Postoperative Complications Detection — MCQs
Post-operative pulmonary thromboembolism is seen in all, except:
Which of the following is the LEAST significant risk factor for postoperative pulmonary complications?
Which of the following is not a risk factor for postoperative pulmonary complication?
The complication which will not occur after PCNL surgery:
A patient develops sudden onset fever and confusion 2 days post-splenectomy. Most appropriate initial antibiotic?
A patient with ITP on steroids underwent splenectomy. Patient got fever on 3rd post-operative day. Next investigation is likely to reveal?
Postoperative pulmonary complications are seen/expected in all except:
Which of the following are the common complications associated with enteral nutrition in postoperative patients ? 1. Tube malposition, displacement 2. Diarrhoea, constipation 3. Predisposition to systemic sepsis 4. Electrolytic imbalance Select the correct answer using the code given below :
Patient can safely undergo major lung resection without an increased risk of postoperative complications if:
Which of the following surgical incisions is associated with the highest risk of postoperative pulmonary complications ?
Postoperative Complications Detection Indian Medical PG Practice Questions and MCQs
Question 1: Post-operative pulmonary thromboembolism is seen in all, except:
- A. Obese male
- B. Pregnant female
- C. Estrogen therapy
- D. Tall and thin man (Correct Answer)
Explanation: ***Tall and thin man*** - A **tall and thin man** is generally at a lower risk for developing post-operative pulmonary thromboembolism compared to the other options. - While prolonged immobility post-surgery can increase risk for anyone, factors like **obesity**, **pregnancy**, and **estrogen therapy** significantly elevate the risk. *Obese male* - **Obesity** is a major risk factor for venous thromboembolism (VTE) due to factors like increased venous stasis and chronic inflammation. - Adipose tissue also produces prothrombotic factors, further increasing the risk of **pulmonary embolism (PE)**. *Pregnant female* - **Pregnancy** induces a hypercoagulable state to prevent excessive bleeding during childbirth, increasing the risk of VTE. - This risk is further elevated in the post-partum period and with surgical procedures like a **Cesarean section**. *Estrogen therapy* - **Estrogen therapy**, such as in oral contraceptives or hormone replacement therapy, can increase the synthesis of clotting factors and decrease natural anticoagulant proteins. - This prothrombotic effect significantly raises the risk of **deep vein thrombosis (DVT)** and subsequent **PE**.
Question 2: Which of the following is the LEAST significant risk factor for postoperative pulmonary complications?
- A. Age > 60 years (Correct Answer)
- B. ASA class 3 and 4 patients
- C. Longer surgeries >2 hr
- D. Upper Abdominal surgery
Explanation: ***Age > 60 years*** - While age is a factor, it is generally considered **less significant** than other comorbid conditions or surgical factors in predicting postoperative pulmonary complications. - Pulmonary function naturally declines with age, but healthy elderly individuals may still tolerate surgery well if other risk factors are controlled. *ASA class 3 and 4 patients* - Patients classified as **ASA (American Society of Anesthesiologists) 3 or 4** have severe systemic disease or life-threatening systemic disease, respectively. - This significantly increases their risk of **postoperative pulmonary complications** due to their underlying health issues. *Longer surgeries >2 hr* - **Prolonged duration of surgery** (typically defined as >2-3 hours) is a significant independent risk factor for pulmonary complications. - This is due to longer periods of **immobility**, ventilation, and exposure to anesthetics, contributing to atelectasis and pneumonia risk. *Upper Abdominal surgery* - **Upper abdominal surgery** is one of the highest risk categories for postoperative pulmonary complications. - Incisions in this area can cause *diaphragmatic dysfunction*, pain leading to shallow breathing, and impaired cough reflex.
Question 3: Which of the following is not a risk factor for postoperative pulmonary complication?
- A. Normal BMI (18.5-24.9) (Correct Answer)
- B. Age 25-40 years
- C. Upper abdominal surgery
- D. Patient with 20 pack years of smoking
Explanation: ***Patient with 20 pack years of smoking*** - This is a significant risk factor for postoperative pulmonary complications, as **chronic smoking** impairs lung function and mucociliary clearance. - Patients with a history of **20 pack-years or more** are at a substantially increased risk of developing atelectasis, pneumonia, and respiratory failure after surgery. *Normal BMI (18.5-24.9)* - A **normal BMI** is not considered a risk factor for postoperative pulmonary complications; instead, it is associated with a lower risk compared to obesity or underweight states. - Patients with a normal BMI generally have **better respiratory mechanics** and lung volumes, reducing their susceptibility to pulmonary issues. *Age 25-40 years* - This age range is generally associated with a **lower risk** of postoperative pulmonary complications compared to very young or elderly patients. - Younger adults typically have **better physiological reserves** and healthier lungs, contributing to a reduced incidence of respiratory problems post-surgery. *Upper abdominal surgery* - **Upper abdominal surgery** is a significant risk factor for postoperative pulmonary complications due to its proximity to the diaphragm. - It often leads to **diaphragmatic dysfunction**, reduced lung volumes, and increased pain, all of which predispose patients to atelectasis and pneumonia.
Question 4: The complication which will not occur after PCNL surgery:
- A. Organ injury
- B. Urethral stricture (Correct Answer)
- C. Bleeding
- D. Sepsis
Explanation: ***Urethral stricture*** - **Urethral stricture** is a complication typically associated with transurethral procedures involving instrumentation through the urethra, such as a **Transurethral Resection of the Prostate (TURP)** or repeated urethral catheterisation. - **PCNL (Percutaneous Nephrolithotomy)** involves direct access to the kidney through the skin in the flank, bypassing the urethra entirely, therefore, making urethral stricture not a direct complication of this procedure. *Organ injury* - **Organ injury**, particularly to adjacent organs like the **colon**, **pleura**, or **spleen/liver**, can occur during PCNL if the access tract is misdirected or during instrumentation. - This is a well-recognised but infrequent complication requiring careful pre-operative planning and imaging guidance. *Bleeding* - **Bleeding** is a common complication of PCNL due to the invasive nature of the procedure, involving puncture of the kidney and fragmentation of stones. - It can range from minor self-limiting bleeding to significant haemorrhage requiring transfusion or further intervention such as **angiography** and **embolization**. *Sepsis* - **Sepsis** is a serious potential complication, particularly if the patient has pre-existing urinary tract infection or if bacteria are dislodged during stone fragmentation. - **Infection** can disseminate into the bloodstream, leading to severe systemic inflammatory response syndrome and septic shock.
Question 5: A patient develops sudden onset fever and confusion 2 days post-splenectomy. Most appropriate initial antibiotic?
- A. Azithromycin
- B. Ceftriaxone (Correct Answer)
- C. Vancomycin
- D. Piperacillin-tazobactam
Explanation: ***Ceftriaxone*** - Patients post-splenectomy are at high risk for **overwhelming post-splenectomy infection (OPSI)**, often caused by **encapsulated bacteria** like *Streptococcus pneumoniae* [2]. - **Ceftriaxone** provides broad coverage against common pathogens in OPSI, including both Gram-positive and Gram-negative bacteria, and can penetrate the CNS in cases of meningitis, which is crucial given the patient's confusion [1], [2]. *Azithromycin* - Primarily targets **atypical bacteria** (e.g., *Mycoplasma*, *Chlamydia*) and some Gram-positive organisms, but has limited efficacy against the most common encapsulated bacteria responsible for OPSI. - It is not a first-line antibiotic for severe, potentially life-threatening infections in asplenic patients. *Vancomycin* - Effective against **methicillin-resistant *Staphylococcus aureus* (MRSA)** and **multi-drug resistant *Streptococcus pneumoniae***, but does not cover Gram-negative organisms [2], [3]. - While important for resistant Gram-positives, it should typically be used in combination with another antibiotic (like a third-generation cephalosporin) in this critical setting, or reserved for cases where MRSA is suspected [3]. *Piperacillin-tazobactam* - Provides broad-spectrum coverage, including **Gram-positive, Gram-negative, and anaerobic bacteria**, making it suitable for many severe infections. - However, for suspected OPSI with a high risk of encapsulated bacteria like *Streptococcus pneumoniae* and potential meningitis, a third-generation cephalosporin like **ceftriaxone** is often preferred as initial monotherapy due to excellent penetration into the CSF and robust activity against these specific pathogens.
Question 6: A patient with ITP on steroids underwent splenectomy. Patient got fever on 3rd post-operative day. Next investigation is likely to reveal?
- A. Focal Intra-abdominal collection
- B. UTI
- C. Post-operative site infection
- D. Pulmonary consolidation (Correct Answer)
Explanation: ***Pulmonary consolidation*** - Post-splenectomy patients are at increased risk of **pulmonary complications**, including atelectasis and pneumonia, due to reduced diaphragmatic excursion and pain. Fever on day 3 suggests a developing infection or inflammatory process in the lungs. - **Splenectomy** affects the immune response, making patients more susceptible to infections and exaggerating inflammatory responses to surgical trauma, which can manifest as pulmonary issues. *Focal Intra-abdominal collection* - While intra-abdominal collections can cause fever post-operatively, they typically present later (around day 5-7), and symptoms are often localized with abdominal pain or distension. - This patient had ITP and underwent splenectomy, making **pulmonary complications** more prominent earlier on. *UTI* - Urinary tract infections can cause fever post-operatively, but are usually associated with **urinary symptoms** like dysuria, frequency, or urgency, which are not mentioned. - While prolonged catheterization increases risk, it is less common to be the primary cause of fever on day 3 after splenectomy compared to pulmonary issues. *Po site infection* - Surgical site infections more commonly manifest with localized signs of inflammation such as **redness, warmth, swelling, or purulent discharge**, which are not described. - While possible, a prominent fever on day 3 following a splenectomy, especially in a patient on steroids (which can mask some inflammatory signs), places **pulmonary issues** higher on the differential.
Question 7: Postoperative pulmonary complications are seen/expected in all except:
- A. Upper abdominal surgery
- B. Age >70
- C. Patient with 7 pack years of smoking (Correct Answer)
- D. BMI>30
Explanation: ***Patient with 7 pack years of smoking*** - While smoking is a risk factor for pulmonary complications, a history of **7 pack-years** is considered a relatively low cumulative exposure compared to other significant risk factors. - The impact of smoking on postoperative complications is often more pronounced with **higher pack-year histories** or in the presence of existing pulmonary disease. *Upper abdominal surgery* - **Upper abdominal surgery** is associated with a high risk of postoperative pulmonary complications due to proximity to the diaphragm, leading to pain-related **splinting** and **reduced lung volumes**. - This can result in **atelectasis** and pneumonia, as diaphragmatic function is often impaired. *Age >70* - **Advanced age** (over 70 years) is a significant independent risk factor for postoperative pulmonary complications due to age-related physiological changes, including **decreased lung elasticity** and **reduced cough reflex**. - Older patients often have comorbidities that further increase their susceptibility to these complications. *BMI>30* - A **BMI greater than 30** (obesity) significantly increases the risk of postoperative pulmonary complications due to altered respiratory mechanics, including **reduced functional residual capacity** and **increased work of breathing**. - Obese patients also have a higher incidence of **sleep apnea**, which can exacerbate postoperative hypoxia.
Question 8: Which of the following are the common complications associated with enteral nutrition in postoperative patients ? 1. Tube malposition, displacement 2. Diarrhoea, constipation 3. Predisposition to systemic sepsis 4. Electrolytic imbalance Select the correct answer using the code given below :
- A. 1, 2 and 4
- B. 1, 3 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Tube malposition/displacement** is a common mechanical complication (10-15% incidence), which can lead to ineffective feeding or aspiration into the respiratory tract. - **Diarrhoea and constipation** are frequent gastrointestinal complications (10-20% incidence), occurring due to formula intolerance, rapid infusion rates, or altered gut motility in postoperative patients. - **Predisposition to systemic sepsis**: While enteral nutrition itself has lower infection risk than parenteral nutrition, complications like **aspiration pneumonia** (from tube malposition), **contaminated formula**, and **prolonged ileus** can predispose to severe infections and sepsis in postoperative patients. This is particularly relevant when enteral feeding is improperly managed. *1, 2 and 4* - This combination includes **electrolyte imbalances** (hypokalemia, hypophosphatemia, hypomagnesemia), which are indeed common metabolic complications requiring monitoring. - However, in the context of postoperative patients, the infection risk (sepsis) from aspiration and feeding-related complications is considered a more significant acute complication than electrolyte disturbances, which are generally manageable with proper monitoring and formula adjustment. *1, 3 and 4* - This option incorrectly excludes **diarrhoea and constipation**, which are among the **most common complications** of enteral nutrition, occurring in 10-20% of patients. - GI complications are a primary reason for enteral feeding intolerance and cannot be omitted. *2, 3 and 4* - This option incorrectly omits **tube malposition/displacement**, which is the most important **mechanical complication** directly related to the enteral feeding method. - Without proper tube placement verification, feeding cannot be safely administered, making this a critical complication to recognize.
Question 9: Patient can safely undergo major lung resection without an increased risk of postoperative complications if:
- A. FEV1 > 2L, Normal DLCO (Correct Answer)
- B. FEV1 > 1L, Decreased DLCO
- C. FEV1 > 1L, Normal DLCO
- D. FEV1 > 2L, Decreased DLCO
Explanation: ***FEV1 > 2L, Normal DLCO*** - A **forced expiratory volume in 1 second (FEV1)** greater than 2 liters indicates **good baseline pulmonary function**, suggesting the patient can tolerate a significant reduction in lung tissue. - A **normal diffusing capacity of the lung for carbon monoxide (DLCO)** implies preserved alveolar-capillary membrane function and adequate gas exchange, which are crucial for maintaining oxygenation post-resection. *FEV1 > 1L, Normal DLCO* - While a normal DLCO is favorable, an **FEV1 only marginally above 1 liter** may still indicate some degree of airflow obstruction or reduced lung capacity. - This level of FEV1, although acceptable for some procedures, may not be sufficient to consider a major lung resection **safely without increased risk** due to the potential for significant postoperative respiratory compromise. *FEV1 > 1L, Decreased DLCO* - A **decreased DLCO** indicates impaired gas exchange, even if the FEV1 is somewhat preserved, suggesting underlying parenchymal lung disease or pulmonary vascular issues. - This combination significantly **increases the risk of postoperative complications** such as hypoxemia and pulmonary hypertension, making major lung resection unsafe. *FEV1 > 2L, Decreased DLCO* - Although an **FEV1 greater than 2 liters** is generally a good indicator of ventilatory capacity, a **decreased DLCO** still points to impaired gas exchange. - The presence of **impaired DLCO** suggests a higher risk of postoperative pulmonary complications, particularly respiratory failure and hypoxemia, even with good FEV1.
Question 10: Which of the following surgical incisions is associated with the highest risk of postoperative pulmonary complications ?
- A. Median sternotomy
- B. Horizontal laparotomy
- C. Vertical laparotomy
- D. Lateral thoracotomy (Correct Answer)
Explanation: ***Lateral thoracotomy*** - **Lateral thoracotomy** is associated with the **highest risk of postoperative pulmonary complications** among common surgical incisions, with complication rates ranging from **15-70%** depending on the procedure. - This incision **directly violates the chest wall** with rib resection or spreading, causing severe postoperative pain that significantly impairs respiratory mechanics. - The procedure disrupts **intercostal muscles**, damages **intercostal nerves**, and violates the **pleura**, leading to immediate risks like **pneumothorax**, **hemothorax**, and **pleural effusion**. - Severe pain leads to **splinting**, **shallow breathing**, **impaired cough**, and **reduced lung expansion**, markedly increasing the risk of **atelectasis**, **pneumonia**, and **respiratory failure**. - The **ipsilateral lung** is particularly affected with reduced functional residual capacity and impaired secretion clearance. *Vertical laparotomy* - **Upper abdominal vertical incisions** are indeed associated with high pulmonary complication rates (**30-50%**), second only to thoracotomy. - Pain leads to **diaphragmatic splinting** and impaired respiratory mechanics, increasing risk of **atelectasis** and **pneumonia**. - However, the chest wall itself remains intact, making complications generally less severe than with thoracotomy. *Median sternotomy* - While a major thoracic procedure, **median sternotomy** has relatively **lower pulmonary complication rates** compared to lateral thoracotomy. - The sternal split preserves **intercostal muscles** and **nerve integrity**, resulting in less severe pain and better preserved respiratory mechanics. - Postoperative pain management is generally more effective than with lateral thoracotomy. *Horizontal laparotomy* - **Transverse abdominal incisions** (e.g., Pfannenstiel, transverse supraumbilical) cause significantly less pain than vertical incisions. - These incisions follow **natural tissue planes**, cause less muscle disruption, and allow better respiratory mechanics. - Lower pain levels facilitate **effective coughing**, **deep breathing**, and **early mobilization**, reducing pulmonary complication risk.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free