ABCS Risk Assessment & Management 2 — Questions and Answers
Question 1: A patient taking warfarin for atrial fibrillation requests an elective rhinoplasty. What is the most appropriate next step in risk management?
- Proceed with surgery while continuing anticoagulation
- Coordinate with the patient's cardiologist to determine safe bridging or hold strategy (Correct answer)
- Refuse surgery outright due to bleeding risk
- Switch the patient to aspirin one week before surgery
Correct answer: Coordinate with the patient's cardiologist to determine safe bridging or hold strategy
Coordinating with the managing cardiologist ensures a safe anticoagulation management plan tailored to the patient's thromboembolic risk profile.
Question 2: Which ASA physical status classification applies to a patient with well-controlled Type 2 diabetes and a BMI of 31?
- ASA I
- ASA II (Correct answer)
- ASA III
- ASA IV
Correct answer: ASA II
ASA II describes patients with mild systemic disease that does not limit activity, such as well-controlled diabetes or mild obesity.
Question 3: Intraoperative hypotension in a patient undergoing abdominoplasty under general anesthesia is most immediately managed by:
- Administering epinephrine 1 mg IV bolus
- Increasing inhalational anesthetic concentration
- Fluid resuscitation and vasopressors as indicated after identifying the cause (Correct answer)
- Immediately terminating the procedure
Correct answer: Fluid resuscitation and vasopressors as indicated after identifying the cause
Identifying the cause of hypotension while simultaneously supporting perfusion with fluids and vasopressors is the appropriate initial management algorithm.
Question 4: Which preoperative lab finding would most significantly increase perioperative risk for elective facial liposuction?
- Hemoglobin of 12.5 g/dL
- Platelet count of 180,000/µL
- Serum creatinine of 3.2 mg/dL (Correct answer)
- Fasting glucose of 105 mg/dL
Correct answer: Serum creatinine of 3.2 mg/dL
A creatinine of 3.2 mg/dL indicates significant renal impairment, increasing risk for fluid and electrolyte disturbances, delayed drug clearance, and wound healing complications.
Question 5: A smoker requests elective facelift surgery. Which counseling strategy best addresses risk reduction?
- Advise cessation for at least 4 weeks before and 4 weeks after surgery (Correct answer)
- Advise switching to nicotine patches the day before surgery
- Proceed without restriction since smoking only affects lung function
- Recommend postponing surgery indefinitely
Correct answer: Advise cessation for at least 4 weeks before and 4 weeks after surgery
Smoking cessation for at least 4 weeks preoperatively significantly reduces the risk of flap necrosis, wound dehiscence, and infection.
Question 6: A patient with a history of malignant hyperthermia (MH) requires general anesthesia for breast augmentation. The appropriate management is to:
- Use succinylcholine as the neuromuscular agent of choice
- Avoid all triggering agents and have dantrolene immediately available (Correct answer)
- Proceed with standard protocol since MH only occurs in pediatric patients
- Use propofol TIVA but keep volatile agents available as backup
Correct answer: Avoid all triggering agents and have dantrolene immediately available
MH-susceptible patients must receive a trigger-free anesthetic (TIVA) and dantrolene must be stocked and accessible in the operating room.
Question 7: When performing a risk-benefit analysis for a patient with a BMI of 42 requesting a combined abdominoplasty and liposuction, the primary concern is:
- Cosmetic outcome expectations
- Significantly elevated risk for VTE, wound complications, and respiratory events (Correct answer)
- Insurance reimbursement limitations
- Availability of appropriately sized surgical instruments
Correct answer: Significantly elevated risk for VTE, wound complications, and respiratory events
Morbid obesity dramatically elevates risk for deep vein thrombosis, pulmonary embolism, wound dehiscence, and pulmonary compromise, especially with combined procedures.
ABCS Risk Assessment & Management 2
A patient taking warfarin for atrial fibrillation requests an elective rhinoplasty.
What is the most appropriate next step in risk management?