AIM EXAM PRACTICE · 4TH YEAR MBBS
KMU Past Paper Practice
Topic 3: Preoperative Assessment, Surgical Safety, Consent & Operative Principles
20 A-type Single Best Answer MCQs
MCQ 1
Question:
A patient with stable chronic lung disease needs urgent surgery for an obstructed bowel. The anaesthetist identifies increased respiratory risk, but delaying treatment may worsen the obstruction. What is the best overall decision-making principle?
Options:
Delay surgery until all respiratory risk has disappeared
Use the lung condition alone to decide against surgery
Balance the urgency against risk and plan precautions
Proceed without communicating the respiratory findings
Choose the incision before assessing anaesthetic risk
Correct Answer: Balance the urgency against risk and plan precautions
Explanation: Fitness is a risk–benefit judgement. Urgent disease may require surgery while the team addresses modifiable respiratory risks.
MCQ 2
Question:
During preoperative review, a patient recalls a severe reaction during a previous anaesthetic but cannot name the medicine involved. The planned procedure is elective. Which action best uses this history?
Options:
Clarify the previous event with the anaesthesia team
Assume that the reaction cannot recur
Discuss the history only after induction
Change the abdominal incision to avoid it
Replace the surgical consent discussion with it
Correct Answer: Clarify the previous event with the anaesthesia team
Explanation: A previous anaesthetic reaction may affect the current plan; its details should be investigated and communicated before elective anaesthesia.
MCQ 3
Question:
A healthy patient has normal vital signs, no relevant symptoms and a minor planned procedure. A colleague proposes a broad panel of investigations “just to be safe.” What is the most appropriate testing principle?
Options:
Order tests according to the patient’s age alone
Obtain imaging before taking a clinical history
Request every available test before anaesthesia
Use the ASA category as the sole investigation
Request tests that address a relevant clinical question
Correct Answer: Request tests that address a relevant clinical question
Explanation: Preoperative tests are selected from the history, examination and planned procedure; a broad routine panel may add little useful information.
MCQ 4
Question:
A patient awaiting elective surgery has developed wheeze and a productive cough since the surgical assessment several weeks ago. What is the best interpretation of the earlier assessment?
Options:
It establishes that the current symptoms are harmless
It must be updated because the patient’s condition changed
It removes the need for respiratory examination
It requires a change from laparoscopy to open surgery
It confirms that postoperative monitoring is unnecessary
Correct Answer: It must be updated because the patient’s condition changed
Explanation: New respiratory symptoms may alter anaesthetic risk, so an earlier assessment cannot stand without clinical reassessment.
MCQ 5
Question:
An elective surgical patient has a poorly controlled medical condition identified at assessment. Treatment can improve the condition, and postponement poses little immediate danger. Which plan best reduces avoidable perioperative risk?
Options:
Proceed because the operative site is separate
Ignore the finding if consent has been signed
Review the condition only after discharge
Optimise the condition and reassess the plan
Replace medical treatment with a surgical drain
Correct Answer: Optimise the condition and reassess the plan
Explanation: Elective surgery provides an opportunity to address a reversible risk before exposing the patient to operative stress.
MCQ 6
Question:
A patient with decision-making capacity accepts an operation but declines a blood transfusion for personal reasons. Significant blood loss is possible. What is the most appropriate preoperative approach?
Options:
Clarify the refusal, explain risks and document a plan
Assume that consent to surgery includes transfusion
Ask a relative to reverse the patient’s decision
Avoid discussing the possibility of major bleeding
Leave the issue for the recovery team to resolve
Correct Answer: Clarify the refusal, explain risks and document a plan
Explanation: The patient’s specific wishes affect operative preparation; informed discussion and clear documentation allow the team to plan accordingly.
MCQ 7
Question:
During a clinic examination, a patient understands that the doctor wishes to measure blood pressure and voluntarily offers an arm. Which type of consent is illustrated by this simple interaction?
Options:
Written consent
Proxy consent
Emergency consent
Implied consent
Advance consent
Correct Answer: Implied consent
Explanation: The patient’s informed cooperation can indicate agreement to a simple, low-risk interaction; an operation requires a fuller consent process.
MCQ 8
Question:
A patient has not yet discussed a planned operation but is about to receive a medicine that may impair alertness. When should the substantive surgical consent discussion take place?
Options:
During transfer into the operating theatre
Before the medicine may impair the patient’s decision
After the anaesthetist has induced anaesthesia
During recovery when the procedure is complete
Whenever a relative is available to sign the form
Correct Answer: Before the medicine may impair the patient’s decision
Explanation: The patient needs a meaningful opportunity to understand information and decide while able to do so.
MCQ 9
Question:
Immediately before an operation on a paired organ, the team notices that the site marking and the consent record indicate different sides. What is the best response?
Options:
Follow the marking because it is visible
Follow the record because it is signed
Ask the scrub nurse to choose a side
Begin anaesthesia and resolve it later
Pause until the discrepancy is resolved
Correct Answer: Pause until the discrepancy is resolved
Explanation: Conflicting site information must be reconciled before proceeding to prevent a wrong-site operation.
MCQ 10
Question:
At the team pause before incision, a surgeon asks whether indicated infection-prevention medication has been administered. What is the principal safety purpose of this check?
Options:
To determine which sutures will be absorbable
To replace the need for sterile technique
To confirm prophylaxis was given at the intended stage
To establish the patient’s postoperative diagnosis
To decide whether a surgical specimen is required
Correct Answer: To confirm prophylaxis was given at the intended stage
Explanation: When prophylaxis is indicated, the team checks that it has been administered appropriately before the incision.
MCQ 11
Question:
During an operation, a sterile instrument touches a non-sterile surface before it enters the wound. What should the team do?
Options:
Use it if no visible dirt is present
Replace it with a sterile instrument
Rinse it with fluid from the wound
Use diathermy to heat its surface
Document the contact after closure
Correct Answer: Replace it with a sterile instrument
Explanation: Contact with a non-sterile surface breaks asepsis even if contamination cannot be seen.
MCQ 12
Question:
A patient is expected to have limited mobility after a major operation. The preoperative team identifies additional factors that increase the likelihood of venous thrombosis. What should be included in the perioperative plan?
Options:
Avoid discussing the risk until discharge
Replace the operation with a longer incision
Use a drain to prevent venous clot formation
Assume that anaesthesia removes the risk
Consider prevention according to individual risk
Correct Answer: Consider prevention according to individual risk
Explanation: Operative and patient factors inform the need for suitable venous thromboembolism prevention.
MCQ 13
Question:
A patient with previous abdominal surgery needs another operation. When planning access, the surgeon reviews the old scar and the location of the current disease. What is the main principle guiding incision choice?
Options:
Select the incision with the shortest skin mark
Repeat the previous incision without assessment
Provide adequate access while limiting tissue injury
Use an incision that cannot be extended
Choose the incision after the wound is closed
Correct Answer: Provide adequate access while limiting tissue injury
Explanation: The operative target, prior scars and likely need for extension matter more than skin-incision length alone.
MCQ 14
Question:
During closure, a surgeon considers whether a suture should remain permanently or provide support while tissue heals and then be absorbed. What primarily guides this choice?
Options:
The support required by the tissue being closed
The time spent completing the consent form
The number of theatre staff on duty
The position of the anaesthesia machine
The colour of the outer wound dressing
Correct Answer: The support required by the tissue being closed
Explanation: Suture selection depends on the tissue and how long it needs mechanical support during healing.
MCQ 15
Question:
A wound is being closed after tissue removal has left a substantial space beneath the skin. The surgeon considers whether postoperative fluid may collect there. What is the main concern associated with this space?
Options:
Formation of a difficult airway
Failure of the consent discussion
Development of an anaesthetic allergy
Accumulation of fluid in the wound
Loss of instrument-count records
Correct Answer: Accumulation of fluid in the wound
Explanation: A residual space between tissue planes can permit a postoperative fluid collection to form.
MCQ 16
Question:
A surgeon places a drain without a suction reservoir and positions it so fluid can leave the operative area. Which mechanism best describes its action?
Options:
Electrical current applied to tissue
Active removal by a vacuum source
Absorption through a wound suture
Gas pressure from pneumoperitoneum
Passive flow aided by gravity
Correct Answer: Passive flow aided by gravity
Explanation: A passive drain permits fluid to leave without a suction device, relying on pressure differences and gravity.
MCQ 17
Question:
Following surgery, drain output falls abruptly while swelling develops near its entry site. The patient remains in pain. What should the team consider first?
Options:
The operation no longer needs observation
The drain may be blocked or displaced
The swelling confirms normal healing
The patient has developed an airway injury
The skin sutures should be changed routinely
Correct Answer: The drain may be blocked or displaced
Explanation: Less output alongside increasing local swelling can mean fluid is collecting because the drain is no longer functioning.
MCQ 18
Question:
Before monopolar diathermy is used, a team member notices that the return electrode is poorly attached to the patient. What harm is this check intended to prevent?
Options:
Retention of a surgical instrument
Misidentification of a specimen
Failure of abdominal insufflation
Unintended burn at the return site
Development of venous thrombosis
Correct Answer: Unintended burn at the return site
Explanation: Poor electrode contact can concentrate returning electrical energy over a small area and injure the skin.
MCQ 19
Question:
During laparoscopic access, an instrument is introduced through the abdominal wall before dissection begins. Which important complication is specifically associated with this stage?
Options:
Injury to an underlying vessel or organ
Failure of informed consent after recovery
Loss of function from a blocked drain
Burn beneath a diathermy return electrode
Formation of a clot from prolonged immobility
Correct Answer: Injury to an underlying vessel or organ
Explanation: Entry instruments can damage structures beneath the abdominal wall, making access a distinct safety consideration.
MCQ 20
Question:
A surgeon discusses robotic assistance for a selected minimally invasive procedure involving difficult dissection in a confined space. Which potential technical feature may support its use?
Options:
Elimination of the need for abdominal access
Removal of all anaesthetic requirements
Articulated instruments with magnified viewing
Guaranteed absence of operative bleeding
Automatic selection of each operative step
Correct Answer: Articulated instruments with magnified viewing
Explanation: Robotic assistance can improve instrument movement and visualisation in selected procedures, while the surgeon remains in control.
