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FLS MODULES EXAM SCRIPT 2026 FULL
SOLUTIONS GRADED A+
โ Type of light source typically used. Answer: 300 Watt Xenon lamp โ 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 โ Troubleshooting: 2 causes of small operating field despite measured pressure same or higher than set pressure (eg 15 mmHg). Answer: 1. pt may not be sufficiently relaxed or 2. there is mechanical obstruction of insufflation system โ 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 โ As tissue temp raised past ***C protein denaturation occurs.. Answer: 60C
โ Superficial eschar formation with minimal depth of necrosis = this term. Answer: fulguration โ Which ESU mode is this: heat quickly so water converts to steam โ> cell explodes ; heat is dissipated in steam with minimal lateral thermal damage but poor coagulation.. Answer: cut โ Which ESU mode is this: Rapid surface heating. Intermittent wave form present with high voltage.. Answer: coag โ This occurs when current follows path of least resistance through unintentional pathways.. Answer: current diversion โ Bipolar tissue sealing devices can seal up to ***mm diameter vessels. Answer: 7mm โ Type of technology described: high frequency vibration using piezoelectric transducer. Answer: ultrasonic coagulation โ How inadvertent tissue injury can occur with use of an ultrasonic coagulation instrument. Answer: outside of active (vibrating) blade is unprotected and can inadvertently injure tissue that comes into contact with it during / immediately after use.
โ The greatest amount of change in pH and arterial CO2 occurs over this amount of time. Answer: 20 mins โ Insufflation gas that is assoc with less postop pain and acid/base changes. Answer: nitrous oxide โ Why nitrous oxide isn't used. Answer: Fire 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) โ Effects of pneumoperitoneum on preload/afterload/CO. Answer: increased preload, increased afterload, decreased cardiac output โ Most common anbl heart rate from pneumo?. Answer: sinus tach โ How pnemo affects LE venous flow rate. Answer: reduces due to IVC pressure โ Pneumo can cause persistent bradcardia or SVT?. Answer: bradyarrhythmias โ Why intraop UOP is unreliable surrogate for volume status. Answer: Intraop oliguria is common (d/t decreased
renal blood flow due to intra-abdominal pressure) โ Ideal surgeon's elbow flexion and degree of arm abduction. Answer: Elbows flex between 60-120 degrees, Arms no more than 30 degrees from body โ Some relative contraindications to laparoscopy (6). Answer: inability to tolerate GA long-standing peritonitis (increase risk injury during initial trocar insertion and limit exposure) large mass massive chronically incarcerate ventral/inguinal hernia (lose space and difficult to reduce) severe pulmonary edema or cardiac disease โ Commonly mistaken as contraindications to laparoscopy but merely require special considerations (9). Answer: Diaphragm injury, GI Bleed, perforated viscus, bowel obstruction, abdominal trauma, IUP/ectopic, obesity, COPD, renal insufficiency โ Why Argon and Helium aren't used? (main risk). Answer: inc risk of gas embolism due to decreased solubility in blood (also much more $$) โ Typical bed position for upper adb surgery. Answer: rev Tburg
โ Avoid *** when collecting biopsies because it will render studies suboptimal.. Answer: electrocautery โ Needle size for FNA. Answer: 20-22G โ Needle size for core bx. Answer: 14-18g โ Typical bx type on liver (2) Type of liver lesion that should not be bx'd (2). Answer: core bx or wedge bx vascular lesions (bleeding risk), cystic/fluid filled lesions (no necessary) โ When bx hollow viscera, what step is often necessary if the bx site was left thin to prevent a leak. Answer: may need to place serosal stitch โ Port position (general) for kidneys/adrenal. Answer: subcostal โ Describe FNA technique. Answer: plunger creates suction and move needle back and forth a few times then release suction before pulling it out
โ Peritoneal washings - minimal amount of instilled fluid How long it sits before aspiration. Answer: 100mL 3 - 5 mins โ Preferred needle tip for lap suturing. Answer: tapered โ Preferred grasper shape for knot tying (straight vs curved). Answer: curved โ Ideal placement of two ports + camera for intracorporeal knot tying. Answer: at least 10 cm apart ports for intracorporeal knot tying with camera in between like triangle โ Tip for positioning needle laparoscopically - when to know that it's perpendicular from the light source. Answer: glint of light from needle indicates it is perpendicular to light source โ Where to grasp suture when introducing it through a port. Answer: 5- 10mm from swedge
โ These mechanical approx tools are simple and helpful for small tubular structures; not good for closing openings in hollow organs. Answer: clips โ Device that applies 2-3 rows of staples on each side of knife blade and cut tissue between rows. Answer: linear stapler โ General idea between choosing staple size for a linear stapler. Answer: smaller staples = more hemostasis, thinner tissue, larger staples= thicker tissue โ Typical staple size for vascular structures/ mesentery? For GI tract? For distal stomach/ unusually thick GI tract. Answer: 2-2.5mm (white) 3 - 3.5mm (blue) 4 - 4.5mm (green) โ Ideal suture length for intracorp knot tying. Answer: 6in/ 15cm
โ Trocar size best suited for introducing a standard SH-type needle. Answer: 10-12mm โ Strategies to control internal bleeding at a port site, when there is rapid bleeding and the source isn't visible laparoscopically. Answer: Higher 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) โ Mono vs bipolar: works in "wet" field, less lateral thermal spread, lower energy requirement. Answer: bipolar โ Medical reasons why postop pain should be well managed. Answer: increase risk of internal tissue approximation failure, pulmonary aspiration, external wound problems โ Visceral complications: stomach, SB, colon, bladder, ureters; typical mechanisms of injury -- electrosurgical burn, full/partial thickness tear, anastomotic leak, devascularization/ischemia โ present at
โ Name of hand-tied knot that can be used for extracorporeal knot tying. It's the knot that comes pre-tied on an Endoloop. Answer: Roeder's knot โ Bleeding in this space must be suspected if seeing free blood not from port or operative site; usually requires conversion to laparotomy. Answer: Retroperitoneal โ Risk factors for PONV (7). Answer: female gender, young age, history of motion sickness, non-smoking, opioid administration, use of volatile anesthetic agents, procedure length โ Shoulder pain from diaphragmatic irritation 2/2 pneumo typically lasts this amount of time postop. Answer: 1-3 days โ Name of laparoscopic rod-lens system. Answer: Hopkins rod-lens system
