ABA Patient Assessment and Evaluation 3 — Questions and Answers
Question 1: A patient with end-stage renal disease on hemodialysis presents for arteriovenous fistula revision. Which preoperative concern is most specific to this patient population?
- Risk of contrast nephropathy
- Hyperkalemia-induced cardiac dysrhythmias (Correct answer)
- Aspiration risk due to uremic gastroparesis
- Coagulopathy due to vitamin K deficiency
Correct answer: Hyperkalemia-induced cardiac dysrhythmias
Patients on hemodialysis are prone to hyperkalemia, which can cause life-threatening dysrhythmias; a preoperative potassium level and recent dialysis timing must be confirmed.
Question 2: Which of the following best describes the significance of a STOP-BANG score of 5 or greater in a preoperative patient?
- Low risk for obstructive sleep apnea
- Moderate risk requiring polysomnography before surgery
- High risk for obstructive sleep apnea requiring perioperative precautions (Correct answer)
- Definitive diagnosis of obstructive sleep apnea
Correct answer: High risk for obstructive sleep apnea requiring perioperative precautions
A STOP-BANG score ≥ 5 indicates high risk for moderate-to-severe OSA, warranting perioperative precautions such as continuous pulse oximetry and possible CPAP use.
Question 3: A 55-year-old patient reports a prior episode of 'awareness during surgery' years ago. Which preoperative action is most important when planning the current anesthetic?
- Avoid all volatile agents and use total intravenous anesthesia
- Document the history, assess for contributing factors, and discuss the anesthetic plan and monitoring with the patient (Correct answer)
- Premedicate with benzodiazepines to prevent recurrence
- Perform a BIS monitor calibration test before induction
Correct answer: Document the history, assess for contributing factors, and discuss the anesthetic plan and monitoring with the patient
Thorough documentation and counseling are essential; identifying prior risk factors (light anesthesia, paralysis without adequate hypnosis) guides the individualized anesthetic plan.
Question 4: Which preoperative cardiac evaluation is indicated in a patient with poor functional capacity (< 4 METs) scheduled for high-risk vascular surgery who has two clinical risk factors per the Revised Cardiac Risk Index?
- Proceed directly to surgery with intraoperative invasive monitoring
- Coronary angiography
- Pharmacologic stress testing (Correct answer)
- Routine 12-lead ECG only
Correct answer: Pharmacologic stress testing
Per ACC/AHA guidelines, patients with poor functional capacity, elevated surgical risk, and clinical risk factors may benefit from pharmacologic stress testing to guide further management.
Question 5: During preoperative evaluation, a patient with rheumatoid arthritis taking methotrexate presents for elective shoulder surgery. Which airway concern is most critical for this population?
- Limited mouth opening due to temporomandibular joint involvement
- Atlantoaxial instability causing risk of cervical cord injury during intubation (Correct answer)
- Laryngeal edema from chronic NSAID use
- Subglottic stenosis from prolonged corticosteroid therapy
Correct answer: Atlantoaxial instability causing risk of cervical cord injury during intubation
Rheumatoid arthritis can cause atlantoaxial subluxation, which poses a risk of cervical spinal cord injury during neck manipulation for intubation.
Question 6: A patient scheduled for elective spine surgery has a preoperative hemoglobin of 8.2 g/dL. Which is the most appropriate next step?
- Proceed with surgery and transfuse intraoperatively as needed
- Postpone surgery and investigate the cause of anemia before proceeding (Correct answer)
- Administer preoperative erythropoietin and proceed in one week
- Order an echocardiogram to assess cardiac reserve
Correct answer: Postpone surgery and investigate the cause of anemia before proceeding
Preoperative anemia increases perioperative risk; identifying and treating the underlying cause (iron deficiency, bleeding) optimizes outcomes before elective high-blood-loss procedures.
Question 7: In the preoperative assessment of a patient with myasthenia gravis, which factor most influences the choice of neuromuscular blocking agent?
- The patient's acetylcholinesterase inhibitor regimen
- Profound sensitivity to nondepolarizing agents requiring significantly reduced doses (Correct answer)
- Resistance to succinylcholine requiring higher doses
- The need for postoperative neostigmine reversal regardless of agent used
Correct answer: Profound sensitivity to nondepolarizing agents requiring significantly reduced doses
Myasthenia gravis patients have reduced acetylcholine receptors at the neuromuscular junction, making them exquisitely sensitive to nondepolarizing neuromuscular blocking agents.
ABA Patient Assessment and Evaluation 3
A patient with end-stage renal disease on hemodialysis presents for arteriovenous fistula revision.
Which preoperative concern is most specific to this patient population?