AS3.1-6 | Preoperative Evaluation and Medication — Practice Quiz

Correct. The primary purpose of the preoperative evaluation is risk identification, risk optimisation, and anaesthetic planning — not to make the surgical decision or obtain consent alone.

Preoperative evaluation = risk stratification + optimisation + anaesthetic plan. Uncontrolled hypertension (>160/100) warrants optimisation before elective surgery.

The preoperative evaluation's three goals are: risk identification, risk optimisation, and anaesthetic planning. The decision to proceed is surgical; the anaesthesiologist's role is to assess and optimise perioperative risk.

Correct. For every cardiac medication, the anaesthesiologist must document the drug name, dose, frequency, indication, and perioperative management (continue vs withhold) — e.g., beta-blockers are generally continued, ACE inhibitors may be withheld on the day of surgery.

Medication history = drug, dose, frequency, indication, perioperative plan. Beta-blockers: continue. ACE inhibitors: often withheld day of surgery. Anticoagulants: timing of last dose and bridging plan essential.

The anaesthesiology-relevant medication history must document drug name, dose, frequency, indication, and whether to continue or withhold perioperatively. 'A tablet for his heart' could be a beta-blocker, ACE inhibitor, digoxin, or anticoagulant — each with different perioperative implications.

Correct. Mallampati Class II: soft palate, uvula, and fauces visible but tonsillar pillars NOT seen. This predicts a moderately difficult airway.

Mallampati grades the oropharyngeal view, predicting laryngoscopic difficulty. Class II is common and indicates potential moderate difficulty — combine with thyromental distance, mouth opening, and neck mobility for full airway assessment.

Mallampati classification: I = soft palate, uvula, fauces, tonsillar pillars all visible; II = soft palate, uvula, fauces visible (pillars not seen); III = soft palate and base of uvula only; IV = soft palate not visible. Only uvula base and soft palate = Class II.

Correct. In an ASA I patient with normal history and examination undergoing a minor elective procedure, investigations should be guided by clinical findings — indiscriminate routine testing wastes resources and generates false positives.

Investigation selection is problem-driven, not routine. Apply: 'What clinical concern does this test address, and will the result change management?' Knee arthroscopy in a healthy 35-year-old requires no preoperative tests.

Preoperative investigations must be clinically justified, not ordered as a routine checklist. An ASA I patient with a normal clinical assessment requires no investigations for minor surgery. Tests are ordered when the history or examination identifies specific concerns.

Correct. ASA III = severe systemic disease with substantive functional limitation but not immediately life-threatening. Stable angina with functional limitation (unable to climb >1 flight) fits ASA III.

ASA classification grades systemic disease severity, NOT operative risk or airway difficulty. The E suffix (e.g., ASA IIIE) denotes an emergency procedure. ASA is NOT the Mallampati score.

ASA classification: I = healthy; II = mild systemic disease, no functional limitation; III = severe systemic disease with substantive limitation; IV = severe systemic disease that is a constant threat to life. Stable angina with functional limitation = ASA III.

Correct. Multiple optimised comorbidities in a patient on optimal therapy does not make surgery impossible. The correct approach is to document the risk, plan the anaesthetic accordingly, ensure specialist review where indicated, and proceed with the patient's informed consent.

Fitness decisions integrate all findings: optimised ≠ risk-free. Document risk level, specialist input for complex cases, and ensure the patient has given informed consent understanding perioperative risks.

Fitness for surgery does not mean absence of risk — it means risk has been identified, optimised where possible, communicated, and an anaesthetic plan formulated. Patients on optimal therapy for multiple comorbidities are documented as high-risk, not declared unfit.

Correct. Benzodiazepines (midazolam, diazepam) are the primary anxiolytic premedicants. Oral midazolam 7.5 mg 1 hour preoperatively achieves reliable anxiolysis in adults.

Five goals of premedication: anxiolysis, analgesia, aspiration prevention, PONV prophylaxis, autonomic modification. Match the drug class to the goal. Midazolam = anxiolysis; no role in aspiration prophylaxis.

Midazolam is a benzodiazepine whose primary preoperative use is anxiolysis. Aspiration prophylaxis uses ranitidine/sodium citrate; PONV prophylaxis uses ondansetron/dexamethasone; analgesia uses opioids/NSAIDs.

Correct. Dexamethasone 4–8 mg IV at induction is one of the most cost-effective single-agent PONV prophylaxis measures. It must be used cautiously in diabetics (causes hyperglycaemia) and in patients with suspected bowel perforation.

Dexamethasone 4–8 mg IV at induction = first-line PONV prophylaxis. Caution: causes hyperglycaemia (monitor in diabetics); avoid where bowel perforation is suspected (immunosuppression).

Midazolam = anxiolysis; atropine = reduces secretions/bradycardia; ketamine = induction/analgesia with no PONV benefit. Dexamethasone 4–8 mg IV at induction is the gold-standard single-agent PONV prophylactic, noting its hyperglycaemic effect in diabetics.