ABA Perioperative Patient Management 3

Question 1

A 58-year-old patient with a recent drug-eluting coronary stent (placed 4 months ago) requires semi-urgent colon resection. What is the best antiplatelet management strategy?

Accepted Answer

Continue aspirin; consider continuing P2Y12 inhibitor or bridge with cangrelor/tirofiban after multidisciplinary discussion

Answer

Drug-eluting stents require dual antiplatelet therapy for at least 12 months; semi-urgent surgery within that window requires cardiology input, continuation of aspirin, and individualized P2Y12 management.

Question 2

Which parameter BEST predicts fluid responsiveness in a mechanically ventilated patient without arrhythmia?

Accepted Answer

Pulse pressure variation (PPV) > 13%

Answer

PPV > 13% in a fully mechanically ventilated patient without arrhythmia or right heart failure is the most validated dynamic predictor of fluid responsiveness.

Question 3

A patient undergoing spine surgery in the prone position develops sudden hypotension and bradycardia after a previously stable 3-hour course. The MOST likely cause is:

Accepted Answer

Venous air embolism

Answer

Venous air embolism can occur in prone spine surgery due to the elevated operative field creating negative venous pressure; it presents with sudden cardiovascular collapse and mill-wheel murmur.

Question 4

In a patient with morbid obesity (BMI 52) undergoing bariatric surgery, which ventilation strategy reduces postoperative pulmonary complications MOST effectively?

Accepted Answer

Low tidal volume (6–8 mL/kg IBW) with PEEP 8–10 cmH₂O and recruitment maneuvers

Answer

Lung-protective ventilation using IBW-based tidal volumes, moderate PEEP, and periodic recruitment maneuvers reduces atelectasis and PPCs in obese patients.

Question 5

Postoperative nausea and vomiting (PONV) prophylaxis with ondansetron works primarily by:

Accepted Answer

Blocking 5-HT₃ receptors in the chemoreceptor trigger zone and vagal afferents

Answer

Ondansetron is a selective 5-HT₃ antagonist that blocks serotonin-mediated signaling in the CTZ and peripheral vagal afferents responsible for nausea.

(ABA) ASA (American Society of Anesthesiologists) Board Certification Practice Test

(ABA) ASA (American Society of Anesthesiologists) Board Certification Practice Test

ABA Perioperative Patient Management 3