Preoperative Evaluation and Management Practice Questions

Q: Atropine as preanesthesia has all effects except?

Bronchoconstriction. **Explanation:** Atropine is a competitive **muscarinic acetylcholine receptor antagonist** (anticholinergic). Its use in premedication is based on its ability to block parasympathetic (vagal) activity. **Why "Bronchoconstriction" is the correct answer:** Atropine causes **bronchodilation**, not bronchoconstriction. By blocking the M3 receptors on bronchial smooth muscle, it inhibits the constrictive effects of acetylcholine. This increases anatomical dead space but is beneficial in preventing intraoperative bronchospasm. **Analysis of other options:** * **A. Decrease secretion:** Atropine is a potent antisialagogue. It blocks M3 receptors in salivary and bronchial glands, reducing secretions. This is crucial for maintaining a clear airway and preventing laryngospasm during induction. * **C. Prevent bradycardia:** Atropine exerts a positive chronotropic effect by blocking M2 receptors at the SA node, thereby counteracting vagal-induced bradycardia caused by surgical maneuvers (e.g., traction on extraocular muscles) or drugs (e.g., succinylcholine, halothane). * **D. Prevent hypotension:** By preventing or treating bradycardia, atropine helps maintain cardiac output (CO = HR × SV), thereby preventing a drop in blood pressure associated with vagal stimulation. **NEET-PG High-Yield Pearls:** 1. **Blood-Brain Barrier:** Atropine is a tertiary amine; it **crosses** the BBB and can cause Central Anticholinergic Syndrome (confusion/delirium), especially in the elderly. 2. **Order of Potency:** * **Antisialagogue:** Scopolamine > Glycopyrrolate > Atropine. * **Tachycardia:** Atropine > Glycopyrrolate > Scopolamine. 3. **Contraindication:** Relative contraindication in patients with **narrow-angle glaucoma** (causes mydriasis) and prostatic hypertrophy (causes urinary retention). 4. **Glycopyrrolate** is often preferred over Atropine as it is a quaternary ammonium (does not cross BBB) and has a longer duration of action.

Q: Polygelin content is found in which of the following fluids?

Haemaccel. **Explanation:** **Haemaccel** is a synthetic colloid used for volume replacement. It is specifically composed of **Polygeline**, which is a polymer of degraded gelatin cross-linked with urea. It has a molecular weight of approximately 30,000 Daltons and is unique because it contains significant concentrations of electrolytes, specifically **Calcium (6.25 mmol/L)** and Potassium. **Analysis of Options:** * **Gelofuscine (Option A):** This is also a gelatin-based colloid, but it consists of **succinylated gelatin** in isotonic saline. Unlike Haemaccel, it does not contain calcium and is not cross-linked with urea. * **Hartmann's Solution (Option B):** This is a crystalloid, also known as **Ringer's Lactate**. It contains sodium chloride, sodium lactate, potassium chloride, and calcium chloride, but no gelatin or polygeline. * **Hetastarch (Option D):** This is a **Hydroxyethyl Starch (HES)**, a synthetic colloid derived from amylopectin. It is a glucose polymer, not a protein/gelatin derivative. **High-Yield Clinical Pearls for NEET-PG:** 1. **Calcium Content:** Because Haemaccel contains calcium, it should **not** be infused through the same line as citrated blood, as it may cause clotting (recalcification of blood). 2. **Anaphylaxis:** Gelatins (Haemaccel and Gelofuscine) have a higher incidence of anaphylactoid reactions compared to starches or crystalloids due to histamine release. 3. **Renal Safety:** Unlike older Hydroxyethyl starches, polygelins have a minimal effect on renal function and coagulation profiles. 4. **Metabolism:** Polygelin is primarily excreted unchanged by the kidneys.

Question 1

A 27-year-old male patient is referred for resection of pheochromocytoma. Which of the following medications should the patient be taking prior to surgery?

Accepted Answer

Phenoxybenzamine

Answer

Propranolol

Answer

Labetalol

Answer

Hydralazine

Question 2

Which statement regarding calcium channel blockers in anesthesia is TRUE?

Accepted Answer

They should be given in normal doses as they prevent MI and angina.

Answer

They need to be decreased as they augment hypotension and muscle relaxation.

Answer

They should be withheld because they lower LES pressure.

Answer

All of the above.

Question 3

A 45-year-old male with a history of smoking is scheduled for elective surgery. Which of the following statements regarding the effects of smoking is FALSE?

Accepted Answer

Carbon monoxide shifts the O2-Hb dissociation curve to the right.

Answer

The effect of nicotine on aortic and carotid bodies can increase sympathetic tone.

Answer

Muscle relaxant dose requirements are increased in smokers.

Answer

Smoking decreases surfactant levels.

Question 4

Atropine when used as a pre-medication causes all of the following symptoms except:

Accepted Answer

Bronchoconstriction

Answer

Skin flush

Answer

Prevents bradycardia

Answer

Dryness of mouth

Question 5

Atropine as preanesthesia has all effects except?

Accepted Answer

Bronchoconstriction

Answer

Decrease secretion

Answer

Prevent bradycardia

Answer

Prevent hypotension

Question 6

According to AHA/American College of Cardiology guidelines, which of the following is NOT considered surgery with high risk in patients with known coronary artery disease?

Accepted Answer

Carotid endarterectomy

Answer

Emergency surgery

Answer

Peripheral vascular surgery

Answer

Aortic aneurysm surgery

Question 7

A drug belongs to the anticholinergic drug group and is primarily used in preanesthetic medication and also during surgery. Which of the following can be this drug?

Accepted Answer

Glycopyrrolate

Answer

Pipenzolate methyl bromide

Answer

Isopropamide

Answer

Dicyclomine

Question 8

Polygelin content is found in which of the following fluids?

Accepted Answer

Haemaccel

Answer

Gelofuscine

Answer

Hartmann's solution

Answer

Hetastarch

Question 9

Which of the following is used as a preanesthetic medication?

Accepted Answer

Glycopyrrolate

Answer

Propanthelene

Answer

Ipratropium bromide

Answer

Hyoscine

Question 10

A 2-year-old child is scheduled for elective tonsillectomy and adenoidectomy. The mother reports the child has a runny nose. In which of the following situations would you proceed with the surgery?

Accepted Answer

Child is having bilateral bronchial breath sounds

Answer

Child is afebrile

Answer

Child is not actively wheezing

Answer

Child is alert and feeding normally

Preoperative Evaluation and Management — MCQs

Preoperative Evaluation and Management — MCQs

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