Anaesthesia — Practice Questions

Anaesthesia — Anaesthesia and Perioperative Care, NMC MBBS licence examination syllabus (Nepal Medical Council).

Anaesthesia and perioperative care — NMC-style practice questions

Practice questions written for this chapter. These are not past NMC papers.

📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter. All doses, fasting times and anticoagulation timings come from national guidance.

Level 1–2 — recall and understanding

Q1. Which best predicts a patient's ability to tolerate major surgery? A. A normal resting ECG B. FUNCTIONAL CAPACITY — what they can actually do C. Age alone D. A normal chest X-ray ANSWER: B. Why: exercise tolerance in concrete terms — stairs, distance, hills — demonstrates cardiorespiratory reserve better than resting investigations in a patient without symptoms. LEARNING POINT: "Can you climb two flights of stairs without stopping?"

Q2. A patient on long-term steroids is having surgery. Their steroid should be: A. Stopped the day before B. CONTINUED, and usually INCREASED C. Halved D. Replaced with an antibiotic ANSWER: B. Why: surgery is a major physiological stress, and a patient on long-term steroids cannot mount their own cortisol response. Omitting the dose risks adrenal crisis. LEARNING POINT: this is among the commonest avoidable perioperative catastrophes.

Level 3–4 — application and clinical reasoning

Q3. During local anaesthetic infiltration a patient reports perioral tingling and tinnitus, then becomes confused. You should: A. Continue and finish the procedure quickly B. STOP INJECTING IMMEDIATELY, call for help and support airway and circulation C. Give more local anaesthetic D. Reassure — this is anxiety ANSWER: B. Why: these are early features of local anaesthetic systemic toxicity, progressing to seizures and cardiac arrhythmia. Continuing to inject worsens it. LEARNING POINT: aspirate before injecting and stay within the maximum dose for that agent and weight.

Q4. A man on anticoagulation for atrial fibrillation is admitted for elective surgery and the drug is simply not written up. This represents: A. Appropriate practice B. A decision made BY DEFAULT — both stopping and continuing carry risk and it must be explicit C. Correct, since anticoagulants are always stopped D. Correct, since surgery overrides stroke risk ANSWER: B. Why: stopping without a plan exposes him to stroke; continuing without a plan exposes him to bleeding. Either may be right, but it must be a considered documented decision. LEARNING POINT: escalate to the surgical and anaesthetic teams for an explicit plan.

Q5. Which group is at particularly HIGH risk of aspiration under anaesthesia? A. Fasted elective patients B. EMERGENCY surgery, PREGNANCY, bowel obstruction and reflux C. Young healthy adults only D. Patients having local anaesthesia ANSWER: B. Why: anaesthesia abolishes airway reflexes, and these groups have either a full stomach or delayed gastric emptying. LEARNING POINT: an unfasted patient needing life-saving surgery is not delayed — the technique is adapted.

Level 5 — exception-based

Q6. Why is a FAMILY anaesthetic history asked before surgery? A. To assess anxiety levels B. Because MALIGNANT HYPERTHERMIA is inherited C. To predict pain tolerance D. It is not necessary ANSWER: B. Why: malignant hyperthermia is an inherited susceptibility triggered by specific anaesthetic agents, presenting with rising end-tidal carbon dioxide, rigidity and tachycardia before fever appears. LEARNING POINT: knowing beforehand allows the trigger agents to be avoided entirely.

Q7. Why is prolonged preoperative starvation avoided? A. It has no effect either way B. It is HARMFUL — particularly in children, the elderly and diabetic patients C. It reduces aspiration risk further, so is encouraged D. It shortens hospital stay ANSWER: B. Why: unnecessary prolonged fasting causes dehydration, hypoglycaemia and distress without adding safety. Fasting times are specified precisely for this reason. LEARNING POINT: take fasting times from current national guidance.

Syllabus points

Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions

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