Anaesthesia for Comorbidities (Cardiac, Respiratory, Renal, Hepatic, Endocrine) MCQs

Anaesthesia · 26 free questions with answers & explanations.

1. A 62-year-old man with severe aortic stenosis (valve area 0.7 cm²) requires urgent laparotomy for perforated viscus. Which haemodynamic goal is MOST critical during induction of anaesthesia?
2. A patient with end-stage renal disease on haemodialysis is scheduled for arteriovenous fistula revision under regional anaesthesia. Which muscle relaxant is MOST appropriate if general anaesthesia becomes necessary?
3. A patient with Child-Pugh class C cirrhosis requires emergency bowel resection. Which of the following physiological derangements most directly prolongs the action of induction agents such as propofol and thiopentone?
4. A 55-year-old diabetic woman on long-term insulin therapy is brought for elective cholecystectomy. Her morning blood glucose is 210 mg/dL. Which is the MOST appropriate perioperative glucose management target during major abdominal surgery?
5. A patient with severe COPD (FEV1 30% predicted) is scheduled for right hemicolectomy. Which ventilation strategy is MOST appropriate to minimise dynamic hyperinflation during mechanical ventilation?
6. A patient with Addison's disease on maintenance hydrocortisone 20 mg/10 mg daily is scheduled for a total hip replacement under general anaesthesia. What is the recommended perioperative steroid supplementation?
7. A 58-year-old man with severe aortic stenosis (valve area 0.7 cm², mean gradient 52 mmHg) is scheduled for elective laparoscopic cholecystectomy. Which haemodynamic goal is MOST critical during induction of general anaesthesia?
8. A patient with end-stage renal disease (eGFR 8 mL/min) on haemodialysis requires emergency appendicectomy. Which neuromuscular blocking agent is preferred for RSI to avoid prolonged paralysis?
9. A patient with Child-Pugh class B cirrhosis requires anaesthesia for a non-hepatic elective procedure. Which agent is MOST appropriate for induction and maintenance to minimise hepatotoxic risk?
10. A diabetic patient on long-term insulin is scheduled for major abdominal surgery. Which perioperative glucose target is recommended by current guidelines to balance hypoglycaemia risk against hyperglycaemia-related infections?
11. A patient with severe COPD (FEV1 35% predicted) is posted for right hemicolectomy under general anaesthesia. Which ventilatory strategy during surgery is MOST appropriate to prevent dynamic hyperinflation?
12. A patient with known phaeochromocytoma is under pre-operative alpha-blockade with phenoxybenzamine for 2 weeks. During intraoperative tumour manipulation, the anaesthetist notes a sudden blood pressure rise to 240/130 mmHg. What is the FIRST-LINE agent to control this hypertensive crisis?
13. A 65-year-old man with severe aortic stenosis (valve area 0.7 cm²) is scheduled for elective hip replacement. Which haemodynamic goal is most critical intraoperatively to prevent cardiovascular collapse?
14. A patient with Child-Pugh class B cirrhosis requires cholecystectomy. Which inhalational agent is safest for maintenance of anaesthesia given hepatic considerations?
15. A 58-year-old with stage 3b CKD (eGFR 28 mL/min) requires emergency laparotomy. Which muscle relaxant is the preferred choice to minimise risk of prolonged neuromuscular blockade?
16. A type 1 diabetic patient is listed for elective knee arthroscopy. She takes insulin glargine 20 U at night and insulin lispro before meals. What is the most appropriate perioperative insulin management?
17. A patient with known obstructive sleep apnoea (OSA) on home CPAP at 10 cmH₂O is scheduled for laparoscopic cholecystectomy. Which perioperative precaution is MOST important?
18. A patient with hypertrophic obstructive cardiomyopathy (HOCM) develops intraoperative hypotension with a dynamic outflow gradient. Which intervention is MOST appropriate?
19. A 72-year-old patient with FEV1/FVC 0.58 and FEV1 45% predicted undergoes thoracotomy with right upper lobectomy. Which intraoperative ventilation strategy best reduces postoperative pulmonary complications?
20. A phaeochromocytoma patient is taken for laparoscopic adrenalectomy. Intraoperatively, the blood pressure rises to 240/130 mmHg during tumour manipulation. The drug of first choice is:
21. A 62-year-old man with severe aortic stenosis (valve area 0.7 cm², mean gradient 52 mmHg) is scheduled for elective total hip replacement. Which of the following haemodynamic goals is MOST critical to maintain intraoperatively?
22. A patient with end-stage renal disease on haemodialysis is receiving succinylcholine for rapid sequence intubation. The serum potassium measured 4 h after the last dialysis session is 5.1 mEq/L. What is the expected rise in serum K+ after succinylcholine administration?
23. A patient with Child-Pugh class C cirrhosis requires emergency laparotomy. Which opioid is MOST appropriate for intraoperative analgesia given the altered pharmacokinetics?
24. A diabetic patient on metformin requires an elective procedure under general anaesthesia involving iodinated contrast. Which of the following is the recommended perioperative management regarding metformin?
25. A 55-year-old patient with severe COPD (FEV1 28% predicted) needs anaesthesia for a femoral hernia repair. Which ventilatory strategy BEST prevents dynamic hyperinflation?
26. A patient with hypertrophic obstructive cardiomyopathy (HOCM) develops hypotension under general anaesthesia. Which intervention is MOST appropriate?