Preoperative Evaluation and Management Practice Questions

Q: Premedication is prescribed to – a) Allay anxiety b) Make the patient asleep before coming for operation c) Reduce the dose of induction agents d) Produce amnesia

Allay anxiety. ***Allay anxiety*** - Premedication frequently includes anxiolytic agents like **benzodiazepines** to calm the patient before surgery. - Reducing anxiety helps in achieving a smoother induction of anesthesia and can improve the patient's overall experience. *Reduce the dose of induction agents* - While some premedication agents like **opioids** or sedatives can have an anesthetic-sparing effect, this is a secondary benefit, not the primary goal. - The main aim is patient comfort and psychological preparation, not primarily dose reduction. *Produce amnesia* - Amnesia, particularly **anterograde amnesia**, is a desirable side effect of some premedication drugs like **midazolam**. - However, it's a consequence of the anxiolytic effect rather than the sole or primary reason for prescribing premedication. *Make the patient asleep before coming for operation* - While some premedication agents can cause **somnolence** or light sleep, the goal is not to have the patient fully asleep before entering the operating room. - The primary aim is to make the patient relaxed and comfortable, not unconscious.

Q: Nil per oral orders for an 8-year-old child posted for elective nasal polyp surgery at 8 AM include all of the following EXCEPT:

Milk can be taken at 7 AM in morning. **Milk can be taken at 7 AM in morning** - For an 8-year-old undergoing elective surgery at 8 AM, **milk is considered a solid or heavy fluid** and should be stopped at least **6 hours pre-operatively**. - Taking milk at 7 AM, just one hour before surgery, significantly increases the risk of **pulmonary aspiration** during anesthesia. *Apple juice can be taken at 10 PM previous night* - **Clear liquids**, such as apple juice, can generally be consumed up to **2 hours before surgery** in children. - Taking apple juice at 10 PM the night before for an 8 AM surgery falls well within the safe fasting window for clear liquids. *Can take sips of water up to 6 AM in morning* - **Sips of water** are considered a clear liquid and can be consumed up to **2 hours before surgery** in children. - Allowing water until 6 AM for an 8 AM surgery is appropriate and helps prevent dehydration without increasing aspiration risk. *Rice can be consumed at 11 PM previous night* - **Solid foods**, like rice, require a longer fasting period, typically at least **6-8 hours before surgery**. - Consuming rice at 11 PM the night before, for an 8 AM surgery, allows for sufficient gastric emptying and is generally safe.

Q: Which of the following signs of congestive cardiac failure constitute a major risk to the surgical patient undergoing anaesthesia ?

Jugular venous distention and third heart sound. ***Jugular venous distention and third heart sound*** - **Jugular venous distention (JVD)** indicates elevated right atrial pressure and **central venous pressure**, signifying significant volume overload and potential right ventricular dysfunction. - A **third heart sound (S3)** is a strong indicator of **ventricular dysfunction** and high filling pressures, suggesting severe heart failure and poor cardiac reserve, which poses a major risk during anesthesia. *Pedal oedema* - **Pedal edema** can be a sign of fluid overload, but it is a relatively mild and chronic symptom of heart failure compared to acute decompensation. - While it reflects increased hydrostatic pressure, it doesn't alone signify the immediate, critical hemodynamic instability that poses a major perioperative risk. *Basal crepitations on auscultation* - **Basal crepitations** (rales) suggest **pulmonary congestion** due to left ventricular failure, indicating fluid in the small airways. - Although concerning, this sign primarily reflects lung involvement and not necessarily the critical, global hemodynamic compromise indicated by JVD and S3. *Cardiomegaly* - **Cardiomegaly** (enlarged heart) is an imaging finding that reflects chronic cardiac remodeling due to long-standing heart disease. - It indicates a history of heart failure but does not directly reflect the **acute hemodynamic status** and immediate risk of decompensation during surgery.

Q: Which of the following drugs need not be stopped before surgery?

Digitalis. ***Digitalis*** - **Digitalis (digoxin)** is often continued through surgery, especially in patients with **heart failure** or **atrial fibrillation** to maintain cardiac function. - Its cessation could precipitate **cardiac decompensation** or arrhythmias, which are high-risk events during surgery. *High Dose Aspirin* - **High-dose aspirin** should generally be stopped before surgery due to its **antiplatelet effects**, increasing the risk of perioperative bleeding. - The duration of discontinuation depends on the type of surgery and individual patient risk. *Metformin* - **Metformin** should be stopped before surgery due to the risk of **lactic acidosis**, especially in situations involving **renal impairment** or hypoperfusion associated with surgery. - It's typically held on the day of surgery and for 24-48 hours post-operatively, depending on renal function. *Warfarin* - **Warfarin** is a strong oral anticoagulant that must be discontinued before most surgeries to prevent **excessive bleeding**. - It is typically stopped 5 days pre-op, and patients often receive **bridging therapy** with heparin, depending on their risk for thromboembolism.

Q: A 4-month-old child can be given clear fluid until how many hours prior to surgery?

2 hrs. ***2 hrs*** - Current guidelines from the **American Society of Anesthesiologists (ASA)** recommend a minimum fasting period of **2 hours for clear liquids** in infants and children. - This recommendation balances the risk of **pulmonary aspiration** with the benefit of preventing dehydration and patient discomfort. *4 hrs* - A 4-hour fasting period for clear fluids is longer than typically required for infants and children and may lead to unnecessary dehydration without additional safety benefits. - This duration is more commonly associated with non-human milk formula or solid food. *3 hrs* - While closer to the recommended time, 3 hours for clear fluids in an infant is still slightly longer than the current standard. - It does not offer a significant advantage over the 2-hour guideline and may still contribute to prolonged fasting. *1 hr* - A 1-hour fasting period for clear fluids in an infant is generally considered too short and carries an increased risk of **pulmonary aspiration** during induction of anesthesia. - Insufficient time for gastric emptying could lead to complications if regurgitation occurs.

Q: In anesthesiology, mild systemic disease is classified under which ASA grade?

2. 2 - ASA Grade 2 is defined as a patient with mild systemic disease that is well-controlled and does not limit daily activities. - Examples include a controlled hypertension, controlled type 2 diabetes without systemic complications, or a mild obesity (BMI 30-40). 4 - ASA Grade 4 indicates a patient with severe systemic disease that is a constant threat to life. - This includes conditions such as recent myocardial infarction, stroke, or severe valvular disease, which pose significant risks to patient safety during surgery. 3 - ASA Grade 3 describes a patient with severe systemic disease that limits activity but is not incapacitating. - Examples include poorly controlled hypertension or diabetes, stable angina, or moderate chronic obstructive pulmonary disease (COPD). 1 - ASA Grade 1 is assigned to a healthy patient without any systemic disease. - This classification implies no physiological, physical, or psychological disturbance, other than the condition requiring surgery.

Q: ASA classification is done for – a) Status of patient b) Risk c) Pain d) Lung disease

ab. ***ab*** - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is used to assess a patient's **overall health (status)** before surgery. - This classification helps in determining the **anesthetic risk** and guides anesthetic management. *ac* - While patient status is assessed, ASA classification does not primarily classify **pain** or pain management strategies. - **Lung disease** can influence a patient's ASA status, but it's not the sole or primary factor being classified independently. *a* - The ASA classification evaluates the patient's **overall health or status** but significantly aims to assess the **risk** associated with anesthesia and surgery. - Without considering risk, the classification loses its primary purpose in surgical planning. *bc* - The ASA system is indeed used to stratify **risk** for anesthesia and surgery, but it primarily does this by categorizing the patient's **overall physical status**. - It does not directly classify **pain** as an independent variable; patient conditions causing pain would contribute to their overall status.

Q: A moribund patient who has little chance of survival but is submitted to surgery as a last resort belongs to ASA class-

V. ***V*** - An ASA Physical Status **Class V** patient is defined as a **moribund patient** who is not expected to survive without the operation, often with a high risk of mortality within 24 hours even with surgery. - The description of a patient with "**little chance of survival** but submitted to surgery as a last resort" perfectly matches this classification. *II* - ASA Class II describes a patient with a **mild systemic disease** that is well-controlled and does not limit activity, such as well-controlled hypertension or diabetes. - This patient's condition is far more severe than what is classified as ASA Class II. *VI* - ASA Class VI is reserved for a **declared brain-dead patient** whose organs are being removed for donor purposes. - While the patient is moribund, they are not brain dead, and the surgery is for their own survival, not organ donation. *IV* - ASA Class IV describes a patient with a **severe systemic disease** that is a constant threat to life, such as unstable angina or severe cardiac disease. - While severe, Class IV patients generally have a better chance of survival than the patient described, who is already considered moribund and unlikely to survive without the surgery.

Q: A 62-year-old patient with uncontrolled hypertension resulting in a ruptured aortic aneurysm submitted to surgery belongs to ASA class-

IV. ***IV*** - An **ASA Class IV** patient has a **severe systemic disease** that is a constant threat to life. - An **uncontrolled ruptured aortic aneurysm** with uncontrolled hypertension clearly signifies a life-threatening condition, which is the hallmark of ASA Class IV. *VI* - **ASA Class VI** is reserved for a **brain-dead patient** whose organs are being removed for donor purposes. - This patient is alive and undergoing surgery, so Class VI does not apply. *V* - **ASA Class V** describes a **moribund patient** who is not expected to survive without the operation. - While a ruptured aortic aneurysm is severe, ASA V implies an even more immediate and profound risk of death, often associated with multiple organ failure or profound shock, which is not explicitly stated here. *III* - **ASA Class III** is defined by **severe systemic disease** that limits activity but is not incapacitating. - Uncontrolled hypertension and a ruptured aortic aneurysm represent a critical, life-threatening situation, classifying the patient beyond a simple Class III.

Q: Breast milk should be discontinued for how long prior to surgery

4 hours. ***4 hours*** - The American Society of Anesthesiologists (ASA) guidelines recommend a minimum **fasting period of 4 hours** for infants who are fed breast milk prior to elective procedures requiring general anesthesia or sedation. - Breast milk is digested relatively quickly compared to formula or solid foods, reducing the risk of **pulmonary aspiration** if this guideline is followed. *6 hours* - A 6-hour fasting period is typically recommended for **cow's milk-based formula**, nonhuman milk, or light meals, as these take longer to digest than breast milk. - For breast milk, this duration is unnecessarily long and could lead to **dehydration or discomfort** in the infant. *8 hours* - An 8-hour fasting period is usually reserved for **heavy or fatty meals** and is not applicable to breast milk, which is a liquid and is rapidly digested. - Such a long fasting interval for breastfed infants could increase the risk of **hypoglycemia** and dehydration. *2 hours* - A 2-hour fasting period is generally recommended only for **clear liquids** (e.g., water, clear apple juice) in infants and children. - Breast milk contains proteins and fats that require a longer digestion time than clear liquids, making a 2-hour fast insufficient to minimize the risk of **pulmonary aspiration**.

Question 1

Premedication is prescribed to – a) Allay anxiety b) Make the patient asleep before coming for operation c) Reduce the dose of induction agents d) Produce amnesia

Accepted Answer

Allay anxiety

Answer

Reduce the dose of induction agents

Answer

Produce amnesia

Answer

Make the patient asleep before coming for operation

Question 2

Nil per oral orders for an 8-year-old child posted for elective nasal polyp surgery at 8 AM include all of the following EXCEPT:

Accepted Answer

Milk can be taken at 7 AM in morning

Answer

Apple juice can be taken at 10 PM previous night

Answer

Can take sips of water up to 6 AM in morning

Answer

Rice can be consumed at 11 PM previous night

Question 3

Which of the following signs of congestive cardiac failure constitute a major risk to the surgical patient undergoing anaesthesia ?

Accepted Answer

Jugular venous distention and third heart sound

Answer

Pedal oedema

Answer

Basal crepitations on auscultation

Answer

Cardiomegaly

Question 4

Which of the following drugs need not be stopped before surgery?

Accepted Answer

Digitalis

Answer

High Dose Aspirin

Answer

Metformin

Answer

Warfarin

Question 5

A 4-month-old child can be given clear fluid until how many hours prior to surgery?

Accepted Answer

2 hrs

Answer

4 hrs

Answer

3 hrs

Answer

1 hr

Question 6

In anesthesiology, mild systemic disease is classified under which ASA grade?

Accepted Answer

2

Answer

4

Answer

3

Answer

1

Question 7

ASA classification is done for – a) Status of patient b) Risk c) Pain d) Lung disease

Accepted Answer

ab

Answer

ac

Answer

a

Answer

bc

Question 8

A moribund patient who has little chance of survival but is submitted to surgery as a last resort belongs to ASA class-

Accepted Answer

V

Answer

II

Answer

VI

Answer

IV

Question 9

A 62-year-old patient with uncontrolled hypertension resulting in a ruptured aortic aneurysm submitted to surgery belongs to ASA class-

Accepted Answer

IV

Answer

VI

Answer

V

Answer

III

Question 10

Breast milk should be discontinued for how long prior to surgery

Accepted Answer

4 hours

Answer

6 hours

Answer

8 hours

Answer

2 hours

Preoperative Evaluation and Management — MCQs

Preoperative Evaluation and Management — MCQs

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