Postoperative Care — MCQs
A patient after undergoing thoracotomy complains of severe pain. The BEST method of pain control in this patient would be:
A postoperative patient with pH 7.25, MAP (mean arterial pressure) 60 mm Hg is treated with?
Patients who need surgery within 24 hours are categorized under which color category in a disaster management triage?
Steps in review of patient's history during secondary survey of trauma care can be summarised as
Which Benzodiazepine decreases post-operative nausea & vomiting:-
Blood loss during major surgery is best estimated by:
What is the most common cause of postoperative fever on the first postoperative day?
Which of the following intravenous anaesthetic agent causes decrease in postoperative nausea and vomiting :
Which of the following should be considered as the cause of generalized convulsions 20 minutes postoperatively?
Which inducing agent is associated with the highest incidence of postoperative vomiting?
Postoperative Care Indian Medical PG Practice Questions and MCQs
Question 1: A patient after undergoing thoracotomy complains of severe pain. The BEST method of pain control in this patient would be:
- A. Oral morphine
- B. Diazepam rectal suppository
- C. Intercostal cryoanalgesia (Correct Answer)
- D. IV fentanyl
Explanation: ***Intercostal cryoanalgesia*** - **Intercostal cryoanalgesia** involves applying extreme cold to the intercostal nerves, leading to temporary nerve denervation and prolonged pain relief. This technique is particularly effective for **post-thoracotomy pain** due to its targeted action and reduced systemic side effects compared to opioids. - The goal is to provide **long-lasting pain control** specifically at the surgical site, allowing for better respiratory mechanics and early mobilization. *Oral morphine* - Oral morphine can provide systemic pain relief, but its onset of action is slower, and it carries the risk of significant **sedation** and **respiratory depression**, which are major concerns in a patient who has just undergone thoracotomy. - While effective, it may not provide optimal local pain control for incisional pain and often requires higher doses to achieve adequate relief, increasing the risk of adverse effects. *Diazepam rectal suppository* - Diazepam is a **benzodiazepine** primarily used for anxiety, muscle spasms, and seizures, not for severe acute surgical pain. It has **no significant analgesic properties**. - Its sedative effects would be contraindicated after thoracotomy due to the risk of respiratory depression and masking potential neurological changes. *IV fentanyl* - IV fentanyl is a potent opioid with a rapid onset and short duration of action, making it useful for breakthrough pain or during immediate post-operative periods. However, it requires **continuous monitoring** and frequent re-dosing. - Like other opioids, it carries risks of **respiratory depression**, nausea, and sedation, making it less ideal for sustained primary pain control immediately after thoracotomy where lung function is critical.
Question 2: A postoperative patient with pH 7.25, MAP (mean arterial pressure) 60 mm Hg is treated with?
- A. Only normal saline
- B. fluid restriction
- C. Fluid therapy with CVP monitoring (Correct Answer)
- D. I.V. sodium bicarbonate
Explanation: ***Fluid therapy with CVP monitoring*** - The patient's **MAP of 60 mmHg** indicates **hypotension** and potential **hypovolemic shock**, while pH 7.25 suggests **acidosis**, which could be metabolic due to poor perfusion. Initial treatment should focus on **restoring circulating volume** to improve blood pressure and organ perfusion. - **Central venous pressure (CVP) monitoring** is crucial to guide fluid resuscitation. It helps assess the patient's fluid status and ensures that enough fluid is given to improve cardiac output without causing fluid overload, especially in a severely ill patient. *Only normal saline* - While normal saline is used for fluid resuscitation, simply stating "only normal saline" is insufficient because it doesn't address the **critical need for monitoring** to guide treatment. - The amount and rate of fluid administration need to be carefully controlled based on the patient's response and hemodynamic parameters. *Fluid restriction* - **Fluid restriction** would be contraindicated in this patient because the **low MAP** suggests **hypovolemia or cardiogenic shock**, requiring fluid repletion, not restriction. - Restricting fluids could further worsen hypotension and organ hypoperfusion, leading to increased acidosis and organ damage. *I.V. sodium bicarbonate* - Administering **I.V. sodium bicarbonate** to correct acidosis without addressing the underlying cause of hypotension and poor perfusion is generally not recommended. - The acidosis (pH 7.25) is likely due to **poor tissue oxygenation and lactic acid production** from inadequate blood flow; correcting this with fluids will resolve the acidosis.
Question 3: Patients who need surgery within 24 hours are categorized under which color category in a disaster management triage?
- A. Green
- B. Yellow (Correct Answer)
- C. Blue
- D. Black
Explanation: ***Yellow*** - Patients in the **yellow category** are those who require **significant medical attention** and intervention, such as surgery, but whose condition is stable enough to withstand a delay of a few hours up to 24 hours without immediate threat to life or limb. - This category indicates a **delayed but urgent need** for treatment, distinguishing them from immediate (red) or minor (green) cases. *Blue* - The color **blue** is generally **not a standard triage category** in most commonly used disaster protocols (e.g., START, JumpSTART). - Triage systems typically use red, yellow, green, and black to prioritize patients based on immediate medical need and prognosis. *Green* - The **green category** is for patients with **minor injuries** who are considered "walking wounded" and can often wait for treatment for several hours, sometimes up to a few days. - These individuals are **stable** and do not require immediate intervention to preserve life or limb. *Black* - The **black category** is reserved for individuals who are **deceased** or have injuries so severe that survival is unlikely given the available resources, often implying **palliative care** rather than active life-saving interventions in a mass casualty event. - This category signifies that resources would be better allocated to patients with a higher chance of survival.
Question 4: Steps in review of patient's history during secondary survey of trauma care can be summarised as
- A. TRIAGE
- B. ABCDE
- C. AMPLE (Correct Answer)
- D. None of the options
Explanation: ***AMPLE*** - The **AMPLE history** is a mnemonic used during the **secondary survey** in trauma care to gather crucial patient information - It stands for **Allergies, Medications, Past medical history/Pregnancy, Last meal, and Events** surrounding the injury. *TRIAGE* - **Triage** is the process of prioritizing patients based on the severity of their condition and the likelihood of benefit from immediate treatment. - It is an initial assessment done to determine the urgency of care, not a detailed historical review for a single patient. *ABCDE* - The **ABCDE approach** (**Airway, Breathing, Circulation, Disability, Exposure**) is part of the **primary survey** in trauma care. - It focuses on identifying and managing immediate life-threatening conditions. *None of the options* - This option is incorrect because **AMPLE** specifically describes the historical review process during the secondary survey.
Question 5: Which Benzodiazepine decreases post-operative nausea & vomiting:-
- A. Midazolam (Correct Answer)
- B. Diazepam
- C. Lorazepam
- D. All of the options
Explanation: ***Midazolam*** - **Midazolam** is a commonly used benzodiazepine in anesthesia that has been shown to have **antiemetic properties** and can decrease the incidence of **postoperative nausea and vomiting (PONV)**. - Its mechanism may involve its sedative and anxiolytic effects, indirectly reducing the triggers for nausea. *Diazepam* - While **diazepam** is a benzodiazepine with sedative and anxiolytic effects, it is not primarily known for reducing PONV. - Its longer duration of action compared to midazolam can also contribute to unwanted **postoperative sedation**. *Lorazepam* - **Lorazepam** is another benzodiazepine used for anxiolysis and sedation but is not a primary agent for the prevention of PONV. - Like diazepam, its prolonged effects can lead to **delayed recovery** and drowsiness, which may not be desirable in the postoperative period. *All of the options* - While all listed drugs are benzodiazepines, only **midazolam** is consistently recognized and utilized for its ability to reduce PONV in the perioperative setting. - The other benzodiazepines do not demonstrate the same consistent benefit in PONV reduction and may have other side effects that limit their utility for this specific purpose.
Question 6: Blood loss during major surgery is best estimated by:
- A. Transesophageal USG Doppler
- B. Visual assessment
- C. Suction bottles (Correct Answer)
- D. Cardiac output by thermodilution
Explanation: ***Suction bottles*** - Measuring the volume of fluid collected in **suction bottles** (after subtracting irrigating fluid) provides a direct and quantifiable estimate of blood loss. - This method is widely used in surgery due to its **simplicity and relative accuracy** for assessing blood collected from the surgical field. *Transesophageal USG Doppler* - This technique primarily assesses **cardiac function** and **blood flow dynamics**, not directly quantifying blood loss. - While it can indicate hypovolemia, it doesn't provide a precise measurement of the volume of blood lost. *Visual assessment* - **Visual estimation** of blood loss by surgical staff is notoriously inaccurate and can lead to significant underestimation or overestimation. - It is highly subjective and depends on factors like lighting, the color of the blood-soaked materials, and individual experience. *Cardiac output by thermodilution* - **Thermodilution** is used to measure cardiac output, which can reflect hemodynamic status and help guide fluid resuscitation. - It does not directly quantify the amount of blood lost but rather assesses the **body's response** to blood loss.
Question 7: What is the most common cause of postoperative fever on the first postoperative day?
- A. Atelectasis (Correct Answer)
- B. Wound infection
- C. Pulmonary embolism
- D. UTI
Explanation: ***Atelectasis*** - **Atelectasis** is the most common cause of fever on the **first postoperative day** due to the collapse of lung alveoli, leading to impaired gas exchange. - It is frequently caused by **anesthesia, pain, and immobility** reducing deep breaths and coughing. *Wound infection* - **Wound infections** typically manifest later, generally around **3 to 7 days post-surgery**, as bacterial growth and inflammation require more time. - While it can cause fever, it is unlikely to be the cause within the **first 24-48 hours**. *Pulmonary embolism* - A **pulmonary embolism** is a serious complication, but fever is not its primary or most common early symptom; instead, patients often present with **dyspnea, tachypnea, and chest pain.** - Although it can occur, it's generally less frequent on the **first postoperative day** compared to atelectasis. *UTI* - **Urinary tract infections (UTIs)** usually develop a few days after surgery, often associated with **catheterization**, and present with dysuria, frequency, and suprapubic pain. - While fever can occur with a UTI, it is rarely the cause of fever within the **first 24 hours** after surgery.
Question 8: Which of the following intravenous anaesthetic agent causes decrease in postoperative nausea and vomiting :
- A. Propofol (Correct Answer)
- B. Etomidate
- C. Ketamine
- D. Thiopentone
Explanation: ***Propofol*** - **Propofol** has antiemetic properties, which contributes to a reduced incidence of **postoperative nausea and vomiting (PONV)**. - Its mechanism of action in reducing PONV is thought to involve effects on **dopaminergic receptors** and **serotonin pathways** in the brain. *Etomidate* - **Etomidate** is not known to significantly reduce PONV and may even have a neutral effect or slightly increase it compared to propofol. - Its primary advantages include **cardiovascular stability**, which is unrelated to antiemetic effects. *Ketamine* - **Ketamine** is associated with a higher incidence of PONV, especially at higher doses, due to its **psychedelic side effects** and stimulation of the chemoreceptor trigger zone. - It is known for causing **emergence delirium** and does not possess antiemetic properties. *Thiopentone* - **Thiopentone** (Thiopental) does not have any significant antiemetic properties and is not typically used for its effect on PONV. - It was historically used as an induction agent but has largely been replaced by newer drugs like propofol.
Question 9: Which of the following should be considered as the cause of generalized convulsions 20 minutes postoperatively?
- A. Enflurane (Correct Answer)
- B. Halothane
- C. Isoflurane
- D. Sevoflurane
Explanation: ***Enflurane*** - **Enflurane** is well-known to cause **generalized convulsions** or seizure-like activity during emergence from anesthesia, particularly when inspired concentrations exceed 3.0% or with hypocapnia. - The risk of seizures is a significant reason why enflurane is rarely used in modern anesthetic practice compared to newer volatile agents. *Halothane* - **Halothane** is associated with cardiac arrhythmias and hepatotoxicity but generally does not cause generalized convulsions as a primary side effect. - While it can lower the seizure threshold, overt seizures are not a common complication of halothane administration. *Isoflurane* - **Isoflurane** is associated with CNS depression and can, in rare cases, cause myoclonus, but it is not typically linked to generalized tonic-clonic convulsions. - It is often used in neurosurgery due to its beneficial effects on cerebral blood flow and minimal seizure-inducing potential. *Sevoflurane* - **Sevoflurane**, while capable of causing excitatory movements or myoclonus during induction and emergence, is not a common cause of clear-cut generalized convulsions in healthy patients. - High concentrations in pediatric patients or those with pre-existing seizure disorders might slightly increase the risk of seizure-like EEG changes, but it is less epileptogenic than enflurane.
Question 10: Which inducing agent is associated with the highest incidence of postoperative vomiting?
- A. Thiopentone
- B. Propofol
- C. Etomidate
- D. Ketamine (Correct Answer)
Explanation: ***Ketamine*** - While **ketamine** is a valuable anesthetic, it is associated with a higher incidence of **postoperative nausea and vomiting (PONV)** due to its effects on the central nervous system. - This is particularly noted in adult patients undergoing procedures where ketamine is used as the primary inducing agent or for maintenance. *Etomidate* - **Etomidate** is known for its **hemodynamic stability**, making it a good choice for patients with cardiovascular disease. - It has a moderate incidence of **PONV**, generally considered lower than ketamine but higher than propofol. *Thiopentone* - **Thiopentone** (now less commonly used) was a traditional barbiturate inducing agent. - Its incidence of **PONV** is generally considered moderate and not the highest among common inducing agents. *Propofol* - **Propofol** is well-known for its **antiemetic properties**, which contribute to a significantly lower incidence of **PONV**. - It is often favored in patients at high risk for PONV precisely because of this beneficial side effect.
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