CSFA Postoperative and Emergency Care 3 — Questions and Answers
Question 1: Following a laparoscopic cholecystectomy, a patient complains of severe right shoulder pain. What is the most likely cause?
- Brachial plexus injury from positioning
- Referred pain from residual CO2 irritating the diaphragm (Correct answer)
- Pulmonary embolism
- Myocardial ischemia radiating to the shoulder
Correct answer: Referred pain from residual CO2 irritating the diaphragm
Residual carbon dioxide trapped under the diaphragm causes phrenic nerve irritation, which refers pain to the shoulder tip postoperatively.
Question 2: The surgical first assistant notes that a patient's blood pressure is 80/50 mmHg and heart rate is 128 bpm one hour post-abdominal surgery. The abdomen is distended. What emergency condition should be suspected?
- Pulmonary embolism
- Neurogenic shock
- Intra-abdominal hemorrhage (Correct answer)
- Septic shock
Correct answer: Intra-abdominal hemorrhage
Hypotension with tachycardia and abdominal distension in the early postoperative period strongly suggests intra-abdominal hemorrhage requiring urgent evaluation.
Question 3: Which scoring system is used in the PACU to assess a patient's readiness for discharge?
- Glasgow Coma Scale
- Aldrete Score (Correct answer)
- APACHE II Score
- SOFA Score
Correct answer: Aldrete Score
The Aldrete (or Modified Aldrete) Score evaluates activity, respiration, circulation, consciousness, and oxygen saturation to determine PACU discharge readiness.
Question 4: A patient develops sudden dyspnea, hypotension, and jugular venous distension after a central line placement. What is the most likely emergency?
- Hemothorax
- Tension pneumothorax (Correct answer)
- Air embolism
- Cardiac tamponade
Correct answer: Tension pneumothorax
Tension pneumothorax after central line insertion presents with dyspnea, hypotension, JVD, and absent breath sounds on the affected side, requiring immediate needle decompression.
Question 5: Which of the following best describes the purpose of incentive spirometry in the postoperative period?
- Reduce postoperative nausea and vomiting
- Prevent atelectasis by promoting deep breathing and alveolar expansion (Correct answer)
- Measure oxygen saturation non-invasively
- Deliver aerosolized bronchodilators directly to the lungs
Correct answer: Prevent atelectasis by promoting deep breathing and alveolar expansion
Incentive spirometry encourages sustained maximal inspiration to open collapsed alveoli and prevent postoperative atelectasis and pneumonia.
Question 6: A patient with a history of latex allergy requires emergency surgery. Which of the following is the most critical preoperative preparation?
- Administer prophylactic epinephrine before incision
- Ensure a latex-free surgical environment and have anaphylaxis medications immediately available (Correct answer)
- Pretreat with corticosteroids and H1/H2 blockers only and proceed with standard setup
- Postpone the surgery until an allergy specialist evaluates the patient
Correct answer: Ensure a latex-free surgical environment and have anaphylaxis medications immediately available
A latex-free OR environment combined with immediate availability of epinephrine and anaphylaxis management drugs is the standard of care for latex-allergic patients.
Question 7: Postoperative nausea and vomiting (PONV) is MOST likely to occur in which patient population?
- Elderly male patients undergoing regional anesthesia
- Female nonsmokers with a history of PONV receiving opioid analgesia (Correct answer)
- Male smokers undergoing short ambulatory procedures
- Pediatric patients undergoing orthopedic surgery under spinal anesthesia
Correct answer: Female nonsmokers with a history of PONV receiving opioid analgesia
Female sex, nonsmoker status, history of PONV or motion sickness, and postoperative opioid use are the four major independent risk factors for PONV.
CSFA Postoperative and Emergency Care 3
Following a laparoscopic cholecystectomy, a patient complains of severe right shoulder pain.
What is the most likely cause?