Preoperative Assessment (PAC) and Special Conditions MCQs

Anaesthesia · 24 free questions with answers & explanations.

1. A patient taking dual antiplatelet therapy (aspirin + clopidogrel) for a drug-eluting coronary stent placed 8 months ago requires urgent hip arthroplasty. The most appropriate anaesthetic management regarding antiplatelet therapy is:
2. The Revised Cardiac Risk Index (RCRI/Lee Index) assigns 1 point each for six clinical variables to predict major adverse cardiac events (MACE) perioperatively. Which of the following is NOT one of the six RCRI variables?
3. According to the American College of Cardiology/AHA perioperative cardiac evaluation guidelines, which patient group should undergo pharmacological stress testing before elective non-cardiac surgery?
4. Obstructive sleep apnoea (OSA) diagnosed preoperatively requires specific anaesthetic considerations. Which postoperative monitoring strategy is most appropriate for a patient with severe OSA undergoing major abdominal surgery?
5. Malignant hyperthermia (MH) crisis is triggered by succinylcholine and volatile anaesthetics. The primary biochemical defect involves which molecular target?
6. A patient on clopidogrel for a drug-eluting coronary stent placed 6 weeks ago requires an urgent non-cardiac surgical procedure. What is the most appropriate management?
7. A patient with severe aortic stenosis (valve area 0.6 cm², mean gradient 55 mmHg) requires hip replacement. Which haemodynamic goal is most critical during intraoperative management?
8. Malignant hyperthermia (MH) develops intraoperatively. The earliest clinical sign is usually:
9. A patient on aspirin 75 mg daily for coronary stent placed 3 months ago is scheduled for elective laparoscopic cholecystectomy. The MOST appropriate perioperative antiplatelet management is:
10. In a morbidly obese patient (BMI 48 kg/m2) undergoing laparoscopic bariatric surgery, drug dosing of propofol for total intravenous anaesthesia (TIVA) should be based on which body weight measure for maintenance infusion?
11. A patient with known phaeochromocytoma is undergoing laparoscopic adrenalectomy. Despite adequate preoperative alpha-blockade with phenoxybenzamine, intraoperative hypertensive crisis occurs during tumour manipulation. The drug of choice for acute blood pressure control in this situation is:
12. A patient with hypertrophic obstructive cardiomyopathy (HOCM) requires appendicectomy under general anaesthesia. During induction, sudden severe hypotension occurs. Which combination of management steps is MOST appropriate?
13. A 68-year-old patient with CKD stage 4 (eGFR 18) is scheduled for hip replacement. Which neuromuscular blocking agent choice and reversal strategy is MOST appropriate to minimise risk from altered pharmacokinetics?
14. A patient with severe obstructive sleep apnoea (OSA, AHI 52) requires post-operative opioid analgesia. Continuous pulse oximetry shows intermittent desaturations to 82% in the PACU. The MOST effective intervention to reduce perioperative respiratory complications in this patient is:
15. According to the Lee Revised Cardiac Risk Index (RCRI), which combination of factors in a patient scheduled for major non-cardiac surgery places him at HIGHEST cardiac risk (RCRI score 3)?
16. A patient with a recently placed coronary artery drug-eluting stent (DES) 3 months ago on dual antiplatelet therapy (DAPT: aspirin + clopidogrel) requires elective hip replacement. What is the recommended management of antiplatelet therapy?
17. A patient is on dual antiplatelet therapy (aspirin + clopidogrel) following coronary artery stenting 3 months ago and requires elective laparoscopic cholecystectomy. What is the correct management of antiplatelet therapy?
18. Revised Cardiac Risk Index (RCRI/Lee Index) includes which 6 factors for estimating perioperative major cardiac events?
19. A 28-year-old G2P1 at 34 weeks gestation requires emergency appendicectomy for perforated appendicitis. Which consideration is MOST critical when planning anaesthesia?
20. A 70-year-old man with mechanical aortic valve prosthesis is on warfarin (INR 2.5–3.5). He needs elective colectomy. What is the MOST appropriate perioperative anticoagulation strategy?
21. Using the Revised Cardiac Risk Index (RCRI/Lee Index), which set of preoperative risk factors gives a score of 3 with approximately 10% risk of major adverse cardiac events (MACE)?
22. A 65-year-old man with known ischaemic heart disease is scheduled for elective right hemicolectomy. His last coronary stent was placed 4 months ago and he is on dual antiplatelet therapy. Regarding perioperative management, the MOST appropriate strategy is:
23. A patient with end-stage renal disease on haemodialysis requires anaesthesia. Which muscle relaxant should be AVOIDED due to the accumulation of active metabolites?
24. A patient with end-stage renal disease on haemodialysis requires elective surgery. Dialysis was performed the previous day. Which electrolyte abnormality is of greatest immediate anaesthetic concern and why?