ABA Clinical Practice & Patient Safety 2

Question 1

A patient with suspected malignant hyperthermia (MH) crisis develops a temperature of 39.8°C, masseter spasm, and rising ETCO2. What is the FIRST priority intervention?

Accepted Answer

Discontinue all triggering agents and change to a clean circuit

Answer

Removing the triggering agent (volatile anesthetics and succinylcholine) is the first step in MH management before dantrolene administration.

Question 2

Which of the following best describes the 'surgical safety checklist' Sign-Out phase according to WHO guidelines?

Accepted Answer

Reviewing key concerns for recovery and specimen labeling before the patient leaves the OR

Answer

The Sign-Out phase occurs before the patient leaves the OR and covers instrument counts, specimen labeling, equipment issues, and recovery concerns.

Question 3

A 70 kg patient undergoing laparoscopic surgery develops sudden hypotension, tachycardia, and decreased ETCO2 despite high airway pressures. The MOST likely diagnosis is:

Accepted Answer

Venous gas embolism

Answer

Venous gas embolism from CO2 insufflation presents with sudden cardiovascular collapse and a characteristic mill-wheel murmur, with a drop in ETCO2 due to dead space increase.

Question 4

Which monitoring modality is MOST useful for detecting intraoperative awareness during total intravenous anesthesia (TIVA)?

Accepted Answer

Processed EEG (e.g., BIS monitor)

Answer

Processed EEG monitors like BIS are particularly valuable during TIVA because end-tidal agent concentration cannot be used to verify adequate depth.

Question 5

A patient receiving an epidural infusion develops sudden onset bilateral lower extremity weakness and urinary retention 12 hours postoperatively. What is the MOST urgent next step?

Accepted Answer

Order an emergent MRI of the spine to rule out epidural hematoma

Answer

New-onset neurological deficits after epidural analgesia require emergent MRI to rule out epidural hematoma, as delays beyond 8 hours worsen neurological outcomes.

(ABA) American Board of Anesthesiology Practice Test

(ABA) American Board of Anesthesiology Practice Test

ABA Clinical Practice & Patient Safety 2