Postoperative Care Practice Questions

Q: A female, 12 hours post open cholecystectomy under general anesthesia, presents with dyspnea and crepitations in the right lower lobe. What is the probable cause?

Atelectasis. ### Explanation **Correct Option: B. Atelectasis** Atelectasis (alveolar collapse) is the most common cause of postoperative fever and respiratory distress within the first **24–48 hours** after surgery. * **Mechanism:** In upper abdominal surgeries (like open cholecystectomy), diaphragmatic dysfunction, pain-induced splinting, and the effects of general anesthesia lead to shallow breathing and decreased functional residual capacity (FRC). This results in the collapse of small airways, typically in the basal lobes. * **Clinical Presentation:** Patients present with dyspnea, tachypnea, and characteristic **fine crepitations** (crackles) over the affected area. **Why other options are incorrect:** * **A. Drug-induced collapse:** While opioids can cause respiratory depression, they typically present with a decreased respiratory rate (bradypnea) and sedation rather than localized crepitations. * **C. Pulmonary edema:** This usually presents with bilateral diffuse crackles, frothy sputum, and signs of fluid overload or cardiac failure, rather than localized findings in the right lower lobe. * **D. Myocardial infarction:** While possible, it is rare in a young female post-cholecystectomy without prior history. It would more likely present with chest pain and ECG changes rather than isolated basal crepitations. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Atelectasis is the most common cause of fever on **Postoperative Day 1 (POD 1)**. * **Risk Factors:** Upper abdominal and thoracic surgeries carry the highest risk due to proximity to the diaphragm. * **Prevention/Treatment:** Incentive spirometry, early mobilization, and adequate analgesia (to prevent splinting) are the mainstays of management. * **Mnemonic (5 W’s of Post-op Fever):** **W**ind (Atelectasis - Day 1-2), **W**ater (UTI - Day 3), **W**alking (DVT/PE - Day 5), **W**ound (Infection - Day 7), **W**onder drugs (Drug fever).

Q: Which of the following drugs is believed to be effective in the treatment of post-operative shivering?

Pethidine. **Explanation:** **Postoperative Shivering (POS)** is a common complication following general or spinal anesthesia, occurring in up to 40% of patients. It increases oxygen consumption, CO2 production, and cardiac output, making its management crucial. **Why Pethidine (Meperidine) is the Correct Answer:** Pethidine is considered the **gold standard** and the most effective drug for treating postoperative shivering. Unlike other opioids, pethidine acts on **kappa (κ) receptors** in addition to mu (μ) receptors. Its unique efficacy stems from its ability to significantly **lower the shivering threshold** (the core temperature at which the body initiates shivering) more effectively than any other drug. A low dose (10–25 mg IV) usually provides rapid relief. **Analysis of Incorrect Options:** * **Ondansetron (A):** While some studies suggest 5-HT3 antagonists may have a prophylactic role in preventing shivering by modulating central temperature regulation, they are not the primary treatment of choice compared to pethidine. * **Diclofenac Sodium (B) & Paracetamol (D):** These are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and non-opioid analgesics. While excellent for postoperative pain management, they do not act on the thermoregulatory center in the hypothalamus to suppress the shivering reflex. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of POS:** Primarily due to intraoperative core hypothermia and the effects of volatile anesthetics on the hypothalamus. * **Other drugs used:** Tramadol, Clonidine, and Dexmedetomidine are also used, but Pethidine remains the most classic answer. * **Non-pharmacological management:** Forced-air warming blankets (Bair Hugger) are the most effective preventive measure. * **Pethidine Side Effect:** Be cautious of its metabolite, **normeperidine**, which can lower the seizure threshold (especially in renal failure).

Q: A risk score for predicting postoperative nausea and vomiting after inhalational anesthesia comprises all of the following factors except?

Obesity. The question refers to the **Apfel Simplified Risk Score**, which is the gold standard for predicting Postoperative Nausea and Vomiting (PONV) in adults undergoing inhalational anesthesia. ### **Explanation of the Correct Answer** **D. Obesity:** While intuitively linked to many surgical complications, multiple large-scale clinical trials have demonstrated that **Obesity (BMI > 30 kg/m²)** is **not** an independent risk factor for PONV. Therefore, it is not included in the Apfel scoring system. ### **Analysis of Incorrect Options** The Apfel score consists of four independent predictors, each assigned 1 point. The options below are the established risk factors: * **A. Female Gender:** Women are approximately 3 times more likely to suffer from PONV than men (likely due to hormonal influences). * **B. Prior History of PONV or Motion Sickness:** Patients with a sensitive "vomiting center" or vestibular system have a significantly higher baseline risk. * **C. Non-smoking Status:** Interestingly, smoking appears to have a protective effect against PONV (potentially due to enzyme induction or desensitization of nicotinic receptors). Thus, being a **non-smoker** is a risk factor. * *(Note: The fourth factor not listed in the options is the use of **Postoperative Opioids**).* ### **Clinical Pearls for NEET-PG** * **Apfel Score Interpretation:** * 0 factors: 10% risk * 1 factor: 21% risk * 2 factors: 39% risk * 3 factors: 61% risk * 4 factors: 79% risk * **Pediatric Equivalent:** The **Zeev-Pohl Score** is used for children (factors include: surgery duration >30 mins, age >3 years, strabismus surgery, and history of PONV). * **Emetogenic Anesthetics:** Nitrous oxide and volatile inhalational agents (Isoflurane, Sevoflurane) are major triggers; **Propofol** is the only anesthetic with anti-emetic properties. * **Surgery Type:** Laparoscopic, gynecological, and strabismus surgeries carry the highest PONV risk.

Q: Which of the following complications is most likely to occur after receiving several units of blood transfusion?

Metabolic alkalosis. **Explanation:** The correct answer is **Metabolic Alkalosis**. This occurs primarily due to the metabolism of **sodium citrate**, which is used as an anticoagulant in stored blood bags. 1. **Mechanism of Correct Answer:** Each unit of whole blood or packed red blood cells contains a significant amount of citrate. Once transfused, the liver metabolizes citrate into **bicarbonate (HCO₃⁻)**. In massive transfusions (typically defined as >10 units in 24 hours or >4 units in 1 hour), the sudden load of bicarbonate exceeds the kidney's excretory capacity, leading to an increase in blood pH and metabolic alkalosis. 2. **Why Incorrect Options are Wrong:** * **Metabolic Acidosis:** While stored blood is slightly acidic due to the accumulation of lactic acid and pyruvic acid over time, this is transient. Once transfused, the metabolic conversion of citrate to bicarbonate quickly shifts the balance toward alkalosis. Acidosis is only seen in the initial phase of a massive transfusion or in patients with severe liver failure who cannot metabolize citrate. * **Respiratory Alkalosis/Acidosis:** These are primary disorders of ventilation (CO₂ elimination). Blood transfusion does not directly affect the respiratory drive or CO₂ exchange in a way that would predictably cause these conditions as a primary metabolic consequence. **High-Yield Clinical Pearls for NEET-PG:** * **Citrate Toxicity:** Rapid transfusion can lead to hypocalcemia because citrate chelates ionized calcium. Always monitor for signs like prolonged QT interval or tetany. * **Potassium Shift:** Stored blood contains high extracellular potassium (due to RBC lysis). However, post-transfusion, as the cells become active and the alkalosis persists, **hypokalemia** is more common than hyperkalemia. * **Hypothermia:** Transfusing cold blood can shift the oxyhemoglobin dissociation curve to the left, further complicating tissue oxygen delivery.

Question 1

Which of the following drugs is believed to be effective in the treatment of postoperative shivering?

Accepted Answer

Pethidine

Answer

Ondansetron

Answer

Diclofenac sodium

Answer

Paracetamol

Question 2

What is the most common rhythm disturbance during the early post-operative period?

Accepted Answer

Tachycardia

Answer

Bradycardia

Answer

Ventricular fibrillation

Answer

Complete heart block

Question 3

In intravenous hyperalimentation, which of the following are administered?

Accepted Answer

Amino acids

Answer

Hypertonic saline

Answer

Fats

Answer

Dextrose

Question 4

A female, 12 hours post open cholecystectomy under general anesthesia, presents with dyspnea and crepitations in the right lower lobe. What is the probable cause?

Accepted Answer

Atelectasis

Answer

Drug-induced collapse

Answer

Pulmonary edema

Answer

Myocardial infarction

Question 5

A patient who underwent surgery under general anesthesia without intraoperative complications complains of respiratory difficulty and low PO2 postoperatively. The patient is unable to lift their head or legs. What is the most likely cause?

Accepted Answer

Prolonged action of muscle relaxant

Answer

Respiratory acidosis

Answer

Pulmonary embolism

Answer

Fentanyl-induced chest rigidity

Question 6

Which of the following drugs is believed to be effective in the treatment of post-operative shivering?

Accepted Answer

Pethidine

Answer

Ondansetron

Answer

Diclofenac Sodium

Answer

Paracetamol

Question 7

Shivering is observed in the early postoperative period. What is the cause?

Accepted Answer

Halothane

Answer

Chloroform

Answer

Trichloroethylene

Answer

Ether

Question 8

After successful resuscitation and achieving stable spontaneous circulation, what is the next appropriate step?

Accepted Answer

Assess central nervous system involvement

Answer

Measure blood glucose

Answer

Evaluate spontaneous respiratory effort

Answer

Assess volume status

Question 9

A risk score for predicting postoperative nausea and vomiting after inhalational anesthesia comprises all of the following factors except?

Accepted Answer

Obesity

Answer

Female gender

Answer

Prior history of motion sickness

Answer

Non-smoking status

Question 10

Which of the following complications is most likely to occur after receiving several units of blood transfusion?

Accepted Answer

Metabolic alkalosis

Answer

Metabolic acidosis

Answer

Respiratory alkalosis

Answer

Respiratory acidosis

Postoperative Care — MCQs

Postoperative Care — MCQs

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