ABA Perioperative Patient Management 5

Question 1

A patient develops bronchospasm under general anesthesia with severe wheezing and rising peak airway pressures. After deepening anesthesia, which pharmacological intervention is MOST appropriate?

Accepted Answer

Inhaled albuterol via the ETT

Answer

Inhaled albuterol administered via the endotracheal tube is the first-line bronchodilator for intraoperative bronchospasm after ensuring adequate anesthetic depth.

Question 2

Which of the following preoperative findings most significantly increases the risk of postoperative pulmonary complications?

Accepted Answer

FEV₁/FVC ratio < 0.7 with FEV₁ 45% predicted

Answer

Severe obstructive lung disease (FEV₁ < 50% predicted) is a major independent risk factor for postoperative pulmonary complications, especially with thoracic or upper abdominal surgery.

Question 3

A 70-year-old patient on warfarin for atrial fibrillation (INR 2.8) requires emergent appendectomy. The FASTEST way to reverse anticoagulation is:

Accepted Answer

4-factor prothrombin complex concentrate (PCC) plus vitamin K IV

Answer

4-factor PCC provides immediate reversal of all vitamin K–dependent factors with a smaller volume than FFP; IV vitamin K ensures sustained reversal.

Question 4

During a right hepatectomy, the surgeon temporarily occludes the portal triad (Pringle maneuver). The MOST expected hemodynamic change is:

Accepted Answer

Decrease in cardiac preload and blood pressure

Answer

The Pringle maneuver excludes portal and hepatic arterial flow, reducing venous return and causing hypotension that requires vasopressor or fluid support.

Question 5

Which electrolyte disturbance is MOST commonly associated with massive transfusion of packed red blood cells?

Accepted Answer

Hypocalcemia due to citrate chelation

Answer

Citrate used as an anticoagulant in stored PRBCs chelates ionized calcium, causing hypocalcemia during massive transfusion, impairing cardiac contractility.

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

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

ABA Perioperative Patient Management 5