ABPS Preoperative Assessment & Postoperative Care 4 — Questions and Answers
Question 1: Which criterion is part of the STOP-BANG questionnaire used preoperatively to screen for obstructive sleep apnea?
- Smoking history
- Neck circumference >40 cm (Correct answer)
- Resting O2 saturation <95%
- Apnea witnessed during waking hours
Correct answer: Neck circumference >40 cm
Neck circumference >40 cm is one of the eight STOP-BANG criteria used to identify patients at high risk for obstructive sleep apnea.
Question 2: What is the recommended minimum preoperative fasting time for clear liquids before elective plastic surgery under general anesthesia per ASA guidelines?
- 1 hour
- 2 hours (Correct answer)
- 4 hours
- 8 hours
Correct answer: 2 hours
ASA guidelines recommend a minimum fasting period of 2 hours for clear liquids prior to elective procedures under general or regional anesthesia.
Question 3: A postoperative breast augmentation patient reports sudden onset of asymmetric swelling, pain, and erythema 2 years after surgery. The most important diagnosis to exclude is:
- Late seroma from implant shell failure
- Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) (Correct answer)
- Capsular contracture Baker Grade III
- Implant malposition
Correct answer: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)
BIA-ALCL must be excluded in any patient with late-onset periprosthetic effusion, as it is a rare but serious T-cell lymphoma associated with textured implants.
Question 4: In a patient with sickle cell trait undergoing elective rhinoplasty, which preoperative precaution is most critical?
- Administration of prophylactic hydroxyurea
- Ensuring adequate oxygenation and hydration (Correct answer)
- Ordering preoperative exchange transfusion
- Avoiding all opioid analgesics postoperatively
Correct answer: Ensuring adequate oxygenation and hydration
Adequate oxygenation, hydration, and normothermia are critical to prevent sickling crises in patients with sickle cell trait during perioperative care.
Question 5: Which postoperative instruction is most important after blepharoplasty to prevent corneal damage?
- Apply warm compresses every 2 hours
- Use lubricating eye drops and avoid dry environments (Correct answer)
- Wear sunglasses only during daylight hours
- Avoid all screen time for 2 weeks
Correct answer: Use lubricating eye drops and avoid dry environments
Lubricating eye drops protect the cornea from exposure keratitis, which can occur if lagophthalmos (incomplete eye closure) is present postoperatively.
Question 6: When performing a risk-benefit discussion for an obese patient requesting panniculectomy, which complication should receive the most emphasis?
- Scar hypertrophy
- Wound healing complications and infection (Correct answer)
- Anesthetic awareness
- Postoperative nausea
Correct answer: Wound healing complications and infection
Obese patients undergoing panniculectomy have significantly elevated rates of wound dehiscence, infection, and poor healing due to tissue tension and ischemia.
Question 7: A patient is taking metformin for type 2 diabetes before elective breast reconstruction with TRAM flap. What is the appropriate perioperative management of metformin?
- Continue metformin throughout the perioperative period
- Hold metformin 24–48 hours before surgery due to lactic acidosis risk (Correct answer)
- Switch to insulin one week preoperatively
- Increase metformin dose to maintain glycemic control
Correct answer: Hold metformin 24–48 hours before surgery due to lactic acidosis risk
Metformin should be held 24–48 hours before surgery because contrast media, decreased renal perfusion, or hypoxia can increase lactic acidosis risk.
ABPS Preoperative Assessment & Postoperative Care 4
Which criterion is part of the STOP-BANG questionnaire used preoperatively to screen for obstructive sleep apnea?