Fundamentals of Laparoscopic Surgery (FLS) Practice Exam

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• Which statement best describes how the FLS scoring system evaluates overall technical performance?
• Which statement best describes the role of tissue capture in needle passage during suturing?
• Which finding affects the viability of access through the umbilicus?
• In a monopolar electrosurgical circuit, what is the correct current flow path?
• Postoperative vascular injuries may present with which of the following signs?
• Which ASA physical status may not tolerate pneumoperitoneum well during laparoscopy, requiring caution with ventilation?
• The open approach using a small incision with direct visualization to place a device into the peritoneal cavity is known as what technique?
• How does poor depth perception affect FLS task performance?
• In retroperitoneal biopsy, which energy source may be used safely away from critical structures?
• Which practice reduces the risk of thermal injury near delicate structures during energy use?
• What is the concept of triangulation in laparoscopic geometry?
• What is a key challenge of extracorporeal knot tying compared with intracorporeal?
• In pregnancy, initial access should be tailored based on which factor?
• In suturing, what is the difference between intracorporeal knots and extracorporeal knots?
• For obese patients, what is the maximum trocar length mentioned for insertion?
• Maintaining stable pneumoperitoneum is essential because it preserves what?
• Which of the following most accurately explains the reason for maintaining good triangulation during laparoscopic suturing?
• Roedner's knot is tied completely extrapoportally and then pushed down. It is used for which structures?
• In a linear stapler, which statement is true?
• Which of the following is NOT a recommended practice to minimize thermal injury risk during energy use?
• Which practice helps mitigate smoke during laparoscopic dissection?
• In diagnostic laparoscopy for trauma, which requirements apply?
• Which cardiovascular complication related to pneumoperitoneum can be mitigated by certain preoperative medications?
• Which option describes preoperative CO2 checks for delivery readiness?
• Should NSAIDs including ASA be discontinued preoperatively for laparoscopy?
• Ultrasonic shears consist of which components?
• In ultrasonic devices, what is the function of the passive jaw?
• Which anatomical knowledge is most critical to avoid injury during laparoscopy?
• For retroperitoneal exposure, what position is used for structures above the iliac bifurcation?
• Under low pressure with high flow, which location should be checked for CO2 leakage?
• Which device uses mechanical energy converted to high-frequency ultrasonic vibration to cut tissue?
• What risk is associated with the active blade when it is unprotected?
• For safe sealing with bipolar energy, which step is essential before cutting?
• How should instrument movements be paced to minimize tissue trauma?
• Why is hemostasis after biopsy often performed secondarily?
• Ultrasonic dissection uses what mechanism?
• What is a common entry-related complication and its prevention?
• Which statement about continuous sutures is true?
• How does countertraction facilitate laparoscopic suturing?
• Which of the following is NOT listed as a common source of unrecognized bleeding during laparoscopy?
• When using bipolar energy for hemostasis, which description is accurate?
• To prevent loss of pneumoperitoneum during suctioning, where should the suction tip be kept?
• Which statement describes port placement for small bowel examination?
• When Palmer's point is used, what is a recommended step?
• Which of the following is NOT listed as a mechanism of nerve injury in laparoscopy?
• Which finding is a relative contraindication to laparoscopic appendectomy?
• How should port placement be optimized for ergonomic instrument use?
• Which of the following is listed as a post-operative injury that can occur later after surgery?
• Capacitive coupling hazard in laparoscopic energy devices is best described by which statement?
• Compared with CO2, Nitric Oxide as an insufflation gas is associated with which acid-base effect?
• Which aspects of the Global Rating Scale reflect performance quality?
• In a monopolar setup, which component completes the circuit by returning current to the generator?
• What is the objective of pattern cutting in laparoscopic tasks?
• Extraperitoneal gas extravasation can cause which of the following complications?
• What is the typical warfarin discontinuation time before elective laparoscopy?
• Which factor is most closely associated with knot security in laparoscopic suturing?
• During small bowel handling, which approach minimizes injury?
• What is the initial management step for suspected gas embolus during laparoscopy?
• What is the typical intraabdominal pressure and CO2 volume used during laparoscopy?
• Which of the following is a potential complication of Veress needle insertion?
• Which instrument movement principle improves efficiency in peg transfer?
• Which practice is LEAST helpful for pacing instrument movements to minimize tissue trauma?
• In triangulation, how are the instrument tips arranged?
• Name a common knot-tying pattern used in intracorporeal suturing?
• What is the recommended setup for examining the small bowel during laparoscopy?
• Which of the following is NOT listed as a risk factor for postoperative nausea and vomiting (PONV)?
• Which energy devices are commonly used in laparoscopy for coagulation and cutting, respectively?
• What is a hazard of laparoscopic monopolar current diversion?
• Which finding increases the risk of enterotomy due to adhesions during laparoscopy?
• Wedge biopsy can be performed with which instruments?
• Roedner's knot is used for which structures?
• Calot’s triangle is an anatomic region important for safely identifying which structures during gallbladder surgery?
• Liver biopsy is generally performed to evaluate parenchymal disease, and which biopsy methods are appropriate?
• Biopsy forceps are commonly used for which procedures?
• Which practice is NOT a recommended lens fog prevention practice during laparoscopy?
• Why is structured team communication important in laparoscopy?
• Which parameter is routinely monitored during CO2 pneumoperitoneum to assess ventilation status?
• What is the recommended port separation for intracorporeal knot tying?
• What strategy helps prevent lens fog during laparoscopy?
• What is the primary purpose of maintaining adequate abdominal insufflation during laparoscopy?
• Which error most commonly reduces score in pattern cutting?
• Which statement about Argon and Helium as alternative gases is true?
• In monopolar electrosurgery, which statement describes the frequency change at the active electrode?
• To avoid inadvertent cutting of vessels before adequate sealing, what is essential during bipolar activation?
• Which statement best describes monopolar cut mode?
• Which cognitive skill is crucial for pattern cutting accuracy?
• Nitric Oxide cannot be used in which scenario?
• In laparoscopy, which statement best describes the purpose of direct visualization entry for peritoneal access?
• In monopolar energy delivery, current density is determined by which factor?
• Complete loss of the operative image requires checking which of the following first?
• What is the objective of dissection in laparoscopic tissue handling?
• In obese patients, what trocar modification is recommended?
• What is the maximum recommended arm abduction to avoid brachial plexus injury during a laparoscopic procedure?
• What are the recommended staple heights for vascular, GI tract, and distal stomach or thickened GI tract respectively?
• Which of the following is NOT a recommended approach to minimizing tissue trauma during laparoscopic tasks?
• Which preoperative medication is used to ease anxiety and produce amnesia?
• Bipolar energy uses what configuration?
• What is the most common light source used in laparoscopic procedures?
• During laparoscopic entry, which condition is specifically associated with an increased risk of injury from trocar insertion?
• Which method is considered most accurate to confirm Veress needle intraperitoneal position at the start of laparoscopy?
• What is an early sign of CO2 embolism during laparoscopy and immediate management?
• Which of the following is a troubleshooting step for troubleshooting the image display during laparoscopy?
• Which imaging modality may be used to assist retroperitoneal biopsy?
• Which biopsy method should not be used for vascular lesions such as hemangioma?
• Which factor most influences peg transfer efficiency?
• Which ergonomic adjustments help reduce surgeon fatigue during laparoscopy?
• Postoperative vascular injuries are often accompanied by which finding?
• Which considerations ensure proper sterilization of instrumentation used in FLS training?
• Which statement lists the four core tasks in the FLS psychomotor skills test?
• Fine-needle aspiration uses a needle gauge typically in which range?
• Name two safety steps for establishing pneumoperitoneum.
• Which of the following is an anticipated cardiovascular effect of CO2 pneumoperitoneum that informs prophylaxis?
• Which biopsy method should be avoided during laparoscopy?
• Which scenario is a relative contraindication for emergency laparoscopy?
• Which statement describes a renal effect of pneumoperitoneum?
• Which statement best describes monopolar coagulation mode?
• Which CO2-related change tends to be greatest in the first 20 minutes of pneumoperitoneum?
• What is the purpose of a pre-procedure safety check in FLS?
• Which condition is a relative contraindication to pelvic laparoscopy?
• Which safety consideration is true for bipolar energy?
• What port size is generally required for linear staplers?
• When insufflator pressure is equal to or greater than the preset pressure, which is the most likely cause?
• Which practice helps prevent instrument collisions in a restricted workspace?
• Which of the following is NOT a lens fog prevention strategy?
• Which statement about fine-needle aspiration (FNA) is true?
• Which finding is characteristic of a gas embolus during laparoscopy?
• In pregnant patients, which position is recommended as a precaution during laparoscopy?
• Which core task involves tying knots inside the abdomen using instruments?
• What is the role of suction/irrigation in achieving precise tissue manipulation?
• In monopolar desiccation, what is the primary mechanism of hemostasis?
• Shoulder pain after laparoscopy lasts for 1-3 days. Which option matches this duration?
• When visualization is compromised, what is the recommended sequence of actions?
• Which leg support system provides better individualization in longer procedures?
• What technique is recommended to visualize the liver during laparoscopy?
• Which factors exacerbate a fall in cardiac output during pneumoperitoneum?
• How is suture handling evaluated in the FLS scoring system?
• Which arrhythmia is most commonly associated with pneumoperitoneum during laparoscopic procedures?
• Which instrument is used in the Hasson open technique to access the peritoneal cavity?
• During staging laparoscopy, peritoneal washings are obtained to provide what type of information?
• What is the ergonomic position recommended for intracorporeal knot tying?
• Which condition can lead to bipolar hazards due to improper functioning of the device?
• In ovarian biopsy planning, decisions depend on which factors?
• When intraoperative cardiac output decreases due to pneumoperitoneum, which is an appropriate initial management step?
• Which measure helps reduce the risk of nerve injury during laparoscopy?
• Bipolar energy delivery uses impedance feedback to achieve sealing through what process?
• Which approach is recommended for trocar insertion in thin patients to minimize complications?
• Compared with monopolar, bipolar energy delivery is characterized by which statement?
• Which history increases the risk of intra-abdominal adhesions?
• During monopolar desiccation, what happens to impedance as tissue dries?
• What two broad factors contribute to a high global performance in FLS tasks?
• Which factor is considered when choosing the entry technique for pneumoperitoneum in patients with prior abdominal surgery?
• How is "tissue handling" defined in FLS scoring?
• In the context of energy use for hemostasis, bipolar energy is associated with which advantage?
• Which finding is a relative contraindication to foregut laparoscopic procedures?
• Postoperative shoulder pain after laparoscopy typically lasts how long?
• Why is triangulation important in laparoscopic suturing?
• Which statement best describes the objective difference between pattern cutting and dissection?
• In pattern cutting, what is the primary goal?
• Epidural anesthesia in laparoscopic surgery can be used as an adjunct to GA and provides which benefits?
• Which statement about interrupted sutures is true?
• What is the purpose of diagnostic laparoscopy for the anterior abdominal wall?
• Who performed the first laparoscopic cholecystectomy?
• In suspected solid organ injury, which imaging modality is preferred when the patient is hemodynamically stable?
• Which finding is a preoperative consideration for gaining access through the umbilicus?
• Which preoperative medication has effects similar to atropine but causes less dry mouth?
• Which condition is a relative contraindication to laparoscopic hernia repair?
• Which of the following is a possible cause of reduced illumination during laparoscopy?
• The saline drop test is used to verify placement of which instrument?
• Which of the following is a true statement about using Nitric Oxide as an alternative insufflation gas in laparoscopy?
• Argon and Helium as alternative gases: which statement is true?
• What strategies help prevent instrument collisions in a restricted workspace?
• Why should ports be removed under direct lap visualization?
• Which condition is a relative contraindication to laparoscopic colon resection?
• For laparoscopy in small bowel obstruction, which entry method is recommended?
• Veress needle insertion sites are commonly located at which locations?
• How do you differentiate the bile duct from hepatic vessels on a laparoscopic view?
• Postoperative vascular injuries tend to involve which type of vessels?
• What is a primary chemical effect of CO2 absorption during pneumoperitoneum?
• Why are dyed sutures preferred?
• Where are intracorporeal knots formed?
• Under a low pressure with high flow setting, which finding best explains the loss of working space?
• Why is maintaining stable pneumoperitoneum essential during FLS tasks?
• If visualization remains poor after attempting defogging and camera adjustments, what is the recommended step?
• What is a notable risk when using Nitric Oxide as an insufflation gas?
• To minimize tissue friction during an extracorporeal knot, which method is recommended?
• What is the purpose of a circumferential bite in suturing?
• Which of the following is an absolute contraindication to laparoscopy?
• Which item is considered important to review in preoperative history for laparoscopic surgery?
• Bipolar hazards include improper functioning when metal is inside the jaws; which items exemplify this metal?
• Which of the following describes a preoperative troubleshooting step for the CO2 delivery system?
• What gauge range is typical for hepatic core needle biopsy?
• Where should the monitor be placed when examining the small bowel?
• Which complication can occur due to insufflation with CO2 during laparoscopy?
• Who performed the first laparoscopic appendectomy?
• When performing hemostasis, monopolar energy is generally preferred for which situation?
• Compare Veress needle entry and open (Hasson) entry for establishing pneumoperitoneum.
• Roedner's knot is used for which structures?
• Which practice best reduces the risk of dropping a ring during peg transfer?
• What factor most influences knot security in intracorporeal suturing?
• What is the recommended positioning for diagnostic laparoscopy for suspected appendicitis?
• Which measures help prevent hypothermia during pneumoperitoneum?
• Which statement about core needle biopsy is true?
• Which practice proactively reduces lens fogging before it occurs?
• Which condition is a relative contraindication to laparoscopic cholecystectomy?
• If the insufflator shows low pressure with no flow, which action should be performed first?
• What is an effective approach to controlling small intraoperative bleeding in FLS tasks?
• What is the typical extracorporeal knot length?
• What is a hallmark of proper tissue handling that minimizes trauma?
• In monopolar desiccation, which sequence best describes the tissue changes?
• Which factor specifically reduces functional residual capacity during pneumoperitoneum?
• What environmental factor commonly degrades visualization, and how is it mitigated?
• Which condition is a relative contraindication to laparoscopic hernia repair?
• How would you describe proper tissue handling in a high-quality FLS attempt?
• When is conversion to an open approach considered in the FLS context?
• In a linear stapler, how many rows of staples are placed on either side of the knife blade?
• Which technique is used to verify intraperitoneal placement before insufflation by aspirating with syringe?
• During peritoneal washings, what is the typical volume of normal saline used?
• What informs the time target for a peg transfer attempt?
• When excising a visceral lesion that is small and superficial, what technique helps prevent leakage?
• Which of the following is NOT a mechanism of nerve injury?
• Which structures are exposed in retroperitoneal exposure?
• Bipolar devices can seal vessels up to what size?
• What is a best practice for pattern cutting quality?
• Which is a cardiovascular effect of pneumoperitoneum?
• In peg transfer, what is the essential skill to prevent dropping rings?
• Which preoperative medication is used to minimize the risk of aspiration during anesthesia?
• Which description best matches a Veress needle?
• Which statement best describes the time course of possible post-operative injuries?
• Which preoperative drug may prevent bradyarrhythmias caused by pneumoperitoneum, albeit with the side effect of dry mouth?
• Which of the following is a common error in peg transfer that can degrade your score?
• What is the mechanism of tissue coagulation in monopolar electrosurgery?
• Which liver condition increases the risk of bleeding and postoperative ascites?
• Why is repeated practice with a simulator central to FLS mastery?
• Which statement best describes the pulmonary response to CO2 pneumoperitoneum?
• What is the primary difference between monopolar and bipolar energy?
• Which condition is a relative contraindication to laparoscopic antireflux surgery?
• What is the starting point when examining the bowel for suspected small bowel obstruction?
• Which technique helps prevent tissue tearing when passing the needle?
• Which laparoscopic instrument is commonly used to grasp and manipulate tissue?
• What does tucking the arms help prevent when the operating table is flexed?