CFA Perioperative Assessment 3 — Questions and Answers
Question 1: During intraoperative assessment, the first assistant notices the patient's urine output has fallen to 15 mL/hr for the past two hours. What does this most likely indicate?
- Urinary tract infection
- Inadequate renal perfusion or fluid deficit (Correct answer)
- Normal intraoperative output
- Catheter malposition only
Correct answer: Inadequate renal perfusion or fluid deficit
Oliguria (less than 0.5 mL/kg/hr) during surgery typically indicates decreased renal perfusion due to hypovolemia, hypotension, or inadequate cardiac output.
Question 2: The surgeon asks the first assistant to assess abdominal wall tension during a laparotomy. Increased tension is MOST likely caused by:
- Excessive neuromuscular blockade
- Hypothermia of the abdominal wall
- Inadequate muscle relaxation or increased intra-abdominal pressure (Correct answer)
- Patient positioning on a bean bag
Correct answer: Inadequate muscle relaxation or increased intra-abdominal pressure
Increased abdominal wall tension during surgery is most commonly caused by insufficient neuromuscular blockade or elevated intra-abdominal pressure from bowel distension or bleeding.
Question 3: Intraoperatively, the patient develops sudden hypotension, tachycardia, and bronchospasm 20 minutes after receiving cefazolin. The first assistant should immediately recognize this as:
- Vasovagal syncope
- Anaphylaxis (Correct answer)
- Pulmonary embolism
- Malignant hyperthermia
Correct answer: Anaphylaxis
The triad of hypotension, tachycardia, and bronchospasm following antibiotic administration is classic for anaphylaxis and requires immediate treatment with epinephrine.
Question 4: During a lengthy orthopedic procedure, the first assistant should monitor for signs of compartment syndrome. Which finding is the EARLIEST indicator?
- Absent distal pulses
- Pain out of proportion to injury and pain with passive stretch (Correct answer)
- Cyanosis of the extremity
- Blistering of the skin
Correct answer: Pain out of proportion to injury and pain with passive stretch
Pain out of proportion and pain with passive muscle stretch are the earliest clinical signs of compartment syndrome, before vascular compromise develops.
Question 5: The patient's core temperature drops to 35.2°C (95.4°F) during a prolonged abdominal case. Which intraoperative complication is most directly associated with this finding?
- Hyperkalemia
- Coagulopathy and increased bleeding (Correct answer)
- Increased anesthetic requirement
- Tachyarrhythmia
Correct answer: Coagulopathy and increased bleeding
Hypothermia impairs platelet function and coagulation factor activity, leading to coagulopathy and increased intraoperative blood loss.
Question 6: During retraction of bowel in a laparotomy, the first assistant observes the small bowel appears dusky and cyanotic. The FIRST action should be:
- Continue the operation and document the finding
- Notify the surgeon and release retractor tension immediately (Correct answer)
- Apply warm saline-soaked laparotomy pads
- Increase IV fluid rate
Correct answer: Notify the surgeon and release retractor tension immediately
Dusky bowel indicates compromised perfusion, and immediately notifying the surgeon and releasing excess retractor pressure is the first step to restore blood flow.
Question 7: A patient undergoing total knee replacement develops sudden intraoperative hypotension and desaturation during tourniquet release. The most likely cause is:
- Malignant hyperthermia
- Cement embolism or fat embolism syndrome (Correct answer)
- Air embolism from IV line
- Tension pneumothorax
Correct answer: Cement embolism or fat embolism syndrome
Tourniquet release can flush fat, cement particles, or debris into the circulation, causing fat embolism syndrome with cardiovascular and pulmonary compromise.
CFA Perioperative Assessment 3
During intraoperative assessment, the first assistant notices the patient's urine output has fallen to 15 mL/hr for the past two hours.
What does this most likely indicate?