FLS Written Exam Questions and
Answers
Laparoscope diameters - Correct Answers -2-10 mm
Laparoscope lengths - Correct Answers -30-45 cm
Hopkins Rod lens system - Correct Answers -light from source to operative field >>
capture and transmit reflected light through the scope and camera couple >> light
sensitive chip in the camera head
Decreasing ability for image capture with what factors? - Correct Answers -increasing
length, increasing angle, and decreasing diameter (ex: 5 mm, 30 degree scope admits
less light than a 10 mm, 0 degree scope)
Laparoscopic damage susceptibility increases with which factors? - Correct Answers -
decreasing diameter, increasing length
0 degree laparocope most useful? - Correct Answers -when structures most in line with
the trocars and in small places (deep pelvis, high mediastinum)
30- and 45-degree laparocope - Correct Answers -offer more flexibility/versatility than 0
degree (but need more skills)
Troubleshooting smudge on laparoscope? - Correct Answers -o Wipe on clean tissue
(liver or bowel)
o Remove scope and clean with towel
o Clean port (newer systems may not need this as no mechanical seal)
Warmed/humidified CO2 - Correct Answers -decreases postop pain and temperature
(compared to gas directly from cylinder)
but is not clinically significant in cases < 90min
High powered light source wattage? - Correct Answers -300 watt Xenon lamp
"Picture in Picture" feature - Correct Answers -· Helpful if need for intra-op of flexible
endoscopy or ultrasound of GI or GU tract, liver ultrasound, hysteroscopy, bile duct
exploration
o Basically smaller picture in corner to show scope imaging + additional images
, · Work space decrease in size: Actual pressure higher than set pressure = - Correct
Answers -o Patient may not be sufficiently relaxed or there is obstruction
o Twitch monitors may not represent this well as diaphragm recovery from paralytics
differs from skeletal muscles
o Mechanical obstruction - closed valve on port, kink, standing on tubing
o Prophylactic antiemetics: Serotonin 5-HT3 receptor antagonists - Correct Answers -·
Ondansetron
· Tropisetron
· Dolasetro
· Granisetron
o Prophylactic antiemetics: Antihistamine H1 antagonists - Correct Answers -·
Promethazine
· Cyclizine
o Prophylactic antiemetics: others - Correct Answers -· Metoclopramide
· Dexamethasone
· Droperidol
Rescue antiemetic therapy - Correct Answers -Initiate antiemetic treatment ASAP if no
prophylaxis, switch classes if first drug didn't work
Shoulder pain - Correct Answers -Due to both chemical and pressure effects of
pneumoperitoneum leading to diaphragmatic irritation. Self-limited and lasts 1-3 days
Low pressure and high flow rate = - Correct Answers -= leak in system
o tubing disconnected from insufflator or port
o Valve open—check to make sure valves are cloed
o Check all port sites for leaking CO2
o Hollow organs check distension of bowel or bladder catheter
Waveforms - Correct Answers -coag, cut, blend
· Tissue effects: - Correct Answers -o Vaporization: 'cut', non-contact, deep injury with
minimal lateral damage
o Fulguration: 'coag', non-contact, superficial wide injury
o Desiccation: either, contact with instrument, deep/penetrating injury
--However, 'cut' gives you most thorough desiccation!
Harmonic scalpel - Correct Answers -· uses mechanical energy, so no dispersive
electrode needed
o Little lateral injury, good for small vessels
Answers
Laparoscope diameters - Correct Answers -2-10 mm
Laparoscope lengths - Correct Answers -30-45 cm
Hopkins Rod lens system - Correct Answers -light from source to operative field >>
capture and transmit reflected light through the scope and camera couple >> light
sensitive chip in the camera head
Decreasing ability for image capture with what factors? - Correct Answers -increasing
length, increasing angle, and decreasing diameter (ex: 5 mm, 30 degree scope admits
less light than a 10 mm, 0 degree scope)
Laparoscopic damage susceptibility increases with which factors? - Correct Answers -
decreasing diameter, increasing length
0 degree laparocope most useful? - Correct Answers -when structures most in line with
the trocars and in small places (deep pelvis, high mediastinum)
30- and 45-degree laparocope - Correct Answers -offer more flexibility/versatility than 0
degree (but need more skills)
Troubleshooting smudge on laparoscope? - Correct Answers -o Wipe on clean tissue
(liver or bowel)
o Remove scope and clean with towel
o Clean port (newer systems may not need this as no mechanical seal)
Warmed/humidified CO2 - Correct Answers -decreases postop pain and temperature
(compared to gas directly from cylinder)
but is not clinically significant in cases < 90min
High powered light source wattage? - Correct Answers -300 watt Xenon lamp
"Picture in Picture" feature - Correct Answers -· Helpful if need for intra-op of flexible
endoscopy or ultrasound of GI or GU tract, liver ultrasound, hysteroscopy, bile duct
exploration
o Basically smaller picture in corner to show scope imaging + additional images
, · Work space decrease in size: Actual pressure higher than set pressure = - Correct
Answers -o Patient may not be sufficiently relaxed or there is obstruction
o Twitch monitors may not represent this well as diaphragm recovery from paralytics
differs from skeletal muscles
o Mechanical obstruction - closed valve on port, kink, standing on tubing
o Prophylactic antiemetics: Serotonin 5-HT3 receptor antagonists - Correct Answers -·
Ondansetron
· Tropisetron
· Dolasetro
· Granisetron
o Prophylactic antiemetics: Antihistamine H1 antagonists - Correct Answers -·
Promethazine
· Cyclizine
o Prophylactic antiemetics: others - Correct Answers -· Metoclopramide
· Dexamethasone
· Droperidol
Rescue antiemetic therapy - Correct Answers -Initiate antiemetic treatment ASAP if no
prophylaxis, switch classes if first drug didn't work
Shoulder pain - Correct Answers -Due to both chemical and pressure effects of
pneumoperitoneum leading to diaphragmatic irritation. Self-limited and lasts 1-3 days
Low pressure and high flow rate = - Correct Answers -= leak in system
o tubing disconnected from insufflator or port
o Valve open—check to make sure valves are cloed
o Check all port sites for leaking CO2
o Hollow organs check distension of bowel or bladder catheter
Waveforms - Correct Answers -coag, cut, blend
· Tissue effects: - Correct Answers -o Vaporization: 'cut', non-contact, deep injury with
minimal lateral damage
o Fulguration: 'coag', non-contact, superficial wide injury
o Desiccation: either, contact with instrument, deep/penetrating injury
--However, 'cut' gives you most thorough desiccation!
Harmonic scalpel - Correct Answers -· uses mechanical energy, so no dispersive
electrode needed
o Little lateral injury, good for small vessels
