ABA Patient Assessment and Evaluation 2 — Questions and Answers
Question 1: A 68-year-old patient with severe aortic stenosis is scheduled for elective hip replacement. Which hemodynamic parameter is most critical to maintain intraoperatively?
- Low heart rate and high preload (Correct answer)
- High heart rate and low systemic vascular resistance
- Low systemic vascular resistance and high heart rate
- High heart rate and high preload
Correct answer: Low heart rate and high preload
Severe aortic stenosis requires maintaining a slow, regular heart rate and adequate preload to optimize stroke volume across the fixed obstruction.
Question 2: Which laboratory finding in a preoperative patient most strongly indicates the need to postpone elective surgery?
- Hemoglobin of 10.5 g/dL
- Serum potassium of 3.3 mEq/L
- Serum potassium of 2.8 mEq/L (Correct answer)
- INR of 1.3
Correct answer: Serum potassium of 2.8 mEq/L
A serum potassium below 3.0 mEq/L significantly increases the risk of perioperative dysrhythmias and warrants correction before elective procedures.
Question 3: During preanesthetic evaluation, a patient reports taking clopidogrel for a coronary stent placed 4 months ago. The surgeon wants to proceed with elective colectomy. What is the most appropriate recommendation?
- Proceed with surgery using platelet transfusion standby
- Discontinue clopidogrel and proceed after 5–7 days
- Defer surgery until at least 12 months of dual antiplatelet therapy is completed (Correct answer)
- Switch to aspirin only and proceed immediately
Correct answer: Defer surgery until at least 12 months of dual antiplatelet therapy is completed
Drug-eluting stents require at least 12 months of dual antiplatelet therapy to prevent in-stent thrombosis; elective non-cardiac surgery should be deferred until this window is complete.
Question 4: A patient with a BMI of 42 kg/m² presents for laparoscopic cholecystectomy. Which airway assessment finding most increases the risk of difficult mask ventilation?
- Mallampati class III
- Thyromental distance of 5 cm
- Presence of a beard (Correct answer)
- Interincisor gap of 4 cm
Correct answer: Presence of a beard
A beard is one of the five MOANS predictors of difficult mask ventilation because it prevents an adequate seal between the mask and the face.
Question 5: Which preoperative pulmonary function test result in a patient scheduled for pneumonectomy predicts the highest risk of postoperative respiratory failure?
- FEV1 of 65% predicted
- DLCO of 55% predicted
- Predicted postoperative FEV1 less than 40% (Correct answer)
- FVC of 70% predicted
Correct answer: Predicted postoperative FEV1 less than 40%
A predicted postoperative FEV1 (ppoFEV1) less than 40% is the threshold associated with high risk of respiratory failure and mortality after pneumonectomy.
Question 6: A patient scheduled for elective surgery is found to have a blood pressure of 178/108 mmHg at the preoperative clinic. He has no end-organ damage. What is the most appropriate action?
- Cancel surgery and refer for blood pressure management
- Proceed with surgery; mild-to-moderate hypertension does not increase perioperative risk significantly (Correct answer)
- Administer IV labetalol immediately and proceed
- Perform an echocardiogram before proceeding
Correct answer: Proceed with surgery; mild-to-moderate hypertension does not increase perioperative risk significantly
Stage 2 hypertension without evidence of end-organ damage does not independently warrant cancellation; the decision to proceed should balance surgical urgency against suboptimal control.
Question 7: When assessing a patient with obstructive sleep apnea (OSA) preoperatively, which finding is most associated with severe disease and impacts anesthetic planning the most?
- AHI of 8 events/hour
- Snoring reported by bed partner
- AHI > 30 events/hour with daytime hypoxemia (Correct answer)
- Epworth Sleepiness Scale score of 10
Correct answer: AHI > 30 events/hour with daytime hypoxemia
Severe OSA defined by AHI > 30 with daytime hypoxemia indicates significant ventilatory compromise and substantially increases perioperative respiratory risk.
ABA Patient Assessment and Evaluation 2
A 68-year-old patient with severe aortic stenosis is scheduled for elective hip replacement.
Which hemodynamic parameter is most critical to maintain intraoperatively?