FLS Modules Latest Update -

FLS Modules Latest Update - Exam 360 Questions with 100% Verified Correct Answers with Guaranteed A+ Verified by Professor absolute contraindications to blind veress needle insertion points - CORRECT

ANSWER: 1. insertion into abdominal scar from prior open operation

• through previously placed intraperitoneal mesh for hernia repair

allen stirrups - CORRECT ANSWER: better than candy cane as they have better

individualization, especially in longer procedures

alternative gases: Argon and Helium - CORRECT ANSWER: eliminate the complication of acidosis, but are much less soluble in blood. Decreased solubility increases the risk of extra-peritoneal gas extravasation (gas embolus)

Alternative gases: NO - CORRECT ANSWER: 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

anterior abdominal wall dx lap - CORRECT ANSWER: to look for post op bleeding,

adhesions, hernia or tumor. use angled scope.

ASA level not appropriate for lap surgery - CORRECT ANSWER: 4-5, might not be able to tolerate pneumoperitoneum due to decreased venous return and need for hyperventilation

benefits of braided suture - CORRECT ANSWER: easier to handle, lack elastic

memory, don't fray 1 / 4

biopsy forceps - CORRECT ANSWER: for incisional or excisional, or peritoneal

implants.

biopsy methods and what to avoid - CORRECT ANSWER: 1. peritoneal washings

2. FNA

• Core needle
• incisional (wedge)
• excisional

avoid electrocautery

biopsy of visceral lesions - CORRECT ANSWER: if small and superficial can excise, use serosal stitch to avoid leakage

bipolar definition - CORRECT ANSWER: 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 - CORRECT ANSWER: computer measures tissue impedance

of grasped tissue--.controlled energy delivery--> denaturation of collagen-->creation of permanent seal

bipolar hazards: improper functioning if metal is within the jaws - CORRECT ANSWER: including clips or staples

bipolar hazards: inadvertent cutting of vessels before adequate sealing - CORRECT ANSWER: make sure to complete entire activation cycle prior to cutting 2 / 4

bipolar hazards: inadvertent thermal injury - CORRECT ANSWER: avoid activating the device in close proximity to adjacent organs

cardiac arrhythmia due to pneumoperitoneum (3) - CORRECT ANSWER: 1. sinus tach

(most common, self limited)

• PVCs
• bradycardia (due to pressure effect, vagally mediated)

cardiovascular effects of pneumo - CORRECT ANSWER: 1. increased preload

• increased afterload
• decreased CO

choice of staple height - CORRECT ANSWER: 1. vascular: 2-2.5mm

• GI tract 3-3.5 mm
• distal stomach or thickened GI tract 4-4.5 mm

CO2 chemical effects - CORRECT ANSWER: 1. increases arterial co2 concentration--> drop in serum pH

• increases end tidal co2 (greatest change In the first 20 minutes)

complications of veress needle insertion (8) - CORRECT ANSWER: 1. bowel injury

• mesenteric or omental vascular injury
• retroperitoneal vascular injury
• cardiac arrhythmia
• hypotension
• high airway pressures
• pneumothorax 3 / 4

• gas embolism

contraindications to laparoscopy: absolute (4) - CORRECT ANSWER: 1. inability to tolerate laparotomy

• hypovolemic shock
• lack of proper surgical training
• lack of appropriate institutional support

contraindications to laparoscopy: relative (5) - CORRECT ANSWER: 1. inability to tolerate general anesthesia

• long standing peritonitis (can increase risk of injury on trocar insertion)
• large abdominal or pelvic mass
• massive incarcerated ventral and inguinal hernias (can have loss or peritoneal space)
• severe cardiopulmonary disease (intolerance to proper positioning)

R/B ratio dictates

core needle biopsy - CORRECT ANSWER: most commonly used for liver biopsy but

should not be used for vascular lesions like hemangioma. 14-18gauge needle. more risk for bleeding compared to FNA

decrease in CO - CORRECT ANSWER: Exacerbated by reverse trendelenburg and

hypovolemia. may be caused by vagally induced bradycardia

decreasing light in the camera for... - CORRECT ANSWER: decreasing diameter,

increasing scope angle (ie 5mm and 30 degree has less light than 10mm 0 degree)

desired intraabdominal pressure and how much co2 - CORRECT ANSWER: 10-15

mmHg

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