CFA Perioperative Assessment 2 — Questions and Answers
Question 1: A patient scheduled for elective surgery has a serum creatinine of 2.4 mg/dL. What is the PRIMARY concern for the first assistant?
- Increased bleeding risk due to platelet dysfunction
- Impaired drug clearance and increased anesthetic sensitivity (Correct answer)
- Elevated infection risk from immune suppression
- Risk of hypercalcemia during surgery
Correct answer: Impaired drug clearance and increased anesthetic sensitivity
Elevated creatinine indicates renal impairment, which delays drug clearance and increases sensitivity to anesthetics and other perioperative medications.
Question 2: During a preoperative assessment, the patient reports taking warfarin for atrial fibrillation. Which lab value is MOST critical to review before proceeding?
- Partial thromboplastin time (PTT)
- International normalized ratio (INR) (Correct answer)
- Platelet count
- Bleeding time
Correct answer: International normalized ratio (INR)
INR directly measures the anticoagulant effect of warfarin and is the standard test used to guide perioperative anticoagulation management.
Question 3: A patient has a BMI of 48. Which perioperative complication should the first assistant anticipate most vigilantly?
- Intraoperative hypothermia
- Difficult airway and respiratory compromise (Correct answer)
- Severe intraoperative bradycardia
- Postoperative hypercalcemia
Correct answer: Difficult airway and respiratory compromise
Morbid obesity significantly increases the risk of difficult intubation and postoperative pulmonary complications including hypoxia and atelectasis.
Question 4: Which ASA physical status classification describes a patient with severe systemic disease that is a constant threat to life?
- ASA II
- ASA III
- ASA IV (Correct answer)
- ASA V
Correct answer: ASA IV
ASA IV describes a patient with a severe systemic disease that is a constant threat to life, while ASA V is a moribund patient not expected to survive without surgery.
Question 5: A patient undergoing preoperative assessment reports smoking one pack per day for 20 years. Which pulmonary function change is MOST expected?
- Increased FEV1/FVC ratio
- Decreased residual volume
- Reduced FEV1 and air trapping (Correct answer)
- Increased vital capacity
Correct answer: Reduced FEV1 and air trapping
Chronic smoking causes obstructive pulmonary disease, characterized by reduced FEV1, decreased FEV1/FVC ratio, and air trapping.
Question 6: When reviewing a patient's preoperative ECG, which finding would require immediate notification of the surgeon and anesthesiologist?
- Sinus bradycardia at 58 bpm
- Newly discovered left bundle branch block (Correct answer)
- P-R interval of 0.18 seconds
- QTc of 420 ms
Correct answer: Newly discovered left bundle branch block
A new left bundle branch block may indicate acute myocardial infarction or significant cardiac pathology and requires immediate evaluation before elective surgery.
Question 7: A patient with a known latex allergy is scheduled for a laparoscopic cholecystectomy. What is the MOST important preoperative action?
- Administer prophylactic epinephrine before induction
- Ensure a latex-free environment is prepared in the OR (Correct answer)
- Cancel the surgery and refer to an allergist
- Premedicate with antihistamines only
Correct answer: Ensure a latex-free environment is prepared in the OR
The highest priority is ensuring a completely latex-free operative environment, including all instruments, gloves, and supplies, to prevent anaphylaxis.
CFA Perioperative Assessment 2
A patient scheduled for elective surgery has a serum creatinine of 2.4 mg/dL.
What is the PRIMARY concern for the first assistant?