FLS Cognitive Exam — Questions and Answers

Question 1: Which of the following initial insufflation flow rates is most appropriate when using the Veress needle to confirm correct placement?

5–6 L/min
15–20 L/min
1–2 L/min (Correct answer)
8–10 L/min

Correct answer: 1–2 L/min

Starting at a low flow rate (1–2 L/min) allows monitoring of pressure rise; a rapid pressure increase at low flow suggests incorrect placement.

Question 2: The Veress needle technique relies on a spring-loaded blunt obturator that advances when the needle enters which structure?

The retroperitoneum
The peritoneal cavity (Correct answer)
Subcutaneous fat
The anterior fascia

Correct answer: The peritoneal cavity

Once the sharp tip passes through the peritoneum and resistance drops, the spring-loaded blunt stylet springs forward to protect intraabdominal organs.

Question 3: Which cardiovascular effect is most likely due to the effects of pneumoperitoneum during laparoscopic surgery?

Bradycardia (Correct answer)
Premature ventricular contractions (PVCs)
Ventricular fibrillation (V-fib)
Tachycardia

Correct answer: Bradycardia

Explanation: Bradycardia, or a decrease in heart rate, is the cardiovascular effect most commonly associated with the effects of pneumoperitoneum during laparoscopic surgery. This response is believed to be mediated by the vagal nerve stimulation caused by the elevated intra-abdominal pressure.

Question 4: What does ASA class 3 indicate?

Healthy patient with no systemic disease
Mild systemic disease with no functional limitations
Severe systemic disease that limits the patient's activity and may or may not be related to the reason for surgery (Correct answer)
Patient with severe systemic disease that is a constant threat to life

Correct answer: Severe systemic disease that limits the patient's activity and may or may not be related to the reason for surgery

Explanation: ASA class 3 denotes a patient with severe systemic disease that limits their activity, and this condition may or may not be related to the reason for surgery. It indicates significant health concerns that may impact the patient's perioperative care and overall outcome.

Question 5: In the FLS peg transfer task, which camera orientation is most critical for accurate performance?

Camera positioned behind the dominant hand
Camera aimed downward at 45° toward the pegs (Correct answer)
Camera maximally zoomed in on one peg at a time
Camera at the same height as the pegs with a straight-on view

Correct answer: Camera aimed downward at 45° toward the pegs

A downward angled view provides the spatial perspective needed to see the peg tops, judge ring placement, and coordinate bimanual transfer in the FLS trainer.

Question 6: The Palmer's point entry site for Veress needle insertion is located at:

2 cm below the umbilicus in the midline
3 cm below the left costal margin in the midclavicular line (Correct answer)
Right iliac fossa, McBurney's point
2 cm above the pubic symphysis

Correct answer: 3 cm below the left costal margin in the midclavicular line

Palmer's point, 3 cm below the left costal margin in the midclavicular line, is used as an alternative entry site when umbilical adhesions are suspected.

Question 7: Before exiting the abdomen at the end of a laparoscopic procedure, which of the following should be checked?

All of the above (Correct answer)
The dependent portions of the abdomen
The abdominal wall at each previous trocar site
The operative field

Correct answer: All of the above

Explanation: Ensuring all these areas are checked helps prevent complications and ensures patient safety.

Question 8: What is the primary function of the mitochondria in cells relevant to Fundamentals of Laparoscopic Surgery?

To synthesize proteins
To remove waste products
To produce energy (ATP) through cellular respiration (Correct answer)
To store genetic information

Correct answer: To produce energy (ATP) through cellular respiration

Mitochondria are the "powerhouses" of the cell, converting nutrients into ATP (adenosine triphosphate) through cellular respiration, providing the energy needed for cellular functions.

Question 9: In Fundamentals of Laparoscopic Surgery, what role does continuing education play in trocar placement?

To increase testing frequency for compliance purposes
To keep professionals current with evolving standards, technologies, and best practices (Correct answer)
To replace initial certification requirements
To prevent professionals from advancing in their careers

Correct answer: To keep professionals current with evolving standards, technologies, and best practices

Continuing education ensures professionals stay current with new developments, evolving standards, and emerging best practices in their field, maintaining competence throughout their careers.

Question 10: What is a key benefit of implementing performance metrics in Fundamentals of Laparoscopic Surgery complications management?

Providing measurable data to track progress and inform decision-making (Correct answer)
Reducing employee autonomy
Replacing strategic planning entirely
Eliminating the need for qualitative feedback

Correct answer: Providing measurable data to track progress and inform decision-making

Performance metrics provide objective, quantifiable data that helps track progress toward goals, identify areas for improvement, and support evidence-based decision-making.

Question 11: During laparoscopic clip application, the surgeon should ensure clearance of the clip applier jaws by at least how much on both sides of the target structure?

No clearance is required if the duct is well visualized
At least 10 mm of jaw clearance on each side
1–2 mm of jaw clearance on each side
At least 3–5 mm of jaw clearance on each side (Correct answer)

Correct answer: At least 3–5 mm of jaw clearance on each side

Ensuring 3–5 mm of jaw clearance on each side of the structure guarantees the clip fully encircles it and closes completely, reducing the risk of partial occlusion or misapplication.

Question 12: In Fundamentals of Laparoscopic Surgery, why is energy devices knowledge important for professional certification?

It demonstrates competence and ensures practitioners meet established standards (Correct answer)
It has no practical relevance to daily work
It is only required for administrative purposes
It is important only for entry-level positions

Correct answer: It demonstrates competence and ensures practitioners meet established standards

Professional certification in specific knowledge areas demonstrates that practitioners have met established competency standards, ensuring quality of service and public protection.

Question 13: Which of the following will be decreased by pneumoperitoneum during laparoscopic surgery?

Renal vascular resistance
Cardiac index (CI) (Correct answer)
Pulmonary vascular resistance (PVR)
Systemic vascular resistance (SVR)
Pulmonary capillary wedge pressure (PCWP)

Correct answer: Cardiac index (CI)

Explanation: Pneumoperitoneum during laparoscopic surgery can decrease cardiac index (CI) due to factors such as increased intra-abdominal pressure, reduced venous return, and altered cardiovascular dynamics. This reduction in CI can impact overall cardiac function during the procedure.

Question 14: In Fundamentals of Laparoscopic Surgery, why is extracorporeal suturing knowledge important for professional certification?

It is important only for entry-level positions
It is only required for administrative purposes
It has no practical relevance to daily work
It demonstrates competence and ensures practitioners meet established standards (Correct answer)

Correct answer: It demonstrates competence and ensures practitioners meet established standards

Professional certification in specific knowledge areas demonstrates that practitioners have met established competency standards, ensuring quality of service and public protection.

Question 15: Which of the following is a contraindication to the use of CO₂ pneumoperitoneum?

Severe COPD with CO₂ retention (Correct answer)
Prior abdominal surgery
Mild hypertension
Obesity

Correct answer: Severe COPD with CO₂ retention

Patients with severe COPD who already retain CO₂ may not be able to adequately eliminate the additional absorbed CO₂, leading to dangerous hypercarbia.

Question 16: Which approach is most effective for mastering energy devices in Fundamentals of Laparoscopic Surgery?

Memorizing textbook definitions without understanding
Relying solely on on-the-job experience
Combining theoretical study with practical application and regular review (Correct answer)
Studying only immediately before examinations

Correct answer: Combining theoretical study with practical application and regular review

The most effective approach combines theoretical understanding with practical application, reinforced by regular review and assessment, enabling deeper comprehension and long-term retention.

Question 17: In Fundamentals of Laparoscopic Surgery, what does the PDCA cycle stand for?

Prioritize, Delegate, Communicate, Approve
Process, Design, Create, Analyze
Prepare, Develop, Control, Assess
Plan, Do, Check, Act (Correct answer)

Correct answer: Plan, Do, Check, Act

The PDCA cycle (Plan-Do-Check-Act) is a continuous improvement framework where you plan the change, implement it, check the results, and act on what you learned to refine the process.

Question 18: What is the primary cardiovascular effect of elevated intraabdominal pressure (>15 mmHg) during laparoscopy?

Increased venous return and elevated cardiac output
Decreased venous return and reduced cardiac output (Correct answer)
Decreased systemic vascular resistance
Increased heart rate with no change in preload

Correct answer: Decreased venous return and reduced cardiac output

Elevated IAP compresses the inferior vena cava, reducing venous return and preload, which decreases cardiac output.

Question 19: What is the recommended initial trocar location for laparoscopic surgery?

Umbilicus (Correct answer)
Epigastric region
Right upper quadrant
Left lower quadrant

Correct answer: Umbilicus

Explanation: The umbilicus is the standard initial trocar insertion site for laparoscopic surgery. This location provides central access to the abdominal cavity and facilitates instrument insertion for various procedures. Additionally, it minimizes the risk of injury to surrounding structures.

Question 20: In Fundamentals of Laparoscopic Surgery, what does pH measure?

The temperature of a liquid
The pressure within a container
The acidity or alkalinity of a solution on a scale of 0 to 14 (Correct answer)
The viscosity of a solution

Correct answer: The acidity or alkalinity of a solution on a scale of 0 to 14

pH measures the hydrogen ion concentration in a solution, indicating its acidity (pH < 7), neutrality (pH = 7), or alkalinity (pH > 7) on a scale from 0 to 14.

Question 21: What is a best practice in Fundamentals of Laparoscopic Surgery ergonomics and setup?

A method or technique recognized as superior based on evidence and expert consensus (Correct answer)
The cheapest available approach
A practice used only by large organizations
Any practice that is easy to implement

Correct answer: A method or technique recognized as superior based on evidence and expert consensus

Best practices are methods, techniques, or approaches that are recognized through evidence, research, and expert consensus as producing superior results and are recommended for adoption.

Question 22: A sudden drop in end-tidal CO₂ (EtCO₂) combined with cardiovascular collapse during insufflation most likely indicates:

Subcutaneous emphysema
CO₂ gas embolism (Correct answer)
Tension pneumothorax
Vasovagal response

Correct answer: CO₂ gas embolism

A massive CO₂ embolism causes a 'millwheel' murmur, cardiovascular collapse, and a precipitous fall in EtCO₂ as venous return is obstructed.

Question 23: What is a best practice in Fundamentals of Laparoscopic Surgery pattern cutting?

A method or technique recognized as superior based on evidence and expert consensus (Correct answer)
The cheapest available approach
Any practice that is easy to implement
A practice used only by large organizations

Correct answer: A method or technique recognized as superior based on evidence and expert consensus

Best practices are methods, techniques, or approaches that are recognized through evidence, research, and expert consensus as producing superior results and are recommended for adoption.

Question 24: The standard laparoscope used in FLS tasks has a 0° or 30° lens. What is the primary advantage of the 30° (angled) lens?

It allows the surgeon to 'look around corners' by rotating the scope (Correct answer)
It produces less light loss than a 0° scope
It magnifies the image more than a 0° scope
It provides a wider field of view without moving the scope

Correct answer: It allows the surgeon to 'look around corners' by rotating the scope

Rotating a 30° angled scope redirects the viewing angle, allowing visualization behind structures and in areas not accessible with a straight 0° lens.

Question 25: The phenomenon of 'fulcrum effect' in laparoscopy means that when the surgeon moves the instrument handle to the right, the instrument tip moves:

To the left (in the opposite direction) (Correct answer)
To the right, as with open surgery
Diagonally, depending on trocar angle
Straight upward due to leverage

Correct answer: To the left (in the opposite direction)

Because the trocar acts as a fixed pivot point (fulcrum), handle and tip move in opposite directions — a key psychomotor adaptation required for laparoscopic skill.

Question 26: What is the best alternate site for Veress needle insertion besides the umbilicus?

Palmer's point (Correct answer)
Left lower quadrant
Epigastric region
Right upper quadrant

Correct answer: Palmer's point

Explanation: Palmer's point, located in the left upper quadrant just below the costal margin, is considered the best alternate site for Veress needle insertion besides the umbilicus. This site provides access to the peritoneal cavity while minimizing the risk of injury to intra-abdominal organs.

Question 27: What should be included in the initial consultation for laparoscopic surgery?

Details of pneumoperitoneum
Types of trocars used
Type of insufflation gas to be used
Possibility of conversion to open surgery (Correct answer)

Correct answer: Possibility of conversion to open surgery

Explanation: The initial consultation for laparoscopic surgery should include discussing the possibility of conversion to open surgery with the patient. This ensures informed consent and preparedness for potential complications or challenges during the procedure.

Question 28: Which level of biological organization represents the most complex in Fundamentals of Laparoscopic Surgery anatomy knowledge?

Ecosystem (Correct answer)
Tissue
Organ
Cell

Correct answer: Ecosystem

The hierarchy from simplest to most complex goes: atom → molecule → cell → tissue → organ → organ system → organism → population → community → ecosystem → biosphere.

Question 29: In Fundamentals of Laparoscopic Surgery, what is homeostasis?

A type of immune response
The body's ability to maintain a stable internal environment despite external changes (Correct answer)
A rapid increase in body temperature
The process of cell division

Correct answer: The body's ability to maintain a stable internal environment despite external changes

Homeostasis is the process by which biological systems maintain internal stability and balance (temperature, pH, glucose levels, etc.) while adjusting to changing external conditions.

Question 30: The 'sword fighting' artifact in laparoscopy refers to:

Camera rotation causing horizon tilt
Crossed light cables creating image interference
Light reflections causing glare on instruments
Instrument tip collision caused by poor triangulation and camera alignment (Correct answer)

Correct answer: Instrument tip collision caused by poor triangulation and camera alignment

Sword fighting occurs when instruments and/or the camera are aligned coaxially rather than triangulated, causing frequent clashing that impairs bimanual coordination.

Question 31: Light intensity in laparoscopy follows the inverse square law, which means doubling the distance from light source to tissue:

Reduces light intensity to one-quarter of its original level (Correct answer)
Halves the light intensity at the tissue
Has no effect if the light source is at maximum power
Doubles the reflected light reaching the camera

Correct answer: Reduces light intensity to one-quarter of its original level

By the inverse square law, intensity decreases proportionally to the square of the distance, so doubling the distance reduces light to 1/4 of its original intensity.

Question 32: What is the most important step to confirm correct Veress needle placement BEFORE beginning insufflation?

Check that the needle length is appropriate
Perform the hanging drop test or aspiration test (Correct answer)
Confirm the patient is in Trendelenburg position
Rotate the needle 360°

Correct answer: Perform the hanging drop test or aspiration test

The hanging drop test and aspiration test together confirm peritoneal entry and absence of bowel or vascular injury before gas is introduced.

Question 33: What is the recommended minimum distance from the common bile duct when placing the proximal clip on the cystic duct?

3 mm (Correct answer)
5 mm
2 mm
1 mm

Correct answer: 3 mm

A minimum of 3 mm from the common bile duct is recommended to avoid incorporating the bile duct in the clip and risking a bile duct injury.

Question 34: What is the primary objective of trocar placement in Fundamentals of Laparoscopic Surgery?

To ensure competence and proficiency in core trocar placement concepts (Correct answer)
To limit access to the profession
To generate revenue for testing organizations
To replace practical experience entirely

Correct answer: To ensure competence and proficiency in core trocar placement concepts

The primary objective of trocar placement knowledge is to ensure practitioners have the competence and proficiency needed to perform effectively and safely in their professional roles.

Question 35: During monopolar cautery, which method involves quickly turning cell water to steam, causing the cell to explode?

None of the above
Blending (Blend)
Coagulation (Coag)
Cutting (Correct answer)

Correct answer: Cutting

Explanation: During monopolar cautery, the cutting mode uses high-frequency electrical current to rapidly vaporize tissue, turning cell water into steam and causing the cell to explode. This process allows for precise tissue cutting during surgery.

Question 36: What is the relationship between theory and practice in Fundamentals of Laparoscopic Surgery ergonomics and setup?

Theory and practice are completely unrelated
Theory replaces the need for any practical experience
Theory provides the foundation and framework that guides effective practical application (Correct answer)
Practice is only important; theory is unnecessary

Correct answer: Theory provides the foundation and framework that guides effective practical application

Theory and practice are complementary: theoretical knowledge provides the conceptual framework and understanding that guides effective, evidence-based practical application in professional settings.

Question 37: Which statement is NOT true about general anesthesia in laparoscopic surgery?

Complete neuromuscular relaxation
Fewer hemodynamic changes compared to local anesthesia (Correct answer)
Good control of ventilation
Allows for more flexibility during positioning

Correct answer: Fewer hemodynamic changes compared to local anesthesia

Explanation: General anesthesia typically induces significant hemodynamic changes, including alterations in blood pressure and heart rate, whereas local anesthesia generally produces fewer systemic effects.

Question 38: What is the relationship between theory and practice in Fundamentals of Laparoscopic Surgery ligating loop placement?

Theory replaces the need for any practical experience
Practice is only important; theory is unnecessary
Theory and practice are completely unrelated
Theory provides the foundation and framework that guides effective practical application (Correct answer)

Correct answer: Theory provides the foundation and framework that guides effective practical application

Theory and practice are complementary: theoretical knowledge provides the conceptual framework and understanding that guides effective, evidence-based practical application in professional settings.

Question 39: Which gas is most commonly used for laparoscopic insufflation and why?

Nitrous oxide — non-flammable
Carbon dioxide — rapidly absorbed and non-flammable (Correct answer)
Helium — inert and colorless
Oxygen — highly soluble

Correct answer: Carbon dioxide — rapidly absorbed and non-flammable

Carbon dioxide is preferred because it is highly soluble in blood, rapidly eliminated by the lungs, and non-flammable, reducing risk of gas embolism and surgical fire.

Question 40: What is the consequence of placing a clip too close to the neck of the gallbladder on the cystic duct?

Increased operative time only
Increased risk of trocar site hernia
Inadequate pneumoperitoneum maintenance
Potential for a retained gallstone to be trapped in the cystic duct remnant (Correct answer)

Correct answer: Potential for a retained gallstone to be trapped in the cystic duct remnant

Placing a clip too close to the gallbladder neck risks trapping stones in the cystic duct remnant, leading to retained stone syndrome and recurrent symptoms.

Question 41: What is the relationship between theory and practice in Fundamentals of Laparoscopic Surgery energy devices?

Theory replaces the need for any practical experience
Theory and practice are completely unrelated
Theory provides the foundation and framework that guides effective practical application (Correct answer)
Practice is only important; theory is unnecessary

Correct answer: Theory provides the foundation and framework that guides effective practical application

Theory and practice are complementary: theoretical knowledge provides the conceptual framework and understanding that guides effective, evidence-based practical application in professional settings.

Question 42: Which approach is most effective for mastering ergonomics and setup in Fundamentals of Laparoscopic Surgery?

Studying only immediately before examinations
Relying solely on on-the-job experience
Memorizing textbook definitions without understanding
Combining theoretical study with practical application and regular review (Correct answer)

Correct answer: Combining theoretical study with practical application and regular review

The most effective approach combines theoretical understanding with practical application, reinforced by regular review and assessment, enabling deeper comprehension and long-term retention.

Question 43: When checking the Veress needle during laparoscopic surgery, which is the most accurate indicator to ensure proper placement?

No flow of CO2 and high pressures
Aspirating enteric contents
Flow of CO2 and low pressures (Correct answer)
Aspirating blood

Correct answer: Flow of CO2 and low pressures

Explanation: The most accurate indicator of proper Veress needle placement is the flow of CO2 with low pressures. This indicates that the needle tip is in the peritoneal cavity, allowing for safe insufflation of the abdomen. Aspirating blood or enteric contents may indicate inadvertent vessel or bowel penetration, while no flow of CO2 or high pressures may suggest improper needle placement.

Question 44: What is the relationship between theory and practice in Fundamentals of Laparoscopic Surgery extracorporeal suturing?

Theory and practice are completely unrelated
Theory provides the foundation and framework that guides effective practical application (Correct answer)
Practice is only important; theory is unnecessary
Theory replaces the need for any practical experience

Correct answer: Theory provides the foundation and framework that guides effective practical application

Theory and practice are complementary: theoretical knowledge provides the conceptual framework and understanding that guides effective, evidence-based practical application in professional settings.

Question 45: In Fundamentals of Laparoscopic Surgery, what is the purpose of the scientific method in anatomy knowledge?

To replace professional judgment entirely
To provide a systematic approach for investigating questions and testing hypotheses (Correct answer)
To eliminate the need for observation
To guarantee specific experimental outcomes

Correct answer: To provide a systematic approach for investigating questions and testing hypotheses

The scientific method provides a structured, systematic approach for asking questions, forming hypotheses, designing experiments, collecting data, and drawing evidence-based conclusions.

Question 46: When the camera is positioned too close to the target tissue in the FLS box trainer, the result is:

Loss of spatial orientation and inability to see instrument tips (Correct answer)
Better magnification and improved task performance
Reduced glare from the light source
Improved depth perception due to shorter focal length

Correct answer: Loss of spatial orientation and inability to see instrument tips

Placing the camera too close eliminates the surrounding context needed for spatial orientation, making it difficult to coordinate instrument movements.

Question 47: In Fundamentals of Laparoscopic Surgery, what role does continuing education play in intracorporeal suturing?

To increase testing frequency for compliance purposes
To replace initial certification requirements
To keep professionals current with evolving standards, technologies, and best practices (Correct answer)
To prevent professionals from advancing in their careers

Correct answer: To keep professionals current with evolving standards, technologies, and best practices

Continuing education ensures professionals stay current with new developments, evolving standards, and emerging best practices in their field, maintaining competence throughout their careers.

Question 48: What is the advantage of using polymer locking clips (e.g., Hem-o-lok) over standard titanium clips for laparoscopic procedures?

They are MRI-compatible with zero artifact
They require less dissection clearance around the vessel
They are absorbed within 30 days eliminating long-term foreign body
They provide a self-locking mechanism reducing risk of dislodgement (Correct answer)

Correct answer: They provide a self-locking mechanism reducing risk of dislodgement

Polymer locking clips feature a ratcheting mechanism that locks them in place once applied, significantly reducing the risk of accidental dislodgement compared to non-locking titanium clips.

Question 49: All of the following are preoperative checks except:

Spare CO2 tank
Muscle relaxation (Correct answer)
Ancillary equipment availability
All power sources are on

Correct answer: Muscle relaxation

Explanation: Muscle relaxation is monitored and maintained during the procedure, not as a preoperative check. Preoperative checks include ensuring ancillary equipment is available, having a spare CO2 tank, and making sure all power sources are on.

Question 50: Which of the following is a relative contraindication for laparoscopic surgery?

Previous abdominal surgery (Correct answer)
Inability to tolerate a laparotomy
Hypovolemic shock, uncorrectable
Lack of appropriate facilities

Correct answer: Previous abdominal surgery

Explanation: Previous abdominal surgery is a relative contraindication for laparoscopic surgery due to potential adhesions and altered anatomy, which may increase the complexity and risk of complications during the procedure. However, it does not necessarily preclude laparoscopic surgery and may require careful consideration and planning by the surgical team.

Question 51: In Fundamentals of Laparoscopic Surgery, what is the primary function of strategic planning in complications management?

To manage the organization's social media presence
To handle day-to-day operational tasks
To conduct annual performance reviews
To set long-term goals and determine the best approach to achieve them (Correct answer)

Correct answer: To set long-term goals and determine the best approach to achieve them

Strategic planning involves defining the organization's direction, making decisions on allocating resources, and establishing priorities to achieve long-term objectives.

Question 52: In Fundamentals of Laparoscopic Surgery, why is ergonomics and setup knowledge important for professional certification?

It demonstrates competence and ensures practitioners meet established standards (Correct answer)
It is only required for administrative purposes
It has no practical relevance to daily work
It is important only for entry-level positions

Correct answer: It demonstrates competence and ensures practitioners meet established standards

Professional certification in specific knowledge areas demonstrates that practitioners have met established competency standards, ensuring quality of service and public protection.

Question 53: In FLS box trainer tasks, the camera is typically placed through which port?

The rightmost 5 mm port
A dedicated 2 mm port at the top of the box
The left lateral 5 mm port
The umbilical 10–12 mm central port (Correct answer)

Correct answer: The umbilical 10–12 mm central port

The FLS box trainer camera port is in the central umbilical position, mirroring the standard laparoscopic camera placement in most abdominal procedures.

Question 54: What is a best practice in Fundamentals of Laparoscopic Surgery trocar placement?

A practice used only by large organizations
A method or technique recognized as superior based on evidence and expert consensus (Correct answer)
Any practice that is easy to implement
The cheapest available approach

Correct answer: A method or technique recognized as superior based on evidence and expert consensus

Best practices are methods, techniques, or approaches that are recognized through evidence, research, and expert consensus as producing superior results and are recommended for adoption.

Question 55: When terminating pneumoperitoneum at the end of a laparoscopic procedure, the surgeon should:

Leave residual CO₂ to reduce postoperative pain
Desufflate completely before removing trocars to minimize shoulder pain (Correct answer)
Simply remove the trocars without deflating
Switch to oxygen insufflation for residual gas

Correct answer: Desufflate completely before removing trocars to minimize shoulder pain

Complete desufflation removes CO₂ that would otherwise track to the diaphragm and cause referred shoulder pain (phrenic nerve irritation) postoperatively.

Question 56: In Fundamentals of Laparoscopic Surgery, what role does continuing education play in energy devices?

To increase testing frequency for compliance purposes
To prevent professionals from advancing in their careers
To replace initial certification requirements
To keep professionals current with evolving standards, technologies, and best practices (Correct answer)

Correct answer: To keep professionals current with evolving standards, technologies, and best practices

Continuing education ensures professionals stay current with new developments, evolving standards, and emerging best practices in their field, maintaining competence throughout their careers.

Question 57: In FLS skills assessment, 'camera navigation' is evaluated as part of task performance because:

Poor camera positioning directly increases task time and error rates in all five FLS tasks (Correct answer)
Camera navigation is only relevant for advanced laparoscopic procedures
The examiner controls the camera during testing
Surgeons are graded on identifying anatomical structures verbally

Correct answer: Poor camera positioning directly increases task time and error rates in all five FLS tasks

Suboptimal camera positioning limits visualization, forcing awkward instrument angles and reducing precision — this directly inflates completion time and error scores in all FLS tasks.

Question 58: What is the primary objective of energy devices in Fundamentals of Laparoscopic Surgery?

To ensure competence and proficiency in core energy devices concepts (Correct answer)
To replace practical experience entirely
To limit access to the profession
To generate revenue for testing organizations

Correct answer: To ensure competence and proficiency in core energy devices concepts

The primary objective of energy devices knowledge is to ensure practitioners have the competence and proficiency needed to perform effectively and safely in their professional roles.

Question 59: What is the recommended initial intraabdominal pressure (IAP) for creating pneumoperitoneum in a standard adult laparoscopic procedure?

8–10 mmHg
12–15 mmHg (Correct answer)
18–20 mmHg
5–7 mmHg

Correct answer: 12–15 mmHg

A working pressure of 12–15 mmHg provides adequate visualization while minimizing hemodynamic and respiratory compromise in most adults.

Question 60: What is the primary purpose of stakeholder analysis in Fundamentals of Laparoscopic Surgery complications management?

To evaluate employee attendance records
To identify and understand the interests and influence of all parties affected by decisions (Correct answer)
To schedule project timelines
To calculate financial returns on investment

Correct answer: To identify and understand the interests and influence of all parties affected by decisions

Stakeholder analysis identifies all parties who have an interest in or are affected by a project or decision, assessing their level of influence and interest to develop appropriate engagement strategies.

Question 61: What is the primary objective of ergonomics and setup in Fundamentals of Laparoscopic Surgery?

To limit access to the profession
To generate revenue for testing organizations
To replace practical experience entirely
To ensure competence and proficiency in core ergonomics and setup concepts (Correct answer)

Correct answer: To ensure competence and proficiency in core ergonomics and setup concepts

The primary objective of ergonomics and setup knowledge is to ensure practitioners have the competence and proficiency needed to perform effectively and safely in their professional roles.

Question 62: Which approach is most effective for mastering intracorporeal suturing in Fundamentals of Laparoscopic Surgery?

Memorizing textbook definitions without understanding
Relying solely on on-the-job experience
Studying only immediately before examinations
Combining theoretical study with practical application and regular review (Correct answer)

Correct answer: Combining theoretical study with practical application and regular review

The most effective approach combines theoretical understanding with practical application, reinforced by regular review and assessment, enabling deeper comprehension and long-term retention.

Question 63: What should you do with the harmonic scalpel to avoid inadvertent injury?

All of the above (Correct answer)
Keep the active blade upwards and in view
Be aware of the blade
Grab and elevate your target

Correct answer: All of the above

Explanation: To avoid inadvertent injury with the harmonic scalpel, it's important to be aware of the blade, grab and elevate your target, and keep the active blade upwards and in view to prevent unintended tissue damage. These precautions help ensure safe and effective use of the harmonic scalpel during laparoscopic surgery.

Question 64: Why is patient positioning important in laparoscopic surgery?

All of the above (Correct answer)
To avoid position-related complications
To identify the location of the target anatomy
To avoid deep vein thrombosis (DVTs)

Correct answer: All of the above

Explanation: Patient positioning is crucial in laparoscopic surgery to achieve multiple goals, including preventing deep vein thrombosis (DVTs), facilitating visualization of target anatomy, and minimizing position-related complications such as nerve injuries or pressure ulcers. All of these factors contribute to the safety and success of the surgical procedure.

Question 65: A 'hissing' sound heard when the Veress needle is inserted into the abdomen most likely indicates:

Vascular injury
Needle placement into a hollow viscus
Subcutaneous placement of the needle
Correct peritoneal entry with free gas flow (Correct answer)

Correct answer: Correct peritoneal entry with free gas flow

A hissing sound as gas flows freely indicates the needle tip is in the peritoneal cavity with low resistance, confirming correct placement.

Question 66: The 'aspiration test' during Veress needle placement involves attaching a syringe and aspirating; a positive (correct placement) result is:

No aspirate and free saline instillation without resistance (Correct answer)
Bloody aspirate indicating vascular access
Air aspirate confirming bowel entry
Bile aspirate confirming peritoneal entry

Correct answer: No aspirate and free saline instillation without resistance

No aspirate combined with free instillation of saline (which drops in without resistance) confirms the needle is in the free peritoneal space.

Question 67: In Fundamentals of Laparoscopic Surgery, what role does continuing education play in ergonomics and setup?

To increase testing frequency for compliance purposes
To replace initial certification requirements
To keep professionals current with evolving standards, technologies, and best practices (Correct answer)
To prevent professionals from advancing in their careers

Correct answer: To keep professionals current with evolving standards, technologies, and best practices

Continuing education ensures professionals stay current with new developments, evolving standards, and emerging best practices in their field, maintaining competence throughout their careers.

Question 68: In Fundamentals of Laparoscopic Surgery, why is trocar placement knowledge important for professional certification?

It is only required for administrative purposes
It demonstrates competence and ensures practitioners meet established standards (Correct answer)
It has no practical relevance to daily work
It is important only for entry-level positions

Correct answer: It demonstrates competence and ensures practitioners meet established standards

Professional certification in specific knowledge areas demonstrates that practitioners have met established competency standards, ensuring quality of service and public protection.

Question 69: Which clip material is most commonly used in modern laparoscopic clip appliers?

Stainless steel
Absorbable polymer
Cobalt-chromium alloy
Titanium (Correct answer)

Correct answer: Titanium

Titanium clips are most commonly used because they are lightweight, MRI-compatible, and provide strong occlusion without significant artifact on postoperative imaging.

Question 70: The use of all-plastic or all-metal trocars can avoid which problem?

Capacitative coupling (Correct answer)
Insulation failure
Unintended direct coupling
None of the above.

Correct answer: Capacitative coupling

Explanation: All-plastic or all-metal trocars eliminate the risk of capacitative coupling, which can occur when a metal trocar comes into contact with an insulated electrosurgical instrument, leading to unintended energy transfer and tissue injury. Using trocars made of non-conductive materials prevents this problem.

Question 71: Which laparoscopic procedure can be performed with local anesthesia alone?

Cholecystectomy (Chole)
Ectopic pregnancy (Ectopic)
Appendectomy (Appy)
Diagnostic laparoscopy (Correct answer)

Correct answer: Diagnostic laparoscopy

Explanation: A diagnostic laparoscopy, which involves a visual examination of the abdominal cavity, can be performed with local anesthesia alone. It is often used to diagnose various abdominal conditions and does not typically require general anesthesia.

Question 72: In Fundamentals of Laparoscopic Surgery, why is peg transfer skills knowledge important for professional certification?

It has no practical relevance to daily work
It demonstrates competence and ensures practitioners meet established standards (Correct answer)
It is important only for entry-level positions
It is only required for administrative purposes

Correct answer: It demonstrates competence and ensures practitioners meet established standards

Professional certification in specific knowledge areas demonstrates that practitioners have met established competency standards, ensuring quality of service and public protection.

Question 73: Which of the following is NOT a sign of gas embolus during laparoscopic surgery?

Bradycardia (Correct answer)
Tachycardia
Mill wheel murmur
Hypotension

Correct answer: Bradycardia

Explanation: While hypotension, tachycardia, and a mill wheel murmur are signs of gas embolus during laparoscopic surgery, bradycardia is not typically associated with this complication. Bradycardia is more commonly seen as a response to pneumoperitoneum, rather than gas embolism.

Question 74: During laparoscopy, hypercarbia (elevated PaCO₂) occurs primarily because:

High IAP increases dead space ventilation
CO₂ displaces oxygen in the alveoli
CO₂ diffuses across the peritoneum into the bloodstream (Correct answer)
The patient is over-ventilated

Correct answer: CO₂ diffuses across the peritoneum into the bloodstream

CO₂ used for insufflation readily diffuses across the peritoneal membrane into the bloodstream, raising PaCO₂ and requiring increased minute ventilation.

Question 75: Which approach is most effective for mastering extracorporeal suturing in Fundamentals of Laparoscopic Surgery?

Studying only immediately before examinations
Relying solely on on-the-job experience
Combining theoretical study with practical application and regular review (Correct answer)
Memorizing textbook definitions without understanding

Correct answer: Combining theoretical study with practical application and regular review

The most effective approach combines theoretical understanding with practical application, reinforced by regular review and assessment, enabling deeper comprehension and long-term retention.

Question 76: A clip placed on the cystic duct is found to be applied at an oblique angle after deployment. What is the main concern?

Difficulty with specimen bag insertion
Incomplete duct occlusion leading to possible bile leak (Correct answer)
Increased risk of postoperative MRI artifact
Interference with subsequent clip placement on the artery

Correct answer: Incomplete duct occlusion leading to possible bile leak

An obliquely placed clip may not fully occlude the duct lumen, leaving a channel for bile to leak postoperatively, which is a common cause of post-cholecystectomy bile leaks.

Question 77: When the laparoscope is rotated during a procedure, the horizon on the monitor tilts. To maintain proper orientation, the surgeon should:

Remove and re-insert the scope
Tilt the monitor to match the scope rotation
Switch to a 0° scope immediately
Counter-rotate the scope to restore the horizon or use camera rotation correction software (Correct answer)

Correct answer: Counter-rotate the scope to restore the horizon or use camera rotation correction software

Counter-rotating the scope back to horizon or using the camera head's rotation correction restores proper anatomical orientation on the monitor.

Question 78: In the FLS skills lab, the simulated 'insufflation' box trainer assesses the learner's ability to:

Perform precise manipulation tasks under camera visualization within a confined space (Correct answer)
Manage actual CO₂ gas pressure in a live abdomen
Inject saline to confirm needle placement
Calibrate the insufflator to the correct pressure

Correct answer: Perform precise manipulation tasks under camera visualization within a confined space

The FLS box trainer simulates a pneumoperitoneum environment (a closed box with a camera) to teach and assess laparoscopic manual skills under realistic spatial constraints.

Question 79: Which of the following is NOT an absolute contraindication for laparoscopic surgery?

Lack of proper surgical training
Uncorrectable hypovolemic shock
Inability to tolerate laparotomy
Bowel obstruction (Correct answer)

Correct answer: Bowel obstruction

Explanation: While bowel obstruction presents challenges for laparoscopic surgery, it is not an absolute contraindication. Laparoscopic techniques can often be used to diagnose and treat bowel obstructions, although careful patient selection and surgical expertise are required to minimize risks.

Question 80: In Fundamentals of Laparoscopic Surgery, what role does continuing education play in ligating loop placement?

To increase testing frequency for compliance purposes
To keep professionals current with evolving standards, technologies, and best practices (Correct answer)
To replace initial certification requirements
To prevent professionals from advancing in their careers

Correct answer: To keep professionals current with evolving standards, technologies, and best practices

Continuing education ensures professionals stay current with new developments, evolving standards, and emerging best practices in their field, maintaining competence throughout their careers.

FLS Cognitive Exam

The FLS Cognitive Exam assesses theoretical knowledge of laparoscopic surgery, covering equipment, physiology, intraoperative techniques, and complication management required for SAGES/ACS-AEI certification.

Questions

90 min

Time Limit

75%

To Pass

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Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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