Preoperative and Postoperative Care Practice Questions

Q: All of the following are causes of postoperative wound dehiscence except?

Vitamin B complex deficiency. **Explanation:** Postoperative wound dehiscence (burst abdomen) is a serious surgical complication usually occurring 5–8 days post-surgery. It is multifactorial, involving patient-related (systemic) and technical (local) factors. **Why Vitamin B complex deficiency is the correct answer:** While Vitamin B complex is essential for general metabolism, it does not play a direct role in collagen synthesis or wound tensile strength. In contrast, **Vitamin C (Ascorbic acid)** is the critical vitamin for wound healing, as it is a mandatory cofactor for the hydroxylation of proline and lysine residues during collagen synthesis. Therefore, Vitamin B deficiency is not a recognized cause of dehiscence. **Analysis of Incorrect Options:** * **Malignancy:** Cancer induces a catabolic state and is often associated with cachexia and poor tissue perfusion, significantly impairing the body’s inflammatory and proliferative responses. * **Hypoproteinaemia:** Albumin is essential for wound healing. Low protein levels (especially <3 g/dL) lead to prolonged inflammatory phases and decreased collagen production, weakening the incision line. * **Jaundice:** Obstructive jaundice is a well-known risk factor. High bilirubin levels and associated bile salt deficiencies impair fibroblast proliferation and collagen cross-linking, leading to poor wound strength. **NEET-PG High-Yield Pearls:** * **Most common cause:** Technical error (improper suturing/tension). * **Most common systemic cause:** Anemia and malnutrition. * **Clinical Sign:** The "Pink Toothbrush" sign—a serosanguinous (pinkish) discharge from the wound is the earliest clinical predictor of impending dehiscence. * **Management:** Immediate coverage with sterile saline-soaked gauze followed by urgent re-exploration and secondary closure (tension-free).

Q: Pneumococcal vaccination is indicated in which of the following conditions?

Postsplenectomy. **Explanation:** **1. Why Postsplenectomy is the Correct Answer:** The spleen is the primary organ responsible for filtering encapsulated bacteria from the bloodstream and producing opsonizing antibodies. Patients who are asplenic (post-splenectomy) or have functional asplenia are at a high risk for **Overwhelming Post-Splenectomy Infection (OPSI)**. The most common and lethal causative organism is *Streptococcus pneumoniae*. Therefore, pneumococcal vaccination is a mandatory, life-saving indication in these patients to prevent invasive pneumococcal disease. **2. Analysis of Other Options:** * **Sickle Cell Anemia (B):** While patients with Sickle Cell Anemia do require pneumococcal vaccination due to functional asplenia (splenic infarction), in the context of standard NEET-PG questioning, **Postsplenectomy** is considered the "most classic" and absolute indication among the choices provided. * **HIV (C):** HIV patients are immunocompromised and are recommended to receive the vaccine, but it is a secondary indication compared to the anatomical absence of the spleen. * **After Radiotherapy (D):** Radiotherapy itself is not a direct indication for pneumococcal vaccination unless it results in significant splenic damage or is part of a pre-transplant conditioning regimen. **3. High-Yield Clinical Pearls for NEET-PG:** * **Timing:** For elective splenectomy, vaccinate **2 weeks before** surgery. For emergency splenectomy, vaccinate **2 weeks after** surgery (to ensure an adequate immune response). * **The "Big Three" Vaccines:** Post-splenectomy patients must be immunized against the three main encapsulated organisms: *S. pneumoniae*, *Haemophilus influenzae* type b (Hib), and *Neisseria meningitidis*. * **Vaccine Types:** Usually, a combination of PCV13 (Conjugate) followed by PPSV23 (Polysaccharide) is recommended for maximum coverage.

Q: Complications of total thyroidectomy are all, EXCEPT:

Hypercalcaemia. **Explanation:** The correct answer is **B. Hypercalcaemia**. Total thyroidectomy is a procedure where the entire thyroid gland is removed, often putting adjacent structures at risk. **Why Hypercalcaemia is the exception:** Post-thyroidectomy, the most common metabolic complication is **hypocalcaemia**, not hypercalcaemia. This occurs due to the accidental removal, devascularization, or thermal injury of the parathyroid glands during surgery. Since the parathyroid glands regulate calcium levels via Parathyroid Hormone (PTH), their impairment leads to a drop in serum calcium. **Analysis of other options:** * **Hypocalcaemia (A) & Parathyroid loss (D):** These are closely linked. The parathyroid glands (usually four) lie on the posterior aspect of the thyroid capsule. Even in expert hands, **parathyroid loss** or ischemia is a recognized complication, leading to transient or permanent **hypocalcaemia**. * **Hoarseness of voice (C):** This occurs due to injury to the **Recurrent Laryngeal Nerve (RLN)**, which runs in the tracheoesophageal groove. Unilateral injury causes hoarseness, while bilateral injury can lead to acute airway obstruction (stridor). **NEET-PG High-Yield Pearls:** 1. **Most common complication overall:** Postoperative hypocalcaemia (transient in ~20%, permanent in <1-2%). 2. **Most common nerve injured:** External branch of the Superior Laryngeal Nerve (leads to loss of high-pitched voice/easy vocal fatigue). 3. **Most dreaded complication:** Postoperative hemorrhage causing airway compression (requires immediate bedside hematoma evacuation). 4. **Chvostek’s and Trousseau’s signs:** Clinical indicators of latent tetany due to post-surgical hypocalcaemia.

Q: Which of the following is NOT a standard practice performed before surgery?

Initiation of anticoagulation. **Explanation:** The goal of preoperative care is to optimize the patient’s physiological state and minimize the risk of complications [1]. **Why Option D is correct:** **Initiation of anticoagulation** is generally contraindicated immediately before surgery. Anticoagulants (like Warfarin or Heparin) increase the risk of intraoperative and postoperative hemorrhage [3]. In fact, standard practice involves **discontinuing** anticoagulants (e.g., stopping Warfarin 5 days prior) or "bridging" with short-acting agents like LMWH, which are also timed to wear off before the incision. **Why the other options are incorrect:** * **A. Shaving the surgical site:** While routine "shaving" with a razor is now discouraged due to micro-abrasions that increase Surgical Site Infection (SSI) risk, hair removal using **electric clippers** immediately before surgery is still a standard practice if hair interferes with the procedure. * **B. Draping the patient:** This is a fundamental step in maintaining a sterile field. Draping occurs after skin antisepsis to prevent the transfer of microorganisms from non-sterile areas to the surgical wound. * **C. Control of blood glucose:** Hyperglycemia impairs wound healing and increases SSI risk [4]. Maintaining perioperative glucose (typically <180 mg/dL) is a critical standard of care [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Hair Removal:** If necessary, use clippers; **never** use a razor the night before surgery (increases SSI risk). * **Prophylactic Antibiotics:** Should be administered within **60 minutes before** the skin incision [4]. * **Smoking Cessation:** Ideally, patients should stop smoking at least **4 weeks** before surgery to reduce pulmonary complications and improve wound healing. * **DVT Prophylaxis:** While *anticoagulation* is not "initiated" as a standard for all, **thromboprophylaxis** (mechanical or pharmacological) is assessed based on Caprini scores.

Q: Which of the following is NOT a complication of Total Parenteral Nutrition (TPN)?

Aspiration pneumonia. **Explanation:** The correct answer is **A. Aspiration pneumonia**. Total Parenteral Nutrition (TPN) involves the intravenous administration of nutrients, bypassing the gastrointestinal (GI) tract entirely. **Aspiration pneumonia** is a complication associated with **Enteral Nutrition** (tube feeding), where gastric contents or formula may be refluxed and inhaled into the lungs. Since TPN does not involve the stomach or esophagus, it cannot cause aspiration. **Analysis of Incorrect Options:** * **B. Hypokalemia:** This is a common feature of **Refeeding Syndrome**. When insulin is released in response to TPN glucose, it causes an intracellular shift of potassium, magnesium, and phosphate, leading to low serum levels. * **C. Hypoglycemia:** This typically occurs as **rebound hypoglycemia** if TPN is discontinued abruptly. The body’s high endogenous insulin levels (stimulated by the TPN) persist briefly after the infusion stops, causing blood sugar to drop. * **D. Hyperglycemia:** This is the most common metabolic complication of TPN. It occurs due to rapid infusion rates, physiological stress, or underlying insulin resistance, often requiring exogenous insulin scale coverage. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication of TPN:** Hyperglycemia. * **Most common infectious complication:** Catheter-related bloodstream infection (CRBSI), often due to *Staphylococcus aureus* or *Candida*. * **Refeeding Syndrome:** Characterized by **Hypophosphatemia** (the hallmark), hypokalemia, and hypomagnesemia. * **Hepatobiliary complications:** Long-term TPN can lead to cholestasis, gallstones (due to lack of CCK-mediated gallbladder contraction), and steatosis.

Q: All of the following are complications of TPN except?

Hypochloremia. **Explanation:** Total Parenteral Nutrition (PN) is a complex intravenous therapy that bypasses the gastrointestinal tract, frequently leading to metabolic and electrolyte imbalances. **Why Hypochloremia is the correct answer:** TPN is more commonly associated with **Hyperchloremia**, not hypochloremia. This occurs because many amino acids in TPN solutions are provided as chloride salts (e.g., Lysine hydrochloride). An excess of these chloride ions can lead to **Hyperchloremic Metabolic Acidosis**. Therefore, hypochloremia is not a standard complication of TPN. **Analysis of Incorrect Options:** * **Volume Overload:** TPN solutions are highly osmolar and require significant fluid volume for administration. In patients with compromised cardiac or renal function, this can easily lead to fluid overload and pulmonary edema. * **Hypokalemia:** This is a classic feature of **Refeeding Syndrome**. When glucose is infused, insulin is released, shifting potassium, magnesium, and phosphate from the extracellular to the intracellular compartment, resulting in low serum levels. * **Metabolic Acidosis:** As mentioned, the use of crystalline amino acid solutions (hydrochloride salts) and the metabolism of certain lipids can increase the acid load, leading to metabolic acidosis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common metabolic complication:** Hyperglycemia. * **Refeeding Syndrome triad:** Hypophosphatemia (most characteristic), Hypokalemia, and Hypomagnesemia. * **Hepatobiliary complication:** Cholestasis and cholelithiasis (due to lack of enteral stimulation and CCK release). * **Most common infection:** Coagulase-negative Staphylococci (*S. epidermidis*) via the central line.

Q: A complication in the first 48 hours of total parenteral nutrition is?

Hyperglycemia. **Explanation:** **Hyperglycemia** is the most common metabolic complication occurring in the early phase (first 48 hours) of Total Parenteral Nutrition (TPN). This occurs because TPN solutions contain high concentrations of dextrose. When infused rapidly or in patients with underlying stress (which induces insulin resistance), the pancreas may fail to secrete sufficient insulin to maintain glucose homeostasis. If left unmanaged, this can lead to osmotic diuresis and hyperosmolar non-ketotic coma. **Analysis of Options:** * **Hypernatremia (A) & Hyperkalemia (B):** While electrolyte imbalances can occur, they are typically a result of improper formulation or underlying renal issues rather than an inherent early complication of standard TPN initiation. In fact, **Hypokalemia** is more common during the early phase as part of "Refeeding Syndrome," where insulin drives potassium into the cells. * **Selenium Deficiency (D):** This is a **late complication** of TPN. Trace element deficiencies (like Selenium, Zinc, or Copper) and vitamin deficiencies usually manifest only after several weeks or months of long-term parenteral nutrition without adequate supplementation. **Clinical Pearls for NEET-PG:** * **Refeeding Syndrome:** Characterized by Hypophosphatemia (most common), Hypomagnesemia, and Hypokalemia. It occurs when nutrition is reintroduced to a severely malnourished patient. * **Most common late complication:** Hepatobiliary dysfunction (e.g., cholestasis, steatosis, or gallstones due to gallbladder stasis). * **Most common infectious complication:** Catheter-related bloodstream infection (CRBSI), often caused by *Staphylococcus aureus* or *Coagulase-negative Staphylococci*. * **Monitoring:** Blood glucose should be monitored every 6 hours during the initial 48 hours of TPN.

Q: What is the commonest cause of water intoxication in a surgical patient?

Excessive infusion of 5% glucose. **Explanation:** **Why 5% Glucose is the Correct Answer:** The most common cause of water intoxication (dilutional hyponatremia) in surgical patients is the **excessive administration of hypotonic fluids**, specifically 5% Dextrose (Glucose). Once infused, the glucose is rapidly metabolized by the body, leaving behind "free water." In the postoperative period, surgical stress triggers a physiological release of **Antidiuretic Hormone (ADH)**. This prevents the kidneys from excreting excess water, leading to hemodilution, a drop in serum sodium levels, and subsequent cellular edema (water intoxication). **Analysis of Incorrect Options:** * **Colorectal wash with plain water:** While this can theoretically cause water absorption through the bowel mucosa, it is an uncommon practice today and rarely leads to systemic intoxication compared to IV fluids. * **SIADH:** Though SIADH causes water retention, in a surgical context, the "transient" elevation of ADH due to pain and stress is a physiological response rather than the pathological syndrome itself. * **Irrigation during TURP:** This causes "TURP Syndrome" due to the absorption of glycine or sorbitol. While it involves water intoxication, it is procedure-specific and not the *most common* cause across general surgical patients. **High-Yield Clinical Pearls for NEET-PG:** * **Early signs:** Headache, confusion, and nausea (due to cerebral edema). * **Late signs:** Seizures, coma, and papilledema. * **Management:** Restriction of free water. In symptomatic cases, cautious use of hypertonic (3%) saline is indicated. * **Gold Standard:** Always monitor urine output and serum electrolytes in patients receiving prolonged hypotonic infusions postoperatively.

Question 1

All of the following are causes of postoperative wound dehiscence except?

Accepted Answer

Vitamin B complex deficiency

Answer

Malignancy

Answer

Hypoproteinaemia

Answer

Jaundice

Question 2

Pneumococcal vaccination is indicated in which of the following conditions?

Accepted Answer

Postsplenectomy

Answer

Sickle cell anemia

Answer

HIV

Answer

After radiotherapy

Question 3

Complications of total thyroidectomy are all, EXCEPT:

Accepted Answer

Hypercalcaemia

Answer

Hypocalcaemia

Answer

Hoarseness of voice

Answer

Parathyroid loss

Question 4

Which of the following is NOT a standard practice performed before surgery?

Accepted Answer

Initiation of anticoagulation

Answer

Shaving the surgical site

Answer

Draping the patient

Answer

Control of blood glucose levels

Question 5

Which of the following is NOT a complication of Total Parenteral Nutrition (TPN)?

Accepted Answer

Aspiration pneumonia

Answer

Hypokalemia

Answer

Hypoglycemia

Answer

Hyperglycemia

Question 6

All of the following are complications of TPN except?

Accepted Answer

Hypochloremia

Answer

Volume overload

Answer

Hypokalemia

Answer

Metabolic acidosis

Question 7

A patient on warfarin therapy can be taken for elective surgery if the INR is?

Accepted Answer

2

Answer

1.4

Answer

1.6

Answer

1.8

Question 8

What is a contraindication for major thoracic surgery?

Accepted Answer

Recent myocardial infarction within 3 months

Answer

Recent myocardial infarction within 9 months

Answer

Recent myocardial infarction within 12 months

Answer

Recent myocardial infarction within 18 months

Question 9

A complication in the first 48 hours of total parenteral nutrition is?

Accepted Answer

Hyperglycemia

Answer

Hypernatremia

Answer

Hyperkalemia

Answer

Selenium deficiency

Question 10

What is the commonest cause of water intoxication in a surgical patient?

Accepted Answer

Excessive infusion of 5% glucose

Answer

Colorectal wash with plain water

Answer

Syndrome of inappropriate secretion of ADH

Answer

Irrigation during transurethral resection of the prostate

Preoperative and Postoperative Care — MCQs

Preoperative and Postoperative Care — MCQs

On this page

Practice by Chapter

Want unlimited practice?