Preoperative Assessment & Postoperative Care Flashcards
7 cards from real ABPS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Preoperative Assessment & Postoperative Care flashcards as text
Which finding on a preoperative EKG would most likely require cardiology clearance before elective flap reconstruction?
Answer: New left bundle branch block (LBBB)
A new LBBB may indicate acute cardiac pathology such as ischemia or cardiomyopathy and requires cardiology evaluation before elective surgery.
What is the most appropriate postoperative drain management following modified radical mastectomy with immediate reconstruction?
Answer: Remove drains when output is <30 mL per day for 2 consecutive days
Standard protocol is to remove closed-suction drains when output falls below 30 mL/day for two consecutive days to reduce infection risk while preventing seroma.
Which factor is most predictive of flap failure in free tissue transfer for breast reconstruction?
Answer: Prior radiation to the chest wall
Prior radiation causes microvascular damage and tissue fibrosis, significantly increasing the risk of anastomotic failure and fat necrosis in free flap reconstruction.
A patient presents with erythema, warmth, and fluctuance over a breast implant site 10 days postoperatively. After aspiration reveals purulent fluid, what is the next step?
Answer: IV antibiotics and implant removal with washout
Established periprosthetic infection with purulent fluid requires implant removal, pocket washout, and IV antibiotics to eliminate the biofilm-colonized foreign body.
What is the primary role of preoperative nutritional assessment in free flap surgery candidates?
Answer: Identifying hypoalbuminemia and malnutrition that impairs wound healing
Hypoalbuminemia (<3.5 g/dL) and malnutrition are associated with impaired immunity, poor wound healing, and increased flap complication rates in reconstructive surgery.
A patient undergoes free DIEP flap breast reconstruction. On postoperative day 1, flap monitoring reveals capillary refill >3 seconds and dusky color. What is the priority action?
Answer: Return to the operating room immediately for vascular exploration
Signs of venous or arterial compromise in a free flap demand immediate return to the OR for anastomosis exploration, as flap salvage rates drop sharply after 6 hours of ischemia.
Which preoperative cardiac risk stratification tool is most commonly used for plastic surgery patients undergoing major elective procedures?
Answer: Revised Cardiac Risk Index (RCRI)
The Revised Cardiac Risk Index (RCRI) is the standard validated tool for estimating perioperative major cardiac event risk in non-cardiac surgery patients.