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FLS Modules Exam Questions and Answers, Exams of Advanced Education

Illinois State University (ISU)Advanced Education

FLS Modules Exam Questions and Answers

Typology: Exams

2024/2025

Available from 07/07/2025

johniewalker91
johniewalker91 🇺🇸

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FLS Modules Exam
Name of laparoscopic rod-lens system - answer Hopkins rod-lens system
Type of light source typically used - answer300 Watt Xenon lamp
How to check for damage of the fiber optic light cable - answer holding one end up to
light and other end up to eye and look to see black
dots
Troubleshooting: 2 causes of small operating field despite measured pressure same or
higher than set pressure (eg 15 mmHg) - answer1. pt may not be sufficiently relaxed or
2.
there is mechanical obstruction of insufflation system
How electrical frequency changes from the wall to the monopolar/bipolar after it goes
through the ESU? - answer low frequency current from wall to high frequency
As tissue temp raised past ***C protein denaturation occurs. - answer60C
Superficial eschar formation with minimal depth of necrosis = this term - answer
fulguration
Which ESU mode is this: heat quickly so water converts to steam —> cell explodes ;
heat is dissipated in
steam with minimal lateral thermal damage but poor coagulation. - answercut
Which ESU mode is this: Rapid surface heating. Intermittent wave form present with
high voltage. - answercoag
This occurs when current follows path of least resistance through unintentional
pathways. - answercurrent diversion
Bipolar tissue sealing devices can seal up to ***mm diameter vessels - answer7mm
Type of technology described: high frequency vibration using piezoelectric transducer -
answerultrasonic coagulation
How inadvertent tissue injury can occur with use of an ultrasonic coagulation instrument
- answeroutside of active (vibrating) blade is unprotected and can inadvertently injure
tissue that comes into contact with it during / immediately after use.
ASA Class *** can't tolerate pneumoperitoneum - answer4-5
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FLS Modules Exam

Name of laparoscopic rod-lens system - answer Hopkins rod-lens system Type of light source typically used - answer300 Watt Xenon lamp How to check for damage of the fiber optic light cable - answer holding one end up to light and other end up to eye and look to see black dots Troubleshooting: 2 causes of small operating field despite measured pressure same or higher than set pressure (eg 15 mmHg) - answer1. pt may not be sufficiently relaxed or

there is mechanical obstruction of insufflation system How electrical frequency changes from the wall to the monopolar/bipolar after it goes through the ESU? - answer low frequency current from wall to high frequency As tissue temp raised past ***C protein denaturation occurs. - answer60C Superficial eschar formation with minimal depth of necrosis = this term - answer fulguration Which ESU mode is this: heat quickly so water converts to steam —> cell explodes ; heat is dissipated in steam with minimal lateral thermal damage but poor coagulation. - answercut Which ESU mode is this: Rapid surface heating. Intermittent wave form present with high voltage. - answercoag This occurs when current follows path of least resistance through unintentional pathways. - answercurrent diversion Bipolar tissue sealing devices can seal up to ***mm diameter vessels - answer7mm Type of technology described: high frequency vibration using piezoelectric transducer - answerultrasonic coagulation How inadvertent tissue injury can occur with use of an ultrasonic coagulation instrument

  • answeroutside of active (vibrating) blade is unprotected and can inadvertently injure tissue that comes into contact with it during / immediately after use. ASA Class *** can't tolerate pneumoperitoneum - answer4-

Potentially hazardous effect in which current is passed from an active electrode to a metal object (eg another lap instrument - called a passive electode or capacitor) not in contact with tissue. Then, when the passive electrode/ capacitor touches tissue, it can discharge the stored current - answercapacitative coupling What type of procedure can be performed without using GA? - answerDx lap may be performed using local anesthesia alone or with mild sedation. prophylactic agents (2) that may help prevent bradyarrhythmia a/w pneumoperitoneum - usualy only used PRN intraoperatively - answeratropine/Glycopyrrolate pH/ etCO2 changes during laparoscopy from CO2 insufflation - answerAs rate of CO absorption through peritoneal membrane overcomes elimination by lungs and buffer system there is a ride in arterial CO2 and end tidal CO2 with drop in serum pH. When pH changes reach steady state from CO2 insufflation - answer1 hour The greatest amount of change in pH and arterial CO2 occurs over this amount of time - answer20 mins Insufflation gas that is assoc with less postop pain and acid/base changes - answernitrous oxide Why nitrous oxide isn't used - answerFire hazard if using electrocautery in presence of open bowel (supports combustion) Not flammable itself and won't ignite with mono/bipolar cautery. Only combusts with methane/hydrogen gas (i.e. in bowel injury) Effects of pneumoperitoneum on preload/afterload/CO - answerincreased preload, increased afterload, decreased cardiac output Most common anbl heart rate from pneumo? - answersinus tach How pnemo affects LE venous flow rate - answerreduces due to IVC pressure Pneumo can cause persistent bradcardia or SVT? - answerbradyarrhythmias Why intraop UOP is unreliable surrogate for volume status - answerIntraop oliguria is common (d/t decreased renal blood flow due to intra-abdominal pressure) Ideal surgeon's elbow flexion and degree of arm abduction - answerElbows flex between 60-120 degrees, Arms no more than 30 degrees from body Some relative contraindications to laparoscopy (6) - answerinability to tolerate GA

Typical bx type on liver (2) Type of liver lesion that should not be bx'd (2) - answercore bx or wedge bx vascular lesions (bleeding risk), cystic/fluid filled lesions (no necessary) When bx hollow viscera, what step is often necessary if the bx site was left thin to prevent a leak - answermay need to place serosal stitch Port position (general) for kidneys/adrenal - answersubcostal Describe FNA technique - answerplunger creates suction and move needle back and forth a few times then release suction before pulling it out Peritoneal washings - minimal amount of instilled fluid How long it sits before aspiration - answer100mL 3-5 mins Preferred needle tip for lap suturing - answertapered Preferred grasper shape for knot tying (straight vs curved) - answercurved Ideal placement of two ports + camera for intracorporeal knot tying - answerat least 10 cm apart ports for intracorporeal knot tying with camera in between like triangle Tip for positioning needle laparoscopically - when to know that it's perpendicular from the light source - answerglint of light from needle indicates it is perpendicular to light source Where to grasp suture when introducing it through a port - answer5-10mm from swedge Intracorp knot tying steps (first throw with needle R --> L) (5 steps) - answer1 form c loop w right hand instrument 2 left hand instrument goes on top of loop 3 right hand loops suture around L hand twice 4 left hand grasps tail of suture 5 strands pulled in opp directions to cinch down knot

Trick with intracorp knot tying for tissue that needs to be approximated over a wide distance or is on some tension - answersliding square knot technique (tie a square knot loosely. Then pull the two strands on the L side to "flip over" the knot and make it a slip knot. Slide down the knot to the tissue. Then pull strands horizontally to lock it in place) Min suture length for extracorp knot tying - answer30"/76cm How to minimize tissue friction/damage when pulling needle back through same port in extracorp knot tying - answeruse 2nd instrument as a "fulcrum" to keep the suture exiting the tissue at a shallow angle These mechanical approx tools are simple and helpful for small tubular structures; not good for closing openings in hollow organs - answerclips Device that applies 2-3 rows of staples on each side of knife blade and cut tissue between rows - answerlinear stapler General idea between choosing staple size for a linear stapler - answersmaller staples = more hemostasis, thinner tissue, larger staples= thicker tissue Typical staple size for vascular structures/ mesentery? For GI tract? For distal stomach/ unusually thick GI tract - answer2-2.5mm (white) 3-3.5mm (blue) 4-4.5mm (green) Ideal suture length for intracorp knot tying - answer6in/ 15cm Trocar size best suited for introducing a standard SH-type needle - answer10-12mm Strategies to control internal bleeding at a port site, when there is rapid bleeding and the source isn't visible laparoscopically - answerHigher rate of bleed w/o visible source: control w/ grasper, may employ temporary control w/ Foley if available (pass it through site then inflate and pull up on foley against abd wall to tamponade), dissection to identify source, suture ligation and/or energy source as needed, full thickness abdominal wall sutures w/ laparoscopic assisted technique (small skin incision over bleeding site, place sutures proximal and distal to expected direction of vessels)