\mouth
- |\H2 |\blocker |\or |\sodium |\citrate- |\minimize |\effects |\of |\aspiration |
should |\it |\occur untucked |\arm |\position |- |\CORRECT |\ANSWERS |\✔✔do |\not |\abduct |\
90degrees, |\to |\avoid |\a |\brachial |\plexus |\injury tucked |\arms |- |\CORRECT |\ANSWERS |\✔✔make |\sure |\to |\avoid |\hand |
injury |\if |\table |\is |\flexed |\during |\operation
allen |\stirrups |- |\CORRECT |\ANSWERS |\✔✔better |\than |\candy |\cane |\as |
they |\have |\better |\individualization, |\especially |\in |\longer |\procedures veress |\needle |- |\CORRECT |\ANSWERS |\✔✔spring |\loaded |\needele |\with |
a |\sharp |\tip |\and |\a |\conduit |\for |\the |\insufflation |\of |\gas veress |\needle |\insertion |\places |- |\CORRECT |\ANSWERS |\✔✔umbillicus |
and |\LUQ veress |\needle |\intraperitoneal |\check |- |\CORRECT |\ANSWERS |\✔✔1. |\most |\accurate |\method |\is |\connecting |\insufflation, |\initiate |\gas |\at |\low |\flow, |\if |\pressure |\is |\low |\and |\co2 |\flows--> |\correct |\position
- |\aspiration |\with |\syringe |\to |\make |\sure |\not |\in |\vessel |\or |\GI |\tract, |
then |\inject |\saline |\and |\water |\should |\flow |\with |\little |\resistance - |\saline |\drop |\test
- |\percussion |\of |\abdomen |\after |\insufflation desired |\intraabdominal |\pressure |\and |\how |\much |\co2 |- |\CORRECT |
ANSWERS |\✔✔10-15 |\mmHg 1-3 |\L |\Co suggested |\step |\if |\utilizing |\palmer's |\point |- |\CORRECT |\ANSWERS |
✔✔NG |\for |\gastric |\decompression
- |\blunt |\tip |\trochar |\is |\inserted |\under |\direct |\visualization |\and |
secured |\to |\the |\fascia |\with |\the |\stay |\sutures things |\to |\monitor |\with |\co2 |\pneumoperitoneum |(6) |- |\CORRECT |
ANSWERS |\✔✔1. |\cardiac |\rhythm - |\pulse |\ox
- |\end |\tidal |\co
- |\heart |\rate
- |\BP
- |\urine |\output CO2 |\chemical |\effects |- |\CORRECT |\ANSWERS |\✔✔1. |\increases |\arterial |
co2 |\concentration--> |\drop |\in |\serum |\pH - |\increases |\end |\tidal |\co2 |(greatest |\change |\In |\the |\first |\ 20 |\minutes) pulmonary |\physiology |\with |\co2 |\pneumo |- |\CORRECT |\ANSWERS |\✔✔1. |\increased |\minute |\ventilation |\to |\eliminate |\absorbed |\CO
- |\reduced |\functional |\residual |\capacity |(because |\of |\increased |\intra- abominal |\pressure)
- |\increased |\peak |\airway |\pressure
- |\reduced |\pulmonary |\compliance
overview |\of |\cardiovascular |\effects |\of |\co2 |\pneumo |- |\CORRECT |
ANSWERS |\✔✔1. |\systemic |\vascular |\changes
- |\cerebral |\auto |\regulation |\of |\blood |\flow
- |\vagal |\responsiveness |\to |\reverse |\trendenenberg
- |\increased |\venous |\stasis |\because |\of |\pressure |\in |\peritoneum |(need |\for |\use |\of |\VTE |\ppx) Alternative |\gases: |\NO |- |\CORRECT |\ANSWERS |\✔✔benefits: |\less |\acid- base |\disturbance, |\increased |\patient |\tolerability |\in |\patients |\with |
severe |\cardio |\pulmonary |\disease, |\less |\post |\op |\pain risks: |\fire |\hazard |\with |\electrocautery, |\cannot |\be |\used |\with |
suspected |\bowel |\perf alternative |\gases: |\Argon |\and |\Helium |- |\CORRECT |\ANSWERS |
✔✔eliminate |\the |\complication |\of |\acidosis, |\but |\are |\much |\less |\soluble |\in |\blood. |\Decreased |\solubility |\increases |\the |\risk |\of |\extra-peritoneal |
gas |\extravasation |(gas |\embolus) cardiovascular |\effects |\of |\pneumo |- |\CORRECT |\ANSWERS |\✔✔1. |
increased |\preload - |\increased |\afterload
- |\decreased |\CO
hypothermia |\related |\to |\pneumo |- |\CORRECT |\ANSWERS |\✔✔use |
humidified |\and |\warmed |\gas, |\warm |\IVF, |\bear |\hugger, |\warm |
irrigation, |\warm |\air |\temp extraperitoneal |\gas |\extravasation |\can |\cause |(4) |- |\CORRECT |\ANSWERS |\✔✔1. |\subcutaneous |\gas
- |\thoracic |\gas
- |\delayed |\co2 |\toxicity
- |\gas |\embolus gas |\embolus |- |\CORRECT |\ANSWERS |\✔✔- |\occurs |\in |\less |\than |\1% |\of |
cases
- |\diagnosis: |\sudden |\CV |\collapse |\due |\to |\impaired |\venous |\return |\to |
the |\heart. |\JVD, |\hypotension, |\tachycardia, |\mill |\wheel |\murmur -treatment: |\cessation |\of |\insufflation, |\fluid |\administration, |
trendelenberg |\with |\L |\side |\down |\position |\prevent |\embolus |\from |
traveling, |\central |\line |\into |\Right |\heart |\to |\break |\up |\embolus most |\common |\sources |\of |\unrecognized |\bleeding |(3) |- |\CORRECT |
ANSWERS |\✔✔1. |\trocar |\injury |\to |\abdominal |\wall |\vessels
- |\injury |\to |\vessels |\or |\organs |\away |\from |\the |\operative |\field
- |\tamponade |\of |\venous |\bleeding |\by |\pnuemo First |\lap |\appy |- |\CORRECT |\ANSWERS |\✔✔ 1980 |\by |\Semm |(GYN |\Doc)
First |\lap |\chole |- |\CORRECT |\ANSWERS |\✔✔Eric |\muhe |\ 1985 visualizing |\liver |- |\CORRECT |\ANSWERS |\✔✔use |\angled |\scope, |\look |\for |
macronodularity |\associated |\with |\cirrhosis, |\can |\use |\ultrasound anterior |\abdominal |\wall |\dx |\lap |- |\CORRECT |\ANSWERS |\✔✔to |\look |\for |
post |\op |\bleeding, |\adhesions, |\hernia |\or |\tumor. |\use |\angled |\scope. dx |\lap |\for |\suspected |\appy |- |\CORRECT |\ANSWERS |\✔✔tuck |\left |\or |\both |\arms, |\surgeon |\and |\assisteant |\to |\both |\stand |\on |\left. |\trendelenberg |
with |\left |\tilt examining |\the |\small |\bowel |- |\CORRECT |\ANSWERS |\✔✔two |\monitors, |
one |\at |\head |\and |\one |\at |\feet. |(left |\shoulder |\and |\right |\hip). |\ports |\all |
on |\L |\side |\of |\abdomen. |\systematic |\examination |\of |\the |\bowel |\from |
one |\end |\to |\the |\next. |\use |\graspers |\for |\atraumatic |\handling. |\handle |
mesenteric |\fat |\as |\opposed |\to |\bowel |\wall. |\start |\at |\ileocecal |\valve |\for |\SBO exposure |\of |\retroperitoneal |\structures |- |\CORRECT |\ANSWERS |\✔✔- |
spleen, |\kidneys, |\adrenals
- |\lateral |\or |\semilateral |\positioning |\for |\structures |\above |\iliac |
bifurcation
