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FLS Modules 2025 Questions and Answers Rated A+, Exams of Advanced Education

Illinois State University (ISU)Advanced Education

FLS Modules 2025 Questions and Answers Rated A+

Typology: Exams

2024/2025

Available from 07/07/2025

johniewalker91
johniewalker91 🇺🇸

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FLS Modules 2025
Warfarin discontinue time - answer3 days
Laparoscopic instruments diameter and length ranges - answer2-10mm, 30-45cm
Hopkins rod lens - answer light has to travel back through the rod to capture the image.
decreasing light in the camera for... - answer decreasing diameter, increasing scope
angle (ie 5mm and 30 degree has less light than 10mm 0 degree)
When is zero degree scope most useful - answer when working in a small area directly
in line with the scope and ports, like the pelvis
how to check fiber optics light connection - answer black dots= broken fibers
why does it fog up? - answer temperature and humidity discrepancy between the OR
and body
tools for defogging - answer- FRED antilog (must dry before putting back in)
- put laparoscope in hot water
methods to clean a smudged lens - answer- gently wipe on clean tissue (liver, uterus,
bowel)
- remove scope and clean with hot water and gauze
Insufflation gas type and reasoning - answerCO2- readily available, inexpensive, non
combustable, warmed and humidified better
other gasses used in laparoscopy - answer-nitrous oxide
-helium (inert substance)
why is the CO2 warmed and humidified for laparoscopy? - answerstatistically significant
decreases in body temp and post-op pain
(not significant with surgery lasting <90 mins)
high flow insufflation - answer10 or more L per minute
preventing loss of pneumo with suctioning - answerkeep suction tip below the fluid level
components of the video tower - answer-light source
-camera control unit
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Download FLS Modules 2025 Questions and Answers Rated A+ and more Exams Advanced Education in PDF only on Docsity!

FLS Modules 2025

Warfarin discontinue time - answer3 days Laparoscopic instruments diameter and length ranges - answer2-10mm, 30-45cm Hopkins rod lens - answer light has to travel back through the rod to capture the image. decreasing light in the camera for... - answer decreasing diameter, increasing scope angle (ie 5mm and 30 degree has less light than 10mm 0 degree) When is zero degree scope most useful - answer when working in a small area directly in line with the scope and ports, like the pelvis how to check fiber optics light connection - answer black dots= broken fibers why does it fog up? - answer temperature and humidity discrepancy between the OR and body tools for defogging - answer- FRED antilog (must dry before putting back in)

  • put laparoscope in hot water methods to clean a smudged lens - answer- gently wipe on clean tissue (liver, uterus, bowel)
  • remove scope and clean with hot water and gauze Insufflation gas type and reasoning - answerCO2- readily available, inexpensive, non combustable, warmed and humidified better other gasses used in laparoscopy - answer-nitrous oxide -helium (inert substance) why is the CO2 warmed and humidified for laparoscopy? - answerstatistically significant decreases in body temp and post-op pain (not significant with surgery lasting <90 mins) high flow insufflation - answer10 or more L per minute preventing loss of pneumo with suctioning - answerkeep suction tip below the fluid level components of the video tower - answer-light source -camera control unit

-video monitor -insufflator most common light source - answer300W xenon lamp troubleshooting steps: gas preOP - answer1. check that co2 tank is full (gauge may read 'empty' if connected to central CO2 supply)

  1. check co2 tank gasket is secured (need a wrench, spare gasket)
  2. check that spare co2 tank is available in the OR troubleshooting steps: image - answer1. check that the monitor is plugged in and turned on
  3. check that all cables are connected correctly and securely troubleshooting steps: view of operative field is reduced in size - answerimmediately check the insufflator control panel to determine cause troubleshooting steps: loss of working space: insufflator settings: -measured pressure is the same or higher than the preset pressure flow rate = 0 - answer1. the patient may not be adequately relaxed or there is a mechanical block of gas flow
  4. inspect abdomen for rhythmic muscle contraction and palpate the abdomen for firmness
  5. check port valves to make sure they are open
  6. check for kinks in tubing and make sure no one is standing on them troubleshooting steps: loss of working space: insufflator settings: -low pressure and high flow rate flow rate = high - answer1. there is a leak in the insufflation circuit
  7. check that the tubing has not become disconnected from insufflator or port
  8. check that all valves are closed
  9. check all port sites for leaking co
  10. check for foley catheter bag distention or bowel distention troubleshooting steps: loss of working space: insufflator settings: -low pressure and no flow flow rate = 0 - answer1. make sure that the insufflator power is on
  11. check gas level in the tank troubleshooting steps: loss of working space: complete loss of operative image (blank monitor) - answer1. check for disconnected power cords, video cables
  12. check for blown light source bulb
  13. check for disconnected light cable (at scope or light source)

potential hazards of laparoscopic monopolar: capacitive coupling - answertransfer of current from an active electrode through its insulation to a passive electrode. -2 conductors separated by an insulator for this to occur active electrode (such as monopolar hook) can give a charge if it touches a grasper or camera briefly (passive electrode), they store energy, then they contact tissue and injure it using a metal trocar with a plastic screw anchor, which prevents the trocar from draining its charge potential hazards of laparoscopic monopolar: narrow return circuit - answerwhen current passes through ligated tissue -b/c smaller surface area, increased current density -unintended injury will occur d/t excessive heating at the ligasure ex: avoid at appendiceal stump bipolar definition - answertissue is placed between two electrodes. current flows only through the tissue contiguous with both electrodes. lower energy requirement, less lateral tissue damage. bipolar vessel sealing devices can seal vessels up to ___ mm in diameter - answer mm bipolar energy delivery - answercomputer measures tissue impedance of grasped tissue-->controlled energy delivery--> denaturation of collagen-->creation of permanent seal lower energy used = less lateral thermal spread can also have a cutting blade to divide tissue after sealing (ex: LigaSure) bipolar hazards: inadvertent thermal injury - answeravoid activating the device in close proximity to adjacent organs bipolar hazards: inadvertent cutting of patent vessels before adequate sealing - answermake sure to complete entire activation cycle prior to cutting bipolar hazards: improper functioning if metal is within the jaws - answerwatch out for clips or staples ultrasonic dissection - answermechanical energy converted to high frequency ultrasonic vibration uses a pizoelectric transducer, uses a torque wrench

ultrasonic shears - answerconsist 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 how fast does the pizoelectric transducer vibrate the active blade in ultrasonic shears - answer50,000 times per second = 50,000 hertz

  • lower power = more hemostasis
  • higher power = more cutting ex: being used on small bowel mesentery Monitor should be placed at what height in relation to eye level? - answerat or slightly below eye level (to decrease neck strain) Ideal ergonomic position for surgeon? - answer- arms at less than 30 degree angle out to side -elbows flexed between 60 and 120 degrees -wrists slightly pronated with thumbs up important history to consider preOP (5) - answer1. hx abdomino-pelvic surgery
  1. hx radiation
  2. hx prosthetics (hip)
  3. sig cardiopulmonary conditions
  4. hx DVT or coagulation disorders
  5. hx anesthesia complications
  • don't forget about potential stress dose steroids NSAIDs including ASA - answerdo not need to be discontinued ASA level not appropriate for lap surgery - answerASA class 4 and 5 might not be able to tolerate pneumoperitoneum due to decreased venous return and need for hyperventilation obese patients: trocar insertion - answeruse of longer trocars (up to 100mm) thin patients: trocar insertion - answer1. elevate abdomen
  1. consider placing veress needle away from the midline near the costal margin
  2. consider utilizing open approach or visiport for direct visualization contraindications to laparoscopy: absolute (4) - answer1. inability to tolerate laparotomy
  3. hypovolemic shock
  1. inability to tolerate trendelenberg lap foregut procedures relative contraindications (2) - answer1. previous gastric operation at GE juntion
  2. hepatosplenomegaly lap antireflux surgery relative contraindications (5) - answer1. esophogeal shortening
  3. epithelial dysplasia
  4. previous gastric surgery at GE juntction
  5. liver enlargement
  6. large hiatal hernia lap hernia repair relative contraindications (4) - answer1. large, chronically incarcerated hernia
  7. acutely incarcerated hernia
  8. need for removal of large prosthetics
  9. need for skin graft removal or large scar revision things that are NOT contraindications (commonly mistaken) (9) - answer1. diaphragm injury
  10. GI bleed
  11. perforated viscus
  12. bowel obstruction
  13. abdominal trauma
  14. IUP or ectopic preg
  15. obesity
  16. COPD
  17. renal insufficiency When to use laparoscopy for trauma patients? - answer-no immediately life-threatening injuries present -patient doesn't have an uncorrectable hemodynamic instability to detect intraperitoneal or visceral injury after penetrating trauma precautions in pregnancy - answer1. tailoring initial access based on fundal height
  18. Left lateral position
  19. lowering insufflation pressures
  20. FHT pre- and post-op lap SBO precautions - answerneed to use a direct visualization entry Indications for local anesthesia: - answer- diagnostic laparoscopy
  • tubal ligation
  • select inguinal hernia repairs

epidural anesthesia - answercan 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 - answer1. benzo- ease anxiety and cause amnesia

  1. atropine- may prevent Brady arrhythmias caused by pneumoperitoneum (but causes dry mouth)
  2. glycopyrrelate- as above but less dry mouth
  3. H2 blocker or sodium citrate- minimize effects of aspiration should it occur untucked arm position - answerdo not abduct >90degrees, to avoid a brachial plexus injury tucked arms - answermake sure to avoid hand injury if table is flexed during operation If the use of steep reverse trendelenberg position is used, a ______ may prevent the patient from sliding. - answerfootboard allen stirrups - answerbetter than candy cane as they have better individualization, especially in longer procedures For surgical access to the adrenal gland and kidney, what patient position would be used?
  • splenectomy
  • nephrectomy
  • adrenalectomy - answerlateral decubitus position and modified lateral decubitus position (rotation of the OR table to supine position) veress needle - answerspring loaded needele with a sharp tip and a conduit for the insufflation of gas veress needle insertion places - answerumbillicus and LUQ
  • abdominal wall is thinnest at the umbilicus veress needle intraperitoneal check - answer1. most accurate method is connecting insufflation, initiate gas at low flow, if pressure is low and co2 flows--> correct position
  1. aspiration with syringe to make sure not in vessel or GI tract, then inject saline and water should flow with little resistance
  2. saline drop test / hanging drop test
  3. percussion of abdomen after insufflation for tympany desired intraabdominal pressure and how much co2 - answer10-15 mmHg 1-3 L Co suggested step if utilizing palmer's point - answerNG for gastric decompression

pulmonary physiology with co2 pneumo - answer1. increased minute ventilation to eliminate absorbed CO

  1. reduced functional residual capacity (because of increased intra-abominal pressure and diaphragm being pushed cephalad)
  2. increased peak airway pressure
  3. reduced pulmonary compliance overview of cardiovascular effects of co2 pneumo - answer1. systemic vascular changes
  4. cerebral auto regulation of blood flow
  5. vagal responsiveness to reverse trendenenberg
  6. increased venous stasis because of pressure in peritoneum (need for use of VTE ppx) The development of hypercarbia is influenced by? (3) - answer- the body's buffer system
  • the patient's pulmonary system
  • extraperitoneal insufflation What are alternative gases to CO2? - answer- nitrous oxide (N2O)
  • air
  • helium
  • argon Alternative gases: N2O - answerbenefits: less acid-base disturbance, increased patient tolerability in patients with severe cardio pulmonary disease, less post op pain risks: fire hazard with electrocautery in the presence of open bowel (cannot be used with suspected bowel perf) alternative gases: Argon and Helium (inert gases) - answereliminate the complication of acidosis, but are much less soluble in blood. Decreased solubility increases the risk of extra-peritoneal gas extravasation (gas embolus) more expensive compared to CO2, need special insufflators that aren't readily available cardiovascular effects of pneumo - answer1. increased preload
  1. increased afterload
  2. decreased cardiac output decrease in cardiac output
  • may be caused by?
  • exacerbated by? - answer-may be caused by vagally-induced bradycardia

-exacerbated by reverse trendelenburg and hypovolemia. manifestations of decrease in cardiac output? - answerreduced tissue perfusion

  • hypotension
  • cardiac arrhythmia
  • decreased UOP
  • increased end-tidal CO what to do if decreased CO intraop (5) - answer1. desufflate immediatey
  1. check insufflator setting and fuctions
  2. check for adequate relaxation
  3. check intravascular volume status
  4. check for other causes of hypotension cardiac arrhythmia due to pneumoperitoneum (3) - answer1. sinus tach (most common, self limited)
  5. PVCs
  6. bradycardia (due to pressure effect, vagally mediated) What is the most common cardiac arrhythmia during pneumoperitoneum? - answerbradycardia Venous flow rates drop anywhere from -% during pneumoperitoneum. - answer26-39% increased vena cava resistance Incidence of VTE following laparoscopic chole is? - answer<0.5% Renal effects of pneumoperitoneum - answer1. increased intrabdominal pressure decreases renal blood flow--> intra-op oliguria is common
  7. renin and ADH release results in Na and free water resorption
  8. post-op oliguria should resolve within a few hours
  9. don't fluid overload--> CHF hypothermia related to pneumoperitoneum - answeruse humidified and warmed gas, warm IVF, bear hugger, warm irrigation, warm air temp extraperitoneal gas extravasation can cause (4) - answer1. subcutaneous gas
  10. thoracic gas
  11. delayed co2 toxicity
  12. gas embolus gas embolus
  • incidence
  • diagnosis
  1. excisional avoid electrocautery FNA - answer20-22 gauge needle, long enough needle, contents expelled into cytology solution, cell yields are small but can be adequate, give no info regarding architecture core needle biopsy - answermost commonly used for liver biopsy but should not be used for vascular lesions like hemangioma. 14-18 gauge needle. more risk for bleeding compared to FNA biopsy forceps - answerfor incisional (larger lesions) or excisional (small lesions), or peritoneal implants. wedge biopsy - answerutilize scalpel, scissors, or staple device. can be excisional or incisional. peritoneal washings/scrapings - answerobtain prognostic information that may guide further therapy. obtain early in staging lap. 100cc of 0.9%NS unless there is abundant ascites. aspirate after 3-5 minutes. liver biopsy - answergenerally for parenchymal disease. ex cirrhosis. Core needle or wedge biopsy. ovary biopsy - answeroophorectomy vs wedge resection vs biopsy forceps based on menopausal status, suspicion for malignancy. avoid seeding abdominal wall with specimen biopsy of visceral lesions - answerif small and superficial can excise, use serosal stitch to avoid leakage retroperitoneal bx - answerto assess LN or unidentified mass. US may be used. monopolar may be used but not in the vicinity of vasculature or nerves. hemostasis after biopsy (6) - answerobtained secondarily to avoid thermal injury to specimen
  2. direct pressure
  3. monopolar
  4. bipolar
  5. ultrasonic
  6. topical hemostatic agents
  7. sutures

benefits of braided suture - answereasier to handle, lack elastic memory, don't fray what type of needle is preferred for laparoscopic suturing? - answertapered needles (smooth) preferred over cutting needles dyed sutures preferred because? - answerdon't blend in with blood intracorporeal knot tying ergonomics - answerelbows flexed at 90 degrees and ports at least 10cm apart interrupted vs continuous sutures - answer1. interrupted less cumbersome but each requires a knot

  1. continuous needs constant tension (done with assistant's help and/or intermittently locking the throws) extracorporeal knot length - answer30 inches or 75cm minimize tissue friction extracorporeal knot - answeruse instrument as a fulcrum, because of the 180 degree angle roedner's knot - answertied completely exrtraporporeally then pushed down. used for: blood vessels, appendix, fallopian tube, cut end of cystic duct linear staplers - answer2-3 rows of staples on either side of knife blade require 12 mm port generally choice of staple height - answer1. vascular: 2-2.5mm
  2. GI tract 3-3.5 mm
  3. distal stomach or thickened GI tract 4-4.5 mm removing ports under direct lap visualization because: - answerbleeding may not be evident during procedure, and may not be evident externally after port is removed. when to use monopolar for hemostasis - answersmall vessels, slow rate of bleeding, need a relatively dry operative field when to use bipolar for hemostasis - answerlarger vessels, works in wet operative field, less lateral thermal spread, lower energy requirement risk factors for PONV (8) - answer1. female
  4. young
  5. history of PONV
  6. motion sicknress