BCA Preoperative Evaluation & Risk Assessment 3

Question 1

A patient with obstructive sleep apnea (OSA) is scheduled for laparoscopic cholecystectomy. Which preoperative finding is most concerning for perioperative respiratory complications?

Accepted Answer

AHI >30 events/hour with daytime hypercapnia (PaCO2 >45 mmHg)

Answer

Severe OSA with daytime hypercapnia indicates obesity hypoventilation syndrome, conferring highest perioperative respiratory risk.

Question 2

Which of the following best describes the concept of metabolic equivalents (METs) in preoperative cardiac risk stratification?

Accepted Answer

≥4 METs functional capacity (e.g., climbing one flight of stairs) indicates acceptable perioperative cardiac risk

Answer

Patients who can achieve ≥4 METs (equivalent to climbing a flight of stairs or walking on level ground at 4 mph) have acceptable perioperative cardiac risk without further testing.

Question 3

A patient with Child-Pugh Class C cirrhosis requires emergency appendectomy. What is the estimated perioperative mortality?

Accepted Answer

50–85%

Answer

Child-Pugh Class C cirrhosis carries an estimated perioperative mortality of 50–85% for abdominal surgery due to coagulopathy, portal hypertension, and hepatic decompensation risk.

Question 4

When assessing a patient for thoracic surgery, the 'stair-climbing test' is used because patients who can climb ≥ how many flights without stopping have acceptable pulmonary reserve?

Accepted Answer

3 flights (≥12 m vertical height)

Answer

Climbing ≥3 flights (approximately 12 meters vertical) correlates with VO2 max ≥20 mL/kg/min, indicating sufficient pulmonary reserve for major thoracic resection.

Question 5

A patient with myasthenia gravis is scheduled for thymectomy. Which preoperative feature most increases the risk of postoperative mechanical ventilation?

Accepted Answer

Duration of disease >6 years, pyridostigmine dose >750 mg/day, preoperative vital capacity <2.9 L, and presence of concurrent pulmonary disease

Answer

The Leventhal criteria predict need for postoperative ventilation: disease >6 years, pyridostigmine >750 mg/day, VC <2.9 L, and concurrent pulmonary disease.

(BCA) Board of Certification in Anesthesiology Practice Test

(BCA) Board of Certification in Anesthesiology Practice Test

BCA Preoperative Evaluation & Risk Assessment 3