Patient Selection and Preoperative Evaluation — MCQs
Which of the following is NOT a CONTRAINDICATION for laparoscopic surgery:
What is the key characteristic of Body Mass Index (BMI) considerations for the Asian population?
Which of the following is considered an absolute contraindication for MRI in most clinical scenarios?
Abbreviated laparotomy done for:
A 50 year old male is posted for elective laparoscopic cholecystectomy. No history of comorbidities. His surgery is scheduled at 2 PM on the day of surgery. Which of the following is against the ASA guidelines for preoperative fasting
Which of the following is not a component of the Goldman Revised Cardiac Risk Index?
Steps in review of patient's history during secondary survey of trauma care can be summarised as
A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?
What is true about carcinoma of the esophagus?
In patients with osteoarthritis of the knee joint, atrophy occurs most commonly in which muscle?
Patient Selection and Preoperative Evaluation Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a CONTRAINDICATION for laparoscopic surgery:
- A. Severe COPD
- B. Bowel herniation
- C. Endometriosis (Correct Answer)
- D. Severe cardiac compromise
Explanation: ***Endometriosis*** - **Endometriosis** is a *common indication* for laparoscopic surgery, as laparoscopy allows for both diagnosis and treatment (e.g., excision or ablation of endometrial implants). - It is *not* a contraindication; in fact, laparoscopy is the **gold standard** for diagnosing and managing endometriosis due to its minimally invasive nature and excellent visualization. *Severe COPD* - **Severe COPD** is a significant *contraindication* because pneumoperitoneum increases intra-thoracic pressure and elevates the diaphragm, reducing functional residual capacity. - This can cause *hypercarbia*, *hypoxemia*, and respiratory compromise in patients with already limited pulmonary reserve, making general anesthesia and laparoscopy high-risk. *Bowel herniation* - **Incarcerated or strangulated bowel herniation** is generally a *relative contraindication* due to the risk of intestinal injury during trocar insertion or manipulation. - The presence of *adhesions* and compromised bowel can make laparoscopic access challenging, though experienced surgeons may still attempt laparoscopic repair in selected cases. *Severe cardiac compromise* - **Severe cardiac compromise** is a significant *contraindication* because pneumoperitoneum causes increased intra-thoracic pressure, reduced venous return, and increased systemic vascular resistance. - This can lead to decreased *cardiac output*, arrhythmias, and hemodynamic instability, posing substantial risk to patients with severe cardiovascular disease.
Question 2: What is the key characteristic of Body Mass Index (BMI) considerations for the Asian population?
- A. Increased morbidity at lower values (Correct Answer)
- B. BMI cut-offs for obesity differ from international standards
- C. Increased morbidity at higher BMI values
- D. Obesity is defined as > 25 kg/m2
Explanation: ***Increased morbidity at lower values*** - Due to differences in body composition and fat distribution, Asian populations tend to experience **higher risks of developing obesity-related diseases** (e.g., type 2 diabetes, cardiovascular disease) at **lower BMI values** compared to non-Asian populations. - This increased morbidity at lower BMI values highlights the need for population-specific BMI cut-offs for health risk assessment. *BMI cut-offs for obesity differ from international standards* - While it is true that **BMI cut-offs for obesity differ for Asian populations**, this option does not fully describe *why* these cut-offs differ. - The difference in cut-offs is precisely *because* increased morbidity is seen at lower BMI values, making this option less specific than the correct answer. *Increased morbidity at higher BMI values* - While morbidity does increase at higher BMI values in all populations, this statement is **true for Caucasians and other populations**, but the defining characteristic for Asian populations is the *lower* BMI at which morbidity risk begins to significantly increase. - This option does not capture the unique aspect of BMI and health risks in the Asian population. *Obesity is defined as > 25 kg/m2* - For many Asian populations, a BMI of **> 25 kg/m²** is often used as the cut-off for **overweight**, not necessarily obesity, and **obesity is often defined at > 27.5 kg/m² or 30 kg/m² depending on the specific group**. - The international standard for obesity (BMI ≥ 30 kg/m²) is often considered too high for many Asian populations to capture risk effectively.
Question 3: Which of the following is considered an absolute contraindication for MRI in most clinical scenarios?
- A. Claustrophobia
- B. Pacemaker (Correct Answer)
- C. Penile prosthesis
- D. Joint replacement
Explanation: ***Pacemaker*** - The strong magnetic fields and radiofrequency pulses of **MRI** can interfere with the function of a **pacemaker**, potentially causing device malfunction, dislodgement, or heating of leads, which can be life-threatening. - While some newer pacemakers are MRI-conditional, the presence of an older or non-MRI-conditional pacemaker is an **absolute contraindication** to MRI. *Claustrophobia* - **Claustrophobia** is a relative contraindication or a challenge for MRI, often managed with sedation or open MRI scanners, but it does not pose an immediate physical threat. - It affects patient comfort and compliance but is not an **absolute contraindication** in terms of safety. *Penile prosthesis* - Most modern **penile prostheses** are made of MRI-compatible materials and are generally safe for MRI. - While some older devices might cause artifacts, they do not typically pose a significant safety risk during an **MRI** scan. *Joint replacement* - **Joint replacements**, especially newer ones, are often made of non-ferromagnetic materials and are increasingly becoming MRI-safe. - While older or certain types of metallic implants can cause **image artifacts**, they are not an **absolute contraindication** for MRI unless the material is known to be ferromagnetic and prone to movement or heating.
Question 4: Abbreviated laparotomy done for:
- A. Hemodynamically stable patients with minor trauma
- B. Damage control in hemodynamically unstable trauma patients (Correct Answer)
- C. Elective abdominal surgeries
- D. Early wound healing promotion
Explanation: ***Damage control in hemodynamically unstable trauma patients*** - **Abbreviated laparotomy** is a key component of **damage control surgery**, primarily indicated for hemodynamically unstable trauma patients. - The goal is to rapidly control life-threatening issues like hemorrhage and contamination, then temporarily close the abdomen for physiologic stabilization before definitive repair. *Hemodynamically stable patients with minor trauma* - These patients typically do not require prompt surgical intervention; their injuries can often be managed non-operatively or with standard surgical techniques. - An abbreviated laparotomy is an aggressive approach reserved for severe, life-threatening scenarios, not minor trauma in stable patients. *Elective abdominal surgeries* - Elective surgeries are planned procedures performed on stable patients with no immediate life-threatening conditions. - They allow for complete surgical repair in a single setting, which is the opposite of the staged approach of an abbreviated laparotomy. *Early wound healing promotion* - The focus of an abbreviated laparotomy is on resuscitation and source control, not primarily on wound healing. - The initial closure is temporary, often leaving the wound open, which is not conducive to early, primary wound healing.
Question 5: A 50 year old male is posted for elective laparoscopic cholecystectomy. No history of comorbidities. His surgery is scheduled at 2 PM on the day of surgery. Which of the following is against the ASA guidelines for preoperative fasting
- A. Water at 12:00 PM
- B. Black coffee at 5:30 AM
- C. Pancakes at 10:00 AM (Correct Answer)
- D. A non-clear liquid (e.g., orange juice) at 7:30 AM
Explanation: **Pancakes at 10:00 AM** - According to ASA guidelines, the fasting period for solid food is typically **6-8 hours** before surgery. Eating pancakes, which are solid food, at 10:00 AM for a 2:00 PM surgery (4-hour interval) violates this guideline. - This short fasting period for solids increases the risk of **pulmonary aspiration** during induction of anesthesia. *Water at 12:00 PM* - Water is considered a clear liquid, and ASA guidelines typically allow clear liquids until **2 hours** before surgery. Drinking water at 12:00 PM for a 2:00 PM surgery is within these guidelines. - Rapid gastric emptying of clear liquids minimizes the risk of aspiration. *Black coffee at 5:30 AM* - Black coffee is considered a clear liquid, and it is consumed well within the **2-hour** fasting window for clear liquids before a 2:00 PM surgery. - The absence of milk or cream ensures it is treated as a clear liquid, which empties quickly from the stomach. *A non-clear liquid (e.g., orange juice) at 7:30 AM* - Non-clear liquids, such as orange juice, are treated similarly to light meals and generally require a fasting period of **6 hours** before surgery. Drinking orange juice at 7:30 AM for a 2:00 PM surgery (6.5-hour interval) is compliant with these guidelines. - The protein and pulp in non-clear liquids delay gastric emptying compared to clear liquids.
Question 6: Which of the following is not a component of the Goldman Revised Cardiac Risk Index?
- A. History of preoperative treatment with insulin
- B. History of preoperative serum creatinine >2.0 mg/dL
- C. Age > 80 yrs (Correct Answer)
- D. History of ischemic heart disease
Explanation: ***Age > 80 yrs*** - **Age** is not a parameter included in the Goldman Revised Cardiac Risk Index for predicting postoperative cardiac complications. - The index focuses on specific medical conditions and surgical risk factors. *History of preoperative treatment with insulin* - This is a component of the **Goldman Revised Cardiac Risk Index**, indicating **insulin-dependent diabetes mellitus**. - Diabetes requiring insulin treatment is a significant risk factor for cardiac complications during surgery. *History of preoperative serum creatinine >2.0 mg/dL* - An elevated **serum creatinine** (>2.0 mg/dL) is a recognized component of the index, reflecting **renal insufficiency**. - **Renal impairment** is associated with increased cardiac risk in the perioperative period. *History of ischemic heart disease* - This is a key component of the Goldman Revised Cardiac Risk Index, as a history of **ischemic heart disease** (e.g., prior myocardial infarction, angina) significantly increases perioperative cardiac risk. - Patients with existing heart disease are more susceptible to cardiac events during and after surgery.
Question 7: 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 8: A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?
- A. History + c/e + routine labs + V/Q scan
- B. History + c/e + routine labs
- C. History + c/e + routine labs + stress test (Correct Answer)
- D. History + c/e + routine labs + angiography to assess graft patency
Explanation: ***History + c/e + routine labs + stress test*** - A **stress test** is crucial in patients with a history of MI and CABG to assess **myocardial ischemia** and functional capacity, guiding perioperative management. - This evaluation helps determine the patient's **cardiac risk** for non-cardiac surgery and the need for further cardiac optimization. *History + c/e + routine labs + angiography to assess graft patency* - **Coronary angiography** is an invasive procedure and is generally not indicated as a routine preoperative assessment unless there are new, significant cardiac symptoms or signs of **graft dysfunction**. - Assessing graft patency through angiography carries risks and would only be justified if there were strong clinical indications suggesting acute or severe **cardiac ischemia**. *History + c/e + routine labs* - While critical for any preoperative assessment, **routine history, physical examination, and basic laboratory tests** are insufficient for a patient with a significant cardiac history like MI and CABG. - This approach would **underestimate the cardiac risk** and might miss undetected ischemia, leading to adverse perioperative cardiac events. *History + c/e + routine labs + V/Q scan* - A **ventilation-perfusion (V/Q) scan** is primarily used to diagnose **pulmonary embolism** or assess regional lung function. - It does not provide information about myocardial ischemia or cardiac functional capacity, making it **irrelevant** for assessing cardiac risk in this clinical scenario.
Question 9: What is true about carcinoma of the esophagus?
- A. The most common site is the lower end.
- B. Both adenocarcinoma and squamous cell carcinoma occur. (Correct Answer)
- C. The commonest histology is adenocarcinoma.
- D. It is more common in females.
Explanation: **Explanation:** Carcinoma of the esophagus is a significant topic in surgical oncology. The correct answer is **Option B** because esophageal cancer primarily manifests in two distinct histological types: **Squamous Cell Carcinoma (SCC)** and **Adenocarcinoma (EAC)**. While their risk factors and primary locations differ, both are recognized as the major pathological variants of the disease. **Analysis of Options:** * **Option A & C:** Historically, SCC was the most common type globally and typically occurred in the **middle third** of the esophagus. However, in Western countries, the incidence of Adenocarcinoma (usually involving the **lower third**) is rising due to GERD and Barrett’s esophagus. Globally, SCC remains more prevalent, making "Adenocarcinoma" or "Lower end" incorrect as absolute "most common" statements without geographic context. * **Option D:** Esophageal cancer shows a strong **male predominance** (often 3:1 or higher), largely due to higher rates of smoking and alcohol consumption (for SCC) and central obesity/GERD (for EAC) in men. **High-Yield Clinical Pearls for NEET-PG:** * **Most common type (Worldwide/India):** Squamous Cell Carcinoma. * **Most common type (Western world):** Adenocarcinoma. * **Risk Factors:** SCC is associated with smoking, alcohol, and achalasia cardia; EAC is strongly linked to **Barrett’s Esophagus** (metaplasia). * **Investigation of Choice:** Upper GI Endoscopy with biopsy. * **Staging:** Contrast-enhanced CT (CECT) for distant spread; **Endoscopic Ultrasound (EUS)** is the most accurate for T and N staging. * **Lymphatic Spread:** The esophagus lacks a serosa, leading to early mediastinal spread.
Question 10: In patients with osteoarthritis of the knee joint, atrophy occurs most commonly in which muscle?
- A. Quadriceps only (Correct Answer)
- B. Hamstrings only
- C. Both quadriceps and hamstrings
- D. Gastrocnemius
Explanation: In patients with osteoarthritis (OA) of the knee, muscle atrophy is a hallmark clinical finding, and the **Quadriceps femoris** is the most commonly and severely affected muscle group. ### Why Quadriceps only is the correct answer: The primary mechanism is **Arthrogenic Muscle Inhibition (AMI)**. Pain, swelling, and joint laxity associated with OA trigger a presynaptic inhibition of the alpha-motoneurons supplying the quadriceps. This prevents the muscle from being fully activated, leading to disuse atrophy. The quadriceps (specifically the *Vastus Medialis Obliquus*) is highly sensitive to joint effusion; even a small amount of intra-articular fluid can inhibit its contraction. This creates a vicious cycle: weak quadriceps fail to absorb shock during gait, leading to increased joint loading and accelerated cartilage degeneration. ### Why other options are incorrect: * **Hamstrings only:** While hamstrings may show some weakness due to overall decreased activity, they do not undergo the same level of reflex inhibition as the extensors. In fact, hamstrings often become relatively "overactive" to stabilize the joint, which can lead to flexion contractures. * **Both quadriceps and hamstrings:** Although generalized limb wasting can occur in advanced stages, the atrophy is significantly disproportionate. The quadriceps waste earlier and more profoundly than the hamstrings. * **Gastrocnemius:** This muscle is primarily involved in ankle plantarflexion. While it crosses the knee joint, it is not the primary stabilizer affected by the neuro-mechanical changes of knee OA. ### High-Yield Clinical Pearls for NEET-PG: * **Vastus Medialis Obliquus (VMO):** This is the first component of the quadriceps to show visible wasting in knee pathologies. * **Quadriceps Lag:** A clinical sign where the patient can passively straighten the knee but cannot maintain active extension, often due to quadriceps weakness/atrophy. * **Management:** Strengthening the quadriceps is the most effective non-pharmacological intervention to reduce pain and improve function in knee OA.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free