23.IR and IE/24.Lap and thoracoscopy

Question 1

What is the maximum insuflation of the abdomen with CO2

a. 10 mmhg
b. 12 mmhg
c. 15 mmhg
d. 17 mmhg

Answer 1

c 15 (but 10-12 is generally recommended)

8-10 mm Hg generally enough working space
14 cm H20 per the anesthesia for procedures chapter

Question 2

What is false about Veress needles?
A) It contains a spring loaded trochar.
B) It is used to create a pneumothorax
C) It is used to create a pneumoperitoneum
D) It can be used to directly penetrate the abdomen without any incisions.

Answer 2

D false

Question 3

Which of the following is true regarding abdominal access?
A The modified Hasson technique involves the use of a veress needle with a hanging drop
B Improper placement of a needle into the subcutaneous space will not result in SQ emphysema
C Initial intraabdominal pressure >6mmHg and low CO2 flow indicates malpositioning, likely in the SQ
D Falciform fat visualization is not a confirmatory mechanism of being within the abdomen

Answer 3

C is correct

A (false, blunt trochar with Hasson)

Question 4

True or false: insufflation is not necessary for thoracoscopy

Answer 4

(TRUE)

Question 5

What are the most common port sizes for laparoscopy?
A. 5 and 10mm 
B. 4 and 12mm 
C. 5 and 12 mm 
D. 4 and 10mm

Answer 5

5 and 12mm

Question 6

Which of the following statements is true?
A Drainage catheters are only available in non-locking loop conformations
B Guiding catheters are named for their inner diameter.
C Low pressure occlusion balloons are filled with contrast and used to dilate and efface strictures
D Locking loop or Cope loop catheters are preferred because of suture locking mechanism to secure the loop

Answer 6

D is true

A (also locking loop)
B(OUTER)
C (HIGH pressure)

Question 7

Which of the following materials is reconstrainable?

a. Woven stents
b. Laser cut stents
c. Permanent metallic embolics
d. Polyvinyl alcohol embolic

Answer 7

c designed to fit anatomy

few exceptions with the Laser cut
mesh self-expanding also reconstrainable

Question 8

what is the preferred light source for -scopy?

Answer 8

Xenon

Question 9

Which of the following is NOT a feature of using CO2 for insufflation?

a. Rapidly excreted from circulation
b. Low solubility means there is a risk of gas emboli
c. Detrimental effects on cellular, hormonal and immunologic function
d. cheap and odorless

Answer 9

B. Highly soluble = low risk

Question 10

true/false: Woven or braided stents are reconstrainable

Answer 10

false
Mesh self-expanding are

woven and laser cut are NOT reconstrainable

Question 11

T/F

The Ho:YAG laser is used for extracorporeal lithotripsy

Answer 11

False
INTRAcorporeal - stone fragmentation and retrieval
can also be used for cutting and coagulation

Question 12

t/f: Iohexal is a Low-osmolarity, nonionic, iodinated contrast media

Answer 12

true

Question 13

True/false: Polyvinyl alcohol and NBCA are types of liquid embolics

Answer 13

False: polyvinyl alcohol comes in amorphous, granular or spherical forms (permanent particulate). Glue = NBCA = liquid

Question 14

T/F concerning MIS?
Bipolar electrocautery should be used with great caution compared to monopolar, as several potentially hazardous problems can occur.

Answer 14

False caution with monopolar

• (Bipolar) electrosurgery is safer because it is usually of lower voltage current and energy passed between the tips

Question 15

T/F: A defect in the insulation of the bipolar instrument shaft can result in the passage of current to tissues that are not in the visual field, leading to iatrogenic injury.

Answer 15

False:(monopolar)

Question 16

T/F: Direct coupling injuries can occur when the monopolar instrument through which the electrical current is passed comes into contact with the telescope or other instrument, resulting in iatrogenic damage to tissues that may lie outside the visual field.

Answer 16

true

Question 17

True or false: 3 chip cameras provide superior optical clarity and each process one color, red, blue, and yellow.

Answer 17

False: 3 chip = better, colors = red, blue, and GREEN

Question 18

What pressure can cause cardiorespiratory depression in the thoracic cavity?

Answer 18

3 mm Hg

Question 19

how can one lung ventilation be accomplished? (3)

Answer 19

selective intubation
bronchial blockers
double lumen endobronchial intubation

Question 20

Which of the following is true for hemostasis/sealing in MIS?
A. Disposable hemostatic clips are more cost-effective than M/L-10 reusable multifire hemoclip applier
B. One of the strongest slip knots is the 4S modified Roeder knot
C. Vessel sealing devices work by application of monopolar or ultrasonic energy
D.For the ligasure thermal spread ranged from 1.5 to 3.2 and decreased as vessel size increased

Answer 20

A. more cost-effective = M/L-10 reusable multifire hemoclip applier
B. true
C. Vessel sealing devices=BIPOLAR or ultrasonic energy
D.For the ligasure thermal spread ranged from 1.5 to 3.2 and dIS GREATER as vessel size increased

Question 21

True?
A. A hanging drop is used with the Hasson technique
B. The Veress needle technique can be used paramedian with little risk
C. Upon establishment of a pneumoperitoneum, the abdominal cavity should be tympanic
D. A blunt trochar is needed to penetrate the abdomen after using a verress needle

Answer 21

A. A hanging drop is used with the Veress needle
B. The Hasson technique can be used paramedian but it can be difficult to prevent leakage
C. true
D. A sharp trochar Could Be Used to penetrate the abdomen after using a verress needle (inflated)