Preoperative and Postoperative Care Practice Questions

Q: What should be the minimum value of HbA1c to safely carry out a surgical procedure in an emergency setting?

<10. ***<10*** - In an **emergency setting**, the priority is to proceed rapidly with surgery; current guidelines suggest that an **HbA1c <10%** is acceptable to proceed without significant delay for optimization. - While lower HbA1c is ideal, delaying an emergency procedure to achieve an HbA1c below 10% is generally **not recommended**, as the benefits of urgent surgery outweigh the risks associated with this level of glycemic control [1]. *<7* - An HbA1c of **<7% is the general target** for optimal glycemic control in most diabetic patients, especially in an elective setting. - Achieving this level in an emergency would likely require **delaying surgery**, which is not feasible or safe when immediate intervention is needed. *<8* - An HbA1c of **<8%** represents good control for many individuals, particularly older adults or those with comorbidities. - While better than 10%, it is not the absolute minimum required to proceed with an **emergency surgery**, as timely intervention is paramount. *<8* - An HbA1c of **<8%** represents good control for many individuals, particularly older adults or those with comorbidities. - While better than 10%, it is not the absolute minimum required to proceed with an **emergency surgery**, as timely intervention is paramount.

Q: MC late complication of central venous line is:

Sepsis. **Sepsis** - **Catheter-related bloodstream infections (CRBSIs)** are the most common late complication of central venous lines, leading to sepsis [1]. - The risk of sepsis increases with the **duration** of catheter placement, frequency of line access, and inadequate aseptic technique [1]. *Air embolism* - An **air embolism** is typically an immediate or early complication during insertion or removal of the central line, or connection/disconnection of administration sets. - It is not considered a late complication as it occurs due to a sudden entry of air into the venous system. *Thromboembolism* - While **thrombosis** can complicate central venous lines, leading to potential thromboembolism, it is less common than sepsis as a late complication [2]. - The formation of a thrombus is often localized to the catheter tip or vessel wall and may or may not lead to a symptomatic embolism [2]. *Cardiac arrhythmias* - **Cardiac arrhythmias** can occur during central venous line insertion if the guidewire or catheter tip irritates the myocardium, making it an immediate or early complication. - This is usually a transient event and not a long-term or late complication associated with the mere presence of the catheter.

Q: After splenectomy, which is the most important vaccine that needs to be given?

Pneumococcal. ***Pneumococcal*** - The spleen plays a crucial role in clearing **encapsulated bacteria**, such as *Streptococcus pneumoniae* [1], [2]. - Patients who have undergone a **splenectomy** are at significantly increased risk of severe, life-threatening **pneumococcal infections**, making this vaccine essential [3]. *Rotavirus* - This vaccine protects against **rotavirus infections**, which primarily cause **severe gastroenteritis** in infants and young children. - There is no direct link between **splenectomy** and an increased susceptibility to severe rotavirus disease that would prioritize this vaccine over others. *BCG* - The **BCG (Bacillus Calmette-Guérin) vaccine** is used to prevent **tuberculosis**. - While immunocompromised individuals may be at higher risk for tuberculosis, **splenectomy** itself does not specifically increase susceptibility to *Mycobacterium tuberculosis* in a way that makes BCG the most critical post-splenectomy vaccine. *MMR* - The **MMR (Measles, Mumps, and Rubella) vaccine** protects against common viral diseases. - These are **viral infections**, and the absence of the spleen does not specifically predispose individuals to more severe outcomes from these diseases to the extent seen with encapsulated bacterial infections.

Question 1

Which of the following statements is NOT correct regarding total parenteral nutrition (TPN)?

Accepted Answer

In abdominal injury, early parenteral nutrition should be started after a minimum of 2 weeks of bowel rest

Answer

Lipids form 20-30% of energy source

Answer

Carbohydrates typically provide 40-60% of the energy source

Answer

Proteins typically provide around 10-15% of the energy source

Question 2

What should be the minimum value of HbA1c to safely carry out a surgical procedure in an emergency setting?

Accepted Answer

<10

Answer

<7

Answer

<8

Answer

<8

Question 3

MC late complication of central venous line is:

Accepted Answer

Sepsis

Answer

Thromboembolism

Answer

Cardiac arrhythmias

Answer

Air embolism

Question 4

After splenectomy, which is the most important vaccine that needs to be given?

Accepted Answer

Pneumococcal

Answer

Rotavirus

Answer

BCG

Answer

MMR

Preoperative and Postoperative Care — MCQs

Preoperative and Postoperative Care — MCQs

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