FLS Exam Questions and Answers
What are the laparoscope diameters? - Correct Answers -2-10mm
Which degree scope is best for a field in line with port? - Correct Answers -0 degree
How to prevent fogging of scope? - Correct Answers -Use anti fog solution or put scope
in hot water/hot bath
What is the most commonly used light source? - Correct Answers -300 W Xenon lamp
What if there is initial low pressure and high flow rate at entry? - Correct Answers -Leak
in insufflator circuit, make sure everything plugged in correctly
Benefits of monopolar - Correct Answers -Tissue is heated quickly, less thermal
damage/coagulation
Monopolar voltage/frequency - Correct Answers -Low voltage/High frequency
In general, if an ovary is larger than 5 cm or has complex internal US characteristics,
biopsy should be by: - Correct Answers -Oophorectomy
Which needle is safer for use in laparoscopic surgery taper or cutting needle? - Correct
Answers -Taper needle (Smooth)
Needle shape - Correct Answers -Straight, Partially straight, curved
Optimal port position for intracorporeal knot tying - Correct Answers -At least 10 cm
apart
(Surgeons elbows flexed at 90 degrees and adjacent to the surgeon's body)
Needle positioning - Correct Answers -Pick up in the correct orientation
Pass needle back and forth rotating each pass
Fine adjustments by nudging needle and manipulating suture
What does coagulation mode do? - Correct Answers -Repid surface heating with
shallow depth of necrosis, intermittent wave form with higher voltage
,Risk of monopolar - Correct Answers -Current can be diverted through unintentional
pathways, leading to inadvertent tissue injury. Don't use hybrid ports that mix metal with
plastic
Why do you need a grounding pad for monopolar? - Correct Answers -Capacitative
coupling - transfer of energy between two conductors separated by an insulator, transfer
to passive electrode. Can release with tissue injury, but no issue if ground plate is
working as capacitor can't store the charge
Benefits of bipolar - Correct Answers -lower energy, producing less lateral tissue
damage and necrosis. Don't need a grounding pad
Risk of bipolar - Correct Answers -Risk of cutting patient vessels before adequate
sealing, and device doesn't work if there is metal between the jaws
Risk of ultrasonic dissection (harmonic) - Correct Answers -Active blade can injure
something due to high frequency (50mHz)
Discontinue aspirin day of surgery? - Correct Answers -No
How to enter in patient with bowel obstruction? - Correct Answers -Direct visualization
Cut vs Coag - Correct Answers -cut - heat tissue quickly to convert cell water to steam,
lysing the cell
Coag - heat more widely dispersed, less cutting action
smaller tissue area, greater current density and faster heating - Correct Answers -e.g.
Bovie tip
Cut mode - Correct Answers -- Low voltage
- High frequency
- Continuous waveform
- Heats tissue quickly; cell water converts to steam and causes cell to explode
Coagulation mode - Correct Answers -- High voltage
- Low frequency
- Intermittent waveform
- Rapid tissue heating, shallow depth of necrosis
- Non-contact: relies on sparking to tissue
Capacitive coupling - Correct Answers -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 - Correct Answers -monopolar instrument in direct contact w/ metal
portion of another instrument
, Besides capacitative coupling and direct coupling, other hazards of electrocautery -
Correct Answers -- Current diversion
- Narrow return circuit
Bipolar - Correct Answers -- 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 - Correct Answers -7 mm
ultrasonic coagulation shears seals vessels up to ____ mm in diameter - Correct
Answers -5 mm
ultrasonic coagulation shears - Correct Answers -- combo compression and friction
- ONE active blade
- monopolar capacity w/ the one blade
- no capacitative coupling
- high power (MAX): cut
- low power (MIN): coag
How many days prior to surgery does warfarin has to be discontinued? - Correct
Answers -3 days
ASA 2 - Correct Answers -Mild to moderate systemic disease
ASA 3 - Correct Answers -severe systemic disease that limits patient activity, may or
may not be related to reason for surgery
ASA 4 - Correct Answers -Severe systemic disturbances that limit patient and are life-
threatening with or without surgery
ASA 5 - Correct Answers -Little change for survival but surgery last resort (resuscitative
effort)
ASA classes that may not be appropriate for LSC sx - Correct Answers -ASA 4 and 5
- body cannot handle decreased venous return, need for hyperventilation
Length of trocar needed for obese pt - Correct Answers ->100 mm
ABSOLUTE C/I to LSC Sx - Correct Answers -- Inability to tolerate laparotomy
- Hypovolemic shock
- Lack proper surgeon training/experience
- Lack appropriate institutional support
What are the laparoscope diameters? - Correct Answers -2-10mm
Which degree scope is best for a field in line with port? - Correct Answers -0 degree
How to prevent fogging of scope? - Correct Answers -Use anti fog solution or put scope
in hot water/hot bath
What is the most commonly used light source? - Correct Answers -300 W Xenon lamp
What if there is initial low pressure and high flow rate at entry? - Correct Answers -Leak
in insufflator circuit, make sure everything plugged in correctly
Benefits of monopolar - Correct Answers -Tissue is heated quickly, less thermal
damage/coagulation
Monopolar voltage/frequency - Correct Answers -Low voltage/High frequency
In general, if an ovary is larger than 5 cm or has complex internal US characteristics,
biopsy should be by: - Correct Answers -Oophorectomy
Which needle is safer for use in laparoscopic surgery taper or cutting needle? - Correct
Answers -Taper needle (Smooth)
Needle shape - Correct Answers -Straight, Partially straight, curved
Optimal port position for intracorporeal knot tying - Correct Answers -At least 10 cm
apart
(Surgeons elbows flexed at 90 degrees and adjacent to the surgeon's body)
Needle positioning - Correct Answers -Pick up in the correct orientation
Pass needle back and forth rotating each pass
Fine adjustments by nudging needle and manipulating suture
What does coagulation mode do? - Correct Answers -Repid surface heating with
shallow depth of necrosis, intermittent wave form with higher voltage
,Risk of monopolar - Correct Answers -Current can be diverted through unintentional
pathways, leading to inadvertent tissue injury. Don't use hybrid ports that mix metal with
plastic
Why do you need a grounding pad for monopolar? - Correct Answers -Capacitative
coupling - transfer of energy between two conductors separated by an insulator, transfer
to passive electrode. Can release with tissue injury, but no issue if ground plate is
working as capacitor can't store the charge
Benefits of bipolar - Correct Answers -lower energy, producing less lateral tissue
damage and necrosis. Don't need a grounding pad
Risk of bipolar - Correct Answers -Risk of cutting patient vessels before adequate
sealing, and device doesn't work if there is metal between the jaws
Risk of ultrasonic dissection (harmonic) - Correct Answers -Active blade can injure
something due to high frequency (50mHz)
Discontinue aspirin day of surgery? - Correct Answers -No
How to enter in patient with bowel obstruction? - Correct Answers -Direct visualization
Cut vs Coag - Correct Answers -cut - heat tissue quickly to convert cell water to steam,
lysing the cell
Coag - heat more widely dispersed, less cutting action
smaller tissue area, greater current density and faster heating - Correct Answers -e.g.
Bovie tip
Cut mode - Correct Answers -- Low voltage
- High frequency
- Continuous waveform
- Heats tissue quickly; cell water converts to steam and causes cell to explode
Coagulation mode - Correct Answers -- High voltage
- Low frequency
- Intermittent waveform
- Rapid tissue heating, shallow depth of necrosis
- Non-contact: relies on sparking to tissue
Capacitive coupling - Correct Answers -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 - Correct Answers -monopolar instrument in direct contact w/ metal
portion of another instrument
, Besides capacitative coupling and direct coupling, other hazards of electrocautery -
Correct Answers -- Current diversion
- Narrow return circuit
Bipolar - Correct Answers -- 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 - Correct Answers -7 mm
ultrasonic coagulation shears seals vessels up to ____ mm in diameter - Correct
Answers -5 mm
ultrasonic coagulation shears - Correct Answers -- combo compression and friction
- ONE active blade
- monopolar capacity w/ the one blade
- no capacitative coupling
- high power (MAX): cut
- low power (MIN): coag
How many days prior to surgery does warfarin has to be discontinued? - Correct
Answers -3 days
ASA 2 - Correct Answers -Mild to moderate systemic disease
ASA 3 - Correct Answers -severe systemic disease that limits patient activity, may or
may not be related to reason for surgery
ASA 4 - Correct Answers -Severe systemic disturbances that limit patient and are life-
threatening with or without surgery
ASA 5 - Correct Answers -Little change for survival but surgery last resort (resuscitative
effort)
ASA classes that may not be appropriate for LSC sx - Correct Answers -ASA 4 and 5
- body cannot handle decreased venous return, need for hyperventilation
Length of trocar needed for obese pt - Correct Answers ->100 mm
ABSOLUTE C/I to LSC Sx - Correct Answers -- Inability to tolerate laparotomy
- Hypovolemic shock
- Lack proper surgeon training/experience
- Lack appropriate institutional support
