Download FLS Written questions with answers and more Exams General Surgery in PDF only on Docsity!
FLS |\Written |\questions |\with |\answers
Laparoscope |\diameters |- |\CORRECT |\ANSWERS |\✔✔2-10 |\mm Laparoscope |\lengths |- |\CORRECT |\ANSWERS |\✔✔30-45 |\cm Hopkins |\Rod |\lens |\system |- |\CORRECT |\ANSWERS |\✔✔light |\from |\source |\to |\operative |\field |>> |\capture |\and |\transmit |\reflected |\light |\through |
the |\scope |\and |\camera |\couple |>> |\light |\sensitive |\chip |\in |\the |\camera |
head Decreasing |\ability |\for |\image |\capture |\with |\what |\factors? |- |\CORRECT |
ANSWERS |\✔✔increasing |\length, |\increasing |\angle, |\and |\decreasing |
diameter |(ex: |\ 5 |\mm, |\ 30 |\degree |\scope |\admits |\less |\light |\than |\a |\ 10 |
mm, |\ 0 |\degree |\scope) Laparoscopic |\damage |\susceptibility |\increases |\with |\which |\factors? |- |
CORRECT |\ANSWERS |\✔✔decreasing |\diameter, |\increasing |\length 0 |\degree |\laparocope |\most |\useful? |- |\CORRECT |\ANSWERS |\✔✔when |
structures |\most |\in |\line |\with |\the |\trocars |\and |\in |\small |\places |(deep |
pelvis, |\high |\mediastinum)
30- |\and |\45-degree |\laparocope |- |\CORRECT |\ANSWERS |\✔✔offer |\more |
flexibility/versatility |\than |\ 0 |\degree |(but |\need |\more |\skills) Troubleshooting |\smudge |\on |\laparoscope? |- |\CORRECT |\ANSWERS |
✔✔o |\Wipe |\on |\clean |\tissue |(liver |\or |\bowel) o |\Remove |\scope |\and |\clean |\with |\towel o |\Clean |\port |(newer |\systems |\may |\not |\need |\this |\as |\no |\mechanical |
seal) Warmed/humidified |\CO2 |- |\CORRECT |\ANSWERS |\✔✔decreases |\postop |
pain |\and |\temperature |(compared |\to |\gas |\directly |\from |\cylinder) but |\is |\not |\clinically |\significant |\in |\cases |< |\90min High |\powered |\light |\source |\wattage? |- |\CORRECT |\ANSWERS |\✔✔ 300 |
watt |\Xenon |\lamp "Picture |\in |\Picture" |\feature |- |\CORRECT |\ANSWERS |\✔✔· |\Helpful |\if |
need |\for |\intra-op |\of |\flexible |\endoscopy |\or |\ultrasound |\of |\GI |\or |\GU |
tract, |\liver |\ultrasound, |\hysteroscopy, |\bile |\duct |\exploration o |\Basically |\smaller |\picture |\in |\corner |\to |\show |\scope |\imaging |+ |
additional |\images
Harmonic |\scalpel |- |\CORRECT |\ANSWERS |\✔✔· |\uses |\mechanical |\energy, |\so |\no |\dispersive |\electrode |\needed o |\Little |\lateral |\injury, |\good |\for |\small |\vessels · |\Ligasure |- |\CORRECT |\ANSWERS |\✔✔o |\Bipolar, |\continuous |\waveform, |
measures |\tissue |\impedance |\and |\shuts |\down |\as |\needed o |\single |\application |\is |\sufficient! If |\jewelry |\cannot |\be |\removed, |\then? |- |\CORRECT |\ANSWERS |\✔✔· |\use |
gauze |\and |\tape |\to |\increase |\contact |\area |\and |\to |\minimize |\current |
concentration |
· |\jewelry |\should |\not |\between |\dispersive |\electrode |\and |\surgical |\site Current |\Density |= |- |\CORRECT |\ANSWERS |\✔✔Current |(amps)/Area |
(cm2) Current |\Density |\proportional |\to |- |\CORRECT |\ANSWERS |\✔✔power |(the |\current) Current |\Density |\inversely |\proportional |\to |- |\CORRECT |\ANSWERS |\✔✔o |\tissue |\resistance |\and |\area |\squared o |\Smaller |\the |\contact |\area, |\greater |\the |\current |\density |>> |\faster |
heating
o |\Tip |\of |\electrode |\is |\small, |\so |\contacting |\a |\small |\area |\of |\tissue |
generates |\high |\current |\density dispersive |\pad |(grounding |\pad) |\location |- |\CORRECT |\ANSWERS |\✔✔o |
minimal |\heating |\and |\maintains |\low |\density -- |\don't |\place |\on |\hair, |\bony |\prominence, |\or |\scars |\which |\may |\cause |
decrease |\in |\contact |\surface |\area |\and |\increase |\risk |\of |\burns -close |\to |\surgical |\field, |\near |\vascular |\muscle |\mass |(due |\to |\increased |\water |\content), |\transverse Monopolar |\cutting: |- |\CORRECT |\ANSWERS |\✔✔· |\Circuit |(Electrical |
surgical |\unit) |\ESU |\converts |\low |\frequency |\current |\from |\wall |\unit |\to |
high |\frequency |\current |(active |\electrode |- |\metallic |\portion |\of |
instrument) |\and |\dispersive |\electrode |\connected |\to |\generator o |\Cutting: |\Heat |\tissue |\quickly |\making |\cell |\water |\converted |\to |\steam |\and |\causing |\cell |\to |\explode |--> |\vaporization § |\Heat |\dissipated |\with |\minimal |\lateral |\dispersal, |\poor |\thermal |
coagulation § |\Unmodulated |\waveform |\with |\low |\voltage § |\Electrode |\should |\not |\contact |\tissue |\directly § |\Steam |\bubble |>> |\sensation |\of |\flowing |\thru |\tissue |\with |\little |
resistance
Capacitive |\coupling |- |\CORRECT |\ANSWERS |\✔✔o |\Transfer |\of |\current |
from |\active |\electrode |(monopolar) |\to |\passive |\electrode |(grasper) |\via |
insulation |(plastic |\sheath |\over |\grasper) § |>2 |\conductors |\separated |\by |\insulator § |\Electrode |\are |\metal |\conductors |(metal |\port |\of |\laparoscopic |
instrument) § |>40% |\power |\can |\go |\to |\passive |\electrode § |\Cap |\coupling: |\Occurs |\when |\charge |\in |\active |\electrode |\is |\stored |\in |\passive |\electrode |(capacitor), |\charge |\to |\adjacent |\tissues |\results |\in |
burn. § |\If |\in |\constant |\contact |\with |\tissue |\it |\will |\go |\to |\the |\grounding |\pad |
because |\the |\capacitor |\cannot |\hold |\the |\charge. Direct |\coupling |- |\CORRECT |\ANSWERS |\✔✔o |\When |\electrode |\comes |
into |\contact |\with |\metal |--> |\thermal |\injury o |\If |\L |\shaped |\instrument |"charges" |\shaft |\of |\a |\grasper |\that |\is |\not |
touching |\tissue, |\grasper |\will |\hold |\the |\charge |\and |\release |\the |\stored |\energy |\on |\whatever |\tissue |\is |\touched |\next Narrow |\return |\circuit |- |\CORRECT |\ANSWERS |\✔✔· |\Increases |\local |
tissue |\density |\and |\excessive |\tissue |\heating |\may |\occur |- |\delayed |
perforation |\may |\occur o |\When |\current |\is |\allowed |\to |\pass |\through |\ligated |\tissue |--> |\current |\density |\increases |\in |\logarithmic |\fashion |(e.g. |\applying |\current |\to |
appendiceal |\stump |\leading |\to |\delayed |\perforation |\or |\blow |\out)
Bipolar |- |\CORRECT |\ANSWERS |\✔✔· |\Tissue |\between |\two |\electrodes, |
no |\need |\for |\dispersive |\electrode, |\smaller |\area |(less |\resistance), |\less |
lateral |\tissue |\dispersal |\compared |\to |\monopolar o |\May |\seal |\vessels |\up |\to |\7mm |>> |\denaturation |\of |\collagen |\on |
vessel |\wall, |\creating |\permanent |\seal o |\Some |\have |\cutting |\device |\incorporated |\to |\divide |\the |\vessel |\after o |\Hazards § |\Thermal |\injury § |\Cutting |\patent |\vessels |\before |\sealing § |\Improper |\device |\function |\if |\metal |\within |\jaws Piezoelectric |\transducer |- |\CORRECT |\ANSWERS |\✔✔o |\Converts |
electrical |\energy |\to |\ultrasonic |\vibration |= |\tissue |\heating o |\Torque |\is |\needed o |\Vibration |\seals |\and |\divides |\tissue o |\Shears: |\Vibrating |\jaw |\and |\Passive |\jaw |(acts |\as |\backstop |\to |\trap |
tissue |\against |\active |\blade) |- |\minimal |\heat |\is |\transferred; |\active |
blade |\is |\unprotected! Piezoelectric |\transducer |\power |- |\CORRECT |\ANSWERS |\✔✔o |\50k |\times |\per |\sec |\or |\Hertz o |\Lower |\power |\settings |\lead |\to |\better |\hemostasis; |\higher |\power |
settings |\lead |\to |\better |\cutting
Trocar |\placement |\in |\thin |\patients |- |\CORRECT |\ANSWERS |\✔✔o |
Aortoiliac |\vessels |\may |\be |\in |\close |\proximity |\to |\anterior |\abdominal |
wall |\thus |\elevate |\abdominal |\wall |\or |\place |\Veress |\away |\from |\midline |(along |\coastal |\margin) |\or |\go |\in |\with |\an |\optical |\trocar Absolute |\contraindications |\to |\laparoscopic |\surgery |- |\CORRECT |
ANSWERS |\✔✔Inability |\to |\tolerate |\laparotomy hypovolemic |\shock lack |\of |\proper |\surgeon |\training lack |\of |\institutional/facility |\support Relative |\contraindications |\to |\laparoscopic |\surgery |- |\CORRECT |
ANSWERS |\✔✔Inability |\to |\tolerate |\GETA longstanding |\peritonitis |(as |\likely |\will |\have |\dense |\adhesions |= |
increased |\risk |\of |\injury |\and |\limit |\operative |\exposure) large |\pelvic |\mass |\due |\to |\decreased |\visualization incarcerated |\ventral |\and |\inguinal |\hernias |(challenging |\to |\reduce |
hernia |\and |\can |\lead |\to |\decreased |\peritoneal |\space) severe |\cardiac |\or |\pulm |\disease intolerance |\to |\positioning previous |\abdominal |\surgery** Cirrhosis |\increases |\risk |\of |- |\CORRECT |\ANSWERS |\✔✔· |\bleeding |\and |
ascites |\leakage |\from |\the |\incisions
in |\small |\bowel |\obstruction |\how |\to |\handle |\bowel? |- |\CORRECT |
ANSWERS |\✔✔· |\follow/handle |\areas |\distal |\to |\transition |\point |\to |\avoid |\handling |\distended |\bowel Contraindications |\to |\LSC |\cholecystectomy |- |\CORRECT |\ANSWERS |
✔✔Gallbladder |\cancer, |\portal |\hypertension, |\cirrhosis, |\acute |
cholecystitis, |\Mirizzi |\syndrome |(common |\hepatic |\duct |\obstruction |
from |\EXTRINSIC |\compression |\from |\impacted |\stone |\in |\cystic |\duct |\or |
infundibulum |\of |\gallbladder) Contraindications |\to |\LSC |\Appendectomy |- |\CORRECT |\ANSWERS |
✔✔Large |\abscess, |\phlegmon Contraindications |\to |\LSC |\Emergency |\laparoscopy |- |\CORRECT |
ANSWERS |\✔✔Longstanding |\peritonitis, |\hemodynamic |\instability |
partially |\corrected |\with |\resuscitation, |\massive |\bowel |\dilation Contraindications |\to |\LSC |\Colon |\resection |- |\CORRECT |\ANSWERS |
✔✔Large |\fixed |\mass, |\dense |\pelvic |\adhesions, |\massive |\bowel |
dilation, |\T4 |\tumors Contraindications |\to |\LSC |\Pelvic |\laparoscopy |- |\CORRECT |\ANSWERS |
✔✔large |\fixed |\mass, |\inability |\to |\tolerate |\Trendelenburg
Local |\anesthesia |\hopes |\to |\improve |- |\CORRECT |\ANSWERS |\✔✔parietal |\pain |(peritoneal |\pain |--> |\sharp, |\localized) |\at |\trocar |\sites |(will |\not |
improve |\visceral |\pain |\from |\pneumoperitoneum |\or |\manipulation) Can |\perform |\under |\local |\anesthesia |\or |\IV |\sedation |- |\CORRECT |
ANSWERS |\✔✔diagnostic |\LSC, |\inguinal |\hernia |\repair, |\and |\tubal |
ligation Regional |\anesthesia |(epidural): |\improves |- |\CORRECT |\ANSWERS |\✔✔· |
muscle |\relaxation, |\postop |\analgesia, |\decrease |\ileus, |\decrease |
postoperative |\pain General |\anesthesia |\good |\for |- |\CORRECT |\ANSWERS |\✔✔o |\allows |
complete |\neuromuscular |\relaxation, |\provides |\good |\control |\of |
ventilation, |\allows |\more |\flexibility |\of |\patient |\positioning o |\However, |\leads |\to |\more |\hemodynamic |\changes |\than |\local o |\Premedicated |\with |\benzo |>> |\ease |\anxiety, |\amnesia o |\Atropine |\may |\cause |\bradycardia |\with |\pneumoperitoneum |\thus |
only |\use |\intraoperatively |(not |\prophylactically |\due |\to |\dry |\mouth) |- |
may |\be |\substituted |\with |\glycopyrrolate |\and |\only |\use |\if |\needed Allen |\stirrups |\or |\split |\table |\are |\better |\than |\candycane |- |\CORRECT |
ANSWERS |\✔✔due |\to |\less |\extreme |\angulation
Knees |\should |\be |\kept |\at |\the |\level |\of |\the |\table |- |\CORRECT |\ANSWERS |\✔✔to |\decrease |\risk |\by |\instruments Lateral |\decubitus |\position |- |\CORRECT |\ANSWERS |\✔✔o |\Avoid |\stretch |
on |\brachial |\plexus o |\Roll |\placed |\on |\dependent |\side |\can |\protect |\axilla, |\upper |\arm |\held |
in |\a |\sling, |\bean |\bag |\keeps |\patient |\at |\correct |\angle o |\Beanbag |\padding |\is |\necessary |\to |\prevent |\pressure |\injury o |\Flex |\the |\bed |\when |\operating |\on |\adrenals |\to |\increase |\space |\in |
coastal |\regions Modified |\decubitus |- |\CORRECT |\ANSWERS |\✔✔§ |\Secure |\patient |\to |
table |\to |\avoid |\NM |\injury |\and |\slippage § |\Good |\if |\conversion |\to |\open |\surgery |\is |\needed § |\Commonly |\used |\for: |\Splenectomy, |\nephrectomy, |\and |
adrenalectomy |(good |\for |\procedures |\that |\need |\extraction |\of |\large |
specimens) 10-15mmHg |= |- |\CORRECT |\ANSWERS |\✔✔1-3L |\CO Veress |\needle |- |\CORRECT |\ANSWERS |\✔✔Spring |\loaded |\needle |- |\outer |\sheath |\has |\sharp |\tip |\and |\is |\shorter |\than |\the |\inner |\blunt |\tip, |\inner |
needle |\is |\the |\conduit |\for |\insufflation |\gas
CO2 |\insufflation |--> |\respiratory |\changes |--> |- |\CORRECT |\ANSWERS |
✔✔Increased |\intraabdominal |\pressure |\reduces |\functional |\residual |
capacity |
increases |\peak |\airway |\pressure decreases |\pulmonary |\compliance CV |\changes |\due |\to |\insufflation |- |\CORRECT |\ANSWERS |\✔✔caused |\by: |
pressure |\of |\pneumoperitoneum, |\patient |\position, |\acid |\base |
disturbance |\from |\CO o |\Increased |\pre |\and |\after |\load |--> |\decreased |\cardiac |\output o |\Decreased |\Cardiac |\output |--> |\Cardiac |\index |\is |\decreased o |\Arrhythymias: |\sinus |\tachycardia |(most |\common; |\usually |\mild |\and |
self-limited), |\PVCs |(rarely |\problematic), |\bradycardia |(due |\to |\vagal |
response, |\soon |\after |\pneumoperitoneum |\achieved) Insufflation |\effect |\on |\vena |\cava |- |\CORRECT |\ANSWERS |\✔✔§ |\26-39% |
decrease |\venous |\flow |\rate § |\0.5% |\chance |\of |\VTE
§ |\Patient |\specific: |\Age>40, |\history |\of |\DVT, |\immobility, |\varicose |\veins, |\cancer, |\chronic |\renal |\failure, |\obesity, |\peripartum, |\CHF, |\myocardial |
infarction, |\HRT, |\OCPs, |\multiparity, |\IBD, |\severe |\infection Insufflation |\effect |\on |\renal |\system |- |\CORRECT |\ANSWERS |\✔✔o |
Increased |\intraabdominal |\pressure |\reduces |\renal |\perfusion |\à |
decreased |\filtration |\and |\UOP o |\Release |\in |\renin |\and |\ADH |--> |\free |\water |\and |\salt |\reabsorption |= |
oliguria o |\Intraoperative |\oliguria |\is |\common, |\usually |\resolves |\within |\a |\few |
hours |\postop Hypothermia |\risk |\with |\insufflation |- |\CORRECT |\ANSWERS |\✔✔· |\high |
risk |\with |\longer |\cases |(>90min), |\use |\warm |\or |\humidified |\CO2 |\gas o |\Warm |\IV |\fluids o |\Forced |\air |\body |\surface |\warmer o |\Warm |\room |\temperature o |\Warm |\irrigation |\fluid Gas |\embolism |\risk |\with |\insufflation |- |\CORRECT |\ANSWERS |\✔✔o |
Small, |\asymptomatic |\emboli |\occur |\frequently o |\Symptomatic |\are |\rare |<0.015% |\and |\manifest |\as |\sudden |
cardiovascular |\collapse
more |\expensive |\and |\less |\readily |\available 5mm |\or |\smaller |\do |\not |\require |\closure |\of |\fascia |\except |\in |- |
CORRECT |\ANSWERS |\✔✔pediatric |\patients o |\Most |\common |\sites |\of |\unrecognized |\bleeding |- |\CORRECT |
ANSWERS |\✔✔§ |\Trocar |\injury |\of |\abdominal |\wall |\vessels § |\Injury |\to |\vessels |\or |\organs |\away |\from |\operative |\field |(e.g. |\liver |
and |\spleen) § |\Tamponade |\of |\venous |\bleeding |\by |\pneumo |(which |\is |\why |\you |
have |\to |\drop |\pressure |\before |\closing) Hypercarbia |\is |\influenced |\by |- |\CORRECT |\ANSWERS |\✔✔· |\the |\body's |
buffer |\system, |\patient's |\pulmonary |\system, |\and |\extraperitoneal |
insufflation Diagnostic |\laparoscopy |\for |\trauma |- |\CORRECT |\ANSWERS |\✔✔· |\Not |
performed |\if |\hypotension |\uncorrectable · |\Can |\be |\helpful |\to |\assess |\injury |\and |\reduces |\non-therapeutic |
laparotomy |\rate |(no |\evidence |\of |\increased |\tension |\pneumothorax |
with |\diagnostic |\laparoscopy |\with |\diaphragm |\injury) if |\unknown |\etiology |\with |\possibility |\of |\GI |\etiology |- |\CORRECT |
ANSWERS |\✔✔Can |\start |\on |\left |\side
this |\allows |\maximal |\access |\to |\upper |\and |\lower |\abdomen |(3 |\left |
ports) FNA |- |\CORRECT |\ANSWERS |\✔✔No |\architecture |\information, |\needle |
placed |\percutaneously |(can |\be |\done |\laparoscopically) often |\done |\with |\spinal |\needle, |\20-22 |\gauge, |\plunger |\with |\finger |
loops |\helpful, |\short |\rapid |\strokes Done |\for |\cytology |\examination Core |\needle |\biopsy |- |\CORRECT |\ANSWERS |\✔✔Form |\of |\incisional |
biopsy most |\commonly |\used |\for |\the |\liver |(cirrhosis, |\carcinoma) want |\to |\avoid |\vascular |\lesions |\such |\as |\hemangioma 14-18 |\gauge, |\more |\at |\risk |\for |\bleeding |\than |\FNA
