Postoperative Care, PONV and Recovery Complications MCQs

Anaesthesia · 19 free questions with answers & explanations.

1. A 35-year-old non-smoking female with a history of motion sickness and PONV receives a 90-minute laparoscopic gynaecological procedure under volatile anaesthetic. According to the Apfel simplified PONV score, how many risk factors does she have, and what prophylaxis strategy is recommended?
2. A patient in the PACU following thoracotomy has SpO2 88% on 8 L/min O2 via face mask. Respiratory rate is 28/min, and paradoxical abdominal movement is noted. Breath sounds are absent on the right. The MOST likely diagnosis and immediate action is:
3. The mechanism of action of dexamethasone in PONV prophylaxis is BEST explained by:
4. In the PACU, a patient develops hyperthermia (39.8°C), muscle rigidity, tachycardia, and masseter spasm 20 minutes after receiving succinylcholine for tracheal intubation followed by isoflurane maintenance. Malignant hyperthermia is suspected. The FIRST pharmacological intervention is:
5. Aldrete scoring system is used for discharge from the PACU. A patient scores 2 for Activity, 2 for Respiration, 2 for Circulation, 1 for Consciousness (responds to name but drowsy), and 2 for SpO2. What is the Aldrete score, and can the patient be discharged?
6. A female non-smoker patient is scheduled for laparoscopic gynaecological surgery under general anaesthesia with volatile agent. Using the Apfel simplified risk score, how many risk factors for PONV does she have, and what antiemetic prophylaxis is indicated?
7. The mechanism by which dexamethasone reduces PONV is:
8. A patient in the PACU after thyroidectomy is agitated, hoarse, with rising ETCO2 and declining SpO2. Examination reveals a tense neck haematoma. What is the IMMEDIATE management priority before anything else?
9. A patient in the recovery room develops stridor, accessory muscle use, and paradoxical chest-abdomen movement 20 minutes after extubation following a 3-hour neck dissection. The MOST likely diagnosis is:
10. Emergence agitation (delirium) in the PACU is characterised by which constellation and which patient group is at HIGHEST risk?
11. A 34-year-old woman undergoes laparoscopic gynaecological surgery under general anaesthesia. She is a non-smoker, has a history of PONV, does not use opioids postoperatively, and received volatile anaesthesia. Using the Apfel score, what is her risk of PONV?
12. A patient in the PACU after laparoscopic appendicectomy has SpO₂ 87% on 4 L/min nasal prongs. On examination, respiratory rate is 6/min with a see-saw pattern, he is difficult to arouse, and there is bilateral miosis. What is the diagnosis and immediate treatment?
13. Postoperative emergence delirium (ED) in adults is MOST reliably distinguished from residual anaesthesia effects by which feature?
14. Regarding postoperative cognitive dysfunction (POCD), which patient population is at highest risk, and which anaesthetic technique has evidence of reduced incidence?
15. Which antiemetic combination is recommended for prophylaxis in a high-risk PONV patient (Apfel score 4) undergoing elective laparoscopic hysterectomy under volatile anaesthesia?
16. A 28-year-old woman undergoes laparoscopic cholecystectomy with isoflurane + N2O anaesthesia. She has a history of PONV, non-smoker, uses opioids postoperatively, no history of motion sickness. According to the Apfel simplified risk score, what is her PONV risk?
17. A patient with 4/4 Apfel risk factors for PONV undergoes elective laparoscopic hysterectomy. Which prophylactic strategy is recommended by SAMBA/PONV guidelines?
18. A patient in the recovery room develops stridor and paradoxical chest movement 25 minutes after extubation following thyroidectomy. The MOST likely cause and IMMEDIATE management is:
19. Postoperative delirium in elderly patients is BEST prevented by which perioperative strategy?