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FLS GUIDE QUESTIONS WITH CORRECT ANSWERS, Exams of Advanced Education

Illinois State University (ISU)Advanced Education

FLS GUIDE QUESTIONS WITH CORRECT ANSWERS

Typology: Exams

2024/2025

Available from 07/07/2025

johniewalker91
johniewalker91 🇺🇸

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FLS GUIDE
Smaller tissue area, greater current density and faster heating - answere.g. Bovie tip
Cut mode - answer- Low voltage
- High frequency
- Continuous waveform
- Heats tissue quickly; cell water converts to steam and causes cell to explode
Coagulation mode - answer- High voltage
- Low frequency
- Intermittent waveform
- Rapid tissue heating, shallow depth of necrosis
- Non-contact: relies on sparking to tissue
Capacitive coupling - answer Transfer current from active electrode through insulation
to passive electrode- electrode to plastic part another LSC instrument
- if constant contact w/ tissue will not store energy and no injury
Direct coupling – answer monopolar instrument in direct contact w/ metal portion of
another instrument
Besides capacitive coupling and direct coupling, other hazards of electrocautery -
answer- Current diversion
- Narrow return circuit
Bipolar - answer- forceps w/ two twins (one active other return)
- no pt return electrode required)
- no capacitative coupling
- works in "wet" operative field
- less thermal spread compared to monopolar
bipolar seals vessels up to _____ mm in diameter - answer7 mm
ultrasonic coagulation shears seals vessels up to ____ mm in diameter - answer5 mm
ultrasonic coagulation shears - answer- combo compression and friction
- ONE active blade
- monopolar capacity w/ the one blade
- no capacitative coupling
- high power (MAX): cut
- low power (MIN): coag
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FLS GUIDE

Smaller tissue area, greater current density and faster heating - answere.g. Bovie tip Cut mode - answer- Low voltage

  • High frequency
  • Continuous waveform
  • Heats tissue quickly; cell water converts to steam and causes cell to explode Coagulation mode - answer- High voltage
  • Low frequency
  • Intermittent waveform
  • Rapid tissue heating, shallow depth of necrosis
  • Non-contact: relies on sparking to tissue Capacitive coupling - answer Transfer current from active electrode through insulation to passive electrode- electrode to plastic part another LSC instrument
  • if constant contact w/ tissue will not store energy and no injury Direct coupling – answer monopolar instrument in direct contact w/ metal portion of another instrument Besides capacitive coupling and direct coupling, other hazards of electrocautery - answer- Current diversion
  • Narrow return circuit Bipolar - answer- forceps w/ two twins (one active other return)
  • no pt return electrode required)
  • no capacitative coupling
  • works in "wet" operative field
  • less thermal spread compared to monopolar bipolar seals vessels up to _____ mm in diameter - answer7 mm ultrasonic coagulation shears seals vessels up to ____ mm in diameter - answer5 mm ultrasonic coagulation shears - answer- combo compression and friction
  • ONE active blade
  • monopolar capacity w/ the one blade
  • no capacitative coupling
  • high power (MAX): cut
  • low power (MIN): coag

warfarin is to be discontinued ____ days prior to surgery - answer3 days mild to moderate systemic disease - answerASA 2 severe systemic disease that limits patient activity, may or may not be related to reason for surgery - answerASA 3 severe systemic disturbances that limit patient and are life-threatening with or without surgery - answerASA 4 Little change for survival but surgery last resort (resuscitative effort) - answerASA 5 ASA classes that may not be appropriate for LSC sx - answerASA 4 and 5

  • body cannot handle decreased venous return, need for hyperventilation Length of trocar needed for obese pt - answer>100 mm ABSOLUTE C/I to LSC - answer- Inability to tolerate laparotomy
  • Hypovolemic shock
  • Lack proper surgeon training/experience
  • Lack appropriate institutional support Relative C/I to LSC - answer- Inability to tolerate GETA
  • Long-standing peritonitis
  • Large abd/pelvic mass
  • Massive incarcerated ventral and inguinal hernias
  • Severe cardiopulmonary dz NOT C/I to LSC - answer- Diaphragm injury
  • GI bleed
  • Performed viscus
  • Bowel obstruction
  • Abd trauma if HD stable
  • COPD
  • Renal insufficiency Preop precautions - answerBe aware of
  • Visceral arterial aneurysm (risk injury w/ trocar insertion)
  • prior ventral hernia repair w/ mesh (NO blind entry w/ veress or trocar through mesh!)
  • H/o peritonitis (risk adhesions and enterotomy)
  • Cirrhosis (increased risk of bleeding and ascites leak through ports/wounds)
  • Intestinal obstruction GETA pre-meds - answerBZ, atropine/glycopyrrolate (prevent bradyarrhythmia from pneumoperitoneum), H2 blocker
  • 10-12 mm trocar accommodates standard SH needle Length of suture for intracorporeal knot tying - answer6 inches (15 cm) Length of suture for extracorporeal knot tying - answer30 inches (76 cm) 2-2.5 mm staples used for - answer- white/grey in color
  • vascular, thinner tissue 3-3.5 mm staples - answer- blue
  • for majority GI tract 4-4.5 mm staples - answer- green
  • for distal stomach, thickened portions of GI tract Monopolar cautery - answer- smaller vessels, slow rate bleeding, need relatively dry operative field Days until full diet tolerated - answer1-2d for fundoplication 3-6d for colon resection Postop - vascular injury smaller vessels - answer- usu superior/inferior epigastric vessels, mesenteric arteries/veins --> abd wall or peritoneal hematomas.
  • Surgery if con't bleeding, infxn, HD instability In the event of a blank screen, which is NOT a likely problem site? - answerFRED anti- fog solution If the laparoscopic view of the operative field is reduced in size, thus compromising proper exposure of the operative field, which of the following should be immediately checked? - answercheck the insufflator control panel to determine the cause of the loss of working space in the operative field all of the following are pre-operative checks except? - answercheck for adequate muscle relaxation. Correct answers include checking that a spare CO2 tank is in the OR, availability of ancillary equipment, and all power sources are connected and appropriate units are switched on During monopolar electrosurgery, the method of heating tissue quickly, converting all water to steam and causing the cell to explode is descriptive of which of the following: - answercutting mode click on the point that is in danger of thermal burn if a monopolar electrode is applied to the end of the appendiceal stump? - answerthe diameter at the ligature is half that at the stump, so the current density will be 16X greater

the use of all plastic or all metal trocars can avoid which problem during electrosurgery?

  • answercapacitative coupling is a result of using a metal tracer with a plastic screw anchor, which prevents the tracer from draining its charge (instrument can store the charge and then transmit to tissue next time it touches something) when using the ultrasonic shears, the entire portion of the active blade is exposed. In order to avoid inadvertent delivery of energy to tissue in contact with the bottom portion of the active blade, one should do the following: - answerbe aware of the contact points the blade is engaging, grab the target tissue and elevate it, and keep the active blade upwards in view of the surgeon ASA class 3 - answersevere systemic disease that limits the patient's activity and may or may not be related to the reason for surgery initial consultation should include which of the following? - answerpossibility of conversion to open surgery which of the following is a relative contraindication to laparoscopic surgery? - answerprevious abdominal surgery which of these is NOT an absolute contraindication to laparoscopic surgery? - answerbowel obstruction (contraindications include uncorrectable hypovolemic shock, lack of proper surgical training, and inability to tolerate laparotomy) which procedure may be performed using local anesthesia alone or with mild sedation?
  • answerdiagnostic laparoscopy important features in patient positioning for laparoscopic surgery include: - answeravoidance of position related complications, prevention of DVT, and location of target organ the most commonly used anesthetic for laparoscopic procedures is general anesthesia. all of the following are true EXCEPT - answerthere are fewer hemodynamic changes compared to a local anesthetic (true answers are it allows for complete neuromuscular relaxation, it provides good control of ventilation, an tit allows for more flexibility of patient positioning) what is the most common site for initial trocar insertion? - answerumbilicus When checking placement of Veress needle, which of the following is the most accurate method to detect proper intraperitoneal placement? - answerinsufflator display revealing flow of CO2 and low initial pressure umbilical Veress needle insertion and blind tracer insertion is contraindicated in all of the following EXCEPT? - answerprevious open cholecystectomy via right subcostal

what is the correct patient position for diagnostic laparoscopy for appendectomy? - answertrendelenburg which of the following pathology can be diagnosed laparoscopically? - answerCrohns, traumatic diaphragm injury, and ovarian cyst what are of the abomden is best for placement of ports to view kidneys and adrenal glands? - answerUpper abdomen (epigastric, RUQ, LUQ) retraction of the uterus can be accomplished by? - answertransvaginal manipulator, blunt grasper, laparoscopic retractor, and suture placed through abdominal wall what is the correct needle gage for performing core biopsies? - answer14-18 gauge In general, if an ovarian cyst is larger than 5cm or has complex internal US findings, biopsy should be done by? - answeroophorectomy general principles of successful laparoscopic tissue biopsy include all of the following EXCEPT: - answerremove biopsy specimen with an energy source to avoid bleeding (correct answers include avoid contacting tissue of extraction site with specimen, excisions biopsy of small lesions is appropriately, generally avoid biopsy of fluid filled liver lesions) what size tracer will accommodate a standard SH type needle? - answer10-12mm trocar what is the ideal suture length for intracorporeal knot tying? - answer6 inches (15cm) what is the ideal suture length for extracorporeal knot tying? - answer30 inches (75cm) which of the following about intracorporeal suturing is not true? - answergrasping the needle is the ideal way to control it when transporting the suture in and out of the abdomen true statements include: the ideal suture length is about 6inches, the ideal orientation for suturing is from 3 o'clock to 9 o'clock, pulling the needling along its arc through the tissue will minimize damage general principles regarding hemostasis during laparoscopy include all of the following EXCEPT: - answerapplying vascular clips to the general area is usually sufficient correct statements include: it is best to specifically identify the bleeding point, avoiding injury to adjacent structures is important, adding extra ports may be necessary, conversion to open may be necessary

all of the following are generally true regarding port site bleeding EXCEPT - answerthere is no need to remove ports under direct visualization correct answers include: external hemorrhage may require extension of skin incision, internal hemorrhage may not be present while port is in place, internal hemorrhage may not be visible from skin incision, ports placed through the rectus muscle should be done under direct laparoscopic visualization when compared to monopoly cautery, bipolar cautery affords all of the following advantages EXCEPT - answermore beneficial for capillary sized vessels correct answers include: useful for larger vessels, functions better in "wet" operative field, has advanced computer devices available,e has less lateral thermal spread when dividing a large vascular structure, which of the following is true? - answerthe surgeon must be prepared to immediately intervene in case vascular control is lost for how many days postoperatively will shoulder pain secondary to diaphragmatic irritation typically persist? - answer1-3 days which of the following classes of medications should NOT be considered to treat a patient with postoperative nausea and vomiting? - answermorphine sulfate correct answers include antihistamines, serotonin receptor antagonists, and corticosteroids a patient in the early postoperative period following laparoscopic surgery who complains of several days of increasing pain should be managed by? - answerinstructing the patient that he/she needs to be evaluated to determine the cause of the increasing pain